Mark Amundsen 3-12-13 UCDavis Med CTR

13925 Whittier Blvd. Whittier, CA 90605 Tel: (562) 696-1181 Fax: (562) 945-0663 www.arslegal.
com
Record Review
Name Employer WCAB/ADJ # ARS Invoice # Copy Location Date of Injury Date 09/13/2002 Page 1483 : Mark Amundsen : State Of CA Dept Of Fish And Game : ADJ8724115 : 438281-01 : UC Davis Medical Center - Custodian Of Medical Records - Cypress Biding : 06/15/2010
2009 ARS
Review Radiology UC Davis Medical Center LUMBAR SPINE IMPRESSION: No significant radiographic abnormality identified in the lumbar spine for the patients chronological age. Physical Therapy Report Tom Carry, M.P.T. SUBJECTIVE: 43-year-old male with a long history of low back pain, which began approximately 9 years prior after performing a series of situps. Back pain has gradually worsened with referral into his left leg. Complaints include constant low back pain radiating into the anterolateral thigh with shooting pain into the knee. ASSESSMENT: Signs and symptoms consistent with chronic low back pain, moderate in severity and irritability. PLAN: Joint and soft tissue mobilization. Trunk stabilization program. lower extremity strengthening. Increasing lower extremity flexibility/endurance. Ultrasound. Ice with IFC.
10/24/2002 Page 0270
The order in which the records have been copied may have been changed to provide you with the sequence of medical treatment then followed by all other documents in the file. Please review all records carefully.
Mark Amundsen Copy Location: UC Davis Medical Center - Custodian Of Medical Records - Cypress Biding Date of Injury: 06/15/2010 Date 12/20/2002 Page 1484 Review Radiology UC Davis Medical Center MRI LUMBOSACRAL SPINE
2009 ARS
09/08/2003 Page 0014
IMPRESSION: Other than the annular tear involving the L5-S1 disc to the left of the midline, and the degenerative changes of the facet, no abnormality is seen. Progress Report Gary Colins, M.D. SUBJECTIVE: 43-year-old male with history of chronic low back pain and left-sided sciatic pain. Pain started 9 years prior while doing sit ups. Become progressively worse, especially for 2 years with no specific reason. MEDICATIONS: Vicodin. Prozac. Cyclobenzaprine. PREPROCEDURE DIAGNOSES AND ASSESSMENT: 1. Lumbar degenerative disc disease. 2. Lumbar radiculitis. 3. Lumbar facet arthropathy. 4. Obsessive-compulsive personality disorder. 5. Obesity. POSTPROCEDURE DIAGNOSES AND ASSESSMENT: Same. PROCEDURE: L5-S1 lumbar epidural steroid injection. RECOMMENDATIONS: Follow up 6-8 weeks for repeat lumbar epidural steroid injection. Continue home therapy programs and medications as needed. Instructed and educated on all aspects of the plan of care.
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Mark Amundsen Copy Location: UC Davis Medical Center - Custodian Of Medical Records - Cypress Biding Date of Injury: 06/15/2010 Date 10/03/2003 Page 0018
2009 ARS
Review Progress Report Victor Baquero, M.D. SUBJECTIVE: Follow up regarding cervicalgia. Had 2nd injection in the lumbar back with less relief this time than the last time. Has been in less pain, functioning better. Able to walk around. Can sit more than 30 minutes before being uncomfortable. Doing back exercises that are also helping him along. ASSESSMENT: 1. Radiculopathy along the left leg. 2. Mood-wise, improved on the Prozac. 3. Weight loss of 30 pounds due to exercise and dieting. 4. Health care maintenance. PLAN: Continue seeing Pain Management. Advised to try to back off the Vicodin if possible and will try to transition over to anti-inflammatories along with Flexeril. To continue seeing the counselor for his grief reaction. Praised for his efforts and advised to continue good work. Follow up for physical. Screening blood work was ordered. Ordered testosterone level.
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2009 ARS
Review Progress Report Victor Baquero, M.D. SUBJECTIVE: Follow up on labs. Reports left sided hip pain radiates to the groin. Clicking and locking sometimes and some morning stiffness on the hips. Pain has been chronic and radicular symptoms are better. Hip pain has not really been well relieved by the opioid medication. ASSESSMENT: 1. Follow up on lab work. 2. Hypotesteronism due to chronic opioid use. 3. Left-sided hip pain somewhat chronic. PLAN: Discussed cholesterol results. Recommend dietary changes and exercises. Recheck in few months. Replace AndroGel. Recheck lab work in 1 month. X-rays. Continue medications. Consider Ultram and Non-steroidal anti-inflammatory drugs. Consider referral to orthopaedics. Continue treatment as needed. Radiology UC Davis Medical Center BILATERAL HIPS/PELVIS IMPRESSION: Mild bilateral osteoarthritis of the hips.
12/01/2003 Page 1485
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Mark Amundsen Copy Location: UC Davis Medical Center - Custodian Of Medical Records - Cypress Biding Date of Injury: 06/15/2010 Date 12/04/2003 Page 1486 01/05/2004 Page 0022 Review Radiology UC Davis Health System BILATERAL HIP
2009 ARS
IMPRESSION: Mild bilateral osteoarthritis of the hips. Progress Report Victor Baquero, M.D. SUBJECTIVE: 44-year-old male with history of chronic low back pain, which radiates down to the knee. Started 9 years prior while he was doing sit ups and has progressively increased in severity and frequency over for 2 years. Pain is described as sharp, shooting, and cutting. MEDICATIONS: Fluoxetine. Flexeril. Norco. ALLERGIES: Ibuprofen. PREPROCEDURAL ASSESSMENT: 1. Lumbar facet arthropathy. 2. Lumbar degenerative disc disease. 3. Lumbar radiculitis. 4. Obsessive compulsive personality disorder. 5. Obesity. POSTPROCEDURAL ASSESSMENT: Same. PLAN: Follow up in 4-6 weeks for 2nd left L4-L5 and L5-S1 intraarticular facet joint injection. Was also encouraged and advised to continue with strengthening and exercise regimen.
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2009 ARS
Review Progress Report Victor Baquero, M.D. SUBJECTIVE: Follow up on chronic back pain. Has not had significant relief with epidural injections. ASSESSMENT: Chronic back pain. PLAN: Follow up with pain management. Refer to Ortho spine for further evaluation. Pain control. Oxycontin. Discussed potential of going on disability discussed. Referral to be seen by ortho spine. Androgel has not been covered. Will submit a prior authorization to his insurance company. Progress Report Gary Collins, M.D. SUBJECTIVE: Follow up. ASSESSMENT: 1. Lumbar radiculitis. 2. Lumbar degenerative disc disease. 3. Lumbar facet arthropathy. 4. Hip osteoarthritis. 5. Urinary retention. PLAN: Repeat MRI of the lumbar spine. Trial of left S1 selective nerve root block. Follow up with primary care physician to rule out urinary tract etiology to his urinary retention symptoms.
03/02/2004 Page 0029
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Mark Amundsen Copy Location: UC Davis Medical Center - Custodian Of Medical Records - Cypress Biding Date of Injury: 06/15/2010 Date 03/08/2004 Page 1489 04/05/2004 Page 0033 Review Radiology UC Davis Health System MR LUMBOSACRAL SPINE
2009 ARS
IMPRESSION: Unremarkable MRI of the lumbosacral spine for age. Progress Report Victor Baquero, M.D. SUBJECTIVE: Chronic lumbar pain with radiculitis. Has gastroesophageal reflux disease symptoms that are intermittent, more pronounced when he is laying flat on his stomach. ASSESSMENT: 1. Chronic radiculitis, lumbago. 2. Filled out disability forms for chronic lumbar pain. 3. Gastroesophageal reflux disease symptoms. 4. Other brief somatic questions that were answered in the office. PLAN: Follow up with Pain clinic. Continue Norco. Continue Aleve. Neurontin. Recommend over-the-counter Prilosec or H2 blocker.
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2009 ARS
Review Consultation James Ressler, P.A.-C. CHIEF COMPLAINT: Low back pain, left leg pain, and left groin pain. HISTORY OF PRESENT ILLNESS: 44-year-old male, with history of chronic low back pain and left leg radiculopathy for 3 and 9 years, respectively, associated with left groin pain that has been evaluated in the past with a multiplicity of workups, including x-rays that has been recently taken. IMPRESSIONS: Chronic low back pain with underlying mild degenerative disc disease of the L5-S1 segment, with L4-5 or L5-S1 left leg radiculopathy. PLAN: Continue with conservative modalities. He will not be a good surgical candidate for total hip arthroplasty. Monitor on an interim basis. Progress Report Lana Wania-Galicia, M.D. SUBJECTIVE: With radiation down the anterior aspect of the left lower extremity. Reports that it is worsened by driving extended period of time and by prolonged sitting. Pain is described as burning, cramping, sharp, and shooting. ASSESSMENT: 1. Lumbar radiculitis. 2. Lumbar degenerative disc disease. 3. Lumbar facet arthropathy. 4. History of hip osteoarthritis. 5. History of urinary retention. RECOMMENDATIONS: Follow up in 4-6 weeks for repeat left S1 selective nerve root block. Instructed to call and postpone appointment to a later date if he has substantial relief with minimal to no pain at the time of his next appointment. Encourage to continue with home exercise which is a critical aspect of patients overall pain management.
04/29/2004 Page 0035
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2009 ARS
Review Progress Report Jeffrey Applebaum, M.D. SUBJECTIVE: Was carrying 15 pound elderly dog when he slipped and fell, landing on his buttock and back area. Has had a prior back problem. Has seen Dr. Baquero and has undergone physical therapy. ASSESSMENT: Contusion to the lumbar area in a fall in a patient with underlying chronic lumbar syndrome. PLAN: Decrease Norco. Start Indocin, Ambien, and Flexeril. Discussed precautions against falling and injury. Ice or heat to the affected area and follow up with primary care physician for possible forgery physical therapy if persistent problem. Progress Report Carol Paton, ma SUBJECTIVE: Chronic complaint of low back pain for 3 years. ASSESSMENT: 1. Chronic debilitating back pain. 2. Depression, well controlled. PLAN: Failed Elavil. Ultram. Norco. Oxycontin. Darvocet. Nonsteroidal anti-inflammatory drugs. Neurontin. Flexeril. Steroid injections. Physical therapy.
07/09/2004 Page 0041
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2009 ARS
Review Progress Report Jessica Shaw, M.A. SUBJECTIVE: Presents for chronic complaint of low back pain for 3 years. ASSESSMENT: 1. Chronic debilitating back pain. 2. Depression, well controlled.
08/31/2004 Page 0046
PLAN: Androgel. Fentanyl. Progress Report Kenten Wang, D.O. CHIEF COMPLAINT: Low back pain. ALLERGIES: Ibuprofen. Morphine sulfate. IMPRESSION: With low back pain that radiates down the left side, especially towards the hip. RECOMMENDATIONS: Physical therapy. recommend stretching program. Being followed by the Anesthesia Pain Service for steroid injections. Follow up with patient after physical therapy program.
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2009 ARS
Review Progress Report Sheri Groves, M.A. SUBJECTIVE: Follow up on disability. Chronic lumbago/sciatica. Stable on medications. Needs refill. Seeing spine clinic. Optimistic with new stretches and physical therapy that was requested. ASSESSMENT: 1. Lumbago. 2. Dermatophytosis of foot. PLAN: Continue physical therapy and spine clinic. Norco. Filled disability forms extended until 01/01/05. Ketoconazole 2% topical cream. Follow up if not better. Progress Report Sheri Groves, M.A. SUBJECTIVE: Back is getting better. Doing physical therapy daily. Intermittent palpitations. Recurrent nose bleed. ASSESSMENT: 1. Backache. Chronic lumbago, improving. 2. Palpitations. 3. Epistaxis. PLAN: Extended disability until end of February. Discussed care and warning signs. Will set up Holter monitor. Referral to ENT. Prominent vomeral vascularity. Discussed care and warning signs. Follow up in office if not better.
02/01/2005 Page 0054
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Mark Amundsen Copy Location: UC Davis Medical Center - Custodian Of Medical Records - Cypress Biding Date of Injury: 06/15/2010 Date 03/24/2005 Page 0058 Review Progress Report Yoav Hahn, M.D. CHIEF COMPLAINT: Nasal obstruction. Epistaxis.
2009 ARS
HISTORY: With history of epistaxis since he was approximately 10 years old. Reports that this epistaxis occurs intermittently. Reports he has been cauterized every 5 years and has significant improvement in the epistaxis after the cauterization. ASSESSMENT: 1. Epistaxis. 2. Nasal obstruction. 3. Right ethmoid pain. PLAN: Underwent cauterization with silver nitrate sticks in the ENT Clinic of the left Kiesselbachs plexus. Instructed to use nasal saline approximately 6 times a day as well as petroleum jelly on a q-tip to the left nasal septum everyday. Ordered a CT scan to assess his sinuses for any disease. Discussed options of the treatment of the nasal obstruction.
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Mark Amundsen Copy Location: UC Davis Medical Center - Custodian Of Medical Records - Cypress Biding Date of Injury: 06/15/2010 Date 04/15/2005 Page 1491 Review Radiology UC Davis Health System CT SINUS
2009 ARS
01/19/2006 Page 0061
IMPRESSIONS: 1. No abnormal lesion identified in the right retroorbital fossa. 2. Small left maxillary sinus retention cyst versus polyp. Progress Report Ernestine Taylor, M.A. SUBJECTIVE: Follow up on right hip pain. Status post physical therapy, stretches but do not clear symptoms continuously. Seen by ortho and spine clinic. Started riding bike daily and doing exercises. Stretches daily. ASSESSMENT: 1. Enthesoathy of hip. 2. Lumbago. PLAN: Discussed care and warning signs. Continue exercises. Follow up with ortho for reevaluation. Methadone. Orthopedic-general referral. Baclofen. Stretches discussed. Non-steroidal anti-inflammatory drugs, ice, or heat. Avoid activities that exacerbate pain. Consider physical therapy. Follow up if not better. Follow up in office if not better.
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Review Progress Report David Moehring, M.D. HISTORY: Has a long history of low back, left posterior pelvic and thigh pain intermittently. 3 years prior, had series of epidural steroids, which significantly improved his symptoms. He remains dependent on nonsteroidal anti-inflammatory drugs and fairly heavy dose of narcotics. Symptoms are of left-sided sacroiliac pain with some radiation down the posterior thigh, occasionally below the knee. RECOMMENDATIONS: On considerable medication at the time and gathered his symptoms have not greatly increased in severity, but are rather chronic complaint. Return in few months. Radiology UC Davis Health System PELVIS IMPRESSION: Bilateral osteoarthritis. Radiology UC Davis Health System LUMBAR SPINE IMPRESSION: Mild degenerative changes.
02/13/2006 Page 1493 02/13/2006 Page 1494
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2009 ARS
Review Progress Report Teri Rhodewalt, M.A. SUBJECTIVE: Follow up on chronic hip pain. Trying to stay active. ASSESSMENT: Enthesopathy of hip. Left hip, chronic. PLAN: Pain management referral, MR lower extremity joint with/without contrast. Follow up in office if not better. Progress Report Jason Miller, M.D. SUBJECTIVE: Follow up. MEDICATIONS: Norco. Testosterone. Fluoxetine. Naprosyn. Occasional Tylenol use. ALLERGIES: Morphine sulfate. Ibuprofen. Fentanyl. Methadone. ASSESSMENT: 1. Left groin pain, unknown etiology. 2. Bilateral hip osteoarthritis. 3. Hypogonadism secondary to chronic opioid use. 4. Lumbar degenerative disc disease. 5. Lumbar radiculitis history. 6. Obesity. RECOMMENDATIONS: Scheduled for an MR left hip joint on 04/21/06. Counseled the patient that physical therapy is likely going to be a mainstay in his treatment.
03/28/2006 Page 0074
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Mark Amundsen Copy Location: UC Davis Medical Center - Custodian Of Medical Records - Cypress Biding Date of Injury: 06/15/2010 Date 04/21/2006 Page 1496 Review Radiology UC Davis Health System MRI PELVIS
2009 ARS
05/01/2006 Page 0080
IMPRESSIONS: 1. Advanced osteoarthritis of the left hip. 2. Ganglion cyst along the inferomedial aspect of the left hip. Progress Report Sheri Groves, M.A. SUBJECTIVE: Woke up Saturday morning and pain was through the roof. 2 days prior he mowed the lawn but he is not sure that it was the cause of pain. Taking 10-12 Norco. Reports that he is waiting MRI ordered by pain clinic. ASSESSMENT: 1. Backache. 2. Lumbago. PLAN: Toradol. Soma. Norco. Reviewed pain management note. Awaiting MRI results. Advanced osteoarthritis of left hip but also suspect nerve involvement. Continue physical therapy. Discontinue Baclofen. Soma trial. Follow up MRI in 2 weeks.
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2009 ARS
Review Progress Report Sheri Groves, M.A. SUBJECTIVE: Recent nose bleeding. history of bilateral cautery. Has sampled through the gamut of non-steroidal anti-inflammatory drugs, opiates, and even muscle relaxants without satisfactory relief for chronic hip pain. ASSESSMENT: 1. Epistaxis. 2. Depressive disorder. Done well on Prozac. 3. Enthesopathy of hip, stable. PLAN: Apply pressure for affected side for several minutes. If not resolving consider Afrin nasal spray or Sudafed. Use Vaseline to moisturize nares. May consider ENT referral for cautery. Cymbalta. Will transition off Prozac and try Cymbalta for mood and pain. Discussed care and warning signs. Follow up in 3-4 weeks. Discussed alternative pain medications at length. Dilaudid. Progress Report David Moehring, M.D. SUBJECTIVE: To discuss the results of his MRI. Latter showed extensive degenerative arthritis of the left hip, as well as cyst formation. DIAGNOSIS: Degenerative arthritis, left hip. PLAN: Scheduled for another MRI for some reason.
06/01/2006 Page 0088
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2009 ARS
Review Progress Report Sheri Groves, M.A. SUBJECTIVE: Follow up of left hip pain. Dr. Mooring recommended hip replacement. Cymbalta has not been covered yet. Still having hard time getting pain relief on oral medication. Has tried just about everything. ASSESSMENT: Enthesopathy of hip. PLAN: Discussed results, care, medications, non-surgical options, etc. Follow up with pain clinic for localized injections. Continue medications. Follow up in office if not better. Progress Report Sheri Groves, M.A. SUBJECTIVE: Increasing hip pain. Started working the week of this visit. Sits 90% of the time. There is some aggravation of hip pain with the increased activity with travel. ASSESSMENT: 1. Enthesopathy of hip, end stage osteoarthritis. 2. Brachial neuritis, left cervical radiculopathy. 3. Depressive disorder, improved. PLAN: Aleve. Soma. Discussed care and warning signs. Follow up if not better.
10/27/2006 Page 0092
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Review Progress Report Victor Bacquero, M.D. SUBJECTIVE: Follow up on medications. About 3 times, has had episodes of epigastric malaise, decreased appetite, some constipation, no nausea or vomiting, fever or chills. MEDICATIONS: Soma. Norco. Fluoxetine. Aleve. Glucosamine. Methadone. ASSESSMENT: 1. Enthesopathy of hip. 2. Stomach function. 3. Screening endoc/nut/met/immune. PLAN: Sed rate westergren, anti-nuclear. Rheumatoid factor. Pain management referral. Discussed care and warning signs. Celiac reflexive panel. Blood count. Comprehensive metabolic panel. Lipid panel with DLDL reflex. Urinalysis chem only. TSH with free T4. Prostate-specific antigen screen. Follow up if not better. Progress Report Victor Bacquero, M.D. SUBJECTIVE: Socially not doing well, because he got fired 2 weeks prior. Thinks the Prozac is not working anymore. Has not been on Prozac for 10 years. Seems to poop out every 3 years. Zoloft was not effective. ASSESSMENT: 1. Adjustment disorder with anxiety. 2. Enthesopathy of hip. 3. Backache. 4. Brachial neuritis, left C6-7. PLAN: Recent stressors. Decreased mood. Discussed care and treatment plan. Request follow up in 4 weeks. Encourage counseling and exercise as well as stress management. Celexa. Methadone. Discussed physical therapy. Exercises. Pain management consult and ultimately spine clinic consult.
04/20/2007 Page 0101
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Mark Amundsen Copy Location: UC Davis Medical Center - Custodian Of Medical Records - Cypress Biding Date of Injury: 06/15/2010 Date 04/20/2007 Page 1501 02/19/2008 Page 0106 Review Radiology UC Davis Health System CERVICAL SPINE
2009 ARS
IMPRESSION: Mild degenerative changes. Progress Report Victor Bacquero, M.D. CHIEF COMPLAINT: Medication follow up. Follow up on hip. worse. Able to pop left hip in and out at times. Reports excessive guilt, depressed mood, insomnia, impaired concentration for few months. DIAGNOSES: 1. Backache. 2. Testicular hypofunction. 3. Brachial neuritis. 4. Enthesopathy of hip. 5. Depressive disorder. ASSESSMENT: 1. Advanced osteoarthritis of the left hip. End stage osteoarthritis of the left hip. 2. Depressive disorder. PLAN: Continue plan and medications. Risks and benefits discussed in detail.
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Review Progress Report Victor Bacquero, M.D. SUBJECTIVE: Left hip is getting worse. Almost clicks out of joint routinely. Feels more bone on bone rather than clicking. Pain has increased. Having side effects with the Norco. Requests decreasing dose and increasing methadone. ASSESSMENT: 1. Enthesopathy of hip region. Ongoing. Progressive. 2. Backache, unspecified. 3. Depressive disorder. PLAN: Unable to order tests of follow up with ortho until he is employed due to cost. Methadone. Filled out pain agreement. Fluoxetine. Follow up in 1-2 months. Discussed care and warning signs with Mark and all questions and concerns were fully answered. Progress Report Victor Bacquero, M.D. CHIEF COMPLAINT: Stomach problem, no appetite, no bowel movement, belch after eating and nausea for 4 days. Hip pain, handicap plaque. Tried activia few days prior. Reports having massive headache the whole weekend which resolved at the day of this visit. Feeling better at the day of this visit. Maintaining hydration. Has been taking nonsteroidal anti-inflammatory drugs. ASSESSMENT: 1. Abdominal pain. 2. Advanced osteoarthritis of the left hip. PLAN: Reviewed x-rays. Discussed care and warning signs and all questions and concerns were fully answered. Trial of over-the-counter medications. Fiber. DMV form filled out for temporary disability. Follow up with ortho for total hip replacement. Radiology UC Davis Health System ABDOMEN IMPRESSION: Nonobstructive bowel gas pattern.
02/18/2009 Page 0116
02/18/2009 Page 1509
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2009 ARS
Review Progress Report Gertrudes Montemayor, M.D. SUBJECTIVE: Complains of bodyaches, tiredness, nausea, and diarrhea usually constipated due to methadone, fatigue, symptoms have been present for 5 days. Complains of diarrhea that started 4 days prior, symptoms are improving. ASSESSMENT: 1. Acute upper respiratory infection, improving. 2. Diarrhea, improving. PLAN: Discussed routine upper respiratory infection care. will call or follow up in the office. Recommend symptomatic therapy. May use acetaminophen as needed. Increase oral fluid intake. Discussed hydration. Imodium. Signs and symptoms of dehydration discussed. Follow up stool studies. Routine medication risks, complications, and contraindications reviewed. Progress Report Victor Bacquero, M.D. SUBJECTIVE: Diarrhea, off and on for weeks. Has diarrhea for 8 days, came in the week prior and had upper respiratory illness and diarrhea symptoms. Has had low grade temperature. Stools are watery, foul smelling, no blood. Cramping with associated discomfort. Simple diet. ASSESSMENT: 1. Diarrhea. 2. Colitis. PLAN: C Difficile, toxin A and B EIA, culture. Gastrointestinal, bacit. Cryptosporidium/giardia fa, blood count. Comp, sed rate. westergren. Discussed care and warning signs. Progress Report Victor Bacquero, M.D. SUBJECTIVE: With increased hip pain, something happened about 2-3 weeks prior. Sharp twinges of pain. Requesting evaluation with ortho. ASSESSMENT: Advanced osteoarthritis of the left hip. PLAN: Orthopedic general referral. Continue plan and medications.
05/28/2009 Page 0125
08/20/2009 Page 0130
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Mark Amundsen Copy Location: UC Davis Medical Center - Custodian Of Medical Records - Cypress Biding Date of Injury: 06/15/2010 Date 08/20/2009 Page 1511 Review Radiology UC Davis Health System HIPS BILATERAL WITH PELVIS IMPRESSIONS: 1. Moderate osteoarthritis of the right hip. 2. Severe osteoarthritis of the left hip. Radiology UC Davis Health System LUMBAR SPINE
2009 ARS
08/20/2009 Page 1514
IMPRESSIONS: 1. Mild degenerative changes of the lumbar spine without definite acute bony abnormality. 2. Apparent lucency in the expected location of the L5 pars interarticularis is incompletely evaluated. If there is sufficient clinical concern for spondylolysis, further evaluation could be obtained with oblique views.
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Mark Amundsen Copy Location: UC Davis Medical Center - Custodian Of Medical Records - Cypress Biding Date of Injury: 06/15/2010 Date 12/14/2009 Page 0135 Review Progress Report Jonathan Eastman, M.D. CHIEF COMPLAINT: Left hip pain.
2009 ARS
HISTORY OF PRESENT ILLNESS: Has been experiencing a 6-month history of insidious onset of left hip severe pain. With dull aching pain with occasional mechanical symptoms that are exacerbated by weight bearing activities and activities of daily living. ASSESSMENT: Severe degenerative disc disease of the left hip. PLAN: Discussed options for treating arthritis including medical management, physiotherapy, injection, and surgery. Has exhausted conservative management, recommend total joint arthroplasty of the left hip. this is scheduled on 12/15/09. All questions and concerns were answered. Will plan on doing a metal on metal construct. Will be enrolled in the arixtra study postoperatively for deep venous thrombosis prophylaxis. Radiology UC Davis Health System DUAL-ENERGY DIGITAL SUBTRACTON CHEST IMPRESSION: No evidence of active disease in the chest.
12/14/2009 Page 1519
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Review History and Physical Norma Klein, M.D. HISTORY: With left hip pain and degenerative joint disease and depression. Narcotic allergy includes itching, not hives. Takes chronic pain medication and is a smoker. ALLERGIES: Morphine. Fentanyl. INFORMED CONSENT: Risks and benefits of anesthesia were explained. Patient understands and agrees to proceed. All questions were answered. Operative Report Robert Tamurian, M.D. PREOPERATIVE DIAGNOSIS: Left hip degenerative joint disease. POSTOPERATIVE DIAGNOSIS: Left hip degenerative joint disease.
12/15/2009 Page 0266
12/16/2009 Page 0239
PROCEDURE: Left total hip arthroplasty. Orthopedic Tumor Physician Daily Progress Note Robert Tamurain, M.D. INTERVAL HISTORY: NAE ON. Transferred to floor increased pain overnight. SUBJECTIVE: Awake, alert, in moderate discomfort. ASSESSMENT: Post-operative day 1. Status post left total hip arthroplasty. PLAN: Increase PCA, oral. Pain pharmacy consult for assistance. Arixtra. Monitor H/H. Clinical exam. Post op x-ray. Physical therapy/occupational therapy. advance diet as tolerated. WBAT, left lower extremity. Posterior hip precautions. Discontinue foley hip once mobile. Discuss with staff.
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Review Physical Therapy Report Chad Sherlock, P.T. HISTORY OF PRESENT ILLNESS: 50-year-old male with left hip pain and degenerative joint disease and depression. ASSESSMENT: With left total hip arthroplasty, did well with physical therapy anticipate discharge to home in 2-3 days. PLAN: Bed mobility training. Balance training. Coordination training. Transfer training. Progressive gait training. Therapeutic exercise. Patient education. Occupational Therapy Report Kate McFarland, O.T. SUBJECTIVE: Lives alone. No entry steps and stall shower. Has frontwheeled-walker and single point cane. ASSESSMENT: Should progress well but has not assistance when he goes home, recommend occupational therapy for independence with activities of daily living and functional mobility. PLAN: Bed mobility training. Transfer training. Sitting balance. Functional mobility. Activities of daily living/self care. therapeutic exercise. Adaptive equipment. Durable medical equipment and patient/caregiver education and training.
12/16/2009 Page 0282
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Mark Amundsen Copy Location: UC Davis Medical Center - Custodian Of Medical Records - Cypress Biding Date of Injury: 06/15/2010 Date 12/16/2009 Page 1522 Review Radiology UC Davis Health System PELVIS IMPRESSIONS: 1. Total left hip arthroplasty. 2. Right hip joint osteoarthritis, mild. Orthopedic Tumor Physician Daily Progress Note Robert Tamurain, M.D. SUBJECTIVE: Awake, alert, NAD. ASSESSMENT: Post-operative day 2, status post left total hip arthroplasty.
2009 ARS
12/17/2009 Page 0241
12/17/2009 Page 0276
PLAN: Increase pain controlled analgesia, oral. Appreciate pain pharmacy assistance. Await further recommendations. Arixtra. Monitor H/H, clinical exam. Post op x-ray. Advance diet as tolerated. WBAT left lower extremity. Posterior hip precautions. Discontinue foley once mobile. Discuss with staff. Physical Therapy Report Ilona Pogany, P.T. SUBJECTIVE: Agreeable to physical therapy. ASSESSMENT: Good progress. PLAN: Continue with bed mobility and gait.
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Review Occupational Therapy Report Kate McFarland, O.T. SUBJECTIVE: Pain located in left hip. patient agreeable out of bed. ASSESSMENT: 1. Following precautions well during bed mobility and transfer. 2. Moving slowly. 3. Good return demonstration of adaptive devices.
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PLAN: Continue with toilet transfers. Orthopedic Tumor Physician Daily Progress Note Robert Tamurain, M.D. SUBJECTIVE: NAE ON. Working with physical therapy, foley discontinued. ASSESSMENT: Post-operative day 3 status post left total hip arthroplasty. PLAN: DCPCA, oral. Appreciate pain pharmacy for assistance. Await further recommendations. Arixtra. Monitor H/H. clinical exam. Post op x-ray. Physical therapy/occupational therapy. WBAT left lower extremity. Posterior hip precautions. Discharge planning SNF vs. Home. Discuss with staff.
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Review Physical Therapy Report- Ilona Pogany, P.T. PRINCIPAL AND SIGNIFICANT DIAGNOSIS: Left total hip arthroplasty. DISCHARGE RECOMMENDATION: Continue physical therapy, physical therapy at skilled nursing facility. Minimum assist to stand by assist. Front-wheeled-walker. Home exercise program. Occupational Therapy Report Christine Mulford, O.T. SUBJECTIVE: Pain in left hip. ASSESSMENT: 1. Has progressed well with mobility. 2. Good return demo with dressing aids. 3. Lives alone and is aware he may need some help with instrumental activities of daily living. PLAN: Continue with toileting. Sinkside activities of daily living.
12/18/2009 Page 0286
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Mark Amundsen Copy Location: UC Davis Medical Center - Custodian Of Medical Records - Cypress Biding Date of Injury: 06/15/2010 Date 12/18/2009 Page 2117 Review Discharge Summary Jonathan Eastman, M.D. FOLLOW UP: Follow up with dr. Tamurian in 2-3 weeks. MEDICATIONS: Soma. Benadryl. Colace. Ferrous sulfate. Methadone. Arixtra. Orthopedic Tumor Physician Daily Progress Note Robert Tamurain, M.D. SUBJECTIVE: Resting comfortably, arousable, appropriate. ASSESSMENT: Post-operative day 5 status post left total hip arthroplasty.
2009 ARS
12/20/2009 Page 0248
PLAN: Pain control. Continue regimen. Arixtra for deep venous thrombosis prophylaxis until 12/25. Follow up post transfusion H/H. Continue iron. Physical therapy/occupational therapy. WBAT left lower extremity. Posterior hip precautions. Discharge planning for home once able physical therapy. Patient expresses desire to not return to SNF. Discuss with staff.
Page 30 of 47
2009 ARS
Review Internal Medicine Progress Report Jia Wang, M.D. SUMMARY: 50-year-old male who underwent left total hip replacement about 4 days prior. Was discharged to a skilled nursing facility for rehab. Was found to have worsening anemia during routine lab work. SUBJECTIVE: Had 2 PRBC transfusion. Will restart therapy. MEDICATIONS: Fondaparinux. Fluoxetine. Methadone. Ferrous sulfate. Docusate. Sennosides. Diphenhydramine. Carisoprodol. ASSESSMENT: 1. Anemia. Normocytic anemia. Likely due to surgery. 2. Status post total hip arthroplasty. 3. History of depression. Stable. 4. Full code. PLAN: Will transfuse 2 units of PRBC. Continue iron supplement. Continue iron supplement. Weight bearing as tolerated. Adequate pain control. Dry dressing change. Adequate bowel regimen to prevent constipation. Ortho consult. Continue Prozac.
Page 31 of 47
Mark Amundsen Copy Location: UC Davis Medical Center - Custodian Of Medical Records - Cypress Biding Date of Injury: 06/15/2010 Date 12/21/2009 Page 0246 Review Orthopedic Tumor Physician Daily Progress Note Robert Tamurain, M.D. SUBJECTIVE: Awake, alert, comfortable. ASSESSMENT: Post-operative day 6 status post left total hip arthroplasty.
2009 ARS
12/21/2009 Page 0279
PLAN: Pain control. Arixtra. Physical therapy for clearance at home. Patient does not want to go back to SNF. Discharge home per primary team. Discuss with staff. Physical Therapy Report Michael Dybdahl, P.T. SUBJECTIVE: 50-year-old male who underwent left total hip replacement about 4 days prior. Was discharged to a skilled nursing facility for rehab. Found to have worsening anemia during routine lab work at the day of this visit. Was directly admitted for blood transfusion. ASSESSMENT: 1. Cooperative with evaluation and mobility. 2. Able to demonstrate independent transfer and gait with front-wheeledwalker. 3. Able to verbalize and demonstrate post hip precautions. 4. Cleared physical therapy for discharge home. 5. No new equipment needs.
Page 32 of 47
Mark Amundsen Copy Location: UC Davis Medical Center - Custodian Of Medical Records - Cypress Biding Date of Injury: 06/15/2010 Date 12/21/2009 Page 2119 Review Discharge Summary Mural Adusumalli, M.D. PRINCIPLE DIAGNOSES DURING HOSPITALIZATION: 1. Anemia. 2. Status post left total hip replacement.
2009 ARS
MEDICATIONS: Methadone. Norco. Soma. Diazepam. Benadryl. Docusate. Iron Sulfate. Protonix. Senna. Fondaparinux. Oxycodone. 01/04/2010 Page 0142 FOLLOW UP: Follow up with Orthopaedics and primary care physician. Progress Report Tyler Nathe, M.D. SUBJECTIVE: Doing well. Has been home. Slowly increasing his mobility and his gait. Uses front-wheeled-walker at home and a singlepoint cane. ASSESSMENT: 2 weeks after left total hip arthroplasty. PLAN: Remove staples in clinic. Follow up in 2 months. Repeat radiographs of the pelvis and lateral to left hip. gradually continue to increase activity.
Page 33 of 47
Mark Amundsen Copy Location: UC Davis Medical Center - Custodian Of Medical Records - Cypress Biding Date of Injury: 06/15/2010 Date 02/04/2010 Page 0148 Review Progress Report Victor Baquero, M.D. CHIEF COMPLAINT: Fatigue. ASSESSMENT: 1. Fatigue, non specific. 2. Advanced osteoarthritis of the left hip. Recovering well. 3. Chronic pain medication agreement. 4. Screen-endoc/Nut/Met. 5. Ichthyosis.
2009 ARS
02/22/2010 Page 1524
PLAN: CBC auto + reflex manual differential. Comprehensive metabolic panel. Lipid panel with DLDL reflex. Prostate-specific antigen screen. TSH with free T4 reflex. Urinalysis complete, vitamin D, 25 hydroxy. Testosterone, Bioavailable. Ferritin. Risks and benefits discussed. Radiology UC Davis Health System PELVIS AND LEFT HIP IMPRESSION: Total left arthroplasty without evidence of complication.
Page 34 of 47
2009 ARS
Review Progress Report Robert Tamurian, M.D. SUBJECTIVE: Status post right total hip arthroplasty on 12/15/09, doing well. Progressing with physical therapy. Utilized Arixtra for deep venous thrombosis prophylaxis. Pain controlled on oral medication. ASSESSMENT: Doing well status post right total hip arthroplasty. PLAN: Continue aggressive home physical therapy per total hip arthroplasty protocol and will advance activity level. Return to clinic in 4 months. Will need standing AP pelvis, right hip, to include the entire prosthesis, prior to next appointment. Return to clinic for signs and or symptoms of infection or deep venous thrombosis. Progress Report Robert Tamurian, M.D. SUBJECTIVE: Status post left total hip arthroplasty on 12/15/09, doing well. returns to the adult reconstruction clinic at the University of California, Davis Health System for a 4-month follow up visit. ASSESSMENT: Doing well status post left total hip arthroplasty. PLAN: Continue activities as tolerated per total hip arthroplasty protocol and will continue antibiotic prophylaxis for invasive dental or surgical procedures per protocol. Return to clinic in 6 months. Regarding his left knee pain, he has evidence for some tendonitis of the quadriceps and recommend to continue home exercise program and use over-thecounter non-steroidal anti-inflammatory drugs as needed. Return to clinic for signs and symptoms of infection or deep venous thrombosis.
06/21/2010 Page 0157
Page 35 of 47
Mark Amundsen Copy Location: UC Davis Medical Center - Custodian Of Medical Records - Cypress Biding Date of Injury: 06/15/2010 Date 06/21/2010 Page 1527 Review Radiology UC Davis Health System LEFT HIP
2009 ARS
07/12/2010 Page 0161
IMPRESSIONS: 1. Status post left total hip arthroplasty, unchanged in alignment. No evidence of hardware complication. 2. Moderate osteoarthritis of the right hip. Progress Report Jeffrey Applebaum, M.D. HISTORY: Has noted recent swelling of the feet. This occurs primarily over the metatarsal region. Patient has had some diffuse swelling in addition. Weight has increased and patient has strong family history of hypertension. ASSESSMENT: 1. Dependent edema. Associated with hypertension. 2. Dyslipidemia. 3. Advanced osteoarthritis of the left hip. 4. Vitamin D deficiency. 5. Hypertension. 6. Screening for cancer. 7. High arch. PLAN: Triamterene-hydrochlorothiazide. Follow up with primary care physician in the next 6 weeks. Discussed need for lab with patient, essentially since patient also has apparent hypertension. Fenofibrate nanocrystallized. Continue therapy. Ergocalciferol. TAB. Lipid panel. Hepatic function panel. Gastroenterology referral. Colonoscopy screening. Metatarsal arch pad suggested from super feet or Spenco, then follow up with primary care physician.
Page 36 of 47
2009 ARS
Review Progress Report Victor Baquero, M.D. SUBJECTIVE: Follow up. Right hip bothers him most of the time. Like it did on the left hip 7 years prior. Pain, swelling on the ball of the right foot and toes. Mostly tender and at times numb on the underside of the foot after walking long distances. Felt like socks were bunching up. Started after his hip surgery. Requested restarting Fluoxetine. Some stressors at work. Overall doing well. ASSESSMENT: 1. Advanced osteoarthritis of the right hip, stable. 2. Adjustment reaction. 3. Metatarsalgia. PLAN: Symptoms managed with medications. Risks and benefits discussed in detail. Continue plan and medications. Discussed superfeet orthotics, stretching the Achilles complex. Resume Fluoxetine. Consider podiatry referral if persisting.
Page 37 of 47
2009 ARS
Review Progress Report Nancy Jaeger, M.D. CHIEF COMPLAINT: With muscle pain in legs, the day prior was so bad. States that he could barely walk, his legs felt really weak. Fatigue. MEDICATIONS: Carisoprodol. Ergocalciferol. Fenofibrate. Fluoxetine. Hydrocodone-acetaminophen. Methadone. Triamterene/hydrochlorothiazide. ASSESSMENT: 1. Malaise and fatigue. 2. Vitamin D deficiency. 3. Tobacco use disorder. 4. Depressive disorder. PLAN: Patient declined cervical spine films and nerve conduction study for follow up of tingling of left arm. Follow up with primary care physician regarding need for EKG due to methadone for pain management and encourage follow up with primary care physician for routine care and yearly CPE. Vitamin D supplement encouraged. Follow up with primary care physician. Cessation encouraged. Follow up with primary care physician. Progress Report Victor Baquero, M.D. SUBJECTIVE: Woke up 8 days and felt shaky, achy in the lower extremities, like he ran a marathon. Some lower arm discomfort moving proximally. Shoulders are sore. Thought he was improving and the night prior, he felt like his legs were weak. Difficulty concentrating. Went to work at the day of this visit but was not feeling well. ASSESSMENT: Other malaise and fatigue. Nonspecific. PLAN: Comprehensive metabolic panel. Vitamin D, 25-hydroxy. TSH with free T4 reflex. CBC auto + reflex manual differential. Creatinine kinase.
10/18/2010 Page 0179
Page 38 of 47
2009 ARS
Review Progress Report Victor Baquero, M.D. SUBJECTIVE: Follow up. Still feels weak, tired diffusely. Has mental fatigue as well. Off all supplements and medications except for his vitamin D, low dose thyroid replacement, methadone. Feels better when he takes the methadone. ASSESSMENT: Weakness/fatigue. Suspect physiologic cause. PLAN: Vitamin B12, folate. Sed rate westergren. Anti-nuclear AB, acetylcholine blocking. Cynanocobalamin injection. Electrocardiogram with rhythm strip. Testosterone. Bioavail male, greater than 17, albumin. Cortisol. Discussed care and warning signs with patient. Call or follow up in the office if any problems arise. ECG INTERPRETATION: Normal ECG. Progress Report Xiao Cai, M.D. CHIEF COMPLAINT: Weakness of legs and arms. HISTORY OF PRESENT ILLNESS: 51-year-old male with history of osteoarthritis and chronic pain on methadone and Norco, hypertension, who is referred by his primary physician, Dr. Victor Baquero, for weakness of his legs and arms of 3-month duration. ASSESSMENT: 50-year-old male with osteoarthritis and hip replacement, now with new progressive weakness of the lower and upper extremities with mostly negative physical exam and normal CK, ESR, and ANA. PLAN: Referral to neurology. Will check another CK level and liver function tests to rule out muscle involvement. Advised to abstain from alcohol and minimize the side effects of the medication.
11/02/2010 Page 1537 02/01/2011 Page 0189
Page 39 of 47
Mark Amundsen Copy Location: UC Davis Medical Center - Custodian Of Medical Records - Cypress Biding Date of Injury: 06/15/2010 Date 02/17/2011 Page 0258 Review Consultation Andrew Oh, M.D. CHIEF COMPLAINT: Weakness, rule out chronic inflammatory demyelinating polyneuropathy. IMPRESSION: Weakness.
2009 ARS
03/02/2011 Page 1539
PLAN: EMG/NCS. Acetylcholine receptor binding AB. Acetylcholine receptor modulating AB. Musk antibody. Creatinine kinase. Aldolase. Thyroid stimulating hormone. Thyroxin free. Thyroid peroxidase AB. Lead blood. Follow up return after tests. Diagnostic Exam UC Davis Health System EMG IMPRESSION: Abnormal study. There is evidence of segmental demyelination in the bilateral lower extremities consistent with a predominantly demyelinating polyneuropathy affecting the bilateral lower extremities. There is no evidence of myopathy.
Page 40 of 47
Mark Amundsen Copy Location: UC Davis Medical Center - Custodian Of Medical Records - Cypress Biding Date of Injury: 06/15/2010 Date 03/24/2011 Page 0226 Review Neurology Followup Andrew Oh, M.D. CHIEF COMPLAINT: Weakness. Follow up with specialist.
2009 ARS
MEDICATIONS: Soma. Ergocalciferol. Vitamin D2. Fenofibrate. Hydrocodone-acetaminophen. Methadone. Triamterene/hydrochlorothiazide. IMPRESSION: Weakness. PLAN: Neuropathy panel-motor, cryoglobulin, Hepatitis C AB screen. Fluoroscopy under 60 minutes with radiologist for LP. Cell count CSF. Protein CSF. Glucose CSF. Lyme AB CSF. Syphilis test CSF. Multiple sclerosis panel CSF. Culture CSF. 04/28/2011 Page 1531 FOLLOW UP: Return after tests. Radiology UC Davis Health System FLUOROSCOPY UNDER 60 MINUTES WITH RADIOLOGIST, LUMBAR IMPRESSION: Successful fluoroscopic guided lumbar puncture at the L4-5 level. No immediate complication.
Page 41 of 47
Mark Amundsen Copy Location: UC Davis Medical Center - Custodian Of Medical Records - Cypress Biding Date of Injury: 06/15/2010 Date 05/24/2011 Page 0233 Review Neurology Followup Andrew Oh, M.D. CHIEF COMPLAINT: Weakness, polyneuropathy. Follow up. IMPRESSION: Polyneuropathy. 06/17/2011 Page 1534 PLAN: Neurology clinic referral for Dr. Gorin or Dr. Richman. Radiology UC Davis Health System HIPS BILATERAL WITH PELVIS
2009 ARS
06/20/2011 Page 0195
IMPRESSIONS: 1. Stable left total hip arthroplasty. 2. Osteoarthritis degenerative changes right hip with mild interval progression. Progress Report Victor Baquero, M.D. SUBJECTIVE: Follow up on pain medications, recent x-ray, left sided hip pain. Status post left total hip replacement. Feels pain along left hip and sometimes in the posterior buttocks. The pain is constant, however worse after prolonged walking. Has pain when laying on the ipsilateral side. Symptoms are mild to moderate. ASSESSMENT: 1. Advanced osteoarthritis of the left hip. 2. Polyneuropathy 3. Chronic pain medication agreement. 4. Orthopedic aftercare for joint replacement. 5. Hypothyroid. PLAN: Orthopedic-general referral, methadone. Continue follow up with neurology. Provided advise on treatment and management. Recheck on hypothyroid. TSH, thyroxin, free T4. ECG INTERPRETATION: Borderline ECG.
08/15/2011 Page 1538
Page 42 of 47
2009 ARS
Review Progress Report Victor Baquero, M.D. SUBJECTIVE: On methadone for chronic bilateral hip pain. Severe osteoarthritis. Sees ortho. Follow up on labs. Symptoms of fatigue, dry skin, malaise, and weight gain. ASSESSMENT: 1. Hypothyroid. 2. Advanced osteoarthritis of the left hip. 3. Chronic pain medication agreement. 4. Enthesopathy of hip region. PLAN: TRT discussed. Risks and benefits discussed in detail. Levothyroxine. POC electrocardiogram with rhythm strip. Hydrocodoneacetaminophen.
Page 43 of 47
Mark Amundsen Copy Location: UC Davis Medical Center - Custodian Of Medical Records - Cypress Biding Date of Injury: 06/15/2010 Date 08/16/2011 Page 0207 Review Progress Report Bethany Lipa, M.D. CHIEF COMPLAINT: Leg numbness and weakness.
2009 ARS
IMPRESSIONS: 1. 51-year-old with 10-month history of non-progressive lower limb paresthesias and subjective complaints of weakness. Clinical examination and diagnostic work-up has ruled out central causes. 2. A bilateral polyradiculopathy is less likely due to normal needle EMG examination. 3. Chronicity of lower limb symptoms (with subjective intermittent upper limb weakness) makes AIDP unlikely. A normal CSF protein level and lack of chronic or ongoing axonal loss changes on needle EMG places CIDP lower on the differential. 4. Lack of consistent proximal muscle weakness on examination, the presence of sensory findings and normal needle EMG place myopathy much lower on the differential diagnosis. 5. It is very unlikely that a combined myopathy and peripheral neuropathy co-exist. Despite pes cavus deformity and mild distal lower limb atrophy, conduction velocities on electrodiagnostic testing ranging from 30m/s-58m/s essentially ruling out demyelinating forms of hereditary motor sensory neuropathy. RECOMMENDATIONS: Dr. Richman will review the electrodiagnostic findings from 03/2011 with Dr. Maselli and determine in repeat NCS/EMG. Follow up in 1 month to discuss the possibility in repeating NCS/EMG.
Page 44 of 47
2009 ARS
Review Progress Report David Richman, M.D. SUBJECTIVE: For neurologic evaluation of lower extremity numbness and weakness. IMPRESSIONS: 1. Gait disorder with sensory symptoms. 2. There is a possibility a mild sensory greater than motor neuropathy, the etiology of which has not been identified. DISPOSITION: Review the electrodiagnostic studies with Dr. Maselli and develop plan for further work up after that. Follow up in 2 months. Progress Report David Richman, M.D. SUBJECTIVE: Has very mild motor-sensory mixed neuropathy. IMPRESSIONS: 1. Severe gait disorder. Secondary to arthritis, especially in the hips. 2. Mild sensory greater than motor demyelinating and axonal neuropathy, question etiology. DISPOSITION: No further workup is indicated at this time.
09/27/2011 Page 0215
Page 45 of 47
2009 ARS
Review Progress Report Victor Baquero, M.D. SUBJECTIVE: Reports the variable efficacy with methadone which in the past had worked very well. More active and eating better than before. Has lost weight for few months without trying. Ongoing neuropathy in the lower legs. Bothersome particularly at night with pain. ASSESSMENT: 1. Advanced osteoarthritis of the left hip. 2. Special screening for malignant neoplasms, colon. 3. Routine general medical examination at a health care facility. 4. Other malaise and fatigue. 5. Weight loss. 6. Polyneuropathy. PLAN: Recommend follow up with orthopedics. Gastroenterology referral. Risks and benefits discussed in detail in terms of screening colonoscopy. TSH with free T4 reflex. Comprehensive metabolic panel. CBC auto + reflex manual differential. Prostate-specific antigen screen. Homocysteine.
Page 46 of 47
2009 ARS
Review Emergency Department Report Kelly Owen, M.D. CHIEF COMPLAINT: With past medical history significant for chronic pain on methadone, who presents to the emergency room needing for prescription refill. Note in EMR states that it is okay to refill his prescription early. EMERGENCY ROOM COURSE: Patient is asking for Methadone refill. Dr. Owen gave him a refill for 1.5 days work of methadone and he can follow up with primary medical doctor in 48 hours. Patient understands this, he will be discharge home. Return precautions given. DISPOSITION: Discharge. Anticipate need for further workup for this problem, which includes follow up with primary medical doctor for medication management. CLINICAL IMPRESSION: Medication refill.
Page 47 of 47
STATE OF CALIFORNIA
ARS#: 438281-01
DEPARTMENT OF INDUSTRIAL RELATIONS DIVISION OF INDUSTRIAL ACCIDENTS
WORKERS' COMPENSATION APPEALS BOARD

Case No. ADJ8724115 Mark Amundsen
Claimant/Applicant,
YS.
SUBPOENA DUCES TECUM

(NO APPEAllA,'lCE NECESSARY WHEN RECORDS ARE PRODUCED BY DEPOSITION DATE)
State Of CA Dept Of Fish And Game

Employer/Insurance Carrier/DefendanJ
The People of the State of California Send Greetings to:
Any and all MEDICAL records or writings of any kind; including but not limited to: inpatient and outpatient records, physical therapy, E/R, paramedie care, labs, tests and results, prescriptions, x-ray reports, private and industrial records, including records from Dr. Victor Baquero, M.D. and Dr. Andrew Ob, M.D. All aforementioned records herein that are stored electronically or in digital format must be delivered electronically in PDF or TIF format ou CD, DVD or electronically transferred to ARS via internet. applicant: Mark Amundsen DOH: 09/23/1959 SSN: XXX-XX-tl762
AKA:
Legal Agent for: Erie D. ~er, Esq. on Feb. 15, 2013, at 9 0 clock AM., to testify in the above entitled matter and to bring with you and produce the following described documents. papers, books and records:
Services at 13925 Whittier Blvd., Whittier, CA 90605 (562)696-1181 Fax: (562)945-0663
DC Davis Medical Center Custodian Of Medical Records - Cypress Biding. WE COMMAND YOU to appear before: ASSOCIatedReproduction
For failure to attend and to produce said documents you may be deemed guilty of contempt and liable to pay to the parties aggrieved all damages sustained thereby and forfeit one hundred dollars in addition thereto. This subpoena is issued at the request of the person making the declaration on the reverse hereof, or on the copy which is served herewith Date Jan. 25, 2013
WORKERS' COMPENSATION APPEALS BOARD OF TIlE srATE OF CALIFORNIA
By
------------------
-FOR INJURIES OCCURING ON OR An'ER JANUARY I, 1990 AND BEFORE JANUAIlY I, 1994, Ir no application tor ArQudiCtltion of Claim bas been filed, a deciuation ODder
penalty of perjury Ihat Employee's ClaIm for Workers' CompepsatioD Benefits (Form DWC-J) ball been rded pursuant to Labor Code Sea.loo 5401 mmt be execeted
properly. SEE REVERSE SIDE [SUBPOENA INVALID WlTIIOUT DECLAIlA TION]

You may .ruDy comply with this subpoena by mailin&: the records Within ten (10) days 01 the date of service of this subpoena. described (or authenticated copies, Evidence Code 1561) to the person and place stated above
This subpoena does DOt apply to any member of the Highway Patrol, Sheritl"s Office or City Police Department that deposit of the witness tee bas been made in accordance with Government Code 68097.2 et seq.
unJeslI acc:ompanied by DOtiee (rom tbis Board D2
DIA WeAR FORM 32 (REV. 06/94)
000001
DECLARATION FOR SUBPOENA DUCES TECUM

Case No. ADJ8724115 STATE OF CALIFORNIA, County of LOS ANGELES Eric D. Ledger, Esq. hereby states: That he is the attorney(s) of record or representative(s) for the Applicant/Consumer in the action captioned on the reverse hereof and Associated Reproduction Services, Inc. is designated to act as his legal agent in all respects for the purposes of executing said subpoena and obtaining any records, reports, or evidence of any kind, associated with this subpoena to prove or disprove said injuries. That the subpoenaed Custodian of Record has in his/her possession or under his/her control the documents described on the reverse hereof. That said documents are material to the issues involved in the case for the following reason: To assist in determining one or more of the following: To determine present and/or past physical condition; nature, extent and duration of sickness; injury, disability arising ont of employment & in the course of employment and/or necessity of further treatment; employment occupation and duties, earnings and earnings capacity selfjJrocured and future medical treatment, vocational rehabilitation under Labor Code 129.5 and status as Q.I. W (Qualified Injured Worker).; Jurisdiction and statute of limitations. I declare under penalty of perjury that the foregoing is true and correct. Executed on Jan. 25, 2013, at Whittier, California. Associated Reproduction
CC: State Contract Services Legal Agent for.
Services, Jrc, ... .:...-,.-., .... -,
/Eric D. Ledger, Esg.l Eric 1). Ledger, Esq.
".r
~.r
~a'.<
13925 Whittier Blvd., Whittier, CA 90605 Address (562) 696-1181 Telephone
============================================================================== DECLARATION OF SERVICE STATE OF CALIFORNIA, County of 7I>-bf-~,JcJ,.r.o

I, the undersigned, state that: I served the foregoing subpoena by showing the original and delivering a true copy thereof, together With a copy of the Declaration m support thereof, to each of the following named persons, personally, at the date and place set forth opposite each name. Name of person served Date of service
tl1 A-:L1
LA'" (Zd~P.
V /.,?
2-", at
Place 2315 Stockton Blvd Bldg 12 Sacramento, CA 95817
I declare under penalty of perjury that the foregoing is true and correct. Executed on
'/1...'1
20~,
r;,~I/"-I>-M.s,..tro
, California.
-~~~
G f8.7~,R.. W,kl...--
(\
Signature
000002
ARS# 438281-01-01
ATTORNeY
9821all15.5l D2
AITORNEY
(NQtllUfal~but/lllltlWr. untllJlldms):
, Eric D. Ledger, Esq. Mastagni, Holstedt, Et AI. 1912 IIIh St Sacramento, CA 95811
FAX NO FOR (Name:)
OR PJlRTY WITHOUT
TELEPHONE: ATTOR1'IY
Applicant/Consumer, WORKERS'
Mark Amundsen APPEALS BOARD
NAME
OF COUJlT:
COMPENSATION
STREET ADDRESS: MAIUNG AOORl'SS:
OTY AND ZlP CODE:

PL\lNTIFFIPIiTITlONR: DEFF.NDANTI1l~:
Mark Amundsen State Of CA Dept Of Fish And Game

(Code cw, Proc., ~ 1985.3. 1985.6)
CASE NUMBER:
NOTICE TO CONSUMER OR EMPLOYEE AND OBJECTION
ADJ8724115
NOTICE TO CONSUMER OR EMPLOYEE

'I'Olnemel: Mark
1.
Amundsen
THAT REQUESTING PARTY(name}: SEEKS YOUR RECORDS FOR
PLEASE TAKE NOTICE
Mastagni,
Holstedt,
Et AI.
EXAMINATIONby the parties to this action on lspecltc date): 02/15/2013 The records are described in the subpoena directed to witness (specify name and address of person or entity from whom records are sought): UC Davis Medical Center A copy of the subpoena is attached. 2. IF YOU OBJECT to the production of these records. YOU MUST DO ONE OF THE FOLLOWING BEFORE THE DATE SPECIFIED
IN ITEM
a.
OR b. BELOW.
a. If you are a patty to the above-entitled action, you must file a motion pursuant to Code of Civil Procedure section 1987.1 to quash or modify the subpoena and give notice of that motion to the witness and the depo$ltlon officer named in the subpoena at least five days before the date set for production of the records. b. If you are not a party to this action, you must serve on the requesting party and on the witness, before the date set for production of the records, a written objection that states the specific grounds on which production of such records should be prohibited. You may use the form below to object and state the grounds for your objection. You must complete the Proof of Service on the reverse side indicating whether you personally served or mailed the objection. The objection should not be filed
with the court. MAY WARNING, IF YOUR OBJECTION AND MAY IS NOT RECEIVED BEFORE THE DATE SPECIFIED TO ALL PARTIES. IN ITEM 1. YOUR RECORDS BE PRODUCED BE AVAILABLE
3. YOU OR YOUR ATTORNEY MAY CONTACT THE UNDERSIGNED to determine whether an agreement can be reached in writing to cancel or limit the scope of the subpeona. If no such agreement is reached, and if you are not otherwise represented by an attorney in this action. YOU SHOULD CONSULT AN ATTORNEY TO ADVISE YOU OF YOUR RIGHTS OF PRIVACY.
Dete:
01/25/2013
..~~.~.'?.!?: ~~c;I.!i'.~?:! ~!,.<;I;:

ITYPE OR PRINT NAME)
>
//'
"'1..-:,, /~ "~,/\ ISIGNATURE
..
[XXI ATTORNEY!
OF [ I REQUESTING PARTY
OBJECTION BY NON-PARTY TO PRODUCTION OF RECORDS

1.[ 2,[ II object to the production of all of my records specified in the subpoena. ) I object only to the production of the following specified records:
3. The specific grounds for my objection are as follows:
Date:
" ".". ITYrE 'oR PRiNT "NAME")""""

i
>
{SIGNATUREl
i@ MiiidiWJj use Ju4kllal CouncJI of Callfornla 98:llaM15.51 [NcwJuly J, 1999]
romMopS
(See Ill'Versa 19r pmnt pt code""
NOTICE
TO CONSUMER OR EMPLOYEE ANO !Code 1.'1V. Proe . $:S 1985_3, 1985.6)
OBJECTION
Code of Clvtl Pt<x'edure. Ii 1985.:\.19856, 20'.lO
000003
ARS# 438281-01-01
PLAINTIFF/PETITIONER:
DEFENDANT/RESPONDENT,
Mark.
State
Amund.sen
Of CA Dept Of Fish
(Code CW. Proc . ~
982(a)(15.5l D2 I I And Gam ADJ8724115

CAsE
NUMBER:
PROOF OF SERVICE OF NOTICE TO CONSUMER OR EMPLOYEE AND OBJECTI

1985.3. 1985.6)
[ ] Personal Service
[ X 1 Mail
1. At the time of service I was at least 18 years of age and not a party to this legal action.
2. I served a copy of the Notice to Consumer or Employee and Objection as follows (check either II or b) : a. ( J Personal service. I personally delivered the Notice to consumer or Employee and Objection as follows: (1) Name of person served: (3) Date served: (2) Address: (41Time served: b. [X ] Mail. I deposited the Notice to Consumer or Employee and Objection in the United States mail, in a sealed envelope with postage fully prepaid. The envelope was addressed as follows: (1) Name of person served: Mastagni, Ho1stedt, B:t Al. (3) Date of mailing: 01/25/2013 (2) Address: 1912 -I" St (4) Place of mailing (city and state): Whittier, CA Sacramento, CA 95811 (5) I am a resident of or employed in the county where the Notice to Consumer or Employee and Objection was mailed. c. My residence or business address is (specify): 13925 Whittier Blvd. d. My phone number is (specify): (562)696-1181 I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: 01/25/2013
Michelle Tellez ...................................................... lTYPE OR PRINT NAME)

(Code Otv. Proc . ~
>
[1
/Miche11e Tellez/
(SIGNATURE OF PERSON WHO SERVED)
PROOF OF SERVICE OF OBJECTION TO PRODUCTION OF RECORDS

1985.3. 1985.6)
[ 1 Personel Service
a.
ON THE REQUESTING (1)[ PARTY
Meil
1. At the time of service I was 18 years of age and not a party to this legal action. 2. I served a copy of the Objectin to Production of Records 8S follows (complete either a or b): l Personal service. I personally delivered the Objection to Production of Records as follows: (i) Name of person served: Wi) Date served: (ii) Address where served: (iv) Time served:
(2)[ ] Mail. I deposited the Objection to Production of Records in the United States mail. in a sealed envelope with postage fully prepaid. The envelope was addressed as follows: (i) Name of person served: (iiil Date of mailing: (ii) Address: (iv) Placeof mailing (city and state): (vl I am a resident of or employed in the county where the Objection to Production of Records was mailed.
b. ON THE WITNESS (11[ ] Personatservice. I personally delivered the Objection to Production of Records as follows:
Ii) Name of person served:

{ii} Address where served:
(iiil Date served: (iv) Time served:
(2)( ] Mail. I deposited the Objection to Production of Records in the United States mail. in a sealed envelope with postage fully prepaid. The envelope was addressed as follows: ~.ilName of person served:
(It) Address:
(Iii) Date of mailing: (iv) Placeof mailing (city and state):
~VII am a res~dentof or employed in the county where the Objection to Production of Records was mailed. 3. My restcenoe or busfneas address is (specify): 4. My phone number is (specify): I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date:
......................................................
{TYPE OR PRINT NAMEI
>
(SIGNATURE
OF PFRSON
WHO
SERVED)
~f.rl(i5.5j("'ew;)wy i, HhJ'J)
NOTICE TO CONSUMER OR EMPLOYEE AND OBJECTION

(Code Ctv. Proc . ~ 1985.3, 1985.6)
000004
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CI!HTEIl 2Jl~ STOQ;.TON 8OULEVAJU) SACltAMEWTO, C:'"UI'OI\l'I!A 951'7
Health Information Management Department UC Davis Health System Declaration of Custodian of the Legal Medical Record
2/25/13
Antonia G Kramar, a UCDHS ROI Coordinator, attests to the following: I am the duly authorized UC Davis Health System Custodian of the Legal Medical Record and have the authority to certify medical records. Attached to this affidavit is a true copy of the legal medical records requested in the subpoena duces tecum, patient authorization or other appropriate legal document. The medical records attached belong to Mark Amundsen, MR# 8081369 a UCDHS patient. The records were prepared by the UCDHS personnel in the ordinary course of business at or near the time of the act, condition, or event reference therein. The method used to prepare the attached medical records was photocopying the documents from the patient's original medical chart and/or printing records from the patient's electronic medical record. Pursuant to Evidence Code section 1560[eJ,the records described in the subpoena duces tecum, patient authorization, or other legal document, were delivered to the attorney or his/her designee for copying, or the records were made available to the In-house Certified Professional Photocopier for transmittal and processing to the requestor. I declare under penalty of perjury that the foregoing statements are true and correc if
onia G Kramar ~
Release of Information Unit Health Information Management UC Davis Health System Http://him.ucdavis.edu Phone (916) 734-5205 Fax (916) 734-2126
~_
000005
DECLARATION OF CUSTODIAN OF RECORD

Record Of:
Mark
Amundsen
OOB: 09/23/1959
ARS#:438281-01
001: _0_6~/_15~/~1_0
_
SSN: XXX-XX-0762
I am duly authorized as Custodian of Record (or other qualified witnessl with authority to cartify racords for:
UC Davis Medical Center Custodian Of Medical Records - Cypress Blding
CERTIFICATIONOF RECOROCOPIES Including this declaration, all documents, records and other things called for in the Subpoena Duces Tecum or Authorization which are in my custody have been photocopied either by a photocopy company or my office stall at my office, in my presence, under my direction and control; and the copy submitted with declaration is a true copy thereof. To tha bast of my knowladge all records in existence referred to above were prepared or cOl11li1ed and provided by the personnel of the above named business, in the ordinary course of business, at or near the time of the acts, conditions, or events recorded. No documents, records or other things have been withheld to prevent being photocopied. Certain records were omitted because:
----------------------------
CERTIFICATIONOF NO RECORDS A thorough search of the business revealed no records described in the attached subpoena or authorization for the following reason(s): MedicallBilling/XRay Records I Records destroyed after 5 7 9 years. I Records were lost I misplaced [ I Records destroyed due to Fire Water Theft ( 1Patiant has his I her recoras-( J Xrays are nen-existent at another facility: Name: Phone:-l---j ---------( I BillingIS: -Io-st-,-m-Isp--Ia-ce-d--N-o-t-ke-,p-t -because of at another facility: prepaid Health Plan Name: Contac-t-;--------P-h-on-e-: ----I No recor-ds-t-or-d-a-te-\s-j -sp-e-cl-tle-d-----I Other - comments: PersonnellWage/NonMedical Records I Navar Worked for this Company I Records destroyad after 5 7 I Previous owner kept origiiiillilasI Records kept at: Contact: -------P-h-o-ne-:----J Records we-re-lo-st-/-R1I-s-pl-ac-e-d--I Other: 9 years ------
I Patient never treated at this facility
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ihis certification IS limited to the information prOVided In the attached document. Records may exist under another name, spelling or other identifying data.
I DECLAREunder penalty of perjury that the foregoing is true and correct. Executed on
(Datel
at
(City) (State)
Declarant Witness
Print Name
Print Name --------------------------------. CERTIFICATIONOF PROFESSIONALPHOTOCOPIER I, th.e und.ersl2ned hereby declara that I am an employee of Associated Reproduction Services Inc., 13925 Whittier Blvd Whittier CA 90605 Registration u'!Jbe.r3640, Los Angele~ County. The attached copy ~f records produced to me by the above Custodian' of Records shall be ' transR1lftthed Sordlstrtbute.d to .the authortzed pe~sons or entities and Willbe true copies thereof. I declare under penalty of perjury under the Iaws 0 t e tate of Callforma that the foregOIng IS true and correct. Executed on Print Name
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7-/
2..,J;; II,~
(Date)
at
"
.;~~~ __ ~.r.-iiJ-TO~~~---' U.
Ie l
Signature
000006
(Slala)
A=5 LEGAL
(562) 696-1181
13925 Whittier Blvd., Whittier, CA 90605
FAX, (562) 945-0663
NOTIFICATION MEMO
In order to preserve the integrity of the file copied, we have kept the pages exactly how they were provided from the location. Please note that one or more pages contained within this file may pertain to persons not associated with this case. Usually this is due to the location misfiling the records in other files. It will be the decision of the requestor to remove these pages. The quality of the reproduction of the following documents cannot be improved if originals contain poor or illegible copies.
www.arslegal.com
000007
Amundsen, Mark (MRN 8081369)
UC DAVIS HEALTH SYSTEM
communication record creation was suppressed. Telephone Encounter
Left authorization for early refill on pharmacy's voice mail

Electronically signed byClare Jennings, MA on 1/7/2013 8:51 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. ED Initial Note signed by Kelly P Owen, MD at 01/05/13 2057 Author: Kelly P Owen, MD Service: Emergency Filed: 01/05/13 2057 Note Time: 01/05/13 1835 Author Type: *PHYSICIAN: FACULTY
EMERGENCY DEPARTMENT PHYSICIAN NOTE - Mark Amundsen
Date of Service: Note Started:
1/5/2013 5:50 PM 1/5/2013 6:35 PM
Patient's PCP: Victor Baquero DOB: 9/23/1959
Chief Complaint Patient presents with
Medication/Prescription Refill needs methadone refilled
The history provided by the patient. Interpreter used: No Mark Amundsen is a 53yr old male, with a past medical history significant for chronic pain on methadone, who presents to the ED with a chief complaint of needing prescription refill. Note in EMR states that it is okay to refill his prescription early, however no note stating authorization done. He tried to get medication today and was told by pharmacy that he could not. No changes in chronic pain. No new symptoms, just wants prescription for methadone. A full history, including pertinent past medical, family and social history was reviewed. HISTORY: Active Hospital Problems Medication refill
Allergies Allergen
Reactions
Fentanyl Morphine
Itching
itching
Hives
Past Medical History: NO SIGNIFICANT HISTORY
Past Surgical History: Lap,inguinal hernia repr,initial Total hip arthroplasty 12/15/2009
000008
COPY - Protected Health Information - 02/20/2013 13:09:16-MR0137 Page 2 of 100
Hypertension 7/12/2010 Social History Marital Status: WIDOWED Spouse Name: Years of Education: children: Occupational History Occupation Employer Comment network administra*
Review of patient's family history indicates: Arthritis Mother Cancer Mother Number of Comment: breast and lung
Social History Main Topics Smoking Status: Current Everyday Smoker Packs/Day: 1 Years: 20 Types: Cigarettes Smokeless Status: Not on file Alcohol Use: Yes Comment: rare Drug Use: No Sexual Activity: Not Currently Other Topics None on file Concern
Social History Narrative None on file There is no immunization history for the selected administration types on file for this patient.
Review of Systems Constitutional: Negative for fever and chills. Gastrointestinal: Negative for nausea, vomiting and abdominal pain. Musculoskeletal: Positive for joint pain. All other systems reviewed and are negative. TRIAGE VITAL SIGNS: Temp: 36.8 C (98.2 F) (01/05/13 1751) Temp src: Oral (01/05/13 1751) Pulse: 88 (01/05/13 1751) BP: 116/75 mmHg (01/05/13 1751) Resp: 16 (01/05/13 1751) SpO2: 98 % (01/05/13 1751) Weight: (not recorded) Physical Exam Nursing note and vitals reviewed. Constitutional: He is oriented to person, place, and time. He appears well-developed and wellnourished. HENT:
000009
Head: Normocephalic and atraumatic. Neck: Normal range of motion. Neck supple. Pulmonary/Chest: Effort normal. No respiratory distress. Musculoskeletal: Normal range of motion. He exhibits no edema. Neurological: He is alert and oriented to person, place, and time. He exhibits normal muscle tone. Skin: Skin is warm and dry. Psychiatric: He has a normal mood and affect. His behavior is normal.
INITIAL ASSESSMENT & PLAN, MEDICAL DECISION MAKING, ED COURSE: Mark Amundsen is a 53yr old male who presents with a chief complaint of medication refill. I explained to him that I usually do not refill methadone prescriptions. However, there is adequate documentation in EMR that his PMD had authorized early refill, without MA note stating that pharmacy was called (this occurred at 7:30pm last night), and it is now a weekend. He also began to try to get a refill 4 days ago. Therefore in this case I feel it is reasonable to give refill for 1.5 days worth of methadone and he can follow up with PMD in 48 hours. He was informed that in the future, he would not get pain medication refills from the ED. He understands this. He will be discharged home. Return precautions given. Patient demonstrates understanding of the plan and agrees. All questions answered. MDM COMPLEXITY Overall Complexity of MDM is: minimal LAST VITAL SIGNS: Temp: 36.8 C (98.2 F) (01/05/13 1751) Temp src: Oral (01/05/13 1751) Pulse: 88 (01/05/13 1751) BP: 116/75 mmHg (01/05/13 1751) Resp: 16 (01/05/13 1751) SpO2: 98 % (01/05/13 1751) Weight: (not recorded) Disposition: Based on this diagnosis, the patient will be discharged. Anticipate they will need further workup for this problem, which includes follow up with PMD for medication management. Clinical Impression: Medication refill
PRESENT ON ADMISSION: Are any of the following four conditions present or suspected on admission: decubitus ulcer, infection from an intravascular device, infection due to an indwelling catheter, surgical site infection or pneumonia? No. PATIENT'S GENERAL CONDITION: Good: Vital signs are stable and within normal limits. Patient is conscious and comfortable. Indicators are excellent.
Electronically signed:
000010
Kelly Owen, MD Attending Physician Emergency Medicine
Electronically signed by Kelly P Owen, MD at 1/5/2013 8:57 PM Revision history: > 01/05/13 2057 ED Initial Note signed by Kelly P Owen, MD 01/05/13 1840 ED Initial Note shared by Kelly P Owen, MD ED Triage Note signed by Kelly Kittle, RN at 01/05/13 1759 Author: Kelly Kittle, RN Service: Emergency Filed: 01/05/13 1759 Note Time: 01/05/13 1759 Author Type: .NURSE: (RN or LVN)
Pt here for methadone refill.

Electronically signed by Kelly Kittle, RN at 1/5/2013 5:59 PM Telephone Encounter
Okay to authorize refill.

Electronically signed byVictor Baquero, MD on 1/4/2013 7:50 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Ok to authorize a early refill? What date can patient fill RX?

Electronically signed byClare Jennings, MA on 1/4/2013 2:57 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Pt states phar always gives him a problem when he refills his meds early.Pt would like for you to call walgreens in folsom to let them know that it's ok to refill rx 4 days early. Pt is requesting a call back when done 509-0158
Electronically signed byJasvir K Bhele on 1/4/2013 2:25 PM Chart Review Routing History
000011
Display only: Transcription (RH22341514) on 1/20/2010 7:37 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. H&P signed by Norma Jean Klein, MD at 01/11/10 1233 Author: Norma Jean Klein, Service: Anesthesia MD 12/15/09 0832 01/11/10 1233 Filed: Note Time: Author Type: *PHYSICIAN: FACULTY
This patient was seen, evaluated, and care plan was developed with the resident. I agree with the assessment and plan as outlined in the resident's note. Report electronically signed by Dr. Norma J. Klein, Attending Physician. ANESTHESIOLOGY PREOPERATIVE HISTORY AND PHYSICAL Patient Name: Mark Amundsen is a 50yr male, 99kg Proposed Surgery: Left THA Date of surgery and anesthetic: 12/15/2009 Pre-op Dx / Reason for Surgery: DJD left hip Surgeon: Tamurian Consent: Completed and signed. Active Medical Problems: Mark Amundsen is a 50yr old male with left hip pain and DJD and depression. His narcotic allergy includes itching, not hives. He takes chronic pain medication and is a smoker. Past Medical History Diagnosis Date NO SIGNIFICANT HISTORY
Past Surgical History: Past Surgical History Procedure Lap,inguinal hernia repr,initial open repair
Date
Anesthetic Hx: Previous anesthetic records unavailable for review. Patient denies history of general anesthesia complications. No family history of anesthetic complications. Social / Drug & Alcohol Hx: Current smoker, occ ETOH, no IVDA. Allergies: Allergies Allergen Morphine Fentanyl itching
Reactions Hives
Current Medications:
000012
Current hospital medications: Cefazolin (KEFZOL, ANCEF) 1 g, 1 g, IV, ON-CALL OR, Jonathan G Eastman, MD; Vancomycin (VANCOCIN) ., 1,000 mg, IV, ON-CALL OR, Jonathan G Eastman, MD Review of Systems: CV: Denies chest pain, DOE, palpitations. No history of MI. No HTN. Resp: Denies cough, wheeze, dyspnea. No asthma or emphysema. Neuro: No history of CVA. No syncope or seizures. Musculoskeletal: Denies weakness and pain, aside from hip. Med: No GERD. No known hepatic or renal disease. No easy bleeding. No N/V/D/C. No known infectious disease. Activity: ambulates >1mi no SOB/CP. NPO: criteria met Patient Prescribed a Beta Blocker? No Physical Exam: BP 130/85 | Pulse 68 | Temp 37.2 C (99 F) | Resp 18 | Ht 1.854 m (6' 1") | Wt 97.387 kg (214 lb 11.2 oz) | SpO2 95% General: NAD, well-appearing for age. Airway: MP 1, TMD >5cm, dentition poor. Neck: Full ROM. Lungs: Clear to auscultation bilaterally. Card: Regular and without murmur. Labs / Studies: Lab Results Lab Name WBC HGB HCT PLT
Lab Results Lab Name NA K CL CO2 BUN CR GLU
Value 7.9 12.2* 35.4* 208
Date/Time 12/14/09 1:36 PM 12/14/09 1:36 PM 12/14/09 1:36 PM 12/14/09 1:36 PM
Value 139 3.9 103 28 13 1.01 88
Date/Time 12/14/09 1:36 PM 12/14/09 1:36 PM 12/14/09 1:36 PM 12/14/09 1:36 PM 12/14/09 1:36 PM 12/14/09 1:36 PM 12/14/09 1:36 PM
Cardiovascular Tests: None. Informed Consent: The risks and benefits of general anesthesia were explained to Mark Amundsen. Risks, including sore throat, oral or occular damage, allergic reaction, post-operative nausea and vomiting, heart attack, stroke, and death were addressed. The patient understands these risks and agrees to proceed. All of his questions were answered. ASA Status: II Premedictaion: Versed, ancef.
000013
4/17/2013 5:00 PM
Achieving A Healthy Weight
Chronic Disease Management Folsom
None
Transcription
Transcription Type Pain Referral Letter (2942) Electronically Signed
Document Text September 08, 2003 RE: AMUNDSEN, MARK MR#: 8081369 DOB: 09/23/1959 Date of Service: 09/08/2003 ID 438322 Date and Time 9/8/2003 7:58 PM
Mark Amundsen (MRN8081369)

Author Gary J Collins
Lumbar epidural steroid injection VICTOR HENRIQUE BAQUERO, MD 251 TURNPIKE DRIVE FOLSOM, CA 95630 Dear Dr. Baquero: We had the pleasure of treating your patient, Mark Amundsen, today at the University of California, Davis Center for Pain Medicine. As you know, the patient is a 43-year-old male with a history of chronic lower back pain and left-sided sciatic pain. The pain started approximately 9 years ago while doing sit-ups. It has become progressively worse, especially over the past 2 years with no specific reason. The patient's pain is described as shooting, dull, aching, throbbing. The pain intensity is currently rated as a VAS of 4 (0 to 10) anchored at 0 by "no pain" and at 10 by "the most severe pain imaginable." The average pain for the last week has been a VAS of 3 (0 to 10). CURRENT HEALTH PROBLEMS: The patient states that he currently has none. RESULTS OF MOST RECENT PRIOR PROCEDURES: The patient underwent epidural steroid injection. He noted approximately 65% relief for 2 months. No significant side effects from prior procedure. He reports the prior procedure being very helpful. It got rid of most of his leg pain and reduced his daytime pain considerably. He only uses pain meds at nighttime to assist with sleeping. The patient denies a personal or family history of prior anesthesia problems. The patient has had nothing to eat or drink for 8 hours. The patient denies a history of stridor/snoring/sleep apnea. CURRENT MEDICATIONS: 1. Vicodin. 2. Prozac. 3. Cyclobenzaprine.
000014
ANTICOAGULANT MEDICATIONS: None. ALLERGIES: IBUPROFEN. PHYSICAL EXAMINATION: Preprocedural vital signs Pain 4 out of 10 BP 121/86 Pulse 70 Resp Postprocedural vital signs Pain 3 out of 10 BP 135/90 Pulse 64 Resp
16
O2 Sat 95%
16
O2 Sat 97%
Airway: Mallampati Class 2. Neck ROM - full. Thyroid-Mentum Distance in fingerbreadths - 3. Lungs: Chest expansion normal, clear to auscultation without wheezes or rales. Heart: Regular rate and rhythm - normal S1, S2, no murmur, rub, or gallop. ASA Physical Status: I I. Normal II. Mild Systemic Disease III. Complex Systemic Disease IV. Critical V. Moribund PREPROCEDURAL DIAGNOSIS AND ASSESSMENT: 1. Lumbar degenerative disk disease. 2. Lumbar radiculitis. 3. Lumbar facet arthropathy. 4. Obsessive-compulsive personality disorder. 5. Obesity. POSTPROCEDURAL DIAGNOSIS AND ASSESSMENT: 1. Lumbar degenerative disk disease. 2. Lumbar radiculitis. 3. Lumbar facet arthropathy. 4. Obsessive-compulsive personality disorder. 5. Obesity. NAME OF PROCEDURE: L5-S1 lumbar epidural steroid injection. Informed Consent: The patient's condition and proposed procedures, risks, and alternatives were discussed with the patient or responsible party. The patient's/responsible party's questions were answered. The patient/responsible party appeared to understand and chose to proceed. Informed consent was obtained. SEDATION REPORT: Sedation given: None. PROCEDURE IN DETAIL: This is the second procedure of the first series that the patient is
000015
undergoing. After obtaining written consent, a 22-gauge IV hep lock was placed. The patient was taken back to the fluoroscopy suite and placed in a prone position with a pillow under the abdomen to decrease the lumbar lordosis. The skin overlying the lumbosacral area was prepped and draped in an aseptic fashion. The L5-S1 vertebral interspace was identified by AP fluoroscopy. The skin and subcutaneous tissue overlying the target site of injection was anesthetized using 3 mL of 1% lidocaine with a 25-gauge, 1-inch needle. A 20-gauge, 3-inch Tuohy needle was advanced under fluoroscopic guidance towards the epidural space using a midline approach. The epidural space was identified using a loss of resistance to air technique. After negative aspiration for heme or CSF, a total of 1 mL of Omnipaque 180 was injected. A lumbar epidurogram was confirmed using AP fluoroscopy. After negative aspiration for heme or CSF, 10 mL of a solution containing 2 mL of 40 mg/mL (80 mg) triamcinolone and 8 mL 300 Omnipaque was injected in increments. Dye spread was noted from the S2 level up to the L4 level, left slightly greater than right. The needle was then retracted approximately halfway and the needle track was flushed with 1 mL of PF saline. There were no apparent new sensory deficits in the lower extremities present following the procedure. A sterile bandage was placed over the injection site. The heart rate, pulse oximetry, and blood pressure were continuously monitored throughout the procedure. There were no apparent complications. The patient tolerated the procedure well and was carefully escorted to the recovery room in stable condition. After meeting discharge criteria, the patient was discharged home. RECOMMENDATIONS: A. We will plan to have the patient follow up 6 to 8 weeks for a repeat lumbar epidural steroid injection. The patient has noted significant improvement after his initial injection. He has about 2 months of relief. He will continue with his home therapy programs and medications as needed. If he continues to notice improvement and his pain continues to resolve, he may defer his repeat injection to a later date. B. No medications were prescribed at today's visit. The patient was instructed and educated on all aspects of the plan of care. The patient acknowledged the plan of care. Thank you for allowing us to participate in the care of your patient. Should you have any questions regarding the above treatment plan, please do not hesitate to contact us. Sincerely,
GARY COLLINS, MD CLINICAL FELLOW DEPARTMENT OF ANESTHESIOLOGY & PAIN MEDICINE
000016
THIS WAS ELECTRONICALLY SIGNED - 09/09/2003 7:08 AM PST BY:
THIS WAS ELECTRONICALLY SIGNED - 09/09/2003 11:18 PM PST BY: GAGAN MAHAJAN, MD ASSISTANT PROFESSOR OF CLINICAL ANESTHESIA
GC:cf(trs030e) D: 09/08/2003 07:58 PM T: 09/09/2003 05:36 AM C#: 162377 cc: GAGAN MAHAJAN, MD GARY COLLINS, MD
Display only: Transcription (438322) on 9/8/2003 7:58 PM by Gary J Collins Document history: Transcription (438322) on 9/8/2003 7:58 PM by Gary J Collins
Appointment
Patient Information Patient Name Amundsen, Mark Sex Male
Mark Amundsen (MRN8081369) DOB 9/23/1959
Patient Demographics Address 2025 TARBOLTON CIR FOLSOM CA 95630 Selected Appointment 9/8/2003 9:55 AM
Phone 916-509-0158 (Home) 916-983-4484 (Work) Provider Doctor Staff
E-mail Address mamundsen@sbcglobal.net
Department
Encounter-Level Documents: There are no encounter-level documents. Insurance Information Acct Number 039462515097 1 Payor UCD Patient Insurance ID XEHJ00044785 Group Number PH0010 Plan UCD/B/S HMO Plan Number B72 Plan Address PO BOX 179001 SACRAMENTO, CA 95817-9001 Plan Phone 916-734-0739 PreAuth Phone 916-734-0739 Financial Class P
000017
COMPREHENSIVE CHEMISTRY PANEL (583288) LIPID PANEL (583289) TESTOSTERONE,BIOAVAILABLE (598954)
10/3/2003 10/3/2003 10/3/2003
Encounter Closed By
Closed Date 10032003 Closed Time 12:37
Appointment
Phone 916-509-0158 (Home) 916-983-4484 (Work) Provider Victor Baquero, MD, MD
Department Fol Fam Prac/Int Med
Transcription Type Folsom Clinic Note (7721) Electronically Signed Document Text
ID 526373
Date and Time 10/3/2003 1:39 PM
Author Victor Baquero
LOCATION: IMFFOL PATIENT: AMUNDSEN, MARK MR #: 8081369 SEX: M AGE: 44 DATE OF SERVICE: 10/03/2003 DOB: 09/23/1959 FOLSOM CLINIC NOTE SUBJECTIVE: Mark Amundsen is here for followup regarding his cervicalgia. He had a second injection in the lumbar back with less relief this time than the last time. However, he has been in less pain. He is functioning better. He is able to walk around. He can sit for more than 30 minutes before being uncomfortable. He is doing back exercises that are also helping him along. He is currently taking about 2-1/2 Norco at 10/325 per day and taking one Flexeril at nighttime. Mood-wise, he is doing a lot better. The Prozac at 40 mg is helping him. He has a better outlook. He is now looking for jobs and is optimistic about the future. He says overall mood he went from a 3 to a 6. He is still having a little bit difficult time occasionally. He still cries every now and then. He is seeing a counselor on a monthly basis to go over the grief. For his grief it has been almost a year since his wife's passing and he seems to be moving along pretty good. He is not ready to date at his point. He has noticed some decreased sexual performance with the Prozac but at this point is not concerned. He does state his mind is slightly scattered as well. He attributes it to the Prozac. OBJECTIVE: Vitals: Normal noted. Well-nourished, well-developed, pleasant male in no apparent distress. Skin is warm and moist.
000018
Thought process and concentration are normal. He is laughing and smiling in the office. He affect appears to be full amplitude and mood euthymic. He certainly has more coloration. He is leaner and fitter and appears more alive and alert compared to last visit. ASSESSMENT AND PLAN: 1. Radiculopathy along the left leg. Continue seeing Pain Management. Advised him to try to back off the Vicodin if possible and will try to transition him over to anti-inflammatories along with the Flexeril. 2. Mood-wise, he is improved on the Prozac; however, not yet at what I would consider remission. Advised him that he may want to increase the dose to 60 mg daily if he finds that he plateaus at this level. He is to continue seeing the counselor for his grief reaction. 3. Weight loss of 30 pounds due to exercise and dieting. Praised him for his efforts and advised him to continue the good work. 4. Health care maintenance. Will follow up for a physical in the near future. Screening blood work was ordered. In addition, ordered a testosterone level given the fact he has been on chronic opiates and has some symptoms that may be due to testosterone deficiency.
THIS WAS ELECTRONICALLY SIGNED - 10/06/2003 12:58 PM PST BY: VICTOR HENRIQUE BAQUERO, MD PCN FOLSOM FAMILY AND COMMUNITY MEDICINE
VHB:dkb(usa162) D: 10/03/2003 01:39 PM T: 10/06/2003 11:02 AM C#: 195645
Display only: Transcription (526373) on 10/3/2003 1:39 PM by Victor Baquero Document history: Transcription (526373) on 10/3/2003 1:39 PM by Victor Baquero
Encounter-Level Documents: There are no encounter-level documents. Insurance Information Acct Number 079636570107 1
Financial Class P
000019
Group Number PH0010 Plan UCD/B/S HMO Plan Number B72 Plan Address PO BOX 179001 SACRAMENTO, CA 95817-9001 Plan Phone 916-734-0739 PreAuth Phone 916-734-0739
Other Appointments Today Date & Time 12/1/2003 2:00 PM
Provider Victor Baquero, MD
Center None
Future Appointments Date & Time 4/17/2013 5:00 PM
Provider Achieving A Healthy Weight
Department Chronic Disease Management Folsom
Center None
Appointment
Patient Demographics Address 2025 TARBOLTON CIR FOLSOM CA 95630 Selected Appointment 12/1/2003 2:00 PM
Transcription Type Folsom Clinic Note (7721) Electronically Signed

Document Text
ID 717662
PATIENT: AMUNDSEN, MARK LOCATION: IMFFOL MR #: 8081369 SEX: M AGE: 44 DATE OF SERVICE: 12/01/2003 DOB: 09/23/1959 FOLSOM CLINIC NOTE SUBJECTIVE Mark Amundsen is here for follow up on labs. He also reports leftsided hip pain radiates to the groin. Clicking and locking sometimes and some morning stiffness on the hips. This pain has been chronic and radicular symptoms are better. The hip pain has not really been well relieved by the opioid medication.
000020
OBJECTIVE Vitals normal and noted. Well-nourished, well-developed, pleasant male in no apparent distress. Skin: Warm and moist. Back exam: Stable. Hip exam: Reveals tenderness and limited range of motion with flexion, internal and external rotation, and abduction. Left hip was not examined. ASSESSMENT AND PLAN 1. Follow up on lab work. Discussed cholesterol results. Borderline lipids: Recommended dietary changes and exercise. Recheck in the next few months. 2. Hypotestosteronism due to chronic opioid use most likely: Will replace with AndroGel 5 mg to skin q.d. Recheck lab work in one month. 3. Left-sided hip pain somewhat chronic: X-rays were ordered. Follow up in ________ time. Continue current medication. Consider NSAIDs and prescribed Ultram 50 mg p.o. q.i.d. p.r.n. Consider referral to Orthopaedics given the chronic nature of his hip pain. 4. Radicular symptoms improved at this point: Continue current treatment as needed.
THIS WAS ELECTRONICALLY SIGNED - 12/04/2003 7:20 AM PST BY: VICTOR HENRIQUE BAQUERO, MD PCN FOLSOM FAMILY AND COMMUNITY MEDICINE
VHB:sa(usa161b) D: 12/01/2003 05:52 PM T: 12/01/2003 08:17 PM C#: 265170
Display only: Transcription (717662) on 12/1/2003 5:52 PM by Victor Baquero Document history: Transcription (717662) on 12/1/2003 5:52 PM by Victor Baquero Encounter-Level Documents: There are no encounter-level documents. Insurance Information Acct Number 079636570123 1
Payor UCD Patient Insurance ID XEHJ00044785 Group Number
000021
Acct Number 079636570016 1 Payor UCD Patient Insurance ID XEHJ00044785 Group Number PH0010
Plan UCD/B/S HMO
Financial Class P
Plan Number B72
Plan Address PO BOX 179001 SACRAMENTO, CA 95817-9001
Plan Phone 916-734-0739
PreAuth Phone 916-734-0739
Center None
Appointment
Phone 916-509-0158 (Home) 916-983-4484 (Work) Provider Gagan Mahajan, MD
Department Pain Clinic Acc
ID 822628
Author Lana Louie Wania-Galicia
Document Text January 05, 2004 RE: AMUNDSEN, MARK MR#: 8081369 DOB: 09/23/1959 Date of Service: 01/05/2004
LEFT L4-L5 AND L5-S1 LUMBAR FACET JOINT INJECTION VICTOR HENRIQUE BAQUERO, MD UC DAVIS MEDICAL GROUP FOLSOM 251 TURNPIKE DRIVE
000022
FOLSOM, CA 95630 Dear Dr. Baquero: We had the pleasure of treating your patient, Mark Amundsen, today at the University of California, Davis Center for Pain Medicine. As you know, the patient is a 44-year-old male with a history of chronic low back pain, which radiates down to the left posterolateral aspect of his left lower extremity down to the knee. It started nine years ago while he was doing sit ups and has progressively increased in severity and frequency over the past two years. The patient's pain is described as sharp, shooting and cutting. The pain intensity is currently rated as a VAS of 3/10 (0 to 10) anchored at 0 by "no pain" and at 10 by "the most severe pain imaginable." The average pain for the last week has been a VAS of 45/10 (0 to 10). CURRENT HEALTH PROBLEMS: The patient states that he currently has no health problems. RESULTS OF MOST RECENT PRIOR PROCEDURES: The patient had his second lumbar epidural steroid injection done on 9/8/03, which provided only 10% relief for three weeks. He had excellent results from his first LES, which helped his leg pain -- now does not have leg pain. Neither the first nor second LES have helped the LBP. The patient denies a personal or family history of prior anesthesia problems. The patient has had nothing to eat or drink for eight hours. The patient denies a history of stridor, snoring or sleep apnea. CURRENT MEDICATIONS: 1. Fluoxetine. 2. Flexeril. 3. Norco. ANTICOAGULANT MEDICATIONS: None. ALLERGIES: Ibuprofen, which results in hives and swelling. PHYSICAL EXAMINATION: Preprocedural vital signs VAS 3/10 BP 124/84 Pulse Postprocedural vital signs VAS 1/10 BP 127/89 Pulse
87 70
Resp Resp
16 16
O2 O2
Sat 97% Sat 99%
Airway: Mallampati Class II. Distance in fingerbreadths 3 Lungs: Chest expansion normal, or rales. Heart: Regular rate and rhythm gallop. ASA Physical Status: II
Neck ROM full. Thyroid-Mentum cm. clear to auscultation without wheezes - normal S1, S2, no murmur, rub, or
000023
I. II. III. IV. V.
Normal Mild Systemic Disease Complex Systemic Disease Critical Moribund
PREPROCEDURAL DIAGNOSIS AND ASSESSMENT: 1. Lumbar facet arthropathy. 2. Lumbar degenerative disc disease. 3. Lumbar radiculitis. 4. Obsessive compulsive personality disorder. 5. Obesity. POSTPROCEDURAL DIAGNOSIS AND ASSESSMENT: 1. Lumbar facet arthropathy. 2. Lumbar degenerative disc disease. 3. Lumbar radiculitis. 4. Obsessive compulsive personality disorder. 5. Obesity. NAME OF PROCEDURE: Left L4-L5 and L5-S1 intraarticular facet joint injection. Informed Consent: The patient's condition and proposed procedures, risks, and alternatives were discussed with the patient. The patient's questions were answered. The patient appeared to understand and chose to proceed. Informed consent was obtained. SEDATION REPORT: None. PROCEDURE IN DETAIL: This is the first procedure of the first series that the patient is undergoing. After obtaining written consent, a 22-gauge IV hep lock was placed. The patient was taken back to the fluoroscopy suite and placed in a prone position with a pillow under the abdomen to decrease the lumbar lordosis and to facilitate needle entry into the facet joints. The skin overlying the lumbosacral area was prepped and draped in an aseptic fashion. The upper lumbar facet joints are more vertically oriented and, therefore, visualized on direct AP fluoroscopy. The more inferior facet joints lay at a more oblique angle (with the L5-S1 joint approaching a frontal plane orientation). Adequate visualization of the lower facet joints was achieved by a combination of rotating the fluoroscope and rolling the patient towards the contralateral side. Optimal position occurred when the joint line was first visualized. The facet joints were identified radiographically directly adjacent to the superior articular process of the caudad vertebrae. The skin overlying the target sites of injection was anesthetized using 3 ml of 1% lidocaine with a 25-gauge, 1 inch needle. A 22-gauge, 3.5-inch spinal needle with a bent tip was advanced towards the L4-5 and L5-S1 facet joints on the left side under fluoroscopic guidance. The firm posterior capsule had its characteristic feel and the needle was advanced a few additional millimeters beyond the joint capsule into the joint space, but not into the articular cartilage. After the joint space was entered and aspiration was negative for heme or CSF, 0.5 ml of Omnipaque 180 was injected demonstrating a characteristic
000024
facet arthrogram. After negative aspiration for heme or CSF, 0.5 ml of a solution containing 10 mg of triamcinolone and 0.5 ml of bupivacaine 0.25% was slowly injected at each site. The needles was then removed. The heart rate, pulse oximetry, and blood pressure were continuously monitored throughout the procedure. There were no complications. The patient tolerated the procedure well and was carefully escorted to the recovery room in stable condition. The VAS was 3/10 before the procedure and 0-1/10 ten minutes after the procedure. After meeting discharge criteria, the patient was discharged home. RECOMMENDATIONS/TREATMENT PLAN: 1. The patient will follow up in four to six weeks for the second left L4-L5 and L5-S1 intraarticular facet joint injections. He was also instructed to call and postpone his appointment to a later date if he has substantial relief with minimal to no pain at the time of his next visit. 2. No medications were prescribed at today's visit. 3. The patient was also encouraged and advised to continue with a strengthening and exercise regimen, which is a critical aspect in the overall management of his pain and rehabilitation. The patient was instructed and educated on all aspects of the plan of care. The patient acknowledged the plan of care. Thank you for allowing us to participate in the care of your patient. Should you have any questions regarding the above treatment plan, please do not hesitate to contact us. Sincerely,
LANA WANIA-GALICIA, MD CLINICAL FELLOW DEPARTMENT OF ANESTHESIOLOGY & PAIN MEDICINE THIS WAS ELECTRONICALLY SIGNED - 01/09/2004 6:09 PM PST BY:
THIS WAS ELECTRONICALLY SIGNED - 01/10/2004 4:22 PM PST BY: GAGAN MAHAJAN, MD ASSISTANT PROFESSOR OF CLINICAL ANESTHESIA ATTENDING PHYSICIAN LW:ts(trs029e) D: 01/05/2004 05:57 PM T: 01/06/2004 09:25 AM C#: 304228 cc: LANA WANIA-GALICIA, MD
Display only: Transcription (822628) on 1/5/2004 5:57 PM by Lana Louie Wania-Galicia Document history: Transcription (822628) on 1/5/2004 5:57 PM by Lana Louie Wania-Galicia
Encounter-Level Documents:
000025
Department
Center None
Center None
Appointment
Patient Information Patient Name Amundsen, Mark
Sex Male

DOB 9/23/1959
000026
ID 965421
PATIENT: AMUNDSEN, MARK LOCATION: IMFFOL MR #: 8081369 SEX: M AGE: 44 DATE OF SERVICE: 02/13/2004 DOB: 09/23/1959 FOLSOM CLINIC NOTE SUBJECTIVE: Mark Amundsen is here for follow up on his chronic back pain. He says he has not had significant relief with the epidural injections. He currently takes about 4 Norco's 10/325 at night and he has about 4-1/2 hours of pain relief. He says the Ultram was not very effective. His pain is exacerbated by sitting and some activity. He does a lot of computer work; however, he is currently not employed. He is looking for jobs and is concerned about ability to function in a competitive environment. He also states that his AndroGel was not covered. OBJECTIVE: Vitals: Normal and noted. Well-nourished, well-developed, pleasant male. No apparent distress. Thought processes and concentration are normal. Back exam deferred other than shows full range of motion of the back with mild paraspinal discomfort. Normal neurologic exam, upper and lower extremities. ASSESSMENT/PLAN: 1. CHRONIC BACK PAIN. Has a facet arthropathy and degenerative disc disease. It is recommended he still follow up with Pain Management and will refer to Ortho Spine for further evaluation. 2. PAIN CONTROL. Will start on OxyContin 20 mg 1 p.o. b.i.d. for just q.h.s. Follow up with me to see if there is improvement. 3. DISCUSSED POTENTIAL FOR GOING ON DISABILITY DISCUSSED. Would like referral for him to be seen by Ortho Spine and he is to inquire about the implications of disability. 4. ANDROGEL HAS NOT BEEN COVERED. We will submit a prior authorization to his insurance company. He is definitely hypogonadic with low testosterone levels.
000027
VHB:rp(usa146b) D: 02/13/2004 04:53 PM T: 02/16/2004 08:49 AM C#: 358330
Display only: Transcription (965421) on 2/13/2004 4:53 PM by Victor Baquero Document history: Transcription (965421) on 2/13/2004 4:53 PM by Victor Baquero Encounter-Level Documents: There are no encounter-level documents. Insurance Information Acct Number 079636570024 1 Payor UCD Patient Insurance ID XEHJ00044785 Group Number PH0010 Plan UCD/B/S HMO Plan Number B72 Plan Address PO BOX 179001 SACRAMENTO, CA 95817-9001 Plan Phone 916-734-0739 PreAuth Phone 916-734-0739
Financial Class P
Center None
Appointment
Sex Male

DOB 9/23/1959
Department
Encounter-Level Documents: There are no encounter-level documents. Insurance Information
000028
ID 1024158
Document Text March 02, 2004 RE: AMUNDSEN, MARK MR#: 8081369 DOB: 09/23/1959 Date of Service: 03/02/2004
VICTOR HENRIQUE BAQUERO, MD 251 TURNPIKE DRIVE FOLSOM, CA 95630 Dear Dr. Baquero: We had the pleasure of evaluating your patient, Mark Amundsen, today in follow-up at the University of California, Davis Center for Pain Medicine. As you know, the patient is a 44-year-old male who is being evaluated for left-sided lower back pain primarily and a small amount of right-sided back pain. He states that the pain radiates through his buttocks into the posterior thigh. He is also complaining of anterior groin pain and deep hip pain. Symptoms started approximately three years ago and have been gradually getting worse in frequency and intensity. The pain is present constantly. The patient describes the pain as burning and cutting. The pain intensity is currently rated as a VAS of 3/10 anchored at 0 by "no pain" and at 10 by " the most severe pain imaginable". The average pain for the last week has been a VAS of 4/10. The patient notes a 50% improvement since coming to the Pain Clinic. During the past seven days the patient states that the current medication/treatment regimen has resulted in a 10% reduction in pain. CURRENT MEDICATIONS: 1. Norco. 2. Oxycodone. STOPPED MEDICATIONS: 1. Flexeril. 2. Topamax. 3. Metformin.
000029
ALLERGIES: Motrin. PAST SOCIAL AND FAMILY HISTORY: During the past month, the patient avoided going to work, physically exercising, participating in recreation, and driving because of pain. During the past month, the patient was able to walk eight blocks, sit for 35 minutes, and stand for one hour before pain became the limiting factor. Prior family history was reviewed. REVIEW OF SYSTEMS: The patient admits to diarrhea, sexual dysfunction, urinary retention and difficulty urinating, back pain, joint pain, muscle pain, difficulty falling and remaining asleep and feeling depressed. Constitutional: Sx: no fevers, no unplanned weight loss Eyes: no double or blurred vision ENT: no loss of hearing, no difficulty swallowing Heme/Lymph: no bleeding gums, or low platelet count Endocrine: no known thyroid disease or heat/cold intolerance Skin: no rashes or other lesions Respiratory: no shortness of breath, no wheezing Cardiovascular: no chest pain or palpitations GI: no constipation, abdominal pain, nausea/vomiting Neuro: no loss of consciousness, blackouts, memory loss, muscle weakness, seizures, trouble walking, dizziness, or fatigue Behavioral: No loss of interest in activities/hobbies, difficulty concentrating, feelings of guilt RESULTS OF MOST RECENT PROCEDURE: The patient underwent a left L4-5 and L5-S1 intraarticular facet joint injection. He reported no significant change in his symptoms. He reports no adverse side effects from prior injections. PHYSICAL EXAM: BP: 3/10 Pulse: 108/72 Resp: 68 Weight: 12 O2 Sat: 96% Normally developed, no deformities, well groomed. Oriented to time, person, and place. Normal attention span and concentration. Neuro is intact to pinprick and light touch sensation in the bilateral lower extremities in the L2 through S2 dermatomes. Gait is not antalgic. Manual muscle testing is 5/5 bilateral lower extremities in all planes. Straight leg raising in the sitting position and supine position is negative bilaterally. Patrick's test is negative bilaterally. In the left hip, the patient has increased pain with external rotation significantly greater than internal rotation. He describes this pain as deep into the hip joint. Piriformis test is negative for gluteal pain but this reproduces groin pain. MEDICAL DECISION MAKING ASSESSMENT: 1. Lumbar radiculitis. Primary he describes these symptoms in the left S1 distribution, but he is also noting new symptoms in the right S1 distribution. 2. Lumbar degenerative disc disease. 3. Lumbar facet arthropathy. 4. Hip osteoarthritis.
000030
5.
Urinary retention.
RECOMMENDATIONS/TREATMENT PLAN: 1. Repeat MRI of the L-spine to rule out progression of L5-S1 degenerative disc. Also, rule out central stenosis, which may be causing progression of his radicular symptoms and/or urinary retention problems. MRI LUMBAR SPINE 3/5/04: TECHNIQUE: Proton T1, T2-weighted, and fat suppressed fast spin-echo sagittal and proton transaxial images were obtained through the lumbosacral spine. FINDINGS: No paraspinal masses are evident. No significant disc protrusion or disc bulge is seen. No foraminal or osseous spinal stenosis is evident. No paraspinal abnormalities are detected. Impression: UNREMARKABLE MRI OF THE LUMBOSACRAL SPINE FOR AGE.
2. Trial of left S1 selective nerve root block. If the patient is noting improvement with these procedures, we may progress to pulsed radiofrequency of the dorsal root ganglion at this level. 3. The patient will follow up in orthopedic clinic on 4/9/04 for further evaluation of his left hip osteoarthritis. 4. Urinary retention. The patient is instructed to follow up with his primary care physician to rule out urinary tract etiology to his urinary retention symptoms. This may include the prostate as a source.
The patient was instructed and educated on all aspects of the plan of care. The patient acknowledged the plan of care. Thank you for allowing us to participate in the care of your patient. Should you have any questions or concerns regarding the recommended care plan, please do not hesitate to contact us. Sincerely,
GARY COLLINS, MD CLINICAL FELLOW DEPARTMENT OF ANESTHESIOLOGY & PAIN MEDICINE THIS WAS ELECTRONICALLY SIGNED - 03/03/2004 1:34 PM PST BY:
THIS WAS ELECTRONICALLY SIGNED - 03/09/2004 10:11 AM PST BY: GAGAN MAHAJAN, MD ASSISTANT PROFESSOR OF CLINICAL ANESTHESIA ATTENDING PHYSICIAN
000031
GC:ts(trs029e) D: 03/02/2004 03:22 PM T: 03/02/2004 06:47 PM C#: 379855 cc: GAGAN MAHAJAN, MD Display only: Transcription (1024158) on 3/2/2004 3:22 PM by Gary J Collins Document history: Transcription (1024158) on 3/2/2004 3:22 PM by Gary J Collins Encounter-Level Documents: There are no encounter-level documents. Insurance Information Acct Number 039690810039 1 Payor UCD Patient Insurance ID XEHJ00044785 Group Number PH0010 Plan UCD/B/S HMO Plan Number B72 Plan Address PO BOX 179001 SACRAMENTO, CA 95817-9001 Plan Phone 916-734-0739 PreAuth Phone 916-734-0739 Financial Class P
Center None
Appointment
Department
Encounter-Level Documents: There are no encounter-level documents.
000032
Center None
Appointment
Sex Male

DOB 9/23/1959
ID 1147514
PATIENT: AMUNDSEN, MARK LOCATION: IMFFOL MR #: 8081369 SEX: M AGE: 44 DATE OF SERVICE: 04/05/2004 DOB: 09/23/1959 FOLSOM CLINIC NOTE SUBJECTIVE: Mark Amundsen is here because of several reasons. 1. Chronic lumbar pain with radiculitis. Sees Pain Management. He has disability forms to complete in the office. Would like to know if there is alternative treatments to what he is taking. Currently doing Norco 10/325 anywhere from 1 to 3-1/2 at nighttime only. He takes Aleve. That also seems to help. In addition, he is concerned about increasing doses of the opiates. He wonders about alternative medicines. 2. Has GERD type symptoms that are intermittent, more pronounced when he is laying flat on his stomach. He feels food come up to his throat.
OBJECTIVE: Vitals: Normal and noted. Well-nourished, well-developed, pleasant male. No apparent distress. Exam is unchanged. Slightly overweight. Abdominal exam was deferred.
000033
ASSESSMENT/PLAN: 1. CHRONIC RADICULITIS, LUMBAGO. Continue to follow up with Pain Clinic. Continue Norco for now. He did not have any benefits from the OxyContin and felt no relief. Continue Aleve for now. Was given Neurontin 300 mg to start q.h.s. Increase dose to b.i.d. and then ultimately t.i.d. and see if that helps for neuropathic or neurologic type pain. Follow up with me accordingly. 2. FILLED OUT DISABILITY FORMS for his chronic lumbar pain. 3. GERD SYMPTOMS. Recommended over-the-counter Prilosec or H2 blockers. 4. OTHER BRIEF SOMATIC QUESTIONS that were answered in the office. Overall, spent 25 minutes. More than half the time was spent with patient filling out paperwork.
Display only: Transcription (1147514) on 4/5/2004 5:13 PM by Victor Baquero Document history: Transcription (1147514) on 4/5/2004 5:13 PM by Victor Baquero Encounter-Level Documents: There are no encounter-level documents. Insurance Information Acct Number 079636570040 1
Payor UCD Patient Insurance ID XEHJ00044785 Group Number PH0010 Financial Class P
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
000034
Insurance Information Acct Number 039690810047 1 Payor UCD Patient Insurance ID XEHJ00044785 Group Number PH0010
Plan UCD/B/S HMO
Financial Class P
Plan Number B72
Plan Phone 916-734-0739
Provider Scott M Fishman, MD
Center None
Center None
Appointment
Phone 916-509-0158 (Home) 916-983-4484 (Work) Provider Scott M Fishman, MD, MD
ID 1237596
Document Text April 29, 2004 RE: AMUNDSEN, MARK MR#: 8081369 DOB: 09/23/1959 Date of Service: 04/29/2004
000035
SACRAL TRANSFORAMINAL EPIDURAL INJECTION VICTOR HENRIQUE BAQUERO, MD UC-DAVIS MEDICAL GROUP FOLSOM PRIMARY 251 TURNPIKE DRIVE FOLSOM, CALIFORNIA 95630 Dear Dr. Baquero: We had the pleasure of treating your patient, Mark Amundsen, today at the University of California, Davis Center for Pain Medicine. As you know, the patient is a 44-year-old male with a history of chronic lower back pain which is worse on the left than the right side. It radiates down to the posterior aspect of his buttocks and also reports a component of radiation down the anterior aspect of his left lower extremity. He reports that it is worsened by driving extended period of time and by prolonged sitting. The patient's pain is described as burning, cramping, sharp, shooting. The pain intensity is currently rated as a VAS of 3-4(0 to 10) anchored at 0 by "no pain" and at 10 by "the most severe pain imaginable." The average pain for the last week has been a VAS of 34(0 to 10). CURRENT HEALTH PROBLEMS: The patient states that he currently has arthritis. RESULTS OF MOST RECENT PRIOR PROCEDURES: The patient did not undergo procedural intervention related to the current pain problem at the UC Davis Center for Pain Medicine at the last visit; however, he had a left L4-L5, and L5-S1 intraarticular facet joint injection on 01/05/04 which provided no relief of his pain. The patient denies a personal or family history of prior anesthesia problems. The patient has had nothing to eat or drink for 8 hours. CURRENT MEDICATIONS: 1. Norco. 2. Prozac. 3. Testosterone. ANTICOAGULANT MEDICATIONS: None.
ALLERGIES: Ibuprofen which results in hives. PHYSICAL EXAMINATION: Preprocedural vital signs VAS 3-4/10. BP 131/72. Pulse Postprocedural vital signs VAS 1.5/10. BP 138/84. Pulse
65. 61.
Resp Resp
16. 16.
O2 O2
Sat 97%. Sat 99%.
Airway: Mallampati Class II. Neck ROM full. Thyroid-Mentum Distance in fingerbreadths 3 cm. Lungs: Chest expansion normal, clear to auscultation without wheezes or rales.
000036
Heart: Regular rate and rhythm - normal S1, S2, no murmur, rub, or gallop. ASA Physical Status: II I. Normal II. Mild Systemic Disease III. Complex Systemic Disease IV. Critical V. Moribund PREPROCEDURAL DIAGNOSIS AND ASSESSMENT: 1. Lumbar radiculitis. 2. Lumbar degenerative disc disease. 3. Lumbar facet arthropathy. 4. History of hip osteoarthritis. 5. History of urinary retention. POSTPROCEDURAL DIAGNOSIS AND ASSESSMENT: 1. Lumbar radiculitis. 2. Lumbar degenerative disc disease. 3. Lumbar facet arthropathy. 4. History of hip osteoarthritis. 5. History of urinary retention. NAME OF PROCEDURE: Left S1 selective nerve root block. Informed Consent: The patient's condition and proposed procedures, risks, and alternatives were discussed with the patient. The patient's questions were answered. The patient appeared to understand and chose to proceed. Informed consent was obtained. SEDATION REPORT: None.
PROCEDURE IN DETAIL: This is the first procedure of the first series that the patient is undergoing. After obtaining written consent, a 22-gauge IV hep lock was placed. The patient was taken back to the fluoroscopy suite and placed in a prone position with a pillow under the pelvis to decrease the lumbar lordosis. The skin overlying the lumbosacral area was prepped and draped in an aseptic fashion. The fluoroscope was used to identify the L3, L4 and L5 vertebral bodies and then the sacrum on the AP projection. Visualization of the sacral foramen was aided by medial to lateral and cephalad to caudad repositioning of the fluoroscope so that the anterior and posterior radiolucent circles (sacral foramen) were aligned. The skin and subcutaneous tissue overlying the target site of injection was then anesthetized using 3 ml of 1% lidocaine with a 25-gauge, 1 1/2 inch needle. A 25-gauge, 3 1/2-inch spinal needle with a bent tip was advanced under fluoroscopic guidance until it gently touched the posterior sacral bone above the foramen. After redirecting the needle into the left S1 foramen, the advancing needle passed through the anterior sacral canal, as evidenced by the typical "pop" through the foraminal ligament. Fluoroscopic imaging in the lateral plane helped prevent entry into the pelvis. After negative aspiration for heme or CSF, a total of 2 ml of Omnipaque 180 was injected under live AP fluoroscopy, demonstrating absence of vascular uptake. AP and lateral images demonstrated an excellent S1 neurogram.
000037
Pain provocation by the injected contrast material was negative. After negative aspiration for heme or CSF, 3 ml of a solution containing 1 ml of 40mg/ml (40mg) triamcinolone, 1.5 ml of 0.25% bupivacaine, and 0.5 ml of Omnipaque 300 contrast was injected in increments. The needle was then retracted approximately halfway and the needle track was flushed with 1 ml of 1% lidocaine. A sterile bandage was placed over the injection site. There were no new sensory deficits present in the lower extremities. The heart rate, pulse oximetry, and blood pressure were continuously monitored throughout the procedure. There were no apparent complications. The patient tolerated the procedure well and was carefully escorted to the recovery room in stable condition. The VAS was 3-4/10 before the procedure and 1/10 ten minutes after the procedure. After meeting discharge criteria, the patient was discharged home. RECOMMENDATIONS: A. We will plan to have the patient follow up in 4-6 weeks for a repeat left S1 selective nerve root block. He was instructed to call and postpone this appointment to a later date if he has substantial relief with minimal to no pain at the time of his next appointment. B. No medications were prescribed at today's visit. C. The patient was also apprised that if he gets good relief from this series of left S1 selective nerve root blocks then we will proceed with pulsed radiofrequency ablation of the involved left S1 dorsal root ganglion. D. The patient was also encouraged to continue with his home exercise which is a critical aspect in the patient's overall pain management. The patient was instructed and educated on all aspects of the plan of care. The patient acknowledged the plan of care. Thank you for allowing us to participate in the care of your patient. Should you have any questions regarding the above treatment plan, please do not hesitate to contact us. Sincerely,
THIS WAS ELECTRONICALLY SIGNED - 05/05/2004 10:55 AM PST BY: PAUL G KREIS, MD ASSOC CLINICAL PROF; MEDICAL DIRECTOR, DIVISION OF PAIN MEDICINE ATTENDING PHYSICIAN LW:kl(trs091d) D: 04/29/2004 04:47 PM T: 04/29/2004 06:37 PM C#: 459848
000038
PROZAC 40 MG ORAL CAP (Taking/Discontinued)
1 CAPSULE EVERY MORNING
Immunizations
Immunizations as of 5/25/2004 No immunizations on file. Never Reviewed Mark Amundsen (MRN8081369)
Sex Male DOB 9/23/1959
Appointment
Phone 916-509-0158 (Home) 916-983-4484 (Work) Provider Jeffrey Alan Applebaum, MD
ID 1314478
Author Jeffrey Applebaum
LOCATION: IMFFOL PATIENT: AMUNDSEN, MARK MR #: 8081369 SEX: M AGE: 44 DATE OF SERVICE: 05/19/2004 DOB: 09/23/1959 FOLSOM CLINIC NOTE SUBJECTIVE: The patient was carrying a 15 pound elderly dog when he slipped and fell, landing on his buttock and back area. He has had a prior back problem. He has seen Dr. Baquero and has undergone physical therapy in the past and is on medication but is taking Norco 10/325, five tabs all at once at night. His back is tender to palpation and percussion in the left lumbar area from a contusion. No other significant changes. ASSESSMENT: Contusion to the lumbar area in a fall in a patient with underlying chronic lumbar syndrome. PLAN: Decrease the Norco, maximum of two to three tabs in the evening. Start Indocin 25 mg, one t.i.d., #60, no refills; Ambien 10 mg, one at h.s. p.r.n. sleep, #20; Flexeril 10 mg, half to one b.i.d. to t.i.d. p.r.n. spasm, #60, no refill. Discussed precautions against falling and injury. Ice or heat to the affected area and follow up with PCP for possible further physical therapy if persistent problem.
000039
THIS WAS ELECTRONICALLY SIGNED - 05/20/2004 1:38 PM PST BY: JEFFREY ALAN APPLEBAUM, MD PCN FOLSOM FAMILY AND COMMUNITY MEDICINE
JAA:waw(usa127) D: 05/19/2004 04:32 PM T: 05/20/2004 06:38 AM C#: 488882
Display only: Transcription (1314478) on 5/19/2004 4:32 PM by Jeffrey Applebaum Document history: Transcription (1314478) on 5/19/2004 4:32 PM by Jeffrey Applebaum
Encounter-Level Documents: There are no encounter-level documents. Insurance Information Acct Number 079636570057 1 Payor UCD Patient Insurance ID XEHJ00044785 Group Number PH0010
Plan UCD/B/S HMO
Financial Class P
Plan Number B72
Plan Phone 916-734-0739
Center None
Appointment
Patient Demographics Address
Phone
E-mail Address
000040
Default Flowsheet Data (all recorded)

Encounter Vitals Row Name Enc Vitals BP Pulse Resp Weight Pain Score Pain Loc Excl. in GC? Progress Notes SYSTEM Signed Patient presents with: Back Pain Subjective: Mark Amundsen is a(n) 44yr old male who presents for chronic complaint of low back pain for the past 3 year(s). He associates the onset of pain with no known injury. The pain is described as moderate, altrnating in character. Since its onset the pain is increasing. Associated symptoms: pain radiating to the left upper leg and lower leg . Symptoms are exacerbated by sitting and improved by heat and previous steroid injection, Norco works 50% of a time. ROS: as above History: I did review patients past medical and family/social history. Objective: Back Exam: no midline tenderness in the lumbosacral spine, ROM intact, no muscle spasm and no paraspinous muscle tenderness. Hip range of motion is normal and does not reproduce pain. Straight leg raise is negative bilaterally.DTR+1 bilateral. Assessment: 1.CHRONIC DEBILITATING BACK PAIN,failed elavil, ultram, norco, oxycontin, darvocet, NSAIDs, neurontin, flexeril, steroid injections, PT. 2.DEPRESSION-well controlled. Plan: See Orders. See Patient Education section. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. Visit Notes Paton, Carol A 7/9/2004 10:59 am Vital signs taken, allergies verified, screened for pain, med hx taken (if appropriate), Carol A Paton, MA Electronically signed by Paton, Carol A at 7/9/2004 10:59 am 07/09/04 1058 110/78 mmHg 72 14 102.059 kg (225 lb) 5 of 10 Back No
000041
Created by
Encounter creation information not available
Approved
Disp Refills Start End 135 0 7/19/2004 8/11/2004 NORCO 10 MG-325 MG ORAL TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 ORAL Class: Pharmacy Authorizing Provider: Victor Baquero
Medications at Start of Encounter

Disp Refills 60 0 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 0 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 60 3 ANDROGEL 1 % (25 MG) TD GLPK (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy 10 0 FENTANYL 25 MCG/HR TD PT72 (Taking) Sig - Route: apply q 3 days. - Transdermal 30 0 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 60 3 ROBAXIN-750 750 MG ORAL TAB (Taking) Sig - Route: take 1 - 2 pill hs prn - ORAL Class: Pharmacy Start End
7/15/2004
7/15/2004 6/23/2004
7/9/2004
Pharmacy Selected For Prescriptions

CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630
Office Visit
Orders
Selected Appointment 7/15/2004 9:15 AM
Provider Victor Baquero, MD, MD
Mark Amundsen (MRN 8081369)
Insurance Information Acct Number 079636570073 1

Payor UCD Patient Insurance ID XEHJ00044785 Group Number PH0010
Financial Class P
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
000042
Diagnoses BACKACHE NOS - Primary Reason for Visit Back Pain Level of Service OFFICE VISIT, EST PT, EXPANDED LOW COMPLEX [99213]
724.5
Medications
Disp Refills Start 60 0 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 0 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 60 0 ANDROGEL 1 % (25 MG) TD GLPK (Discontinued) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Historical 30 0 6/23/2004 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 60 3 7/9/2004 ROBAXIN-750 750 MG ORAL TAB (Taking) Sig - Route: take 1 - 2 pill hs prn - ORAL Class: Pharmacy End
7/15/2004
Ordered Medications ANDROGEL 1 % (25 MG) TD GLPK (Discontinued) 2 PACKETS DAILY - Transdermal FENTANYL 25 MCG/HR TD PT72 (Discontinued) apply q 3 days. - Transdermal Discontinued Medications Reason for Discontinue ANDROGEL 1 % (25 MG) TD GLPK Medication Review History Med Rev Hx Medication Administration Report for Amundsen, Mark All administrations No administration data available Pharmacy Selected For Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Disp 60 Refills 3 Start 7/15/2004 End 2/3/2005
10
7/15/2004
2/24/2006
Orders
Order Summary SPINE PROGRAM REFERRAL [100072 Custom] Order #: 3071290
000043
Immunizations
Immunizations as of 7/15/2004 No immunizations on file. Never Reviewed
Visit Summary
Vitals Recorded in This Encounter 07/15/2004 0922 102.513 kg (226 lb) Weight: 56 Pulse: 8 Resp: 122/84 mmHg BP: 4 Pain Score: N Excl. in GC?: Medications Given (Excluding those documented in Imm/Injections Activity) No data found.

Encounter Vitals Row Name Enc Vitals BP Pulse Resp Weight Pain Score Excl. in GC? Progress Notes SYSTEM Signed Patient presents with: Back Pain Subjective: Mark Amundsen is a(n) 44yr old male who presents for chronic complaint of low back pain for the past 3 year(s). He associates the onset of pain with no known injury. The pain is described as moderate, altrnating in character. Since its onset the pain is increasing. Associated symptoms: pain radiating to the left upper leg and lower leg. Norco not working. Sitting worsens the pain. Pain shoots to the left porsterior-lateral region to the ankle. Ocational numbness. no weakness. Tried PT and Pain clinic without success. Symptoms are exacerbated by sitting and improved by heat and previous steroid injection, Norco works 50% of a time. ROS: as above History: I did review patients past medical and family/social history. Objective: 07/15/04 0922 122/84 mmHg 56 8 102.513 kg (226 lb) 4 of 10 No
000044
Back Exam: no midline tenderness in the lumbosacral spine, ROM intact, no muscle spasm and no paraspinous muscle tenderness. Hip range of motion is normal and does not reproduce pain. Straight leg raise is negative bilaterally.DTR+1 bilateral. Assessment: 1.CHRONIC DEBILITATING BACK PAIN,failed elavil, ultram, norco, oxycontin, darvocet, NSAIDs, neurontin, flexeril, steroid injections, PT. Fu with spine clinic. Duragesic trial. Glucosamine. 2.DEPRESSION-well controlled. Plan: See Orders. See Patient Education section. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions.
Visit Notes SHAW, JESSICA J 7/15/2004 9:22 am Vital signs taken, allergies verified, screened for pain, med hx taken (if appropriate). Jessica J Shaw, MA Electronically signed by SHAW, JESSICA J at 7/15/2004 9:22 am All Flowsheet Templates (all recorded) Encounter Vitals Flowsheet
Instructions and Follow-Up

Patient Instructions None
Problem List
Problem List as of 07/15/2004 Problem BACKACHE NOS
Noted Resolved
low back pain - chronic. Tried Methadone, Hydrocodone, Baclofen, Soma, Oxycodone, Tramadol, Toradol, MSContin, Fentanyl, dilaudid.
TESTICULAR HYPOFUNC NEC BRACHIAL NEURITIS NOS Encounter Closed By Closed By BAQUERO, VICTOR H Closed Date 07152004 Closed Time 09:42 Mark Amundsen (MRN 8081369)
Provider Ilya L Khamishon, MD, MD Department Fol Fam Prac/Int Med
Office Visit
Insurance Information
000045
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work) Provider Kenten P-K Wang, DO, DO
Department Spine Clinic
Transcription Type Orthopaedics Clinic Note (2721) Electronically Signed
ID 1695029
Author Kenten P-K Wang
Document Text PATIENT: AMUNDSEN, MARK LOCATION: SPINE MR #: 8081369 SEX: M AGE: 44 DATE OF SERVICE: 08/31/2004 DOB: 09/23/1959 ORTHOPAEDICS CLINIC NOTE LINKING LANGUAGE: The patient seen and examined per referral of Dr. Victor Baquero in Folsom, California. CHIEF COMPLAINT: Low back pain.
HISTORY OF PRESENT ILLNESS: This is a 44-year-old Caucasian male with complaints of low back pain on the left side extending down to his left leg. It started about three years ago in 2001 with no apparent cause. He states the initial low back pain started approximately ten years ago while exercising, has perhaps worsened for the past three years. The pain is located in the low back, left hip and leg. The pain is described as burning, sharp and electric-like and occurs all the time. Activities that decrease pain include lying down and resting. Activities that increase the pain include sitting and standing. Activities that does not change the pain include exercising, bending, lifting, coughing, sneezing, or bowel movements. Functional limitations include going to work, socializing with friends, participating in recreation, and exercising. Previous treatments have included physical therapy (which provided no relief), ice (which provides moderate relief), traction (which provides no relief), TENS unit (which provides no relief). She has been injected with steroids four separate times here at UC Davis Medical Center which provided moderate to no relief. His first injection, he states, was to the disc which provided about 50% relief of his pain. He said that the injection was a facet injection which provided no relief. He also had an S1 injection which provided one day of relief. DIAGNOSTIC STUDIES: ALLERGIES: Previous diagnostic studies have included an MRI.
Ibuprofen, morphine sulfate.
000046
CURRENT MEDICATIONS: methocarbamol 750 mg Norco 10 mg 4 pills naproxen 220 mg four AndroGel 50 mg daily PAST MEDICAL HISTORY:
Prozac 40 mg daily (provides no relief), twice a day (provides a little bit of relief), a day (provides moderate amount of relief), times a day (provides a little bit of relief), (provides no relief). Minor health problems. Tonsillectomy, hernia repair.
PAST SURGICAL HISTORY:
FAMILY HISTORY: Mother dies of lung cancer at age 75. He has two siblings all in good health in their 40s. Family history is significant for lung cancer. SOCIAL HISTORY: He is not currently working. He last worked in April 2003 in computer network administration. He is currently applying for Social Security benefits with the State of California. He drinks alcoholic drinks two per week for the last 23 years. He has quit smoking, about 12 years ago. He used to smoke a pack-and-a-half a day for 17 years. He denies using street drugs. He has a high school diploma. He was in the Navy and honorably discharged. He lives alone in a house in Folsom. He has no children. He is widower. His wife died last year of breast cancer. REVIEW OF SYSTEMS: The history intake form was reviewed with the patient. He answered "yes" to feeling easily fatigued for the past two years, difficulty exercising due to weakness for two years, shortness of breath with trouble breathing with exercise for two years, intermittent loose stools for the past 44 years where he usually had two stools a day. He has weakness in his limb for the past two years. He has morning stiffness, joint pain and pain worse at night for the past three years. He has no equipment needs. He is independent with all activities of daily living. Pain diagram shows aching pain staring from the left iliac crest that radiates down the posterior thigh into his calf. He also has some left-sided anterior thigh or hip aching pain. PHYSICAL EXAMINATION: Weight 222x lb, blood pressure 133/80, temperature 36.8, pulse 69, respirations 16. Pain is rated at 3/10 in the left lower back. General: This is a well-developed, wellnourished male in no acute distress, alert and oriented and cooperative on the examination. His affect appeared bright and easy to laugh. His breathing was non-labored and non-dyspneic. His gait was non-antalgic. His coordination was normal. His reflexes were 2+ in bilateral knee, ankle and medial hamstrings. He had no ankle clonus bilaterally. Manual muscle testing did not reveal any focal weakness. He had 5/5 strength in hip flexors, hip abductors, hip adductors, knee extensors, ankle dorsiflexors, ankle everters, big toe extensors. Of note, on hip adduction patient had significant groin pain bilaterally. Single-leg bridging did not reveal any hamstring cramping or instability. His sensory test did not reveal any focal deficits in the lower limbs. Cardiovascular exam did not show any edema in the lower limbs. Skin examination did not show any rashes bilaterally. Musculoskeletal exam did not show any focal atrophy in the lower limbs. Structural exam did not show any significant iliac crest height difference or leg length discrepancy. Range of motion of the lumbar spine showed no significant pain with flexion. He was able
000047
to get his fingertips close to his foot. Extension and side-bending cause slight pain in both the right and the left hip region. Range of motion of his hips shows pain with hip internal rotation bilaterally and with faber maneuvers bilaterally. He has a lot of groin pain, especially on faber maneuver. Flexibility testing showed significant tightness of his hip adductors. His hamstrings were mildly tight with popliteal angle around 30 degrees. No tension test with straight leg raising and slump testing did not reproduce his symptoms. AP pelvic glide did not cause a significant amount of pain; however, there was discomfort with that maneuver. Palpatory exam did not reveal any lymphadenopathy. There was no significant tenderness along the spinous process. There is mild tenderness along the paraspinal muscles. There was slight tenderness along the left sacral notch compared to the right. Palpation at the insertion site on the pubic rami showed significant tenderness. IMAGING: MRI of the lumbar spine dated 12/20/02 showed degenerative changes of the facets and the disc of L5-S1 with a mild aneuric tear with shifting to the left of midline. A second set of MRI at the lumbar spine dated 3/5/04 showed unremarkable MRI of the lumbosacral spine for his age. I reviewed both to the MRI studies on Stentor and agree with the above findings. IMPRESSION: This is a 44-year-old male with low back pain that radiates down the left side, especially towards the hip. Imaging does not explain the source of his pain. He may have facet-mediated pain at the low back. He may also have left SI joint and hip joint pain. On physical examination, there was significant muscular tightness, especially along the hip adductors. He states he has been trying to strengthening his hip adductors without stretching them and over the past three years his hip pain has gotten worse and when he does not do the exercises the hip pain improves. I feel that the muscular tightness may be contributing to the mechanical changes in the joints which may result in arthritis in the hips and SI joint. RECOMMENDATIONS: 1) A physical therapy program was recommended for the patient to work on adductor stretching and strengthening of the hip abductors. Also recommended was a stretching program for the hip flexors and a strengthening procedure for the hip extensors. I feel that with normalization and balancing of the hip musculature that hip joint mechanics will eventually improve and his hip or SI joint pain will also improve. 2) The patient is currently being followed by the Anesthesia Pain Service for steroid injections. The patient is currently rethinking whether the injections are really helping him. The sites of injection should be directed more towards the joints such as the SI joint and hip joint. These injections should be considered for symptomatic relief. 3) I have asked the patient to follow up with me after his physical therapy program. At that time, and evaluation of the patient's symptoms will be made and, if indicated or if no improvements, consideration for electrodiagnostic testing may be made. Total time spent with patient including history, physical exam and coordination of care was 60 minutes. Of that time, over 75% was spent in face-to-face consultation.
THIS WAS ELECTRONICALLY SIGNED - 09/02/2004 10:29 AM PST BY: KENTEN WANG, DO
000048
ASSISTANT PROFESSOR DEPARTMENT OF PHYSICIAL MEDICINE & REHABILITATION
KW:jm(usa160) D: 08/31/2004 12:49 PM T: 09/01/2004 10:12 PM C#: 629285 cc: VICTOR HENRIQUE BAQUERO, MD, PCN FOLSOM Display only: Transcription (1695029) on 8/31/2004 12:49 PM by Kenten P-K Wang Document history: Transcription (1695029) on 8/31/2004 12:49 PM by Kenten P-K Wang Encounter-Level Documents: There are no encounter-level documents. Insurance Information Acct Number 039690810088 1
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Center None
Appointment
Sex Male

DOB 9/23/1959
Patient Demographics Address 2025 TARBOLTON CIR
Phone 916-509-0158 (Home)
000049
Selected Appointment 9/14/2004 8:16 AM Provider Doctor Staff Department Ucd Registration
Center None
Office Visit

Department Fol Family Practice
Insurance Information Acct Number 079636570099 1 Payor UCD Patient Insurance ID XEHJ00044785 Group Number PH0010 Plan UCD/B/S HMO Plan Number B72 Plan Address PO BOX 179001 SACRAMENTO, CA 95817-9001 Plan Phone 916-734-0739 PreAuth Phone 916-734-0739
Diagnoses LUMBAGO - Primary
724.2
000050
DERMATOPHYTOSIS OF FOOT Reason for Visit Other Level of Service OFFICE VISIT, EST PT, DETAILED MOD COMPLEXITY [99214] disability forms
110.4
Medications
Disp Refills Start End 60 0 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 0 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 60 3 7/15/2004 ANDROGEL 1 % (25 MG) TD GLPK (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy 10 0 7/15/2004 FENTANYL 25 MCG/HR TD PT72 Sig - Route: apply q 3 days. - Transdermal 30 6 8/3/2004 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 30 0 9/10/2004 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB (Taking) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: LAST REFILL 8/17/04 135 0/0 8/11/2004 9/14/2004 NORCO 10 MG-325 MG ORAL TAB (Discontinued) Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 - ORAL Class: Pharmacy 60 3 7/9/2004 ROBAXIN-750 750 MG ORAL TAB (Taking) Sig - Route: take 1 - 2 pill hs prn - ORAL Class: Pharmacy
Ordered Medications
Disp Refills Start End 135 0/0 9/14/2004 1/19/2006 NORCO 10 MG-325 MG ORAL TAB (Discontinued) take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 - ORAL 1 9/14/2004 2/24/2006 90G KETOCONAZOLE 2 % TOP CREA (Discontinued) apply by topical route once daily to the affected area(s) - TOPICAL
Discontinued Medications Reason for Discontinue NORCO 10 MG-325 MG ORAL TAB
000051
Medication Review History Med Rev Hx Medication Administration Report for Amundsen, Mark All administrations No administration data available Pharmacy Selected For Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630
Immunizations
Visit Summary
Vitals Recorded in This Encounter 09/14/2004 0832 98.884 kg (218 lb) Weight: 1.854 m (6' 1") Height: 74 Pulse: 14 Resp: 132/80 mmHg BP: 3 Pain Score: lower Comments: BACK Pain Loc: N Excl. in GC?: Medications Given (Excluding those documented in Imm/Injections Activity) No data found.

Encounter Vitals Row Name Enc Vitals BP Pulse Resp Weight Height Pain Score Pain Loc Excl. in GC? LMP / OB Status - Last Recorded BMI 28.76 kg/m2 Progress Notes SYSTEM Signed Mark Amundsen is a 44yr year old male who is here for the following reason: 09/14/04 0832 132/80 mmHg 74 14 98.884 kg (218 lb) 1.854 m (6' 1") 3 of 10 lower Back No
000052
follow up on dissability. Needs forms filled out. Chronic lumbago/sciatica. Stable on meds. Needs refill. Seeing spine clinic. Optimistic with new stretches and PT that was requested. OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Neuro: Gait normal. Reflexes normal and symmetric. Sensation and strength grossly normal. Musculoskeletal: back:unchanged. ASSESSMENT: 724.2 LUMBAGO (primary encounter diagnosis) Note: Continue PT and spine clinic. Plan: NORCO 10 MG-325 MG ORAL TAB Filled dissability forms extended until 1/1/05 110.4 DERMATOPHYTOSIS OF FOOT. Mocassin type. Plan: KETOCONAZOLE 2 % TOP CREA Spent greater than 25 minutes face to face with patient, over half the time was spent counseling.
PLAN: See Orders. Follow up in office if not better. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. Visit Notes GROVES, SHERI L 9/14/2004 8:33 am Vital signs taken, allergies verified, screened for pain, med hx taken (if appropriate), cc was taken. Sheri L Groves, MA Electronically signed by GROVES, SHERI L at 9/14/2004 8:33 am All Flowsheet Templates (all recorded) Encounter Vitals Flowsheet

Problem List
Noted Resolved
TESTICULAR HYPOFUNC NEC BRACHIAL NEURITIS NOS Encounter Closed By Closed By Closed Date Closed Time
000053
Appointment
Orders
DOB 9/23/1959
Account # 079919927024 Patient Demographics Address 2025 TARBOLTON CIR FOLSOM CA 95630 Selected Appointment 2/1/2005 7:53 AM Provider Doctor Staff Department Ucd Registration Phone 916-509-0158 (Home) 916-983-4484 (Work) E-mail Address mamundsen@sbcglobal.net
Center None
Office Visit
Selected Appointment 2/1/2005 8:00 AM Provider Victor Baquero, MD, MD
Mark Amundsen (MRN 8081369) Department Fol Family Practice
Insurance Information Acct Number 079919927024
000054
1 Payor UCD Patient Insurance ID XEHJ00044785 Group Number PH0010 Plan UCD/B/S HMO Plan Number B72 Plan Address PO BOX 179001 SACRAMENTO, CA 95817-9001 Plan Phone 916-734-0739 PreAuth Phone 916-734-0739
Diagnoses BACKACHE NOS PALPITATIONS EPISTAXIS Reason for Visit Other Nose Problem Heart Problem Level of Service OFFICE/OUTPT VISIT,EST,LEVL IV [99214] forms bleeding irregular beat
724.5 785.1 784.7
Medications
Medications at Start of Encounter Disp Refills Start 30 6 1/11/2005 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 60 0 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 0 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 60 3 7/15/2004 ANDROGEL 1 % (25 MG) TD GLPK (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy 3 11/23/2004 CYCLOBENZAPRINE HCL 10 MG ORAL 60 TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route 2 times per day - ORAL Class: Pharmacy Comment: LAST FILLED 11/2/04 10 0 7/15/2004 FENTANYL 25 MCG/HR TD PT72 Sig - Route: apply q 3 days. - Transdermal 135 0/0 1/10/2005 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB (Taking) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy End 7/10/2005
2/9/2005
000055
Comment: LAST REFILL 9/14/04 LAST FILLED 11/01/04 LAST FILLED 11/23/04 LAST FILLED 12/20/04 90G 1 9/14/2004 KETOCONAZOLE 2 % TOP CREA (Taking) Sig - Route: apply by topical route once daily to the affected area(s) - TOPICAL Class: Pharmacy 135 0/0 9/14/2004 10/14/2004 NORCO 10 MG-325 MG ORAL TAB (Taking) Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 - ORAL Class: Pharmacy 60 3 7/9/2004 ROBAXIN-750 750 MG ORAL TAB (Taking) Sig - Route: take 1 - 2 pill hs prn - ORAL Class: Pharmacy Medication Review History Med Rev Hx Medication Administration Report for Amundsen, Mark All administrations No administration data available Pharmacy Selected For Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630
Orders
Order Summary HOLTER MONITOR [105240 Custom] Order #: 5056620 ENT CLINIC REFERRAL [100012 Custom] Order #: 5056621
Immunizations
Visit Summary
Vitals Recorded in This Encounter 02/01/2005 0803 106.414 kg (234 lb 9.6 oz) Weight: 80 Pulse: 100/80 mmHg BP: 3 Pain Score: BACK Pain Loc: N Excl. in GC?: Medications Given (Excluding those documented in Imm/Injections Activity) No data found.

Encounter Vitals Row Name Enc Vitals BP 02/01/05 0803 100/80 mmHg
000056
Pulse Weight Pain Score Pain Loc Excl. in GC?
80 106.414 kg (234 lb 9.6 oz) 3 of 10 Back No
Progress Notes SYSTEM Signed Mark Amundsen is a 45yr year old male who is here for the following reason: 1. Back is getting better. Doing PT daily - now on his own and is able to do more exercice. He is excited about the improvement. Seeks extension of dissability. Plans to return to work in the near future. 2. Intermittent palpitations. Felt it last night. Pauses in beats and a hard beat afterwards. Only notices at nighttime. No other symptoms or limitations. Never problematic. 3. Recurrent nose bleeds. Has had nose cauterized. These are almost daily. Been using vaseline. OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Nose: nasal septal scabs. Neck: Neck supple. No adenopathy, thyroid symmetric, normal size. Heart: normal rate and regular rhythm, no murmurs, clicks, or gallops. Lumbar spine: exam unchanged. ASSESSMENT: 724.5 BACKACHE NOS Note: Chronic lumbago. improving. The current medical regimen is effective; continue present plan and medications. Extended dissability until End of February. Form filled out. 785.1 PALPITATIONS Note: None observed. Discussed care and warning signs. Plan: Will set up with Holter monitor 784.7 EPISTAXIS Note: referral to ENT. Prominent vomeral vascularity. Plan: Discussed care and warning signs. Spent greater than 25 minutes face to face with patient, over half the time was spent counseling. PLAN: See Orders. Follow up in office if not better. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. Visit Notes GROVES, SHERI L 2/1/2005 8:03 am Vital signs taken, allergies verified, screened for pain, med hx taken (if appropriate), cc was taken. Sheri L Groves, MA
Electronically signed by GROVES, SHERI L at 2/1/2005 8:03 am
All Flowsheet Templates (all recorded) Encounter Vitals Flowsheet
000057
CA 95817-9001
Center None
Appointment
Sex Male

DOB 9/23/1959
Account # 039942058031
Phone 916-509-0158 (Home) 916-983-4484 (Work) Provider Yoav Hahn, MD
Department Ent Physicians
Transcription Type Otolaryngology Referral Letter (2811)

Electronically Signed
ID 2516294
Author Yoav Hahn
VICTOR HENRIQUE BAQUERO, MD Dear Dr. Baquero: Chief complaint: 1) Nasal obstruction. 2) Epistaxis.
History: This is a 45-year-old male with a history of epistaxis since he was approximately ten years old. The patient reports that this epistaxis occurs intermittently. He reports that he has been cauterized every five years and has significant improvement in the epistaxis after the cauterization. He has been having epistaxis recently, though, and his last nose bleed was yesterday. This seems to resolve with some pressure. He also reports that when he blows his nose he can start bleeding. He does report that he does digitally manipulate his intranasal cavity. He has tried nasal saline and petroleum jelly on his nose in the past, however, does not use this
000058
continuously. He denies any hypertension or any other bleeding problems. He denies any nasal masses or any surgeries on his nose in the past. He does report nasal obstruction. He reports that his right side is worse than his left side. He also complains that his right ala collapses when he takes in a deep breath. This is annoying to him; however, it has not significantly affected his life. In addition, the patient reports pain behind his right eye. This seems to improve with anti-sinus medications; however, it does return. He denies any green discharge or any other evidence of sinusitis. Past medical history, past surgical history, medications, allergies, and social history are all per the intake sheets that were all reviewed. On his physical exam, the patient was normocephalic, atraumatic. pupils were equally round and reactive to light. His
His nose and sinuses revealed no significant external deformity. His nose is narrow and tall. His caudal septum is deviated to the right with a slight bend of the posterior septum to the left. There are no mucosal lesions or masses. On examination of his septum on the left in Kiesselbach's plexus there is noted to be some increased vascularity and some redness in the area. There is no active bleeding and no masses or ulcerations noted. There is no sinus tenderness and no mucopurulent discharge. There are no further lesions posteriorly in his nasal cavity. Neck exam reveals no neck adenopathy or masses with no thyroid enlargement or masses. Oral cavity reveals lip, gingiva, and oral mucosa normal. No acute dental infections, and the hard palate is normal. His ear reveals external auditory canals are clear bilaterally. Tympanic membrane intact. No effusion or infection, and clinical normal speech perception. Salivary glands revealed normal parotid and submandibular glands. Neurologic exam revealed cranial nerves II through XII grossly intact. Respiratory exam revealed breathing comfortably. Cardiac exam was no cyanosis or edema. Assessment: pain. 1) Epistaxis. 2) Nasal obstruction. 3) Right ethmoid
Plan: 1) The patient underwent a cauterization with silver nitrate sticks in the ENT Clinic of the left Kiesselbach's plexus. 2) Patient was instructed to use nasal saline approximately six times a day as well as petroleum jelly on a Q-tip to the left nasal septum every day. I have ordered a CT scan to assess his sinuses for any disease. 3) I discussed the options of treatment for the nasal obstruction with the patient. We will discuss this more in the future after the CT scan of the sinuses. Should he request a septoplasty, possibly an alar procedure may be indicated. Sincerely,
YOAV HAHN, MD RESIDENT
000059
DEPARTMENT OF OTOLARYNGOLOGY THIS WAS ELECTRONICALLY SIGNED - 03/26/2005 2:30 PM PST BY:
THIS WAS ELECTRONICALLY SIGNED - 03/31/2005 5:52 PM PST BY: MANSFIELD F SMITH, MD CLINICAL PROFESSOR DEPARTMENT OF OTOLARYNGOLOGY YH:waw(usa127) D: 03/24/2005 02:34 PM T: 03/24/2005 02:43 PM C#: 934933
Display only: Transcription (2516294) on 3/24/2005 2:34 PM by Yoav Hahn Document history: Transcription (2516294) on 3/24/2005 2:34 PM by Yoav Hahn Encounter-Level Documents: There are no encounter-level documents. Insurance Information Acct Number 039942058031 1 Payor UCD Patient Insurance ID XEHJ00044785 Group Number PH0010
Plan UCD/B/S HMO
Financial Class P
Plan Number B72
Plan Phone 916-734-0739
Center None
Telephone/Refill Encounter
Patient Information
Patient Name Amundsen, Mark MRN 8081369 Sex Male
Mark Amundsen (MRN8081369) DOB 9/23/1959 PATIENTPHONE 916-509-0158
Telephone Encounter
3/21/2005 4:34 PM
Provider Victor Baquero, MD, MD Department Fol Family Practice
000060
Approved
Disp Refills Start End 250 0 2/6/2006 4/14/2006 NORCO 10 MG-325 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Authorizing Provider: Victor Baquero

Disp Refills Start End 135 0/0 1/3/2006 2/2/2006 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1049713 / 1052502. Last filled 11/17/05 60 0 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 0 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 300.00 3 12/8/2005 3/8/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 1/19/2006 2/18/2006 BACLOFEN 10 MG TAB (Taking) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 60 3 1/3/2006 4/3/2006 CYCLOBENZAPRINE 10 MG TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route 2 times per day - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1030339. 10 0 7/15/2004 FENTANYL 25 MCG/HR TD PT72 Sig - Route: apply q 3 days. - Transdermal 30 6 1/19/2006 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 90G 1 9/14/2004 KETOCONAZOLE 2 % TOP CREA (Taking) Sig - Route: apply by topical route once daily to the affected area(s) - TOPICAL Class: Pharmacy 0 1/19/2006 2/6/2006 60 METHADONE 5 MG TAB (Discontinued) Sig - Route: take 1 po bid - ORAL 135 0/0 1/19/2006 2/6/2006 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 ORAL Class: Pharmacy

Orders Chart Cosign

Accepted By Victor Baquero Accepted On 2/7/2006 3:44 PM
Office Visit
000061
Insurance Information Acct Number 078080963016 1 Payor AUSHC Patient Insurance ID W142637665 Group Number 620229011
Plan AETNA PPO
Financial Class P
Plan Number A06
Plan Address PO BOX 14089 LEXINGTON, KY 40512-4089
Plan Phone 888-632-3862
Diagnoses ENTHESOPATHY OF HIP - Primary LUMBAGO Reason for Visit Refill Request Medication Problem Level of Service OFFICE/OUTPT VISIT,EST,LEVL III [99213]
726.5 724.2
need to ck meds
Medications
Disp Refills Start End 30 6 1/11/2005 7/10/2005 FLUOXETINE HCL 40 MG ORAL CAP Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 135 0/0 1/3/2006 2/2/2006 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1049713 / 1052502. Last filled 11/17/05 60 0 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 0 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 300.00 3 12/8/2005 3/8/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 60 3 1/3/2006 4/3/2006 CYCLOBENZAPRINE 10 MG TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route 2 times per day - ORAL Class: Pharmacy
000062
Comment: This is a REFILL AUTHORIZATION for prescription number 1030339. 10 0 7/15/2004 FENTANYL 25 MCG/HR TD PT72 Sig - Route: apply q 3 days. - Transdermal 6 1/2/2006 1/19/2006 30 FLUOXETINE 40 MG CAP (Discontinued) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 90G 1 9/14/2004 KETOCONAZOLE 2 % TOP CREA (Taking) Sig - Route: apply by topical route once daily to the affected area(s) - TOPICAL Class: Pharmacy 0/0 9/14/2004 1/19/2006 135 NORCO 10 MG-325 MG ORAL TAB (Discontinued) Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 - ORAL Class: Pharmacy 60 3 7/9/2004 1/19/2006 ROBAXIN-750 750 MG ORAL TAB (Discontinued) Sig - Route: take 1 - 2 pill hs prn - ORAL Class: Pharmacy Ordered Medications Disp Refills Start End 60 0 1/19/2006 2/6/2006 METHADONE 5 MG TAB (Discontinued) take 1 po bid - ORAL 90 2 1/19/2006 4/18/2006 BACLOFEN 10 MG TAB (Discontinued) 1 PO TID PRN - ORAL 0/0 1/19/2006 2/6/2006 135 NORCO 10 MG-325 MG TAB (Discontinued) take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 - ORAL 6 1/19/2006 7/19/2006 30 FLUOXETINE 40 MG CAP (Discontinued) take 1 capsule (40mg) by oral route once daily in the morning - ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. Discontinued Medications Reason for Discontinue ROBAXIN-750 750 MG ORAL TAB NORCO 10 MG-325 MG ORAL TAB FLUOXETINE 40 MG CAP Medication Review History Med Rev Hx Medication Administration Report for Amundsen, Mark All administrations No administration data available Pharmacy Selected For Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630
Orders
Order Summary ORTHOPEDIC-GENERAL REFERRAL [100042 Custom] Order #: 9329932
Immunizations
000063
Immunizations as of 1/19/2006 No immunizations on file.
Never Reviewed
Visit Summary
Vitals Recorded in This Encounter 01/19/2006 0830 106.006 kg (233 lb 11.2 oz) Weight: 79 Pulse: 14 Resp: 110/82 mmHg BP: NO PAIN Pain Score: Medications Given (Excluding those documented in Imm/Injections Activity) No data found.

Encounter Vitals Row Name Enc Vitals BP Pulse Resp Weight Pain Score 01/19/06 0830 110/82 mmHg 79 14 106.006 kg (233 lb 11.2 oz) No pain
Progress Notes SYSTEM Signed Mark Amundsen is a 46yr year old male who is here for the following reason: Follow up on right hip pain. Status post physical therapy, stretches help but do not clear symptoms continuosly. Seen by ortho and spine clinic. Started riding bike daily and doing exercise. Stretches daily. Taking 70mg of norco daily. Interested in other treatment. OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Skin: Skin color, texture, turgor normal. No rashes or lesions. Neuro: Gait normal. Reflexes normal and symmetric. Sensation and strength grossly normal. Musculoskeletal: right hip, tender to palpation with internal and external rotation. ASSESSMENT: 726.5 ENTHESOPATHY OF HIP (primary encounter diagnosis) Note: Discussed care and warning signs. Chronic condition. continue exercise. Follow up with ortho for reevaluation. Plan: METHADONE 5 MG TAB, ORTHOPEDIC-GENERAL REFERRAL, BACLOFEN 10 MG TAB 724.2 LUMBAGO Note: Expect improvement with time. Stretches discussed. NSAIDs, ice or heat may help with symptoms. Avoid activities that exacerbate pain. Consider physical therapy. Follow-up if not better. Plan: NORCO 10 MG-325 MG TAB
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for breakthrough pain. PLAN: See Orders. Follow up in office if not better. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. I reviewed past medical, social and medication history during the visit. Visit Notes TAYLOR, ERNESTINE 1/19/2006 8:42 am Vital signs taken, allergies verified, screened for pain, med hx taken (if appropriate), Ernestine Taylor, MA
Electronically signed by TAYLOR, ERNESTINE at 1/19/2006 8:42 am

Problem List
Problem List as of 01/19/2006 Problem BACKACHE NOS Noted Resolved
TESTICULAR HYPOFUNC NEC BRACHIAL NEURITIS NOS ENTHESOPATHY OF HIP
1/19/2006
MRI 2006 1. ADVANCED OSTEOARTHRITIS OF THE LEFT HIP. 2. GANGLION CYST ALONG THE INFEROMEDIAL ASPECT OF THE LEFT HIP.
Status post total hip replacement. 12/2009
Encounter Closed By Closed By BAQUERO, VICTOR H
Patient Information
Patient Name Amundsen, Mark MRN 8081369 Sex Male DOB 9/23/1959 PATIENTPHONE 916-509-0158
Closed Date 01192006
Closed Time 13:31

Contacts
01/03/2006 3:11 PM Type Phone (Incoming) Contact Amundsen, Mark (Self) Phone 916-983-2589
Telephone Encounter
1/3/2006 3:11 PM
000065
Orders Order Summary

PELVIS 1 OR 2 VIEWS (9686789) L-SPINE 2 OR 3 VIEWS (9686877) Ordered On 2/13/2006 2/13/2006
Encounter Closed By
Closed By INTERFACE, RAD RESULTS Closed Date 02132006 Closed Time 12:03
Appointment
Sex Male

DOB 9/23/1959
Account # 078080963024 Patient Demographics Address 2025 TARBOLTON CIR FOLSOM CA 95630 Selected Appointment 2/13/2006 11:45 AM Provider Xray0 Radfol Department Fol Radiology Phone 916-509-0158 (Home) 916-983-4484 (Work) E-mail Address mamundsen@sbcglobal.net
Encounter-Level Documents: There are no encounter-level documents. Insurance Information Acct Number 078080963024 1 Payor AUSHC Patient Insurance ID W142637665 Group Number 620229011 Plan AETNA PPO Plan Number A06 Plan Address PO BOX 14089 LEXINGTON, KY 40512-4089 Plan Phone 888-632-3862 PreAuth Phone 800-840-2925 Financial Class P
Other Appointments Today Date & Time 2/13/2006 11:30 AM
Provider H. David Moehring, MD
Department Fol Orthopedics
Center None
Department Chronic Disease
Center None
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Management Folsom
Appointment
Sex Male

DOB 9/23/1959
Account # 078080963024 Patient Demographics Address 2025 TARBOLTON CIR FOLSOM CA 95630 Selected Appointment 2/13/2006 11:30 AM Provider H. David Moehring, MD Department Fol Orthopedics Phone 916-509-0158 (Home) 916-983-4484 (Work) E-mail Address mamundsen@sbcglobal.net
Transcription Type Folsom Clinic Note (7721)

ID 4057369
Author H. David Moehring
Document Text PATIENT: AMUNDSEN, MARK LOCATION: ORTFOL MR #: 8081369 SEX: M AGE: 46 DATE OF SERVICE: 02/13/2006 DOB: 09/23/1959 FOLSOM CLINIC NOTE HISTORY: Mr. Amundsen is a 46-year-old, currently unemployed male, who has a long history of low back, left posterior pelvic and thigh pain intermittently. About three years ago, he had a series of epidural steroids, which significantly improved his symptoms. Nevertheless, he remains dependent on NSAIDs and fairly heavy dose of narcotics. Currently, his symptoms are of left-sided sacroiliac pain with some radiation down the posterior thigh, occasionally below the knee. He does not have any bladder or bowel symptoms or any known motor weakness. Secondary complaint is of groin or inguinal pain, which is exacerbated by rotation of the hip. This also has been present for some time. PRESENT MEDICATIONS: Prozac, Norco.
ALLERGIC HISTORY: Patient states that he is allergic to Motrin and methadone, but it is likely that these are more reflective of intolerance than true allergy. PHYSICAL EXAMINATION: Large-statured, healthy-appearing male who is a good historian and seems to be in a talkative and jovial mood today. He has a mildly antalgic limp, but can walk on his toes and heels. He can forward flex and bend at the hips to touch the floor without
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difficulty. Straight leg raising is negative in the sitting position. Rotation and other motions of the right hip are within normal limits and pain free. Examination of the left hip reveals absent internal rotation, as well as mild limitation of external rotation, which is painful. Flexion also causes some pain. He does not have a flexion contracture. Deep tendon reflexes are symmetrical. Motor strength is 5/5 bilaterally. X-RAYS: Patient's x-rays show degenerative arthritis of the hips, left greater than right. RECOMMENDATIONS: The patient is on considerable medication at the time and I gathered his symptoms have not greatly increased in severity, but are rather a chronic complaint. It is likely that there will be progression of his hip arthritis, but the rate of progression is unknown. Currently, I think for a man in his age group and with his other diagnoses, it is best that he exhaust medical options before embarking on total joint replacement. I have asked that he return to see me in a few months to reassess his situation. If he is still symptomatic at that time, we may consider an MRI, as he has reported an occasional snapping sensation about the hip. Today, I could not detect that, but it is possible he may have iliotibial band friction syndrome or some other variant. It is more likely that he has the rather common degenerative joint disease. At any rate, we will consider an MRI if his symptoms suggest labral tear, impingement and so on.
THIS WAS ELECTRONICALLY SIGNED - 02/14/2006 9:48 AM PST BY: DAVID MOEHRING, MD PROFESSOR PCN FOLSOM NETWORK ORTHOPAEDICS
HDM:lmw(usa217) D: 02/13/2006 12:43 PM T: 02/14/2006 09:27 AM C#: 1622170 cc: VICTOR HENRIQUE BAQUERO, MD Display only: Transcription (4057369) on 2/13/2006 12:43 PM by H. David Moehring Document history: Transcription (4057369) on 2/13/2006 12:43 PM by H. David Moehring Encounter-Level Documents: There are no encounter-level documents. Insurance Information Acct Number
Financial Class
000068
Authorizing Provider: Victor Baquero

Disp Refills 300.00 3 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Discontinued) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 BACLOFEN 10 MG TAB (Taking) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 0 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 250 0 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Start 12/8/2005 End 2/27/2006
1/19/2006
2/18/2006
1/19/2006
2/24/2006
2/6/2006
3/8/2006

Office Visit
Orders
Plan AETNA PPO
Financial Class P
Plan Number A06
Plan Phone 888-632-3862
Diagnoses ENTHESOPATHY OF HIP - Primary Reason for Visit Medication Problem Level of Service OFFICE/OUTPT VISIT,EST,LEVL III [99213] f/u
726.5
Left hip
000069
Medications
Medications at Start of Encounter Disp Refills Start 0 60 ALEVE 220 MG ORAL TAB (Discontinued) Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 0 10 AMBIEN 10 MG ORAL TAB (Discontinued) Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 300.00 3 12/8/2005 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 1/19/2006 BACLOFEN 10 MG TAB (Taking) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 3 1/3/2006 60 CYCLOBENZAPRINE 10 MG TAB (Discontinued) Sig - Route: take 1 tablet (10mg) by oral route 2 times per day - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1030339. 0 7/15/2004 10 FENTANYL 25 MCG/HR TD PT72 (Discontinued) Sig - Route: apply q 3 days. - Transdermal 30 6 1/19/2006 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 1 9/14/2004 90G KETOCONAZOLE 2 % TOP CREA (Discontinued) Sig - Route: apply by topical route once daily to the affected area(s) - TOPICAL Class: Pharmacy 250 0 2/6/2006 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Discontinued Medications Reason for Discontinue FENTANYL 25 MCG/HR TD PT72 CYCLOBENZAPRINE 10 MG TAB KETOCONAZOLE 2 % TOP CREA AMBIEN 10 MG ORAL TAB ALEVE 220 MG ORAL TAB Medication Review History Med Rev Hx Medication Administration Report for Amundsen, Mark All administrations No administration data available Pharmacy Selected For Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 End 2/24/2006
2/24/2006
3/8/2006
2/18/2006
2/24/2006
2/24/2006
2/24/2006
3/8/2006
000070
Orders
Order Summary PAIN MANAGEMENT REFERRAL [100048 Custom] Order #: 9843189 MR PELVIS [RAD001 Custom] Order #: 10630675 Canceled Orders MR LOWER EXTREMITY JOINT WITH / WITHOUT CONTRAST [RAD001 Custom] Order #: 9843190
Immunizations
Visit Summary
Vitals Recorded in This Encounter 02/24/2006 0800 106.142 kg (234 lb) Weight: 76 Pulse: 14 Resp: 118/70 mmHg BP: 3 Pain Score: HIP Pain Loc: Medications Given (Excluding those documented in Imm/Injections Activity) No data found.

Encounter Vitals Row Name Enc Vitals BP Pulse Resp Weight Pain Score Pain Loc
02/24/06 0800
118/70 mmHg 76 14 106.142 kg (234 lb) 3 of 10 Hip
Progress Notes SYSTEM Signed Mark Amundsen is a 46yr year old male who is here for the following reason: Follow up on chonic hip pain. Wants to discuss medications. Pain present despite medications. Seen by ortho recently. Trying to stay active. Current outpatient prescriptions prior to 2/24/06: NORCO 10 MG-325 MG TAB, 1-2 po q 6 hours. Max 8 per day., Disp: 250, Rfl: 0 FLUOXETINE 40 MG CAP, take 1 capsule (40mg) by oral route once daily in the morning, Disp: 30, Rfl: 6 BACLOFEN 10 MG TAB, 1 PO TID PRN, Disp: 90, Rfl: 2 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET, 2 PACKETS DAILY, Disp: 300.00, Rfl: 3 DISCONTD: CYCLOBENZAPRINE 10 MG TAB, take 1 tablet (10mg) by oral route 2 times per day, Disp: 60, Rfl: 3 DISCONTD: KETOCONAZOLE 2 % TOPICAL CREAM, apply by topical route once daily to the affected area
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(s), Disp: 90G, Rfl: 1 DISCONTD: FENTANYL 25 MCG/HR 72 HR TRANSDERM PATCH, apply q 3 days., Disp: 10, Rfl: 0 DISCONTD: AMBIEN 10 MG TAB, 1 TABLET AT BEDTIME AS NEEDED, Disp: 10, Rfl: 0 DISCONTD: ALEVE 220 MG TAB, 1 TABLET EVERY 12 HOURS AS NEEDED, Disp: 60, Rfl: 0
OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Skin: Skin color, texture, turgor normal. No rashes or lesions. Musculoskeletal: stable ASSESSMENT: 726.5 ENTHESOPATHY OF HIP (primary encounter diagnosis) Note: Left hip. Chronic. Discussed at length various treatment options. Has exhausted most of the opiate options, failed Ultram and has gastritis with NSAIDs. Consider Glucosamine. Will refer to pain mgmt. Plan: PAIN MANAGEMENT REFERRAL, MR LOWER EXTREMITY JOINT WITH / WITHOUT CONTRAST Discussed with the patient and all questioned fully answered. He will call me if any problems arise. PLAN: See Orders. Follow up in office if not better. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his medical care. No guarantees were made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit.
Visit Notes RHODEWALT, TERI L 2/24/2006 7:54 am Vital signs taken, allergies verified, screened for pain, med hx taken Teri L Rhodewalt, MA Electronically signed by RHODEWALT, TERI L at 2/24/2006 7:54 am All Flowsheet Templates (all recorded) Encounter Vitals Flowsheet

Problem List
Noted Resolved
1/19/2006
000072
Orders Only
Patient Information
Closed Time 12:58

Provider Information
Date 2/13/2006 Provider H. David Moehring, MD Department Fol Internal Medicine
Medications Medications at Start of Encounter

Disp Refills 60 0 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 0 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 300.00 3 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 BACLOFEN 10 MG TAB (Taking) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 60 3 CYCLOBENZAPRINE 10 MG TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route 2 times per day - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1030339. 10 0 FENTANYL 25 MCG/HR TD PT72 Sig - Route: apply q 3 days. - Transdermal 30 6 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 90G 1 KETOCONAZOLE 2 % TOP CREA (Taking) Sig - Route: apply by topical route once daily to the affected area(s) - TOPICAL Class: Pharmacy 250 0 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Start End
12/8/2005
3/8/2006
1/19/2006
2/18/2006
1/3/2006
4/3/2006
7/15/2004 1/19/2006
9/14/2004
2/6/2006
3/8/2006
Medications the Patient Reported Taking

ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking/Discontinued) BACLOFEN 10 MG TAB (Taking/Discontinued) CYCLOBENZAPRINE 10 MG TAB (Taking/Discontinued) FLUOXETINE 40 MG CAP (Taking/Discontinued) KETOCONAZOLE 2 % TOP CREA (Taking/Discontinued) NORCO 10 MG-325 MG TAB (Taking/Discontinued)
000073
Address 2025 TARBOLTON CIR FOLSOM CA 95630 Selected Appointment 4/10/2006 9:46 AM
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Department Ucd Registration
Encounter-Level Documents: There are no encounter-level documents. Insurance Information Acct Number 038112613047 1 Payor AUSHC Patient Insurance ID W142637665 Group Number 620229011
Plan AETNA PPO
Financial Class P
Plan Number A06
Plan Phone 888-632-3862
Center None
Transcription
Transcription Type Pain Letter (2914) Electronically Signed Document Text March 28, 2006 RE: AMUNDSEN, MARK MR#: 8081369 DOB: 09/23/1959 Date of Service: 03/28/2006 ID 4289094 Date and Time 3/28/2006 5:16 PM
Mark Amundsen (MRN8081369) Author Jason M Miller
VICTOR HENRIQUE BAQUERO, MD 251 TURN PIKE DRIVE FOLSOM, CA 95630 Dear Dr. Baquero: It was a pleasure to see your patient, Mark R Amundsen, today in follow-up at the University of California, Davis Center for Pain Medicine. As you know, the patient is a 46-year-old male being
000074
evaluated today for left low lumbar pain and hip pain. The patient has been treated in our clinic before and responded favorably to the first left S1 transforaminal epidural steroid injection. However, subsequent procedures were unsuccessful in providing relief. The patient has also recently undergone consultation in the Spine Clinic and Orthopaedics. The patient states that his lumbar and hip pain radiates mostly down the posterior aspect proximal to the knee and also somewhat to the anterior aspect of the proximal one-third of his thigh. The majority of his radicular symptoms have resolved since his epidural steroid injection, however. The patient's pain started in 1992, and in 2003 he first sought treatment. The pain is present constantly (100% of the time). The patient describes the pain as pins and needles, sharp, shooting and cutting. The pain intensity is currently rated as a VAS of 3.5 anchored at 0 by "no pain" and at 10 by "the most severe pain imaginable". The average pain for the last week has been a VAS of 3/10. At its best, it is 3/10; and at its worst, 4.5/10. RELIEVING AND AGGRAVATING FACTORS Relieving factors for the patient's pain are lying down, medications, relaxation. The pain is aggravated by sitting. The pain is unchanged by standing, walking, exercise, thinking about something else, coughing/sneezing, urination, bowel movements. FUNCTIONAL LIMITATIONS: The patient has avoided driving. The patient can walk 15 blocks, sit for 10 minutes and stand for 1 hour before the pain limits this activity. The patient states that he is often forced to lie down because of pain. CURRENT MEDICATIONS: 1. Norco 10/325. He is taking approximately 8 per day. 2. Baclofen 10 mg 3 times a day. 3. Testosterone gel one packet per day. 4. Fluoxetine 40 mg one per day. 5. Naprosyn two tablets twice a day. 6. Occasional Tylenol use. FAILED PAIN MEDICATIONS: 1. Morphine sulfate causes itching. 2. Ibuprofen, welts. 3. Methadone, inability to concentrate, falling asleep, pain. 4. Fentanyl patch, patient was allergic to the patch material and "didn't work." 5. Patient has also tried MS Contin and he had itching reaction. 6. Soma and Flexeril worked for less than 24 hours. Patient denies use of OxyContin or oxycodone. ALLERGIES: 1. Morphine sulfate. 2. Ibuprofen. 3. Fentanyl. 4. Methadone. As described above. PREVIOUS TREATMENTS: Patient had a transforaminal epidural steroid injection in 2003 which provided near 100% relief of his radicular symptoms. Heat treatments
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were tried and produced moderate pain relief. Traction actually increased the pain, physical therapy and exercise were tried and produced no pain relief. PREVIOUS DIAGNOSTIC STUDIES: The patient has a lumbar MRI report, date of service 03/05/2004, which is generally an unremarkable MRI for his age. Also seen is a pelvis plain view which the report notes bilateral osteoarthritis, exam date 02/13/2006. Also of the lumbar spine, plain films, 02/13/2006, the report notes mild degenerative changes, disc space is preserved, mild osteophyte formation, facet joints unremarkable, sacroiliac joints appear normal. We do have more plain films, 2-view, with the pelvis, exam date 12/01/2003, which show mild bilateral osteoarthritis of the hips. The patient has a pending 04/21/2006 left hip MRI. REVIEW OF SYSTEMS: The patient admits to back pain, joint pain, muscle weakness. Constitutional Sx: no fevers, no unplanned weight loss Eyes: no double vision or blurred vision ENT: no loss of hearing, no difficulty swallowing Heme/Lymph: no bleeding gums or low platelet count Endocrine: no known thyroid disease or heat/cold intolerance Skin: no rashes or other lesions Respiratory: no shortness of breath, no wheezing Cardiovascular: no chest pain or palpitations GI: no constipation, abdominal pain, nausea/vomiting, diarrhea GU: no urinary retention, dysuria, sexual dysfunction Musculoskeletal: no muscle pain Neuro: no loss of consciousness, blackouts, memory loss, seizures, trouble walking, dizziness or fatigue Behavioral: no difficulty falling or remaining asleep, loss of interest in activities/hobbies, difficulty concentrating, feelings of guilt or depressed mood PRIOR MEDICAL HISTORY: The patient denies a prior history of high blood pressure, angina, asthma, stroke, cancer, diabetes, heart attack, chronic cough, psychological or psychiatric problems, seizures or epilepsy, kidney disease, liver disease, arthritis, or bleeding problems. ALL SURGERIES AND APPROXIMATE DATES: Tonsillectomy in 1965, inguinal hernia repair in 1986. complications.
Denies any
PSYCHOSOCIAL HISTORY: Educational Level: The patient's highest educational level achieved was high school graduate. Legal Issues: The patient does not have current claims for litigation related to his pain problem. Psychological Treatments: The patient has taken a grief course in 2003. The patient denies a present or past history of suicide ideation or attempt. Substance Abuse History: The patient denies a history of substance
000076
abuse of alcohol, amphetamines, heroin, cocaine, or other illicit substances. The patient quit a 30-pack-year history 14 years ago. Employment: The patient is currently employed part time. The patient's employment has been affected by the present pain condition. The patient's current occupation is as a systems and network administrator. FAMILY LIVING CIRCUMSTANCES: The patient is currently living with his children. FAMILY HISTORY: The patient denies all pertinent family history. PHYSICAL EXAMINATION: BP 138/91 Pulse 80 Resp 16 Weight 225 pounds O2 Sat 99% Temperature 98.8 Constitutional: Obese, normally developed, no deformities, well groomed. Skin: No lesions, new scars, bruising, or rashes noted. Eyes: Sclerae normal, pupils equal, and reactive with normal accommodation, extraocular movements intact. ENT: External inspection of ears and nose reveals no apparent abnormalities. Lungs: Chest expansion normal, clear to auscultation without wheezes or rales. Heart: Regular rate and rhythm normal S1, S2, no murmur, rub, gallop. Abdominal: Nontender to palpation, nondistended, no rebound tenderness. Musculoskeletal: Gait/station normal free, heel-toe walking, normal tandem gait, not antalgic. Psych: Oriented. Normal attention span and concentration. Neuro: DTRs symmetrical biceps 1+, brachioradialis 1+, triceps 1+, patellar 2+, ankle 2+, Babinski's are downgoing. Motor: Bulk normal, tone normal, abnormal movements none, strength 5/5 throughout the lower extremities. Sensory: Intact to light touch grossly. No allodynia elicited all dermatomes. Back: Active range of motion was generally full for forward flexion, extension and lateral flexion. There was no spinal tenderness, no paraspinal tenderness. In supine position, patient was evaluated for femoral or inguinal herniation but no masses were felt on either side. The patient's adductor compartment corresponding to gracilis versus rectus femoris was tender to deep palpation and reproduced a majority of this patient's primary complaint. Interestingly, continued pressure at this area provided relief to the patient associated with numbness and paresthesias down his left leg. Multiple provocations aimed at isolating hip arthritis were well tolerated, while external rotation and stretching of the adductor compartment was uncomfortable for the patient. Piriformis maneuvers were nonprovocative, as were adduction of the hip. Hip flexion, and especially hip flexion in external rotation, was poorly tolerated with the left leg, although the right leg was unaffected.
MEDICAL DECISION MAKING
000077
REVIEW OF OLD MEDICAL RECORDS: Imaging reports as detailed above. A Folsom clinic note dated 02/13/2006 from Dr. Moehring, notes that the patient does have low back and left posterior pelvic and thigh pain intermittently, and the patient remains dependent on NSAIDs and "fairly heavy doses of narcotics." Symptoms are left-sided sacroiliac pain with some radiation down the posterior thigh, occasionally below the knee, and is exacerbated by rotation of the hip. His medications were Prozac and Norco and Dr. Moehring notes that his allergies are more reflective of intolerance than true allergies. Examination of the left hip reveals absent internal rotation as well as mild limitation of external rotation, which is painful, and that he recommends that, as his symptoms have not greatly increased in severity, it is best that he exhaust medical options before embarking on total joint replacement, that it was possible the patient has an iliotibial band friction syndrome or some variant rather than a common degenerative joint disease, and that they are considering an MRI for his symptoms suggestive of labral tear impingement. A 02/13/2006 progress note states that the patient is on Norco 10/325, fluoxetine 40 mg caps daily, baclofen 10 mg t.i.d., AndroGel and fentanyl 25-mcg transdermal patch, Ambien and Aleve were all discontinued and that the assessment was enthesopathy of the hip. Also reviewed was our last procedure note from 04/29/2004 indicating that he had S1 transforaminal epidural steroid injection. Also reviewed were labs, including a testosterone level of 119.6, which is low, collection date 10/03/2003. ASSESSMENT AND DIFFERENTIAL DIAGNOSIS: 1. Left groin pain, unknown etiology. 2. Bilateral hip osteoarthritis. 3. Hypogonadism secondary to chronic opioid use. 4. Lumbar degenerative disc disease. 5. Lumbar radiculitis history. 6. Obesity. RISK OF COMORBIDITIES: At this juncture, we believe that the patient's constitutional status adds minimal additional risk and complexity to our overall proposed evaluation and treatment. The patient is not currently a candidate for procedural intervention, as more diagnostic studies need to be completed. RECOMMENDATIONS and/or TREATMENT PLAN: The patient is scheduled for an MR of the left hip joint on 04/21/2006. We gave the patient an MRI request to add the left pelvis, including the upper one-third of the proximal thigh, in order to more closely evaluate his adductor compartment, and to look for any tears or inflammatory process. The patient has been tried on multiple opioids in the past. He is currently taking 8 Norco a day, which suggest that a long-acting agent is probably necessary and more appropriate. It is unclear whether this patient's side effects are true allergies or just poor tolerability as starting doses are not known. Many times, a medication is better tolerated by starting with low doses and proceeding with a slow upward titration. For example, methadone
000078
causing problems with coordination, could be possibly be avoided with this low and slow approach. Methadone is a good medication, as it is long-acting, cheap, and thought to reduce neuropathic symptoms and hyperalgesia due to its NMDA antagonism. Thus, retrialing some of these medications might be appropriate. Oxycodone might not have been tried, thus OxyContin is another option that could be tried. We counseled the patient that physical therapy is likely going to be a mainstay in his treatment, as if our diagnostic suspicion is confirmed, there is no procedural intervention that would provide substantial relief to the patient. As we do not have a firm diagnosis however, a physical therapy referral was not generated. We will have the patient follow up in the clinic for further evaluation and treatment after the left hip and pelvis MRI studies are completed. The patient was instructed and educated on all aspects of the plan of care. The patient acknowledged the plan of care. Thank you for allowing us to participate in the care of your patient. Should you have any questions or concerns regarding the recommended care plan, please do not hesitate to contact us. Sincerely,
JASON M MILLER, MD CLINICAL FELLOW DEPARTMENT OF ANESTHESIOLOGY & PAIN MEDICINE THIS WAS ELECTRONICALLY SIGNED - 04/04/2006 1:31 AM PST BY:
THIS WAS ELECTRONICALLY SIGNED - 05/21/2006 10:32 PM PST BY: LANA WANIA-GALICIA, MD ATTENDING PHYSICIAN
JMM:kma(trs196) D: 03/28/2006 05:16 PM T: 03/29/2006 07:15 AM C#: 1728098 cc: JASON M MILLER, MD
Display only: Transcription (4289094) on 3/28/2006 5:16 PM by Jason M Miller Document history: Transcription (4289094) on 3/28/2006 5:16 PM by Jason M Miller
Appointment
Account # 038112613039
000079
Sex Male
DOB 9/23/1959
Account # 038112613054
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Payor AUSHC Patient Insurance ID W142637665 Group Number 620229011 Financial Class P
Plan AETNA PPO
Plan Number A06
Plan Phone 888-632-3862
Center None
Office Visit
Selected Appointment 5/1/2006 2:00 PM Provider Victor Baquero, MD, MD

Payor AUSHC
Financial Class P
000080
Patient Insurance ID W142637665 Group Number 620229011 Plan AETNA PPO Plan Number A06 Plan Address PO BOX 14089 LEXINGTON, KY 40512-4089 Plan Phone 888-632-3862 PreAuth Phone 800-840-2925
Diagnoses BACKACHE NOS - Primary LUMBAGO Reason for Visit Back Pain Level of Service OFFICE/OUTPT VISIT,EST,LEVL III [99213] LOS History Recorded x 4 days
724.5 724.2
Medications
Disp Refills Start 90 2 4/18/2006 BACLOFEN 10 MG TAB (Taking) Sig - Route: take 1 tablet oralley 3 times a day as needed - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1056944. 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 30 6 1/19/2006 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 250 0/0 3/24/2006 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 250 0 4/14/2006 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy End 5/18/2006
4/23/2006
5/1/2006
Ordered Medications Disp Refills Start End 20 0 5/1/2006 5/26/2006 TORADOL ORAL 10 MG TAB (Discontinued) take 1 tablet (10mg) by oral route every 4-6 hours as needed not to exceed 40mg per 24 hours - ORAL
000081
METHADONE 5 MG TAB (Discontinued) 1 po BID - ORAL SOMA 350 MG TAB (Discontinued) 1 po tid - ORAL NORCO 10 MG-325 MG TAB (Discontinued) 1-2 po q 6 hours. Max 8 per day. - ORAL Discontinued Medications
60 90 250
0 0 0
5/1/2006 5/1/2006 5/1/2006
5/26/2006 5/23/2006 5/23/2006
Reason for Discontinue NORCO 10 MG-325 MG TAB Medication Review History Med Rev Hx Medication Administration Report for Amundsen, Mark All administrations No administration data available Pharmacy Selected For Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630
Immunizations
Visit Summary
Vitals Recorded in This Encounter 05/01/2006 1400 101.424 kg (223 lb 9.6 oz) Weight: BP: ! 116/94 mmHg 6 Pain Score: BACK Pain Loc: Medications Given (Excluding those documented in Imm/Injections Activity) No data found.

Encounter Vitals Row Name Enc Vitals BP Weight Pain Score Pain Loc
05/01/06 1400 ! 116/94 mmHg 101.424 kg (223 lb 9.6 oz) 6 of 10 Back
Progress Notes SYSTEM Signed Mark Amundsen is a 46yr year old male who is here for the following reason: Woke up sat morning and pain was "through the roof". 2 days prior he mowed the lawn but he is not sure that that was the cause of the pain. Taking 10-12 norco daily, baclofen not helping. Reports that he is awaiting MRI ordered by pain clinic. Exercises daily - which helps. Some radiation along left posterior lateral thigh to knee. Weakness at times.
000082
OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Extremities: no cyanosis, clubbing, or edema. Skin: Skin color, texture, turgor normal. No rashes or lesions. Neuro: Gait normal. Reflexes normal and symmetric. Sensation and strength grossly normal. Normal quad and achilles reflexes - 2+ symmetric. Mental Status: mild dysthymia from chronic symptoms. ASSESSMENT: 724.5 BACKACHE NOS (primary encounter diagnosis) Note: Chronic lumbago with suspected left L4-5 radiculitis. Reviewed pain management note. Awating MRI results. Advanced osteo arthritis of left hip but also suspect nerve involvement. Continue physical therapy, will modify medications. Plan: TORADOL ORAL 10 MG TAB, METHADONE 5 MG TAB, SOMA 350 MG TAB Per patient methadone at 10 bid caused sedation and constipation. He admits that he thought it would work like the norco and he may have taken more when he was in pain. Risks and benefits discussed in detail. Take 1 every day and advance to bid. This will help for baseline pain. Continue norco for acute pain. Discontinue Baclofen. Soma trial instead. Discussed care and warning signs. Discussed with the patient and all questioned fully answered. He will call me if any problems arise. Will follow up with MRI in 2 weeks. 724.2 LUMBAGO Note: as above. Plan: NORCO 10 MG-325 MG TAB PLAN: See Orders. Follow up in office if not better. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his medical care. No guarantees were made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit. Visit Notes GROVES, SHERI L 5/1/2006 2:07 pm Vital signs taken, allergies verified, screened for pain, pharmacy varified, cc was taken. Sheri L Groves
Electronically signed by GROVES, SHERI L at 5/1/2006 2:07 pm

Problem List
000083
250 0/0 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 250 0 NORCO 10 MG-325 MG TAB (Taking/Disco ntinued) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy 0 250 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy 90 0 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy
5/23/2006
6/22/2006
2/6/2006
4/14/2006
5/23/2006
6/6/2006
5/23/2006
6/22/2006

Orders Chart Cosign

Accepted By Victor Baquero, MD Accepted On 6/1/2006 12:33 PM
Office Visit
Insurance Information Acct Number 078080963057 1 Payor AUSHC Patient Insurance ID W142637665 Group Number 620229011 Plan AETNA PPO Plan Number A06
Financial Class P
Plan Phone 888-632-3862
Diagnoses EPISTAXIS - Primary DEPRESSIVE DISORDER NEC ENTHESOPATHY OF HIP Reason for Visit Nose Problem Pain Level of Service OFFICE/OUTPT VISIT,EST,LEVL III bleeding med check
784.7 311 726.5
Has done well on Prozac in the past.
000084
TORADOL ORAL 10 MG TAB Medication Review History Med Rev Hx Medication Administration Report for Amundsen, Mark All administrations No administration data available Pharmacy Selected For Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630
Orders
Order Summary ENT CLINIC REFERRAL [100012 Custom] Order #: 11156574
Immunizations
Visit Summary
Vitals Recorded in This Encounter 05/26/2006 1430 98.884 kg (218 lb) Weight: 120/84 mmHg BP: 3 Pain Score: BACK Pain Loc: Medications Given (Excluding those documented in Imm/Injections Activity) No data found.

Encounter Vitals Row Name Enc Vitals BP Weight Pain Score Pain Loc 05/26/06 1430 120/84 mmHg 98.884 kg (218 lb) 3 of 10 Back
Progress Notes SYSTEM Signed Mark Amundsen is a 46yr year old male who is here for the following reason: 1. Recent nose bleeding. History of bilateral cautery. The left side is bleeding spontaneously. Lasts about 5 minutes. Some are lasting 30 minutes. No allergic rhinitis symptoms. Not on aspirin. Happening about 3 times a week spontaneously. Using vaseline and has tried Afrin with mixed results. 2. Regarding chronic hip pain. Has sampled through the gamut of NSAIDs, opiates and even muscle relaxants with out satisfactory relief. Reports that while on Prozac he does better. Believes he is beginning to experience poopout. Interested in other SSRI or SNRI. OBJECTIVE:
000085
General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Nose: Mild erythema, scab on left medial vomeral surface. Mental Status: Mild dysthymia. Musculoskeletal: deferred. ASSESSMENT: 784.7 EPISTAXIS (primary encounter diagnosis) Note: For nose bleeds, apply pressure to affected side for several minutes. If not resolving consider Afrin nasal spray or sudafed. Use vaseline bid to moisturize nares. If not resolving consider ENT referral for cautery. Plan: ENT CLINIC REFERRAL 311 DEPRESSIVE DISORDER Note: Has done well on Prozac in the past. Plan: CYMBALTA 30 MG CAP, CYMBALTA 60 MG CAP Will transition off prozac and try cymbalta for mood and pain. Discussed care and warning signs. Follow up in 3-4 weeks. 726.5 ENTHESOPATHY OF HIP Note: stable. Discussed alternative pain medications at length. None of the long acting opiates seem to help. He is currently doing better and plans to follow up with ortho next week. Dilaudid given for acute axacerbations. Discussed care and warning signs. Plan: DILAUDID 2 MG TAB PLAN: See Orders. Follow up in office if not better. Spent greater than 25 minutes face to face with patient, over half the time was spent counseling. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his medical care. No guarantees were made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit. Visit Notes GROVES, SHERI L 5/26/2006 2:26 pm Vital signs taken, allergies verified, screened for pain, pharmacy varified, cc was taken. Sheri L Groves

Problem List
000086
1/19/2006
MRI 2006 1. ADVANCED OSTEOARTHRITIS OF THE LEFT HIP. 2. GANGLION CYST ALONG THE INFEROMEDIAL ASPECT OF THE LEFT HIP. Status post total hip replacement. 12/2009
DEPRESSIVE DISORDER 5/26/2006

Encounter Closed By Closed By BAQUERO, VICTOR H Closed Date 05262006 Closed Time 17:08 Mark Amundsen (MRN8081369) Sex Male DOB 9/23/1959
Appointment
Account # 038112613039
Phone 916-509-0158 (Home) 916-983-4484 (Work) Provider Janice Marie Noort, NP
Payor AUSHC Patient Insurance ID W142637665 Group Number 620229011
Plan AETNA PPO
Plan Number A06
Plan Phone 888-632-3862
Center None
000087
Management Folsom
Appointment
Sex Male

DOB 9/23/1959
Account # 078080963065 Patient Demographics Address 2025 TARBOLTON CIR FOLSOM CA 95630 Selected Appointment 6/1/2006 1:18 PM Department Ucd Registration Phone 916-509-0158 (Home) 916-983-4484 (Work) E-mail Address mamundsen@sbcglobal.net
Plan AETNA PPO
Plan Number A06
Plan Phone 888-632-3862
Provider H. David Moehring, MD
Department Fol Orthopedics
Center None
Center None
Appointment
Sex Male

DOB 9/23/1959
000088
Account # 078080963065 Patient Demographics Address 2025 TARBOLTON CIR FOLSOM CA 95630 Selected Appointment 6/1/2006 1:45 PM Provider H. David Moehring, MD Department Fol Orthopedics Phone 916-509-0158 (Home) 916-983-4484 (Work) E-mail Address mamundsen@sbcglobal.net
Transcription Type Folsom Clinic Note (7721) Electronically Signed

Document Text
ID 4635661
Author H. David Moehring, MD
PATIENT: AMUNDSEN, MARK LOCATION: ORTFOL MR #: 8081369 SEX: M AGE: 46 DATE OF SERVICE: 06/01/2006 DOB: 09/23/1959 FOLSOM CLINIC NOTE SUBJECTIVE: Mark is back to discuss the results of his MRI. The latter showed extensive degenerative arthritis of the left hip, as well as cyst formation. Currently, he reports that his pain is only 3-4 or 5/10, but then states that the Vicodin is no longer working well. OBJECTIVE: Physical examination is unchanged from that recorded previously, except the patient seems to have more pain with any attempt at rotation of the left hip. He is neurovascularly intact. RADIOGRAPHS: DIAGNOSIS: MRI and radiographs are reviewed. Degenerative arthritis, left hip.
RECOMMENDATIONS: The patient is scheduled for another MRI for some reason. It would seem to me that the source of the discomfort is obvious, that being advanced degenerative arthritis revealed on his MRI, and subtly on his plain radiographs of the pelvis and hip. At any rate, he is quite young relatively speaking and, therefore, we want to make sure that he has exhausted medical treatment. Therefore, if his symptoms increase in severity or change in quality and he so desires, we will consider left hip replacement.
THIS WAS ELECTRONICALLY SIGNED - 06/02/2006 11:29 AM PST BY: DAVID MOEHRING, MD PROFESSOR PCN FOLSOM
000089
NETWORK ORTHOPAEDICS
HDM:dhs(usa124) D: 06/01/2006 02:46 PM T: 06/02/2006 06:13 AM C#: 1885294
Display only: Transcription (4635661) on 6/1/2006 2:46 PM by H. David Moehring, MD Document history: Transcription (4635661) on 6/1/2006 2:46 PM by H. David Moehring, MD Encounter-Level Documents: There are no encounter-level documents. Insurance Information Acct Number 078080963065 1 Payor AUSHC Patient Insurance ID W142637665 Group Number 620229011 Plan AETNA PPO Plan Number A06 Plan Address PO BOX 14089 LEXINGTON, KY 40512-4089 Plan Phone 888-632-3862 PreAuth Phone 800-840-2925 Financial Class P
Center None
Patient Information

DOB 9/23/1959 PATIENTPHONE 916-509-0158
Contacts
Telephone Encounter
5/31/2006 1:55 PM
000090
Weight: BP: Pain Score: Pain Loc:
06/06/2006 1430 96.208 kg (212 lb 1.6 oz) 120/80 mmHg 4 HIP
Medications Given (Excluding those documented in Imm/Injections Activity) No data found.

Encounter Vitals Row Name Enc Vitals BP Weight Pain Score Pain Loc
06/06/06 1430
120/80 mmHg 96.208 kg (212 lb 1.6 oz) 4 of 10 Hip
Progress Notes SYSTEM Signed Mark Amundsen is a 46yr year old male who is here for the following reason: Follow up on left hip pain. Saw Dr. Mooring and recommended hip replacement. Has questions on indication. Cymbalta has not been covered yet. Still having a hard time getting pain relief on oral medications. Has tried just about everything. OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Skin: Skin color, texture, turgor normal. No rashes or lesions. Musculoskeletal: unchanged. Mood: euthymic to dysthymic at times. ASSESSMENT: 726.5 ENTHESOPATHY OF HIP (primary encounter diagnosis) Note: discussed results, care, medications, non-surgical options, etc. Plan: will follow up with pain clinic for localized injections if these disorder not help follow up with ortho for hip raplacement. Continue current medications. When available start Cymbalta.
PLAN: See Orders. Follow up in office if not better. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his medical care. No guarantees were made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit.
Visit Notes GROVES, SHERI L 6/6/2006 2:39 pm Vital signs taken, allergies verified, screened for pain, pharmacy varified, cc was taken.
000091
FENTANYL; MORPHINE
Problem List
1/19/2006

Previous Visit 10/12/2006 3:17 PM Department Ucd Registration Encounter # 14784753
Office Visit

Insurance Information Acct Number 078080963107 1 Payor SELF Patient Insurance ID NA

Plan SELF PAY
Financial Class T
Plan Number 100
Diagnoses ENTHESOPATHY OF HIP - Primary BRACHIAL NEURITIS NOS DEPRESSIVE DISORDER NEC Reason for Visit Medication Follow Up Level of Service OFFICE/OUTPT VISIT,EST,LEVL IV needs new adjustment
726.5 723.4 311
Left cervical radiculopathy
000092
[99214] LOS History Recorded
Medications
Medications at Start of Encounter Disp Refills Start End 250 1 10/5/2006 11/4/2006 NORCO 10 MG-325 MG TAB Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 177788 90 0 10/5/2006 11/4/2006 SOMA 350 MG TAB Sig - Route: take 1 tabket 3 times a day - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1178084 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 1/19/2006 4/18/2006 BACLOFEN 10 MG TAB (Taking/Disco ntinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 7/19/2006 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 240 0 10/23/2006 11/22/2006 METHADONE 10 MG TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 1 9/18/2006 10/5/2006 250 NORCO 10 MG-325 MG TAB (Taking/Discontinued) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 0 9/20/2006 10/5/2006 SOMA 350 MG TAB (Taking/Disco ntinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 Ordered Medications Disp Refills Start 90 3 10/27/2006 SOMA 350 MG TAB (Discontinued) 1 po tid - ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176027 1 10/27/2006 300 NORCO 10 MG-325 MG TAB (Discontinued) 1-2 po q 6 hours. Max 8 per day. - ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Medication Review History Med Rev Hx End 11/16/2006
11/16/2006
000093
Medication Administration Report for Amundsen, Mark All administrations No administration data available Pharmacy Selected For Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630
Immunizations
Visit Summary
Vitals Recorded in This Encounter 10/27/2006 0915 98.068 kg (216 lb 3.2 oz) Weight: 72 Pulse: 10 Resp: 100/62 mmHg BP: 5 Pain Score: GENITALIA (S Pain Loc: Medications Given (Excluding those documented in Imm/Injections Activity) No data found.

Encounter Vitals Row Name Enc Vitals BP Pulse Resp Weight Pain Score Pain Loc 10/27/06 0915 100/62 mmHg 72 10 98.068 kg (216 lb 3.2 oz) 5 of 10 Genitalia (specify)
Progress Notes Victor Baquero, MD, MD 10/27/2006 9:40 AM Signed Mark Amundsen is a 47yr year old male who is here for the following reason: Increasing hip pain. Started working this week. Sits 90% of the time. There is some aggravation of hip pain with the increased activity with travel. BP 100/62 | Pulse 72 | Resp 10 | Wt 216 lbs 3.2 oz (98.1kg) OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Mental Status: euthymic. Musculoskeletal: left hip pain. Exam stable. Current outpatient prescriptions: METHADONE 10 MG TAB, 8 po daily FLUOXETINE 40 MG CAP, 1 po daily
000094
NORCO 10 MG-325 MG TAB, 10-14 daily SOMA 350 MG TAB, 1 po tid. ASSESSMENT: 726.5 ENTHESOPATHY OF HIP (primary encounter diagnosis) Note: end stage osteoarthritis. On chronic pain medications. Urged him to follow up with ortho to discuss hip replacement as he is on high doses of opiates and is still in pain. Affecting his life and functioning. Continue methadone for baseline. Norco as needed. Soma as needed for spasms. Discussed care and warning signs. Plan: ALEVE 220 MG TAB SOMA 350 MG TAB, NORCO 10 MG-325 MG TAB 723.4 BRACHIAL NEURITIS NOS Note: Left cervical radiculopathy - radiating to left arm. Plan: he mentioned this at the end of the visit. Suspects may be due to head positioning since he was "watching a lot of tv in bed" with his neck kinked lately. Discussed care and warning signs. Follow up if not better. 311 DEPRESSIVE DISORDER Note: improved. Plan: Discussed care and warning signs. The current medical regimen is effective; continue present plan and medications. Spent greater than 25 minutes face to face with patient, over half the time was spent counseling. PLAN: See Orders. Follow up in office if not better. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his medical care. No guarantees were made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit. Electronically signed by Victor Baquero, MD at 10/27/2006 6:01 PM Visit Notes GROVES, SHERI L 10/27/2006 9:18 am Vital signs taken, allergies verified, screened for pain, pharmacy varified, cc was taken. Sheri L Groves

Problem List
TESTICULAR HYPOFUNC NEC BRACHIAL NEURITIS NOS
000095
Account # 078199740024 Patient Demographics Address 2025 TARBOLTON CIR FOLSOM CA 95630 Selected Appointment 2/14/2007 8:47 AM Department Ucd Registration Phone 916-509-0158 (Home) 916-983-4484 (Work) E-mail Address mamundsen@sbcglobal.net
Plan UCD/B/S HMO
Financial Class P
Plan Number B72
Plan Phone 916-734-0739
Center None
Office Visit
Financial Class P
000096
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Diagnoses ENTHESOPATHY OF HIP STOMACH FUNCTION DIS NEC SCREENING-ENDOC/NUT/MET/IMMUN NEC Reason for Visit Medication Follow Up Other Level of Service OFFICE/OUTPT VISIT,EST,LEVL III [99213]
726.5 536.8 V77.99
note for work
Medications
Medications at Start of Encounter Disp Refills Start End 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 2 1/19/2006 4/18/2006 BACLOFEN 10 MG TAB (Discontinued) 90 Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 1/18/2007 8/18/2007 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 240 0 1/18/2007 2/6/2007 METHADONE 10 MG TAB (Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 240 0 2/9/2007 2/14/2007 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 300 1 2/9/2007 3/11/2007 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 2/9/2007 3/11/2007 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
000097
Discontinued Medications Reason for Discontinue METHADONE 10 MG TAB Medication Review History Med Rev Hx Medication Administration Report for Amundsen, Mark All administrations No administration data available Pharmacy Selected For Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630
Orders
Order Summary PAIN MANAGEMENT REFERRAL [100048 Custom] Order #: 15494746 Canceled Orders BLOOD COUNT [LABNO Custom] Order #: 15494558 SED RATE WESTERGREN [LABNO Custom] Order #: 15494559 ANTI-NUCLEAR AB (ANA) [LAB001 Custom] Order #: 15494560 RHEUMATOID FACTOR [LABNO Custom] Order #: 15494561 COMPREHENSIVE METABOLIC PANEL [LABNO Custom] Order #: 15494562 LIPID PANEL WITH DLDL REFLEX [LABNO Custom] Order #: 15494563 URINALYSIS-CHEM ONLY [LABNO Custom] Order #: 15494564 TSH WITH FREE T4 REFLEX [LABNO Custom] Order #: 15494565 PSA SCREEN [LABNO Custom] Order #: 15494566 CELIAC REFLEXIVE PANEL [LAB001 Custom] Order #: 15494567
Immunizations
Visit Summary
Vitals Recorded in This Encounter 02/14/2007 0845 97.659 kg (215 lb 4.8 oz) Weight: 70 Pulse: 10 Resp: 110/82 mmHg BP: 3 Pain Score: BACK Pain Loc: Medications Given (Excluding those documented in Imm/Injections Activity) No data found.

000098
Pulse Resp Weight Pain Score Pain Loc
70 10 97.659 kg (215 lb 4.8 oz) 3 of 10 Back
Progress Notes Victor Baquero, MD, MD 2/14/2007 9:15 AM Signed Mark Amundsen is a 47yr year old male who is here for the following reason: 1. Follow up on medications. Taking about 10 norco and 8-10 methadone daily. Pain controlled unless he overdoes it. No side effects on medications. 2. About 3 times he has had episodes of epigastric malaise, decreased appetite, some constipation, no nausea or vomiting, fever or chills. No melena. Not taking Aleve regularly. THen it resoleves. Current outpatient prescriptions: SOMA 350 MG TAB, 1 po tid, Disp: 90, Rfl: 3 NORCO 10 MG-325 MG TAB, 2 po q 4 hours. Max 10 per day., Disp: 300, Rfl: 1 FLUOXETINE 40 MG CAP, take 1 capsule (40mg) by oral route once daily in the morning, Disp: 30, Rfl: 6 ALEVE 220 MG TAB, take 1 tablet (220mg) by oral route every 12 hours as needed, Disp: , Rfl: 0 GLUCOSAMINE 1,000 MG TAB, , Disp: , Rfl: 0 METHADONE 10 MG TAB, Take 2 po every 6 hours (max 8 daily), Disp: 240, Rfl: 0 BP 110/82 | Pulse 70 | Resp 10 | Wt 215 lbs 4.8 oz (97.7kg) OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Skin: Skin color, texture, turgor normal. No rashes or lesions. Neuro: normal exam. Mental Status: Appearance/Cooperation: alert, oriented times 3 and well groomed and dressed Attitude: pleasant Behavior :normal Speech: normal volume, rate, and pitch Mood (pt's report) :euthymic Affect: full and appropriate Musculoskeletal: left hip exam unchanged. Still has limitations in range of motion and pain. Abdomen: BS normal. Abdomen soft, non-tender. No masses or organomegaly. ASSESSMENT: 726.5 ENTHESOPATHY OF HIP Note: current medication regimen effective. Discussed that he should try to lower the Norco dose, pain clinic referral initiated. Will follow up with ortho. Plan: SED RATE WESTERGREN, ANTI-NUCLEAR AB (ANA), RHEUMATOID FACTOR, PAIN MANAGEMENT REFERRAL Discussed care and warning signs. The current medical regimen is effective; continue present plan and medications. 536.8 STOMACH FUNCTION DIS NEC Note: non-specific suspect may be related to upper respiratory illness, viral syndromes vs gastritis vs possible IBS. Discussed care and warning signs. Check labs. Discussed with Mark and all questions and concerns were fully answered. He will call me or followup in the office if any problems arise. Plan: CELIAC REFLEXIVE PANEL V77.99 SCREENING-ENDOC/NUT/MET/IMMUN NEC
000099
Note: Plan: BLOOD COUNT, COMPREHENSIVE METABOLIC PANEL, LIPID PANEL WITH DLDL REFLEX, URINALYSIS-CHEM ONLY, TSH WITH FREE T4 REFLEX, PSA SCREEN PLAN: See Orders. Follow up in office if not better. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his medical care. No guarantees were made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit. Electronically signed by Victor Baquero, MD at 2/14/2007 12:46 PM Letters Letter Information BAQUERO, VICTOR H on 2/14/2007 Documentation: Work excuse - illness. Visit Notes GROVES, SHERI L 2/14/2007 8:57 am Vital signs taken, allergies verified, screened for pain, pharmacy varified, cc was taken. Sheri L Groves Electronically signed by GROVES, SHERI L at 2/14/2007 8:57 am All Flowsheet Templates (all recorded) Encounter Vitals Flowsheet Status Open Routing Information

Problem List
1/19/2006

000100
Plan UCD/B/S HMO
Financial Class P
Plan Number B72
Plan Phone 916-734-0739
Provider Xray0 Radfol
Department Fol Radiology
Center None
Center None
Office Visit
Insurance Information Acct Number 078199740040 1 Payor
Financial Class P
000101
UCD Patient Insurance ID XEHJ00044785 Group Number PH0010 Plan UCD/B/S HMO Plan Number B72 Plan Address PO BOX 179001 SACRAMENTO, CA 95817-9001 Plan Phone 916-734-0739 PreAuth Phone 916-734-0739
Diagnoses ADJUSTMENT DISORDER WITH ANXIETY - Primary ENTHESOPATHY OF HIP BACKACHE NOS BRACHIAL NEURITIS NOS Reason for Visit Medication Follow Up Level of Service OFFICE/OUTPT VISIT,EST,LEVL IV [99214] prozac
309.24 726.5 724.5 723.4
left C 6-7
Medications
Medications at Start of Encounter Disp Refills Start End 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 240 0 2/9/2007 2/14/2007 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 240 0 4/6/2007 4/20/2007 METHADONE 10 MG TAB (Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 300 1 3/29/2007 4/28/2007 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 3/22/2007 4/21/2007 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL
000102
Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 Ordered Medications Disp 30 CELEXA 40 MG TAB take 1 tablet (40mg) by oral route once daily - ORAL Discontinued Medications Reason for Discontinue METHADONE 10 MG TAB Medication Review History Med Rev Hx Medication Administration Report for Amundsen, Mark All administrations No administration data available Pharmacy Selected For Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Refills 2 Start 4/20/2007 End 6/20/2007
Orders
Order Summary PHYSICAL THERAPY REFERRAL [100063 Custom] Order #: 16827305 C-SPINE 2 OR 3 VIEWS [RAD001 Custom] Order #: 16830147 Canceled Orders C-SPINE COMPLETE [RAD001 Custom] Order #: 16827304
Immunizations
Visit Summary
Vitals Recorded in This Encounter 04/20/2007 0845 102.059 kg (225 lb) Weight: 68 Pulse: 12 Resp: 102/64 mmHg BP: 3 Pain Score: left Comments: HIP Pain Loc: Medications Given (Excluding those documented in Imm/Injections Activity) No data found.

000103
Pulse Resp Weight Pain Score Pain Loc
68 12 102.059 kg (225 lb) 3 of 10 left Hip
Progress Notes Victor Baquero, MD, MD 4/20/2007 9:23 AM Signed Mark Amundsen is a 47yr year old male who is here for the following reason: Follow up on medication. Socially not doing as well, because he got fired 2 weeks ago. Thinks the prozac is not working anymore. Reports more symptoms of not letting thing go. Has been on Prozac for 10 years. It seems to poop out every 3 years. Zoloft was not effective. Insurance did not cover Effexor. Patient Active Problem List: BACKACHE NOS [724.5] TESTICULAR HYPOFUNC NEC [257.2] BRACHIAL NEURITIS NOS [723.4] ENTHESOPATHY OF HIP [726.5] DEPRESSIVE DISORDER [311] Current outpatient prescriptions: METHADONE 10 MG TAB, Take 2 po every 6 hours (max 8 daily) NORCO 10 MG-325 MG TAB, 2 po q 4 hours. Max 10 per day. FLUOXETINE 40 MG CAP, take 1 capsule (40mg) by oral route once daily in the morning SOMA 350 MG TAB, 1 po tid ALEVE 220 MG TAB, take 1 tablet (220mg) by oral route every 12 hours as needed ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET, 2 PACKETS DAILY GLUCOSAMINE 1,000 MG TAB, BP 102/64 | Pulse 68 | Resp 12 | Wt 225 lbs (102.1kg) OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Eyes: conjunctivae and corneas clear. PERRL, EOM's intact. Fundi benign. Mental Status: Appearance/Cooperation: alert, oriented times 3 and well groomed and dressed Attitude: pleasant Behavior :normal Mood (pt's report) :ahedonia Affect: full and appropriate and flat Thought Process: logical and goal directed Musculoskeletal: stable. ASSESSMENT: 309.24 ADJUSTMENT DISORDER WITH ANXIETY (primary encounter diagnosis) Note: recent stressors. Decreased mood. Discussed care and treatment plan. Request follow up in 4 weeks. Encouraged counseling and exercise as well as stress management. Plan: CELEXA 40 MG TAB I've explained to him that drugs of the SSRI class can have side effects such as weight gain, sexual dysfunction, insomnia, headache, nausea. These medications are generally effective at alleviating symptoms of anxiety and/or depression. Let me know if significant side effects do occur. 726.5 ENTHESOPATHY OF HIP Note: The current medical regimen seems effective; continue present plan and medications. Requested he
000104
follow up with pain clinic - hoever he may be with out health insurance in a few days. Discussed medication use. He seems to go through the medication in less than the prescribed time. He will follow instrurctions on the bottle. Discussed care and warning signs. Discussed with Mark and all questions and concerns were fully answered. He will call me or followup in the office if any problems arise. Plan: METHADONE 10 MG TAB 724.5 BACKACHE NOS Note: as above. Plan: METHADONE 10 MG TAB 723.4 BRACHIAL NEURITIS NOS Note: left C 6-7 As above. Discussed physical therapy. Exercises. Pain management consult and ultimately spine clinic consult. Plan: PHYSICAL THERAPY REFERRAL Spent greater than 25 minutes face to face with patient, over half the time was spent counseling. PLAN: See Orders. Follow up in office if not better. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his/her medical care. No guarantees were made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit. Electronically signed by Victor Baquero, MD at 4/21/2007 2:32 PM Visit Notes GROVES, SHERI L 4/20/2007 8:48 am Vital signs taken, allergies verified, screened for pain, pharmacy varified, cc was taken. Sheri L Groves Electronically signed by GROVES, SHERI L at 4/20/2007 8:48 am All Flowsheet Templates (all recorded) Encounter Vitals Flowsheet

Problem List
Noted Resolved
1/19/2006
000105
Appointment
Sex Male

DOB 9/23/1959
Account # 078319305021 Patient Demographics Address 2025 TARBOLTON CIR FOLSOM CA 95630 Selected Appointment 2/19/2008 1:28 PM Provider Doctor Staff Department Ucd Registration Phone 916-509-0158 (Home) 916-983-4484 (Work) E-mail Address mamundsen@sbcglobal.net
Payor SELF Patient Insurance ID NA Plan SELF PAY Plan Number 100 Financial Class T
Center None
Office Visit
Insurance Information Acct Number 078319305021 1 Payor SELF Patient Insurance ID NA
000106
Plan SELF PAY
Plan Number 100
Diagnoses ENTHESOPATHY OF HIP REGION - Primary DEPRESSIVE DISORDER NEC Reason for Visit Medication Follow Up Level of Service OFFICE/OUTPT VISIT,EST,LEVL III [99213]
726.5 311
methadone, norco, soma, and prozac
Medications
Disp Refills Start 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 3 2/27/2006 300.00 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Discontinued) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Discontinued) Class: Historical Route: ORAL 300 0 1/10/2008 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 0 2/1/2008 300 METHADONE 10 MG TAB (Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 2/1/2008 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 2/1/2008 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 End
2/19/2008
2/19/2008
1/30/2008
2/19/2008
3/2/2008
3/2/2008
Ordered Medications EFFEXOR XR 75 MG 24 HR CAP 1 PO DAILY - ORAL Discontinued Medications Reason for Discontinue GLUCOSAMINE 1,000 MG TAB ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET METHADONE 10 MG TAB
Disp 30 Refills 0 Start 2/19/2008 End 3/20/2008
000107
Medication Review History Med Rev Hx Medication Administration Report for Amundsen, Mark All administrations No administration data available Pharmacy Selected For Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630
Immunizations
Visit Summary
Vitals Recorded in This Encounter 02/19/2008 1330 100.971 kg (222 lb 9.6 oz) Weight: 36.4 C (97.6 F) Temp: Tympanic Temp src: 72 Pulse: 12 Resp: 120/82 mmHg BP: 4 Pain Score: HIP Pain Loc: Medications Given (Excluding those documented in Imm/Injections Activity) No data found.

Encounter Vitals Row Name Enc Vitals BP Pulse Resp Temp Temp src Weight Pain Score Pain Loc Progress Notes 02/19/08 1330 120/82 mmHg 72 12 36.4 C (97.6 F) Tympanic 100.971 kg (222 lb 9.6 oz) 4 of 10 Hip
Victor Baquero, MD, MD 2/19/2008 2:01 PM Signed Chief Complaint Patient presents with Medication Follow Up methadone, norco, soma, and prozac
000108
Mark Amundsen is a 48yr year old male who is here for the following reason: Follow up on hip. Worse. Is able to pop his left hip in and out at times. Still has no insuracne coverage. He reports feeling excessive guilt, depressed mood, insomnia, impaired concentration for the last few months. Currently on Cymbalta for the past few weeks with minimal improvement. Cannot afford it. In the past has tried fluoxetine. Recent stressors include: no work, home, retationship, financial issues, chronic pain. He does not report mood lability. Review of Systems: Constitutional: negative.
History Substance Use Topics Tobacco Use: Alcohol Use: Patient Active Problem List Diagnoses BACKACHE NOS TESTICULAR HYPOFUNC NEC BRACHIAL NEURITIS NOS ENTHESOPATHY OF HIP DEPRESSIVE DISORDER Current outpatient prescriptions Medication NORCO 10 MG-325 MG TAB
Not on file Not on file
Code 724.5 257.2 723.4 726.5 311

Sig 2 po q 4 hours. Max 10 per day. 1 po tid Take 2 po every 6 hours (max 10 daily) take 1 tablet (220mg) by oral route every 12 hours as needed 2 PACKETS DAILY
SOMA 350 MG TAB METHADONE 10 MG TAB ALEVE 220 MG TAB

ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET GLUCOSAMINE 1,000 MG TAB
BP 120/82 | Pulse 72 | Temp (Src) 36.4 C (97.6 F) (Tympanic) | Resp 12 | Wt 100.971 kg (222 lb 9.6 oz) OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Skin: negative. Mental Status: dydthymic. No suicidal ideation. Blunted affect. Musculoskeletal: stable. Left hip pain. ASSESSMENT: 726.5 ADVANCED OSTEOARTHRITIS OF THE LEFT HIP (primary encounter diagnosis) Comment: end stage osteo arthritis of left hip. No insurance. Unable to pursue surgical options.
000109
Plan: The current medical regimen is effective; continue present plan and medications. Risks and benefits discussed in detail. 311 DEPRESSIVE DISORDER Comment: Discussed care and treatment plan. Request follow up in 3 weeks. Encouraged counseling and exercise as well as stress management. Plan: EFFEXOR XR 75 MG 24 HR CAP I've explained to him that drugs of the SSRI class can have side effects such as weight gain, sexual dysfunction, insomnia, headache, nausea. These medications are generally effective at alleviating symptoms of anxiety and/or depression. Let me know if significant side effects do occur. PLAN: See Orders. Discussed care and warning signs with Mark and all questions and concerns were fully answered. He will call or followup in the office if any problems arise. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his/her medical care. No guarantees were made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit.
Electronically signed by Victor Baquero, MD at 2/19/2008 5:42 PM Visit Notes CHERRY MENDOZA Tue Feb 19, 2008 1:42 PM Vitals taken, allergies verified, pharmacy verified, and pain assessed. Cherry Mendoza, MA Electronically signed by CHERRY MENDOZA at Tue Feb 19, 2008 1:42 PM All Flowsheet Templates (all recorded) Encounter Vitals Flowsheet

Problem List
TESTICULAR HYPOFUNC NEC BRACHIAL NEURITIS NOS ADVANCED OSTEOARTHRITIS OF THE LEFT HIP
1/19/2006
000110
DEPRESSIVE DISORDER
5/26/2006 4/30/2008

CHRONIC PAIN MEDICATION AGREEMENT
See letter April 30, 2008 February 4, 2010 - Comment: discussed gradual reduction of methadone. Plan: decrease by 5mg weekly.
Class: Acute Previous Visit 4/29/2008 10:52 AM Department Ucd Registration Encounter # 21634183
Office Visit
Insurance Information Acct Number 078319305047 1 Payor SELF Patient Insurance ID NA Plan SELF PAY
Financial Class T
Plan Number 100
Diagnoses ENTHESOPATHY OF HIP REGION BACKACHE UNSPECIFIED DEPRESSIVE DISORDER NEC Reason for Visit Medication Follow Up Level of Service OFFICE/OUTPT VISIT,EST,LEVL III [99213]
726.5 724.5 311
Medications
Medications at Start of Encounter Disp Refills 30 0 EFFEXOR XR 75 MG 24 HR CAP Sig - Route: 1 PO DAILY - ORAL Class: Pharmacy 300 0 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 75 0 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 0 ALEVE 220 MG TAB Start 2/19/2008 End 3/20/2008
2/21/2008 4/25/2008 10/27/2006
3/12/2008 5/2/2008
000111
Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 30 3 3/12/2008 EFFEXOR XR 150 MG 24 HR CAP (Discontinued) Sig - Route: 1 po daily - ORAL 0 1/10/2008 300 METHADONE 10 MG TAB (Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 4/23/2008 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 1 4/2/2008 300 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 4/4/2008 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 Ordered Medications Disp Refills Start 1 4/30/2008 100 NORCO 10 MG-325 MG TAB (Discontinued) 1 po q 4 hrs for pain. - ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176026 30 6 4/30/2008 FLUOXETINE 40 MG CAP take 1 capsule (40 mg) by oral route once daily in the morning - ORAL Discontinued Medications Reason for Discontinue EFFEXOR XR 150 MG 24 HR CAP NORCO 10 MG-325 MG TAB Medication Review History Med Rev Hx Medication Administration Report for Amundsen, Mark All administrations No administration data available Pharmacy Selected For Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630
4/30/2008
1/30/2008
5/13/2008 4/30/2008
5/4/2008
End 6/24/2008
10/30/2008
Immunizations
Visit Summary
Vitals Recorded in This Encounter 04/30/2008 1330 103.103 kg (227 lb 4.8 oz) Weight: 36.9 C (98.5 F) Temp: Tympanic Temp src: 68 Pulse: 12 Resp:
000112
BP: Pain Score: Comments: Pain Loc:
124/80 mmHg 4 Left hip HIP
Medications Given (Excluding those documented in Imm/Injections Activity) No data found.

Encounter Vitals Row Name Enc Vitals BP Pulse Resp Temp Temp src Weight Pain Score Pain Loc Progress Notes 04/30/08 1330 124/80 mmHg 68 12 36.9 C (98.5 F) Tympanic 103.103 kg (227 lb 4.8 oz) 4 of 10 Left hip Hip
Victor Baquero, MD, MD 4/30/2008 2:24 PM Signed Chief Complaint Patient presents with Medication Follow Up
Mark Amundsen is a 48yr year old male who is here for the following reason: Follow up on medications. Left hip is getting worse. Now almost clicks out of joint routinely. Feels more bone on bone rather than clicking. Pain has increased. Having side effects with the norco. Requests decreasing dose and increasing Methadone. Stopped effexor due to side effects. Restarted fluoxetine 1 week ago. Doing well. Review of Systems: Constitutional: negative. CV: negative. Resp: negative.
History Substance Use Topics Tobacco Use: Alcohol Use: Patient Active Problem List
000113
Diagnoses BACKACHE NOS TESTICULAR HYPOFUNC NEC BRACHIAL NEURITIS NOS ADVANCED OSTEOARTHRITIS OF THE LEFT HIP DEPRESSIVE DISORDER Current outpatient prescriptions Medication NORCO 10 MG-325 MG TAB FLUOXETINE 40 MG CAP METHADONE 10 MG TAB SOMA 350 MG TAB METHADONE 10 MG TAB
Code 724.5 257.2 723.4 726.5 311
ALEVE 220 MG TAB
Sig 1 po q 4 hrs for pain. take 1 capsule (40 mg) by oral route once daily in the morning Take 12 daily (120mg) 1 po tid Take 2 po every 6 hours (max 10 daily) take 1 tablet (220mg) by oral route every 12 hours as needed
BP 124/80 | Pulse 68 | Temp (Src) 36.9 C (98.5 F) (Tympanic) | Resp 12 | Wt 103.103 kg (227 lb 4.8 oz) OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Skin: Skin color, texture, turgor normal. No rashes or lesions. Mental Status: normal though process. Normal mood. Musculoskeletal: stable. ASSESSMENT: 726.5 ENTHESOPATHY OF HIP REGION Comment: ongoing. Progressive. Has no insurance. Unable to order tests or follow up with ortho until he is employed due to cost. Plan: METHADONE 10 MG TAB, NORCO 10 MG-325 MG TAB Increase methadone to 12-13 daily. Will use norco for as needed only. Filled out pain agreement. 724.5 BACKACHE UNSPECIFIED Comment: as above. Plan: METHADONE 10 MG TAB 311 DEPRESSIVE DISORDER Comment: The current medical regimen is effective; continue present plan and medications. Plan: FLUOXETINE 40 MG CAP Follow up in 1-2 months. Discussed care and warning signs with Mark and all questions and concerns were fully answered. He will call or followup in the office if any problems arise.
PLAN: See Orders. Discussed care and warning signs with Mark and all questions and concerns were fully
000114
answered. He will call or followup in the office if any problems arise. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his/her medical care. No guarantees were made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit.
Electronically signed by Victor Baquero, MD at 4/30/2008 2:24 PM Scan on 4/30/2008 by B Vicky Singh : CONTROLLED MED Letters Letter Information BAQUERO, VICTOR H on 4/30/2008 Documentation: CHRONIC PAIN MEDICATION AGREEMENT Visit Notes CHERRY MENDOZA Wed Apr 30, 2008 1:37 PM Vitals taken, allergies verified, pharmacy verified, and pain assessed. Cherry Mendoza, MA Electronically signed by CHERRY MENDOZA at Wed Apr 30, 2008 1:37 PM All Flowsheet Templates (all recorded) Encounter Vitals Flowsheet
Status Sent
Routing Information

Problem List
1/19/2006
DEPRESSIVE DISORDER 5/26/2006 4/30/2008

See letter April 30, 2008
000115
078438665024 1 Payor UCD Patient Insurance ID XEHJ00044785 Group Number PH0010 Plan UCD/B/S HMO Plan Number B72 Plan Address PO BOX 179001 SACRAMENTO, CA 95817-9001 Plan Phone 916-734-0739 PreAuth Phone 916-734-0739
Center None
Office Visit
Insurance Information Acct Number 078438665024 1 Payor UCD Patient Insurance ID XEHJ00044785 Group Number PH0010 Plan UCD/B/S HMO Plan Number B72
Financial Class P
Plan Phone 916-734-0739
Diagnoses Abdominal Pain, Other Specified Site - Primary Enthesopathy of Hip Region Reason for Visit Stomach Problem Hip Pain Reason For Visit History Recorded Level of Service OFFICE/OUTPT VISIT,EST,LEVL IV [99214]
789.09 726.5
no appetite, no BM, belch after eating and nausia X4days, H/A Handicap plaque
000116
Medications
Medications at Start of Encounter Disp Refills Start 100 1 12/12/2008 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 390 0 2/17/2009 METHADONE 10 MG TAB (Taking) Sig - Route: Take 12 daily (120mg) - ORAL 100 1 2/13/2009 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Medication Review History Med Rev Hx Medication Administration Report for Amundsen, Mark All administrations No administration data available Pharmacy Selected For Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 End 1/11/2009
3/17/2009 3/15/2009
Orders
Order Summary ABDOMEN 1 VIEW [RAD001 Custom] Order #: 36121436
Immunizations
Visit Summary
Vitals Recorded in This Encounter 02/18/2009 1545 98.294 kg (216 lb 11.2 oz) Weight: 36.3 C (97.3 F) Temp: Tympanic Temp src: 76 Pulse: 16 Resp: 106/84 mmHg BP: 3 Pain Score: left hip pn Comments: HIP Pain Loc: Medications Given (Excluding those documented in Imm/Injections Activity) No data found.
000117

Encounter Vitals Row Name Enc Vitals BP Pulse Resp Temp Temp src Weight Pain Score Pain Loc Progress Notes 02/18/09 1545 106/84 mmHg 76 16 36.3 C (97.3 F) Tympanic 98.294 kg (216 lb 11.2 oz) 3 of 10 left hip pn Hip
Victor Baquero, MD, MD 2/18/2009 4:41 PM Signed Chief Complaint Patient presents with Stomach Problem no appetite, no BM, belch after eating and nausia X4days, H/A Hip Pain Handicap plaque
Mark Amundsen is a 49yr year old male who is here for the following reason: 4 days with malaise. No appetite. Belching. Limited GI activity. Mild discomfort - dull constant epigastric pain. Tried activia a few days ago. Also reports having a massive headache the whole weekend which resolved today. Feeling better today. No vomiting. Normal urination. Maintaining hydration. No fever or chills. Has been taking NSAIDs daily as well his usual opiates for his hip pain. Review of Systems: Constitutional: negative. CV: negative. Resp: negative. GI: constipation.
History Substance Use Topics Tobacco Use: Alcohol Use: Patient Active Problem List Diagnoses BACKACHE NOS TESTICULAR HYPOFUNC NEC BRACHIAL NEURITIS NOS ADVANCED OSTEOARTHRITIS OF THE LEFT HIP DEPRESSIVE DISORDER CHRONIC PAIN MEDICATION AGREEMENT
Code 724.5 257.2 723.4 726.5 311 719.45
000118
Current outpatient prescriptions prior to encounter Medication Sig Dispense NORCO 10 MG-325 MG TAB 1 po q 4 hrs for pain. 100 METHADONE 10 MG TAB Take 12 daily (120mg) 390 ALEVE 220 MG TAB take 1 tablet (220mg) by oral route every 12 hours as needed
Refill 1 0 0
BP 106/84 | Pulse 76 | Temp (Src) 36.3 C (97.3 F) (Tympanic) | Resp 16 | Wt 98.294 kg (216 lb 11.2 oz) OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Abdomen: BS normal. Abdomen soft, sigmoid fullness which extends to ascending colon and mild fullness over cecal region. No guarding or rebound. No masses or organomegaly. Skin: Skin color, texture, turgor normal. No rashes or lesions. Gait: limping along. ASSESSMENT: 789.09 Abdominal Pain, Other Specified Site (primary encounter diagnosis) Comment: New problem. reviewed xrays with Mr. Amundsen - no acute findings. Consistent with constipation. Discussed care and warning signs with Mark and all questions and concerns were fully answered. He will call or followup in the office if any problems arise. Plan: ABDOMEN 1 VIEW Trial of over the counter medications. Fiber. 726.5 ADVANCED OSTEOARTHRITIS OF THE LEFT HIP Comment: reviewed films. DMV form filled out for temporary dissability. Has limited range of motion due to severe arthritis. Will follow up with ortho for total hip replacement. PLAN: See Orders. Discussed care and warning signs with Mark and all questions and concerns were fully answered. He will call or followup in the office if any problems arise. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his/her medical care. No guarantees were made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit.
Electronically signed by Victor Baquero, MD at 2/18/2009 8:25 PM Visit Notes ELIZABETH ESPINUEVA, MA Wed Feb 18, 2009 4:21 PM Patient roomed, chief complaint noted, allergies verified, blood pressure, pulse, respiration, and weight obtained, screened for pain, and pharmacy verified. Elizabeth Espinueva, M.A.
Electronically signed by ELIZABETH ESPINUEVA, MA at Wed Feb 18, 2009 4:21 PM
000119
5/21/2009 1:30 PM
Provider Department Gertrudes Perlas Montemayor, Fol Family Practice MD

Financial Class P
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Diagnoses Acute URI - Primary Diarrhea Reason for Visit Other Tired Nausea Level of Service OFFICE/OUTPT VISIT,EST,LEVL IV [99214]
465.9 787.91 needs work note/ out for 3days body ache x 3days x 3days
Medications
Disp Refills Start End 100 1 12/12/2008 1/11/2009 NORCO 10 MG-325 MG TAB Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 390 0 5/7/2009 6/4/2009 METHADONE 10 MG TAB (Taking) Sig - Route: Take 13 daily (130mg) - ORAL 100 1 4/27/2009 5/27/2009 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 100 1 4/27/2009 5/27/2009 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008
000120
Immunizations
Visit Summary
Vitals Recorded in This Encounter 05/21/2009 1331 92.534 kg (204 lb) Weight: 36.4 C (97.5 F) Temp: Tympanic Temp src: 89 Pulse: 12 Resp: 110/78 mmHg BP: sitting Orthostatic Position: right arm SITE: regular Cuff Size: 97 % SpO2: Medications Given (Excluding those documented in Imm/Injections Activity) No data found. Progress Notes
Gertrudes Perlas Montemayor, MD 5/21/2009 8:55 PM Signed SUBJECTIVE: Mark Amundsen is a 49yr old male. He is a patient of Dr. Baquero.
Issue 1: He complains of bodyaches, tiredness, nausea, diarrhea (5 stools per day) usually constipated due to methadone, fatigue. Symptoms have been present for 5 days. Symptoms are not worsening. Feeling better. He has tried sleeping with some improvement. Fever:Yes-not measured, now resolved Asthma history: no Sick contacts: no Issue 2: He complains of diarrhea that started 4 days ago. Symptoms are improving. Stool frequency: 5-10 per day Stool quality: watery. Blood in stool: no Nocturnal diarrhea:yes - 2 times this week. Associated abdominal pain:Yes-gas pain
000121
Fever or chills:yes - as above Recent travel or antibiotics:no Tried OTC medications:no Weight loss:yes - lost 10 lbs. Recent URI:yes - as above Recent sick exposures:no Family history of GI cancer or Inflammatory bowel disease:no
Patient Active Problem List Diagnoses BACKACHE NOS TESTICULAR HYPOFUNC NEC BRACHIAL NEURITIS NOS ADVANCED OSTEOARTHRITIS OF THE LEFT HIP DEPRESSIVE DISORDER CHRONIC PAIN MEDICATION AGREEMENT
Code 724.5 257.2 723.4 726.5 311 719.45
Allergies to medications: reviewed and updated Medications: reviewed and updated Social History History Substance Use Topics Tobacco Use: Alcohol Use:
Occasional cigar Twice a month
REVIEW OF SYSTEMS General: some tiredness (not able to work and needs a note), weight loss as above, decreased appetite. Head: no headaches, no dizziness or syncope. Lungs: no dyspnea. CV: no new exertional chest pain OBJECTIVE: BP 110/78 | Pulse 89 | Temp (Src) 36.4 C (97.5 F) (Tympanic) | Resp 12 | Wt 92.534 kg (204 lb) | SpO2 97% He appears well, in no apparent distress. Alert and oriented times three, pleasant and cooperative. Eyes: no conjunctivitis Ears: normal Nose: normal Oropharynx: benign Neck: supple no adenopathy Chest: clear, no wheeze, no rales Skin: no rash Abdomen: soft & nontender. No organomegaly, masses, guarding or rebound. Bowel sounds are normal. DATA: Detailed chart review was provided. Review was helpful in medical decision making.
000122
ASSESSMENT AND PLAN AS DISCUSSED WITH Mr. Amundsen: 465.9C Acute URI (primary encounter diagnosis) Comment: improving Plan: Discussed routine URI care with Mr. Amundsen and all questions and concerns were fully answered. He will call me or followup in the office if any problems arise. Recommend symptomatic therapy. May use acetaminophen as needed according to package directions. 787.91 Diarrhea Comment: improving Plan: Increase oral fluid intake. Discussed hydration. Use Imodium AD (available over-the-counter) as directed. Signs and symptoms of dehydration discussed. Go STAT to nearest hospital emergency department if high fever, dehydration, marked weakness, fainting, increased abdominal pain, blood in stool or vomiting occur. Follow up for stool studies if diarrhea persists. Routine medication risks, complications, and contraindications reviewed. Mr. Amundsen understands and accepts the medication(s). Call or return to clinic prn if these symptoms worsen or fail to improve as anticipated. Reviewed pertinent history with Mr. Amundsen: Past medical history: Yes Social history: Yes Family history: no I have updated any new information in EpicCare. Barriers to learning assessed: none. Mr. Amundsen verbalized understanding of teaching and instructions. No guarantees were made regarding medical care or treatment outcome. Counseling time about 5 minutes. Mr. Amundsen was seen and examined by GIGI MONTEMAYOR, M.D.
Previous Version Electronically signed by Gertrudes Perlas Montemayor, MD at 5/21/2009 8:55 PM Letters Letter Information MONTEMAYOR, GERTRUDES P on 5/21/2009 Documentation: work Visit Notes ANEEKA NALDOZA, MA Thu May 21, 2009 1:33 PM vitals signs taken, allergies verified, screened for pain, aneeka s. naldoza, MA BP 110/78 | Pulse 89 | Temp (Src) 36.4 C (97.5 F) (Tympanic) | Resp 12 | Wt 92.534 kg (204 lb) | SpO2 97% Electronically signed by ANEEKA NALDOZA, MA at Thu May 21, 2009 1:33 PM All Flowsheet Templates (all recorded) Amb Vitals Group Flowsheet Status Sent Routing Information

Patient Instructions
INFORMATION FOR MANAGEMENT OF VOMITING AT HOME
000123
Drink small amounts (1/4 cup) of clear fluid-gaterade or pedialyte, frequently (every 10-15 minutes) as tolerated. Avoid milk and solids until no vomiting for 12 hours. Then advance diet as tolerated. Please report to emergency room if develop dizziness, blood in vomit or passing out.
Problem List
1/19/2006
Class: Chronic DEPRESSIVE DISORDER 5/26/2006 4/30/2008

Class: Acute Encounter Closed By Closed By MONTEMAYOR, GERTRUDES P Closed Date 05212009 Closed Time 20:55 Mark Amundsen (MRN8081369) Sex Male DOB 9/23/1959
Appointment
000124
Patient Name Amundsen, Mark
Sex Male
DOB 9/23/1959
Account # 078438665057
Phone 916-509-0158 (Home) 916-983-4484 (Work) Provider Flabs Labfol
Department Fol Lab
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Center None
Office Visit
Insurance Information Acct Number 078438665057 1 Payor UCD Patient Insurance ID
Financial Class P
000125
XEHJ00044785 Group Number PH0010 Plan UCD/B/S HMO Plan Number B72 Plan Address PO BOX 179001 SACRAMENTO, CA 95817-9001 Plan Phone 916-734-0739 PreAuth Phone 916-734-0739
Diagnoses Diarrhea Colitis Reason for Visit Diarrhea Reason For Visit History Recorded Level of Service OFFICE/OUTPT VISIT,EST,LEVL IV [99214]
LOS History Recorded
787.91 558.9 off and on x's week, pt is feeling very "yucky"
Medications
Medications at Start of Encounter Disp Refills Start End 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 390 0 5/7/2009 6/4/2009 METHADONE 10 MG TAB (Taking) Sig - Route: Take 13 daily (130mg) - ORAL 100 1 4/27/2009 5/27/2009 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 100 1 4/27/2009 5/27/2009 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 Medication Review History Med Rev Hx Medication Administration Report for Amundsen, Mark All administrations No administration data available Pharmacy Selected For Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630
Orders
Order Summary POC OCCULT BLOOD FECES [LABNO Custom] Order #: 40076037 Canceled Orders BLOOD COUNT [LABNO Custom] Order #: 40063723 COMPREHENSIVE METABOLIC PANEL [LABNO Custom] Order #: 40063724
000126
SED RATE WESTERGREN [LABNO Custom] Order #: 40063725 C DIFFICILE TOXIN A & B EIA [LAB001 Custom] Order #: 40063719 CULTURE GASTROINTESTINAL, BACTI [LAB001 Custom] Order #: 40063721 CRYPTOSPORIDIUM/GIARDIA FA [LAB001 Custom] Order #: 40063722
Immunizations
Visit Summary
Vitals Recorded in This Encounter 05/26/2009 1509 92.08 kg (203 lb) Weight: 37.6 C (99.7 F) Temp: Tympanic Temp src: 80 Pulse: 124/78 mmHg BP: Medications Given (Excluding those documented in Imm/Injections Activity) No data found. Progress Notes
Victor Baquero, MD, MD 5/26/2009 8:50 PM Signed Chief Complaint Patient presents with Diarrhea off and on x's week, pt is feeling very "yucky"
Mark Amundsen is a 49yr year old male who is here for the following reason: Diarrhea for the past 8 days. Came in last week and had upper respiratory illness and early diarrhea symptoms. Has had a low grade temperature. Was better towards the end of last week but is worse now. Still on medications. Stools are watery, foul smelling, no blood. Cramping with associated discomfort. Limited appetite. No nausea or vomiting. Simple diet. 3 weeks ago was on amoxicillin for a tooth infection. Review of Systems: Constitutional: fatigue. CV: negative. Resp: negative. Musculoskeletal: negative.
History Substance Use Topics Tobacco Use: Alcohol Use: Patient Active Problem List Diagnoses BACKACHE NOS TESTICULAR HYPOFUNC NEC
Code 724.5 257.2
000127
BRACHIAL NEURITIS NOS ADVANCED OSTEOARTHRITIS OF THE LEFT HIP DEPRESSIVE DISORDER CHRONIC PAIN MEDICATION AGREEMENT
723.4 726.5 311 719.45 Dispense 390 100 100 Refill 0 1 1 0
Current outpatient prescriptions prior to encounter Medication Sig METHADONE 10 MG TAB Take 13 daily (130mg) SOMA 350 MG TAB 1 po tid NORCO 10 MG-325 MG TAB 1 po q 4 hrs for pain. ALEVE 220 MG TAB take 1 tablet (220mg) by oral route every 12 hours as needed
BP 124/78 | Pulse 80 | Temp (Src) 37.6 C (99.7 F) (Tympanic) | Wt 92.08 kg (203 lb) OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Heart: normal rate and regular rhythm, no murmurs, clicks, or gallops. Lungs: clear to auscultation. Abdomen: BS normal to hyperactive. Abdomen soft, mild sensitivity along left lower quadrant. No guarding or rebound. No peritoneal signs. No masses or organomegaly. Skin: Skin color, texture, turgor normal. No rashes or lesions. Rectal: deferred. ASSESSMENT: 787.91 Diarrhea Comment: New problem. Suspect possible C. Diff. See orders. Discussed fluids and electrolyte replacement. Will order labs to eplore the possibility of colitis. I have recommended Pedialyte, Gatorade, soups, water, BRAT diet and to advance diet as tolerated. He is to return to the office if symptoms persist or worsen; I have alerted him to call if the following symptoms develop: High fever, dehydration, marked weakness, fainting, increased abdominal pain, blood in stool or vomit. Contact precautions discussed. Plan: C DIFFICILE TOXIN A & B EIA, CULTURE GASTROINTESTINAL, BACTI, CRYPTOSPORIDIUM/GIARDIA FA, BLOOD COUNT, COMPREHENSIVE METABOLIC PANEL, SED RATE WESTERGREN 558.9U Colitis Comment: as above. Plan: C DIFFICILE TOXIN A & B EIA, CULTURE GASTROINTESTINAL, BACTI, CRYPTOSPORIDIUM/GIARDIA FA, BLOOD COUNT, COMPREHENSIVE METABOLIC PANEL, SED RATE WESTERGREN PLAN: See Orders. Discussed care and warning signs with Mark and all questions and concerns were fully answered. He will call or followup in the office if any problems arise. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his/her medical care. No guarantees were
000128
made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit.
Previous Version Electronically signed by Victor Baquero, MD at 5/26/2009 8:50 PM Visit Notes MANDY CHILSON Tue May 26, 2009 3:00 PM CC and vitals were taken, allergies and pharmacy verified, and screening for pain completed. Mandy Chilson, MA Electronically signed by MANDY CHILSON at Tue May 26, 2009 3:00 PM All Flowsheet Templates (all recorded) Amb Vitals Group Flowsheet

Problem List
1/19/2006

Class: Acute Encounter Closed By Closed By BAQUERO, VICTOR H Closed Date 05262009 Closed Time 20:50 Mark Amundsen (MRN 8081369)
Office Visit
Selected Appointment
000129
Office Visit


Financial Class P
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Diagnoses Enthesopathy of Hip Region - Primary Reason for Visit Hip Problem Refill Request Level of Service OFFICE/OUTPT VISIT,EST,LEVL III [99213]
726.5
Medications
Medications at Start of Encounter Disp Refills Start End 42 0 5/28/2009 6/11/2009 Metronidazole (FLAGYL) 500 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth 3 times daily. No alcohol - ORAL Class: Pharmacy 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 100 1 6/23/2009 7/23/2009 Carisoprodol (SOMA) 350 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 1 7/28/2009 8/27/2009 Hydrocodone 10 mg/Acetaminophen 325 100 mg (NORCO) 10-325 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth every 4 hours if needed for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026
000130
390 0 7/23/2009 Methadone (DOLOPHINE) 10 mg PO Tablet (Discontinued) Sig - Route: Take 13 Tabs by mouth every day. - ORAL 100 1 4/27/2009 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Ordered Medications Methadone (DOLOPHINE) 10 mg PO Tablet (Discontinued) Take 13 Tabs by mouth every day. - ORAL Discontinued Medications Reason for Discontinue Methadone (DOLOPHINE) 10 mg PO Tablet Medication Review History Med Rev Hx Medication Administration Report for Amundsen, Mark All administrations No administration data available Pharmacy Selected For Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Disp 390 Refills 0 Start 8/20/2009
8/20/2009
5/27/2009
End 9/15/2009
Orders
Order Summary ORTHOPEDIC-GENERAL REFERRAL [100042 Custom] Order #: 43512022
Immunizations
Visit Summary
Vitals Recorded in This Encounter 08/20/2009 0814 93.441 kg (206 lb) Weight: 36.6 C (97.9 F) Temp: Tympanic Temp src: 74 Pulse: 10 Resp: 122/80 mmHg BP: sitting Orthostatic Position: right arm SITE: regular Cuff Size: 5 Pain Score: HIP Pain Loc: left Comments: 99 % SpO2:
000131
Medications Given (Excluding those documented in Imm/Injections Activity) No data found. Progress Notes
Victor Baquero, MD, MD 8/20/2009 1:36 PM Signed Chief Complaint Patient presents with Hip Problem Refill Request
Subjective: Mark Amundsen is a 49yr year old male who is here for the following reason: Increased hip pain. "something happened about 2-3 weeks ago". Sharp twinges of pain. Requesting evaluation with ortho. Review of Systems: Constitutional: negative.
History Substance Use Topics Tobacco Use: Alcohol Use: Patient Active Problem List Diagnoses BACKACHE NOS TESTICULAR HYPOFUNC NEC BRACHIAL NEURITIS NOS ADVANCED OSTEOARTHRITIS OF THE LEFT HIP DEPRESSIVE DISORDER CHRONIC PAIN MEDICATION AGREEMENT C. Difficile Diarrhea
Code 724.5 257.2 723.4 726.5 311 719.45 008.45AL
Current outpatient prescriptions prior to encounter Medication Sig Dispense Hydrocodone 10 Take 1 Tab by mouth 100 mg/Acetaminophen 325 mg every 4 hours if (NORCO) 10-325 mg PO Tablet needed for pain. ALEVE 220 MG TAB take 1 tablet (220mg) by oral route every 12 hours as needed
Refill 1 0
BP 122/80 | Pulse 74 | Temp (Src) 36.6 C (97.9 F) (Tympanic) | Resp 10 | Wt 93.441 kg (206 lb) | SpO2 99% OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Mental Status: euthymic. Musculoskeletal: stable. ASSESSMENT: 726.5 ADVANCED OSTEOARTHRITIS OF THE LEFT HIP (primary encounter diagnosis)
000132
Comment: follow up with ortho. The current medical regimen is effective; continue present plan and medications. Plan: ORTHOPEDIC-GENERAL REFERRAL PLAN: See Orders. Discussed care and warning signs with Mark and all questions and concerns were fully answered. He will call or followup in the office if any problems arise. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his/her medical care. No guarantees were made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit.
Previous Version Electronically signed by Victor Baquero, MD at 8/20/2009 1:36 PM Visit Notes ANEEKA NALDOZA, MA Thu Aug 20, 2009 8:16 AM vitals signs taken, allergies verified, screened for pain, aneeka s. naldoza, MA BP 122/80 | Pulse 74 | Temp (Src) 36.6 C (97.9 F) (Tympanic) | Resp 10 | Wt 93.441 kg (206 lb) | SpO2 99% Electronically signed by ANEEKA NALDOZA, MA at Thu Aug 20, 2009 8:16 AM All Flowsheet Templates (all recorded) Amb Vitals Group Flowsheet

Problem List
Noted Resolved
1/19/2006
Class: Chronic DEPRESSIVE DISORDER 5/26/2006
000133

CHRONIC PAIN MEDICATION AGREEMENT 4/30/2008
Class: Acute C. Difficile Diarrhea 5/29/2009
May 29, 2009 - treated with Metronidazole.

Orders Only
Patient Information
Closed Time 13:36

Date 8/18/2009 Provider Robert Michael Tamurian, MD Department Ortho Clinic Acc

Disp Refills Start 42 0 5/28/2009 Metronidazole (FLAGYL) 500 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth 3 times daily. No alcohol - ORAL Class: Pharmacy 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 100 1 6/23/2009 Carisoprodol (SOMA) 350 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 100 1 7/28/2009 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth every 4 hours if needed for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 390 0 7/23/2009 Methadone (DOLOPHINE) 10 mg PO Tablet (Taking) Sig - Route: Take 13 Tabs by mouth every day. - ORAL 100 1 4/27/2009 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 End 6/11/2009
7/23/2009
8/27/2009
8/20/2009
5/27/2009

Metronidazole (FLAGYL) 500 mg PO Tablet (Taking) Carisoprodol (SOMA) 350 mg PO Tablet (Taking/Discontinued) Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet (Taking/Discontinued) Methadone (DOLOPHINE) 10 mg PO Tablet (Taking/Discontinued) NORCO 10 MG-325 MG TAB (Taking/Discontinued)

Ordered On
000134
Stroke Family Status Relation Mother Father
Father Status Deceased Alive
88
Employment History Occupation network administrator Comment: currently unemployed
Employer
Problem List
1/19/2006

Class: Acute C. Difficile Diarrhea 5/29/2009 Mark Amundsen (MRN 8081369) Provider Robert Michael Tamurian, MD Department Ortho Clinic Acc
Office Visit
Selected Appointment 12/14/2009 1:30 PM
Insurance Information Acct Number 038541463121 1 Payor UCD Patient Insurance ID XEHJ00044785 Group Number
Financial Class P
000135
PH0010
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Diagnoses Enthesopathy of Hip Region - Primary Reason for Visit Follow Up With Specialist
726.5
Medications
Medications at Start of Encounter Disp Refills Start End 1 11/2/2009 12/2/2009 Carisoprodol (SOMA) 350 mg PO Tablet 100 Tab Sig - Route: Take 1 Tab by mouth every 8 hours if needed for muscle spasm. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 1 11/2/2009 12/2/2009 Hydrocodone 10 mg/Acetaminophen 325 100 Tab mg (NORCO) 10-325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 hours if needed for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 0 10/27/2006 12/15/2009 ALEVE 220 MG TAB (Discontinued) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 390 Tab 0 12/2/2009 12/30/2009 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 13 Tabs by mouth every day. - ORAL Number of times this order has been changed since signing: 1 Order Audit Trail Medication Review History Med Rev Hx Medication Administration Report for Amundsen, Mark All administrations No administration data available Pharmacy Selected For Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630
Immunizations
Visit Summary
Vitals Recorded in This Encounter 12/14/2009 1352 99.338 kg (219 lb) Weight:
000136
Height: BMI: BSA: Temp: Temp src: Pulse: Resp: BP: Orthostatic Position: SITE: Cuff Size: Pain Score: Pain Loc: Comments:
1.854 m (6' 1") 29 2.26 m2 36.8 C (98.3 F) Tympanic 76 18 142/80 mmHg sitting left arm regular 2 HIP left
Medications Given (Excluding those documented in Imm/Injections Activity) No data found. LMP / OB Status - Last Recorded BMI 28.89 kg/m2 Progress Notes
Jonathan G Eastman, MD, MD 12/14/2009 5:48 PM Signed CC: Left hip pain
HPI: Mark Amundsen is a 50 yr old male has been experiencing a 6month history of insidious onset left hip severe pain. Mark Amundsen describes a dull aching pain with occasional mechanical symptoms that are exacerbated by weight bearing activities and activities of daily living. They rate their pain as 10 out of 10. There has been no improvement with conservative management and radiographic data indicated degenerative joint disease. Mark Amundsen presents for evaluation and management of their joint disease. PMH: has no past medical history on file.depression, chronic pain PSH: Inguinal hernia repair
Allergies: Allergies as of 09/16/2009 - reviewed 09/16/2009 Allergen Reaction Morphine Hives Fentanyl Noted 07/15/2004 05/01/2006
Family History: family history is not on file. Social History: Prior tobacco and alcohol use. Denies illicit drug use. ROS: 14 system review was completed and was negative except as noted in the HPI. Vital Signs:Temp: 36.8 C (98.3 F) (12/14 1352) Temp src: Tympanic (12/14 1352) Pulse: 76 (12/14 1352) BP: 142/80 mmHg (12/14 1352) Resp: 18 (12/14 1352)
000137
SpO2: -Height: 1.854 m (6' 1") (12/14 1352) Wt - Scale: 99.338 kg (219 lb) (12/14 1352) General: AAOX3, No acute distress, normal affect and disposition HEENT: Normocephalic, Extraocular movements intact. Lungs are clear to auscultation bilaterally Heart is regular rate and rhythym. Focused examination of the Left lower extremity was performed. Full hip, knee, and ankle ROM was present. There was no regional adenopathy detected nor any skin changes present. The hip revealed negative flexion contracture and positive severe pain at the extremes of motion was encountered. Knee exam revealed negative crepitus, negative joint line tenderenss and 0 effusion. The ligamentous exam revealed negative pseudolaxity. Foot alinment was wnl. Distal neurovascular exam was normal with 5/5 motor and intact sensation within the autogenous zones of the femoral, sciatic, deep and superficial peroneal, and tibial nerves. DTR's were 2+ and posterior tibial and dorsalis pedis peripheral pulses were 2+. Evaluation of Gait revealed a positive trendelenburg sign/gait and an antalgic gait was observed. Radiographic Data: Bilateral weight bearing x-rays of the Left Hip reveal severe degenerative joint disease. Assessment: Mark Amundsen is a 50yr old male with severe degenerative joint disease of the Lefthip . We discussed the options for treating arthritis including medical management, physiotherapy, injection, and surgery. Given that Mark Amundsen has exhausted conservative management, I recommend Total Joint Arthroplasty of the Lefthip . He is scheduled for this on 12/15/2009. All of the patient's questions and concerns were answered and addressed and he is amenable with the treatment plan. Informed consent was obtained. We will plan on doing a metal on metal construct. He will be enrolled in the Arixtra study postoperatively for DVT prophylaxis.
Electronically signed by Jonathan G Eastman, MD at 12/14/2009 5:48 PM
Robert Michael Tamurian, MD 12/15/2009 5:56 AM Signed Mark Amundsen is a 50yr old male was counseled today regarding risks and benefits of total hip arthroplasty including but not exclusive to: wear, loosening, infection, stiffness, dislocation,leg length discrepancy, persistent pain, prosthetic clicking or squeaking, periprosthetic fracture,dvt,pe,medical and/or cardiac perioperative complications, death, need for revision surgery and she elected to proceed. Pre-op eval, H&P, informed consent completed today. This patient was seen, evaluated, and care plan was developed with the resident on day of service, 12/14/2009. I agree with the assessment and plan as outlined in the resident's note. Report electronically signed by: Robert M. Tamurian, MD Physician ID # 10884, Pager 3059 Attending Physician Assistant Professor Chief, Orthopaedic Oncology Service Deparment of Orthopaedic Surgery University of California, Davis Health System
000138
Electronically signed by Robert Michael Tamurian, MD at 12/15/2009 5:56 AM Visit Notes ROSEMARY BRIXIE, RN Mon Dec 14, 2009 2:31 PM PREOPERATIVE INSTRUCTIONS AND INFORMATION FOR ADULTS
INSTRUCTIONS FOR DAY OF SURGERY/PROCEDURE: Remember to follow the Fasting (NPO) Guidelines (see below). Arrange for someone else to transport you home after your surgery/procedure. Your surgery/procedure will be cancelled if you have not arranged for someone else to bring you home. Do not smoke or drink alcohol. Take a bath or shower on the morning of your surgery/procedure. DO NOT apply cosmetics, creams or lotion after bathing. DO NOT bring valuables or jewelry (including your wedding ring) with you on the day of surgery/procedure. Wear comfortable clothing that either zips or buttons in front. Bring your UC Davis blue card or some form of ID with you. Bring your CPAP machine for sleep apnea if you use one.
FASTING (NPO) GUIDELINES FOR ADULTS NO solid food, dairy products, chewing gum, juice with pulp (e.g. Orange Juice) after midnight. On the Morning of Surgery/Procedure: You may drink clear liquids until 2 hours prior to the time of arrival. Clear liquids include water, clear fruit juice (no pulp), carbonated beverages, and black coffee or tea without cream or milk. Do not drink any alcohol containing beverages. Take only these medications with a sip of water on the morning of surgery: As instructed by MD CONTACT INFORMATION: You will receive a phone call between 2-5 p.m. for the Same Day Surgery Center, or 12 noon-6 p.m. for the Main Operating Room (OR) on the work-day before your surgery/procedure date to confirm the time of check-in and location for your surgery/procedure.
000139
For questions, regarding the time of your surgery/procedure please call: (916) 734-8973 for Main Hospital, (916) 703-5299 or (916) 703-5300 for Same Day Surgery Center. For general questions or concerns, or if you havent heard from the operating room, please call or page your clinic manager or nurse manager at: 916-734-2700 CHECK-IN LOCATIONS FOR DAY OF SURGERY Main Hospital Surgery at 2315 Stockton Blvd., Sacramento, CA 95817 You will have been told to check-in to either: Tower One (Pre Op Surgery Registration) Room 1670 Main OR One (University Surgery Center) Room 1322A Park in Parking Structure #1 (corner of Colonial Way and Stockton Blvd). Cost is $1.50 per day when validated. Same Day Surgery Center 4845 2nd Avenue, Sacramento, CA 95817 Park in Parking Structure #2 (corner of 49th and Y Streets) next to the Lawrence Ellison Ambulatory Care Center. Cost is $1.50 per day when validated. Electronically signed by ROSEMARY BRIXIE, RN at Mon Dec 14, 2009 2:31 PM VIN PLOYNGAM, LVN Mon Dec 14, 2009 1:52 PM Pt roomed, Vital signs taken, medication, allergys, pain score and pharmacy reviewed Vin Ployngam LVN
Electronically signed by VIN PLOYNGAM, LVN at Mon Dec 14, 2009 1:52 PM
All Flowsheet Templates (all recorded) Amb Vitals Group Flowsheet

Problem List
Noted Resolved
1/19/2006
000140



Encounter Closed By Closed By TAMURIAN, ROBERT
Orders Only
Patient Information
Closed Time 05:56

Date 12/10/2009 Provider Robert Michael Tamurian, MD Department Ortho Clinic Acc

Disp Refills Start 100 Tab 1 11/2/2009 Carisoprodol (SOMA) 350 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 8 hours if needed for muscle spasm. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 100 Tab 1 11/2/2009 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 hours if needed for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 0 10/27/2006 ALEVE 220 MG TAB (Discontinued) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 390 Tab 0 12/2/2009 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 13 Tabs by mouth every day. - ORAL Number of times this order has been changed since signing: 1 Order Audit Trail End 12/2/2009
12/2/2009
12/15/2009
12/30/2009

CHEST 2 VIEWS (47978712) Ordered On 12/10/2009
Encounter Closed By
Closed By BRIXIE, ROSEMARY Closed Date 12102009 Closed Time 08:06
Appointment
Patient Information
000141
Address 2025 TARBOLTON CIR FOLSOM CA 95630 Selected Appointment 1/6/2010 11:30 AM
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Provider Robert Michael Tamurian, MD
Department Ortho Clinic Acc
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Center None
Transcription
Transcription Type Orthopaedics Clinic Note (2721) Electronically Signed Document Text PATIENT: AMUNDSEN, MARK LOCATION: ORTHO MR #: 8081369 SEX: M AGE: 50 DATE OF SERVICE: 01/04/2010 DOB: 09/23/1959 ORTHOPAEDICS CLINIC NOTE SURGERY PERFORMED: ID 10977090 Date and Time 1/4/2010 6:16 PM
Mark Amundsen (MRN8081369) Author Tyler J Nathe, MD
Left total hip arthroplasty on 12/15/09.
SUBJECTIVE: Mr. Amundsen is doing well. He has been home. He is slowly increasing his mobility and his gait. He uses a front-wheel walker at home and a single-point cane when he is out and about. He denies any shortness of breath, fevers, chills, or drainage from the wound. He does endorse mild fatigue and of ntoe, he was readmitted postoperatively for anemia and a transfusion.
000142
OBJECTIVE: On exam today his thigh and leg are soft without evidence of DVT. His incision is completely healed without drainage or erythema and he has intact quad and ankle dorsiflxion and ankle plantar flexion muscles intact. ASSESSMENT: Two weeks after left total hip arthroplasty.
PLAN: We will remove his staples in clinic today. We will have the patient follow up in two months' time at which point, we will repeat the radiographs of the AP pelvis and lateral to left hip. He is to gradually continue to increase his activity. He is part of the Arixtra Trial as his DVT prophylaxis. The patient was seen and evaluated with Dr. Tamurian.
THIS WAS ELECTRONICALLY SIGNED - 01/14/2010 3:12 PM PST BY: TYLER NATHE, MD RESIDENT DEPARTMENT OF ORTHOPAEDIC SURGERY
THIS WAS ELECTRONICALLY SIGNED - 01/22/2010 12:10 PM PST BY: ROBERT TAMURIAN, MD
TN:dja(usa141) D: 01/04/2010 06:16 PM T: 01/05/2010 03:50 AM C#: 4852196
Display only: Transcription (10977090) on 1/4/2010 6:16 PM by Tyler J Nathe, MD Document history: Transcription (10977090) on 1/4/2010 6:16 PM by Tyler J Nathe, MD
Appointment
000143
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Center None
Office Visit


Financial Class P
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Diagnoses Orthopedic Aftercare for Joint Replacement - Primary Reason for Visit Follow Up With Specialist
V54.81
left leg hip replacement
Medications
000144
Medications at Start of Encounter Disp Refills Start End Carisoprodol (SOMA) 350 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical Diazepam (VALIUM) 5 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 8 hours if needed. - ORAL Class: Historical DiphenhydrAMINE (BENADRYL) 25 mg PO Capsule Sig - Route: Take 1 Cap by mouth every 6 hours if needed. - ORAL Class: Historical Docusate (COLACE) 100 mg PO Capsule Sig - Route: Take 1 Cap by mouth 2 times daily. - ORAL Class: Historical Ferrous Sulfate (FERATAB) 300 mg (60 mg Iron) PO Tablet Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Historical Fluoxetine (PROZAC) 40 mg PO capsule Sig - Route: Take 1 Cap by mouth every day. - ORAL Class: Historical Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 hours if needed. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources or less as directed by your doctor. ** ORAL Class: Historical 390 Tab 0 12/23/2009 1/20/2010 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 13 Tabs by mouth every day. - ORAL 12/21/2009 Oxycodone 20 mg PO Tab Sig - Route: Take 1 Tab by mouth every 3 hours if needed. For pain. - ORAL Class: Historical Pantoprazole (PROTONIX) 40 mg PO Delayed Release Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Historical SENNOSIDES (SENNA PO) Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical Study Drug - Fondaparinux (IRB 200816251) Syringe Sig - Route: Inject 1 Syringe subcutaneously every morning. - SUBCUTANEOUS Class: Historical Medication Review History Med Rev Hx Medication Administration Report for Amundsen, Mark All administrations No administration data available Pharmacy Selected For Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630
000145
Immunizations
Visit Summary
Vitals Recorded in This Encounter 01/04/2010 1243 96.571 kg (212 lb 14.4 oz) Weight: 37.1 C (98.7 F) Temp: Tympanic Temp src: 70 Pulse: 20 Resp: 125/64 mmHg BP: Medications Given (Excluding those documented in Imm/Injections Activity) No data found. Progress Notes
Robert Michael Tamurian, MD 1/5/2010 1:23 PM Signed This patient was seen, evaluated, and care plan was developed with the resident on day of service, 1/4/2010. I agree with the assessment and plan as outlined in the resident's note. Report electronically signed by: Robert M. Tamurian, MD Physician ID # 10884, Pager 3059 Attending Physician Assistant Professor Chief, Orthopaedic Oncology Service Deparment of Orthopaedic Surgery University of California, Davis Health System
Electronically signed by Robert Michael Tamurian, MD at 1/5/2010 1:23 PM Visit Notes JAIME C LEE Mon Jan 4, 2010 12:44 PM Patient roomed,Vital signs taken, allergies verified, screened for pain. Jaime C Lee, MA Electronically signed by JAIME C LEE at Mon Jan 4, 2010 12:44 PM All Flowsheet Templates (all recorded) Amb Vitals Group Flowsheet

Patient Instructions None Follow-up and Disposition Return in about 6 weeks (around 2/15/2010). Routing History Recorded
000146
Visit Disposition Disposition Return in about 6 weeks (around 2/15/2010). Chart Reviewed By Jessica Rubio on 1/6/2010 8:00 AM Marcella R Smith on 1/19/2010 9:41 AM
Problem List
1/19/2006

Class: Acute C. Difficile Diarrhea 5/29/2009 12/19/2009

Anemia Encounter Closed By Closed By TAMURIAN, ROBERT
000147
Patient Insurance ID XEHJ00044785 Group Number PH0010 Plan UCD/B/S HMO Plan Number B72 Plan Address PO BOX 179001 SACRAMENTO, CA 95817-9001 Plan Phone 916-734-0739 PreAuth Phone 916-734-0739
Provider Flabs Labfol
Department Fol Lab
Center None
Center None
Office Visit

Diagnoses Other Malaise and Fatigue - Primary Enthesopathy of Hip Region Pain in Joint, Pelvic Region and Thigh Screen-Endoc/Nut/Met NEC Ichthyosis Reason for Visit Fatigue Level of Service OFFICE/OUTPT VISIT,EST,LEVL IV
780.79 726.5 719.45 V77.99 757.1
000148
[99214]
Medications
Medications at Start of Encounter Disp Refills Start End Carisoprodol (SOMA) 350 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical 2/4/2010 Diazepam (VALIUM) 5 mg PO Tablet (Discontinued) Sig - Route: Take 1 Tab by mouth every 8 hours if needed. - ORAL Class: Historical 2/4/2010 DiphenhydrAMINE (BENADRYL) 25 mg PO Capsule (Discontinued) Sig - Route: Take 1 Cap by mouth every 6 hours if needed. - ORAL Class: Historical 2/4/2010 Docusate (COLACE) 100 mg PO Capsule (Discontinued) Sig - Route: Take 1 Cap by mouth 2 times daily. - ORAL Class: Historical 2/4/2010 Ferrous Sulfate (FERATAB) 300 mg (60 mg Iron) PO Tablet (Discontinued) Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Historical Fluoxetine (PROZAC) 40 mg PO capsule Sig - Route: Take 1 Cap by mouth every day. - ORAL Class: Historical 0 1/8/2010 2/8/2010 Hydrocodone 10 mg/Acetaminophen 325 100 Tab mg (NORCO) 10-325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 390 Tab 0 1/20/2010 2/17/2010 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 13 Tabs by mouth every day. - ORAL 2/4/2010 12/21/2009 Oxycodone 20 mg PO Tab (Discontinued) Sig - Route: Take 1 Tab by mouth every 3 hours if needed. For pain. - ORAL Class: Historical 2/4/2010 Pantoprazole (PROTONIX) 40 mg PO Delayed Release Tablet (Discontinued) Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Historical 2/4/2010 SENNOSIDES (SENNA PO) (Discontinued) Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical 2/4/2010 Study Drug - Fondaparinux (IRB 200816251) Syringe (Discontinued) Sig - Route: Inject 1 Syringe subcutaneously every morning. - SUBCUTANEOUS Class: Historical Discontinued Medications
Reason for Discontinue
SENNOSIDES (SENNA PO)
000149
Pantoprazole (PROTONIX) 40 mg PO Delayed Release Tablet Ferrous Sulfate (FERATAB) 300 mg (60 mg Iron) PO Tablet Docusate (COLACE) 100 mg PO Capsule DiphenhydrAMINE (BENADRYL) 25 mg PO Capsule Diazepam (VALIUM) 5 mg PO Tablet Study Drug - Fondaparinux (IRB 200816251) Syringe Oxycodone 20 mg PO Tab Medication Review History Med Rev Hx Medication Administration Report for Amundsen, Mark All administrations No administration data available Pharmacy Selected For Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630
Orders
Order Summary Canceled Orders CBC AUTO + REFLEX MANUAL DIFF [LABNO Custom] Order #: 50090394 COMPREHENSIVE METABOLIC PANEL [LABNO Custom] Order #: 50090395 LIPID PANEL WITH DLDL REFLEX [LABNO Custom] Order #: 50090396 PSA SCREEN [LABNO Custom] Order #: 50090397 TSH WITH FREE T4 REFLEX [LABNO Custom] Order #: 50090398 URINALYSIS-COMPLETE [LABNO Custom] Order #: 50090399 VITAMIN D, 25 HYDROXY [LABNO Custom] Order #: 50090400 TESTOSTERONE,BIOAVAILABLE [LAB001 Custom] Order #: 50090401 FERRITIN [LABNO Custom] Order #: 50090402
Immunizations
Visit Summary
Vitals Recorded in This Encounter 02/04/2010 0842 95.255 kg (210 lb) Weight: 36.3 C (97.3 F) Temp: Tympanic Temp src: 114/80 mmHg BP: sitting Orthostatic Position: right arm SITE: regular Cuff Size: 2 Pain Score: BACK Pain Loc: Medications Given (Excluding those documented in Imm/Injections Activity) No data found. Progress Notes
000150
Victor Baquero, MD, MD 2/4/2010 12:57 PM Signed Chief Complaint Patient presents with Fatigue
Subjective: Mark Amundsen is a 50yr year old male who is here for the following reason: Feeling fatigued. Not depressed but more like a generalized fatigue for some time. Status post hip surgery. Pain is 2/3 out of 10. Interested in backing off his methadone. Sleep is normal. Gets very little sun. No GI symptoms. No melena. Was anemic after the surgery. No fever or chills or upper respiratory illness symptoms. Also describes itchy skin on the lower extremities for a few weeks. No rash. Review of Systems: Constitutional: fatigue. CV: negative. Resp: negative. GI: negative.
History Substance Use Topics Tobacco Use: Alcohol Use: rare
Yes -- 1.0 packs/day for 20 years Yes
Patient Active Problem List Diagnoses BACKACHE NOS TESTICULAR HYPOFUNC NEC BRACHIAL NEURITIS NOS ADVANCED OSTEOARTHRITIS OF THE LEFT HIP DEPRESSIVE DISORDER CHRONIC PAIN MEDICATION AGREEMENT C. Difficile Diarrhea Anemia Orthopedic Aftercare for Joint Replacement
Code 724.5 257.2 723.4 726.5 311 719.45 008.45AL 285.9Y V54.81B
Current outpatient prescriptions prior to encounter Medication Sig Dispense Methadone (DOLOPHINE) 10 Take 13 Tabs by mouth every 390 Tab mg PO Tablet day. Hydrocodone 10 Take 1 Tab by mouth every 4 100 Tab mg/Acetaminophen 325 mg to 6 hours if needed for pain. (NORCO) 10-325 mg PO For breakthrough pain. ** Do Tablet not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. Fluoxetine (PROZAC) 40 mg Take 1 Cap by mouth every PO capsule day.
Refill 0 0
000151
Carisoprodol (SOMA) 350 mg Take 2 Tabs by mouth every PO Tablet day at bedtime. BP 114/80 | Temp(Src) 36.3 C (97.3 F) (Tympanic) | Wt 95.255 kg (210 lb) OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Eyes: conjunctivae and corneas clear. PERRL, EOM's intact. sclerae normal. Nose: normal. Mouth: normal. Neck: Neck supple. No adenopathy, thyroid symmetric, normal size. Heart: normal rate and regular rhythm, no murmurs, clicks, or gallops. Lungs: clear to auscultation. Extremities: no cyanosis, clubbing, or edema. Skin: Dry scaly lamellar skin on lower extremities. ASSESSMENT: 780.79 Fatigue (primary encounter diagnosis) Comment: non-specific. Suspect anemia vs vitamin D deficiency vs hypogonadism. Less likely mood related. Plan: CBC AUTO + REFLEX MANUAL DIFF, COMPREHENSIVE METABOLIC PANEL, LIPID PANEL WITH DLDL REFLEX, PSA SCREEN, TSH WITH FREE T4 REFLEX, URINALYSIS-COMPLETE, VITAMIN D, 25 HYDROXY, TESTOSTERONE,BIOAVAILABLE, FERRITIN 726.5 ADVANCED OSTEOARTHRITIS OF THE LEFT HIP Comment: status post surgery. Recovering well. Plan: 719.45 CHRONIC PAIN MEDICATION AGREEMENT Comment: discussed gradual reduction of methadone Plan: decrease by 5mg weekly. Risks and benefits discussed in detail. V77.99 Screen-Endoc/Nut/Met NEC Comment: Plan: PSA SCREEN 757.1X Ichthyosis Comment: Discussed treament of dry skin or Ichthyosis vulgaris. Discussed the importance of lotions to maintain the skin barrier and avoidance of frequent washing. Discussed how environmental factors can affect skin dryness as well as the importance of avoiding scratching. Plan: AmLactin PLAN: See Orders. Discussed care and warning signs with Mark and all questions and concerns were fully answered. He will call or followup in the office if any problems arise. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his/her medical care. No guarantees were made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit.
Electronically signed by Victor Henrique Baquero, MD at 2/4/2010 12:57 PM
000152
Visit Notes CLARE JENNINGS, MA Thu Feb 4, 2010 8:43 AM Vital signs taken, allergies verified, screened for pain, pharmacy verified, and verified immunization status. Clare Jennings, MA Electronically signed by CLARE JENNINGS, MA at Thu Feb 4, 2010 8:43 AM All Flowsheet Templates (all recorded) Amb Vitals Group Flowsheet

Problem List
1/19/2006

Class: Acute C. Difficile Diarrhea 5/29/2009 12/19/2009 1/5/2010 Closed Time 12:57 Mark Amundsen (MRN8081369)

Anemia Orthopedic Aftercare for Joint Replacement Encounter Closed By Closed By BAQUERO, VICTOR H Closed Date 02042010
Appointment
000153
Center None
Office Visit
Selected Appointment 2/22/2010 2:45 PM Provider Robert Michael Tamurian, MD
Mark Amundsen (MRN 8081369) Department Ortho Clinic Acc
Financial Class P
Plan Phone 916-734-0739
Diagnoses Enthesopathy of Hip Region - Primary Reason for Visit Follow Up With Specialist
726.5
Medications
Medications at Start of Encounter Disp Refills Start 60 Tab 0 2/19/2010 Methadone (DOLOPHINE) 10 mg PO Tablet (Taking) Sig - Route: Take by mouth. Maximum of 2 tablets up to 4 times a day - ORAL Class: Handwritten Rx End 3/19/2010
000154
Carisoprodol (SOMA) 350 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical Fluoxetine (PROZAC) 40 mg PO capsule (Taking) Sig - Route: Take 1 Cap by mouth every day. - ORAL Class: Historical 0 1/8/2010 2/8/2010 Hydrocodone 10 mg/Acetaminophen 325 100 Tab mg (NORCO) 10-325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 0 1/20/2010 2/19/2010 390 Tab Methadone (DOLOPHINE) 10 mg PO Tablet (Discontinued) Sig - Route: Take 13 Tabs by mouth every day. - ORAL Medication Review History Med Rev Hx Medication Administration Report for Amundsen, Mark All administrations No administration data available
Orders
Order Summary HIP 2+ VIEWS, LEFT + AP PELVIS [RAD001 Custom] Order #: 50338725
Immunizations
Visit Summary
Vitals Recorded in This Encounter 02/22/2010 1453 97.977 kg (216 lb) Weight: 1.854 m (6' 1") Height: 28.6 BMI: 2.25 m2 BSA: 36.7 C (98.1 F) Temp: Tympanic Temp src: 73 Pulse: 18 Resp: 133/80 mmHg BP: sitting Orthostatic Position: left arm SITE: 2 Pain Score: HIP Pain Loc: Medications Given (Excluding those documented in Imm/Injections Activity) No data found.
000155
LMP / OB Status - Last Recorded BMI 28.50 kg/m2 Progress Notes
Robert Michael Tamurian, MD 3/1/2010 8:48 AM Signed Mark Amundsen Returns today s/p Right THA on 12/15/2009, doing well. Progressing with physical therapy. Utilized arixtra for dvt prophylaxis. Pain controlled on oral medication. No change in medical history since last visit.
C (98.1 F) (Tympanic) | Resp 18 | Ht 1.854 m (6' 1") | Wt BP 133/80 | Pulse 73 | Temp(Src) 36.7 97.977 kg (216 lb) AAOx3, No Acute distress, normal affect and disposition The wound is well healed without signs of infection, no erythema, tenderness or discharge. Leg Lengths Equal Lower extremities reveal no signs of deep venous thrombosis; calves and thighs are soft without swelling, induration or tenderness, Homan's sign is negative. Positive trendelenburg gait, stable with lateral support. Radiographs reveal excellent component positioning without change or signs of loosening. No evidence for hardware failure. A/P Doing well s/p Right THA. Continue aggressive home physical therapy per THA protocol and will advance activity level. Return to clinic in 4 months with Patient will need a standing AP Pelvis, AP/Lateral Right Hip, TO INCLUDE THE ENTIRE PROSTHESIS, PRIOR TO NEXT APPOINTMENT Refilled oral analgesics. Patient instructed to return to clinic for signs and or symptoms of infection or dvt. Electronically signed by: Robert M. Tamurian, MD Physician ID # 10884, Pager 3059 Attending Physician Assistant Professor Chief, Orthopaedic Oncology Service Deparment of Orthopaedic Surgery University of California, Davis Health System
Electronically signed by Robert Michael Tamurian, MD at 3/1/2010 8:48 AM Visit Notes MELINDA EHLERS Mon Feb 22, 2010 2:55 PM Pt roomed, vitals taken, pain scale 2/10, pt reports having pain in Lt hip. Medications, allergies, and pharmacy reviewed by Melinda Ehlers, LVN
Electronically signed by MELINDA EHLERS at Mon Feb 22, 2010 2:55 PM
000156
Created by Clare Jennings, MA on 7/1/2010 7:42 AM Approved

Disp 200 Tab Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Class: Normal Authorizing Provider: Victor Henrique Baquero, MD Refills 0 Start 7/1/2010 End 7/27/2010
Office Visit
Orders
Diagnoses Orthopedic aftercare for joint replacement - Primary Tendonitis/capsulitis/periarthritis Pain in joint, lower leg Follow-up examination, following other surgery Hip joint replacement by other means Level of Service OFFICE/OUTPT VISIT,EST,LEVL III [99213]
V54.81 726.90 719.46 V67.09 V43.64
Dx added by coding staff Dx added by coding staff Dx added by coding staff
Medications
Disp Refills 1 Carisoprodol (SOMA) 350 mg PO Tablet 100 Tab Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Pharmacy Start 6/4/2010 End 9/4/2010
000157
ERGOCALCIFEROL (VITAMIN D PO) Sig - Route: Take by mouth. - ORAL Class: Historical Fluoxetine (PROZAC) 40 mg PO capsule Sig - Route: Take 1 Cap by mouth every day. - ORAL Class: Historical 0 6/4/2010 7/5/2010 Hydrocodone 10 mg/Acetaminophen 325 100 Tab mg (NORCO) 10-325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 200 Tab 0 6/7/2010 7/7/2010 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Medication Review History Med Rev Hx Medication Administration Report for Amundsen, Mark All administrations No administration data available
Orders
Order Summary HIP 2+ VIEWS, LEFT + AP PELVIS [RAD001 Custom] Order #: 55593818 Canceled Orders HIP 2+ VIEWS, RIGHT + AP PELVIS [RAD001 Custom] Order #: 55574719
Immunizations
Visit Summary
Vitals Recorded in This Encounter 06/21/2010 1401 103.42 kg (228 lb) Weight: 1.854 m (6' 1") Height: 30.1 BMI: 2.31 m2 BSA: 36.9 C (98.4 F) Temp: Tympanic Temp src: 68 Pulse: 133/89 mmHg BP: sitting Orthostatic Position: left arm SITE: regular Cuff Size: 2 Pain Score: KNEE Pain Loc: Medications Given (Excluding those documented in Imm/Injections Activity)
000158
No data found. LMP / OB Status - Last Recorded BMI 30.08 kg/m2 Progress Notes
Robert Michael Tamurian, MD 6/21/2010 7:16 PM Addendum Mark Amundsen is a 50yr old male returns today s/p Left THA on 12/15/2009, doing well. Mark Amundsen returns to the adult reconstruction clinic at the University of California, Davis Health System for a 4 month(s) follow up visit.
Mark Amundsen has resumed full activity in keeping with standard restrictions for total joint replacment patients. Pain is reported using a visual analog pain scale as 2 / 10 in his anterior left knee and they are not requiring analgesics for the operative Hip since reconstructive surgery. Medical history does not have any new diagnoses or changes since prior office visit dated 2/22/2010. ROS: A Complete review of systems was performed. Except as noted in the HPI, pertinent positives were none. All other systems were negative. BP 133/89 | Pulse 68 | Temp(Src) 36.9 C (98.4 F) (Tympanic) | Ht 1.854 m (6' 1") | Wt 103.42 kg (228 lb) AAOx3, No Acute distress, normal affect and disposition. Nonicteric sclerae, Breathing Nonlabored. Focused exam of the Left knee and hip was performed. Left knee is stable and tender to palpation at the superior pole of the patella and quad tendon The wound is well healed without signs of infection, no erythema, tenderness or discharge. Skin does not reveal any new lesions. Palpation of the regional nodal basin does not reveal any lymphadenopathy. Leg Lengths Equal Lower extremities reveal no signs of deep venous thrombosis; calves and thighs are soft without swelling, induration or tenderness, Homan's sign is negative. Motor and sensory exam reveal no deficits throughout all dermatomes of the Left lower extremity. Peripheral pulses are 2+, normal reflexes. Gait does not reveal a trendelenburg sign to the Left side. Radiographs of the Left hip were ordered an personally reviewed. Today's film reveal excellent component positioning, restoration of limb alignment and length, without change or signs of loosening. Excellent osseointegration of the stem and socket, No evidence for hardware failure. A/P Doing well s/p Left THA. Continue activities as tolerated per THA protocol and will continue antibiotic prophylaxis for invasive dental or surgical procedures per protocol. Return to clinic in 6 months. Mark Amundsen will need a standing AP Pelvis, AP/Lateral Left Hip, TO INCLUDE THE ENTIRE PROSTHESIS, PRIOR TO NEXT APPOINTMENT Regarding his left knee pain, he has evidence for some tendonitis of the quadriceps and I recommend he continue his home exercise program and use OTC NSAIDS as needed. Patient instructed to return to clinic for signs and or symptoms of infection or dvt. Electronically signed by: Robert M. Tamurian, MD Physician ID # 10884, Pager 3059 Attending Physician
000159
Assistant Professor Chief, Orthopaedic Oncology Service Deparment of Orthopaedic Surgery University of California, Davis Health System
Visit Notes MELINDA EHLERS, LVN Mon Jun 21, 2010 2:02 PM Pt roomed, vitals taken, pain scale 2/10, medications, allergies, and pharmacy reviewed by Melinda Ehlers, LVN Electronically signed by MELINDA EHLERS, LVN at Mon Jun 21, 2010 2:02 PM All Flowsheet Templates (all recorded) Amb Vitals Group Flowsheet

Patient Instructions None Follow-up and Disposition Return in about 6 months (around 12/21/2010). Routing History Recorded Visit Disposition Disposition Return in about 6 months (around 12/21/2010). Chart Reviewed By Victor Henrique Baquero, MD on 6/22/2010 12:52 PM Grace Lee on 7/10/2010 5:34 PM Chart Cosign Accepted By Robert Michael Tamurian, MD Accepted On 6/25/2010 9:47 AM
Problem List
Noted Resolved
1/19/2006
Class: Chronic
000160
Office Visit
Provider Jeffrey Alan Applebaum, MD


Financial Class P
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Diagnoses Dependent edema - Primary Dyslipidemia Enthesopathy of hip region Vitamin D deficiency Hypertension Screening for cancer High arch
782.3 272.4 726.5 268.9 401.9 V76.9 755.67
with metatarsalgia and soft tissue swelling
Reason for Visit Foot Problem

Reason For Visit History Recorded
swollen R>L starded getting bad 3 days / 3 months possibly
Level of Service OFFICE/OUTPT VISIT,EST,LEVL IV [99214]
Medications
Medications at Start of Encounter Disp Refills 1 Carisoprodol (SOMA) 350 mg PO Tablet 100 Tab Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Pharmacy ERGOCALCIFEROL (VITAMIN D PO) (Discontinued) Sig - Route: Take by mouth. - ORAL Class: Historical Fluoxetine (PROZAC) 40 mg PO capsule Sig - Route: Take 1 Cap by mouth every day. - ORAL Class: Historical Start 6/4/2010 End 9/4/2010
7/12/2010
000161
0 6/4/2010 7/5/2010 Hydrocodone 10 mg/Acetaminophen 325 100 Tab mg (NORCO) 10-325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 200 Tab 0 7/1/2010 7/31/2010 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Ordered Medications
Disp Refills Start End 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. - ORAL 3 7/12/2010 11/16/2010 30 Tab Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg PO Tablet (Discontinued) Take 1 Tab by mouth every morning. - ORAL 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Take 1 Tab by mouth every morning after a meal. - ORAL
Discontinued Medications Reason for Discontinue ERGOCALCIFEROL (VITAMIN D PO) Medication Review History Med Rev Hx Medication Administration Report for Amundsen, Mark All administrations No administration data available Pharmacy Selected For Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630
Orders
Order Summary GASTROENTEROLOGY REFERRAL [100015 Custom] Order #: 56373075 Future Orders Expected By LIPID PANEL [LABNO Custom] Order #: 7/12/10 56373076 7/12/10 HEPATIC FUNCTION PANEL [LABNO Custom] Order #: 56373077 Expires 7/12/11 7/13/11
Immunizations
Visit Summary
Vitals Recorded in This Encounter 07/12/2010 0915 101.606 kg (224 lb) Weight: 76 Pulse:
000162
Resp: BP: Comments: Orthostatic Position: SITE: Cuff Size: Pain Score: Pain Loc:
18 ! 138/98 mmHg 138/90 on rech/ja sitting right arm regular 2 FOOT
Jeffrey Alan Applebaum, MD 7/12/2010 9:58 AM Signed SUBJECTIVE: Mark Amundsen is a 50yr old male. Chief Complaint Patient presents with Foot Problem swollen R>L starded getting bad 3 days / 3 months possibly
Additional chief complaint(s): Hi arched feet, dyslipidemia History: Patient has noted recent swelling of his feet. This occurs primarily over the metatarsal region. Patient has had some diffuse swelling in addition. Weight has increased and patient has strong family history of hypertension. Patient has not monitor his own blood pressure. Patient has dyslipidemia on recent lab and ongoing vitamin D deficiency but is not taking adequate supplement. Patient does not specifically watch his diet and weight continues to rise. No chest pain, shortness of breath or abdominal pain. See EMR for PMH, FH, SH: Reviewed and updated medications and allergies. History Substance Use Topics Tobacco Use: Yes -- 1.0 packs/day for 20 years Alcohol Use: Yes rare . Note the patient's smoking Review of Systems No headaches. No back or leg pains.. OBJECTIVE: BP 138/98 | Pulse 76 | Resp 18 | Wt 101.606 kg (224 lb) General exam shows he is alert and in no acute distress. : HEENT: Within normal limits except for missing front teeth Neck: supple Lungs: clear Heart: regular rhythm without murmur Abdomen: obese Extremities: dependent edema is mild. Anterior foot swelling and very high arched feet Neurologic: no focal deficits Spine: normal
000163
Skin: clear without jaundice or cyanosis. No peripheral acrocyanosis Psychiatric: patient moderately anxious. No overt depression. Data : lab, imaging, office procedures, outside records ( reviewed/discussed) Reviewed recent laboratory data including a low vitamin D level. Dyslipidemia noted. . Will need EKG ASSESSMENT: 782.3AB Dependent edema (primary encounter diagnosis) Comment: associated with hypertension Plan: TRIAMTERENE-HYDROCHLOROTHIAZIDE 37.5 MG-25 MG TAB Followup with PCP in the next six weeks. Will need EKG at that time 272.4CB Dyslipidemia Comment: discussed need for lab with patient, especially since patient also has apparent hypertension Plan: FENOFIBRATE NANOCRYSTALLIZED 145 MG TAB 726.5 ADVANCED OSTEOARTHRITIS OF THE LEFT HIP Comment: Plan: continue therapy 268.9G Vitamin D deficiency Comment: Plan: ERGOCALCIFEROL (VITAMIN D2) 50,000 UNIT CAP See note in After Visit Summary 401.9AH Hypertension Comment: Plan: TRIAMTERENE-HYDROCHLOROTHIAZIDE 37.5 MG-25 MG TAB, LIPID PANEL, HEPATIC FUNCTION PANEL New onset and needs associated weight loss V76.9B Screening for cancer Comment: Plan: GASTROENTEROLOGY REFERRAL Needs update : colonoscopy screening 755.67G High arch Comment: with metatarsalgia and soft tissue swelling Plan: Metatarsal arch pad suggested from super feet or Spenco, then follow up with PCP Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. Jeffrey Alan Applebaum, MD
Electronically signed by Jeffrey Alan Applebaum, MD at 7/12/2010 9:58 AM
000164
Visit Notes Stephanie L Esparza, LVN Mon Jul 12, 2010 9:18 AM Vital signs taken, allergies verified, screened for pain, pharmacy verified. Stephanie L Esparza, LVN Electronically signed by Stephanie L Esparza, LVN at Mon Jul 12, 2010 9:18 AM All Flowsheet Templates (all recorded) Amb Vitals Group Flowsheet

I have reviewed your recent lab results, and they are printed below. Your vitamin D level is very low. Please supplement with Vitamin D2 50,000 U gel caps 2 times a week for next 2 months. I have called in this medication to your pharmacy. Repeat vitamin D level in 3 months. Following the Vitamin D2 50,000 U gel caps , continue with over the counter vitamin D3 2000 IU tablets, 1 per day till further notice. Follow up with me please in next 12months. BP 138/98 initially; Maxzide 25mg daily and avoid salt Abnormal lipids, Cholesterol Triglycerides Tricor 1 tablet daily with dinner Lab in 1month , fasting, Then follow up with Victor Baquero,MD A laboratory test has been ordered for you. Please call (916) 985-9300 to schedule an appointment. Do not eat or drink anything but water for 12 hours prior to your test. You will receive a letter or telephone call with your results. Check BP outside of clinic occasionally
Follow-up and Disposition Return in about 6 weeks (around 8/23/2010), or if symptoms worsen or fail to improve. Routing History Recorded Visit Disposition Disposition Return in about 6 weeks (around 8/23/2010), or if symptoms worsen or fail to improve. Chart Reviewed By Victor Henrique Baquero, MD on 7/14/2010 1:29 PM
Problem List
Noted Resolved
low back pain - chronic.
000165
Tried Methadone, Hydrocodone, Baclofen, Soma, Oxycodone, Tramadol, Toradol, MSContin, Fentanyl, dilaudid.
Other testicular hypofunction Class: Chronic BRACHIAL NEURITIS NOS ADVANCED OSTEOARTHRITIS OF THE LEFT HIP
1/19/2006

Class: Acute C. difficile diarrhea Anemia Orthopedic Aftercare for Joint Replacement Dyslipidemia 5/29/2009 12/19/2009 1/5/2010 2/1/2010 7/12/2010
See lab
Class: Chronic Vitamin D deficiency Class: Chronic Hypertension 7/12/2010 7/12/2010
Mild , With fluid retention

Class: Acute High arch 7/12/2010

Encounter Closed By Closed By APPLEBAUM, JEFFREY Closed Date 07122010 Closed Time 09:59 Mark Amundsen (MRN8081369) Sex Male DOB 9/23/1959
Appointment
000166
FOLSOM CA 95630 Selected Appointment 10/12/2010 8:08 AM
916-983-4484 (Work) Department Ucd Registration
Encounter-Level Documents: There are no encounter-level documents. Insurance Information Acct Number 078548433107 1 Payor UCD Patient Insurance ID XEHJ00044785 Group Number PH0010 Plan UCD/B/S HMO Plan Number B72 Plan Address PO BOX 179001 SACRAMENTO, CA 95817-9001 Plan Phone 916-734-0739 PreAuth Phone 916-734-0739
Financial Class P
Center None
Office Visit

Diagnoses Enthesopathy of hip region - Primary Adjustment reaction Metatarsalgia Reason for Visit Foot Problem Level of Service OFFICE/OUTPT VISIT,EST,LEVL IV [99214] hip/ right
726.5 309.9 726.70
Medications
Medications at Start of Encounter Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule
Disp 8 Cap Refills 1 Start 7/12/2010 End 5/24/2012
000167
Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. - ORAL Class: Pharmacy 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet 30 Tab Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 100 Tab 1 9/22/2010 12/23/2010 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Pharmacy 9/24/2010 Fluoxetine (PROZAC) 40 mg PO capsule (Discontinued) Sig - Route: Take 1 Cap by mouth every day. - ORAL Class: Historical 0 9/22/2010 10/23/2010 Hydrocodone 10 mg/Acetaminophen 325 100 Tab mg (NORCO) 10-325 mg Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 200 Tab 0 9/20/2010 10/20/2010 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL 30 Tab 3 7/12/2010 7/12/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy Ordered Medications Fluoxetine (PROZAC) 40 mg capsule (Discontinued) Take 1 Cap by mouth every day. - ORAL Discontinued Medications Reason for Discontinue Fluoxetine (PROZAC) 40 mg PO capsule Medication Review History Med Rev Hx Medication Administration Report for Amundsen, Mark All administrations No administration data available Pharmacy Selected For Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Disp 30 Cap Refills 6 Start 9/24/2010 End 10/18/2010
Immunizations
Visit Summary
Vitals Recorded in This Encounter 09/24/2010 0948 98.431 kg (217 lb) Weight: 36.4 C (97.5 F) Temp:
000168
Temp src: Pulse: BP: Orthostatic Position: SITE: Cuff Size: Pain Score: Pain Loc:
Tympanic 70 118/80 mmHg sitting left arm large 2 HIP
Victor Baquero, MD, MD 9/24/2010 10:11 AM Signed Chief Complaint Patient presents with Foot Problem hip/ right
Subjective: Mark Amundsen is a 51yr old male who is here for the following reason: 1. Follow up. 2. Right hip bothers him most of the time. Like it did on the left hip 7 years ago. 3. Pain, swelling ont he ball of the right foot and toes. Mostly tender and at times numb on the underside of the foot after walking long distances. Felt like socks were bunching up. Started after his hip surgery. 4. requested restarting the fluoxetine. Some stressors at work. Overall doing well. Review of Systems: Constitutional: negative. CV: negative. Resp: negative. Neuro: as above otherwise negative. .
Patient Active Problem List Diagnoses BACKACHE NOS TESTICULAR HYPOFUNC NEC BRACHIAL NEURITIS NOS ADVANCED OSTEOARTHRITIS OF THE LEFT HIP DEPRESSIVE DISORDER CHRONIC PAIN MEDICATION AGREEMENT Anemia Orthopedic Aftercare for Joint Replacement Dyslipidemia Vitamin D deficiency
Code 724.5 257.2 723.4 726.5 311 719.45 285.9Y V54.81B 272.4CB 268.9G
000169
Hypertension High arch Current outpatient prescriptions ordered prior to encounter Medication Sig Carisoprodol (SOMA) 350 mg Take 2 Tabs by mouth every Tablet day at bedtime. Ergocalciferol, Vitamin D2, Take 1 Cap by mouth. take 1 (VITAMIN D) 50,000 unit PO capsule by oral route twice weekly for next 2 months. Capsule Then lab follow up 4 weeks later. Fenofibrate (TRICOR) 145 mg Take 1 Tab by mouth every PO Tablet morning after a meal. Fluoxetine (PROZAC) 40 mg Take 1 Cap by mouth every capsule day. Hydrocodone 10 Take 1 Tab by mouth every 4 mg/Acetaminophen 325 mg to 6 hours if needed for pain. (NORCO) 10-325 mg Tablet For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. Methadone (DOLOPHINE) 10 Take 2 Tabs by mouth every mg Tablet 6 hours. Triamterene 37.5 Take 1 Tab by mouth every mg/Hydrochlorothiazide 25mg morning. (MAXZIDE-25) 37.5-25 mg PO Tablet
401.9AH 755.67G
Dispense 100 Tab 8 Cap
Refill 1 1
30 Tab 30 Cap 100 Tab
11 6 0
200 Tab 30 Tab
0 3
BP 118/80 | Pulse 70 | Temp(Src) 36.4 C (97.5 F) (Tympanic) | Wt 98.431 kg (217 lb) OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Skin: Skin color, texture, turgor normal. No rashes or lesions. Neuro: Gait normal. Reflexes normal and symmetric. Sensation and strength grossly normal. Mental Status: euthymic. Musculoskeletal: right foot. High arch. Limited extension to 90 degees. Not tender to palpation along foot or metatarsals. Negative squeeze test. ASSESSMENT: 726.5 ADVANCED OSTEOARTHRITIS OF THE RIGHT HIP (primary encounter diagnosis) Comment: stable. Symptoms managed with current medications. Not interested in doing a right hip replacement at this time. Risks and benefits discussed in detail. Plan: The current medical regimen is effective; continue present plan and medications. 309.9CU Adjustment reaction Comment: requested restarting the fluoxetine. Some stressors at work. Overall doing well. Plan: see orders. Resume Fluoxetine dose 20mg - advance to 40 after 1 week. 726.70A Metatarsalgia Comment: discussed superfeet orthotics, stretching the achilles complex. Remote possibility of Charcot-Marie-Tooth disease. However has no family history of this. Plan: consider podiatry referral if persisting. PLAN:
000170
See Orders. Discussed care and warning signs with Mark and all questions and concerns were fully answered. He will call or followup in the office if any problems arise. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his/her medical care. No guarantees were made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit.
Electronically signed by Victor Henrique Baquero, MD at 9/24/2010 1:27 PM Visit Notes Clare Jennings, MA Fri Sep 24, 2010 9:48 AM Vital signs taken, allergies verified, screened for pain, pharmacy verified, and verified immunization status. Clare Jennings, MA Electronically signed by Clare Jennings, MA at Fri Sep 24, 2010 9:48 AM All Flowsheet Templates (all recorded) Amb Vitals Group Flowsheet

Problem List
1/19/2006

Class: Acute C. difficile diarrhea Anemia 5/29/2009 12/19/2009 7/12/2010
000171
Sent: Mon Oct 18, 2010 8:51 AM Subject: Non-urgent Medical Advice Question Hi Dr baqueroIt's time for another refill on the Methadone prescription. I will be out on Wednesday, so I'm hoping I can pick up a script on Tuesday evening. The problem I came in for last week (uncontrollable shaking and fatigue) is still occurring, so I doubt it's a virus. I will be coming in soon for a consultation... Regards, Mark Amundsen Electronically signed by Clare Jennings, MA at 10/18/2010 8:59 AM Routing History 10/18/2010 9:00 AM
From Clare Jennings, MA To Victor Henrique Baquero, MD Priority Routine
Created by Clare Jennings, MA on 10/18/2010 8:59 AM Approved Disp 200 Tab Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Class: Normal Authorizing Provider: Victor Henrique Baquero, MD Refills 0 Start 10/18/2010 End 11/12/2010
Office Visit
Orders
Selected Appointment 10/12/2010 9:45 AM Provider Nancy Jaeger, MD, MD
Plan UCD/B/S HMO
Financial Class P
Plan Number B72
Plan Phone 916-734-0739
Diagnoses 780.79
000172
Malaise and fatigue - Primary Vitamin D deficiency Tobacco use disorder Depressive disorder, not elsewhere classified Reason for Visit Muscle Pain Fatigue
Reason For Visit History Recorded
268.9 305.1 311
in legs, yesterday was so bad, pt sts that he could barely walk, his legs felt realy weak.
Level of Service OFFICE/OUTPT VISIT,EST,LEVL IV [99214]
Medications
Disp Refills Start End 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 8 Cap 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. - ORAL Class: Pharmacy 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet 30 Tab Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 100 Tab 1 9/22/2010 12/23/2010 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Pharmacy 30 Cap 6 9/24/2010 3/24/2011 Fluoxetine (PROZAC) 40 mg capsule Sig - Route: Take 1 Cap by mouth every day. - ORAL Class: Pharmacy 0 9/22/2010 10/23/2010 Hydrocodone 10 mg/Acetaminophen 325 100 Tab mg (NORCO) 10-325 mg Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 200 Tab 0 9/20/2010 10/20/2010 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL 30 Tab 3 7/12/2010 7/12/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy
Immunizations
000173
Immunizations as of 10/12/2010 No immunizations on file.
Never Reviewed
Visit Summary
Vitals Recorded in This Encounter 10/12/2010 0943 98.431 kg (217 lb) Weight: 36.4 C (97.6 F) Temp: Tympanic Temp src: 70 Pulse: 132/80 mmHg BP: sitting Orthostatic Position: right arm SITE: regular Cuff Size: NO PAIN Pain Score: 99 % SpO2: Medications Given (Excluding those documented in Imm/Injections Activity) No data found. Progress Notes
Nancy Jaeger, MD, MD 10/12/2010 12:06 PM Signed Chief Complaint Patient presents with Muscle Pain in legs, yesterday was so bad, pt sts that he could barely walk, his legs felt realy weak. Fatigue
Mark Amundsen is a 51yr old male patient of Victor Henrique Baquero, MD here with 2 day history of vague symptoms consistent with generalized malaise and weakness at legs along with possible myalgia and reported tingling of left arm; patient also mentions one episode of loose stool without blood 10/11/10 and none currently; no fever/chills; no neck or chest pain; no shortness of breath; no congestion; no known sick contacts; nothing makes his symptoms better; nothing makes his symptoms worse; over the counter medications tried: none He denies a history of chills, fevers, wheezing, shortness of breath, chest pain, dizziness, nausea, vomiting and anorexia. Patient admits to smoke cigarettes. ROS: General: no fever/chills Psych: patient reports recently restarting Prozac at 20 mg and then increased to 40 due to history of possible OCD and depression
Patient Active Problem List Diagnoses BACKACHE NOS TESTICULAR HYPOFUNC NEC BRACHIAL NEURITIS NOS ADVANCED OSTEOARTHRITIS OF THE LEFT HIP DEPRESSIVE DISORDER CHRONIC PAIN MEDICATION AGREEMENT Anemia
Code 724.5 257.2 723.4 726.5 311 719.45 285.9Y
000174
Orthopedic Aftercare for Joint Replacement Dyslipidemia Vitamin D deficiency Hypertension High arch
V54.81B 272.4CB 268.9G 401.9AH 755.67G
Past Medical History Diagnosis NO SIGNIFICANT HISTORY Hypertension
Date 7/12/2010
Current outpatient prescriptions ordered prior to encounter Medication Sig Carisoprodol (SOMA) 350 mg Take 2 Tabs by mouth every Tablet day at bedtime. Ergocalciferol, Vitamin D2, Take 1 Cap by mouth. take 1 (VITAMIN D) 50,000 unit PO capsule by oral route twice Capsule weekly for next 2 months. Then lab follow up 4 weeks later. Fenofibrate (TRICOR) 145 mg Take 1 Tab by mouth every PO Tablet morning after a meal. Fluoxetine (PROZAC) 40 mg Take 1 Cap by mouth every capsule day. Hydrocodone 10 Take 1 Tab by mouth every 4 mg/Acetaminophen 325 mg to 6 hours if needed for pain. (NORCO) 10-325 mg Tablet For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. Methadone (DOLOPHINE) 10 Take 2 Tabs by mouth every mg Tablet 6 hours. Triamterene 37.5 Take 1 Tab by mouth every mg/Hydrochlorothiazide 25mg morning. (MAXZIDE-25) 37.5-25 mg PO Tablet Allergies: Allergies Allergen Morphine Fentanyl itching
History Social History Marital Status: Spouse Name: Number of Children: Years of Education: Occupational History
Refill 1
11 6 0
200 Tab 30 Tab
0 3
Reactions Hives
WIDOWED N/A N/A N/A
000175
network administrator Social History Main Topics Tobacco Use: Alcohol Use: rare Drug Use: Sexually Active: Other Topics Not on file Social History Narrative No narrative on file Family History Problem Arthritis Cancer breast and lung
Yes -- 1.0 packs/day for 20 years Yes No Not Currently Concern
Relation Mother Mother
Age of Onset
PE: BP 132/80 | Pulse 70 | Temp(Src) 36.4 C (97.6 F) (Tympanic) | Wt 98.431 kg (217 lb) | SpO2 99% General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Neck: Supple; no LAD. Heart: normal rate and regular rhythm, no murmurs, clicks, or gallops. Lungs: clear to auscultation. Abdomen: BS normal. Abdomen soft, non-tender. No masses or organomegaly. Extremities: no cyanosis, clubbing, or edema. Neuro: grossly intact. Assessment and Plan: 780.79T Malaise and fatigue (primary encounter diagnosis) Comment: x 2 days; afebrile; unclear diagnosis or etiology; possible viral illness vs further need for workup if symptoms continue Plan: patient declined C spine films and nerve conduction study for workup of tingling of left arm; patient to follow-up with PCP regarding need for EKG due to Methadone for pain mgnt and encouraged follow-up with PCP for routine care and yearly CPE 268.9G Vitamin D deficiency Comment: no current supplement Plan: supplement encouraged; to follow-up with PCP 305.1 Tobacco use disorder Comment: not ready to quit Plan: cessation encouraged 311 DEPRESSIVE DISORDER Comment: back on Prozac per patient; denies SI or HI Plan: follow-up with PCP Total encounter time including history, physical examination, and coordination of care was approximately 15 minutes of which more than 50% was spent counseling regarding assessment/diagnosis and treatment plan. No guarantees were made regarding his medical care or treatment outcome. Barriers to Learning: none. Patient verbalizes understanding of teaching and instructions.
000176
Electronically signed by: Nancy Jaeger, MD Diplomat, American Board of Family Medicine Associate physician UCDHS Primary Care Network, Folsom (916)985-9300
Electronically signed by Nancy Jaeger, MD at 10/12/2010 12:06 PM
Nancy Jaeger, MD, MD 10/12/2010 5:29 PM Addendum LM at patient's home to check on current status and LM encouraging to schedule to see Dr Baquero 10/13/10 for possible EKG and check on status; patient also encouraged on message left to seek immediate attention for worsening symptoms or concerns. Nancy Jaeger, MD, MD 10/13/2010 12:39 PM Addendum LM second set of message at cell phone listed under work number and home number asking patient to call back to check on overall status and to ensure he gets seen for possible EKG if symptoms continue or any concerns; I hasked patient to call 985-9300 to respond to call.
Letters Letter Information JAEGER, NANCY on 10/12/2010 Visit Notes MANDY CHILSON Tue Oct 12, 2010 9:48 AM CC and vitals were taken, allergies and pharmacy verified, and screening for pain completed. Mandy Chilson, MA
Electronically signed by MANDY CHILSON at Tue Oct 12, 2010 9:48 AM Status Sent
Routing Information

Call or return to clinic if symptoms worsen, fail to improve or other symptoms develop.
Follow-up and Disposition Return if symptoms worsen or fail to improve. Routing History Recorded Visit Disposition Disposition Return if symptoms worsen or fail to improve. Chart Reviewed By Victor Henrique Baquero, MD on 10/12/2010 1:02 PM Victor Henrique Baquero, MD on 10/12/2010 7:56 PM Victor Henrique Baquero, MD on 10/13/2010 1:37 PM
000177
Problem List
1/19/2006

See lab


Encounter Closed By Closed By JAEGER, NANCY Closed Date 10122010 Closed Time 12:07 Mark Amundsen (MRN8081369) Sex Male DOB 9/23/1959
Appointment
Account # 078548433107 Patient Demographics Address 2025 TARBOLTON CIR Phone 916-509-0158 (Home) E-mail Address mamundsen@sbcglobal.net
000178
CA 95817-9001
Center None
Office Visit


Financial Class P
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Diagnoses Other malaise and fatigue - Primary Reason for Visit Tremors Level of Service OFFICE/OUTPT VISIT,EST,LEVL IV [99214] follow up
780.79
Medications
Disp Refills Start End 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 8 Cap 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. - ORAL Class: Pharmacy 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet 30 Tab Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 100 Tab 1 9/22/2010 12/23/2010 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Pharmacy
000179
30 Cap 6 9/24/2010 10/18/2010 Fluoxetine (PROZAC) 40 mg capsule (Discontinued) Sig - Route: Take 1 Cap by mouth every day. - ORAL Class: Pharmacy 0 9/22/2010 10/23/2010 Hydrocodone 10 mg/Acetaminophen 325 100 Tab mg (NORCO) 10-325 mg Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 200 Tab 0 10/18/2010 11/17/2010 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL 30 Tab 3 7/12/2010 7/12/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy Discontinued Medications Reason for Discontinue Fluoxetine (PROZAC) 40 mg capsule Medication Review History Med Rev Hx Medication Administration Report for Amundsen, Mark All administrations No administration data available Pharmacy Selected For Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630
Orders
Order Summary Future Orders COMPREHENSIVE METABOLIC PANEL [LABNO Custom] Order #: 60316381 VITAMIN D, 25 HYDROXY [LABNO Custom] Order #: 60316382 TSH WITH FREE T4 REFLEX [LABNO Custom] Order #: 60316383 CBC AUTO + REFLEX MANUAL DIFF [LABNO Custom] Order #: 60317435 CREATINE KINASE [LABNO Custom] Order #: 60317546 Expected By 10/18/10 10/18/10 10/18/10 10/18/10 10/18/10 Expires 10/18/11 10/18/11 10/18/11 10/18/11 10/18/11
Immunizations
Visit Summary
Vitals Recorded in This Encounter 10/18/2010 1451 98.431 kg (217 lb) Weight: 36.8 C (98.2 F) Temp:
000180
Temp src: Pulse: BP: Orthostatic Position: SITE: Cuff Size: Pain Score: Pain Loc:
Tympanic 77 126/86 mmHg sitting left arm large 2 HIP
Victor Baquero, MD, MD 10/18/2010 3:05 PM Signed Chief Complaint Patient presents with Tremors follow up
Subjective: Mark Amundsen is a 51yr old male who is here for the following reason: Woke up 8 days ago and felt shaky, achy in the lower extremities - like he ran a maraqtho. Some lower arm discomfort moving proximally. Shoulders are sore. Thought he was improving and last night he felt like his legs were weak. Difficuly concentrating. Went to work today but was not feeling well. No fever or chills. One instance of diarrhea - normal now. Did go off the prozac after these symptoms started - had been on it for 2 weeks. Review of Systems: Constitutional: fatigue. CV: negative. Resp: negative. GI: negative. GU: negative. Musculoskeletal: negative. Integumentary: negative. Neuro: otherwise negative. Endo: negative.
Patient Active Problem List Diagnoses BACKACHE NOS TESTICULAR HYPOFUNC NEC BRACHIAL NEURITIS NOS ADVANCED OSTEOARTHRITIS OF THE LEFT HIP DEPRESSIVE DISORDER
Code 724.5 257.2 723.4 726.5 311
000181
CHRONIC PAIN MEDICATION AGREEMENT Anemia Orthopedic Aftercare for Joint Replacement Dyslipidemia Vitamin D deficiency Hypertension High arch
719.45 285.9Y V54.81B 272.4CB 268.9G 401.9AH 755.67G
Current outpatient prescriptions ordered prior to encounter Medication Sig Carisoprodol (SOMA) 350 mg Take 2 Tabs by mouth every Tablet day at bedtime. Ergocalciferol, Vitamin D2, Take 1 Cap by mouth. take 1 (VITAMIN D) 50,000 unit PO capsule by oral route twice Capsule weekly for next 2 months. Then lab follow up 4 weeks later. Fenofibrate (TRICOR) 145 mg Take 1 Tab by mouth every PO Tablet morning after a meal. Fluoxetine (PROZAC) 40 mg Take 1 Cap by mouth every capsule day. Hydrocodone 10 Take 1 Tab by mouth every 4 mg/Acetaminophen 325 mg to 6 hours if needed for pain. (NORCO) 10-325 mg Tablet For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. Methadone (DOLOPHINE) 10 Take 2 Tabs by mouth every mg Tablet 6 hours. Triamterene 37.5 Take 1 Tab by mouth every mg/Hydrochlorothiazide 25mg morning. (MAXZIDE-25) 37.5-25 mg PO Tablet
Refill 1 1
11 6 0
200 Tab 30 Tab
0 3
BP 126/86 | Pulse 77 | Temp(Src) 36.8 C (98.2 F) (Tympanic) | Wt 98.431 kg (217 lb) OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Eyes: conjunctivae and corneas clear. PERRL, EOM's intact. sclerae normal. Mouth: normal. Neck: Neck supple. No adenopathy, thyroid symmetric, normal size. Heart: normal rate and regular rhythm, no murmurs, clicks, or gallops. Lungs: clear to auscultation. Abdomen: BS normal. Abdomen soft, non-tender. No masses or organomegaly. Extremities: no cyanosis, clubbing, or edema. Skin: Skin color, texture, turgor normal. No rashes or lesions. Neuro: Gait normal. Reflexes normal and symmetric. Sensation and strength grossly normal. Very faint resting tremor - barely discernable. Mental Status: Appearance/Cooperation: in no apparent distress Behavior :normal Mood (pt's report) :Mood pt's report, euthymic Affect: full and appropriate Musculoskeletal: normal ASSESSMENT:
000182
780.79 Other malaise and fatigue (primary encounter diagnosis) Comment: non-specific. I suspect physiologic process vs subacute viral illness vs medication related. Labs requested. Discussed care and warning signs with Mark and all questions and concerns were fully answered. He will call or followup in the office if any problems arise. Will await lab results. Continue hydration. Avoid supplementation with over the counter supplements. . Plan: COMPREHENSIVE METABOLIC PANEL, VITAMIN D, 25 HYDROXY, TSH WITH FREE T4 REFLEX, CBC AUTO + REFLEX MANUAL DIFF, CREATINE KINASE PLAN: See Orders. Discussed care and warning signs with Mark and all questions and concerns were fully answered. He will call or followup in the office if any problems arise. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his/her medical care. No guarantees were made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit. Electronically signed by: Victor Baquero, MD Associate Physician Associate Medical Director UC Davis Medical Group, Folsom
Electronically signed by Victor Henrique Baquero, MD at 10/18/2010 5:14 PM Visit Notes Clare Jennings, MA Mon Oct 18, 2010 2:52 PM Vital signs taken, allergies verified, screened for pain, pharmacy verified, and verified immunization status. Clare Jennings, MA
Electronically signed by Clare Jennings, MA at Mon Oct 18, 2010 2:52 PM

Problem List
Other testicular hypofunction Class: Chronic BRACHIAL NEURITIS NOS
000183
Date & Time 4/17/2013 5:00 PM
Center None
Office Visit
Financial Class P
Plan Phone 916-734-0739
Diagnoses Weakness - Primary Reason for Visit Fatigue Level of Service OFFICE/OUTPT VISIT,EST,LEVL IV [99214]
780.79 possible thyroid prob, not doing any better
Medications
Medications at Start of Encounter Disp Refills Start End 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 8 Cap 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. - ORAL Class: Pharmacy 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet 30 Tab Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 3 10/20/2010 1/18/2011 Levothyroxine (LEVOXYL) 50 mcg Tablet Sig - Route: Take 1 Tab by mouth every day. take on an empty stomach - ORAL Class: Pharmacy 100 Tab 1 9/22/2010 12/23/2010 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL
000184
Class: Pharmacy 0 10/20/2010 11/20/2010 Hydrocodone 10 mg/Acetaminophen 325 100 Tab mg (NORCO) 10-325 mg Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 200 Tab 0 10/18/2010 11/17/2010 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL 30 Tab 3 7/12/2010 7/12/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy Medication Review History Med Rev Hx Medication Administration Report for Amundsen, Mark All administrations No administration data available Pharmacy Selected For Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630
Orders
Order Summary CYANOCOBALAMIN INJ CLINIC [J3420 Custom] Order #: 60917191 POC ELECTROCARDIOGRAM WITH RHYTHM STRIP [93000 Custom] Order #: 60917192 Canceled Orders TESTOSTERONE,BIOAVAIL MALE>17 [LABNO Custom] Order #: 60917267
Future Orders VITAMIN B12 [LABNO Custom] Order #: 60917185 FOLATE [LABNO Custom] Order #: 60917187 SED RATE WESTERGREN [LABNO Custom] Order #: 60917188 ANTI-NUCLEAR AB (ANA) [LAB001 Custom] Order #: 60917189 ACETYLCHOLINE BLOCKING AB [LABNO Custom] Order #: 60917190 ALBUMIN [LABNO Custom] Order #: 60917268 CORTISOL [LABNO Custom] Order #: 60917271 Expected By 11/2/10 Expires 11/2/11
11/2/10 11/2/10 11/2/10 11/2/10 11/2/10 11/2/10
11/2/11 11/3/11 11/2/11 11/2/11 11/2/11 11/2/11
Immunizations
Immunizations as of 11/2/2010 Name Date 11/2/2010 Cyanocobalamin inj clinic Site: Left deltoid Given By: Clare Jennings, MA Dose VIS Date 1,000mcg NA Never Reviewed Route Intramuscular
000185
Visit Summary
Vitals Recorded in This Encounter 11/02/2010 1209 97.523 kg (215 lb) Weight: 36.3 C (97.3 F) Temp: Tympanic Temp src: 66 Pulse: 130/80 mmHg BP: sitting Orthostatic Position: left arm SITE: regular Cuff Size: 2 Pain Score: HIP Pain Loc: Medications Given (Excluding those documented in Imm/Injections Activity) No data found. Progress Notes
Victor Baquero, MD, MD 11/2/2010 1:50 PM Signed Chief Complaint Patient presents with Fatigue possible thyroid prob, not doing any better
Subjective: Mark Amundsen is a 51yr old male who is here for the following reason: Follow up. Still feels weak, tired diffusely. Has mental fatigue as well. No focal symptoms. Off all supplements and medications except for his vitamin D, low dose thyroid replacement, methadone. Feels better when he takes the methadone - it increases his energy and alertness. No pain or other constitutional symptoms. Not able to return to work yet due to symptoms. No focal neurologic symptoms. Review of Systems: Constitutional: negative. CV: negative. Resp: negative. Neuro: fatigue otherwise normal.
Patient Active Problem List Diagnoses BACKACHE NOS TESTICULAR HYPOFUNC NEC ADVANCED OSTEOARTHRITIS OF THE LEFT HIP DEPRESSIVE DISORDER CHRONIC PAIN MEDICATION AGREEMENT
Code 724.5 257.2 726.5 311 719.45
000186
Anemia Orthopedic Aftercare for Joint Replacement Dyslipidemia Vitamin D deficiency Hypertension High arch
285.9Y V54.81B 272.4CB 268.9G 401.9AH 755.67G Dispense 100 Tab Refill 1
Current outpatient prescriptions ordered prior to encounter Medication Sig Carisoprodol (SOMA) 350 mg Take 2 Tabs by mouth every Tablet day at bedtime. Ergocalciferol, Vitamin D2, Take 1 Cap by mouth. take 1 (VITAMIN D) 50,000 unit PO capsule by oral route twice Capsule weekly for next 2 months. Then lab follow up 4 weeks later. Fenofibrate (TRICOR) 145 mg Take 1 Tab by mouth every PO Tablet morning after a meal. Hydrocodone 10 Take 1 Tab by mouth every 4 mg/Acetaminophen 325 mg to 6 hours if needed for pain. (NORCO) 10-325 mg Tablet For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. Levothyroxine (LEVOXYL) 50 Take 1 Tab by mouth every mcg Tablet day. take on an empty stomach Methadone (DOLOPHINE) 10 Take 2 Tabs by mouth every mg Tablet 6 hours. Triamterene 37.5 Take 1 Tab by mouth every mg/Hydrochlorothiazide 25mg morning. (MAXZIDE-25) 37.5-25 mg PO Tablet
8 Cap
30 Tab 100 Tab
11 0
30 Tab 200 Tab 30 Tab
3 0 3
BP 130/80 | Pulse 66 | Temp(Src) 36.3 C (97.3 F) (Tympanic) | Wt 97.523 kg (215 lb) OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Eyes: conjunctivae and corneas clear. PERRL, EOM's intact. sclerae normal. Heart: normal rate and regular rhythm, no murmurs, clicks, or gallops. Lungs: clear to auscultation. Extremities: no cyanosis, clubbing, or edema. Skin: Skin color, texture, turgor normal. No rashes or lesions. Neuro: Gait normal. Reflexes normal and symmetric. Sensation normal. Midly week. No fatiguability. Mental Status: blunted. Tired apearing. Normal answers to questions. Musculoskeletal: grossly normal. DATA (reviewed with patient): EKG: normal . ASSESSMENT: 780.79L Weakness/fatigue (primary encounter diagnosis)
000187
Comment: suspect physiologic cause. Vit D and thyroid replacement have not helped much. Possibly related to methadone. Will check further labs to rule out more rare disorders. Offered B12 injection. Follow up in 1-2 weeks. Discussed care and warning signs with Mark and all questions and concerns were fully answered. He will call or followup in the office if any problems arise. Plan: VITAMIN B12, FOLATE, SED RATE WESTERGREN, ANTI-NUCLEAR AB (ANA), ACETYLCHOLINE BLOCKING AB, CYANOCOBALAMIN INJ CLINIC, POC ELECTROCARDIOGRAM WITH RHYTHM STRIP, TESTOSTERONE,BIOAVAIL MALE>17, ALBUMIN, CORTISOL PLAN: See Orders. Discussed care and warning signs with Mark and all questions and concerns were fully answered. He will call or followup in the office if any problems arise. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his/her medical care. No guarantees were made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit. Electronically signed by: Victor Baquero, MD Associate Physician Associate Medical Director UC Davis Medical Group, Folsom
Electronically signed by Victor Henrique Baquero, MD at 11/2/2010 1:50 PM Visit Notes Clare Jennings, MA Tue Nov 2, 2010 12:48 PM EKG done per doctors order Electronically signed by Clare Jennings, MA at Tue Nov 2, 2010 12:48 PM Clare Jennings, MA Tue Nov 2, 2010 12:09 PM Vital signs taken, allergies verified, screened for pain, pharmacy verified, and verified immunization status. Clare Jennings, MA Electronically signed by Clare Jennings, MA at Tue Nov 2, 2010 12:09 PM All Flowsheet Templates (all recorded) Amb Vitals Group Flowsheet Custom Formula Data Flowsheet

Problem List
Problem List as of 11/02/2010 Problem Noted Resolved
000188
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Center None
Office Visit
Provider Barton Lahn Wise, MD, MD

Department Rheumatology Acc
Referring Provider Victor Baquero, MD Insurance Information Acct Number 038697465029 1

Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Diagnoses Weakness - Primary Enthesopathy of hip region Pain in joint, pelvic region and thigh
780.79 726.5 719.45
000189
Reason for Visit Consultation Weakness
Medications
Medications at Start of Encounter Disp Refills Start End 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 8 Cap 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. - ORAL Class: Pharmacy 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet 30 Tab Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 1 9/22/2010 2/1/2011 100 Tab Carisoprodol (SOMA) 350 mg Tablet (Discontinued) Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Pharmacy 0 1/21/2011 2/21/2011 Hydrocodone 10 mg/Acetaminophen 325 100 Tab mg (NORCO) 10-325 mg Tablet (Taking) Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 240 Tab 0 1/24/2011 2/23/2011 Methadone (DOLOPHINE) 10 mg Tablet (Taking) Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Class: Handwritten Rx Discontinued Medications Reason for Discontinue Carisoprodol (SOMA) 350 mg Tablet Medication Review History Med Rev Hx Medication Administration Report for Amundsen, Mark All administrations No administration data available Pharmacy Selected For Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630
Orders
Order Summary NEUROLOGY CLINIC REFERRAL [100029 Custom] Order #: 64440434 Future Orders CREATINE KINASE [LABNO Custom] Order #: 64440432 HEPATIC FUNCTION PANEL [LABNO Expected By 2/1/11 2/1/11 Expires 2/1/12 2/1/12
000190
Custom] Order #: 64440433
Immunizations
Visit Summary
Vitals Recorded in This Encounter 02/01/2011 0922 101.515 kg (223 lb 12.8 oz) Weight: 1.854 m (6' 1") Height: 29.6 BMI: 2.29 m2 BSA: 36.8 C (98.2 F) Temp: Oral Temp src: 68 Pulse: 16 Resp: 106/69 mmHg BP: sitting Orthostatic Position: left arm SITE: regular Cuff Size: 3 Pain Score: HIP Pain Loc: both wise Comments: Medications Given (Excluding those documented in Imm/Injections Activity) No data found. LMP / OB Status - Last Recorded BMI 29.53 kg/m2 Transcription Type RHEUM Referral Letter Ext (1712) Electronically Signed Document Text February 01, 2011 RE: AMUNDSEN, MARK MR#: 8081369 DOB: 09/23/1959 Date of Service: 02/01/2011 ID 11900701 Date and Time 2/1/2011 4:57 PM Author Xiao Cai, MD
VICTOR HENRIQUE BAQUERO, MD
000191
Dear Dr. Baquero: Thank you for referring your patient Mr. Amundsen to us for consultation. Chief Complaint: Weakness of legs and arms.
History of Present Illness: Mr. Amundsen is an 51-year-old gentleman with a history of osteoarthritis and chronic pain on methadone and Norco, hypertension, who is referred by his primary physician, Dr. Victor Baquero, for weakness of his legs and arms of three-month duration. This patient has history of osteoarthritis of the hip requiring left arthroplasty back in December 2009, and chronic right hip pain requiring high-dose methadone and Norco. In terms of his most acute symptoms of weakness, he reports development of weakness in his thigh and upper arms over a weekend in October. He said he woke up one day barely able to walk or stand up. He feels like he ran a marathon. He is no longer able to walk for more than five minutes because of weakness. As a result, he has been on disability around the same time because he no longer is able to return to work as a network administrator. Besides the weakness, he also complains of worsening left hip pain around his left arthroplastic site. He denies any joint swelling or erythema around the adjoining region. He denies any myalgia or muscle tenderness. He denies any difficulty with activities such as putting his clothes on, brushing his hair. He denies any fever or chills but feels that his temperature has not been regulated properly. He reports about 15 minutes of morning stiffness. For the last eight to nine weeks, he also noted that the anterior aspect of his right foot right underneath his right toes and near the dorsum of his foot, with burning and increasing painful sensation. He denies any sensory loss in the area. He thinks his symptoms are possibly related to some sort of neurologic involvement per his reading on line. All his symptoms feel improved but not resolved with the methadone and ethanol use on alcohol. He also thinks his worsening left hip pain might be due to the particular brand of his prosthesis he had, as there is a recall of left hip prosthesis that was similar to his but not his particular model. The patient denies any trauma or recent travel. Past Medical History: Osteoarthritis status post left arthroplasty in 2009, history of low back pain, hypertension, hypertriglyceridemia. Past Surgical History: Hernia repair in 1986, tonsillectomy in 1966, left hip replacement in 2009. Medications: Methadone 20 mg every 6 hours, 240 per month; Norco 10/325 q4-6 hours as needed, Soma 350 2 tabs q.h.s. Allergies: Morphine, fentanyl.
Social History: The patient has been on disability since October because of weakness. Prior to that he used to work as a network administrator. He was married, but his wife is deceased. Now he currently lives in Folsom by himself. He reports drinking one beer per week, history of one-pack smoking for the last 30 years. He denies any illicit drug use.
000192
Family History: Mom had either lung cancer or breast cancer in 70's. She also has history of rheumatoid arthritis. Dad had stroke at 88. Both brother and sister have asthma. Review of Systems: Constitutional fatigue and weakness, headaches, muscle spasm, sensitivity. GU: Frequent urination at night. Musculoskeletal: Morning stiffness for 30 minutes, bilateral hip pain left greater than right. Extremities: Some swelling of his right foot. The rest of the 14-point review of systems is negative except for positives noted in HPI. Physical Examination: Vitals: Temp 98.2, heart rate 68, blood pressure 106/69, weight 224, 3 of 10 pain in his hips. General: Overweight, middle-aged gentleman who appears his stated age, in no acute distress walking and speaking without any difficulty. Skin: No rashes. HEENT: Eyes anicteric, EOMs full, PERRLA, oral mucosa pink and moist without exudates, tongue midline. Neck: Supple with no lymphadenopathy. Lungs: CTAB. CV: No JVDR, normal S1 and S2 without murmurs, rubs, or gallops. Abdomen: Soft, nondistended, nontender. Extremities: +2 bilateral pulses, no lower extremity edema. Musculoskeletal: No effusion in the joints of the hands, wrist, elbows, knees, ankles, and feet bilaterally. There is full range of motion in the extension and flexion of his joints. He has a full range of motion in his hands, wrists, elbows, knees, ankles, and hips. There is no synovitis throughout the exam. Neuro: Cranial nerves II through XII intact, deep tendon reflexes were tested in brachioradialis, biceps, triceps, and Achilles areas bilaterally and were 2+ throughout. DTRs were 1+ bilaterally at the patellae, but were symmetric. Motor strength was 5 out of 5 for biceps, deltoids , quadriceps, gastrocnemius, anterior tibialis, neck and grip. His gait was mildly wide-based with decreased motor strength on his left side. He walks slumped over but was able to be in a neutral position when asked to extend his back. He does require holding himself up when going from a sitting position to a standup position. Mental Status: The patient appears depressed but alert and oriented x 3 and answers appropriately to questions. Laboratories from 11/02/2010 were all in the normal limits. CK 40, acetylcholine antibody was 8, ESR is 8, ANA is negative. BMP from 10/18/2010 was within normal limits, and CBC also within normal limits. Assessment and Plan: 51 yo man with osteoarthritis and hip replacement, now with new progressive weakness of the lower and upper extremities with mostly negative physical exam and normal CK, ESR and ANA. 1) Weakness. The patient described symptoms of weakness of a progressive nature, now involving weakness of his back, which is somewhat atypical to have. Little of his weakness is convincing for rheumatologic disease and his inflammatory markers such as ESR and ANA are all negative. The patient's presentation does not fit the picture of rheumatological diseases such as polymyositis or rheumatoid arthritis. His symptoms of 15 minutes of morning stiffness is too brief to be rheumatalgically related. His age again is fairly young to present with polymyalgia rheumatica and he has no pains that are strongly suggestive of RA by distribution or otherwise. In terms of other possible differentials, in certain cases chronic use of
000193
methadone can cause muscle breakdown leading to weakness. However, his CK from February 2010 was normal, in addition to his LFT's. However, given his methadone use, we think it is reasonable to check another CK level; we suspect the CK is again going to be normal. In addition to other explanations, his weakness we think is likely more neurological rather than rheumatological. We may consider something like chronic inflammatory demyelinating polyneuropathy (CIDP) which can present with progressive weakness. The patient also reports a component of neuropathic pain isolated to his right foot, although his physical exam did not show any gross sensory loss. It is somewhat odd to have isolated neuropathic pain in one extremity without any involvement to other extremities; CIDP can cause asymmetric sensory and modal changes. As a result, we think it is best to refer him to our Neurology colleagues to see whether further workup is necessary. We will defer workup such as nerve conduction studies to them. In the meantime, we will check another CK level and LFT's to rule out muscle involvement, however we expect the yield to be low. 2) Chronic pain. We note that the patient is on high-dose methadone for his chronic pain, but he also reports occasional drinking with his opiate. We spoke to him extensively regarding the possible interaction with this combination of opiates and alcohol. We have advised him to abstain from alcohol to minimize the side effects of the medication. I have educated/instructed the patient regarding all aspects of the above-stated plan of care. The patient acknowledges understanding of plan of care. I spent 60 minutes with this patient, more than 50 percent of which was in counseling regarding his symptoms and questions. Followup: The patient does not need to be followed-up by Rheumatology at this time as this is not likely rheumatologic in nature. He can certainly be rereferred to our Clinic if new information arises that points toward rheumatologic disease as needed or he may call prn.
XIAO CAI, MD RESIDENT DEPARTMENT OF INTERNAL MEDICINE THIS WAS ELECTRONICALLY SIGNED - 02/04/2011 12:15 PM PST BY: I saw, examined, and interviewed the patient personally. I agree with the resident's note and assessment and plan which we developed together. THIS WAS ELECTRONICALLY SIGNED - 02/02/2011 5:30 PM PST BY: BARTON WISE, MD ATTENDING
XC:cg(ucd039) D: 02/01/2011 04:57 PM T: 02/02/2011 09:48 AM C#: 5343837
000194
Relation Mother Father Employment History Occupation network administrator Comment: currently unemployed
Status Deceased Alive Employer
Problem List
Problem List as of 06/20/2011 Problem Unspecified backache Other testicular hypofunction Class: Chronic Brachial neuritis or radiculitis NOS ADVANCED OSTEOARTHRITIS OF THE LEFT HIP Class: Chronic DEPRESSIVE DISORDER Noted Resolved
10/22/2010 1/19/2006 5/26/2006 4/30/2008

Class: Acute C. difficile diarrhea Anemia Orthopedic aftercare for joint replacement Dyslipidemia 5/29/2009 12/19/2009 1/5/2010 2/1/2010 7/12/2010
See lab

Class: Acute High arch 7/12/2010 2/17/2011 3/5/2011 3/29/2011 3/29/2011 Mark Amundsen (MRN 8081369) Provider Victor Baquero, MD, MD Department Fol Family Practice

DELETED: Weakness DELETED: Demyelinating neuropathy Class: Acute Preop testing Polyneuropathy
Office Visit
Insurance Information Acct Number 078661756060
Financial Class P
000195
Diagnoses Enthesopathy of hip region - Primary Polyneuropathy Pain in joint, pelvic region and thigh Orthopedic aftercare for joint replacement Hypothyroid Reason for Visit Medication Follow Up Test Results Level of Service OFFICE/OUTPT VISIT,EST,LEVL IV [99214]
726.5 356.9 719.45 V54.81 244.9
x rays
Medications
Disp Refills Start End 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 8 Cap 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. - ORAL Class: Pharmacy 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet 30 Tab Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 100 Tab 1 4/29/2011 7/30/2011 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Pharmacy 1 6/3/2011 7/3/2011 Hydrocodone 10 mg/Acetaminophen 325 100 Tab mg (NORCO) 10-325 mg Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed. - ORAL Class: Pharmacy 240 Tab 0 5/26/2011 6/20/2011 Methadone (DOLOPHINE) 10 mg Tablet (Discontinued) Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Class: Handwritten Rx
000196
Ordered Medications Methadone (DOLOPHINE) 10 mg Tablet (Discontinued) Take 2 Tabs by mouth every 6 hours. - ORAL Discontinued Medications Reason for Discontinue Methadone (DOLOPHINE) 10 mg Tablet Medication Review History Med Rev Hx Medication Administration Report for Amundsen, Mark All administrations No administration data available Pharmacy Selected For Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Disp 7 Tab Refills 0 Start 6/20/2011 End 7/13/2011
Orders
Order Summary ORTHOPEDIC-GENERAL REFERRAL [100042 Custom] Order #: 70165625 Future Orders THYROID STIMULATING HORMONE [LABNO Custom] Order #: 70166206 THYROXINE, FREE (FREE T4) [LABNO Custom] Order #: 70166207 Expected By 6/20/11 6/20/11 Expires 6/19/12 6/19/12
Immunizations
Visit Summary
Vitals Recorded in This Encounter 06/20/2011 0834 101.152 kg (223 lb) Weight: 36.2 C (97.2 F) Temp: Tympanic Temp src: 76 Pulse: 118/86 mmHg BP: sitting Orthostatic Position: left arm SITE: regular Cuff Size: 4 Pain Score: HIP Pain Loc:
000197
Victor Baquero, MD, MD 6/20/2011 2:22 PM Signed Chief Complaint Patient presents with Medication Follow Up Test Results x rays
Subjective: Mark Amundsen is a 51yr old male who is here for the following reason: Follow up on pain medications, recent xray, left sided hip pain. Status post left total hip replacement. Feels pain along lateral left hip and someitimes in the posterior buttocks. This pain is constant, however worse after prolonged walking. Has pain when laying on the ipsilateral side. Symptoms are mild to moderate. Pain medications don't work as well when the pain is more pronounced. Had to increase the methaodne. Reports ongoing neurologic symptoms - seeing neurology for this. Tingling, numbness wymmetrically to the lower extremities. No new symptoms. Pending neurology work up. Abnormal NCT. Notes heat intolerance as well. Not sure what that may be due to. Needs refills of his pain medications. Review of Systems: Constitutional: negative. CV: negative. Resp: negative.
History Substance Use Topics Smoking status:
Types: Smokeless tobacco: Alcohol Use: rare
Current Everyday Smoker -- 1.0 packs/day for 20 years Cigarettes Not on file Yes
Patient Active Problem List Diagnoses BACKACHE NOS TESTICULAR HYPOFUNC NEC ADVANCED OSTEOARTHRITIS OF THE LEFT HIP DEPRESSIVE DISORDER CHRONIC PAIN MEDICATION AGREEMENT Anemia Orthopedic Aftercare for Joint Replacement Dyslipidemia Vitamin D deficiency Hypertension High arch Preop testing Polyneuropathy
Code 724.5 257.2 726.5 311 719.45 285.9Y V54.81B 272.4CB 268.9G 401.9AH 755.67G V72.84P 356.9AG
000198
Current outpatient prescriptions ordered prior to encounter Medication Sig Carisoprodol (SOMA) 350 mg Take 2 Tabs by mouth every Tablet day at bedtime. Ergocalciferol, Vitamin D2, Take 1 Cap by mouth. take 1 (VITAMIN D) 50,000 unit PO capsule by oral route twice Capsule weekly for next 2 months. Then lab follow up 4 weeks later. Fenofibrate (TRICOR) 145 mg Take 1 Tab by mouth every PO Tablet morning after a meal. Hydrocodone 10 Take 1 Tab by mouth every 4 mg/Acetaminophen 325 mg to 6 hours if needed. (NORCO) 10-325 mg Tablet Methadone (DOLOPHINE) 10 Take 2 Tabs by mouth every mg Tablet 6 hours. Triamterene 37.5 Take 1 Tab by mouth every mg/Hydrochlorothiazide 25mg morning. (MAXZIDE-25) 37.5-25 mg Tablet
Refill 1 1
30 Tab 100 Tab 7 Tab 30 Tab
11 1 0 3
C (97.2 F) (Tympanic) | Wt 101.152 kg (223 lb) BP 118/86 | Pulse 76 | Temp(Src) 36.2 OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Skin: Skin color, texture, turgor normal. No rashes or lesions. Neuro: hypaesthesias in lower extremities. Mild weakness. Limited exam. . Mental Status: normal mentation. Euthymic. Musculoskeletal: Area over the left greater trocanther is tender to palpation. Limited range of motion of the left hip. ASSESSMENT: 726.5 ADVANCED OSTEOARTHRITIS OF THE LEFT HIP (primary encounter diagnosis) Comment: xrays reviewed. Right hip osteo arthritis. Left hip - status post hip replacement. Discussed pain medicaition, ortho follow up. Consider steroid injection for presumptive trochantheric bursitis. However will try stretches first. Handout given. Plan: ORTHOPEDIC-GENERAL REFERRAL, Methadone (DOLOPHINE) 10 mg Tablet 356.9AG Polyneuropathy Comment: continue follow up with neurology. Provided advice on treatmet and management. Plan: 719.45 CHRONIC PAIN MEDICATION AGREEMENT Comment: Plan: Methadone (DOLOPHINE) 10 mg Tablet V54.81B Orthopedic aftercare for joint replacement Comment: as above. Plan: Methadone (DOLOPHINE) 10 mg Tablet 244.9AA Hypothyroid Comment: recheck. See HPI. Heat intolerance. No other symptoms. Plan: THYROID STIMULATING HORMONE, THYROXINE, FREE (FREE T4)
000199
PLAN: See Orders. Discussed care and warning signs with Mark and all questions and concerns were fully answered. He will call or followup in the office if any problems arise.
Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his/her medical care. No guarantees were made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit. Electronically signed by: Victor Baquero, MD Associate Physician Associate Medical Director UC Davis Medical Group, Folsom
Electronically signed by Victor Henrique Baquero, MD at 6/20/2011 2:22 PM Visit Notes Clare Jennings, MA Mon Jun 20, 2011 8:35 AM Vital signs taken, allergies verified, screened for pain, pharmacy verified, and verified immunization status. Clare Jennings, MA Electronically signed by Clare Jennings, MA at Mon Jun 20, 2011 8:35 AM All Flowsheet Templates (all recorded) Amb Vitals Group Flowsheet Custom Formula Data Flowsheet

Problem List
10/22/2010 1/19/2006 5/26/2006 4/30/2008

Class: Acute C. difficile diarrhea Anemia 5/29/2009 12/19/2009 7/12/2010
000200
Class: Acute Preop testing Polyneuropathy
3/29/2011 3/29/2011
8/16/2011 Mark Amundsen (MRN8081369)
Appointment
DOB 9/23/1959
Account # 078661756086 Patient Demographics Address 2025 TARBOLTON CIR FOLSOM CA 95630 Selected Appointment 8/16/2011 9:47 AM
Department Ucd Registration Phone 916-509-0158 (Home) 916-983-4484 (Work) E-mail Address mamundsen@sbcglobal.net
Plan UCD/B/S HMO
Financial Class P
Plan Number B72
Plan Phone 916-734-0739
Center None
Office Visit
Insurance Information Acct Number
Financial Class
000201
078661756086 1 Payor UCD Patient Insurance ID XEHJ00044785 Group Number PH0010 Plan UCD/B/S HMO Plan Number B72
Plan Phone 916-734-0739
Diagnoses Hypothyroid Enthesopathy of hip region Pain in joint, pelvic region and thigh Enthesopathy of hip region Reason for Visit Medication Follow Up Level of Service OFFICE/OUTPT VISIT,EST,LEVL IV [99214]
244.9 726.5 719.45 726.5
Medications
Medications at Start of Encounter Disp Refills Start End 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 8 Cap 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. - ORAL Class: Pharmacy 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet 30 Tab Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 100 Tab 1 4/29/2011 8/16/2011 Carisoprodol (SOMA) 350 mg Tablet (Discontinued) Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Pharmacy 7 Tab 0 8/9/2011 9/8/2011 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. 9 daily. - ORAL Class: Handwritten Rx Ordered Medications Levothyroxine (SYNTHROID) 75 mcg Tablet (Discontinued)
Disp 30 Tab Refills 11 Start 8/16/2011 End 11/4/2011
000202
Take 1 Tab by mouth every morning before a meal. take on an empty stomach - ORAL 100 Tab 1 8/16/2011 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet (Discontinued) Take 1 Tab by mouth every 4 to 6 hours if needed. - ORAL 1 8/16/2011 100 Tab Carisoprodol (SOMA) 350 mg Tablet (Discontinued) Take 2 Tabs by mouth every day at bedtime. - ORAL Discontinued Medications
10/26/2011
2/21/2012
Reason for Discontinue Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet Carisoprodol (SOMA) 350 mg Tablet Medication Review History Med Rev Hx Medication Administration Report for Amundsen, Mark All administrations No administration data available Pharmacy Selected For Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630
Orders
Order Summary POC ELECTROCARDIOGRAM WITH RHYTHM STRIP [93000 Custom] Order #: 72477287
Immunizations
Visit Summary
Vitals Recorded in This Encounter 08/16/2011 0952 103.42 kg (228 lb) Weight: 36.4 C (97.6 F) Temp: Tympanic Temp src: 67 Pulse: 114/74 mmHg BP: sitting Orthostatic Position: left arm SITE: regular Cuff Size: 4 Pain Score: HIP Pain Loc: Medications Given (Excluding those documented in Imm/Injections Activity) No data found. Progress Notes
000203
Victor Baquero, MD, MD 8/16/2011 1:22 PM Signed Chief Complaint Patient presents with Medication Follow Up
Subjective: Mark Amundsen is a 51yr old male who is here for the following reason: 1. On methadone for chronic bilateral hip pain. Severe osteo arthritis. Sees ortho. On methadone long term. No side effects. 2. Follow up on labs. Symptoms of fatigue, dry skin, malaise, weight gain. Review of Systems: Constitutional: negative. CV: negative. Resp: negative.
History Substance Use Topics Smoking status: Types: Smokeless tobacco: Alcohol Use: rare
Patient Active Problem List Diagnoses BACKACHE NOS TESTICULAR HYPOFUNC NEC ADVANCED OSTEOARTHRITIS OF THE LEFT HIP DEPRESSIVE DISORDER CHRONIC PAIN MEDICATION AGREEMENT Anemia Orthopedic Aftercare for Joint Replacement Dyslipidemia Vitamin D deficiency Hypertension High arch Polyneuropathy Current outpatient prescriptions ordered prior to encounter Medication Sig Carisoprodol (SOMA) 350 mg Take 2 Tabs by mouth every Tablet day at bedtime. Ergocalciferol, Vitamin D2, Take 1 Cap by mouth. take 1 (VITAMIN D) 50,000 unit PO capsule by oral route twice Capsule weekly for next 2 months. Then lab follow up 4 weeks later. Fenofibrate (TRICOR) 145 mg Take 1 Tab by mouth every PO Tablet morning after a meal. Methadone (DOLOPHINE) 10 Take 2 Tabs by mouth every mg Tablet 6 hours. 9 daily.
Code 724.5 257.2 726.5 311 719.45 285.9Y V54.81B 272.4CB 268.9G 401.9AH 755.67G 356.9AG
Dispense 100 Tab Refill 1
8 Cap
30 Tab 7 Tab
11 0
000204
Triamterene 37.5 Take 1 Tab by mouth every mg/Hydrochlorothiazide 25mg morning. (MAXZIDE-25) 37.5-25 mg Tablet
30 Tab
BP 114/74 | Pulse 67 | Temp(Src) 36.4 C (97.6 F) (Tympanic) | Wt 103.42 kg (228 lb) OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Skin: Skin color, texture, turgor normal. No rashes or lesions. Mental Status: blunted affect normal mood. Musculoskeletal: moderate osteo arthritis of hips. Limited evaluation. Antalgic gait. ASSESSMENT: 244.9AA Hypothyroid Comment: labs and symptoms consistent with mild hypothyroid state. TRT discussed. Risks and benefits discussed in detail. Will initiate treatment. Recheck labs in 6 weeks. Plan: Levothyroxine (SYNTHROID) 75 mcg Tablet 726.5 ADVANCED OSTEOARTHRITIS OF THE LEFT HIP Comment: on methadone. EKG checked per guidelines. Normal QT interval. Requested repeat in 6 months. The current medical regimen is effective; continue present plan and medications. Plan: POC ELECTROCARDIOGRAM WITH RHYTHM STRIP 719.45 CHRONIC PAIN MEDICATION AGREEMENT Comment: as above. Plan: 726.5 Enthesopathy of hip region Comment: continue follow up with ortho. Plan: Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet PLAN: See Orders. Discussed care and warning signs with Mark and all questions and concerns were fully answered. He will call or followup in the office if any problems arise. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his/her medical care. No guarantees were made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit. Electronically signed by: Victor Baquero, MD Associate Physician Associate Medical Director UC Davis Medical Group, Folsom
Electronically signed by Victor Henrique Baquero, MD at 8/16/2011 1:22 PM Visit Notes Clare Jennings, MA Tue Aug 16, 2011 9:59 AM EKG done per doctors order Electronically signed by Clare Jennings, MA at Tue Aug 16, 2011 9:59 AM
000205
Clare Jennings, MA Tue Aug 16, 2011 9:53 AM Vital signs taken, allergies verified, screened for pain, pharmacy verified, and verified immunization status. Clare Jennings, MA Electronically signed by Clare Jennings, MA at Tue Aug 16, 2011 9:53 AM All Flowsheet Templates (all recorded) Amb Vitals Group Flowsheet Custom Formula Data Flowsheet

Problem List
10/22/2010 1/19/2006 5/26/2006 4/30/2008

See lab

Class: Acute High arch 7/12/2010 2/17/2011 3/5/2011 3/29/2011 3/29/2011
Closed Time

DELETED: Weakness DELETED: Demyelinating neuropathy Class: Acute Preop testing Polyneuropathy Encounter Closed By Closed By
Closed Date
8/16/2011
000206
BAQUERO, VICTOR H
08162011
13:22 Mark Amundsen (MRN 8081369)
Office Visit
Provider David P Richman, MD, MD
Department Neurology Faculty Acc
Referring Provider Victor Baquero, MD Insurance Information Acct Number 038697465086 1 Payor UCD Patient Insurance ID XEHJ00044785 Group Number PH0010
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Diagnoses Polyneuropathy - Primary Abnormality of gait Disturbance of skin sensation Other malaise and fatigue Reason for Visit Consultation Level of Service OFFICE/OUTPT VISIT,EST,LEVL IV [99214]
356.9 781.2 782.0 780.79
Dx added by coding staff Dx added by coding staff Dx added by coding staff
New Patient
Medications
Medications at Start of Encounter Disp Refills Start End 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 8 Cap 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. - ORAL Class: Pharmacy 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet 30 Tab Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy
000207
30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 100 Tab 1 8/16/2011 11/16/2011 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Pharmacy 1 8/16/2011 9/15/2011 Hydrocodone 10 mg/Acetaminophen 325 100 Tab mg (NORCO) 10-325 mg Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed. - ORAL Class: Pharmacy 30 Tab 11 8/16/2011 8/15/2012 Levothyroxine (SYNTHROID) 75 mcg Tablet Sig - Route: Take 1 Tab by mouth every morning before a meal. take on an empty stomach - ORAL Class: Pharmacy 7 Tab 0 8/9/2011 9/8/2011 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. 9 daily. - ORAL Class: Handwritten Rx Medication Review History Med Rev Hx Medication Administration Report for Amundsen, Mark All administrations No administration data available Pharmacy Selected For Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630
Immunizations
Visit Summary
Vitals Recorded in This Encounter 08/16/2011 1307 103.8 kg (228 lb 13.4 oz) Weight: 1.854 m (6' 1") Height: 30.3 BMI: 2.31 m2 BSA: 36.8 C (98.2 F) Temp: Oral Temp src: 58 Pulse: 16 Resp: 111/63 mmHg BP: sitting Orthostatic Position: left arm SITE: large Cuff Size:
000208
Pain Score: Pain Loc: Comments:
4 HIP bilateral
Bethany Marie Lipa, MD 8/16/2011 7:01 PM Addendum, Last edited by: David P Richman, MD (8/23/2011 8:59 AM) Neurology Clinic Initial Evaluation by Dr. Richman
Referring Physician: Victor Baquero 251 Turn Pike Drive Folsom, Ca 95630 (916) 985-9300 CC: Leg numbness and weakness HPI: Mr. Amundsen is a 51-year-old right-handed male with complaints of leg weakness and numbness. He recalls new onset of acute right foot swelling and numbness approximately 10 months ago. Two months later he experienced an acute onset of bilateral "leg fatigue", leg weakness, and numbness upon waking one morning. He denies any any muscle pain or preceding events including viral illness, gastroenterisit, vaccinations or falls/trauma. Since onset of symptoms, he reports minimal progression of weakness (has worsened by ~10%) and no progression of numbness. He has had difficulty walking long distances >100 yards, ascending and descending stairs and getting up from a low chair. He denies any worsening of weakness toward the end of the day, but does report worsening leg fatigue with any physical activity. He has experienced several episodes of shoulder weakness but states that this completely resolves after several days. Was not prescribed statins in the past. He denies any hand weakness or forearm muscle wasting. He reports 4 episodes of blurry vision in the past 10 months, but denies double vision, eye lid drooping, change in voice quality, difficulty chewing or swallowing solids/liquids. Muscle weakness has been accompanied by a constant numbness/pins and needles/burning sensation in his bilateral lower limbs (feet > legs). He denies any exacerbating or relieving factors with respect to leg numbness. Work-up thus far has included electrodiagnostic studies, CSF analysis (results below), anti-ACh receptor Ab (negative), Serum protein electrophoresis (negative) and urine heavy metals. He was recently seen by by Dr. Oh (June 2011) who requested a second opinion regarding the possible diagnosis of CIDP and treatment with steroids. In addition to seeing neurology, he has also been evaluated by Dr. Wise (rheumatology) who ruled out a rheumatologic condition (also suspected CIDP). Drs. Chesak (Fellow), Bakshi and Maselli performed electrodiagnostic studies in March of 2011 which revealed evidence of "segmental demyelination in the bilateral lower extremities consistent with a predominantly demyelinating polyneuropathy affecting the bilateral lower extremities with no evidence of myopathy." Decreased conduction velocities (30-31m/s) were noted on bilateral tibial and left peroneal motor studies. Right sural SNAP was absent, while left had diminished amplitude with conduction slowing (34m/s). Needle EMG of the bilateral lower limbs and left upper limb was essentially normal. PSHx: Tonsillectomy in 1965, inguinal hernia repair in 1986, left THA 12/15/09. PMHx: HTN, anemia, Bilateral hip osteoarthritis s/p Left THA, Hypogonadism secondary to chronic opioid use, Lumbar degenerative disc disease, Lumbar radiculitis, Obesity. Pt denies history of DM or prior treatment with chemotherapy.
000209
ALLERGIES: morphine and fentanyl cause pruritis MEDICATIONS: - Carisoprodol (SOMA) 350 mg Tablet, 2 Tabs by mouth every day at bedtime. - Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet, 1 Tab by mouth every 4 to 6 hours if needed. - Methadone (DOLOPHINE) 10 mg Tablet, 2 Tabs by mouth every 6 hours. SOCIAL HISTORY: Quit smoking 20 years ago. Rare alcohol use. Previously worked as a network administrator. Currently not working. Lives alone in a 1-floor home. Family Hx: Mother: Italian/German, died at 75 cancer (breast vs. Lung) Father: Norway/Ireland, died at 83 complications of stroke Denies family history of myopathy or neuropathy.
Exam: Temp: 36.8 C (98.2 F) (08/16 1307) Temp src: Oral (08/16 1307) Pulse: 58 (08/16 1307) BP: 111/63 mmHg (08/16 1307) Resp: 16 (08/16 1307) SpO2: -Height: 1.854 m (6' 1") (08/16 1307) Weight: 103.8 kg (228 lb 13.4 oz) (08/16 1307) General: sitting on exam table in NAD, WN WD, cooperative, A&O x3 MSK: Inspection: Pes cavus bilaterally Minimal atrophy bilateral distal legs ROM: full, functional active ankle dorsiflexion bilaterally Neurologic exam: CN: visual fields intact bialterally, +red reflex, PERRLA, EOMI, no ptosis noted with sustained upward gaze, facial sensation intact, face symmetric, normal SCM and shoulder shrug strength bilaterally, Soft palate elevates symmetrically, Tongue midline (+furrow midline). Sensation: Patchy sensory loss in bilateral lower limbs to light touch and pin prick Proprioception intact + stocking glove sensory loss to ankle level bilaterally Slightly diminished vibratory sense on right to the level of mid tarsal bone, > 10 second delay in vibratory sense bilaterally. Rhomberg negative. Motor: normal tone, minimal distal lower limb atrophy. MMT exam effort dependent: Shoulder abduction 4/5 bilat, 5/5 strength in remaining upper limb muscle groups. Hip flexion: pain-limited on the left (3-/5) 5/5 on the right Knee extension: 4/5 bilaterally; 5-/5 on the left 4/5 on the right EHL: 4/5 bilaterally PF: able to toe-walk 1+ brachioradialis, 2+ pronator and triceps, absent biceps Ankle DF:
Muscle stretch reflexes: bilat.
1+ quadriceps, absent triceps surae bilaterally Clonus: absent Babinski: absent (down-going bilaterally)
000210
Hoffman: absent GAIT: ambulates with SC in right hand, stiff knee gait (lack of normal knee flexion in swing phase), no foot drop, foot slap or Trendelenburg noted. Able to perform heel walking, toe walking and tandem gait. (Of note, on Dr. Richman's examination, MMT revealed 5/5 strength throughout, except pain-limited left hip flexion). LAB RESULTS: Normal: CK (45), Aldolase (5.7), B12 (478), Folate, ESR (8), BMP, LFTs, fasting glucose (94) ANA negative. 25 hydroxy vitamin D borderline low (25.1). Acetylcholine receptor binding antibody negative. Acetylcholine receptor blocking antibody negative. Acetylcholine receptor modulating antibody negative. MuSK antibody negative. *TSH elevated (3.42, 4.54). Free T4 normal. Thyroid peroxidase antibody negative. Urine heavy metals negative. Blood lead level not elevated. Hepatitis C antibody negative. Cryoglobulin 0. Ganglioside antibodes negative. Serum protein electrophoresis normal. Serum immunofixation normal. MAG antibody negative. SGPG antibody negative. CSF protein 44. CSF glucose 55. CSF WBC 3. CSF RBC 1. CSF Lyme antibody by ELISA negative. CSF VDRL nonreactive. CSF Gram stain and culture negative. CSF IgG synthesis rate <0. CSF IgG index 0.43 (0.28 - 0.66). CSF oligoclonal bands negative. Radiology results: Lumbar spine MRI without contrast 03/2004: Normal. No disc bulges, foraminal or central canal stenosis. Impression: 51-year-old with 10-month history of non-progressive lower limb parasthesias and subjective complaints of weakness. Clinical examination and diagnostic work-up has ruled out central causes. A bilateral polyradiculopathy is less likely due to normal needle EMG examination. Chronicity of lower limb symptoms (with subjective intermittent upper limb weakness) makes AIDP unlikely. A normal CSF protein level and lack of chronic or ongoing axonal loss changes on needle EMG places CIDP lower on the differential. Lack of consistent proximal muscle weakness on examination, the presence of sensory findings and normal needle EMG place myopathy much lower on the differential diagnosis. It is very unlikely that a combined myopathy and peripheral neuropathy co-exist. Despite pes cavus deformity and mild distal lower limb atrophy, conduction velocities on electrodiagnostic testing ranging from 30m/s-58m/s essentially ruling out demyelinating forms of hereditary motor sensory neuropathy.
000211
Recommendations: 1. Dr. Richman will review the electrodiagnostic findings from 3/2011 with Dr. Maselli and determine in repeat NCS/EMG is indicated. 2. Follow-up in 1 month to discuss possibility of repeating NCS/EMG. The patient was seen and examined with Dr. Richman and the plan was formed jointly. Bethany Lipa Neuromuscular fellow PM&R This patient was seen, evaluated, and care plan was developed with the resident (see my accompanying note). I agree with the assessment and plan as outlined in the resident's note except as noted. Report electronically signed by DAVID P RICHMAN, M.D., MD.
Previous Version Electronically signed by Bethany Marie Lipa, MD at 8/16/2011 7:01 PM Electronically signed by David P Richman, MD at 8/23/2011 8:59 AM Transcription Type Neurology Referral Letter (2211)
ID 12191415
Author David P Richman, MD
Document Text August 17, 2011 RE: AMUNDSEN, MARK MR#: 8081369 DOB: 09/23/1959 Date of Service: 08/16/2011
VICTOR HENRIQUE BAQUERO, MD UCDMG FOLSOM Dear Dr. Baquero: Thank you very much for sending Mr. Amundsen for neurologic evaluation concerning lower extremity numbness and weakness. I saw the patient this afternoon with Dr. Lipa and her note of our complete evaluation is enclosed. I have taken a history from the patient, examined him and reviewed his medical records, laboratory data and images, verifying the findings of Dr. Lipa except as noted below. I have discussed the findings and plan with Dr. Lipa and the patient. Ten months ago the patient developed tingling, numbness in the soles of his feet. He is not sure exactly the rate of onset although he states he began to notice it on awakening one morning. These symptoms gradually ascended to about the level of the mid-calf and he began to have occasional difficulty walking. He thinks this is related to his weakness. There were some times when he had some mild numbness in his hands as well. He has had an extensive work up for neuropathy showing mildly decreased motor conduction velocities in the tibial and peroneal
000212
nerves on one side and the absence of sural snap. Needle EMG of the lower limbs and upper limbs are normal. Previous examinations have observed normal motor function except for hip flexion and extension which was on the order of 4-5 minus. The patient's work up has included a CSF protein normal (upper limit), gangliocyte antibodies, serum immunofixation, mag antibodies have all been normal. My examination today reveals inconsistent sensory examination involving light touch and pin sensation. Vibration sensation is normal. Motor exam is completely normal with quite variable effort but maximum power is normal except for 5- hip flexion on the left. Impression: 1) Gait disorder with sensory symptoms. The patient's disability seems to be somewhat out of proportion to the findings on his exam and on his electrodiagnostic studies. Most of his disability appears to relate to his bilateral hip disease (with relatively recent left hip replacement and severe arthritis in the right hip). 2) There is possibly a mild sensory greater than motor neuropathy, the etiology of which has not been identified. It is very unlikely that we are dealing with chronic inflammatory demyelinating polyneuropathy. Disposition: I will review the electrodiagnostic studies with Dr. Maselli and develop a plan for further work up after that. The patient is to call in a few days and return here in two months. Thanks again for referring this most pleasant gentleman. Sincerely,
DAVID P RICHMAN, MD PROFESSOR DEPARTMENT OF NEUROLOGY THIS WAS ELECTRONICALLY SIGNED - 08/22/2011 7:46 PM PST BY:
DPR:lmw(usa288) D: 08/17/2011 01:40 PM T: 08/18/2011 07:43 AM C#: 5449824 cc: ANDREW K OH, MD UCDMG Display only: Transcription (12191415) on 8/17/2011 1:40 PM by David P Richman, MD Document history: Transcription (12191415) on 8/17/2011 1:40 PM by David P Richman, MD
000213
Visit Notes KANDIS CHEATUM Tue Aug 16, 2011 1:09 PM Vital signs taken, allergies verified, screened for pain. Pt is a new pt, no refills are needed at this time. Kandis Cheatum MA Electronically signed by KANDIS CHEATUM at Tue Aug 16, 2011 1:09 PM All Flowsheet Templates (all recorded) Amb Vitals Group Flowsheet Custom Formula Data Flowsheet

Patient Instructions None Follow-up and Disposition Return in about 1 month (around 9/16/2011) for Dr. Richman. Visit Disposition Disposition Return in about 1 month (around 9/16/2011) for Dr. Richman.
Problem List
Problem List as of 08/16/2011 Problem Unspecified backache Other testicular hypofunction Class: Chronic Brachial neuritis or radiculitis NOS ADVANCED OSTEOARTHRITIS OF THE LEFT HIP Class: Chronic DEPRESSIVE DISORDER
Noted Resolved
10/22/2010 1/19/2006 5/26/2006 4/30/2008

See lab

Class: Acute High arch 7/12/2010 2/17/2011 3/5/2011

DELETED: Weakness DELETED: Demyelinating neuropathy
000214
Diagnoses Polyneuropathy - Primary Abnormality of gait Osteoarth NOS-pelvis Reason for Visit Follow Up With Specialist Level of Service OFFICE/OUTPT VISIT,EST,LEVL IV [99214]
356.9 781.2 715.95
Dx added by coding staff Dx added by coding staff
1m FU/OB
Medications
Medications at Start of Encounter Disp Refills Start End 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 8 Cap 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. - ORAL Class: Pharmacy 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet 30 Tab Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 100 Tab 1 8/16/2011 11/16/2011 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Pharmacy 30 Tab 11 8/16/2011 8/15/2012 Levothyroxine (SYNTHROID) 75 mcg Tablet Sig - Route: Take 1 Tab by mouth every morning before a meal. take on an empty stomach - ORAL Class: Pharmacy 240 Tab 0 9/2/2011 10/2/2011 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. 9 daily. - ORAL Class: Handwritten Rx Medication Review History Med Rev Hx
000215
Medication Administration Report for Amundsen, Mark All administrations No administration data available Pharmacy Selected For Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630
Immunizations
Visit Summary
Vitals Recorded in This Encounter 09/27/2011 1005 100.4 kg (221 lb 5.5 oz) Weight: 1.854 m (6' 1") Height: 29.3 BMI: 2.28 m2 BSA: 36.6 C (97.9 F) Temp: Oral Temp src: 68 Pulse: 16 Resp: 102/68 mmHg BP: sitting Orthostatic Position: left arm SITE: large Cuff Size: 3 Pain Score: HIP Pain Loc: bilateral Comments: Medications Given (Excluding those documented in Imm/Injections Activity) No data found. LMP / OB Status - Last Recorded BMI 29.20 kg/m2 Progress Notes
David P Richman, MD, MD 9/27/2011 10:44 AM Signed See dictated letter.

Electronically signed by David P Richman, MD at 9/27/2011 10:44 AM Transcription Type Neurology Referral Letter (2211)
ID 12246657
Date and Time 9/29/2011 11:01 AM
000216
Document Text September 29, 2011 RE: AMUNDSEN, MARK MR#: 8081369 DOB: 09/23/1959 Date of Service: 09/27/2011
VICTOR HENRIQUE BAQUERO, MD UCDMG FOLSOM Dear Dr. Baquero: I saw Mr. Amundsen in followup of his length-dependent neuropathy. I reviewed his electrodiagnostic studies with Dr. Maselli, and it seems clear that he has very mild motor-sensory mixed neuropathy. The patient tells me that since his visit, he has continued to have significant difficulty with walking. He tells me that, in fact, he knows that he has severe left hip disease (he has previously had a right hip replacement). He continues to have some 5/10 burning dysesthesias in the forefoot bilaterally on the plantar surfaces to about the MP joints. Review of systems reveals no fever, no cough, no rash. Past medical history reveals that he continues on treatment for his chronic pain syndrome. Physical examination today reveals blood pressure of 102/68, pulse 68 and regular, respirations 16, temperature 97.9, weight 100.4 kg, and height 6 feet 1 inch. The patient appears well and in no distress. The pain on passive movement of his hips is unchanged. There are no orbitocranial bruits. Spine is unremarkable. Chest is clear. Abdomen is negative. There is no lymphadenopathy. Neurologic examination reveals normal mental status (30/30). Cranial nerve exam reveals normal visual fields and fundi, PERRLA at 4 mm. Extraocular movements are full without nystagmus. Facial sensation and facial motor function are normal, and the lower cranial nerves are normal. Motor exam reveals normal bulk, tone, and strength throughout with some occasional give-way weakness. Sensation reveals decreased pin and light touch sensation to about the ankles bilaterally. Vibration sensation is absent in the right toes and normal in the left toes, normal at the ankles. Finger-to-nose and heel-knee-shin testing is normal. The patient's gait is very labored and antalgic appearing. Deep tendon reflexes are 2+ throughout, except for absent ankle jerks, and plantar responses are flexor. Impression: 1) Severe gait disorder - this is secondary to his arthritis, especially in his hips. 2) Mild sensory greater than motor demyelinating and axonal neuropathy - question etiology. There are no laboratory data to support the diagnosis of chronic, inflammatory, demyelinating polyneuropathy. Disposition: 1) No further workup is indicated at this time. I will be glad to see him if you and Dr. Oh feel that his neurologic symptoms are worsening. With kindest regards.
000217
Sincerely,
DPR:vns(trs239) D: 09/29/2011 11:01 AM T: 10/01/2011 08:00 AM C#: 5469240 cc: ANDREW K OH, MD Display only: Transcription (12246657) on 9/29/2011 11:01 AM by David P Richman, MD Document history: Transcription (12246657) on 9/29/2011 11:01 AM by David P Richman, MD Visit Notes KANDIS CHEATUM Tue Sep 27, 2011 10:05 AM Vital signs taken, allergies verified, screened for pain. Pt states that he does not need refills today.Kandis Cheatum MA I Electronically signed by KANDIS CHEATUM at Tue Sep 27, 2011 10:05 AM All Flowsheet Templates (all recorded) Amb Vitals Group Flowsheet Custom Formula Data Flowsheet

Patient Instructions None Follow-up and Disposition Return if symptoms worsen or fail to improve. Visit Disposition Disposition Return if symptoms worsen or fail to improve.
Problem List
Problem List as of 09/27/2011 Problem
Noted Resolved
000218
Unspecified backache Other testicular hypofunction Class: Chronic Brachial neuritis or radiculitis NOS ADVANCED OSTEOARTHRITIS OF THE LEFT HIP Class: Chronic DEPRESSIVE DISORDER
10/22/2010 1/19/2006 5/26/2006 4/30/2008

See lab

Class: Acute High arch 7/12/2010 2/17/2011 3/5/2011 3/29/2011 3/29/2011 Closed Time 10:44 Mark Amundsen (MRN8081369)

DELETED: Weakness DELETED: Demyelinating neuropathy Class: Acute Preop testing Polyneuropathy Encounter Closed By Closed By RICHMAN, DAVID P Closed Date 09272011
8/16/2011
Appointment
Encounter-Level Documents:
000219
Department Fol Lab
Center None
Office Visit

Financial Class P
Plan Address PO BOX 179001 SACRAMENTO,
Plan Phone 916-734-0739
000220
CA 95817-9001
Diagnoses Enthesopathy of hip region - Primary Special screening for malignant neoplasms, colon Routine general medical examination at a health care facility Other malaise and fatigue Weight loss Polyneuropathy Pain in joint, pelvic region and thigh Orthopedic aftercare for joint replacement Reason for Visit Medication Follow Up Level of Service OFFICE/OUTPT VISIT,EST,LEVL IV [99214]
726.5 V76.51 V70.0 780.79 783.21 356.9 719.45 V54.81
Medications
Disp Refills Start End 60 tablet 0 8/22/2012 11/22/2012 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 tablets by mouth every day at bedtime. - ORAL Class: Pharmacy 60 tablet 0 11/19/2012 2/19/2013 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 tablets by mouth every day at bedtime. - ORAL Class: Pharmacy 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 8 Cap 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. - ORAL Class: Pharmacy 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet 30 Tab Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 0 11/19/2012 12/19/2012 Hydrocodone 10 mg/Acetaminophen 325 100 tablet mg (NORCO 10) 10-325 mg per tablet Sig - Route: Take 1 tablet by mouth every 4 to 6 hours if needed for pain. - ORAL Class: Pharmacy 270 tablet 0 10/23/2012 11/20/2012 Methadone (DOLOPHINE) 10 mg Tablet (Discontinued) Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx
Ordered Medications Disp 270 tablet Methadone (DOLOPHINE) 10 mg Tablet (Discontinued) Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Refills 0 Start 11/20/2012 End 12/14/2012
000221
Discontinued Medications Reason for Discontinue Methadone (DOLOPHINE) 10 mg Tablet Medication Review History Med Rev Hx Medication Administration Report for Amundsen, Mark All administrations No administration data available Pharmacy Selected For Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630
Orders
Order Summary GASTROENTEROLOGY REFERRAL [100015 Custom] Order #: 91762974 Future Orders TSH WITH FREE T4 REFLEX [LABNO Custom] Order #: 91762971 COMPREHENSIVE METABOLIC PANEL [LABNO Custom] Order #: 91762972 CBC AUTO + REFLEX MANUAL DIFF [LABNO Custom] Order #: 91762973 PSA SCREEN [LABNO Custom] Order #: 91762975 HOMOCYSTEINE [LABNO Custom] Order #: 91763972 Expected By 11/20/12 11/20/12 11/20/12 11/20/12 11/20/12 Expires 11/20/13 11/20/13 11/20/13 11/20/13 11/20/13
Immunizations
Visit Summary
Vitals Recorded in This Encounter 11/20/2012 1031 95.255 kg (210 lb) Weight: 36.2 C (97.2 F) Temp: Tympanic Temp src: 70 Pulse: 112/76 mmHg BP: sitting Orthostatic Position: left arm SITE: Medications Given (Excluding those documented in Imm/Injections Activity) No data found. Progress Notes
000222
Victor Baquero, MD, MD 11/20/2012 6:28 PM Signed
Chief Complaint Patient presents with Medication Follow Up
Subjective: Mark Amundsen is a 53yr old male who is here for the following reason: 1. reports the variable efficacy with methadone which in the past had worked very well. Currently it appears to work sometimes and not others. It also does not seem to last as long. He has noted that when he takes the methadone with food it does not work as well. 2. He is more active and eating better than before. However has lost weight over the past few months without trying. Reports no melena or bowel symptoms. Has not had a colonoscopy. Denies any constitutional symptoms. 3. ongoing neuropathy in the lower legs. Bothersome particularly at night with pain. Inquires about other treatment options. Review of Systems: Constitutional: negative. CV: negative. Resp: negative.
Patient Active Problem List Diagnoses Unspecified backache Other testicular hypofunction ADVANCED OSTEOARTHRITIS OF THE LEFT HIP DEPRESSIVE DISORDER CHRONIC PAIN MEDICATION AGREEMENT Anemia Orthopedic aftercare for joint replacement Dyslipidemia Vitamin D deficiency Hypertension High arch Polyneuropathy Current Outpatient Prescriptions on File Prior to Visit Medication Sig Carisoprodol (SOMA) 350 Take 2 tablets by mouth mg Tablet every day at bedtime. Carisoprodol (SOMA) 350 Take 2 tablets by mouth mg Tablet every day at bedtime. Dispense 60 tablet Refill 0
60 tablet
000223
Ergocalciferol, Vitamin D2, Take 1 Cap by mouth. take 8 Cap 1 (VITAMIN D) 50,000 unit 1 capsule by oral route PO Capsule twice weekly for next 2 months. Then lab follow up 4 weeks later. Fenofibrate (TRICOR) 145 Take 1 Tab by mouth every 30 Tab 11 mg PO Tablet morning after a meal. Hydrocodone 10 Take 1 tablet by mouth 100 tablet 0 mg/Acetaminophen 325 mg every 4 to 6 hours if (NORCO 10) 10-325 mg needed for pain. per tablet 270 tablet 0 Methadone (DOLOPHINE) Take 3 tablets by mouth 10 mg Tablet every 8 hours. 9 daily. Triamterene 37.5 Take 1 Tab by mouth every 30 Tab 3 mg/Hydrochlorothiazide morning. 25mg (MAXZIDE-25) 37.525 mg Tablet BP 112/76 | Pulse 70 | Temp(Src) 36.2 C (97.2 F) (Tympanic) | Wt 95.255 kg (210 lb) OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Heart: normal rate and regular rhythm, no murmurs, clicks, or gallops. Lungs: clear to auscultation. Skin: Skin color, texture, turgor normal. No rashes or lesions. Mental Status: euthymic. Musculoskeletal: stable. Limited exam of the hip. Has pain in the right and left hip and gait is normal to antalgic. ASSESSMENT: 726.5 ADVANCED OSTEOARTHRITIS OF THE LEFT HIP (primary encounter diagnosis) Comment: Recommended followup with orthopedics. He continues to have symptoms in both hips although he had replacement hip surgery several years back. Plan: V76.51 Special screening for malignant neoplasms, colon Comment: Risks and benefits discussed in detail in terms of screening colonoscopy. Patient agreed to proceed with screening colonoscopy. Plan: GASTROENTEROLOGY REFERRAL V70.0 Routine general medical examination at a health care facility Comment: return to clinic for complete physical examination. Plan: TSH WITH FREE T4 REFLEX, COMPREHENSIVE METABOLIC PANEL, CBC AUTO + REFLEX MANUAL DIFF, PSA SCREEN 780.79 Other malaise and fatigue Comment: Nonspecific constitutional symptoms. Labs ordered. Plan: HOMOCYSTEINE 783.21 Weight loss Comment: see HPI. Unsure if it is related to changes in diet and activity or something 000224
physiologic. Plan: TSH WITH FREE T4 REFLEX, COMPREHENSIVE METABOLIC PANEL, CBC AUTO + REFLEX MANUAL DIFF 356.9 Polyneuropathy Comment: Discussed various treatment options as well as exploring further labs. Plan: Consider gabapentin.
PLAN: See Orders. Discussed care and warning signs with Mark and all questions and concerns were fully answered. He will call or followup in the office if any problems arise. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his/her medical care. No guarantees were made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit. Electronically signed by: Victor Baquero, MD Associate Physician Associate Medical Director UC Davis Medical Group, Folsom
Electronically signed by Victor Baquero, MD at 11/20/2012 6:28 PM Visit Notes Clare Jennings, MA Tue Nov 20, 2012 10:32 AM Vital signs taken, allergies verified, screened for pain, pharmacy verified, and verified immunization status. Clare Jennings, MA Electronically signed by Clare Jennings, MA at Tue Nov 20, 2012 10:32 AM All Flowsheet Templates (all recorded) Amb Vitals Group Flowsheet Custom Formula Data Flowsheet

Problem List
Problem List as of 11/20/2012 Problem Unspecified backache Other testicular hypofunction Noted Resolved
000225
Center None
Office Visit
Provider Andrew Kim Oh, MD, MD

Department Carm Neurology

Financial Class P
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Diagnoses Polyneuropathy - Primary Reason for Visit Weakness Follow Up With Specialist Level of Service OFFICE/OUTPT VISIT,EST,LEVL V [99215]
356.9
Medications
Medications at Start of Encounter Disp Refills Start End 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 8 Cap 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. - ORAL Class: Pharmacy 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet 30 Tab Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL
000226
Class: Pharmacy 100 Tab 1 2/1/2011 5/4/2011 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical 0 3/18/2011 4/18/2011 Hydrocodone 10 mg/Acetaminophen 325 100 Tab mg (NORCO) 10-325 mg Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 240 Tab 0 3/14/2011 4/13/2011 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Class: Handwritten Rx Medication Review History Med Rev Hx Medication Administration Report for Amundsen, Mark All administrations No administration data available Pharmacy Selected For Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630
Orders
Order Summary FLUOROSCOPY UNDER 60 MINUTES WITH RADIOLOGIST [RAD001 Custom] Order #: 66574346 Canceled Orders CELL COUNT, CSF [LAB001 Custom] Order #: 66574449 PROTEIN CSF [LABNO Custom] Order #: 66574450 GLUCOSE CSF [LABNO Custom] Order #: 66574451 LYME(B.BURGDORFERI) AB, CSF [LABNO Custom] Order #: 66574452
Future Orders NEUROPATHY PANEL - MOTOR [LAB001 Custom] Order #: 66574011 CRYOGLOBULIN [LABNO Custom] Order #: 66574012 HEPATITIS C AB SCREEN [LABNO Custom] Order #: 66574013 SYPHILIS TEST CSF (VDRL) [LAB001 Custom] Order #: 66574453 MULTIPLE SCLEROSIS PANEL [LAB001 Custom] Order #: 66574454 CULTURE CSF (INCLUDES GS), BACTI [LAB001 Custom] Order #: 66574455 Expected By 3/24/11 Expires 3/23/12
3/24/11 3/24/11 3/24/11 3/24/11 3/24/11
3/23/12 3/23/12 3/23/12 3/23/12 3/23/12
Immunizations
Visit Summary
000227
Vitals Recorded in This Encounter 03/24/2011 0824 101.152 kg (223 lb) Weight: 1.854 m (6' 1") Height: 29.5 BMI: 2.28 m2 BSA: 76 Pulse: 16 Resp: 126/78 mmHg BP: sitting Orthostatic Position: right arm SITE: large Cuff Size: 3 Pain Score: HIP Pain Loc: Medications Given (Excluding those documented in Imm/Injections Activity) No data found. LMP / OB Status - Last Recorded BMI 29.42 kg/m2 Progress Notes
Andrew Kim Oh, MD, MD 3/24/2011 8:30 AM Signed
UNIVERSITY OF CALIFORNIA DAVIS HEALTH SYSTEM PRIMARY CARE NETWORK - CARMICHAEL NEUROLOGY NEUROLOGY CLINIC FOLLOWUP PATIENT: Mark Amundsen MRN: 8081369 SEX: male AGE: 51yr DOB: 9/23/1959 DATE OF SERVICE: 3/24/2011 LOCATION: NEUCAR CHIEF COMPLAINT: Weakness Follow Up With Specialist HISTORY OF PRESENT ILLNESS: Mark Amundsen is a 51yr old right-handed man who returns today in neurological followup regarding severe weakness located mostly in the legs but also in the back over a duration of 45 months with associated difficulty walking. He denies associated weakness of neck muscles or weakness of face muscles or blepharoptosis or dysarthria or dysphagia or dysphonia. He reports some chronic numbness in the right forefoot but otherwise there is no associated numbness or
000228
tingling or pain. With regard to timing, the weakness is constant and nonfluctuating. He has chronic left hip problems and he had left total hip arthroplasty but he attributes his walking problem to weakness rather than his left hip problem. He is on Norco and methadone for chronic pain. Dr. Wise of rheumatology did not think he had a rheumatologic condition but did suspect chronic inflammatory demyelinating polyneuropathy. EMG in March 2011 showed evidence of segmental demyelination in the bilateral lower extremities consistent with a predominantly demyelinating polyneuropathy affecting the bilateral lower extremities with no evidence of myopathy. PAST MEDICAL HISTORY: ADVANCED OSTEOARTHRITIS OF THE LEFT HIP DEPRESSIVE DISORDER CHRONIC PAIN MEDICATION AGREEMENT Anemia Orthopedic Aftercare for Joint Replacement Dyslipidemia Vitamin D deficiency Hypertension MEDICATIONS: Carisoprodol (SOMA) 350 mg Tablet, Take 2 Tabs by mouth every day at bedtime. Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule, Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. Fenofibrate (TRICOR) 145 mg PO Tablet, Take 1 Tab by mouth every morning after a meal. Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet, Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. Methadone (DOLOPHINE) 10 mg Tablet, Take 2 Tabs by mouth every 6 hours. Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet, Take 1 Tab by mouth every morning. ALLERGIES: Allergies Allergen Morphine Fentanyl itching
Reactions Hives
SOCIAL HISTORY: History of cigarette smoking. Rare alcohol use. Previously worked as a network administrator. FAMILY HISTORY: Noncontributory. REVIEW OF SYSTEMS: All systems reviewed on 3/24/2011 and all systems are negative except as mentioned in the history of present illness. PHYSICAL EXAMINATION: Vital signs: BP 126/78 | Pulse 76 | Resp 16 | Ht 1.854 m (6' 1") | Wt 101.152 kg (223 lb) | BMI 29.42 kg/m2 General appearance: Patient appears well, in no acute distress. Eyes: Anicteric. Respiratory: Chest clear to auscultation. Ears, nose, mouth, and throat: Normal. Musculoskeletal: Neck supple. Normal range of joint motion.
000229
Cardiovascular: Heart sounds regular. Skin: No jaundice. Psychiatric: Normal mood and affect. Neurological: DTRs intact. Power 5/5 throughout. Normal muscle bulk with no muscle atrophy. Gait is slow and deliberate, out of proportion to any weakness demonstrated on individual muscle testing. OTHER DATA: Laboratory results: CK normal. Aldolase normal. B12 normal (478). Folate normal. ESR normal (8). ANA negative. Electrolytes, BUN, creatinine all normal. LFTs normal. 25 hydroxy vitamin D borderline low (25.1). Fasting glucose normal (94). Acetylcholine receptor binding antibody negative. Acetylcholine receptor blocking antibody negative. Acetylcholine receptor modulating antibody negative. MuSK antibody negative. TSH elevated (3.42, 4.54). Free T4 normal. Thyroid peroxidase antibody negative. Urine heavy metals negative. Blood lead level not elevated. Radiology results: Lumbar spine MRI without contrast 03/05/2004: Normal. No disc bulges. No foraminal stenosis. No central canal stenosis. IMPRESSION/PLAN: 780.79L Weakness (primary encounter diagnosis) Comment: The abnormalities he displays when walking are out of proportion to any muscle weakness demonstrated on individual muscle strength testing. His reflexes are also normal. For these reasons, on a scale of nil-low-intermediate-high, my level of suspicion of chronic inflammatory demyelinating polyneuropathy is somewhere between nil and low but EMG testing showed findings consistent with polyneuropathy. Many etiologies are possible. His workup so far has not revealed an obvious cause. He may have mild hypothyroidism which could be a contributing etiology. Will need CSF analysis, MAG antibody assay, SPEP, and cryoglobulins. Plan: NEUROPATHY PANEL - MOTOR, CRYOGLOBULIN, HEPATITIS C AB SCREEN. FLUOROSCOPY UNDER 60 MINUTES WITH RADIOLOGIST for LP. CELL COUNT CSF, PROTEIN CSF, GLUCOSE CSF, LYME (B.BURGDORFERI) AB CSF, SYPHILIS TEST CSF (VDRL), MULTIPLE SCLEROSIS PANEL CSF, CULTURE CSF (INCLUDES GS). COMMENT: I explained to Mr. Amundsen the diagnosis, prognosis, treatment options, risks, benefits, and his right to choose treatment options. He verbalized a good understanding and all questions were answered to his satisfaction. I provided reassurance and directed him to contact me as needed for further information. FOLLOWUP: Return after tests.
000230
Electronically signed by Andrew K. Oh, M.D. 3/24/2011 Health Sciences Associate Clinical Professor of Neurology Primary Care Network - Carmichael University of California Davis Health System 7551 Madison Avenue Citrus Heights, CA 95610 (916) 904-3000 Fax (916) 863-2966
Electronically signed by Andrew Kim Oh, MD at 3/24/2011 1:23 PM Visit Notes RONALD P ROJAS Thu Mar 24, 2011 8:25 AM Patient presents with: Weakness Follow Up With Specialist Vital signs taken, allergies verified, screened for pain, med hx taken. Ronald P Rojas Electronically signed by RONALD P ROJAS at Thu Mar 24, 2011 8:25 AM All Flowsheet Templates (all recorded) Amb Vitals Group Flowsheet Custom Formula Data Flowsheet

Patient Instructions None Follow-up and Disposition Routing History Recorded Chart Reviewed By Victor Henrique Baquero, MD on 3/26/2011 11:24 AM Barton Lahn Wise, MD on 8/22/2011 11:15 AM
Problem List
Noted Resolved
10/22/2010 1/19/2006 5/26/2006
000231
4/30/2008
See lab


DELETED: Weakness DELETED: Demyelinating neuropathy Class: Acute Encounter Closed By Closed By OH, ANDREW
Patient Information
Closed Time 13:24

Telephone Encounter
3/18/2011 8:25 AM
Reason for Call

Refill Request
Routing History
3/18/2011 8:25 AM
Created by
Clare Jennings, MA on 3/18/2011 8:25 AM
Approved
Disp Refills Start End 100 Tab 0 3/18/2011 4/29/2011 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10325 mg Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy Authorizing Provider: Victor Henrique Baquero, MD

Disp Refills Start End 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy
000232
5/24/2011 8:15 AM
Provider Andrew Kim Oh, MD, MD

Financial Class P
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Diagnoses Polyneuropathy - Primary Reason for Visit Weakness Follow Up With Specialist Level of Service OFFICE/OUTPT VISIT,EST,LEVL V [99215] Polyneuropathy
356.9
Medications
Medications at Start of Encounter Disp Refills Start End 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 8 Cap 50,000 unit PO Capsule (Taking) Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. - ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 0 4/29/2011 5/30/2011 Hydrocodone 10 mg/Acetaminophen 325 100 Tab mg (NORCO) 10-325 mg Tablet (Taking) Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet (Taking) Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 100 Tab 1 4/29/2011 7/30/2011 Carisoprodol (SOMA) 350 mg Tablet (Taking)
000233
Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Pharmacy 240 Tab 0 Methadone (DOLOPHINE) 10 mg Tablet (Taking) Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Class: Handwritten Rx Medication Review History Med Rev Hx Medication Administration Report for Amundsen, Mark All administrations No administration data available
5/4/2011
6/3/2011
Pharmacy Selected For Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630
Orders
Order Summary NEUROLOGY CLINIC REFERRAL [100029 Custom] Order #: 69071201
Immunizations
Immunizations as of 5/24/2011 Name Date 11/2/2010 Cyanocobalamin inj clinic Site: Left deltoid Given By: Clare Jennings, MA
Dose VIS Date 1,000mcg NA
Never Reviewed Route Intramuscular
Visit Summary
Vitals Recorded in This Encounter 05/24/2011 0818 102.059 kg (225 lb) Weight: 1.854 m (6' 1") Height: 29.7 BMI: 2.3 m2 BSA: 77 Pulse: 16 Resp: 112/80 mmHg BP: sitting Orthostatic Position: right arm SITE: large Cuff Size: 4 Pain Score: HIP Pain Loc: Bilateral to include low back Comments: Medications Given (Excluding those documented in Imm/Injections Activity) No data found. LMP / OB Status - Last Recorded BMI 29.69 kg/m2
000234
Progress Notes
UNIVERSITY OF CALIFORNIA DAVIS HEALTH SYSTEM PRIMARY CARE NETWORK - CARMICHAEL NEUROLOGY NEUROLOGY CLINIC FOLLOWUP PATIENT: Mark Amundsen MRN: 8081369 SEX: male AGE: 51yr DOB: 9/23/1959 DATE OF SERVICE: 5/24/2011 LOCATION: NEUCAR CHIEF COMPLAINT: Weakness Polyneuropathy Follow Up With Specialist HISTORY OF PRESENT ILLNESS: Mark Amundsen is a 51yr old right-handed man who returns today in neurological followup regarding severe weakness located mostly in the legs but also in the back over a duration of 78 months with associated difficulty walking. He denies associated weakness of neck muscles or weakness of face muscles or blepharoptosis or dysarthria or dysphagia or dysphonia. He reports chronic numbness in the feet with associated tingling and burning discomfort. With regard to timing, the weakness is constant and nonfluctuating. He has chronic left hip problems and he had left total hip arthroplasty but he attributes his walking problem to weakness rather than his left hip problem. He is on Norco and methadone for chronic pain. Dr. Wise of rheumatology did not think he had a rheumatologic condition but did suspect chronic inflammatory demyelinating polyneuropathy. EMG in March 2011 showed evidence of segmental demyelination in the bilateral lower extremities consistent with a predominantly demyelinating polyneuropathy affecting the bilateral lower extremities with no evidence of myopathy. CSF results were normal (CSF protein near upper limit of normal). PAST MEDICAL HISTORY: ADVANCED OSTEOARTHRITIS OF THE LEFT HIP DEPRESSIVE DISORDER CHRONIC PAIN MEDICATION AGREEMENT Anemia Orthopedic Aftercare for Joint Replacement Dyslipidemia Vitamin D deficiency Hypertension MEDICATIONS: Carisoprodol (SOMA) 350 mg Tablet, Take 2 Tabs by mouth every day at bedtime. Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule, Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. Fenofibrate (TRICOR) 145 mg PO Tablet, Take 1 Tab by mouth every morning after a meal.
000235
Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet, Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. Methadone (DOLOPHINE) 10 mg Tablet, Take 2 Tabs by mouth every 6 hours. Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet, Take 1 Tab by mouth every morning. ALLERGIES: Allergies Allergen Morphine Fentanyl itching
Reactions Hives
SOCIAL HISTORY: History of cigarette smoking. Rare alcohol use. Previously worked as a network administrator. FAMILY HISTORY: Noncontributory. REVIEW OF SYSTEMS: All systems reviewed on 5/24/2011 and all systems are negative except as mentioned in the history of present illness. PHYSICAL EXAMINATION: Vital signs: BP 112/80 | Pulse 77 | Resp 16 | Ht 1.854 m (6' 1") | Wt 102.059 kg (225 lb) | BMI 29.69 kg/m2 General appearance: Patient appears well, in no acute distress. Eyes: Anicteric. Respiratory: Chest clear to auscultation. Ears, nose, mouth, and throat: Normal. Musculoskeletal: Neck supple. Normal range of joint motion. Cardiovascular: Heart sounds regular. Skin: No jaundice. Psychiatric: Normal mood and affect. Neurological: MSRs now hypoactive in lower extremities, a new finding. Power 5-/5 in proximal lower extremities, 5/5 elsewhere. Normal muscle bulk with no muscle atrophy. Gait is slow and he ambulates with a cane. OTHER DATA: Laboratory results: CK normal. Aldolase normal. B12 normal (478). Folate normal. ESR normal (8). ANA negative. Electrolytes, BUN, creatinine all normal. LFTs normal. 25 hydroxy vitamin D borderline low (25.1). Fasting glucose normal (94). Acetylcholine receptor binding antibody negative. Acetylcholine receptor blocking antibody negative. Acetylcholine receptor modulating antibody negative. MuSK antibody negative. TSH elevated (3.42, 4.54). Free T4 normal.
000236
Thyroid peroxidase antibody negative. Urine heavy metals negative. Blood lead level not elevated. Hepatitis C antibody negative. Cryoglobulin 0. Ganglioside antibodes negative. Serum protein electrophoresis normal. Serum immunofixation normal. MAG antibody negative. SGPG antibody negative. CSF protein 44. CSF glucose 55. CSF WBC 3. CSF RBC 1. CSF Lyme antibody by ELISA negative. CSF VDRL nonreactive. CSF Gram stain and culture negative. CSF IgG synthesis rate <0. CSF IgG index 0.43 (0.28 - 0.66). CSF oligoclonal bands negative. Radiology results: Lumbar spine MRI without contrast 03/05/2004: Normal. No disc bulges. No foraminal stenosis. No central canal stenosis. IMPRESSION/PLAN: 356.9AG Polyneuropathy (primary encounter diagnosis) Comment: His chief complaint is weakness but there is also distal numbness and tingling. His reflexes are now hypoactive, which is a new finding. EMG showed findings consistent with demyelinating polyneuropathy. He may have mild hypothyroidism which could be a contributing etiology but it doesn't seem like that would be the primary cause. CSF protein was within normal limits but near the upper limit of the normal range. Plan: NEUROLOGY CLINIC REFERRAL for Dr. F. Gorin or Dr. D. Richman. Question to be answered: Is this a potentially steroid-responsive neuropathy like CIDP but with a normal CSF protein?
Electronically signed by Andrew Kim Oh, MD at 5/24/2011 9:15 AM Visit Notes
000237
RONALD P ROJAS Tue May 24, 2011 8:19 AM Patient presents with: Weakness - Polyneuropathy Follow Up With Specialist Vital signs taken, allergies verified, screened for pain, med hx taken. Ronald P Rojas Electronically signed by RONALD P ROJAS at Tue May 24, 2011 8:19 AM All Flowsheet Templates (all recorded) Amb Vitals Group Flowsheet Custom Formula Data Flowsheet

Patient Instructions None Follow-up and Disposition Routing History Recorded Chart Reviewed By Victor Henrique Baquero, MD on 5/24/2011 12:42 PM Barton Lahn Wise, MD on 6/7/2011 10:59 AM
Problem List
Noted Resolved
10/22/2010 1/19/2006 5/26/2006 4/30/2008

See lab

000238
Report electronically signed by: Robert M. Tamurian, MD Physician ID # 10884, Pager 3059 Attending Physician Assistant Professor Chief, Orthopaedic Oncology Service Deparment of Orthopaedic Surgery University of California, Davis Health System Electronically signed by Robert Michael Tamurian, MD at 12/23/2009 8:44 AM Revision history: > 12/23/09 0844 Progress Notes addendum by Robert Michael Tamurian, MD 12/20/09 0641 Progress Notes addendum by Jonathan G Eastman, MD 12/20/09 0640 Progress Notes signed by Jonathan G Eastman, MD Progress Notes signed by Robert Michael Tamurian, MD at 12/23/09 0842 Author: Robert Michael Service: Orthopedics Author Tamurian, MD Type: 12/16/09 0835 12/23/09 0842 Filed: Note Time:
ORTHOPEDIC TUMOR PHYSICIAN DAILY PROGRESS NOTE MRN: 8081369 Date of Arrival: 12/15/2009 Today's Date: 12/16/2009 Time: 0835
*PHYSICIAN: FACULTY
INTERVAL HISTORY NAE ON. Transferred to floor. Increased pain over night SUBJECTIVE Awake, alert, in moderate discomfort Vital Signs Summary Temp Min: 36 C (96.8 F) Max: 38 C (100.4 F) BP: 126/80 mmHg Pulse Min: 70 Max: 93 Resp Min: 10 Max: 18 SpO2 Min: 94 % Max: 100 % Liter flow Min: 10 L/min Max: 10 L/min Current Vitals : Temp: 37.7 C (99.8 F) Pulse: 90 Resp: 18 SpO2: 95 % Liter flow: 10 L/min INTERVAL LABS CBC Recent labs for the past 24 hours WHITE BLOOD CELL COUNT HEMOGLOBIN HEMATOCRIT PLATELET COUNT 12/16/09 0530 6.3 9.5* 27.6* 154
000239
BASIC METABOLIC PANEL Recent labs for the past 24 hours 12/16/09 0530 GLUCOSE 129* UREA NITROGEN, BLOOD (BUN) 5* CREATININE BLOOD 0.93 SODIUM 135 POTASSIUM 3.9 CHLORIDE 103 CARBON DIOXIDE TOTAL 27 CALCIUM 8.0*
No results found for this basename: PT:*,APTT:*,INR:* in the last 24 hours No results found for this basename: ESR:*,CREATIVEPR:* in the last 24 hours Ins and Outs: Date Shift I Shift Total N T A K E O U T P U T Other
0700-1459
12/16/09 0700 - 12/17/09 0659 1500-2259 2300-0659
Daily Total
Shift Total
Physical Exam L LE: Dressing c/d/i. NVI distally with no deficit A&P POD # 1 s/p L THA - pain control: Increased PCA, PO. Pain pharmacy consult for assistance - Arixtra - EBLA: monitor H/H, clinical exam - Post op XR - PT/OT - Advance diet as tolerated - WBAT L LE - Posterior hip precautions - DC foley once mobile - Discuss with staff Report Completed by: Jonathan G Eastman, MD This patient was seen and evaluated by myself, on day of service, 12/16/2009. The care plan was developed by the resident, of which I have reviewed the patient's chart, post-operative course, and the above plan. I
000240
Report Completed by: Jonathan G Eastman, MD
This patient was seen and evaluated by the resident, on day of service, 12/18/2009. The care plan was developed by the resident of which I have reviewed the patient's chart, post-operative course, and the above plan. I agree with the assessment and plan as outlined in the resident's note. Report electronically signed by: Robert M. Tamurian, MD Physician ID # 10884, Pager 3059 Attending Physician Assistant Professor Chief, Orthopaedic Oncology Service Deparment of Orthopaedic Surgery University of California, Davis Health System
Electronically signed by Robert Michael Tamurian, MD at 12/23/2009 8:41 AM Revision history: > 12/23/09 0841 Progress Notes addendum by Robert Michael Tamurian, MD 12/18/09 0853 Progress Notes signed by Jonathan G Eastman, MD Progress Notes signed by Robert Michael Tamurian, MD at 12/23/09 0840 Author: Robert Michael Service: Orthopedics Author Tamurian, MD Type: 12/17/09 1133 12/23/09 0840 Filed: Note Time:
ORTHOPEDIC TUMOR PHYSICIAN DAILY PROGRESS NOTE Date of Arrival: 12/15/2009 MRN: 8081369 Today's Date: 12/17/2009 Time: 1133
*PHYSICIAN: FACULTY
INTERVAL HISTORY NAE ON. Working with PT. Pain present. Control not yet optimal SUBJECTIVE Awake, alert, NAD Vital Signs Summary Temp Min: 36.7 C (98 F) Max: 37.7 C (99.8 F) BP: 107/66 mmHg Pulse Min: 77 Max: 87 Resp Min: 16 Max: 18 SpO2 Min: 96 % Max: 99 % No Data Recorded Current Vitals : Temp: 37.7 C (99.8 F) Pulse: 83 Resp: 16 SpO2: 99 % Liter flow: 10 L/min INTERVAL LABS CBC Recent labs for the past 24 hours WHITE BLOOD CELL COUNT 12/17/09 0615 7.4
000241
HEMOGLOBIN HEMATOCRIT PLATELET COUNT
7.8* 22.8* 134
BASIC METABOLIC PANEL Recent labs for the past 24 hours 12/17/09 0615 GLUCOSE 119* UREA NITROGEN, BLOOD (BUN) 9 CREATININE BLOOD 0.96 SODIUM 135 POTASSIUM 4.2 CHLORIDE 100 CARBON DIOXIDE TOTAL 29 CALCIUM 8.0*
No results found for this basename: PT:*,APTT:*,INR:* in the last 24 hours No results found for this basename: ESR:*,CREATIVEPR:* in the last 24 hours Ins and Outs: Date Shift I Oral N T Crystalloid A K E Shift Total O U T P U T Other
0700-1459 480
12/17/09 0700 - 12/18/09 0659 1500-2259 2300-0659
Daily Total 480
70 550 0
70 550 0
Shift Total
Physical Exam L LE: Incision c/d/i. NVI distally with no deficit A&P POD # 2 s/p L THA - pain control: Increased PCA, PO. Appreciate pain pharmacy for assistance. Await further recs - Arixtra - EBLA: monitor H/H, clinical exam - Post op XR - PT/OT - Advance diet as tolerated - WBAT L LE - Posterior hip precautions
000242
- DC foley once mobile - Discuss with staff Report Completed by: Jonathan G Eastman, MD This patient was seen and evaluated by the resident, on day of service, 12/17/2009. The care plan was developed by the resident of which I have reviewed the patient's chart, post-operative course, and the above plan. I agree with the assessment and plan as outlined in the resident's note. Report electronically signed by: Robert M. Tamurian, MD Physician ID # 10884, Pager 3059 Attending Physician Assistant Professor Chief, Orthopaedic Oncology Service Deparment of Orthopaedic Surgery University of California, Davis Health System
Electronically signed by Robert Michael Tamurian, MD at 12/23/2009 8:40 AM Revision history: > 12/23/09 0840 Progress Notes addendum by Robert Michael Tamurian, MD 12/17/09 1134 Progress Notes signed by Jonathan G Eastman, MD Progress Notes filed by Joanna Baginski, MD at 12/22/09 1441 Author: Joanna Baginski, Service: (none) MD 12/22/09 1441 12/22/09 1440 Filed: Note Time: Author Type: *PHYSICIAN: FACULTY
Scan on: 12/22/2009 2:40 PM by: Joanna Baginski, MD [101052744] - PATIENT PROPERTY RECORD Progress Notes filed by Robert Michael Tamurian, MD at 12/22/09 1424 Author: Robert Michael Service: (none) Author Tamurian, MD Type: 12/22/09 1424 12/22/09 1424 Note Filed: Time:
*PHYSICIAN: FACULTY
Scan on: 12/22/2009 2:24 PM by: Robert Michael Tamurian, MD [195644588] - PATIENT EDUCATION RECORD Nurse Progress signed by Christena R Schob, RN at 12/21/09 1914 Author: Christena R Schob, Service: (none) Author RN Type: 12/21/09 1913 12/21/09 1914 Filed: Note Time:
NURSE PROGRESS NOTE
.NURSE: (RN or LVN)
Note Started:
Problem #:
12/21/2009, 1914
Problem name: discharge
Data: Pt discharged home after instructions given.
000243
agree with the assessment and plan as outlined in the resident's note. Report electronically signed by: Robert M. Tamurian, MD Physician ID # 10884, Pager 3059 Attending Physician Assistant Professor Chief, Orthopaedic Oncology Service Deparment of Orthopaedic Surgery University of California, Davis Health System Electronically signed by Robert Michael Tamurian, MD at 12/23/2009 8:42 AM Revision history: > 12/23/09 0842 Progress Notes addendum by Robert Michael Tamurian, MD 12/16/09 0838 Progress Notes addendum by Jonathan G Eastman, MD 12/16/09 0837 Progress Notes signed by Jonathan G Eastman, MD Progress Notes signed by Robert Michael Tamurian, MD at 12/23/09 0841 Author: Robert Michael Service: Orthopedics Author Tamurian, MD Type: 12/23/09 0841 12/18/09 0851 Filed: Note Time:
ORTHOPEDIC TUMOR PHYSICIAN DAILY PROGRESS NOTE MRN: 8081369 Date of Arrival: 12/15/2009 Today's Date: 12/18/2009 Time: 0851
*PHYSICIAN: FACULTY
INTERVAL HISTORY NAE ON. Working with PT. Foley dc'd. SUBJECTIVE Awake, alert, NAD Vital Signs Summary Temp Min: 36.7 C (98.1 F) Max: 37.2 C (99 F) BP: 119/69 mmHg Pulse Min: 79 Max: 90 Resp Min: 15 Max: 16 SpO2 Min: 97 % Max: 100 % No Data Recorded Current Vitals : Temp: 36.9 C (98.4 F) Pulse: 90 Resp: 16 SpO2: 97 % Liter flow: 10 L/min INTERVAL LABS CBC Recent labs for the past 24 hours WHITE BLOOD CELL COUNT HEMOGLOBIN HEMATOCRIT PLATELET COUNT 12/18/09 0715 7.8 7.1* 20.9* 147
000244
BASIC METABOLIC PANEL Recent labs for the past 24 hours 12/18/09 0715 GLUCOSE 128* UREA NITROGEN, BLOOD (BUN) 8 CREATININE BLOOD 0.83 SODIUM 135 POTASSIUM 4.3 CHLORIDE 102 CARBON DIOXIDE TOTAL 29 CALCIUM 8.2*
No results found for this basename: PT:*,APTT:*,INR:* in the last 24 hours No results found for this basename: ESR:*,CREATIVEPR:* in the last 24 hours Ins and Outs: Date Shift I Crystalloid N T A K Shift Total E O U T P U T Shift Total
0700-1459 54
12/18/09 0700 - 12/19/09 0659 1500-2259 2300-0659
Daily Total 54
54
54
Physical Exam L LE: Incision c/d/i A&P POD # 3 s/p L THA - pain control: DCPCA, PO. Appreciate pain pharmacy for assistance. Await further recs - Arixtra - EBLA: monitor H/H, clinical exam - Post op XR - PT/OT - WBAT L LE - Posterior hip precautions - DC planning SNF vs. Home. - Discuss with staff
000245
Type Unstructured to Doctor Preliminary

Document Text Hi Dr Baquero and Teri-
ID RH21751131
Its about time for another refill on Methadone. I know its early , but this is due to the horrible weather we have had, and due to the hip replacement I had on December 15h, 2009!!!!!!! YYEEEAAAHHH!!! They tried to move it back to the end of March, but when I said No way , they offered Dec 15th, and I took it. The surgeon totally underestimated the amount of pain meds the procedure would require, even though we had discussed it extensively before the procedure. Other than that everything was A-OK, I;m getting around quite well with the walker, but Im still spending most of my time in bed. Anyway, if I could get a refill on Thursday the 24th, or Monday the 28th, that would be great, I figured yall would be out on of those weeks anyhow,,, Regards, /> Mark Amundsen
Display only: Transcription (RH21751131) on 12/23/2009 1:53 PM
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes signed by Robert Michael Tamurian, MD at 12/23/09 0847 Author: Robert Michael Service: Orthopedics Author Tamurian, MD Type: 12/23/09 0847 12/21/09 1138 Filed: Note Time:
*PHYSICIAN: FACULTY
INTERVAL HISTORY NAE ON. Responded appropriately to transfusion. States he ambulated throughout hospital last night looking for a vending machine. No symptoms of light headed, fatigue. SUBJECTIVE Awake, alert, comfortable. Vital Signs Summary Temp Min: 36.1 C (97 F) Max: 37.1 C (98.8 F) BP: 105/64 mmHg
000246
Pulse Min: 71 Max: 78 Resp Min: 16 Max: 18 SpO2 Min: 96 % Max: 99 % No Data Recorded Current Vitals : Temp: 36.9 C (98.4 F) Pulse: 75 Resp: 16 SpO2: 96 % INTERVAL LABS CBC Recent labs for the past 24 hours 12/21/09 0550 WHITE BLOOD CELL 5.7 COUNT HEMOGLOBIN 8.0* HEMATOCRIT 23.6* PLATELET COUNT 232
BASIC METABOLIC PANEL Recent labs for the past 24 hours 12/21/09 0550 GLUCOSE 106 UREA NITROGEN, BLOOD (BUN) 11 CREATININE BLOOD 0.84 SODIUM 135 POTASSIUM 4.1 CHLORIDE 101 CARBON DIOXIDE TOTAL 30 CALCIUM 8.1*
12/20/09 1505 -8.5* 24.9* --
No results found for this basename: PT:*,APTT:*,INR:* in the last 24 hours No results found for this basename: ESR:*,CREATIVEPR:* in the last 24 hours Ins and Outs: Date Shift I Oral N T A K Shift Total E O U T P U T Shift Total
0700-1459 360
12/21/09 0700 - 12/22/09 0659 1500-2259 2300-0659
Daily Total 360
360
360
Physical Exam
000247
L LE: Incision c/d/i. NVI distally. Stands without assistance to show incision. A&P POD # 6 s/p L THA - Pain control- adequate - Arixtra - PT for clearance to home. Pt does not want to go back to SNF. With description of his activity level last night, should be able to clear PT. - EBLA - Pt asymptomatic and responded to transfusion. Stable from ortho standpoint. DC home per primary team. - Discuss with staff Report Completed by: Jonathan G Eastman, MD This patient was seen and evaluated by the resident, on day of service, 12/21/2009. The care plan was developed by the resident of which I have reviewed the patient's chart, post-operative course, and the above plan. I agree with the assessment and plan as outlined in the resident's note. Report electronically signed by: Robert M. Tamurian, MD Physician ID # 10884, Pager 3059 Attending Physician Assistant Professor Chief, Orthopaedic Oncology Service Deparment of Orthopaedic Surgery University of California, Davis Health System Electronically signed by Robert Michael Tamurian, MD at 12/23/2009 8:47 AM Revision history: > 12/23/09 0847 Progress Notes addendum by Robert Michael Tamurian, MD 12/21/09 1141 Progress Notes signed by Jonathan G Eastman, MD Progress Notes signed by Robert Michael Tamurian, MD at 12/23/09 0844 Author: Robert Michael Service: Orthopedics Author Tamurian, MD Type: 12/23/09 0844 12/20/09 0638 Filed: Note Time:
*PHYSICIAN: FACULTY
INTERVAL HISTORY Admitted from SNF for decreasing H/H. Pt was asymptomatic. Denies feeling light-headed, tired. SUBJECTIVE Resting comfortably, arousable, appropriate Vital Signs Summary Temp Min: 36.5 C (97.7 F) Max: 37.5 C (99.5 F) BP: 98/54 mmHg Pulse Min: 69 Max: 78 Resp Min: 18 Max: 18 SpO2 Min: 94 % Max: 98 %
000248
No Data Recorded Current Vitals : Temp: 36.5 C (97.7 F) Pulse: 69 Resp: 18 SpO2: 94 % INTERVAL LABS CBC Recent labs for the past 24 hours WHITE BLOOD CELL COUNT HEMOGLOBIN HEMATOCRIT PLATELET COUNT 12/20/09 0020 5.6 6.7* 19.1* 207
BASIC METABOLIC PANEL Recent labs for the past 24 hours 12/20/09 0020 GLUCOSE 92 UREA NITROGEN, BLOOD (BUN) 13 CREATININE BLOOD 0.79 SODIUM 136 POTASSIUM 3.9 CHLORIDE 101 CARBON DIOXIDE TOTAL 30 CALCIUM 8.2*
No results found for this basename: PT:*,APTT:*,INR:* in the last 24 hours No results found for this basename: ESR:*,CREATIVEPR:* in the last 24 hours Ins and Outs: Physical Exam L LE: Incision c/d/i. NVI distally A&P POD # 5 s/p L THA - Pain control. Continue on current regimen - Arixtra for DVT prophylaxis until 12/25 - F/u post transfusion H/H. Continue iron. - PT/OT - WBAT L LE - Posterior hip precautions - DC planning for home once able per PT. Pt expresses desire to not return to SNF - discuss with staff Report Completed by: Jonathan G Eastman, MD This patient was seen and evaluated by the resident, on day of service, 12/20/2009. The care plan was developed by the resident of which I have reviewed the patient's chart, post-operative course, and the above plan. I agree with the assessment and plan as outlined in the resident's note.
000249
Time:
INTERNAL MEDICINE DAILY PROGRESS NOTE Date: 12/20/2009 Time: 1443
SUMMARY: Patient is a 50-year-old man who underwent left total hip replacement about four days ago. Patient was discharged to a skilled nursing facility for rehab. He was found to have worsening anemia during routine lab work today. Patient was directly admitted for blood transfusion. Patient denies chest pain, no worsening shortness of breath, has some generalized weakness and fatigue, no nausea, vomiting, no fever, chills, no abdominal pain, no diarrhea or constipation, no dysuria. He has left leg (especially left thigh) swelling after the surgery. There is no worsening swelling. Patient denies hemoptysis, no hematemesis, no melena or hematochezia, no evidence of bleeding. SUBJECTIVE: Had 2 PRBC tranfusion. No active bleeding on clinical study for Fondaparinux. Will restart the therapy. Patient left the medicine at SNF. MEDICATIONS: Scheduled Medications Study Drug - Fondaparinux (IRB 200816251) Syringe 2.5 mg, SUBCUTANEOUS, ONCE Fluoxetine (PROZAC) Capsule 40 mg, ORAL, QAM Methadone (DOLOPHINE) Tablet 40 mg, ORAL, BID Methadone (DOLOPHINE) Tablet 50 mg, ORAL, Daily Bedtime Ferrous Sulfate (FERATAB) Tablet 300 mg, ORAL, TID Docusate (COLACE) Capsule 100 mg, ORAL, BID Sennosides (SENOKOT) Tablet 2 Tab, ORAL, Daily Bedtime DiphenhydrAMINE (BENADRYL) Capsule 25 mg, ORAL, PRE-MED Carisoprodol (SOMA) Tablet 700 mg, ORAL, Daily Bedtime IV Medications PRN Medications DiphenhydrAMINE (BENADRYL) Capsule 25-50 mg, ORAL, Q6H PRN Bisacodyl (DULCOLAX) Suppository 10 mg, RECTALLY, Q24H PRN Acetaminophen (TYLENOL) Tablet 650 mg, ORAL, Q4H PRN Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) Tablet 1 Tab, ORAL, Q4H PRN OBJECTIVE: Vital Signs Summary Temp Min: 36.1 C (97 F) Max: 37.5 C (99.5 F) | BP: (95-121)/(50-68) | Pulse Min: 69 Max: 78 | Resp Min: 17 Max: 18 | SpO2 Min: 94 % Max: 98 % | Current Vitals Temp: 36.6 C (97.9 F) | BP: 95/50 mmHg | Pulse: 73 | Resp: 17 | SpO2: 98 % | | Weight: 96.253 kg (212 lb 3.2 oz) Intake and Output Last Two Completed Shifts In: 1300 (1000 Oral 300 Blood) Out: 0 Current Shift Physical Exam GENERAL: Patient is alert, oriented x3, in no acute distress. Speaking full sentences. HEENT: Pupils equal, round, reactive to light, extraocular movement intact. Oropharynx clear, mucous membranes moist.
000250
NECK: No JVD, no lymphadenopathy. LUNGS: Clear to auscultation bilaterally. HEART: Regular rate rhythm, S1, S2 normal, no murmur. ABDOMEN: Soft, nontender, nondistended, bowel sounds present. EXTREMITIES: Diffuse edema of the left leg, especially left thigh. Surgical wound is clean and intact with dressing in place, minimal discharge, no erythema. Right leg: No edema or cyanosis or clubbing. As per patient and ortho, the swelling are the same. NEUROLOGIC: Cranial nerves II through XII grossly intact. LAB TESTS/STUDIES: BLOOD COUNTS Recent labs for the past 72 hours 12/20/09 0020 WHITE BLOOD CELL 5.6 COUNT RED CELL COUNT 2.11* HEMOGLOBIN 6.7* HEMATOCRIT 19.1* MCV 90.6 MCH 31.7 RDW 13.5 PLATELET COUNT 207 NUCLEATED RBC/100 WBC - BC COMMENTS --
12/18/09 0715 7.8 2.29* 7.1* 20.9* 91.2 31.0 13.0 147 ---
BASIC METABOLIC PANEL Recent labs for the past 72 hours 12/20/09 0020 GLUCOSE 92 UREA NITROGEN, BLOOD 13 (BUN) CREATININE BLOOD 0.79 SODIUM 136 POTASSIUM 3.9 CHLORIDE 101 CARBON DIOXIDE TOTAL 30 CALCIUM 8.2*
12/18/09 0715 128* 8 0.83 135 4.3 102 29 8.2*
ASSESSMENT & PLAN: 1. Anemia. Patient has normocytic anemia. His HH is slowly trending down. Likely due to the surgery. There is no evidence of active bleeding at this time. Patient is otherwise hemodynamically stable with minimal symptoms. Will transfuse two units of PRBCs tonight. Will follow post-transfusion CBC to see if patient responds to transfusion appropriately. If not, may consider further imaging study of the surgical site to rule out bleeding. Will continue iron supplement. As per patient and ortho, the leg swelling has no change. No rectal bleeding. 2. Status post total hip arthroplasty. Patient is weightbearing as tolerated to his left lower extremity. Will provide adequate pain control. Will provide dry dressing change to the surgical incision site daily. Will provide adequate bowel regimen to prevent constipation. Ortho consult is follow in him.
000251
3. History of depression. This is stable. Continue Prozac. 4. Patient is a full code. DVT RISK ASSESSMENT AND PREVENTION PLAN: Patient is on Arixtra trial for DVT prophylaxis. Will continue. This will be ended on December 25, 2009. Patient left the medicaton at the SNF if stable over night, may transfer him back to SNF tomorrow.
Report Electronically Signed by: Jia Wang M.D. Internal Medicine Attending PI 09895. Page 40878
Electronically signed by Jia Wang, MD at 12/20/2009 2:51 PM H&P signed by Ru Ya Cai, MD at 12/20/09 0730 Author: Ru Ya Cai, MD Service: (none) Filed: 12/20/09 0732 Note Time: 12/19/09 0000 Author Type: *PHYSICIAN: FACULTY
PATIENT: AMUNDSEN, MARK LOCATION: MR #: 8081369 SEX: M AGE: 50 ADMISSION DATE: 12/19/2009 DOB: 09/23/1959 INPATIENT HISTORY AND PHYSICAL CHIEF COMPLAINT: Anemia. HISTORY OF PRESENT ILLNESS: Patient is a 50-year-old man who underwent left total hip replacement about four days ago. Patient was discharged to a skilled nursing facility for rehab. He was found to have worsening anemia during routine lab work today. Patient was directly admitted for blood transfusion. Patient denies chest pain, no worsening shortness of breath, has some generalized weakness and fatigue, no nausea, vomiting, no fever, chills, no abdominal pain, no diarrhea or constipation, no dysuria. He has left leg (especially left thigh) swelling after the surgery. There is no worsening swelling. Patient denies hemoptysis, no hematemesis, no melena or hematochezia, no evidence of bleeding. REVIEW OF SYSTEMS: All systems have been reviewed which are negative except as indicated in HPI. PAST MEDICAL HISTORY: Depression, left hip pain and DJD. PAST SURGICAL HISTORY: Tonsillectomy when he was a child, left inguinal hernia repair many years ago, left total hip arthroplasty December 15,2009. ALLERGIES: MORPHINE (CAUSED HIVES), FENTANYL (CAUSED ITCHING). MEDICATIONS: Soma 350 mg one tablet q.8h. as needed, Valium 5 mg q.8h. as needed, Benadryl 25 mg q.6h. as needed, Colace 100 mg b.i.d., FeSO4 300 mg t.i.d., Protonix 40 mg q.a.m., methadone 40 mg at 8:00 a.m. and 4:00 p.m. and 50 mg at 10:00 p.m., oxycodone 20 mg q.3h. as needed for pain, senna two tablets q.h.s., Arixtra 2.5 mg subcu daily (which will be ended December 25, 2009).
000252
FAMILY HISTORY: Significant for grandmother had a cancer, unknown kind. Mother died from lung cancer. SOCIAL HISTORY: Patient is a previous smoker, quit in 1999. Occasional alcohol, no illicit drug use. Patient was in the military, honorably discharged. Widowed. PHYSICAL EXAMINATION: VITAL SIGNS: Pending. GENERAL: Patient is alert, oriented x3, in no acute distress. Speaking full sentences. HEENT: Pupils equal, round, reactive to light, extraocular movement intact. Oropharynx clear, mucous membranes moist. NECK: No JVD, no lymphadenopathy. LUNGS: Clear to auscultation bilaterally. HEART: Regular rate rhythm, S1, S2 normal, no murmur. ABDOMEN: Soft, nontender, nondistended, bowel sounds present. EXTREMITIES: Diffuse edema of the left leg, especially left thigh. Surgical wound is clean and intact with dressing in place, minimal discharge, no erythema. Right leg: No edema or cyanosis or clubbing. NEUROLOGIC: Cranial nerves II through XII grossly intact. LABS: Sodium 135, potassium 4.3, chloride 102, bicarb 29, BUN 8, creatinine 0.83, glucose 128. WBC 7.8, hemoglobin 7.1, hematocrit 20.9, platelets 147,000. ASSESSMENT: This is a 50-year-old man who underwent left total hip arthroplasty on December 15, discharged to a skilled nursing facility for rehab, was found to have worsening anemia during routine lab work. Patient was admitted for blood transfusion. TREATMENT PLAN: 1. Anemia. Patient has normocytic anemia. His HH is slowly trending down. Likely due to the surgery. There is no evidence of active bleeding at this time. Patient is otherwise hemodynamically stable with minimal symptoms. Will transfuse two units of PRBCs tonight. Will follow post-transfusion CBC to see if patient responds to transfusion appropriately. If not, may consider further imaging study of the surgical site to rule out bleeding. Will continue iron supplement. 2. Status post total hip arthroplasty. Patient is weightbearing as tolerated to his left lower extremity. Will provide adequate pain control. Will provide dry dressing change to the surgical incision site daily. Will provide adequate bowel regimen to prevent constipation. 3. History of depression. This is stable. Continue Prozac. 4. Patient is a full code. DVT RISK ASSESSMENT AND PREVENTION PLAN: Patient is on Arixtra trial for DVT prophylaxis. Will continue. This will be ended on December 25, 2009.
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THIS WAS ELECTRONICALLY SIGNED - 12/20/2009 7:30 AM PST BY: ASSOCIATE CLINICAL PROFESSOR DIVISION OF PULMONARY MEDICINE DEPARTMENT OF INTERNAL MEDICINE ATTENDING NOTE:
RU CAI, MD
RC:jm(usa160) D: 12/20/2009 12:13 AM T: 12/20/2009 02:32 AM C#: 4835456
Electronically signed by Ru Ya Cai, MD at 12/20/2009 7:30 AM Revision history:

> 12/20/09 0732 Inpatient H & P (0101) revision by Ru Ya Cai, MD 12/20/09 0328 Inpatient H & P (0101) filed by Ru Ya Cai, MD
Nurse Progress signed by Encarnacion Arenas, RN at 12/20/09 0648 Author: Encarnacion Arenas, Service: (none) Author RN Type: 12/20/09 0647 12/20/09 0648 Filed: Note Time:
.NURSE: (RN or LVN)
1st unit of RBC blood transfusion consumed at 0640 with no reaction noted, afebrile, no acute distress, will monitor till end of shift. Encarnacion Arenas RN Electronically signed by Encarnacion Arenas, RN at 12/20/2009 6:48 AM Nurse Progress signed by Encarnacion Arenas, RN at 12/20/09 0429 Author: Encarnacion Arenas, Service: (none) Author RN Type: 12/20/09 0429 12/20/09 0427 Filed: Note Time: .NURSE: (RN or LVN)
Started 1st unit of RBC blood transfusion, premedicated as ordered, monitored patient with no signs/symptoms of any blood reaction this time, will continue to monitor. Encarnacion Arenas RN Electronically signed by Encarnacion Arenas, RN at 12/20/2009 4:29 AM Nurse Progress signed by Encarnacion Arenas, RN at 12/20/09 0301 Author: Encarnacion Arenas, Service: (none) Author RN Type: 12/20/09 0257 12/20/09 0301 Filed: Note Time: .NURSE: (RN or LVN)
Patient in no acute distress, snacks provided & ate well, voided in the bathroom, H & H result 6.7/19.1, followed up with blood bank & will start blood transfusion when ready, will continue to monitor. Encarnacion Arenas RN
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Center None
Appointment
Phone 916-509-0158 (Home) 916-983-4484 (Work) Provider James Paul Ressler, PA, PA
Department Carm Orthopaedics
Transcription Type Carmichael Consult (6804) Electronically Signed
ID 1162910
Author James Paul Ressler
Document Text PATIENT: AMUNDSEN, MARK LOCATION: ORTCAR MR #: 8081369 SEX: M AGE: 44 DATE OF SERVICE: 04/09/2004 DOB: 09/23/1959 CARMICHAEL CONSULTATION Chief complaint: Low back pain, left leg pain, left groin pain. Dear Dr. Baquero: I evaluated Mr. Mark Amundsen in consultation, per your request. HPI: This is a 44-year-old Caucasian male, 6 foot 1, 223 pounds, with a history of chronic low back pain and left leg radiculopathy for 3
000255
and 9 years, respectively, associated with left groin pain that has been evaluated in the past with a multiplicity of workups, including x-rays that had been taken recently by you, which I have personally reviewed today. Thirteenth of September 2002, limited view: The AP and lateral spot view shows some minimal degenerative changes to the L5-S1 segment but otherwise normal. He has also had bilateral hip films, AP pelvis, and bilateral lateral of the hips from December 1, 2003, showing mild to early moderate DJD. The patient has had persistent complaints of low back pain, which had been primarily relieved with the use of epidural steroid injections, which had been accomplished at the Pain Management Center at UC-Davis Medical Center. His next epidural is scheduled now for April 2004. During these epidural injection, he has had symptomatic relief of his left leg radiculopathy, but they have been, yet, been unable to help him with his current complaints that center around his left leg pain. The patient has been on a plethora of medications, including Vicodin, OxyContin, Norco, Topamax, Prozac, meclofenamate all with some minimal symptomatic improvement. He denied any bowel or bladder symptomatology. He has no other constitutional symptoms consisting of fever, chills, night sweat, or weight loss. He has a normal appetite. He has no history of any carcinomas. His alleviating factors are primarily with the epidurals. His aggravating factors are primarily prolonged sitting. He denied any bowel or bladder symptomatology, no history of incontinence. He has no foot drop that he has noted on either foot. The patient has undergone a recent MRI on 03/05/04 of the LS spine, and is not showing any significant areas of stenosis, either centrally or the lateral foramen. There is a previous MRI showing annular tear at L5-S1 but otherwise unremarkable. That was done in 2002. Medications are as listed above. Allergies to ibuprofen, producing welts. Surgeries: Hernia repair on the left side in 1987. Tonsillectomy in 1967. He has a history of right and left ankle fractures, the right x4, in 78, 82, 87, and 96, and the left from 1994, all closed reduced, with cast treatment. He is a previous smoker, quit in 1999, occasional alcohol, no drugs. Unknown last tetanus, with no blood transfusion. He has completed the 12th grade. Was in the military as an E6, honorably discharged, is widowed, currently living in Folsom without children. He denied any diabetes or thyroid disease. His review of systems is positive for occasional shortness of breath with exercising. History of GI complaints, primarily surrounding diarrhea and constipation with complaints of migraine headaches. His family history shows a father was deceased, unknown causes. Mother deceased from lung cancer age 75. He has two siblings, 47 and 39, in apparent good health, respectively. Family history is significant for the carcinoma, as stated above. Denies any coronary artery disease. No other back complaints listed. No other family history of back problems listed. Physical examination: 6 foot 1, 223 pounds. Respirations 18 and unlabored. LS spine examination shows a full range of motion in all
000256
fields with no restrictions. Has pain maximally at the end point of lateral rotational bend. He is knee to straight-leg raise was 90 degrees, downgoing Babinski, no clonus. His muscle group strength in the lower extremities were symmetrically equal at 5/5. Sensation is normal to light touch. He has full range of motion of both hip joints without restrictions and no pain. He has tenderness to palpation along the paravertebral musculature that extends in a bandlike fashion in a bell-like manner around the L3-5 segment. Dorsalis pedis and posterior tib pulses are 2+. He has negative figure-of-four. Impression and plan: Chronic low back pain with underlying mild degenerative disk disease of the L5-S1 segment, with L4-5 or L5-1 left leg radiculopathy. No neurological deficit is noted. Plan: At this point, I would continue with conservative modalities, as he has been doing. Primarily, he has been successful with epidural steroid injections. If he should persist with continued left leg radiculopathy, we would, again, reevaluate. In regard to his hip pathology, he has mild to moderate osteoarthritis. He would not be a good surgical candidate for a total hip arthroplasty. I would monitor that on a interim basis. Should you have any questions or require further information, please feel free to contact me. Thank you, again, for allowing us to participate in his evaluation. Sincerely yours,
THIS WAS ELECTRONICALLY SIGNED - 04/12/2004 1:39 PM PST BY: JAMES RESSLER, PAC SENIOR PHYSICIAN ASSISTANT ORTHOPAEDICS ORTHOPAEDIC SURGERY
THIS WAS ELECTRONICALLY SIGNED - 04/13/2004 1:45 PM PST BY: ROLANDO F ROBERTO, MD
JR:ck(trs109c) D: 04/09/2004 01:30 PM T: 04/09/2004 09:50 PM C#: 431519
Display only: Transcription (1162910) on 4/9/2004 1:30 PM by James Paul Ressler Document history: Transcription (1162910) on 4/9/2004 1:30 PM by James Paul Ressler
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Orders
Patient Information Patient Name Amundsen, Mark Sex Male DOB 9/23/1959
Account # 078661756029
Phone 916-509-0158 (Home) 916-983-4484 (Work) Provider Vflot Imfros
Department Carm Lab
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Center None
Office Visit
Selected Appointment 2/17/2011 8:45 AM Provider Andrew Kim Oh, MD, MD
Mark Amundsen (MRN 8081369) Department Carm Neurology

Payor
Financial Class P
000258
Diagnoses Weakness - Primary Reason for Visit Weakness Consultation Reason For Visit History Recorded Level of Service OFFICE/OUTPT VISIT,NEW,LEVL V [99205]
780.79 Rule out chronic inflammatory demyelinating polyneuropathy Requested by Victor Henrique Baquero, MD, and Barton Lahn Wise, MD
Medications
Medications at Start of Encounter Disp Refills Start End 30 Tab 1 2/16/2011 3/18/2011 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Pharmacy 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 8 Cap 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. - ORAL Class: Pharmacy 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet 30 Tab Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 100 Tab 1 2/1/2011 5/4/2011 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical 0 2/16/2011 3/19/2011 Hydrocodone 10 mg/Acetaminophen 325 100 Tab mg (NORCO) 10-325 mg Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 240 Tab 0 1/24/2011 2/23/2011 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Class: Handwritten Rx Medication Review History
000259
Med Rev Hx Medication Administration Report for Amundsen, Mark All administrations No administration data available Pharmacy Selected For Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630
Orders
Order Summary EMG/NCS [NEURO00007 Custom] Order #: 65113822 Future Orders ACETYLCHOLINE RECEPTOR [LABNO Custom] Order #: 65114094 ACETYLCHOLINE MODULATING AB [LABNO Custom] Order #: 65114095 MUSK ANTIBODY [LAB001 Custom] Order #: 65114096 CREATINE KINASE [LABNO Custom] Order #: 65114097 ALDOLASE [LABNO Custom] Order #: 65114098 THYROID PEROXIDASE (TPO) AB [LABNO Custom] Order #: 65114099 THYROID STIMULATING HORMONE [LABNO Custom] Order #: 65114100 THYROXINE, FREE (FREE T4) [LABNO Custom] Order #: 65114101 LEAD, BLOOD [LABNO Custom] Order #: 65114102 Expected By 2/17/11 2/17/11 2/17/11 2/17/11 2/17/11 2/17/11 2/17/11 2/17/11 2/17/11 Expires 2/17/12 2/17/12 2/17/12 2/17/12 2/17/12 2/17/12 2/17/12 2/17/12 2/17/12
Immunizations
Visit Summary
Vitals Recorded in This Encounter 02/17/2011 0837 101.152 kg (223 lb) Weight: 1.854 m (6' 1") Height: 29.5 BMI: 2.28 m2 BSA: 76 Pulse: 16 Resp: 108/72 mmHg BP: sitting Orthostatic Position: right arm SITE:
000260
Cuff Size: Pain Score: Pain Loc: Comments:
large 4 HIP Bilateral
UNIVERSITY OF CALIFORNIA DAVIS HEALTH SYSTEM PRIMARY CARE NETWORK - CARMICHAEL NEUROLOGY OUTPATIENT NEUROLOGY CONSULTATION PATIENT: Mark Amundsen MRN: 8081369 SEX: male AGE: 51yr DOB: 9/23/1959 DATE OF SERVICE: 2/17/2011 LOCATION: NEUCAR CHIEF COMPLAINT: Weakness Rule out chronic inflammatory demyelinating polyneuropathy Consultation Requested by Victor Henrique Baquero, MD, and Barton Lahn Wise, MD HISTORY OF PRESENT ILLNESS: Mark Amundsen is a 51yr old right-handed man seen today in neurological consultation at the request of Dr. Victor Henrique Baquero of family medicine and Dr. Barton Lahn Wise of rheumatology regarding severe weakness located mostly in the legs but also in the back over a duration of 4-5 months with associated difficulty walking. He denies associated weakness of neck muscles or weakness of face muscles or blepharoptosis or dysarthria or dysphagia or dysphonia. He reports some chronic numbness in the right forefoot but otherwise there is no associated numbness or tingling or pain. With regard to timing, the weakness is constant and nonfluctuating. He has chronic left hip problems and he had left total hip arthroplasty but he attributes his walking problem to weakness rather than his left hip problem. He is on Norco and methadone for chronic pain. Dr. Wise of rheumatology did not think he had a rheumatologic condition but did suspect chronic inflammatory demyelinating polyneuropathy. PAST MEDICAL HISTORY: ADVANCED OSTEOARTHRITIS OF THE LEFT HIP DEPRESSIVE DISORDER CHRONIC PAIN MEDICATION AGREEMENT
000261
Anemia Orthopedic Aftercare for Joint Replacement Dyslipidemia Vitamin D deficiency Hypertension
MEDICATIONS: Carisoprodol (SOMA) 350 mg Tablet, Take 2 Tabs by mouth every day at bedtime. Carisoprodol (SOMA) 350 mg Tablet, Take 1 Tab by mouth 3 times daily. Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule, Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. Fenofibrate (TRICOR) 145 mg PO Tablet, Take 1 Tab by mouth every morning after a meal. Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet, For breakthrough pain. Methadone (DOLOPHINE) 10 mg Tablet, Take 2 Tabs by mouth every 6 hours. Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet, Take 1 Tab by mouth every morning. ALLERGIES: Allergies Allergen Morphine Fentanyl itching
Reactions Hives
SOCIAL HISTORY: History of cigarette smoking. Rare alcohol use. Previously worked as a network administrator. FAMILY HISTORY: Noncontributory. REVIEW OF SYSTEMS: All systems reviewed on 2/17/2011 and all systems are negative except as mentioned in the history of present illness. PHYSICAL EXAMINATION: Vital signs: BP 108/72 | Pulse 76 | Resp 16 | Ht 1.854 m (6' 1") | Wt 101.152 kg (223 lb) | BMI 29.42 kg/m2 General appearance: Patient appears well, in no acute distress. Eyes: Anicteric. Respiratory: Chest clear to auscultation. Ears, nose, mouth, and throat: Normal. Musculoskeletal: Neck supple. Normal range of joint motion. Cardiovascular: No carotid bruits. Heart sounds regular. Skin: No jaundice. Psychiatric: Normal mood and affect. Neurological: Visual fields full to confrontation. PERRL. EOMI. No spontaneous or gaze evoked nystagmus. Facial sensation intact. Facial muscle strength normal. No blepharoptosis. Hearing intact. Palate elevation normal. Sternocleidomastoid function and shoulder shrug normal. Tongue protrudes in midline. No tongue atrophy. No tongue fasciculations. DTRs 2+ and symmetric throughout. Babinski sign absent. Motor power 5/5 and symmetric in distal and proximal muscles including neck muscles. Normal motor tone. Normal muscle bulk with no muscle atrophy and no fasciculations. No pronator drift. Sensation intact to temperature, vibration, and proprioception. Romberg sign absent. Mental status normal. Gait is slow and deliberate, out of proportion to any weakness demonstrated on individual muscle testing. Limb coordination normal without dysmetria. Rapid alternating movements normal.
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OTHER DATA: Old records reviewed: I reviewed prior UC Davis Health System records including a rheumatology note from 02/01/2011 by Dr. Barton Lahn Wise which indicates "...The patient described symptoms of weakness of a progressive nature, now involving weakness of his back, which is somewhat atypical to have. Little of his weakness is convincing for rheumatologic disease and his inflammatory markers such as ESR and ANA are all negative. The patient's presentation does not fit the picture of rheumatological diseases such as polymyositis or rheumatoid arthritis. His symptoms of 15 minutes of morning stiffness is too brief to be rheumatalgically related. His age again is fairly young to present with polymyalgia rheumatica and he has no pains that are strongly suggestive of RA by distribution or otherwise...We may consider something like chronic inflammatory demyelinating polyneuropathy (CIDP) which can present with progressive weakness..." Laboratory results: CK normal. B12 normal (478). Folate normal. ESR normal (8). ANA negative. Electrolytes, BUN, creatinine all normal. LFTs normal. 25 hydroxy vitamin D borderline low (25.1). Fasting glucose normal (94). Acetylcholine receptor blocking antibody negative. TSH borderline elevated (3.42). Free T4 normal. Urine heavy metals negative. Radiology results: I independently visualized the following radiology studies today: Lumbar spine MRI without contrast 03/05/2004: Normal. No disc bulges. No foraminal stenosis. No central canal stenosis. IMPRESSION/PLAN: 780.79L Weakness (primary encounter diagnosis) Comment: New problem to this examiner; additional workup planned. The abnormalities he displays when walking are out of proportion to any muscle weakness demonstrated on individual muscle strength testing. His reflexes are also normal. For these reasons, on a scale of nil-low-intermediate-high, my level of suspicion of chronic inflammatory demyelinating polyneuropathy is somewhere between nil and low. I will request additional testing, as delineated below, to further exclude an organic explanation for his symptoms. Plan: EMG/NCS. ACETYLCHOLINE RECEPTOR BINDING AB. ACETYLCHOLINE RECEPTOR MODULATING AB. MUSK ANTIBODY. CREATINE KINASE. ALDOLASE. THYROID STIMULATING HORMONE. THYROXINE FREE (FREE T4). THYROID PEROXIDASE (TPO) AB. LEAD BLOOD. COMMENT:
000263
I explained to Mr. Amundsen the diagnosis, prognosis, treatment options, risks, benefits, and his right to choose treatment options. He verbalized a good understanding and all questions were answered to his satisfaction. I provided reassurance and directed him to contact me as needed for further information. FOLLOWUP: Return after tests.
Electronically signed by Andrew Kim Oh, MD at 2/17/2011 11:19 AM
Questionnaire
RACE/ETHNICITY/LANGUAGE FORM Question In what language do you feel most comfortable speaking with your doctor or nurse? Select one. Do you consider yourself Hispanic/Latino? (Select one.) Please tell us your race: By race, we mean the major world group or groups from which your ancestors came. (Select as many categories as you need to describe yourself.) We would like you to describe your ethnic background. By ethnicity, we mean the group or groups with whom you share your cultural identity or customs. (Select as many categories as you need to describe your specific Ethnicity.) We would like you to describe your ethnic background. By ethnicity, we mean the group or groups with whom you share your cultural identity or customs. (Select as many categories as you need to describe your specific Ethnicity.) We would like you to describe your ethnic background. By ethnicity, we mean the group or groups with whom you share your cultural identity or customs. (Select as many categories as you need to describe your specific Ethnicity.) We would like you to describe your ethnic background. By ethnicity, we mean the group or groups with whom you share your cultural identity or customs. (Select as many categories as you need to describe your specific Ethnicity.)
Answer ENGLISH [8]
Not Hispanic or Latino [26] White [6]
European [17]
German [21]
Irish [24]
Italian [26]
000264
Visit Notes RONALD P ROJAS Thu Feb 17, 2011 8:43 AM Patient presents with: Weakness - Rule out chronic inflammatory demyelinating polyneuropathy Consultation - Requested by Victor Henrique Baquero, MD, and Barton Lahn Wise, MD Vital signs taken, allergies verified, screened for pain, med hx taken. Ronald P Rojas
Electronically signed by RONALD P ROJAS at Thu Feb 17, 2011 8:43 AM
All Flowsheet Templates (all recorded) Amb Vitals Group Flowsheet Custom Formula Data Flowsheet

Patient Instructions None Follow-up and Disposition Return in about 2 months (around 4/17/2011). Routing History Recorded Visit Disposition Disposition Return in about 2 months (around 4/17/2011). Chart Reviewed By Emily Hazzard, MOSC on 2/17/2011 10:37 AM Victor Henrique Baquero, MD on 2/17/2011 1:20 PM Barton Lahn Wise, MD on 8/22/2011 11:15 AM
Problem List
10/22/2010 1/19/2006 5/26/2006 4/30/2008

000265
Urine output: 200 Anesthetic Complications: No apparent anesthetic complications Disposition: stale, extubated, to pacu Resident signature: Sampaguita (Sam) Tafoya, MD Resident Physician, PGY-3 Department of Anesthesiology and Pain Medicine
Perioperative Presence: Resident Supervision Concurrency: TWO-FOUR CONCURRENT CASES: I was physically present for the key portion(s) of the procedure and during other times, was immediately available to return to the procedure. The key portions of the procedure are documented below. During the time in which my physical presence was not required, a designated backup teaching anesthesiologist was immediately available. Name of Backup Anesthesiologist: Levin Key Portions: Induction Emergence Attending signature: Phat Giang Attending signature: Phat Giang
The information contained on this form is true and correct to the best of my knowledge. Further, I understand that if I misrepresent, falsify or conceal information regarding my participation in the professional service described above, I may be subject to fine, imprisonment, or civil penalty under applicable federal laws. Electronically signed by Phat Giang, MD at 12/29/2009 2:01 PM Revision history: > 12/29/09 1401 Progress Notes signed by Phat Giang, MD 12/15/09 1606 Progress Notes shared by Sampaguita Tafoya, MD Procedures signed by Robert Michael Tamurian, MD at 12/28/09 2156 Author: Jonathan G Service: (none) Author Eastman, MD Type: 12/28/09 2159 12/15/09 0000 Filed: Note Time: PATIENT: AMUNDSEN, MARK LOCATION: D14O MR #: 8081369 SEX: M AGE: 50 OPERATION DATE: 12/15/2009 DOB: 09/23/1959 OPERATION RECORD PREOPERATIVE DIAGNOSIS: Left hip degenerative joint disease. POSTOPERATIVE DIAGNOSIS: *PHYSICIAN: RESIDENT
000266
Same. PROCEDURE PERFORMED: Left total hip arthroplasty. CPT code 27130. ANESTHESIA: General endotracheal anesthesia. INTRAVENOUS FLUIDS: 2 liters crystalloid, 1 liter colloid. ESTIMATED BLOOD LOSS: 600 cc. URINE OUTPUT: 200 cc. SPECIMENS: Arthritic joint surface from the left acetabulum and femoral head. DRAINS: None. COMPLICATIONS: None. OUTCOME: Stable to Recovery Room. COMPONENTS: 1) DePuy Summit femoral component size 7 with extended offset. 2) DePuy Gription acetabular cup size 58 mm with a size 58-mm metal liner. 3) DePuy femoral head size 40 mm with 5-mm neck length. FINDINGS: Severe degenerative arthritis of the left hip. HISTORY OF PRESENT ILLNESS: Mr. Amundsen is a 50-year-old male, who has an approximately six-month history of insidious onset of left hip severe pain. He describes a dull aching pain with occasional mechanical symptoms with weightbearing and activities of daily living. This failed conservative treatment with pain medications and activity modification. He had radiographic evidence of severe osteoarthritis. After discussion of the risks and benefits of procedure, it was felt appropriate to proceed with left total hip arthroplasty. Informed consent was obtained preoperatively. PROCEDURE: Mr. Amundsen was identified in the preoperative holding area. He was identified as Mark Amundsen, #8081369. His left lower extremity was identified as the correct site of surgery and left total hip arthroplasty identified as the correct surgery to be performed. This was verified with the patient. All of his questions and concerns were answered and addressed, and he was amenable to proceeding. Informed consent was verified. His left lower extremity was initialed by Dr. Tamurian. He was then transported the other Operating Suite, placed supine on the operating table. General anesthesia was induced without complication once the endotracheal tube was secured. He was then placed into the right lateral decubitus position with a well-padded axillary roll placed. His left upper extremity was placed in a well- padded, multitask arm board. His down leg was well padded and impervious U-drape was placed around his left lower extremity. Clinical exam showed he was approximately 5 mm to 1 cm short at the left lower extremity. He was held into position with a pegboard. His left lower extremity was then prepped and draped in the normal sterile fashion. He received intravenous cefazolin and vancomycin prior to incision. A surgical pause occurred prior to procedure. The patient was then again identified as Mark Amundsen, 8081369, and his left lower extremity identified as the correct site of surgery, and a left total hip arthroplasty identified as the correct surgery to be performed. This was localized and verified with the anesthesiologist in the Operating Room, circulating nurse, and it was felt appropriate to proceed after the remaining surgical pause criteria were covered. A marking pen was used to mark out his anatomy including his greater trochanteric femoral shaft, anterior and posterior superior iliac spines. Next, an approximately 13-cm curvilinear incision was made starting on the proximal posterior aspect of the femur, coursing proximal and posterior in a curvilinear fashion towards the posterior superior iliac spine. Next, the incision was then made with the 10 blade. This was taken down sharply through the subcutaneous tissues, down to the deep fascia. Bovie electrocautery was used for hemostasis. The iliotibial band and deep fascia were identified and cleared with a Cobb elevator. Next, the deep fascia and IT band was incised sharply with the Bovie electrocautery. This was taken down proximally and distally in line with the incision. Once this was exposed appropriately, the Charnley retractor system was then inserted. This exposed the greater trochanteric bursa, which was excised. Next, the gluteus medius was identified. A Hohmann retractor was placed at the interval between the gluteus medius minimus. Next, the piriformis was identified. This was isolated with a right-angle clamp. This was followed by tagging with an 0 Vicryl. This was then released with Bovie electrocautery at
000267
insertion, and retracted posteriorly. The interval between the gluteus minimus and the capsule was then identified. This was followed by placement of the cobra retractor. The remaining short lateral rotators were then released with Bovie electrocautery down to the level of the lesser trochanter. This exposed the capsule. A T- shaped capsulotomy was then made at the level of piriformis. Both the inferior and superior leaves were then tagged with an 0 Vicryl. These were then reflected exposing the femoral head. Next, the hip was dislocated. All remaining soft tissues were debrided as needed. Hohmann retractors were then placed around the inferior and superior aspect of the femoral head. The proximal femoral cutting guide was then inserted down the femoral shaft and this was placed approximately 13 mm above the lesser troch. A line was drawn with electrocautery. Next, a large oscillating saw was then used to make the femoral neck cut appropriately. The head was then removed with the head grabber to expose the acetabulum. The pulvinar was resected. A small rent was made in the anterior and posterior capsule allowing insertion of Hohmann retractors. The superior anterior labrum was then resected. There was no posterior labrum present. There were large osteophytes present. These were resected with the osteotome. The femoral head was sized to a size 56. We then started reaming with the size 49-mm reamer. This was then medialized appropriately. Next, sequential reaming began with the 51 to 53 to 55 to a 57-mm cup ensuring the appropriate amount of abduction and anteversion. There was a good purchase with the 57-mm reamer. It was then deemed appropriate to proceed with a 15-mm cup. This was selected, attached to its inserter handle. This was placed into the acetabulum, impacted into place ensuring the appropriate amount of abduction and anteversion. This was checked with the alignment guide and found to be appropriate. Next, a trial liner was then inserted and attention was turned to the femur. A femoral neck elevator was then inserted. The box cutting osteotome was used to clear out the femoral neck, exposing the femoral canal. This was followed by a canal finder and a lateralizing reamer to enter the femoral intramedullary canal. This was followed by power broaches, starting with the size 0, 1, up to a 2, 3, 4, 5 and to a 6, 7. This was followed by manual broaching starting at size 3 and finishing with the size 7, ensuring the appropriate amount of anteversion with the broaching. Next, the trial 7 was left in place. The standard offset 40-mm neck and head were trialed. He was notably short. This was then increased up to a size 5 mm where he was still noticeably short. It was then made decision to proceed with an offset neck and +5mm head. With this, he had gross leg length equality as well as stability to 90 degrees of flexion and 80 degrees of internal rotation. There was no evidence of anterior impingement and he was stable in extension. It was deemed appropriate to proceed with these implants. Next, all trial implants were removed. The hole eliminator was then placed in the acetabulum. This was followed by placement of the metal liner. This was lined appropriately and impacted into place. Next, the femoral stem was then placed into the femoral shaft. This was then impacted into place. This was followed by placement of the head onto the Morse taper of the shaft and impacted into place. The hip was reduced. Stability was checked and found to be no change from the prior exam. Next, the wound was copiously irrigated with two liters of pulsed lavage normal saline. Closure then began. The capsule was then repaired with 0 Vicryl in figure-of-eight buried fashion followed by reattachment of the capsule leaves and the piriformis to the greater trochanter with the use of a free needle Next, the Charnley system was removed. The deep fascia was closed with 0 Vicryl in figure-of-eight interrupted fashion. This was followed by irrigation of the soft tissues. This was followed by skin reapproximation with 2-0 Vicryl in a subdermal buried fashion followed by staples for skin closure. The skin was cleansed and dried. A sterile dressing consisting of Xeroform gauze, ABD, and Medipore tape, was applied. The drapes were removed. He was placed into an abduction pillow. Pegs were removed. He was placed supine on the table. He was extubated without difficulty, transferred to his gurney, and to the Recovery Room in stable condition. POSTOPERATIVE PLAN: He will be weightbearing as tolerated in the left lower extremity with posterior hip precautions. He will receive 24 hours of prophylactic antibiotics. He will be enrolled in the Arixtra study for DVT prophylaxis. His wound will be checked on postoperative day number two and he will advance on the postoperative total hip arthroplasty protocol.
000268
THIS WAS ELECTRONICALLY SIGNED - 12/28/2009 9:55 PM PST BY: SURGEON DEPARTMENT OF ORTHOPAEDIC SURGERY THIS WAS ELECTRONICALLY SIGNED - 12/17/2009 11:48 AM PST BY: MD ASSISTANT SURGEON DEPARTMENT OF ORTHOPAEDIC SURGERY JE:seb(usa109) D: 12/16/2009 03:01 PM T: 12/16/2009 04:23 PM C#: 4830014
ROBERT TAMURIAN, MD
JONATHAN EASTMAN,
Electronically signed by Robert Michael Tamurian, MD at 12/28/2009 9:56 PM Revision history: > 12/28/09 2159 Inpatient Op / Procedure Note (0105) revision by Jonathan G Eastman, MD 12/17/09 1151 Inpatient Op / Procedure Note (0105) revision by Jonathan G Eastman, MD 12/16/09 1725 Inpatient Op / Procedure Note (0105) filed by Jonathan G Eastman, MD Telephone Encounter
Patient informed
Triplicate written. Please notify patient. Request follow up with me end of January.
Electronically signed byVictor Henrique Baquero, MD on 12/28/2009 12:11 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes filed by Joanna Baginski, MD at 12/28/09 1026 Service: (none) Author: Joanna Baginski, MD 12/28/09 1026 12/28/09 1025 Note Filed: Time: Author Type: *PHYSICIAN: FACULTY
Scan on: 12/28/2009 10:25 AM by: Joanna Baginski, MD [101052744] - CONSENT TO OPERATION Telephone Encounter
From: Amundsen,Mark Sent: 12/28/2009 5:15 AM
000269

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THERAPY EVALUATION
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PHYSICAL Date: Patient: Birth Date: Referred By: Diagnosis:

10/24/02
AMUNDSEN, Mark 9/23/59 Victor Baquero, M.D.\UCD-Folsom Low back pain
Current Medical History: The patient is a 43 year-old male with a long history of low back pain, which began approximately nine years ago after performing a series of sit-ups. Over the years, back pain has gradually worsened with referral into his left leg. At this time, complaints include constant low back pain radiating into the anterolateral thigh with "shoociug" pain into the knee. X-rays have been negative. No other diagnostic testing has been done. The patient is taking Vicodin for pain and anti-inflammatories as needed. Symptoms tend to be worse at night and he is awakened every 1-2 hours with back pain. Aggravating Factors: Silting greater than 20 minutes, standing greater than 10-15 minutes, and driving. Easing Factors: None at this time.
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Objective Findings: With visual inspection, the left ASIS is anterior, resulting in the left lowe~ extremity being longer in supine and becomes equal in long-sit. Neural screening is clear for deep tendon reflexes and rnyotornal deficits. The patient reports decreased sensation to light touch in the SI dermatome. PALPATION: Tenderness :is present along the left quadratus lumborum and left lumbar paraspinal muscles. There is also tenderness with left late~al P-As of the sacrum. ,4ROM: Lumbar forward flexion = WNL (no pain); extension = WNL (left-sidedlow back pain); left rotation = 90% (no pain), right rotation =, WNL (no pain); and right/left side flexion = WNL. SPECIAL TESTS: The patient has a positive bil~teral quadrant test Negative slump testing. Bilateral straight leg raise is also negative. Manual cervical traction decreases low back left leg pain. Clinical Assessment: Signs and symptoms consistent with chronic low back pain, moderate in severity and irritability.
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l . Increase patient's standing and silting tolerances to greater than 45 minutes. 2. Patient independent with a home exercise program for self-management of symptoms. Plan:
Physical therapy 2 x\week for 4, weeks consisting of joint and soft tissue mobllization, trunk stabilization program, lower extremity strengthening, increasing lower extremlry l1exibility/eritlurance, ultrasound, and ice with [Fe. .
Thank you for this referral. Sincerely,
If you have any questions, please do not hesitate to contact me at 983-5900.
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000270

PHYSICAl THrRAPY.O((UPATIOHAl THrRAPY.SP{[(H
130l E. Bidwell St., #101. Folsom, CA 95630 '"OM[ 9161983.590e
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PHYSICAL THERAPY nEPARTMlCNT
DISCHARGE SUMMARY
Date: Patient: Birth Date: Referred By: Diagnosis: 11/22/02
AMUNDSEN, Mark
9/23/59 Victor Baquero, M.D. Low back pain 10/24/02 llI19/02 6
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The above named patient initiated physical therapy on: The patient was last seen on: The number of visits the patient was seen: The patient is being discontinued from physical therapy for the following reason( s): Patient achieved functional goals Instructed in a home exercise program Reached functional ROM and strength Improved status Plateau in progress Patient self-discharged Dear Dr. Baquero: Lack of attendance
Lack of progress towards goals

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Time limit on prescription
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x x
Further diagnostic tests or surgery scheduled Skilled services no longer needed Other: M.D. request
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We received your request to discharge Mark Amundsen from physical therapy at this time until further diagnostic tests have been performed. He has been instructed in a home exercise program focusing on basic lumbar stabilization exercises. Please inform us of any findings from the diagnostic tests that are to be performed on' Mr. Amundsen.
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If you should have any questions, please contact me at 983-5900 Thank you for this referral. Sincerely, ~~ Tom Curry, MPT. TC:ds
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000271
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Contact Person/Caregiver: / Permanent Address: 2017 Tarbolton Cir Folsom CA 95630 Discharge Address: snf tbd Pre-Hospitalization Level of Care: independent Home Health and/or Resources in Place: nono DME in Place: bath bench, fww, cane Potential Barriers to Discharge: none Anticipated DC Needs: short term snf Comments: record reviewed and spoke with pt at bedside. He is drowsy but arousable and oriented and conversant. Pt interested in short term snf placement as he lives alone and states he has no one to help him. He has no preference for snf, did not look prior to surgery. ecin referral made using managed care listing, and hard fax sent to folsom conval. Await responses. Plan/Follow-up needed: snf placement Electronically Signed by: Alison Peters,RN,CCM Clinical Case Manager/DCP Pgr 762-6840
Electronically signed by Alison Peters, RN at 12/16/2009 3:17 PM Allied Health Progress signed by Chad Sherlock, PT at 12/16/09 1422 Author: Chad Sherlock, PT Service: PM&R Author Type: 12/16/09 1422 12/16/09 1422 Filed: Note Time:
Physical Therapy Note
Physical Therapy
Date: 12/16/2009 Charge: eval Physical therapy evaluation completed; please see report for details. Chad Sherlock, DPT PI# 10497 Vocera: 734-0775 Electronically signed by Chad Sherlock, PT at 12/16/2009 2:22 PM Allied Health Consult signed by Chad Sherlock, PT at 12/16/09 1422 Author: Chad Sherlock, PT Service: PM&R Author Type: 12/16/09 1422 12/16/09 1118 Filed: Note Time: Physical Therapy
000272
PM & R / ACUTE CARE SERVICE
PHYSICAL THERAPY EVALUATION Name: Mark Amundsen MRN: 8081369 Date of Service: 12/16/2009 Time In: 1315 INTAKE INFORMATION AND HISTORY: Therapy Consult(s) Ordered: Physical Therapy, OT Primary Service: Orthopedics Date of Admission: 12/15/2009 Date of Onset (Medicare B only): Diagnosis: L THA Language: English Precautions: WBAT LLE, Post hip precautions History of Present Illness/Injury (Including pertinent test results & procedures): Mark Amundsen is a 50yr old male with left hip pain and DJD and depression. His narcotic allergy includes itching, not hives. He takes chronic pain medication and is a smoker. Past Medical/Surgical History: Past Medical History Diagnosis NO SIGNIFICANT HISTORY
Date
Social History: History Substance Use Topics Tobacco Use: Alcohol Use: rare
SUBJECTIVE EXAM: Current Living Situation: Alone Support at Time of Discharge: no Environment at Discharge: Single level home Environmental Barriers: No entry steps Assistive Devices Owned: bath bench front-wheeled walker single point cane Adaptive Equipment Owned: N/A Prior Level of Function: Ambulating independently with consistent use of FWW Mental Status: Alert and oriented x4 Pain Level / Chief Complaint: 6/10 pain Left hip
000273
OBJECTIVE EXAMINATION: Observation: IVPCA, post op dressing Extremity Status: WFL Except ROM MMT
RUE LUE RLE LLE Sensation Tone Coordination
Ankle 4/5, knee 2/5, hip 2/5 Comments: Left hip limited by post hip precautions. Demonstrated Functional Activities: Key: Dep=Dependent Max=Maximal Mod=Moderate Min=Minimal CG=Contact Guard SB=Stand-By S=Supervised I=Independent NA=Not Applicable NT=Not Tested N=Normal G=Good F=Fair P=Poor U=Unable FWW=Front-Wheeled Walker AC=Axillary Crutches SPC=Single-Point Cane
Level of Assistance Rolling Dep Max Mo d Min C G SB S I N A NT Comments
x x x x x x x 8' with FWW FWW
Scooting
Sidelying/ Supine to Sit Transfer Sit to Stand Transfer Bed to Chair Gait Up/Down Step/Stairs Comments:
Balance:
N Sitting Balance Static Sitting Balance Dynamic Standing Balance Static Standing Balance Dyanamic Comments: G F P U NA NT Comments
x x
x x
ASSESSMENT / RECOMMENDATIONS/ EDUCATION: Physical Therapy Assessment and Discharge Recommendations: 50 year old male with L THA. Did well with PT anticipate DC to home 2-3 days. Patient / Caregiver Education Today: Instructed patient in post hip precautions, and exercises (AP and quad sets).
000274
Method of Teaching: verbal Learner: patient Response: verbalizes understanding and able to give return demonstration
GOALS / TREATMENT PLAN / FUCNTIONAL PROGNOSIS: Patients Goals: Get better. Physical Therapy Goals: Bed Mobility: Ind with supine to sit EOB. Transfers: Ind in and out of bed. Gait: Ind in hallway with AD. Home Exercise Program: Ind with TherEx: AP, SLR, Heelslides x 10 Patient Education: Ind with post hip precautions.
Prognosis: Good Treatment Plan: Bed Mobility Training Balance Training Coordination Training Transfer Training Progressive Gait Training Therapeutic Exercise Patient Education Recommended Frequency of Treatment: Twice a day Recommended Duration of Treatment: 2-3 days Patient / Caregiver Participation in Plan of Care Has the plan of care been explained to the patient / caregiver? Is the patient able to understand the plan of care? Does the patient / caregiver(s) agree with the plan of care? List Barriers that may interfere with plan of care: Interim Report Due: 12/30/09 Reported by: Chad Sherlock, DPT PI# 10497 Vocera: 734-0775 yes yes yes None
Electronically signed by Chad Sherlock, PT at 12/16/2009 2:22 PM Revision history: > 12/16/09 1422 Allied Health Consult signed by Chad Sherlock, PT 12/16/09 1413 Allied Health Consult shared by Chad Sherlock, PT 12/16/09 1408 Allied Health Consult shared by Chad Sherlock, PT 12/16/09 1121 Allied Health Consult shared by Chad Sherlock, PT Allied Health Progress signed by Kate McFarland, OT at 12/16/09 1413 Author: Kate McFarland, OT Service: PM&R Author Occupational Therapy
000275
Date of Service: 12/17/2009 Charge: 30 minutes therapeutic activities AND GAIT Time in: 1545
S: Agreeable to Physical Therapy, rated 5/10 pain, located in left hip O: Patient seen for bed mobility with stand by assist OOB and minimum assist BTB. Sat at edge of bed for few minutes. Transfer with front wheel walker and contact guard assist. Gait training with front wheel walker and contact guard assist ambulated 60ft . The patient left in bed with abduction pillow and ALP. Reviewed in bed therapeutic exercises including heelslides and hip abduction prior getting OOB. A: GOOD progress. P: Continue with therapeutic exercises and bed mobility. Ilona Pogany, PT PI# 09097 Vocera: 734-0775 Electronically signed by Ilona Poga'Ny, PT at 12/17/2009 4:42 PM Allied Health Progress signed by Ilona Poga'Ny, PT at 12/17/09 1538 Author: Ilona Poga'Ny, PT Service: PM&R Author Type: 12/17/09 1531 12/17/09 1538 Filed: Note Time:
Physical Therapy Progress Note
Physical Therapy
Date of Service: 12/17/2009 Charge: 30 minutes gait Time in: 945 S: Agreeable to Physical Therapy, rated 6/10 pain, located in left hip O: Patient received sitting in chair. Transfer with front wheel walker and contact guard assist to stand by assist. Gait training with front wheel walker and stand by assist to contact guard assist ambulated 40ft . BTB with minimum assist. The patient left in bed with abduction pillow and ALP. A: GOOD progress. P: Continue with bed mobility and gait. Ilona Pogany, PT PI# 09097 Vocera: 734-0775 Electronically signed by Ilona Poga'Ny, PT at 12/17/2009 3:38 PM Allied Health Progress signed by Alla Sukach at 12/17/09 1433 Author: Alla Sukach Service: PM&R Filed: 12/17/09 1433 Note Time: 12/17/09 0951 Author Type: Cosigner: Occupational Therapy Kate McFarland, OT at 12/17/09 1502
Occupational Therapy Progress Note
Date of Service: 12/17/2009
000276
Electronically signed by Encarnacion Arenas, RN at 12/20/2009 3:01 AM Nurse Assessment signed by Encarnacion Arenas, RN at 12/20/09 0048 Author Author: Encarnacion Arenas, Service: (none) RN Type: 12/20/09 0048 12/20/09 0045 Filed: Note Time:
ADMIT NURSING NOTE
.NURSE: (RN or LVN)
Note Started:
12/20/2009, 0045
Patient admitted at 2245 direct from Rosewood Nursing Rehab Facility per gurney accompanied by First Responder Transport team; patient was oriented to room and unit. MD notified of patient's arrival on unit at 2300 hours. Admission Assessment and Plan of Care initiated, Patient is alert & oriented x 4, no acute distress, with pale skin, left hip incision with staples & dressing dry & intact, call light in reach, will monitor. Encarnacion Arenas RN Electronically signed by Encarnacion Arenas, RN at 12/20/2009 12:48 AM Allied Health Progress signed by Ilona Poga'Ny, PT at 12/18/09 1632 Author: Ilona Poga'Ny, PT Service: PM&R Author Type: 12/18/09 1632 12/18/09 1629 Filed: Note Time:
PM&R ACUTE CARE SERVICE PHYSICAL THERAPY DISCHARGE REPORT
Physical Therapy
Name: Mark Amundsen MRN: 8081369 Date of Service: 12/18/2009 Charge <30 minutes each therapeutic activities and gait Initial Treatment Date: 12/16/2009 Primary Service: Orthopedics Principal and Significant Associated Diagnoses: left total hip arthroplasty Pain: 3-6/10 left hip Functional Status: Key: Dep=Dependent Max=Maximal Mod=Moderate Min=Minimal CG=Contact Guard SB=Stand-By S=Supervised I=Independent NA=Not Applicable NT=Not Tested FWW=Front-Wheeled Walker AC=Axillary Crutches SPC=Single-Point Cane
Level of Assistance Rolling Dep Ma x Mod Min C G SB S I NA NT Comments:
Onset Date of Illness or Injury: 12/15/2009
x x x Needing assistance for left LE management with pants on x
Scooting
Sidelying/ Supine to Sit Transfer Sit to Stand
000277
Transfer Bed to Chair Gait
x x
x Up/Down Step/Stairs Other: mobilizing with front wheel walker, Reviewed transfers from various surfaces including BSC. Discharge Recommendations: Continued Physical Therapy: PT at Skilled Nursing Facility Level of Assistance or Supervision: minimum assist to stand by assist Equipment: FWW Home Exercise Program: ankle pumps, heel slides and supine hip abduction Disposition: Skilled Nursing Facility Patient / Caregiver Training Completed: Yes Comments: Verbalizing and demonstrating good understanding of precautions Treatment Goals And Objectives: Partially met goals Interim Report Date(s): n/a Discharge Date: 12/18/2009 Reported by: Ilona Pogany,PT PI# 09097 Vocera 734-0775
Electronically signed by Ilona Poga'Ny, PT at 12/18/2009 4:32 PM Discharge Planning (AHS/AVS) signed by Alison Peters, RN at 12/18/09 1234 .DC PLNG/CASE MGMT Author: Alison Peters, RN Service: (none) Author Type: 12/18/09 1234 12/18/09 1233 Filed: Note Time: You are being discharged to Rosewood Post Acute Rehab, 483-8103 Electronically signed by Alison Peters, RN at 12/18/2009 12:34 PM Allied Health Progress signed by Alison Peters, RN at 12/18/09 1233 Author: Alison Peters, RN Service: (none) Author Type: 12/18/09 1233 12/18/09 1229 Note Filed: Time:
Clinical Case Management Skilled Nursing Facility Transfer Note
.DC PLNG/CASE MGMT
Medically stable for transfer to skilled nursing facility per Dr tamurian/eastman Patient/family given options/information regarding SNF transfer:yes Patient/patient representative, agreeable to transfer: yes Name of accepting facility: rosewood post acute rehab Telephone number: 483-8103
000278
Action: See AHS for teaching. No new meds given.
Response: Christena R Schob RN
Electronically signed by Christena R Schob, RN at 12/21/2009 7:14 PM Patient Instructions signed by Christena R Schob, RN at 12/21/09 1805 Author: Christena R Schob, Service: (none) Author RN Type: 12/21/09 1805 12/21/09 1805 Filed: Note Time: .NURSE: (RN or LVN)
Call MD if fever>101, increased pain not helped by pain meds, increased redness or swelling to incision area, pus like drainage, wound opening. Numbness or tingling develops to leg. Increased dizziness or confusion.
Electronically signed by Christena R Schob, RN at 12/21/2009 6:05 PM Allied Health Consult signed by Michael Chris Dybdahl at 12/21/09 1530 Author: Michael Chris Service: PM&R Author Dybdahl Type: 12/21/09 1530 12/21/09 1449 Filed: Note Time:
PM & R / ACUTE CARE SERVICE
Physical Therapy
PHYSICAL THERAPY EVALUATION Charge - Eval Name: Mark Amundsen MRN: 8081369 Date of Service: 12/21/2009 Time In: 14:50 INTAKE INFORMATION AND HISTORY: Therapy Consult(s) Ordered: Physical Therapy Primary Service: Team 6 Hospitalist Date of Admission: 12/19/2009 Date of Onset (Medicare B only): N/A Diagnosis: Anemia. Language: English Precautions: None Patient is a 50-year-old man who underwent left total hip replacement about four days ago. Patient was discharged to a skilled nursing facility for rehab. He was found to have worsening anemia during routine lab work today. Patient was directly admitted for blood transfusion. Patient denies chest pain, no worsening shortness of breath, has some generalized weakness and fatigue, no nausea, vomiting, no fever, chills, no abdominal pain, no diarrhea or constipation, no dysuria. He has left leg (especially left thigh) swelling after the surgery. There is no worsening swelling. Patient denies hemoptysis, no hematemesis, no melena or hematochezia, no evidence of bleeding. History of Present Illness/Injury (Including pertinent test results & procedures): Past Medical/Surgical History:
000279
Depression, left hip pain and DJD. PAST SURGICAL HISTORY: Tonsillectomy when he was a child, left inguinal hernia repair many years ago, left total hip arthroplasty
Social History: Patient is a previous smoker, quit in 1999. Occasional alcohol, no illicit drug use. Patient was in the military, honorably discharged. Widowed.
SUBJECTIVE EXAM: Current Living Situation: With family/friends Support at Time of Discharge: friend Environment at Discharge: Single level home Environmental Barriers: No entry steps Assistive Devices Owned: front-wheeled walker raised toilet seat Adaptive Equipment Owned: Long-handled reacher Prior Level of Function: Ambulating independently with consistent use of walker Mental Status: Alert and oriented x4 Pain Level / Chief Complaint: 3-5/10 pain left hip OBJECTIVE EXAMINATION: Observation: Middle aged male seen in bed Extremity Status: WNL Except left hip ROM MMT
RUE LUE RLE LLE Sensation Tone Coordination
Hip flex 80 degs
3/5
Comments: Demonstrated Functional Activities: Key: Dep=Dependent Max=Maximal Mod=Moderate Min=Minimal CG=Contact Guard SB=Stand-By S=Supervised I=Independent NA=Not Applicable NT=Not Tested N=Normal G=Good F=Fair P=Poor U=Unable FWW=Front-Wheeled Walker AC=Axillary Crutches SPC=Single-Point Cane
Level of Assistance Rolling Dep Max Mo d Min C G SB S I N A NT Comments
x x x x
Scooting
Sidelying/ Supine to Sit Transfer Sit to Stand
000280
Transfer Bed to Chair Gait
x x
x Up/Down Step/Stairs Comments: ambulated 150' on level surface with FWW - WBAT - independent Denies steps at home. Balance: WFL - standing with FWW N
Sitting Balance Static Sitting Balance Dynamic Standing Balance Static Standing Balance Dyanamic Comments:
NA
NT
Comments
ASSESSMENT / RECOMMENDATIONS/ EDUCATION: Physical Therapy Assessment and Discharge Recommendations: Patient was cooperative with eval and mobility - able to demonstrate independent transfer and gait with FWW - Able to verbalize and demonstrate post hip precautions - Cleared PT for D/C home - no new equipment needs. Patient / Caregiver Education Today: reviewed post hip precautions. Method of Teaching: verbal Learner: patient Response: able to give return demonstration GOALS / TREATMENT PLAN / FUCNTIONAL PROGNOSIS: Patients Goals: to go home. Reported by: Michael Dybdahl PT 10634 12/21/2009 Vocera 734-0775 Physician Co-Signature:
Electronically signed by Michael Chris Dybdahl at 12/21/2009 3:30 PM Revision history: > 12/21/09 1530 Allied Health Consult signed by Michael Chris Dybdahl 12/21/09 1453 Allied Health Consult shared by Michael Chris Dybdahl Nurse Assessment signed by Christena R Schob, RN at 12/21/09 0928 Author: Christena R Schob, Service: (none) Author RN Type: 12/21/09 0928 12/21/09 0855 Filed: Note Time: .NURSE: (RN or LVN)
000281
Type: Filed: 12/16/09 1413 Note Time: 12/16/09 1413
Occupational Therapy Note
Date: 12/16/2009 Charge: 30 eval Occupational therapy evaluation completed; please see report for details. Kate McFarland,OT/L PI#010320 X4-0775 Electronically signed by Kate McFarland, OT at 12/16/2009 2:13 PM Allied Health Consult signed by Kate McFarland, OT at 12/16/09 1413 Author: Kate McFarland, OT Service: PM&R Author Type: 12/16/09 1413 12/16/09 0749 Filed: Note Time:
PM& R / ACUTE CARE SERVICE
Occupational Therapy
OCCUPATIONAL THERAPY EVALUATION Name: Mark Amundsen MRN: 8081369 Date of Service: 12/16/2009 Time In: 1320 INTAKE INFORMATION AND HISTORY: Initial Treatment Date: 12/16/09 Therapy Consult(s) Ordered: Physical Therapy and Occupational Therapy Primary Service: Orthopedics Date of Admission: 12/15/2009 Date of Onset (Medicare B only): Diagnosis: s/p left thr Precautions: Fall precautions, Posterior hip precautions and WBAT LLE Language: English History of Present Illness/Injury (Including pertinent test results & procedures): Mark Amundsen is a 49yr old male has been experiencing a 6month history of insidious onset left hip severe pain. Mark Amundsen describes a dull aching pain with occasional mechanical symptoms that are exacerbated by weight bearing activities and activities of daily living. They rate their pain as 10 out of 10. There has been no improvement with conservative management and radiographic data indicated degenerative joint disease. Mark Amundsen presents for evaluation and management of their joint disease. Past Medical/Surgical History: Past Medical History: NO SIGNIFICANT HISTORY Past Surgical History: LAP,INGUINAL HERNIA REPR,INITIAL Comment:open repair Social History: History Substance Use Topics Tobacco Use:
Yes -- 1.0 packs/day for 20 years
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Alcohol Use: rare
Yes
SUBJECTIVE EXAM: Current Living Situation: Alone Support at Time of Discharge: none Environment at Discharge: Single level home Environmental Barriers: No entry steps and Stall shower Assistive Devices Owned: front-wheeled walker single point cane Adaptive Equipment Owned: N/A Prior Level of Function: Ambulating independently with occasional use of spc Independent with all ADLS Mental Status: Alert and oriented x4 Pain Level / Chief Complaint: 6 /10 Left hip OBJECTIVE EXAMINATION: Observation: male in bed with bandage left hip, abd pillow, pca, foley Hand Dominance: Right Extremity Status: WNL Except left LE ROM MMT RUE LUE RLE
0-90 prom at 2/5 hip edge of bed Other: See PT notes for details Sensation Tone Coordination
LLE
Activities of Daily Living:

Key: Dep=Dependent Max=Maximal Mod=Moderate Min=Minimal CG=Contact Guard SB=Stand-By S=Supervised I=Independent NA=Not Applicable NT=Not Tested N=Normal G=Good F=Fair P=Poor U=Unable FWW=Front-Wheeled Walker AC=Axillary Crutches SPC=Single-Point Cane
Level of Assistance: Bed Mobility (roll/selfadjust) Sidelying To Sit / Supine To Sit Transfer Bed To Chair
Dep
Max
Mod
Min
CG
SB x
NA
NT
Commemts
x x
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Transfer Bed To Toilet Transfer To Tub / Shower Grooming / Hygiene Toileting Bathing Upper Bathing Lower Upper Body Dress Lower Body Dress Self-feeding House Keeping Money Management
x x x x x x x x x x x
Cognitive / Visual Perceptual: intact Intact Impaired Orientation Memory Attention Following Directions Communication Problem Solving Judgment/ Safety Visual Fields
NT
Comments
ASSESSMENT / RECOMMENDATIONS / EDUCATION: Occupational Therapy Assessment / Discharge Recommendations: Male who should progress well but has no assistance when he goes home, recommend Occupational Therapy for independence with adls and functional mobility Patient / Caregiver Education Today: post hip precautions Method of Teaching: demonstration and verbal Learner: patient Response: partially understands, needs more practice GOALS / TREATMENT PLAN / FUCNTIONAL PROGNOSIS: Patients Goals: go home independent Occupational Therapy Goals: Prior To Discharge Patient Will Demonstrate: Dressing: Lower Body modified independent Functional transfer to toilet, independent with raised toilet seat over toilet Functional transfer to shower independent with fww Other: supine to sit independent Prognosis: Good Treatment Plan: Bed mobility Training, Transfer Training, Sitting Balance, Functional Mobility, ADL / Self Care, Therapeutic Exercise, Adaptive Equipment, Durable Medical Equipment and Patient / Caregiver Education and Training
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Charge: 45'tx Time in: 0830
S: 6-7/10 Pain, located in L hip. Patient agreeable out of bed. O: Treatment included: bed mobility: supine to longsit to edge of bed without overhead trapeeze, bed flat, and no rail SBA with extra time needed and verbal cueing for technique. Patient sitting edge of bed and completing dressing task. Issued and demonstrated adaptive equipment for lower body dressing. Patient able to donn pants with long-handled reacher putting in L LE first. Doffed B socks with reacher and able to donn B socks with sock-aid. Sit to stand with FWW SBA. Transfer: stand-pivot over to cardiac chair with FWW SBA with verbal cueing for technique. Patient left sitting up in cardiac chair with call button in reacher and blanket over body. A: Patient following precautions well during bed mobility and transfer. Moving slowly. Good return demonstration of adaptive devices. P: Continue with toilet transfers. Alla Sukach, COTA/C (AS) P.I.#010707 Vocera: (916)734-0775
Electronically signed by Kate McFarland, OT at 12/17/2009 3:02 PM Revision history:

> 12/17/09 1433 Allied Health Progress addendum by Alla Sukach 12/17/09 1005 Allied Health Progress signed by Alla Sukach
Consults signed by Mark L Holtsman, RPH at 12/17/09 1330 Author: Mark L Holtsman, Service: (none) RPH 12/17/09 1052 12/17/09 1330 Filed: Note Time: Pain Management Service Pharmacist Note started: 12/17/2009 1100 Patient seen and evaluated with pharmacy intern.
Author Type:
.PHARMACIST
Mark Amundsen is a 50yr old male with left hip pain, DJD, and depression. His narcotic allergy includes itching, not hives. He takes chronic pain medication and is a smoker. Reason for Admission: Patient Active Problem List Diagnoses CHRONIC PAIN MEDICATION AGREEMENT [719.45] Priority: High Class: Acute Overview Note: See letter April 30, 2008
Date Noted 04/30/2008
ADVANCED OSTEOARTHRITIS OF THE LEFT HIP [726.5] 01/19/2006 Priority: High Class: Chronic Overview Note: MRI 2006 1. ADVANCED OSTEOARTHRITIS OF THE LEFT HIP. 2. GANGLION CYST ALONG THE INFEROMEDIAL ASPECT OF THE LEFT HIP.
Currently with out insurance. Unable to see ortho. Managed on opiate medications. Tolerance has developed over time - hence significant doses required. Compliant patient.
000285
Bryan Owens RN
Electronically signed by Bryan Owens at 12/18/2009 10:21 AM Nurse Progress signed by Bryan Owens at 12/18/09 1020 Author: Bryan Owens Service: (none) Filed: 12/18/09 1020 Note Time: 12/18/09 0725 Author Type: .NURSE: (RN or LVN)
NURSE PROGRESS NOTE
Note Started:
Problem #: 2/3
12/18/2009, 1016
Problem name: injury (potential)/knowledge deficit
Data: assessed patient Action: educated patient about risk of fall injury while taking narcotics and ambulation/transfers are affected Response: patient verbalized understanding of information provided Bryan Owens RN
Electronically signed by Bryan Owens at 12/18/2009 10:20 AM Allied Health Progress signed by Christine Rishell Mulford, OT at 12/18/09 1016 Occupational Therapy Author: Christine Rishell Service: PM&R Author Mulford, OT Type: 12/18/09 1008 Jennifer Kennedy, OT at 12/18/09 1016 Cosigner: Filed: Note 01/22/10 1637 Time:
Occupational Therapy Progress Note
Date of Service 12/18/09 Charge: 30tx Time in: 0930 S: 8 /10 Pain, located in L hip O: Tx included: Bed mobility: Supine > long sit > EOB SBA and verbal cues to maintain hip precautions Transfer: EOB > chair with FWW SBA Lower body dressing: doffed/donned socks with Sock aid and reacher SBA, donned sweat pants with reacher SBA Pt with good recall of hip precautions, but needed reminders during mobility Discussed bathing and toileting, pt will need shower chair and raised toilet seat A: Pt has progressed well with mobility, good return demo with dressing aids. Lives alone and is aware he may need some help with IADLs. P Continue with toileting, sinkside ADLs Chris Mulford, COTA/C (CM) P.I. #08137
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4/30/2008
Class: Acute C. Difficile Diarrhea 5/29/2009 Mark Amundsen (MRN 8081369)
Provider Robert Michael Tamurian, MD Department Ortho Clinic Acc
Office Visit
Diagnoses Enthesopathy of Hip Region - Primary Reason for Visit Consultation
726.5
Medications
Medications at Start of Encounter Disp Refills Start End 42 0 5/28/2009 6/11/2009 Metronidazole (FLAGYL) 500 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth 3 times daily. No alcohol - ORAL Class: Pharmacy 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 100 1 8/26/2009 9/25/2009 Carisoprodol (SOMA) 350 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 1 7/28/2009 8/27/2009 Hydrocodone 10 mg/Acetaminophen 325 100 mg (NORCO) 10-325 mg PO Tablet (Taking)
000287
Sig - Route: Take 1 Tab by mouth every 4 hours if needed for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 390 0 9/15/2009 Methadone (DOLOPHINE) 10 mg PO Tablet (Taking) Sig - Route: Take 13 Tabs by mouth every day. - ORAL 100 1 4/27/2009 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Medication Review History Med Rev Hx Medication Administration Report for Amundsen, Mark All administrations No administration data available Pharmacy Selected For Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630
10/13/2009
5/27/2009
Immunizations
Visit Summary
Vitals Recorded in This Encounter 09/16/2009 1038 90.719 kg (200 lb) Weight: 1.854 m (6' 1") Height: 26.4 BMI: 2.16 m2 BSA: 36.2 C (97.1 F) Temp: Tympanic Temp src: 81 Pulse: 18 Resp: 107/81 mmHg BP: sitting Orthostatic Position: right arm SITE: regular Cuff Size: 3 Pain Score: Medications Given (Excluding those documented in Imm/Injections Activity) No data found. LMP / OB Status - Last Recorded BMI 26.39 kg/m2 Progress Notes
Robert Michael Tamurian, MD 9/16/2009 11:45 AM Signed
Dear VICTOR BAQUERO, M.D.,
000288
I had the pleasure of evaluating Mark Amundsen in the Adult Reconstruction clinic today at the University of California, Davis Health System today, at your request. As you may recall, Mark Amundsen is a 49yr old male has been experiencing a 6month history of insidious onset left hip severe pain. Mark Amundsen describes a dull aching pain with occasional mechanical symptoms that are exacerbated by weight bearing activities and activities of daily living. They rate their pain as 10 out of 10. There has been no improvement with conservative management and radiographic data indicated degenerative joint disease. Mark Amundsen presents for evaluation and management of their joint disease. PMH: has no past medical history on file. PSH: has no past surgical history on file.
Family History: family history is not on file. Social History: ROS: 14 system review was completed and was negative except as noted in the HPI. Vital Signs: BP 107/81 | Pulse 81 | Temp (Src) 36.2 C (97.1 F) (Tympanic) | Resp 18 | Ht 1.854 m (6' 1") | Wt 90.719 kg (200 lb) General: AAOX3, No acute distress, normal affect and disposition HEENT: Normocephalic, Extraocular movements intact. Focused examination of the Left lower extremity was performed. Full hip, knee, and ankle ROM was present. There was no regional adenopathy detected nor any skin changes present. The hip revealed negative flexion contracture and positive severe pain at the extremes of motion was encountered. Knee exam revealed negative crepitus, negative joint line tenderenss and 0 effusion. The ligamentous exam revealed negative pseudolaxity. Foot alinment was wnl. Distal neurovascular exam was normal with 5/5 motor and intact sensation within the autogenous zones of the femoral, sciatic, deep and superficial peroneal, and tibial nerves. DTR's were 2+ and posterior tibial and dorsalis pedis peripheral pulses were 2+. Evaluation of Gait revealed a positive trendelenburg sign/gait and an antalgic gait was observed. Radiographic Data: Bilateral weight bearing x-rays of the Left Hip reveal severe degenerative joint disease. Assessment: Mark Amundsen is a 49yr old male with severe degenerative joint disease of the Lefthip . We discussed the options for treating arthritis including medical management, physiotherapy, injection, and surgery. Given that Mark Amundsen has exhausted conservative management, I recommend Total Joint Arthroplasty of the Lefthip . We will schedule for UCD and request preoperative optimization through a preoperative consultation with you. In the interim, our TJA coordinator will schedule Mark Amundsenl for the peri-operative patient information class and they will return to UC Davis @ my adult reconstruction clinic one week prior to their surgery date for a pre-operative evaluation. We will schedule the procedure once pre-operative optimization has been
000289
achieved. Thank you for the referral and the opportunity to participate in the care of your patient. If you have any questions regarding my treatment recommendations don't hesitate to call. Robert M. Tamurian, MD Assistant Professor Chief, Orthopaedic Oncology Service Deparment of Orthopaedic Surgery University of California, Davis Health System
Electronically signed by Robert Michael Tamurian, MD at 9/16/2009 11:45 AM Visit Notes MICHAEL DELACUEVA, LVN Wed Sep 16, 2009 10:40 AM Pt. Roomed. VS taken. Meds, allergies, and pharm reviewed. Michael Dela Cueva LVN. Electronically signed by MICHAEL DELACUEVA, LVN at Wed Sep 16, 2009 10:40 AM All Flowsheet Templates (all recorded) Amb Vitals Group Flowsheet

Patient Instructions None Follow-up and Disposition Routing History Recorded Chart Reviewed By Victor Baquero, MD on 9/16/2009 12:43 PM
Problem List
1/19/2006

See letter April 30, 2008 February 4, 2010 - Comment: discussed gradual reduction of methadone. Plan: decrease by 5mg
000290
Electronically signed by Kristine Palaspas, RN at 12/17/2009 4:14 AM Nurse Progress signed by Kristine Palaspas, RN at 12/17/09 0013 Author: Kristine Palaspas, Service: (none) Author RN Type: 12/17/09 0013 12/16/09 2300 Filed: Note Time:
.NURSE PROGRESS NOTE
.NURSE: (RN or LVN)
Note Started: 12/16/2009, 2300 Problem #: 3 Problem name: Knowledge Deficit
Data: please refer to MPER Action: n/a Response: n/a Kristine. M. Palaspas RN Electronically signed by Kristine Palaspas, RN at 12/17/2009 12:13 AM Nurse Assessment signed by Kristine Palaspas, RN at 12/16/09 2004 Author: Kristine Palaspas, Service: (none) Author RN Type: 12/16/09 2004 12/16/09 1930 Filed: Note Time: .ASSESSMENT NOTE
Note Started: 12/16/2009, 1930
.NURSE: (RN or LVN)
Initial assessment completed and recorded in EMR. Report received from day shift nurse and orders reviewed. Dressing to L hip C/D/I, CSM+. Plan of Care reviewed and appropriate, discussed with patient. Kristine. M. Palaspas RN
Electronically signed by Kristine Palaspas, RN at 12/16/2009 8:04 PM Allied Health Progress signed by Alison Peters, RN at 12/16/09 1517 Author: Alison Peters, RN Service: (none) Author Type: 12/16/09 1517 12/16/09 1513 Filed: Note Time:
CLINICAL CASE MANAGEMENT INITIAL ASSESSMENT NOTE
.DC PLNG/CASE MGMT
Name: MARK AMUNDSEN Date of Birth:9/23/1959 (50yr) Note Date: 12/16/2009 Date of Service: 12/16/2009 Lives with: alone
MRN: 8081369 Gender:male Note Time: 1513 Time of Service: 1500
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Note Started: Problem #: 3
12/16/2009, 1110 Problem name: knowledge
Data: xray Action: educated patient regarding the need for post-op xray. Response: patient verbalized understanding and was cooperative. Mary Tran RN
Electronically signed by Mary Tran, RN at 12/16/2009 11:11 AM Nurse Progress signed by Mary Tran, RN at 12/16/09 1109 Author: Mary Tran, RN Service: (none) Filed: 12/16/09 1109 Note Time: 12/16/09 1106 Author Type: .NURSE: (RN or LVN)
NURSE PROGRESS NOTE
Note Started:
Problem #: 4
12/16/2009, 1106
Problem name: pain
Data: c/o pain 8/10 to L hip, reports that "nothing is working." Action: medicated with medication as ordered, using PCA dilaudid. Pain pharmacist assessed patient today at bedside. Response: Reports pain decreased to 7/10 to L hip and that the lowest pain level achieved was 6/10. Patient would like pain to be at least 5/10 to be comfortable and tolerable. Refused treatment with OT in the AM due to uncontrolled pain. Mary Tran RN
Electronically signed by Mary Tran, RN at 12/16/2009 11:09 AM Nurse Assessment signed by Mary Tran, RN at 12/16/09 1106 Author: Mary Tran, RN Service: (none) Filed: 12/16/09 1106 Note Time: 12/16/09 0730 Author Type: .NURSE: (RN or LVN)
ASSESSMENT NOTE Note Started: 12/16/2009, 1105
Initial assessment completed and recorded in EMR. Report received from night shift nurse and orders reviewed. Plan of Care reviewed and appropriate, discussed with patient. Patient asleep but easily arousable. Patient reported that nothing is working for his pain. Plan is to have pain pharmacist see patient today. Mary Tran RN
000292
Electronically signed by Mary Tran, RN at 12/16/2009 11:06 AM Nurse Progress signed by Beverly Harrelson, RN at 12/16/09 0533 Author: Beverly Harrelson, Service: (none) Author RN Type: 12/16/09 0532 12/16/09 0533 Filed: Note Time:
NURSE PROGRESS NOTE
.NURSE: (RN or LVN)
Note Started:
Problem #: 2
12/15/2009, 1905
Problem name: injury potential
Data: potential for injury Action: fall protocol in place Response: no falls or injuries Beverly Harrelson RN Electronically signed by Beverly Harrelson, RN at 12/16/2009 5:33 AM Nurse Progress signed by Beverly Harrelson, RN at 12/16/09 0532 Author: Beverly Harrelson, Service: (none) Author RN Type: 12/16/09 0521 12/16/09 0532 Filed: Note Time:
NURSE PROGRESS NOTE Note Started: Problem #: 4 12/16/2009, 0521 Problem name: pain
.NURSE: (RN or LVN)
Data: s/p L THA c/o elevated pain Action: positioned for comfort, pca dilaudid w/ 6 min lockout, prn percocet, soma, dilaudid ivp, MD notified earlier of difficult pain control and wrote new orders. Rx given Response: Pt sleeps at intervals, reports pain reduction 7/10 Beverly Harrelson RN
Electronically signed by Beverly Harrelson, RN at 12/16/2009 5:32 AM Revision history:

> 12/16/09 0532 Nurse Progress addendum by Beverly Harrelson, RN 12/16/09 0526 Nurse Progress addendum by Beverly Harrelson, RN 12/16/09 0524 Nurse Progress signed by Beverly Harrelson, RN
000293
Nurse Progress signed by Beverly Harrelson, RN at 12/16/09 0518 Author: Beverly Harrelson, Service: (none) Author RN Type: 12/16/09 0518 12/16/09 0517 Filed: Note Time:
NURSE PROGRESS NOTE
.NURSE: (RN or LVN)
Note Started:
Problem #: 3
12/15/2009, 1915
Problem name: knowledge deficit
Data: knowledge Action: reviewed plan of care Response: see mper Beverly Harrelson RN Electronically signed by Beverly Harrelson, RN at 12/16/2009 5:18 AM Nurse Assessment signed by Beverly Harrelson, RN at 12/16/09 0219 Author: Beverly Harrelson, Service: (none) Author RN Type: 12/16/09 0219 12/16/09 0219 Filed: Note Time:
ASSESSMENT NOTE
.NURSE: (RN or LVN)
Note Started:
12/15/2009, 1900
Initial assessment completed and recorded in EMR. Report received from day shift nurse and orders reviewed. Plan of Care reviewed and appropriate, discussed with patient. Beverly Harrelson RN
Electronically signed by Beverly Harrelson, RN at 12/16/2009 2:19 AM Nurse Progress signed by Patricia L Bailey, RN at 12/15/09 1916 Author: Patricia L Bailey, RN Service: (none) Author Type: 12/15/09 1915 12/15/09 1916 Filed: Note Time:
PACU TRANSFER NOTE Note Started: 12/15/2009, 1916
.NURSE: (RN or LVN)
Patient transferred to Davis 14 unit via bed with room air at 1910 hours. Bed down, locked, side rails up times 4, and call light in reach. Belongings with not applicable. Report in EMR and RN notified of arrival. Assessment unchanged. Patricia L Bailey, RN
Electronically signed by Patricia L Bailey, RN at 12/15/2009 7:16 PM Nurse Progress signed by Patricia L Bailey, RN at 12/15/09 1638
000294
BP: 126/80 mmHg (12/15 1830) Resp: 14 (12/15 1830) SpO2: 96 % (12/15 1830) Height: 1.854 m (6' 1") (12/15 0723) Wt - Scale: 97.387 kg (214 lb 11.2 oz) (12/15 0723)
Okay to D/C from PACU. Eva Boyd MD, CA-1 Dept. Of Anesthesiology and Pain Medicine . Electronically signed by: Phat Giang, MD Assistant Clinical Professor Anesthesiology & Pain Medicine PI# 10063 Pager# 2127 Electronically signed by Phat Giang, MD at 12/17/2009 12:33 PM Revision history:
> 12/17/09 1233 Progress Notes addendum by Phat Giang, MD 12/15/09 1842 Progress Notes signed by Eva K Boyd, MD
Nurse Progress signed by Bryan Owens at 12/17/09 1112 Author: Bryan Owens Service: (none) Filed: 12/17/09 1112 Note Time: 12/17/09 0955
Author Type:
.NURSE: (RN or LVN)
NURSE PROGRESS NOTE
Note Started:
Problem #: 3/4
12/17/2009, 1110
Problem name: knowledge deficit/pain, alt in comfort
Data: patient complained of ongoing severe pain Action: oral pain medicine administered and patient educated about need for adequate pain control in order to increase healing Response: patient stated relief of pain and verbalized understanding of information provided Bryan Owens RN
Electronically signed by Bryan Owens at 12/17/2009 11:12 AM Nurse Assessment signed by Bryan Owens at 12/17/09 1109 Author: Bryan Owens Service: (none) Filed: 12/17/09 1109 Note Time: 12/17/09 0820 Author Type: .NURSE: (RN or LVN)
ASSESSMENT NOTE
000295
Note Started:
12/17/2009, 1109
Initial assessment completed and recorded in EMR. Report received from night shift nurse and orders reviewed. Plan of Care reviewed and appropriate, discussed with patient. Bryan Owens RN
Electronically signed by Bryan Owens at 12/17/2009 11:09 AM Nurse Progress signed by Kristine Palaspas, RN at 12/17/09 0414 Service: (none) Author Author: Kristine Palaspas, RN Type: 12/17/09 0414 12/17/09 0414 Note Filed: Time: .NURSE PROGRESS NOTE Note Started:
Problem #: 2
.NURSE: (RN or LVN)
12/17/2009, 0414
Problem name: Injury
Data: Pt is fall risk. Action: Implement fall protocols. Bed low, call light in reach, siderails up x2. Response: No needs at this time. Will continue to monitor. Kristine. M. Palaspas RN
Electronically signed by Kristine Palaspas, RN at 12/17/2009 4:14 AM Nurse Progress signed by Kristine Palaspas, RN at 12/17/09 0414 Author: Kristine Palaspas, Service: (none) Author RN Type: 12/17/09 0414 12/17/09 0230 Filed: Note Time: .NURSE PROGRESS NOTE Note Started:
Problem #: 4
.NURSE: (RN or LVN)
12/17/2009, 0200
Problem name: Pain
Data: Pt c/o pain level 8/10 to L hip. Action: Medicate pt with Percocet ATC, PCA available at bedside, and Dilaudid IVP for BTP. Response: Pt is sleeping. No s/s of pain, RR = 16. Will continue to monitor. Kristine. M. Palaspas RN
000296
Response: Pt is sleeping. No s/s of pain, RR = 18. Will continue to monitor.
Kristine. M. Palaspas RN
Electronically signed by Kristine Palaspas, RN at 12/18/2009 1:32 AM Nurse Progress signed by Kristine Palaspas, RN at 12/18/09 0131 Author: Kristine Palaspas, Service: (none) Author RN Type: 12/17/09 2200 12/18/09 0131 Filed: Note Time: .NURSE PROGRESS NOTE Note Started:
Problem #: 3
.NURSE: (RN or LVN)
12/17/2009, 2200
Problem name: Knowledge Deficit
Data: Please refer to MPER. Action: n/a Response: n/a Kristine. M. Palaspas RN
Electronically signed by Kristine Palaspas, RN at 12/18/2009 1:31 AM Nurse Assessment signed by Kristine Palaspas, RN at 12/17/09 2023 Service: (none) Author Author: Kristine Palaspas, RN Type: 12/17/09 2023 12/17/09 1930 Filed: Note Time: .ASSESSMENT NOTE
Note Started: 12/17/2009, 1930
.NURSE: (RN or LVN)
Initial assessment completed and recorded in EMR. Report received from day shift nurse and orders reviewed. Plan of Care reviewed and appropriate, discussed with patient. Kristine. M. Palaspas RN
Electronically signed by Kristine Palaspas, RN at 12/17/2009 8:23 PM Allied Health Progress signed by Ilona Poga'Ny, PT at 12/17/09 1642 Author: Ilona Poga'Ny, PT Service: PM&R Author Type: 12/17/09 1642 12/17/09 1637 Filed: Note Time:
Physical Therapy Progress Note
Physical Therapy
000297
Electronically signed by Jennifer Kennedy, OT at 1/22/2010 4:37 PM Nurse Assessment signed by Bryan Owens at 12/18/09 0830 Author: Bryan Owens Service: (none) Filed: 12/18/09 0830 Note Time: 12/18/09 0725 Author Type: .NURSE: (RN or LVN)
ASSESSMENT NOTE
Note Started:
12/18/2009, 0830
Initial assessment completed and recorded in EMR. Report received from night shift nurse and orders reviewed. Plan of Care reviewed and appropriate, discussed with patient. Bryan Owens RN
Electronically signed by Bryan Owens at 12/18/2009 8:30 AM Nurse Progress signed by Kristine Palaspas, RN at 12/18/09 0311 Author: Kristine Palaspas, Service: (none) Author RN Type: 12/18/09 0311 12/18/09 0310 Note Filed: Time: .NURSE PROGRESS NOTE Note Started:
Problem #: 2
.NURSE: (RN or LVN)
12/18/2009, 0310
Problem name: Injury
Data: Pt is fall risk. Action: Implement fall protocols. Bed low, call light in reach, siderails up x2. Response: No needs at this time. Will continue to monitor. Kristine. M. Palaspas RN Electronically signed by Kristine Palaspas, RN at 12/18/2009 3:11 AM Nurse Progress signed by Kristine Palaspas, RN at 12/18/09 0132 Author: Kristine Palaspas, Service: (none) Author RN Type: 12/18/09 0132 12/18/09 0131 Filed: Note Time: .NURSE PROGRESS NOTE
Note Started: Problem #: 4 12/18/2009, 0131 Problem name: Pain
.NURSE: (RN or LVN)
Data: Pt c/o pain 6/10 to L hip. Action: Medicated pt with Methadone per MD orders. Reposition in bed.
000298
Fax number: 352-6288 Accepting MD: g.stauber Name of transport company: 1st respondert Telephone number: 444-1944 Level of transport: bls, ucd managed care auth 121809rs01
Inter/Intra facility transfer complete:yes Chart copied:yes D/C Summary:yes Ambulance RX:yes Admit Orders:yes CXR or TB test:yes Above Documentation sent with patient:yes Comments: per team, pt stable for dc to snf. Spoke with lindsay at rosewood to confirm acceptance today. Claudette at ucdmc notified to give auth to snf. auth obtained for ambulance from rebecca with managed care. Date:12/18/2009 Time:1229 Electronically Signed by Alison Peters,RN,CCM Clinical Case Manager/DCP Pgr 762-6840
Electronically signed by Alison Peters, RN at 12/18/2009 12:33 PM Nurse Progress signed by Bryan Owens at 12/18/09 1021 Author: Bryan Owens Service: (none) Filed: 12/18/09 1021 Note Time: 12/18/09 0745 Author Type: .NURSE: (RN or LVN)
NURSE PROGRESS NOTE
Note Started:
Problem #: 4
12/18/2009, 1021
Problem name: pain, alt in comfort
Data: patient complained of ongoing moderate to severe pain Action: oral pain medicine administered Response: patient stated relief of pain
000299
C#: 4833630
Electronically signed by Jonathan G Eastman, MD at 12/20/2009 5:58 PM Revision history:

> 12/20/09 1801 Discharge Summary (0108) revision by Jonathan G Eastman, MD 12/18/09 1152 Discharge Summary (0108) filed by Jonathan G Eastman, MD
Nurse Progress signed by Christena R Schob, RN at 12/20/09 1601 Author: Christena R Schob, Service: (none) Author RN Type: 12/20/09 1600 12/20/09 1601 Filed: Note Time:
NURSE PROGRESS NOTE
.NURSE: (RN or LVN)
Note Started:
Problem #:
12/20/2009, 1600
Problem name: knowledge
Data: Pt received 2nd unit of prbc. Action: H&H drawn. Possible discharge after results. Response: Pt ready to go home. Christena R Schob RN
Electronically signed by Christena R Schob, RN at 12/20/2009 4:01 PM Nurse Assessment signed by Christena R Schob, RN at 12/20/09 1559 Author: Christena R Schob, Service: (none) Author RN Type: 12/20/09 1559 12/20/09 0805 Filed: Note Time:
ASSESSMENT NOTE Note Started: 12/20/2009
.NURSE: (RN or LVN)
Initial assessment completed and recorded in EMR. Report received from night shift nurse and orders reviewed. Plan of Care reviewed and appropriate, discussed with patient. Pt alert and oriented x3. Pain to left hip 4/10 and tolerable. No resp distress. No other complaints or problems at this time. Christena R Schob, RN
Electronically signed by Christena R Schob, RN at 12/20/2009 3:59 PM Progress Notes signed by Jia Wang, MD at 12/20/09 1451 Author: Jia Wang, MD Service: Internal Medicine Filed: 12/20/09 1451 Note 12/20/09 1442 Author Type: *PHYSICIAN: FACULTY
000300
ASSESSMENT NOTE Note Started: 12/21/2009
Initial assessment completed and recorded in EMR. Report received from night shift nurse and orders reviewed. Plan of Care reviewed with pt, discussed with patient. Pt is alert and oriented x3. Pain 5/10 to left hip and tolerable. No resp distress. No other complaints or problems at this time. Pt hopes to go home today, awaiting MD. Christena R Schob, RN
Electronically signed by Christena R Schob, RN at 12/21/2009 9:28 AM Nurse Focus signed by Darcey Arnold, RN at 12/21/09 0624 Author: Darcey Arnold, RN Service: (none) Filed: 12/21/09 0624 Note Time: 12/21/09 0623 Author Type: .NURSE: (RN or LVN)
Closing Note: Patient is lying down in bed, no s/s of distress. He ambulated to the bathroom with his walker several times during the night with a steady gait. I will continue to monitor until 0715. Darcey Hostetler, RN
Electronically signed by Darcey Arnold, RN at 12/21/2009 6:24 AM Nurse Progress signed by Darcey Arnold, RN at 12/21/09 0046 Author: Darcey Arnold, RN Service: (none) Filed: 12/21/09 0046 Note Time: 12/21/09 0045 Author Type: .NURSE: (RN or LVN)
NURSE PROGRESS NOTE
Note Started:
Problem #:
12/21/2009, 0045
Problem name: pain
Data: s/p total L hip replacement Action: offer prn pain meds as ordered, and administer pt's ATC methadone Response: pt's pain seems to be under control; see MAR Darcey Chloe Arnold RN
Electronically signed by Darcey Arnold, RN at 12/21/2009 12:46 AM Nurse Focus signed by Darcey Arnold, RN at 12/21/09 0044 Author: Darcey Arnold, RN Service: (none) Filed: 12/21/09 0044 Note 12/21/09 0040 Author Type: .NURSE: (RN or LVN)
000301
Recommended Frequency of Treatment: Once a day
Recommended Duration of Treatment: 3-5 days Patient / Caregiver Participation / Education Has the plan of care been explained to the patient / caregiver? Is the patient able to understand the plan of care? Does the patient / caregiver(s) agree with the plan of care? List barriers that may interfere with plan of care Comments: Reported by: Kate McFarland,OT/L PI#010320 X4-0775 Physician Co-Signature: "By electronically co-signing this document, I approve the Plan of Care detailed above." Electronically signed by Kate McFarland, OT at 12/16/2009 2:13 PM Revision history: > 12/16/09 1413 Allied Health Consult signed by Kate McFarland, OT 12/16/09 0750 Allied Health Consult shared by Kate McFarland, OT Consults signed by Dean Williamson, RPH at 12/16/09 1307 Author: Dean Williamson, Service: (none) RPH 12/16/09 1307 12/16/09 0753 Filed: Note Time: Author Type: .PHARMACIST
yes yes yes None
Consult Orders: 1. PAIN PHARMACIST CONSULT [48192766] ordered by Jonathan G Eastman, MD at 12/15/09 1540 Pain Management Service Pharmacist Note started: 12/16/2009,0754 Mark Amundsen is a 50yr old male with left hip pain, DJD, and depression. His narcotic allergy includes itching, not hives. He takes chronic pain medication and is a smoker.
Reason for Admission: Patient Active Problem List Diagnoses CHRONIC PAIN MEDICATION AGREEMENT [719.45] Priority: High Class: Acute Overview Note: See letter April 30, 2008
Date Noted 04/30/2008
ADVANCED OSTEOARTHRITIS OF THE LEFT HIP [726.5] 01/19/2006 Priority: High Class: Chronic Overview Note: MRI 2006 1. ADVANCED OSTEOARTHRITIS OF THE LEFT HIP. 2. GANGLION CYST ALONG THE INFEROMEDIAL ASPECT OF THE LEFT HIP.
Currently with out insurance. Unable to see ortho. Managed on opiate medications. Tolerance has developed over time - hence significant doses required. Compliant patient.
000302
C. Difficile Diarrhea [008.45AL] Overview Note: May 29, 2009 - treated with Metronidazole.
05/29/2009
DEPRESSIVE DISORDER [311] Overview Note: Has done well on Prozac in the past.
05/26/2006
BACKACHE NOS [724.5] Overview Note: low back pain - chronic. Tried Methadone, Hydrocodone, Baclofen, Soma, Oxycodone, Tramadol, Toradol, MSContin, Fentanyl, dilaudid. TESTICULAR HYPOFUNC NEC [257.2] BRACHIAL NEURITIS NOS [723.4] Procedure: total hip arthroplasty Patient appears: comfortable Patient complains of pain at: left hip Patient's pain is 6 at rest and 8-9 with movement where 0 is no pain and 10 is severe pain. Average pain score prior to admission: 4 Patient describes pain as: deep, constant, stabbing and spasm pain. Denies burning/tingling sensations. Patient reports the following symptoms: denies nausea, vomiting, itching, rash, diarrhea, constipation Diet: no appetite, 0% of meals Last Bowel Movement: 12/15/09 Sleeping: didn't sleep due to pain Pain impact on Physical Therapy/Incentive Spirometry: IS not assessed. Patient not sitting up in bed or ambulating. Vital Signs: HR Pulse: 90 (12/16/09 0730), BP BP: 126/80 mmHg (12/16/09 0730), RR Resp: 18 (12/16/09 0730), Sedation Score Sedation score: S - Normal sleep, easy to arouse. (12/16/09 0730), O2 Saturation SpO2: 95 % (12/16/09 0730) Significant PMH: Past Medical History Diagnosis NO SIGNIFICANT HISTORY Date
Lab of Note: BLOOD COUNTS Recent labs for the past 24 hours 12/16/09 0530 WHITE BLOOD CELL COUNT 6.3 RED CELL COUNT 3.03* HEMOGLOBIN 9.5* HEMATOCRIT 27.6* MCV 91.1 MCH 31.5 RDW 13.4 PLATELET COUNT 154 NUCLEATED RBC/100 WBC --
000303
BC COMMENTS
--
BASIC METABOLIC PANEL Recent labs for the past 24 hours 12/16/09 0530 GLUCOSE 129* UREA NITROGEN, BLOOD (BUN) 5* CREATININE BLOOD 0.93 SODIUM 135 POTASSIUM 3.9 CHLORIDE 103 CARBON DIOXIDE TOTAL 27 CALCIUM 8.0*
Allergies: Allergies Allergen Morphine Fentanyl itching
Reactions Hives
Analgesic Regimen Prior To Admission: Methadone (DOLOPHINE) 10 mg PO Tablet, Take 13 Tabs by mouth every day. (pt did not take day of surgery) Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 1 Tab by mouth every 4 hours if needed for pain. (averaged 2-4 tabs per day) Carisoprodol (SOMA) 350 mg PO Tablet, Take 1 Tab by mouth every 8 hours if needed for muscle spasm (averaged 2 per day)_ Current Analgesic Regimen: Oxycodone 5 mg/Acetaminophen 325 mg (PERCOCET) Tablet 1-2 Tab PO Q4H Hydromorphone (DILAUDID) 0.4-3 mg IV, Q1H PRN Diazepam (VALIUM) Tablet 5-10 mg po Q6H PRN Hydromorphone 0.2 mg/mL (DILAUDID) PCA 50 mL, , IV, PCA 12/15 @1600, increased Injection Attempts: 143 incremental at 0653) Injections: 60 Incremental dose: 0.4 Lockout: 6 min Carisoprodol (SOMA) Tablet 350 mg po Q8H PRN Methadone (DOLOPHINE) Tablet 130 mg po QAM Discontinued Medications: Methadone 20 mg IV x 5 during surgery Diazepam 5 mg IV one time only Diazepam 5 mg IV one time only Fentanyl 50 mcg q 5 min IV prn Hydromorphone 0.4-0.6 mg q 15 min IV prn Hydromorphone 0.4-2 mg q 1 hr IV prn Percocet 5/325 q 4 hrs prn 0600-0600 0 0 10 mg 24 mg (started To 0.6 mg
350 mg Started this AM 100 mg 5 mg 5 mg 100 mcg 4.5 mg 16 mg 6 tabs
Assessment: Acute on chronic pain in patient with a history of opioid tolerance secondary to chronic opioid use. Pain with possible musculoskeletal, neuropathic, and spasm components. Patient home opioid requirement equivalent to 750 - 1300 mg po morphine. Patient's in-house 24 hr opioid requirement equivalent to 1935 mg po morphine. First methadone dose given this morning at 0900. Patient may benefit from the restart of his home methadone dose. Patient may also benefit from a more aggressive bowel care regimen. Plan:
000304
1. Continue home Methadone dose as ordered. 2. Continue Soma as written. 3. Agree with increasing Dilaudid PCA dose to 0.6 mg, q6min lock-out, no basal. 4. Decrease prn hydromorphone to 0.4 to 2 mg IV q 4 hr prn. 5. Add Senna 2 tabs po qhs. 7. Hold all medications for respiratory rate < 10 and sedation score >1/4. Report Electronically Signed by: Heather Rae Hertema Pharmacy Intern 12/16/2009, 0754 Above note reviewed with student intern. I agree with the plan and suggestions documented in the note. Thank you for this consult. Please call with any questions. Dean Williamson, Pharm.D. Pain Management Service Pharmacist Pager: 762-1457 Time spent on consulation = 60 mins
Electronically signed by Dean Williamson, RPH at 12/16/2009 1:07 PM Revision history:

> 12/16/09 1307 Consults addendum by Dean Williamson, RPH 12/16/09 1255 Consults signed by Heather Rae Hertema, PHRMINTN
Nurse Progress signed by Mary Tran, RN at 12/16/09 1217 Author: Mary Tran, RN Service: (none) Filed: 12/16/09 1217 Note Time: 12/16/09 1216
Author Type:
.NURSE: (RN or LVN)
NURSE PROGRESS NOTE
Note Started:
Problem #: 2
12/16/2009, 1216
Problem name: injury
Data: post op L THA; at rist for falls. Action: fall protocol implemented, call light within reach. Response: no falls or injuries. Mary Tran RN
Electronically signed by Mary Tran, RN at 12/16/2009 12:17 PM Nurse Progress signed by Mary Tran, RN at 12/16/09 1111 Author: Mary Tran, RN Service: (none) Filed: 12/16/09 1111 Note Time: 12/16/09 1110 Author Type: .NURSE: (RN or LVN)
NURSE PROGRESS NOTE
000305
C. Difficile Diarrhea [008.45AL] Overview Note: May 29, 2009 - treated with Metronidazole. DEPRESSIVE DISORDER [311] Overview Note: Has done well on Prozac in the past.
05/29/2009
05/26/2006
BACKACHE NOS [724.5] Overview Note: low back pain - chronic. Tried Methadone, Hydrocodone, Baclofen, Soma, Oxycodone, Tramadol, Toradol, MSContin, Fentanyl, dilaudid. TESTICULAR HYPOFUNC NEC [257.2] BRACHIAL NEURITIS NOS [723.4]
Procedure: left total hip arthroplasty Patient appears: comfortable, joking, laughing, sitting up in chair Patient complains of pain at: minimal pain in left hip, with pain most intense now on lateral side of left femur Patient's pain is 5/10 at rest and 8/10 with movement where 0 is no pain and 10 is severe pain. Average pain score prior to admission: 4 Patient describes pain as: no longer having stabbing and spasm components. Pain now minimal in the left hip. Pain is now diffuse, constant, and dull in the left femur. Patient continues to deny burning/tingling sensations. Patient reports the following symptoms: denies nausea, vomiting, rash, diarrhea. Patient reports itching, which he attributes to dry skin. Diet: 45-75% Last Bowel Movement: 12/15/09 Sleeping: sleeping well until 2 am, at which time pain became more intense Pain impact on Physical Therapy/Incentive Spirometry: IS not assessed. Patient sitting up in chair during interview. Occupational Therapy (12/17/09): S: 6-7/10 Pain, located in L hip. Patient agreeable out of bed. O: Treatment included: bed mobility: supine to longsit to edge of bed without overhead trapeeze, bed flat, and no rail SBA with extra time needed and verbal cueing for technique. Patient sitting edge of bed and completing dressing task. Issued and demonstrated adaptive equipment for lower body dressing. Patient able to donn pants with long-handled reacher putting in L LE first. Doffed B socks with reacher and able to donn B socks with sock-aid. Sit to stand with FWW SBA. Transfer: stand-pivot over to cardiac chair with FWW SBA with verbal cueing for technique. Patient left sitting up in cardiac chair with call button in reacher and blanket over body. A: Patient following precautions well during bed mobility and transfer. Good return demonstration of adaptive devices. P: Continue with toilet transfers. Vital Signs: HR Pulse: 83 (12/17/09 0820), BP BP: 107/66 mmHg (12/17/09 0820), RR Resp: 16 (12/17/09 0820), Sedation Score Sedation score: 1 - Mildly drowsy but awake, slow response to auditory stimuli (12/17/09 0820), O2 Saturation SpO2: 99 % (12/17/09 0820)
000306
Significant PMH: Past Medical History Diagnosis NO SIGNIFICANT HISTORY
Date
Lab of Note: BLOOD COUNTS Recent labs for the past 24 hours 12/17/09 0615 WHITE BLOOD CELL COUNT 7.4 RED CELL COUNT 2.51* HEMOGLOBIN 7.8* HEMATOCRIT 22.8* MCV 91.0 MCH 31.0 RDW 13.7 PLATELET COUNT 134 NUCLEATED RBC/100 WBC - BC COMMENTS -BASIC METABOLIC PANEL Recent labs for the past 24 hours 12/17/09 0615 GLUCOSE 119* UREA NITROGEN, BLOOD (BUN) 9 CREATININE BLOOD 0.96 SODIUM 135 POTASSIUM 4.2 CHLORIDE 100 CARBON DIOXIDE TOTAL 29 CALCIUM 8.0* Allergies: Allergies Allergen Morphine Fentanyl itching
Reactions Hives
Analgesic Regimen Prior To Admission: Methadone (DOLOPHINE) 10 mg PO Tablet, Take 13 Tabs by mouth every day. (pt did not take day of surgery) Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 1 Tab by mouth every 4 hours if needed for pain. (averaged 2-4 tabs per day) Carisoprodol (SOMA) 350 mg PO Tablet, Take 1 Tab by mouth every 8 hours if needed for muscle spasm (averaged 2 per day)_ Current Analgesic Regimen: Oxycodone 5 mg/Acetaminophen 325 mg (PERCOCET) Tablet 1-2 Tab PO Q4H Diazepam (VALIUM) Tablet 5-10 mg po Q6H PRN Hydromorphone 0.2 mg/mL (DILAUDID) PCA 50 mL, , IV, PCA Injection Attempts: 69 Injections: 47 Incremental dose: 0.6 Lockout: 6 min Carisoprodol (SOMA) Tablet 350 mg po Q8H PRN Methadone (DOLOPHINE) Tablet 130 mg po QAM Hydromorphone (DILAUDID) 0.4-3 mg IV, Q1H PRN (D/C'd) 0600-0600 10 tabs 10 mg 28.2 mg
350 mg 130 mg 9 mg
000307
Assessment: Acute on chronic pain in patient with a history of opioid tolerance secondary to chronic opioid use. Pain with possible musculoskeletal, neuropathic, and spasm components. Patient home opioid requirement equivalent to 750 - 1300 mg po morphine. Patient's in-house 24 hr opioid requirement equivalent to 1400-2000 mg po morphine. Patient may benefit from a divided methadone dose to provide prolonged nighttime baseline pain relief. Patient may benefit from initiation of PCA ween. Patient may also benefit from a more aggressive bowel care regimen. Plan: 1. Trial methadone at 40 mg po at 0800 and 1600 and 50 mg mg po q hs at 2200. 2. Continue Soma, diazepam, and prn hydromorphone as written. 3. Change Dilaudid PCA dose to 0.4 mg, and lock-out to q 10 min, no basal. 4. D/C Percocet 5. Start oxycodone 20-30 mg po q 3 hrs prn breakthrough pain and 60 minutes prior to PT 6. Increase Docusate to 200 mg po BID. 7. Hold all medications for respiratory rate < 10 and sedation score >1/4. Report Electronically Signed by: Heather Rae Hertema Pharmacy Intern 12/17/2009, 1130 Above note reviewed with student intern. I agree with the plan and suggestions documented in the note. Thank you for this consult. Please call with any questions. Mark Holtsman, Pharm.D. Pain Management Pharmacist Co-Director, Inpatient Pain Service Pager: 762-1457 12/17/2009 1325 Time spent on consultation = 90 minutes
Electronically signed by Mark L Holtsman, RPH at 12/17/2009 1:30 PM Revision history: > 12/17/09 1330 Consults addendum by Mark L Holtsman, RPH 12/17/09 1327 Consults addendum by Mark L Holtsman, RPH 12/17/09 1319 Consults signed by Heather Rae Hertema, PHRMINTN Progress Notes signed by Phat Giang, MD at 12/17/09 1233 Author: Phat Giang, MD Service: Anesthesia Filed: 12/17/09 1233 Note Time: 12/15/09 1840 Author Type: *PHYSICIAN: FACULTY
12/15/2009 1840 50yr yo male s/p L hip arthroplasty A/O x 3, Pt with chronic pain issues, pain improved from 10 to 4 after Valium 5 mg x 2 in addition to narcotics. HR/BP/SpO2 and UO within normal limits. Temp: 37.9 C (100.2 F) (12/15 1800) Temp src: Core (12/15 1800) Pulse: 89 (12/15 1830)
000308
02/20/2013
MRN: 8081369, Patient Last, First: AMUNDSEN, MARK
01,15,13
PM
page
1 of
Patient Nam.: pt. Preferred Name: Mod. RGe. N: Account II: Proc.Oate:
AMUNDSEN, MARK
8081369 010016806878
12115/2009
SeX:
Male 0912311959
Operating Room Record Main OR
._-
._ft(
UCD
ooa,
Age:
SOy
L
VerifiGltlon
Chari Copy
OR':
'2
Times
An/llthlllla:
Start 12:33 12:38 12:58 13:15
Stop 15:39 15:25

~Bln-'M1ee18 Out)
Attandlng Surgeowt Ptn"nt
ORnme: Op.Start Surgery TIme:
y"
Prlmlry Anesthe.la Agent
(Turnoyer!(J SurveOfl) {InciSion
nme . Inc,
Clsd.lOp.Slop)
Sevofturene
Personnel
Surgeon Anes Resident

Anes Resident
Ternurian, Robe" Tafoya, Sampaguita "Sam"

Okoye, Chinwe
Case Service:
Primary
Orthopedics
Anesthesiologist
Assislant Surgeon CRNA

Circulator
Giang, Phat Eastman, Jonathan G NOI, Applicable

Holm, Cindy J Okoye, Chinwe
"....
Primlll'Y Primary
"""'OY
SV Anes SV Circulator SV Scrub

SV Surg
Holm, Cindy J
Leake, Alanna
P,-
Prim./'(
"""'0
Scrub
Procedure tntormanon
Procedure Oescrlctlon
Eastman, Jonathan G Leake, Alanna
''''''''
''-
left T1:IA
hawm
Tamutian, Robert
Praop Same DiagnOSis:
Primary Left hip degenerative joint disease

Sptlclmen:
No
POltoD 01.9"0&19:
[ =:
_~'-'J
COl" ClasS:
Elective
Anetlthe!ila Type: General
Medications
Comments
Comment
Used and/or See
saline for trrig
Implanllnformatlon
'~"..l_*-:' ~
_ ~'.:..
fmtl,
\!I;Ui3I.ll.:,;l~llill1~t H:1J1"~!,..lclh.(.~1i
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000309
02/20/2013 MRN: 8081369, Patient Last, First: AMUNDSEN, MARK
01,15,13
PM
Page 2 of
Petlent Neme: Pt. Preferred Med. Rec.#: Name:
AMUNOSEN,MARK
8081:3eg Sex; DOS: Age: M.Ie
Operating Room Record

Main OR
0912311959 50y
-:"=:MC
UCD
Account. : pree. Date: OR.:
010016806878 12/1512009
12
Chait Copy
I Material N"me
!<iI.!1
1217]2-{)S8
Pinnacle
Sector Cup wI Gription 58mm (1217-32-058)
QlI.onlllx 1
Manufacturer
SodY Site
left hip INC
Imolanled
DEPUY ORTI1OPEDICS
b2l.!!
d21f31000
Common',:
Material Name
Summit Stem Iw Duoflx HI Offset Sz 07 (1570-12-135)

BodY Site ImDlanted
I I I
exp 201908
"'
l<!Il
left hip
1571).12_1)5
Manuflldurer
DEPUY ORTHOPEDICS
INC
lWiJlJ!
b2l.!!
Comments:
exp2019-1O
"'
d48ch1
Matenal Ham.
Pinnacle Insert Ultarnet Metal/Metal Neut 40mm 580 (12 J 8-87-458)
l<Il.!!
1218-87458 Bod\! Sift, Implanle;$f
~
Manufacturer DEPUY ORTHOPEDICS INC
left hip Serial'
I..2l.!
]011505
Comments: Material Nam,
exp2014-IO
"'
Apex Hole (J246-03-000)
Bodv Sile tmotanted
!<iI.!1
Eliminator 1246-63000
THA Pinnacle
~
Monufa..-:lurer
left hip
INC
DEPUY ORTHOPEDICS
&!Ii!!
I..2l.!
d3implOOO
,Comments:
fxp2019-09
"'
& Verification
Language:
Nursing Assessment
NPO:
12
Hrs.
English
P~cedure Sit. Per Patient
left hip
Allergies/Reactions
MS Ient.; itchiness Verlflcltion

P,tlent 10
-J
Addressograph plate verified
Name, MR, 008,

LOC (preop)
Alert
Patient Care Data
Confirmed patient has no prosthetics or contact lenses

Medical Record Data
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Page 2 016 Printed: 12J1Sf200g 15:43 Opel1ltlve Note
AC4S92
OperatIng
Room Record'
MR1J1:'OB1JS9
000310
01,15,13
PM
Page 3 of
Patlont Name; Pt. Preferred Name: Mad. Rec . :
AMUNDSEN, MA~K
8061369
Sex:
DOB: Age:
Male 09123/1959
Operating Room Record Main OR Char/Copy
UCD .- fIN:. -~~
Account" :
Proc.Oaw:
ORM;
010016806878
12115/2009 12
SOy
Addressograph
with chart; Allergies verified; Current chart with patient
COIl'S8nts (Stamped, algned, dated, witnessed)
Surgical consent on the chan

Medications
Ordered premedications were given Cloayr. Staples

Autoclav.
No
Site Verification
10 In Preop
Name, MR, 008, Addressograph plate verified

paperwork in Preop
H&P, consent verified with OR schedule; Informed consent note verified with OR schedule
Confirmation procedure I site I conaont
Verified with patient

Site Marking
Surgical site marked

IDlnOR
Name, MR,
Board
ooB, Addressograph
plate verified
Procedure site on count board

Pa138rwork In OR
H&oPt consent verified with DR schedule

Surgical Pause
Yes, prior to incision Nursing Pian/Implementation

OR Risk for anxiety
Circulator available during induction and emergence from anesthesia; Clear, concise explanations Reassurance I support / com fort provided
OR Risk for fluid Imbalance
given;
Sponges within view of anesthesia staff; Suction cannisters within view of anesthesia staff; Urimeter within view of anesthesia staff
OR Risk for hypothermIa
Bair Hugger epptted; Upper bod)'

OR Risk 'or impaired skin Integrity
Nonnal
Potential For Infection

. - ~~ L!.!.Uif,
,.. ),~ :.~,.,.~ . --...",t..... .
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000311
01,15,13
PM
Page 4 of
Patient Name: pt, Preferred Mud. Rec. #: Account Name:
AMUNDSEN,MARK

Sex:
Male 09123/1959
8081369 010016806878
12/1512009
Main OR
-"'''=M(
UCD
#:
ooB:
Age,
Proc. Date:
SOy
CharlCopy
OR':
12
Isolation Precautions: Prep

Hair Removal
Standard Precautions
Removed
with clippers;
by surgeon
P",p
DuraPrep; Prepped by circulator
~-----------Catheters
Foley Bladder
Wound Class
Clean
Drains
No drain
Urine noted on placement

Circulator Comments:
Packing
No packing
Comments:
Dressings Ves
Commentl:
Potential For Injury

Posilion
Position lateral rt side up
Positioning aids
peg board, gel pads, pegs, ax rolls, multHask.
Counts
C:\PIDIIfaIll
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Page 4 of6
Operating Room Record I Operattve Note
Printed: 1211512009
16:-43
AC4592
MR':80813&9
000312
02/20/2013 MRN: 8081369, patien~ Last, First: AMUNDSEN, MARK
01:15:13
PM
Page 5 of 1
Patient Name: Pl Prtlferred Name:
AMUNDSEN,
IV1ARK
Mod.Ret:.':
Account ff : Proc. Date: OR":
eo81~B9
Sex:
OOB:
Age:
Male
Operating Room Record MainOR Chari Copy
--
--Wl..
UCD
010016806878 12115/2009 12
0912J/1959
SOy
praDo count -
a llne
Leake, Alanna; Correct Holm, Cindy J
Instrument .NA
Sharps> Needles
Leake, Alanna; Holm, Cindy J Leake, Alanna; Holm, Cindy J Leake, Alanna; Holm, Cindy J
Leake, Alanna; Leake, Alanna; Holm, Cindy
Small Items - NA
Sponges - Correct
FIrst count
Instrument
- NA
Sharps - Needles- Correct Small Items .. NA

Sponges - Correct Second I;oynt Instrument .. NA
Holm, Cindy 1
Leake. Alanna; Holm. Cindy J

Leake, Alanna; Leake, Alanna; Leake, Alanna; Holm, Cindy Holm, Cindy
J J
Sharps - Needles - Correct

Small Items .. NA
Holm, Cindy J
Leake, Alanna; Holm. Cindy J

Leake, Alanna; Holm, Cindy
Sponges. Correct
Field InslI. bv Scrub after closure InstrumentNA NA
Sharps - NeedlerSmall Items - NA Spcnges . NA
IName:
Cauter SOllie Fon;e FX 01889
R."',en.",
20043001889
Immediate Post.Op Summary

Outcom,,: Skin: Position of patient during surgery, Airway: Extubated, Airway: 02 via face mask to PACU
or Unit, Temp: Normal, 35-37,5 degrees C. Pain: Surgical manipulation, Anxiety ~Drowsy, but responsive
Po.top Skin:
Trlllnsport 8y: Transport Trensport To: Via;
Bovie site clear

Circulator; PACU Anesthesia Resident
Bed
PACU Nurse
ReportGivenTo:
Nurses' Notes
'",
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000313
02/20/2013 MRN: 8081369, Patient L~st, First: AMUNDSEN, MARK
01,15,13
PM
page 6 of
Patlftnt Name: Pt. Preferred Hame: Mod. Rec. tI: Account # : Ptoe. Date:
AMUNDSEN. MARK

Sex:
8081369
010016806878
Male
09123/1959
Main OR
-'.:::MC
UCD
COB: Age:
12115/2009 12
50y
CharfCopy
OR#:
Signature
Signature _
Da
Da te
Signature
C:lJ'roanm
Fija\SISnRePOrU\UCD-UCOINI\UCDNIl,iQt
Page 6 of6
Operating Room "ecord I Op.ratJ . Nots
Printed: 1211512009 MR.:8081369 15:43
AC4592
000314
Admission Information Attending Provider Robert Michael Tamurian, MD Discharge Date/Time 12/18/09 1430
Admitting Provider Robert Michael Tamurian, MD Hospital Service Orthopedics
Admission Type Elective Admission Auth/Cert Status
Admission Date/Time 12/15/09 0717 Service Area UCDHS SERVICE AREA

Referring Provider Robert Michael Tamurian, MD
Unit Room/Bed D14 14787/147871 ORTHOPEDICS/TRAUMA
Admission Status Discharged (Confirmed)
MAR MINI-FLOWSHEET DATA Row Name OTHER IVPB / Flush Medication IVPB / Flush Amount (mL) Pain score Pain location Sedation score 12/15/09 1000 Vanco -AB 200 -AB ---12/15/09 1541 --10 -PB L hip -PB 0 - Awake, alert, normal response to auditory stimuli. -PB 12/15/09 1545 --10 -PB L hip -PB 0 - Awake, alert, normal response to auditory stimuli. -PB 12/15/09 1600 --10 -PB L hip -PB 0 - Awake, alert, normal response to auditory stimuli. -PB 12/15/09 1605 --10 -PB L hip -PB 0 - Awake, alert, normal response to auditory stimuli. -PB 0.2 Hydromorphone 0.2 mg/mL -PB 0.4 -PB
(RETIRED) Medication+Conc*
--
--
--
--
(RETIRED) Incrementalordered (mg)* (RETIRED) Lockouttime (minutes) (RETIRED) Basalrate(mg/hr) (RETIRED) Attempts (RETIRED) Injections (incremental)* (RETIRED) Incrementaldose (mg)CALC (RETIRED) Bolusdose(mg)* (RETIRED) Basaldose(mg)* (RETIRED) TotalPCAdose(mg) CALC
--
--
--
--
--
--
--
--
6 -PB
----
----
----
----
0 -PB 0 -PB 0 -PB
--
--
--
--
0 -PB
----
----
----
----
0 -PB 0 -PB 0 -PB
000315
(RETIRED) TotalPCAvolume (mL)CALC Pain Scale Row Name OTHER Pain score Pain location Sedation score
--
--
--
--
0 mL -PB
--
12/15/09 1615 10 -PB L hip -PB 0 - Awake, alert, normal response to auditory stimuli. -PB -Numeric (NRS) (0-10) -PB
12/15/09 1800
Numeric (NRS) Numeric (NRS) Numeric (NRS) -(0-10) -PB (0-10) -PB (0-10) -PB 12/15/09 1630 12/15/09 1645 12/15/09 1700 12/15/09 1730 10 -PB L hip -PB 0 - Awake, alert, normal response to auditory stimuli. -PB -Numeric (NRS) (0-10) -PB
12/15/09 1815
--S - Normal sleep, easy to arouse. -PB
--S - Normal sleep, easy to arouse. -PB
Pain assessment Pain Scale
No s/s of pain -PB --
No s/s of pain -PB --
10 -JV L hip -JV S - Normal sleep, easy to arouse. -JV -Numeric (NRS) (0-10) -JV 12/15/09 1939 4 -BH ---
Row Name OTHER Pain score Pain location Sedation score
12/15/09 1830
12/15/09 1915
8 -JV -S - Normal sleep, easy to arouse. -JV Grimacing, frowning -JV Numeric (NRS) (0-10) -JV
--S - Normal sleep, easy to arouse. -PB No s/s of pain -PB --
Pain assessment Pain Scale

Row Name OTHER IVPB / Flush Medication IVPB / Flush Amount (mL) Pain score Pain location Sedation score
4 -PB L hip -PB 0 - Awake, alert, normal response to auditory stimuli. -PB -Numeric (NRS) (0-10) -PB
12/15/09 2030
2 -BH L hip -BH --
-Numeric (NRS) (0-10) -BH

12/15/09 2048
--12/15/09 2100 cefazolin -BH 50 -BH [1] ----
12/15/09 2000
12/15/09 2004
------
----0 - Awake, alert, normal response to auditory stimuli. -LH 0.2 Hydromorphone 0.2 mg/mL -LH 0.4 -LH
--4 -BH L hip -BH --
--5 -BH ---
(RETIRED) Incrementalordered (mg)* 6 -BH (RETIRED) Lockouttime (minutes) 0 -BH (RETIRED)
0.2 Hydromorphone 0.2 mg/mL -BH 0.4 -BH
--
--
--
--
--
--
6 -LH
--
--
--
0 -LH
--
--
--
000316
Basalrate(mg/hr) (RETIRED) Attempts (RETIRED) Injections (incremental)* (RETIRED) Incrementaldose (mg)CALC (RETIRED) Bolusdose(mg)* (RETIRED) Basaldose(mg)* (RETIRED) TotalPCAdose(mg) CALC (RETIRED) TotalPCAvolume (mL)CALC Pain assessment
Row Name OTHER Pain score
55 -BH 13 -BH
---
---
---
---
5.2 -BH
--
--
--
--
0 -BH 0 -BH 5.2 -BH
----
----
----
----
26 mL -BH
--
--
--
--
-12/15/09 2146
Nods yes to pain -LH

12/15/09 2200
-12/15/09 2240
-12/15/09 2256
-12/15/09 2257 7 -BH --
7 -BH --
-0.2 Hydromorphone 0.2 mg/mL -BH 0.4 -BH
0 -BH sleeping [2] --
6 -BH --
(RETIRED) Incrementalordered (mg)* (RETIRED) Lockouttime (minutes) (RETIRED) Basalrate(mg/hr) (RETIRED) Attempts (RETIRED) Injections (incremental)* (RETIRED) Incrementaldose (mg)CALC (RETIRED) Bolusdose(mg)* (RETIRED) Basaldose(mg)* (RETIRED) TotalPCAdose(mg) CALC (RETIRED) TotalPCAvolume
--
--
--
--
--
6 -BH
--
--
--
----
0 -BH 24 -BH 13 -BH
----
----
----
--
5.2 -BH
--
--
--
----
0 -BH 0 -BH 5.2 -BH
----
----
----
--
26 mL -BH
--
--
--
000317
(RETIRED) Incrementalordered (mg)* (RETIRED) Lockouttime (minutes) (RETIRED) Basalrate(mg/hr) (RETIRED) Attempts (RETIRED) Injections (incremental)* (RETIRED) Incrementaldose (mg)CALC (RETIRED) Bolusdose(mg)* (RETIRED) Basaldose(mg)* (RETIRED) TotalPCAdose(mg) CALC (RETIRED) TotalPCAvolume (mL)CALC Pain Scale
--
hone 0.2 mg/mL -BO 0.4 -BO
--
--
--
--
10 -BO
--
--
--
----
0 -BO 4 -BO 3 -BO
----
----
----
--
1.2 -BO
--
--
--
----
0 -BO 0 -BO 1.2 -BO
----
----
----
--
6 mL -BO
--
--
--
Numeric (NRS) (0-10) -BO
Numeric (NRS) (0-10) -IC
Transport Row Name Transport Departure time Mode Destination Personnel Time returned
12/16/09 1100 1101 -MT Bed -MT X-ray -MT Patient escort -MT 1145 -MT
Acute Vital Signs Row Name 12/15/09 1915 Vital signs 38 C (100.4 Temp F) -BH Oral -BH Temp src 86 -BH Pulse 135/85 mmHg BP BH 14 -BH Resp Numeric (NRS) Pain Scale
12/15/09 1939 -------
12/15/09 2004 -------
12/15/09 2030 -------
12/15/09 2048 -------
000318
Pain score Pain location Pain assessment Sedation score SpO2 Rhythm (RETIRED) O2 method Row Name Vital signs Temp Temp src Pulse BP Resp Pain Scale
(0-10) -BH 2 -BH L hip -BH --
4 -BH ----
--
96 % -BH Non-monitored BH Room air -BH 12/15/09 2146 -------
---12/15/09 2240 -------
--Nods yes to pain -LH 0 - Awake, alert, normal response to auditory stimuli. -LH ---12/15/09 2256 -------
4 -BH L hip -BH ---
5 -BH ----
---12/15/09 2257 -------
---12/15/09 2300 37.8 C (100 F) -BH Oral -BH 93 -BH 126/75 mmHg -BH 14 -BH Numeric (NRS) (0-10) -BH 7 -BH LLE -BH 0 - Awake, alert, normal response to auditory stimuli. -BH 98 % -BH Room air -BH
12/16/09 0255
Pain score Pain location Sedation score
7 -BH ---
0 -BH sleeping [2] ---
6 -BH ---
7 -BH ---
SpO2 (RETIRED) O2 method Row Name Vital signs Pain score Sedation score Row Name Vital signs Temp Temp src Pulse BP Resp Pain Scale
--12/15/09 2330
--12/16/09 0050
--12/16/09 0145
--12/16/09 0200
-0 - Awake, alert, normal response to auditory stimuli. -LH 12/16/09 0329 -------
8 -BH --
7 -BH --
8 -BH --
0 -BH sleeping --
12/16/09 0400 37.2 C (99 F) -BH Oral -BH 82 -BH 122/72 mmHg BH 14 -BH Numeric (NRS)
12/16/09 0425 -------
12/16/09 0500 -------
12/16/09 0528 -------
000319
score
t, normal response to auditory stimuli. -BO -----
sy but awake, slow response to auditory stimuli -BO 95 % -BO Room air -BO ---
SpO2 (RETIRED) O2 method Intake
drowsy but awake, slow response to auditory stimuli -BO ---
Row Name 12/15/09 1000 12/15/09 1541 12/15/09 1600 IVPB / Flush Vanco -AB --IVPB / Flush Medication 200 -AB --IVPB / Flush Amount (mL) Reported volumes OR volumes -Reported/downtime -PB reason -2000 ml -PB -Crystalloid intake -1000 ML -PB -Colloid -200 ml -PB -Urine (catheter) -600 ml -PB -Estimated blood loss Lactated Ringers -800 mL -PB 700 mL -PB Credit (mL) --100 mL -PB Amount (mL) D5 / 0.45% NaCl 1,000 mL with Potassium Chloride 20 mEq --100 mL/hr -PB Rate (mL/hr)
12/15/09 1700
12/15/09 1800 ---
---
------
------
--100 mL/hr -PB -100 mL -PB
--100 mL/hr JV 800 mL -JV 100 mL -JV
Credit (mL) Amount (mL) Foley 12/15/09 (RETIRED) Properties (RETIRED) Action
---
---
1000 mL -PB 0 mL -PB
(RETIRED) Dressing -Clear -PB -(RETIRED) Site assessment gravity -PB -(RETIRED) Suction --Yellow -PB Yellow -PB (RETIRED) Drainage color -45 ml -PB 20 ml -PB (RETIRED) Amount Row Name 12/15/09 1849 12/15/09 1900 12/15/09 2100 IVPB / Flush -cefazolin -BH IVPB / Flush -Medication -50 -BH [1] IVPB / Flush -Amount (mL) D5 / 0.45% NaCl 1,000 mL with Potassium Chloride 20 mEq --Rate (mL/hr) --
Placement Date: 12/15/09 -PB Removal Date: 12/17/09 -BO Removal Time: 1145 BO --- -PB ---assessed -Open to air -PB -----Yellow -PB 90 ml -PB 12/16/09 0200 ----Yellow -JV 75 ml -JV 12/16/09 0500 cefazolin -BH 50 -BH
100 mL/hr -BH
--
000320
Pain location SpO2 (RETIRED) O2 method Row Name Vital Signs Temp Temp src Pulse BP Resp Pain Scale Pain score Pain location SpO2 (RETIRED) O2 method
L hip -KP 100 % -KP Room air -KP

12/18/09 0850
L hip -BO 97 % -BO Room air -BO

12/18/09 1210
L hip -BO --12/18/09 1303
L hip -BO --12/18/09 1333
L hip -BO ---
-----Numeric (NRS) (0-10) -BO 5 -BO L hip -BO ---
37 C (98.6 F) -BO Oral -BO 80 -BO 98/57 mmHg BO 16 -BO Numeric (NRS) (0-10) -BO 3 -BO L hip -BO 95 % -BO Room air -BO
-----Numeric (NRS) (0-10) -IC 4 -IC LEFT HIP -IC ---
-----Numeric (NRS) (0-10) -BO 4 -BO L hip -BO ---
(Admission) General Row Name 12/15/09 2314 Admission On -BH ID band Allergy band On -BH Mark -BH Preferred name Advance Directive Yes -BH Advance directive? No -BH Copy of AD on chart Miscellaneous Network sports Occupation -BH -- -BH Recent none exposure to infectious disease -- -BH Alternative none therapies Supplements none -BH (list) Yes -BH Orientation to unit Diet at home Regular -BH None -BH Dentures No problems -BH (RETIRED) Urination Constipation (RETIRED) BH Bowel Routine 12/15/09 -BH (RETIRED) Date of last
12/16/09 0730 On -MT On -MT --
12/16/09 1930 On -KP On -KP --
12/17/09 0820 On -BO On -BO --
12/17/09 1930 On -KP On -KP --
---
---
---
---
---
---
---
---
--------
--------
--------
--------
--
--
--
--
000321
-- -BH n/a -- -BH LMP Date n/a (RETIRED) Support system Sibling -BH (RETIRED) Informant's relationship 209-745-2163 (RETIRED) BH Informant phone Widowed -BH (RETIRED) Pt marital status Dr. V. Baquero (RETIRED) Primary MD -BH Eric Amundsen Primary BH support person Relationship Brother -BH support person same as above Support BH person phone English -BH Preferred language Row Name 12/18/09 0725 Admission On -BO ID band Allergy band On -BO
BM Pregnant?
---
---
---
---
--
--
--
--
--
--
--
--
--
--
--
--
---
---
---
---
--
--
--
--
--
--
--
--
--
--
--
--
(RETIRED) (Admission) Functional/Mental Row Name 12/15/09 2318 (RETIRED) Mental Status Alert -BH (RETIRED) LOC Person;Place; Orientation Time -BH Appropriate -BH (RETIRED) Mood/Affect (RETIRED) Independence-Pre-Admit Rating Independent -BH (RETIRED) Grooming Independent -BH Ambulating Independent -BH (RETIRED) Transferring Independent -BH (RETIRED) Eating Independent -BH (RETIRED) Toileting (RETIRED) Independence (Adult-Adm) Assistance (RETIRED) NeedGrooming
000322
GV Resp Pain Scale 18 -GV Numeric (NRS) (0-10) -GV -Numeric (NRS) (0-10) -AB
PB 16 -PB Numeric (NRS) (0-10) -PB 10 -PB L hip -PB 100 % -PB --
PB 13 -PB Numeric (NRS) (0-10) -PB 10 -PB L hip -PB 100 % -PB --
mmHg -PB 17 -PB Numeric (NRS) (0-10) -PB 10 -PB L hip -PB 100 % -PB --
-3 -AB Pain score left hip -AB Pain location -95 % -GV 98 % -AB SpO2 (RETIRED) Pain 4 -GV -Acceptable postprocedure pain score (RETIRED) Pain not related to this admit left hip -GV -(RETIRED) Location Row Name 12/15/09 1605 12/15/09 1615 Vital Signs --Temp Pulse BP Resp Pain Scale Pain score Pain location Pain assessment SpO2 Row Name Vital Signs Temp Pulse BP Resp Pain Scale Pain score Pain location Pain assessment SpO2 Row Name Vital Signs Pain score Pain location Pain assessment ----10 -PB L hip -PB --12/15/09 1730 -81 -JV ! 162/98 mmHg JV 15 -JV Numeric (NRS) (0-10) -JV 10 -JV L hip -JV -94 % -JV 12/15/09 1939 4 -BH --70 -PB ! 165/103 mmHg PB 10 -PB Numeric (NRS) (0-10) -PB 10 -PB L hip -PB -96 % -PB 12/15/09 1800 37.9 C (100.2 F) -JV 75 -JV ! 156/92 mmHg JV 12 -JV Numeric (NRS) (0-10) -JV 8 -JV -Grimacing, frowning -JV 94 % -JV 12/15/09 2004 --Nods yes to pain -LH
-12/15/09 1630
-12/15/09 1645
-12/15/09 1700
-74 -PB ! 173/98 mmHg PB 11 -PB Numeric (NRS) (0-10) -PB 10 -PB L hip -PB -100 % -PB 12/15/09 1815 -78 -PB 149/83 mmHg PB 16 -PB --
-73 -PB ! 161/103 mmHg PB 13 -PB ---No s/s of pain -PB 96 % -PB 12/15/09 1830 -89 -PB 126/80 mmHg PB 14 -PB Numeric (NRS) (0-10) -PB 4 -PB L hip -PB -96 % -PB 12/15/09 2048 5 -BH ---
36.4 C (97.5 F) -PB 74 -PB 129/83 mmHg -PB 14 -PB ---No s/s of pain -PB -12/15/09 1915 38 C (100.4 F) -BH 86 -BH 135/85 mmHg -BH 14 -BH Numeric (NRS) (0-10) -BH 2 -BH L hip -BH -96 % -BH 12/15/09 2146 7 -BH ---
--No s/s of pain -PB 94 % -PB 12/15/09 2030 4 -BH L hip -BH --
000323
(0-10) -BO Pain score Pain location SpO2 Row Name Vital Signs Temp Pulse BP Resp Pain Scale Pain score Pain location SpO2 7 -BO L hip -BO 97 % -BO 12/18/09 1210 37 C (98.6 F) -BO 80 -BO 98/57 mmHg BO 16 -BO Numeric (NRS) (0-10) -BO 3 -BO L hip -BO 95 % -BO
(0-10) -BO 7 -BO L hip -BO -12/18/09 1303 ----Numeric (NRS) (0-10) -IC 4 -IC LEFT HIP -IC --
(0-10) -BO 7 -BO L hip -BO -12/18/09 1333 ----Numeric (NRS) (0-10) -BO 4 -BO L hip -BO --
(0-10) -BO 6 -BO L hip -BO --
(NRS) (0-10) -BO 5 -BO L hip -BO --
(Admission) General Row Name 12/15/09 0732 Admission Surgery/Procedure left total hip artghroplasty GV Placed on patieID band nt -GV Placed on patieAllergy band nt -GV -Preferred name Advance Directive Yes -GV Advance directive? Yes -GV Copy of AD on chart Pt provided info on No -GV AD? (RETIRED) Support System Michelle SniderPrimary support -GV person Support person phone 916-984-2189 GV 12/15/09 1541 -12/15/09 1915 -12/15/09 2314 -12/16/09 0730 --
On -PB On -PB -----
On -BH On -BH -----
On -BH On -BH Mark -BH Yes -BH No -BH --
On -MT On -MT -----
---
---
Tower Lobby Support person GV location English -GV Preferred language Interpreter needed No -GV (RETIRED) Miscellaneous Regular -GV Diet at home 12/14/09 -GV NPO solids date 2200 -GV NPO solids time NPO clear liquids 12/15/09 -GV date
--------
--------
Eric Amundsen BH same as above BH -English -BH -Regular -BH ----
---
--------
000324
NPO clear liquids time (RETIRED) Regular contraceptive use? Dentures Pregnant? LMP Date Row Name Admission ID band Allergy band
2000 -GV No -GV
---
---
---
---
None -GV No -GV --
---12/17/09 0820 On -BO On -BO

12/15/09 2318
---12/17/09 1930 On -KP On -KP
12/16/09 1930 On -KP On -KP
None -BH -- -BH n/a -- -BH n/a 12/18/09 0725 On -BO On -BO
----
(Admission) Functional/Mental Row Name 12/15/09 0735 (RETIRED) Mental Status Alert -GV (RETIRED) LOC Person;Place; Orientation Time -GV (RETIRED) ADLs/Independence Independent -GV (RETIRED) Grooming Independent -GV Ambulating Independent -GV (RETIRED) Transferring Independent -GV (RETIRED) Eating Independent -GV (RETIRED) Toileting None -GV Assistive devices
Alert -BH Person;Place; Time -BH Independent -BH Independent -BH Independent -BH Independent -BH Independent -BH --
(Admission) Risk Assessment Row Name 12/15/09 0736 Sensory Sensory limitations -Abuse No -GV Recently been threatened/injured?
12/16/09 0003
None -BH No -BH
(Admission) Discharge Considerations Row Name 12/15/09 0736 12/15/09 2314 Discharge Considerations Michelle patien-Person to ts friend to pick up pt pick up -GV Support System -Eric Amundsen Primary BH support person -same as above Support BH person phone
12/16/09 0005 --
--
--
000325
OTHER Legal Concerns
--
--
None -BH
(RETIRED) Acute/ICU Assessment Row Name 12/15/09 0723 Received unit -Rec'd unit
12/15/09 1541
12/15/09 1600
12/15/09 1700
12/15/09 1800
Recovery PACU-PB
--
--
--
Height/Weight -1.854 m (6' Height 1") -GV Actual -GV -Height type -97.387 kg (214 Weight lb 11.2 oz) -GV -Weight type Actual -GV (RETIRED) Glasgow coma scale (>2yrs) Spontaneous Spontaneous (RETIRED) PB Eye opening GV Oriented -GV Oriented -PB (RETIRED) Best verbal response Obeys Obeys (RETIRED) commands commands Best motor -GV -PB response 15 -GV 15 -PB (RETIRED) Coma score total (RETIRED) Pupils Brisk -GV Sluggish -PB (RETIRED) Right reaction Brisk -GV Sluggish -PB (RETIRED) Left reaction 3 -GV 2 -PB Right size 3 -GV 2 -PB Left size (RETIRED) Strength Abnormal -GV Abnormal -PB (RETIRED) Group Slight weakness- Slight weakness(RETIRED) -GV -PB Left lower (RETIRED) Sensation WNL -GV (RETIRED) Group (RETIRED) Skin WNL -GV (RETIRED) Group (RETIRED) Pressure Ulcer No -GV (RETIRED) Pressure Ulcer Present? (RETIRED) Cardiac
----Spontaneous PB Oriented -PB
----Spontaneous PB Oriented -PB
----Spontaneous JV Oriented -JV
Obeys commands -PB 15 -PB
Obeys commands -PB 15 -PB
Obeys commands -JV 15 -JV
Sluggish -PB
Sluggish -PB
Sluggish -JV
Sluggish -PB 2 -PB 2 -PB U -PB --
Sluggish -PB 2 -PB 2 -PB U -PB --
Sluggish -JV 2 -JV 2 -JV Abnormal -JV Slight weakness-JV WNL -JV
WNL -PB
WNL -PB
WNL -PB
WNL -PB
WNL -PB
WNL -PB
WNL -JV
No -PB
--
--
No -JV
000326
WNL -GV WNL -PB (RETIRED) Group (RETIRED) Pulses WNL -GV WNL -PB (RETIRED) Group (RETIRED) Capillary refill WNL -GV WNL -PB (RETIRED) Group: Capillary Refill (RETIRED) Edema WNL -GV WNL -PB (RETIRED) Edema ? (RETIRED) Respiratory assessment WNL -GV WNL -PB (RETIRED) Group (RETIRED) Pulmonary secretions WNL -GV -- -PB (RETIRED) None Group (RETIRED) GI WNL -GV Abnormal -PB (RETIRED) Group --(RETIRED) Abdomen -Hypoactive -PB Bowel sounds (RETIRED) Urine -- -GV WNL -PB (RETIRED) pt. has not Group voided -Foley -PB Method Row Name 12/15/09 1915 12/15/09 2313 Height/Weight -1.854 m (6' Height 1") -BH -Reported -BH Height type --- -BH Reason not post op weighed -99.791 kg (220 Weight lb) -BH Reported -BH Weight type ---Weight method (RETIRED) Glasgow coma scale (>2yrs) Spontaneous -(RETIRED) Eye opening BH Oriented -BH -(RETIRED) Best verbal response Obeys -(RETIRED) commands Best motor -BH response 15 -BH -(RETIRED) Coma score total
WNL -PB
WNL -PB
WNL -JV
WNL -PB
WNL -PB
WNL -JV
WNL -PB
WNL -PB
WNL -JV
WNL -PB
WNL -PB
WNL -JV
WNL -PB
WNL -PB
WNL -JV
-- -PB None U -PB ---
-- -PB none U -PB ---
WNL -JV
Abnormal -JV Soft -JV Hypoactive -JV
WNL -PB
WNL -PB
WNL -JV
Foley -PB 12/16/09 0003 -------
Foley -PB 12/16/09 0730 -------
Foley -JV 12/16/09 1357 ---95.89 kg (211 lb 6.4 oz) -MT Actual -MT Standing scale -MT ---
---
Spontaneous MT Oriented -MT
--
--
Obeys commands -MT 15 -MT
--
--
000327
(RETIRED) Pupils Sluggish -BH -(RETIRED) Right reaction Sluggish -BH -(RETIRED) Left reaction 2 -BH -Right size 2 -BH -Left size (RETIRED) Strength Abnormal -BH -(RETIRED) Group Slight weakness- -(RETIRED) -BH Left lower (RETIRED) Sensation WNL -BH -(RETIRED) Group --(RETIRED) Left lower (RETIRED) Skin WNL -BH -(RETIRED) Group (RETIRED) Pressure Ulcer No -BH -(RETIRED) Pressure Ulcer Present? (RETIRED) Cardiac WNL -BH -(RETIRED) Group (RETIRED) Pulses WNL -BH -(RETIRED) Group (RETIRED) Capillary refill WNL -BH -(RETIRED) Group: Capillary Refill (RETIRED) Edema WNL -BH -(RETIRED) Edema ? (RETIRED) Respiratory assessment WNL -BH -(RETIRED) Group (RETIRED) Pulmonary secretions WNL -BH -(RETIRED) Group (RETIRED) GI Abnormal -BH -(RETIRED) Group Soft -BH -(RETIRED) Abdomen Hypoactive -BH -Bowel sounds (RETIRED) Urine
--
Brisk -MT
--
------
Brisk -MT 3 -MT 3 -MT Abnormal -MT Moves against gravity -MT Abnormal -MT Hypersensitive -MT WNL -MT
------
---
---
--
--
No -BH
No -MT
--
--
WNL -MT
--
--
WNL -MT
--
--
WNL -MT
--
--
WNL -MT
--
--
WNL -MT
--
--
WNL -MT
--
----
WNL -MT ---
----
000328
WNL -KP WNL -BO (RETIRED) Edema ? (RETIRED) Respiratory assessment WNL -KP WNL -BO (RETIRED) Group (RETIRED) Pulmonary secretions WNL -KP WNL -BO (RETIRED) Group (RETIRED) GI WNL -KP WNL -BO (RETIRED) Group -Yes -BO (RETIRED) Passing flatus (RETIRED) Urine Abnormal -KP Abnormal -BO (RETIRED) Group Foley -KP Foley -BO Method
WNL -KP
WNL -BO
WNL -KP
WNL -BO
WNL -KP
WNL -BO
WNL -KP Yes -KP
WNL -BO Yes -BO
WNL -KP Voids -KP
WNL -BO Voids -BO

12/15/09 1700
(RETIRED) Acute Cares Row Name 12/15/09 0723 12/15/09 0732 12/15/09 1541 12/15/09 1600 Surgical incision L Hip 12/15/09 (RETIRED) (RETIRED) Location: L Hip -PB Placement Date: 12/15/09 -PB Properties ---- -PB -(RETIRED) assessed Action --Large bulky -(RETIRED) gauze dressing Size/shape -PB --Dry and intact Dry and intact (RETIRED) -PB -PB Dressing --0 ml -PB 0 ml -PB (RETIRED) Drainage amt (RETIRED) Diet Yes -GV ---NPO (RETIRED) Nursing Care Yes -GV ---(RETIRED) Surgical Consent -Completed -PB -Therapeutic Completed -GV time --Completed -PB -Foley care --Standard Acute -(RETIRED) Care (Hill Rom Bed type Advanta) -PB ---- -PB -(RETIRED) foley Toileting --Bedrest -PB -Highest activity --Part -PB -(RETIRED) Activity assist --30 degrees -PB -(RETIRED) HOB
--Dry and intact -PB 0 ml -PB
---
-------
--
000329
Suction available Siderails Bed locked ID band Allergy band
------
---Placed on patient -GV Placed on patient -GV ---
Yes -PB x4 -PB Yes -PB On -PB On -PB
------
------
(RETIRED) Anti-embolism -(RETIRED) Right leg -(RETIRED) Left leg (RETIRED) Ortho device -(RETIRED) Type -(RETIRED) Location -(RETIRED) Assessment -(RETIRED) Action (RETIRED) Braden No -GV (RETIRED) Pressure Ulcer Present?
ALP;Knee-high PB ALP;Knee-high PB adductor wedge -PB between legs PB skin intact -PB assessed -PB
---
---
-----
-----
-----
--
No -PB
--
--
Row Name 12/15/09 1800 12/15/09 1915 12/15/09 2314 12/15/09 2318 Surgical incision L Hip 12/15/09 (RETIRED) (RETIRED) Location: L Hip -PB Placement Date: 12/15/09 -PB Properties ---Dry dressing (RETIRED) Action BH Dry and intact --(RETIRED) Dressing Dry and intact -JV -BH 0 ml -BH --(RETIRED) Drainage 0 ml -JV amt Falls Risk ---No -BH History of falls ---Secondary diagnosis -----Ambulatory aid
12/15/09 2319
----
-IV/Heparin lock (RETIRED) Diet -NPO -Meal and percent taken (RETIRED) Nursing Care -Therapeutic time -Foley care -Highest activity -(RETIRED) Activity
-No -BH 0 / Pt refused -BH Completed -BH Completed -BH Bedrest -BH Full -BH
----
----
-Yes -BH None/bed rest/ wheel chair/ nurse -BH Yes -BH ---
-----
-----
-----
000330
(Admission) Discharge Considerations Row Name 12/16/09 0005 Discharge Considerations Alone -BH Pre-admit Living Arrangements None -BH Help from outside agencies Lines/Drains/Airway None -BH on admission None -BH Environmental barriers None apply -BH Diagnoses for Discharge Planner Notification None -BH Legal Concerns Discharge Planner 1 -BH notification total (RETIRED) IV Assessment Row Name 12/15/09 1000 12/15/09 1541 12/15/09 1915 12/16/09 0730 12/16/09 1930 Peripheral 12/15/09 1000 R hand 16 g (RETIRED) Started by: RN -AB Placement Date: 12/15/09 -AB Placement Time: 1000 -AB Removal Properties Date: 12/18/09 -BO Removal Time: 1425 -BO Location: R hand -AB (RETIRED) Gauge: 16 g -AB Clean/dry/intacClean/dry/intacClean/dry/intacClean/dry/intacClean/dry/intac(RETIRED) t -AB t -KP t -PB t -BH t -MT Condition Transparent -AB Transparent -PB Transparent -BH Transparent -MT Transparent (RETIRED) KP Dressing type Single -AB Single -PB Single -BH Single -MT Single -KP (RETIRED) Number lumens/ports IV started -AB Assumed care Assumed care Assumed care - Assumed care (RETIRED) PB KP BH MT Action Peripheral 12/15/09 L hand 18 g (RETIRED) Started by: OR -PB Placement Date: 12/15/09 -PB Removal Date: 12/17/09 Properties BO Location: L hand -PB (RETIRED) Gauge: 18 g -PB -Clean/dry/intacClean/dry/intacClean/dry/intacClean/dry/intac(RETIRED) t -PB t -BH t -MT t -KP Condition -Transparent -PB Transparent -BH Transparent -MT Transparent (RETIRED) KP Dressing type -Single -PB Single -BH Single -MT Single -KP (RETIRED) Number lumens/ports -Assumed care; Assumed care Assumed care - Assumed care (RETIRED) Saline flush; BH MT KP Action Saline lock -PB Row Name 12/17/09 0820 12/17/09 1930 12/18/09 0725 12/18/09 1425 Peripheral 12/15/09 1000 R hand 16 g (RETIRED) Started by: RN -AB Placement Date: 12/15/09 -AB Placement Time: 1000 -AB Removal Properties Date: 12/18/09 -BO Removal Time: 1425 -BO Location: R hand -AB (RETIRED) Gauge: 16 g -AB Clean/dry/intacClean/dry/intacClean/dry/intac-(RETIRED) t -BO t -KP t -BO Condition
000331
Transparent -BO Transparent -KP Transparent -BO -(RETIRED) Dressing type Single -BO Single -KP Single -BO -(RETIRED) Number lumens/ports Assumed care Assumed care Assumed care -(RETIRED) BO KP BO Action ---Order to disconReason for tinue -BO discontinue Peripheral 12/15/09 L hand 18 g (RETIRED) Started by: OR -PB Placement Date: 12/15/09 -PB Removal Date: 12/17/09 Properties BO Location: L hand -PB (RETIRED) Gauge: 18 g -PB (RETIRED) PACU Vital Signs Row Name 12/15/09 0945 Vital Signs -Temp Temp src Pulse Resp BP -----Numeric (NRS) (0-10) -AB 3 -AB left hip -AB -12/15/09 1423 ----------12/15/09 1541 36 C (96.8 F) -PB Core -PB 83 -PB 16 -PB ! 156/103 mmHg PB 110 -PB Numeric (NRS) (0-10) -PB 10 -PB L hip -PB 0 - Awake, alert, normal response to auditory stimuli. -PB 12/15/09 1545 --72 -PB 13 -PB ! 159/91 mmHg -PB 114 -PB Numeric (NRS) (0-10) -PB 10 -PB L hip -PB 0 - Awake, alert, normal response to auditory stimuli. -PB 12/15/09 1600 36.1 C (97 F) -PB Core -PB 79 -PB 17 -PB ! 166/99 mmHg -PB 123 -PB Numeric (NRS) (0-10) -PB 10 -PB L hip -PB 0 - Awake, alert, normal response to auditory stimuli. -PB 100 % -PB NSR -PB ---
MAP cuff Pain Scale Pain score Pain location Sedation score
verisite done AB Communications preop/postop teachingd one AB -Provider -Other Arterial Blood Gas -Hgb Respiratory -TCDB (RETIRED) Liter -flow -(RETIRED) O2
SpO2 Rhythm Action done Procedures
98 % -AB --
-----
100 % -PB NSR -PB L total hip arthroscopy -PB post op report -PB Tafoya -PB general ett -PB -Completed -PB 10 L/min -PB Non-rebreather
100 % -PB NSR -PB ---
--10.8 ----
-----Room air -PB
---Completed PB -Room air -PB
000332
method (RETIRED) Positioning -(RETIRED) HOB Row Name 12/15/09 1605 Vital Signs -Temp Temp src Pulse Resp BP ------10 -PB L hip -PB -0 - Awake, alert, normal response to auditory stimuli. -PB
mask -PB -12/15/09 1615
30 degrees -PB
12/15/09 1630
-12/15/09 1645
-12/15/09 1700
--70 -PB 10 -PB ! 165/103 mmHg PB 126 -PB Numeric (NRS) (0-10) -PB 10 -PB L hip -PB -0 - Awake, alert, normal response to auditory stimuli. -PB 96 % -PB NSR -PB --
--74 -PB 11 -PB ! 173/98 mmHg -PB 121 -PB Numeric (NRS) (0-10) -PB 10 -PB L hip -PB -0 - Awake, alert, normal response to auditory stimuli. -PB 100 % -PB NSR -PB --
MAP cuff Pain Scale Pain score Pain location Pain assessment Sedation score
36.4 C (97.5 F) -PB -Core -PB 73 -PB 74 -PB 13 -PB 14 -PB ! 161/103 mmHg 129/83 mmHg -PB PB 125 -PB 97 -PB ----No s/s of pain -PB S - Normal sleep, easy to arouse. -PB 96 % -PB NSR -PB anesthesi @ bedside re: L hip spasmsorder received -PB Completed -PB -12/15/09 1830
--
-SpO2 -Rhythm Action done Communications --
--No s/s of pain -PB S - Normal sleep, easy to arouse. -PB -NSR -PB --
Respiratory TCDB (RETIRED) O2 method Row Name Vital Signs Temp Temp src Pulse Resp BP MAP cuff Pain Scale Pain score Pain location Pain assessment
--12/15/09 1730
Completed -PB -12/15/09 1800
Completed -PB -12/15/09 1815
Completed PB Room air -PB

12/15/09 1910
--81 -JV 15 -JV ! 162/98 mmHg -JV 121 -JV Numeric (NRS) (0-10) -JV 10 -JV L hip -JV --
37.9 C (100.2 F) -JV Core -JV 75 -JV 12 -JV ! 156/92 mmHg -JV 113 -JV Numeric (NRS) (0-10) -JV 8 -JV -Grimacing, frowning -JV
--78 -PB 16 -PB 149/83 mmHg PB 105 -PB ---No s/s of pain -PB
--89 -PB 14 -PB 126/80 mmHg PB 94 -PB Numeric (NRS) (0-10) -PB 4 -PB L hip -PB --
-----------
000333
Sedation score
S - Normal sleep, easy to arouse. -JV
S - Normal sleep, easy to arouse. -JV 94 % -JV NSR -JV --
S - Normal sleep, easy to arouse. -PB 94 % -PB NSR -PB --
94 % -JV SpO2 NSR -JV Rhythm Action done Communications report from Patti RN for lunch relief JV Time -Signout -Bed assignment -Level of care Transfer of care --PACU class Respiratory Completed -JV TCDB Room air -JV (RETIRED) O2 method (RETIRED) Positioning -Position -(RETIRED) HOB Row Name 12/15/09 1915 Vital Signs 38 C (100.4 Temp F) -BH Oral -BH Temp src 86 -BH Pulse 14 -BH Resp 135/85 mmHg BP BH Numeric (NRS) Pain Scale (0-10) -BH 2 -BH Pain score Pain location L hip -BH -Pain assessment -Sedation score SpO2 Rhythm 96 % -BH Non-monitored BH
0 - Awake, alert, normal response to auditory stimuli. -PB 96 % -PB NSR -PB --
--
----
-----Completed -PB Room air -PB
-----Completed -PB --
--------
1842 -PB -- -PB upon arrival to pacu Acute -PB 1910 -PB 3 -PB ---
Right side -PB 30 degrees -PB

12/15/09 1939
--12/15/09 2004
--12/15/09 2030
--12/15/09 2048
------4 -BH ----
--------Nods yes to pain -LH 0 - Awake, alert, normal response to auditory stimuli. -LH ---
------4 -BH L hip -BH ---
------5 -BH ----
---
---
---
Respiratory Room air -BH (RETIRED) O2 method (RETIRED) Positioning 30 degrees -BH (RETIRED) HOB
--
--
--
--
--
--
--
--
000334
Row Name Vital Signs Temp Temp src Pulse Resp BP Pain Scale Pain score Pain location Sedation score
12/15/09 2146 ------7 -BH ---
12/15/09 2240 ------0 -BH sleeping [2] ---
12/15/09 2256 ------6 -BH ---
12/15/09 2257 ------7 -BH ---
12/15/09 2300 37.8 C (100 F) -BH Oral -BH 93 -BH 14 -BH 126/75 mmHg -BH Numeric (NRS) (0-10) -BH 7 -BH LLE -BH 0 - Awake, alert, normal response to auditory stimuli. -BH 98 % -BH Room air -BH 12/16/09 0255 0 -BH sleeping --
SpO2 Respiratory (RETIRED) O2 method Row Name Vital Signs Pain score Sedation score Row Name Vital Signs Temp Temp src Pulse Resp BP Pain Scale Pain score Pain location SpO2 Respiratory (RETIRED) O2 method Row Name Vital Signs Temp Temp src
--12/15/09 2330 -0 - Awake, alert, normal response to auditory stimuli. -LH 12/16/09 0329 ------8 -BH ---12/16/09 0537
--12/16/09 0050 8 -BH --
--12/16/09 0145 7 -BH --
--12/16/09 0200 8 -BH --
12/16/09 0400 37.2 C (99 F) -BH Oral -BH 82 -BH 14 -BH 122/72 mmHg BH Numeric (NRS) (0-10) -BH 7 -BH -97 % -BH Room air -BH
12/16/09 0620
12/16/09 0425 ------0 -BH sleeping ---12/16/09 0646
12/16/09 0500 ------7 -BH L hip -BH --12/16/09 0730
12/16/09 0528 ------9 -BH ---12/16/09 0800
---
---
---
37.7 C (99.8 F) -MT Oral -MT
---
000335
Vital Signs Temp Temp src Pulse Resp BP Pain Scale
-----Numeric (NRS) (0-10) -BO 7 -BO L hip -BO 0 - Awake, alert, normal response to auditory stimuli. -BO
-----Numeric (NRS) (0-10) -BO 6 -BO L hip -BO --
SpO2 Respiratory (RETIRED) O2 method Row Name Vital Signs Pain Scale Pain score Pain location Sedation score
--12/18/09 1303
--12/18/09 1333
---
---
37 C (98.6 F) -BO Oral -BO 80 -BO 16 -BO 98/57 mmHg BO Numeric (NRS) (0-10) -BO 3 -BO L hip -BO 1 - Mildly drowsy but awake, slow response to auditory stimuli -BO 95 % -BO Room air -BO
Numeric (NRS) (0-10) -IC 4 -IC LEFT HIP -IC --
Numeric (NRS) (0-10) -BO 4 -BO L hip -BO 1 - Mildly drowsy but awake, slow response to auditory stimuli -BO 12/15/09 2146 7 -BH ----
RN Pain Management
Row Name Pain Assessment Pain score Pain location Pain assessment 12/15/09 2000 12/15/09 2004 12/15/09 2030 12/15/09 2048
-----
Sedation score
--Nods yes to pain -LH 0 - Awake, alert, normal response to auditory stimuli. -LH 0.2 Hydromorphone 0.2 mg/mL -LH 0.4 -LH
4 -BH L hip -BH ---
5 -BH ----
(RETIRED)PCA(MG) 0.2 (RETIRED) Medication+Conc* Hydromorphone 0.2 mg/mL -BH 0.4 -BH (RETIRED) Incrementalordered (mg)* 6 -BH (RETIRED)
--
--
--
--
--
--
6 -LH
--
--
--
000336
Lockouttime (minutes) (RETIRED) Basalrate(mg/hr) (RETIRED) Attempts (RETIRED) Injections (incremental)* (RETIRED) Incrementaldose (mg)CALC (RETIRED) Bolusdose(mg)* (RETIRED) Basaldose(mg)* (RETIRED) TotalPCAdose(mg) CALC (RETIRED) TotalPCAvolume (mL)CALC Row Name Pain Assessment Pulse Resp BP SpO2 Pain Scale
0 -BH 55 -BH 13 -BH
0 -LH ---
----
----
----
5.2 -BH
--
--
--
--
0 -BH 0 -BH 5.2 -BH
----
----
----
----
26 mL -BH
--
--
--
--
12/15/09 2200 ---------
12/15/09 2240 -----0 -BH sleeping [2] ---
12/15/09 2256 -----6 -BH ---
12/15/09 2257 -----7 -BH ---
12/15/09 2300 93 -BH 14 -BH 126/75 mmHg -BH 98 % -BH Numeric (NRS) (0-10) -BH 7 -BH LLE -BH 0 - Awake, alert, normal response to auditory stimuli. -BH --
(RETIRED)PCA(MG) 0.2 (RETIRED) Medication+Conc* Hydromorphone 0.2 mg/mL -BH 0.4 -BH (RETIRED) Incrementalordered (mg)* 6 -BH (RETIRED) Lockouttime (minutes) 0 -BH (RETIRED)
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
000337
(mL)CALC
Row Name OTHER Pain score Pain location Sedation score 12/15/09 2300 12/15/09 2330 12/16/09 0000 12/16/09 0050
12/16/09 0145 7 -BH ---
7 -BH LLE -BH 0 - Awake, alert, normal response to auditory stimuli. -BH --
(RETIRED) Incrementalordered (mg)* (RETIRED) Lockouttime (minutes) (RETIRED) Basalrate(mg/hr) (RETIRED) Attempts (RETIRED) Injections (incremental)* (RETIRED) Incrementaldose (mg)CALC (RETIRED) Bolusdose(mg)* (RETIRED) Basaldose(mg)* (RETIRED) TotalPCAdose(mg) CALC (RETIRED) TotalPCAvolume (mL)CALC Pain Scale Row Name OTHER Pain score (RETIRED) Medication+Conc*
--
--0 - Awake, alert, normal response to auditory stimuli. -LH 0.2 Hydromorphone 0.2 mg/mL -LH 0.4 -LH
----
8 -BH ---
--
--
--
--
--
6 -LH
6 -BH
--
--
----
0 -LH ---
0 -BH 22 -BH 13 -BH
----
----
--
--
5.2 -BH
--
--
----
----
0 -BH 0 -BH 5.2 -BH
----
----
--
--
26 mL -BH
--
--
Numeric (NRS) (0-10) -BH 12/16/09 0200 8 -BH 0.2 Hydromorphone 0.2 mg/mL -BH 0.4 -BH
-12/16/09 0255 0 -BH sleeping --
-12/16/09 0329 8 -BH --
-12/16/09 0400 7 -BH 0.2 Hydromorphone 0.2 mg/mL -BH 0.4 -BH
-12/16/09 0425 0 -BH sleeping --
(RETIRED) Incrementalordered (mg)*
--
--
--
000338
(RETIRED) Lockouttime (minutes) (RETIRED) Basalrate(mg/hr) (RETIRED) Attempts (RETIRED) Injections (incremental)* (RETIRED) Incrementaldose (mg)CALC (RETIRED) Bolusdose(mg)* (RETIRED) Basaldose(mg)* (RETIRED) TotalPCAdose(mg) CALC (RETIRED) TotalPCAvolume (mL)CALC Pain Scale Row Name OTHER IVPB / Flush Medication IVPB / Flush Amount (mL) Pain score Pain location Row Name OTHER Pain score Pain location Sedation score
6 -BH
--
--
6 -BH
--
0 -BH 23 -BH 14 -BH
----
----
0 -BH 19 -BH 7 -BH
----
5.6 -BH
--
--
2.8 -BH
--
0 -BH 0 -BH 5.6 -BH
----
----
0 -BH 0 -BH 2.8 -BH
----
28 mL -BH
--
--
14 mL -BH
--
--
-12/16/09 0528 --9 -BH --
-12/16/09 0537 --9 -BH -12/16/09 0715 ----
12/16/09 0500 cefazolin -BH 50 -BH 7 -BH L hip -BH
Numeric (NRS) -(0-10) -BH 12/16/09 0600 12/16/09 0620 vancomycin -BH 200 -BH --12/16/09 0730 8 -MT L hip -MT S - Normal sleep, easy to arouse. -MT 0.2 Hydromorphone 0.2 mg/mL -MT 0.6 -MT --7 -BH -12/16/09 0800 --S - Normal sleep, easy to arouse. -MT 0.2 Hydromorphone 0.2 mg/mL -MT 0.6 -MT
12/16/09 0642 ----
12/16/09 0646 7 -BH ---
--
--
0.6 -VM (RETIRED) Incrementalordered (mg)* 6 -VM (RETIRED) Lockouttime (minutes) 0 -VM (RETIRED) Basalrate(mg/hr)
--
0.2 Hydromorphone 0.2 mg/mL -MT 0.6 -MT
--
6 -MT
6 -MT
6 -MT
--
0 -MT
0 -MT
0 -MT
000339
(RETIRED) Attempts (RETIRED) Injections (incremental)* (RETIRED) Incrementaldose (mg)CALC (RETIRED) Bolusdose(mg)* (RETIRED) Basaldose(mg)* (RETIRED) TotalPCAdose(mg) CALC (RETIRED) TotalPCAvolume (mL)CALC Pain Scale Row Name OTHER Pain score Pain location Sedation score
---
---
---
---
11 -MT 4 -MT
--
--
--
--
2.4 -MT
----
----
----
----
0 -MT 0 -MT 2.4 -MT
--
--
--
--
12 mL -MT
-12/16/09 0917 8 -MT L hip -MT --
-12/16/09 1005 7 -MT L hip -MT --
-12/16/09 1030 0 -MT -1 - Mildly drowsy but awake, slow response to auditory stimuli -MT
Numeric (NRS) (0-10) -MT 12/16/09 1200 ----
-12/16/09 1212 5 -MT L hip -MT 1 - Mildly drowsy but awake, slow response to auditory stimuli -MT --
--
--
--
(RETIRED) Incrementalordered (mg)* (RETIRED) Lockouttime (minutes) (RETIRED) Basalrate(mg/hr) (RETIRED) Attempts (RETIRED) Injections (incremental)* (RETIRED) Incrementaldose (mg)CALC (RETIRED) Bolusdose(mg)* (RETIRED)
--
--
--
--
--
--
--
6 -MT
--
----
----
----
0 -MT 0 -MT 0 -MT
----
--
--
--
0 -MT
--
---
---
---
0 -MT 0 -MT
---
000340
Basaldose(mg)* -(RETIRED) TotalPCAdose(mg) CALC -(RETIRED) TotalPCAvolume (mL)CALC Nods yes to Pain assessment pain;Grimacing, frowning -MT Numeric (NRS) Pain Scale (0-10) -MT Row Name OTHER IVPB / Flush Medication IVPB / Flush Amount (mL) Pain score Pain location Sedation score 12/16/09 1310 Cefazolin -MT 50 -MT ----
--
--
0 -MT
--
--
--
0 mL -MT
--
Nods yes to pain -MT Numeric (NRS) (0-10) -MT 12/16/09 1407 --7 -MT L hip -MT --
--
--
--
FACES (0-5) MT asleep 12/16/09 1600 --0 -MT -S - Normal sleep, easy to arouse. -MT
--
12/16/09 1642 --5 -MT l hips -MT 1 - Mildly drowsy but awake, slow response to auditory stimuli -MT --
Numeric (NRS) (0-10) -MT 12/16/09 1800 vancomycin KP 200 -KP --1 - Mildly drowsy but awake, slow response to auditory stimuli -MT 0.2 Hydromorphone 0.2 mg/mL -MT 0.6 -MT
--
--
(RETIRED) Incrementalordered (mg)* (RETIRED) Lockouttime (minutes) (RETIRED) Basalrate(mg/hr) (RETIRED) Attempts (RETIRED) Injections (incremental)* (RETIRED) Incrementaldose (mg)CALC (RETIRED) Bolusdose(mg)* (RETIRED) Basaldose(mg)* (RETIRED) TotalPCAdose(mg)
--
--
--
--
--
6 -MT
--
6 -MT
----
----
0 -MT 14 -MT 9 -MT
----
0 -MT 3 -MT 2 -MT
--
--
5.4 -MT
--
1.2 -MT
----
----
0 -MT 0 -MT 5.4 -MT
----
0 -MT 0 -MT 1.2 -MT
000341
CALC (RETIRED) TotalPCAvolume (mL)CALC Pain assessment Pain Scale
--
--
27 mL -MT
--
6 mL -MT
---
Nods yes to pain -MT Numeric (NRS) (0-10) -MT

12/16/09 1904
-FACES (0-5) MT asleep

12/16/09 1930
-Numeric (NRS) (0-10) -MT

12/16/09 1951
--12/16/09 2001 ------
Row Name OTHER IVPB / Flush Medication IVPB / Flush Amount (mL) Pain score Pain location Sedation score
12/16/09 1811
Vancomycin MT 200 -MT ----
------
--8 -KP L hip -KP 0 - Awake, alert, normal response to auditory stimuli. -KP --
--8 -KP L hip -KP --
--
(RETIRED) Incrementalordered (mg)* (RETIRED) Lockouttime (minutes) (RETIRED) Basalrate(mg/hr) (RETIRED) Attempts (RETIRED) Injections (incremental)* Pain assessment Pain Scale Row Name OTHER Pain score Pain location Sedation score (RETIRED) Attempts (RETIRED) Injections
--
--
--
--
--
--
--
6 -MT
--
--
--
----
0 -MT ---
----
----
-4 -KP 4 -KP
---
--12/16/09 2200 8 -KP L hip -KP --
12/16/09 2050 8 -KP L hip -KP 0 - Awake, alert, normal response to auditory stimuli. -KP ---
Nods yes to -pain -KP Numeric (NRS) Numeric (NRS) -(0-10) -KP (0-10) -KP 12/17/09 0000 12/17/09 0028 12/17/09 0159 6 -KP L Hip -KP 0 - Awake, alert, normal response to auditory stimuli. -KP -----7 -KP L hip -KP --
--
---
8 -KP 8 -KP
---
000342
Pain score Pain location SpO2 (RETIRED) O2 method Row Name Vital signs Temp Temp src Pulse BP Resp Pain Scale
8 -BH ---12/16/09 0530 -------
(0-10) -BH 7 -BH
-97 % -BH Room air -BH 12/16/09 0537 -------
0 -BH sleeping ---12/16/09 0620 -------
7 -BH L hip -BH --12/16/09 0646 -------
9 -BH ---12/16/09 0730 37.7 C (99.8 F) -MT Oral -MT 90 -MT 126/80 mmHg -MT 18 -MT Numeric (NRS) (0-10) -MT 8 -MT L hip -MT S - Normal sleep, easy to arouse. -MT 95 % -MT Room air -MT
----
9 -BH ---
7 -BH ---
7 -BH ---
SpO2 (RETIRED) O2 method Respiratory (RETIRED) Incentive spirometer TCDB INR/PTT/PLT Platelet Count Glucose Serum glucose Row Name Vital signs Temp Temp src BP Resp Pain Scale Pain score Pain location Pain
---
---
---
---
--
--
--
--
encouraged MT Completed MT --
--
--
--
--
154
--
--
--
129 12/16/09 0800 ---------
-12/16/09 0917 ----Numeric (NRS) (0-10) -MT 8 -MT L hip -MT Nods yes to pain;Grimacing,
-12/16/09 1005 ----Numeric (NRS) (0-10) -MT 7 -MT L hip -MT Nods yes to pain -MT
-12/16/09 1030 ----FACES (0-5) MT asleep 0 -MT ---
-12/16/09 1212 37.3 C (99.1 F) -MT Oral -MT 118/73 mmHg -MT 18 -MT Numeric (NRS) (0-10) -MT 5 -MT L hip -MT --
000343
assessment Sedation score
S - Normal sleep, easy to arouse. -MT
frowning -MT --
--
1 - Mildly drowsy but awake, slow response to auditory stimuli -MT --12/16/09 1800 ---------1 - Mildly drowsy but awake, slow response to auditory stimuli -MT ---
SpO2 (RETIRED) O2 method Row Name Vital signs Temp Temp src Pulse BP Resp Pain Scale
--12/16/09 1407 -----Numeric (NRS) (0-10) -MT 7 -MT L hip -MT Nods yes to pain -MT --
--12/16/09 1600 -- -MT sleeping ----FACES (0-5) MT asleep 0 -MT --S - Normal sleep, easy to arouse. -MT
--12/16/09 1642 36.7 C (98 F) -MT Oral -MT 80 -MT 95/57 mmHg MT 18 -MT Numeric (NRS) (0-10) -MT 5 -MT l hips -MT -1 - Mildly drowsy but awake, slow response to auditory stimuli -MT 96 % -MT Room air -MT
1 - Mildly drowsy but awake, slow response to auditory stimuli -MT 96 % -MT Room air -MT 12/16/09 1930 36.8 C (98.2 F) -KP Oral -KP 79 -KP 109/62 mmHg -KP 18 -KP Numeric (NRS) (0-10) -KP 8 -KP L hip -KP -0 - Awake, alert, normal response to auditory stimuli. -KP 98 % -KP Room air -KP
Pain score Pain location Pain assessment Sedation score
SpO2 (RETIRED) O2 method Respiratory (RETIRED) Incentive spirometer TCDB Row Name Vital signs Temp Temp src Pulse BP Resp Pain Scale
---
---
--
--
--
--
encouraged KP Completed KP 12/17/09 0159 -----Numeric (NRS) (0-10) -KP 7 -KP L hip -KP Nods yes to
-12/16/09 1951 -----Numeric (NRS) (0-10) -KP 8 -KP L hip -KP Nods yes to
-12/16/09 2050 ----18 -KP Numeric (NRS) (0-10) -KP 8 -KP L hip -KP --
-12/16/09 2200 -----Numeric (NRS) (0-10) -KP 8 -KP L hip -KP Nods yes to
-12/17/09 0000 37 C (98.6 F) -KP Oral -KP 77 -KP 113/67 mmHg KP 18 -KP Numeric (NRS) (0-10) -KP 6 -KP L Hip -KP --
Pain score Pain location Pain
000344
---Credit (mL) Foley 12/15/09 (RETIRED) Placement Date: 12/15/09 -PB Removal Date: 12/17/09 Properties Yellow -PB Yellow -BH -(RETIRED) Drainage color 150 ml -PB 100 ml -BH -(RETIRED) Amount Row Name 12/16/09 0600 12/16/09 1100 12/16/09 1310 IVPB / Flush Cefazolin -MT IVPB / Flush vancomycin -BH -Medication -50 -MT IVPB / Flush 200 -BH Amount (mL) Foley 12/15/09 (RETIRED) Placement Date: 12/15/09 -PB Removal Date: 12/17/09 Properties -Clear;Yellow -(RETIRED) MT Drainage color -700 ml -MT -(RETIRED) Amount Row Name 12/17/09 0500 12/17/09 0820 12/17/09 1145 D5 / 0.45% NaCl 1,000 mL with Potassium Chloride 20 mEq 20 mL/hr -BO -Rate (mL/hr) 20 mL/hr -KP 750 mL -KP 680 mL -BO -Credit (mL) 70 mL -BO -Amount (mL) 250 mL -KP Foley 12/15/09 (RETIRED) Placement Date: 12/15/09 -PB Removal Date: 12/17/09 Properties Clear;Yellow -Clear;Yellow (RETIRED) KP BO Drainage color 1400 ml -KP -900 ml -BO (RETIRED) Amount (Admission) Vital Signs Row Name 12/15/09 2313 Vital Signs 1905 -BH Arrival time HSD/PACU/OR Admitted BH from 1.854 m (6' Height 1") -BH Reported -BH Height type -- -BH Reason not post op weighed 99.791 kg (220 Weight lb) -BH Weight type Reported -BH -Pain score Extended Kg weight 99.791 Kg -BH 12/16/09 0050 -------8 -BH -12/16/09 0145 -------7 -BH --
1000 mL -BH
--
-BO Removal Time: 1145 -BO Clear;Yellow BH 1600 ml -BH 12/16/09 1800 vancomycin -KP 200 -KP Clear;Yellow BH 600 ml -BH 12/16/09 1811 Vancomycin MT 200 -MT
-BO Removal Time: 1145 -BO ---
-12/18/09 0500 20 mL/hr -KP 300 mL -KP 380 mL -KP
-12/18/09 0725 20 mL/hr -BO 140 mL -BO 48 mL -BO
-BO Removal Time: 1145 -BO ---
--
--
12/16/09 0200 -------8 -BH --
12/16/09 0255 -------0 -BH sleeping --
000345
Row Name Vital Signs Temp Temp src Pulse BP Resp Pain Scale Pain score
12/16/09 0329 ------8 -BH
12/16/09 0400 37.2 C (99 F) -BH Oral -BH 82 -BH 122/72 mmHg BH 14 -BH Numeric (NRS) (0-10) -BH 7 -BH -97 % -BH Room air -BH
12/16/09 0620
12/16/09 0425 ------0 -BH sleeping ---12/16/09 0646
12/16/09 0500 ------7 -BH L hip -BH --12/16/09 0730
12/16/09 0528 ------9 -BH ---12/16/09 0917
Pain location --SpO2 -(RETIRED) O2 method Row Name 12/16/09 0537 Vital Signs -Temp Temp src Pulse BP Resp Pain Scale ------
------7 -BH ---
------7 -BH ---
9 -BH Pain score Pain location --Pain assessment SpO2 (RETIRED) O2 method Row Name Vital Signs Weight Weight type Weight method Temp Temp src BP Resp Pain Scale --12/16/09 1005
37.7 C (99.8 F) -MT Oral -MT 90 -MT 126/80 mmHg MT 18 -MT Numeric (NRS) (0-10) -MT 8 -MT L hip -MT --
-----Numeric (NRS) (0-10) -MT 8 -MT L hip -MT Nods yes to pain;Grimacing, frowning -MT --12/16/09 1407
--12/16/09 1030
--12/16/09 1212
95 % -MT Room air -MT

12/16/09 1357
-------Numeric (NRS) (0-10) -MT 7 -MT L hip -MT Nods yes to pain -MT
-------FACES (0-5) MT asleep 0 -MT ---
---37.3 C (99.1 F) -MT Oral -MT 118/73 mmHg MT 18 -MT Numeric (NRS) (0-10) -MT 5 -MT L hip -MT --
95.89 kg (211 lb 6.4 oz) -MT Actual -MT Standing scale -MT ---------
-------Numeric (NRS) (0-10) -MT 7 -MT L hip -MT Nods yes to pain -MT
Pain score Pain location Pain
000346
assessment SpO2 (RETIRED) O2 method Row Name Vital Signs Temp Temp src Pulse BP Resp Pain Scale Pain score Pain location Pain assessment SpO2 (RETIRED) O2 method Row Name Vital Signs Temp Temp src Pulse BP Resp Pain Scale
--12/16/09 1600
--12/16/09 1642
96 % -MT Room air -MT

12/16/09 1930
--12/16/09 1951
--12/16/09 2050
-- -MT sleeping ----FACES (0-5) MT asleep 0 -MT ----12/16/09 2200 -----Numeric (NRS) (0-10) -KP 8 -KP L hip -KP Nods yes to pain -KP --12/17/09 0400 36.9 C (98.4 F) -KP Oral -KP 87 -KP 107/63 mmHg KP 16 -KP Numeric (NRS) (0-10) -KP 7 -KP
36.7 C (98 F) -MT Oral -MT 80 -MT 95/57 mmHg MT 18 -MT Numeric (NRS) (0-10) -MT 5 -MT l hips -MT -96 % -MT Room air -MT 12/17/09 0000 37 C (98.6 F) -KP Oral -KP 77 -KP 113/67 mmHg KP 18 -KP Numeric (NRS) (0-10) -KP 6 -KP L Hip -KP -98 % -KP Room air -KP 12/17/09 0409 -----Numeric (NRS) (0-10) -KP 7 -KP
36.8 C (98.2 F) -KP Oral -KP 79 -KP 109/62 mmHg KP 18 -KP Numeric (NRS) (0-10) -KP 8 -KP L hip -KP -98 % -KP Room air -KP 12/17/09 0159 -----Numeric (NRS) (0-10) -KP 7 -KP L hip -KP Nods yes to pain -KP --12/17/09 0500 -----
-----Numeric (NRS) (0-10) -KP 8 -KP L hip -KP Nods yes to pain -KP --12/17/09 0200 -----Numeric (NRS) (0-10) -KP 7 -KP L hip -KP Nods yes to pain -KP --12/17/09 0600 -----
----18 -KP Numeric (NRS) (0-10) -KP 8 -KP L hip -KP ---12/17/09 0300 -----Numeric (NRS) (0-10) -KP 6 -KP L hip -KP ---12/17/09 0820 37.7 C (99.8 F) -BO Oral -BO 83 -BO 107/66 mmHg -BO 16 -BO Numeric (NRS) (0-10) -BO 8 -BO
Pain score Pain location Pain assessment SpO2 (RETIRED) O2 method Row Name Vital Signs Temp Temp src Pulse BP Resp Pain Scale
--FACES (0-5) -KP Numeric (NRS) (0-10) -KP 0 -KP 6 -KP
Pain score
000347
(RETIRED) Ambulating (RETIRED) Transferring (RETIRED) Eating (RETIRED) Toileting
ed -BH Assistance Needed -BH Assistance Needed -BH Assistance Needed -BH Assistance Needed -BH
(RETIRED) (Admission) Risk Assessment Row Name Falls Risk History of falls Secondary diagnosis Ambulatory aid 12/15/09 2318 No -BH --12/15/09 2319 -Yes -BH None/bed rest/ wheel chair/ nurse -BH Yes -BH -12/16/09 0003 No -BH No -BH [3] None/bed rest/ wheel chair/ nurse -BH Yes -BH Normal/bed rest/ immobile -BH [4] Oriented to own ability -BH 20 -BH [5] None -BH No -BH 12/16/09 0730 No -MT No -MT None/bed rest/ wheel chair/ nurse -MT Yes -MT Normal/bed rest/ immobile -MT 12/16/09 1930 No -KP No -KP None/bed rest/ wheel chair/ nurse -KP Yes -KP Normal/bed rest/ immobile -KP
IV/Heparin lock Gait/transferring
---
Mental status
-----
-----
Total falls risk Sensory Sensory limitations Nutrition Risk (RETIRED) Current/anticipated nutrition support? Tube Feed; TPN; PPN (RETIRED) Persistent nausea/vomiting >or=3days (RETIRED) Persistent diarrhea >or=3days (RETIRED) New onset diabetes (RETIRED) Unintentional wt loss >or=10 lbs in 1 mo (RETIRED) Inadequate
Oriented to own Oriented to ability -MT own ability -KP 20 -MT 20 -KP -----
--
--
No -BH
--
--
--
--
No -BH
--
--
---
---
No -BH No -BH
---
---
--
--
No -BH
--
--
000348
intake>or=1 week (RETIRED) Difficulty swallowing DVT Risk Pt stay expected <36 hrs? Ambulatory for entire admission? Confined to bed > 3 days PTA? Hospitalized in last 2 mos? Surgery < 2 mos or this admit? Admit Dx infection or sepsis? Current Tx for cancer? Abuse Recently been threatened/injured? (RETIRED) Braden (RETIRED) Sensory perception (RETIRED) Moisture (RETIRED) Activity (RETIRED) Mobility (RETIRED) Nutrition
--
--
No -BH
--
--
--------
--------
No -BH No -BH No -BH No -BH No -BH No -BH No -BH
--------
--------
--
--
No -BH
--
--
------
-------
(RETIRED) Friction -and shear (RETIRED) Braden -total -(RETIRED) Pressure Ulcer Present? (RETIRED) Bleeding Risk -(RETIRED) Current bleeding risk? Row Name 12/17/09 0820 Falls Risk No -BO History of falls Yes -BO Secondary diagnosis Ambulatory aid Crutches/cane/ walker -BO IV/Heparin lock Yes -BO Gait/transferring Impaired -BO
---
No impairment - No impairment - No BH MT impairment KP Rarely moist Rarely moist Rarely moist BH MT KP Bedfast -BH Bedfast -MT Bedfast -KP Very limited Slightly limiteSlightly limited -MT BH d -KP Probably Probably Probably inadeqinadeqinadequate -BH uate -MT uate -KP Potential probl- Potential probl- Potential em -BH em -MT problem -KP 15 -BH 16 -MT 16 -KP No -BH No -MT No -KP
--
Yes -BH
--
--
12/17/09 1930
12/18/09 0725
No -KP Yes -KP Crutches/cane/ walker -KP Yes -KP Impaired -KP
No -BO Yes -BO Crutches/cane/ walker -BO Yes -BO Weak -BO
000349
Oriented to own ability -BO 70 -BO Total falls risk (RETIRED) Braden No impairment (RETIRED) BO Sensory perception Rarely moist (RETIRED) BO Moisture Bedfast -BO (RETIRED) Activity Mental status (RETIRED) Mobility (RETIRED) Nutrition (RETIRED) Friction and shear (RETIRED) Braden total (RETIRED) Pressure Ulcer Present? Slightly limited -BO Adequate -BO No apparent problem -BO 18 -BO No -BO
Oriented to own ability -KP 70 -KP No impairment KP Rarely moist KP Bedfast -KP Slightly limited -KP Adequate -KP No apparent problem -KP 18 -KP No -KP
Oriented to own ability -BO 60 -BO No impairment BO Rarely moist BO Walks occasionally -BO Slightly limited -BO Excellent -BO No apparent problem -BO 21 -BO No -BO
(RETIRED) (Admission) Cultural/Religious Row Name 12/16/09 0004 (RETIRED) Cultural/Religious Protestant -BH (RETIRED) Religious preferences none -BH (RETIRED) Cultural/religious practices none -BH (RETIRED) Cultural food preferences (Admission) Vital Signs (SS) Row Name 12/15/09 0723 Vital Signs 0530 -GV Arrival time 0723 -GV Time (vital signs) 1.854 m (6' Height 1") -GV Actual -GV Height type 97.387 kg (214 Weight lb 11.2 oz) -GV Weight type Actual -GV 37.2 C (99 Temp F) -GV 37.2 C -GV Temp (Celsius) 68 -GV Pulse 130/85 mmHg BP 12/15/09 0945 ----------12/15/09 1541 ------36 C (96.8 F) -PB -83 -PB ! 156/103 mmHg 12/15/09 1545 --------72 -PB ! 159/91 mmHg 12/15/09 1600 ------36.1 C (97 F) -PB -79 -PB ! 166/99
000350
Row Name Vital Signs Arrival time Height Height type Reason not weighed Weight Weight type Temp Pulse BP Resp Pain Scale Pain score
12/15/09 2240 ------------
12/15/09 2256 ------------
12/15/09 2257 -----------7 -BH ---12/16/09 0200 8 -BH 12/16/09 0500 -----7 -BH L hip -BH -12/16/09 0730 37.7 C (99.8 F) -MT 90 -MT 126/80 mmHg MT 18 -MT Numeric (NRS) (0-10) -MT 8 -MT
12/15/09 2300 ------37.8 C (100 F) -BH 93 -BH 126/75 mmHg BH 14 -BH Numeric (NRS) (0-10) -BH 7 -BH LLE -BH 98 % -BH -12/16/09 0255 0 -BH sleeping 12/16/09 0528 -----9 -BH --12/16/09 0917 ----Numeric (NRS) (0-10) -MT 8 -MT
12/15/09 2313 1905 -BH 1.854 m (6' 1") -BH Reported -BH -- -BH post op 99.791 kg (220 lb) -BH Reported -BH --------none -BH 12/16/09 0329 8 -BH 12/16/09 0537 -----9 -BH --12/16/09 1005 ----Numeric (NRS) (0-10) -MT 7 -MT
0 -BH 6 -BH sleeping [2] -Pain location ---SpO2 (RETIRED) Pain not related to this admit --(RETIRED) Location Row Name 12/16/09 0050 12/16/09 0145 Vital Signs 8 -BH 7 -BH Pain score Row Name Vital Signs Temp Pulse BP Resp Pain Scale Pain score Pain location SpO2 Row Name Vital Signs Temp Pulse BP Resp Pain Scale 12/16/09 0400 37.2 C (99 F) -BH 82 -BH 122/72 mmHg BH 14 -BH Numeric (NRS) (0-10) -BH 7 -BH -97 % -BH 12/16/09 0620 -----7 -BH 12/16/09 0425 -----0 -BH sleeping --12/16/09 0646 -----7 -BH
Pain score
000351
Pain location Pain assessment SpO2 Row Name Vital Signs Weight Weight type Temp BP Resp Pain Scale Pain score Pain location Pain assessment SpO2 Row Name Vital Signs Temp Pulse BP Resp Pain Scale
---12/16/09 1030 -----FACES (0-5) MT asleep 0 -MT ---12/16/09 1642 36.7 C (98 F) -MT 80 -MT 95/57 mmHg MT 18 -MT Numeric (NRS) (0-10) -MT 5 -MT l hips -MT -96 % -MT 12/17/09 0000 37 C (98.6 F) -KP 77 -KP 113/67 mmHg KP 18 -KP Numeric (NRS) (0-10) -KP 6 -KP L Hip -KP -98 % -KP
---12/16/09 1212 --37.3 C (99.1 F) -MT 118/73 mmHg MT 18 -MT Numeric (NRS) (0-10) -MT 5 -MT L hip -MT -96 % -MT 12/16/09 1930 36.8 C (98.2 F) -KP 79 -KP 109/62 mmHg KP 18 -KP Numeric (NRS) (0-10) -KP 8 -KP L hip -KP -98 % -KP 12/17/09 0159 ----Numeric (NRS) (0-10) -KP 7 -KP L hip -KP Nods yes to pain -KP --
L hip -MT -95 % -MT 12/16/09 1357 95.89 kg (211 lb 6.4 oz) -MT Actual -MT --------12/16/09 1951 ----Numeric (NRS) (0-10) -KP 8 -KP L hip -KP Nods yes to pain -KP -12/17/09 0200 ----Numeric (NRS) (0-10) -KP 7 -KP L hip -KP Nods yes to pain -KP --
L hip -MT Nods yes to pain;Grimacing, frowning -MT -12/16/09 1407 -----Numeric (NRS) (0-10) -MT 7 -MT L hip -MT Nods yes to pain -MT -12/16/09 2050 ---18 -KP Numeric (NRS) (0-10) -KP 8 -KP L hip -KP --12/17/09 0300 ----Numeric (NRS) (0-10) -KP 6 -KP L hip -KP ---
L hip -MT Nods yes to pain -MT -12/16/09 1600 ---- -MT sleeping --FACES (0-5) MT asleep 0 -MT ---12/16/09 2200 ----Numeric (NRS) (0-10) -KP 8 -KP L hip -KP Nods yes to pain -KP -12/17/09 0400 36.9 C (98.4 F) -KP 87 -KP 107/63 mmHg -KP 16 -KP Numeric (NRS) (0-10) -KP 7 -KP L hip -KP -99 % -KP
Pain score Pain location Pain assessment SpO2 Row Name Vital Signs Temp Pulse BP Resp Pain Scale Pain score Pain location Pain assessment SpO2
000352
assist 30 degrees -PB (RETIRED) HOB -Suction available -Siderails -Bed locked -ID band -Allergy band (RETIRED) Precautions -(RETIRED) Immunocompromised (RETIRED) Radiation --(RETIRED) Aspiration -Carotid Precautions -(RETIRED) Fall -(RETIRED) Flight -(RETIRED) Police hold - adult -Police hold - child -(RETIRED) Protective Custody adult -Protective custody child -(RETIRED) Seizure -Sternal Precautions -(RETIRED) Suicide (RETIRED) Anti-embolism (RETIRED) Right leg -(RETIRED) Braden (RETIRED) Pressure No -JV Ulcer Present?
30 degrees -BH Yes -BH x3 -BH Yes -BH On -BH On -BH No -BH No -BH No -BH No -BH Yes -BH No -BH No -BH No -BH No -BH
----On -BH On -BH ----------
----------------
----------------
No -BH No -BH No -BH No -BH ALP -BH No -BH
-------
-------
------12/16/09 1358
Row Name 12/16/09 0003 12/16/09 0730 12/16/09 0900 12/16/09 1300 Surgical incision L Hip 12/15/09 (RETIRED) (RETIRED) Location: L Hip -PB Placement Date: 12/15/09 -PB Properties ----- -MT (RETIRED) Action assessed -dressing on --(RETIRED) MT Size/shape -Dry -MT --(RETIRED) Appearance Dry and intact --(RETIRED) Dressing --MT 0 ml -MT --(RETIRED) Drainage -amt Falls Risk No -BH No -MT --History of falls No -MT --Secondary diagnosis No -BH [3] None/bed rest/ None/bed rest/ --Ambulatory aid wheel chair/ wheel chair/ nurse -BH nurse -MT Yes -BH Yes -MT --IV/Heparin lock
------
-----
000353
Gait/transferring
Mental status
Total falls risk (RETIRED) Diet -(RETIRED) Type -NPO -Meal and percent taken -(RETIRED) Assistance (RETIRED) Nursing Care -Therapeutic time -(RETIRED) Bath (RETIRED) Bath assist Oral care ----
Normal/bed rest/ immobile -BH [4] Oriented to own ability -BH 20 -BH [5]
Normal/bed rest/ immobile -MT Oriented to own ability -MT 20 -MT -----
--
--
--
--Meal -MT No -MT Reg 45 -MT Part -MT
--Meal -MT No -MT Reg 50 -MT Part -MT
-------
Completed -MT ------Standard Acute Care (Hill Rom Advanta) -MT Bedpan -MT Per patient comfort -MT Yes -MT x3 -MT Yes -MT On -MT On -MT Yes -MT Yes -MT ALP -MT ---------------
-------------------
-Bed bath MT Part -MT With assistance-MT Completed MT --------------
Foley care (RETIRED) Bed type
----
(RETIRED) Toileting (RETIRED) HOB
-Suction available -Siderails -Bed locked -ID band -Allergy band (RETIRED) Precautions -(RETIRED) Fall (RETIRED) Spinal Precautions -(RETIRED) None (RETIRED) Anti-embolism (RETIRED) Right leg -(RETIRED) Physical Restrictions -(RETIRED) Left leg --
Hip Restriction
Weight bearing -as tolerated MT Left Posterior -(specify degree in comments) MT abductor pillow-MT between legs --
(RETIRED) Ortho device -(RETIRED) Type --
--
--
(RETIRED) Location
--
--
--
000354
Pulse Resp BP Pain Scale Pain score Pain location Sedation score
----9 -BH ---
----7 -BH ---
----7 -BH ---
90 -MT 18 -MT 126/80 mmHg MT Numeric (NRS) (0-10) -MT 8 -MT L hip -MT S - Normal sleep, easy to arouse. -MT
------S - Normal sleep, easy to arouse. -MT ---
-SpO2 Respiratory -(RETIRED) Incentive spirometer -TCDB -(RETIRED) O2 method (RETIRED) Positioning -Position -(RETIRED) HOB Row Name 12/16/09 0917 Vital Signs -Temp Temp src Resp BP Pain Scale Pain score Pain location Pain assessment Sedation score ---Numeric (NRS) (0-10) -MT 8 -MT L hip -MT Nods yes to pain;Grimacing, frowning -MT --
---
---
95 % -MT encouraged -MT
---
---
Completed -MT Room air -MT
---
--12/16/09 1005 ----Numeric (NRS) (0-10) -MT 7 -MT L hip -MT Nods yes to pain -MT --
--12/16/09 1030 ----FACES (0-5) MT asleep 0 -MT --1 - Mildly drowsy but awake, slow response to auditory stimuli -MT --12/16/09 1800
Supine -MT Per patient comfort -MT 12/16/09 1212 37.3 C (99.1 F) -MT Oral -MT 18 -MT 118/73 mmHg MT Numeric (NRS) (0-10) -MT 5 -MT L hip -MT -1 - Mildly drowsy but awake, slow response to auditory stimuli -MT 96 % -MT Room air -MT
12/16/09 1930
--12/16/09 1407 ----Numeric (NRS) (0-10) -MT 7 -MT L hip -MT Nods yes to pain -MT --
SpO2 Respiratory (RETIRED) O2 method Row Name Vital Signs Temp Temp src Pulse
--12/16/09 1600
--12/16/09 1642
--12/16/09 1951
-- -MT sleeping ---
36.7 C (98 F) -MT Oral -MT 80 -MT
----
36.8 C (98.2 F) -KP Oral -KP 79 -KP
----
000355
Resp BP Pain Scale
--FACES (0-5) MT asleep 0 -MT --S - Normal sleep, easy to arouse. -MT
18 -MT 95/57 mmHg MT Numeric (NRS) (0-10) -MT 5 -MT l hips -MT -1 - Mildly drowsy but awake, slow response to auditory stimuli -MT 96 % -MT --
----
18 -KP 109/62 mmHg KP Numeric (NRS) (0-10) -KP 8 -KP L hip -KP -0 - Awake, alert, normal response to auditory stimuli. -KP 98 % -KP encouraged -KP
--Numeric (NRS) (0-10) -KP 8 -KP L hip -KP Nods yes to pain -KP --
---1 - Mildly drowsy but awake, slow response to auditory stimuli -MT ---
-SpO2 Respiratory -(RETIRED) Incentive spirometer -TCDB -(RETIRED) O2 method (RETIRED) Positioning -Position -(RETIRED) HOB Row Name 12/16/09 2050 Vital Signs -Temp Temp src Pulse Resp BP Pain Scale --18 -KP -Numeric (NRS) (0-10) -KP 8 -KP L hip -KP -0 - Awake, alert, normal response to auditory stimuli. -KP --12/17/09 0300
---
-Room air -MT
---
Completed -KP Room air -KP
---
--12/16/09 2200 -----Numeric (NRS) (0-10) -KP 8 -KP L hip -KP Nods yes to pain -KP --
--12/17/09 0000 37 C (98.6 F) -KP Oral -KP 77 -KP 18 -KP 113/67 mmHg KP Numeric (NRS) (0-10) -KP 6 -KP L Hip -KP -0 - Awake, alert, normal response to auditory stimuli. -KP 98 % -KP Room air -KP
12/17/09 0409
Self -KP Per patient comfort -KP 12/17/09 0159 -----Numeric (NRS) (0-10) -KP 7 -KP L hip -KP Nods yes to pain -KP --
Pain score Pain location Pain assessment Sedation score SpO2 Respiratory (RETIRED) O2 method Row Name Vital Signs Temp
--12/17/09 0400
--12/17/09 0500
--12/17/09 0600
---
36.9 C (98.4 F) -KP Oral -KP
---
---
---
000356
Basalrate(mg/hr) (RETIRED) Attempts (RETIRED) Injections (incremental)* (RETIRED) Incrementaldose (mg)CALC (RETIRED) Bolusdose(mg)* (RETIRED) Basaldose(mg)* (RETIRED) TotalPCAdose(mg) CALC (RETIRED) TotalPCAvolume (mL)CALC Row Name Pain Assessment Pain score Sedation score
24 -BH 13 -BH
---
---
---
---
5.2 -BH
--
--
--
--
0 -BH 0 -BH 5.2 -BH
----
----
----
----
26 mL -BH
--
--
--
--
12/15/09 2330 -0 - Awake, alert, normal response to auditory stimuli. -LH
12/16/09 0000 ---
12/16/09 0050 8 -BH --
12/16/09 0145 7 -BH --
12/16/09 0200 8 -BH --
(RETIRED)PCA(MG) 0.2 (RETIRED) Medication+Conc* Hydromorphone 0.2 mg/mL -LH 0.4 -LH (RETIRED) Incrementalordered (mg)* 6 -LH (RETIRED) Lockouttime (minutes) 0 -LH (RETIRED) Basalrate(mg/hr) -(RETIRED) Attempts -(RETIRED) Injections (incremental)* -(RETIRED) Incrementaldose (mg)CALC -(RETIRED) Bolusdose(mg)* -(RETIRED) Basaldose(mg)* -(RETIRED) TotalPCAdose(mg)
--
--
--
--
6 -BH
--
--
6 -BH
0 -BH 22 -BH 13 -BH
----
----
0 -BH 23 -BH 14 -BH
5.2 -BH
--
--
5.6 -BH
0 -BH 0 -BH 5.2 -BH
----
----
0 -BH 0 -BH 5.6 -BH
000357
CALC (RETIRED) TotalPCAvolume (mL)CALC Row Name Pain Assessment Pulse Resp BP SpO2 Pain Scale Pain score
--
26 mL -BH
--
--
28 mL -BH
12/16/09 0255 -----0 -BH sleeping --
12/16/09 0329 -----8 -BH ---
12/16/09 0400 82 -BH 14 -BH 122/72 mmHg BH 97 % -BH Numeric (NRS) (0-10) -BH 7 -BH -0.2 Hydromorphone 0.2 mg/mL -BH 0.4 -BH
12/16/09 0425 -----0 -BH sleeping ---
12/16/09 0500 -----7 -BH L hip -BH --
Pain location (RETIRED)PCA(MG) -(RETIRED) Medication+Conc*
(RETIRED) Incrementalordered (mg)* (RETIRED) Lockouttime (minutes) (RETIRED) Basalrate(mg/hr) (RETIRED) Attempts (RETIRED) Injections (incremental)* (RETIRED) Incrementaldose (mg)CALC (RETIRED) Bolusdose(mg)* (RETIRED) Basaldose(mg)* (RETIRED) TotalPCAdose(mg) CALC (RETIRED) TotalPCAvolume (mL)CALC
--
--
--
--
--
--
6 -BH
--
--
----
----
0 -BH 19 -BH 7 -BH
----
----
--
--
2.8 -BH
--
--
----
----
0 -BH 0 -BH 2.8 -BH
----
----
--
--
14 mL -BH
--
--
Row Name 12/16/09 0528 Pain Assessment 9 -BH Pain score (RETIRED)PCA(MG) -(RETIRED)
12/16/09 0537 9 -BH --
12/16/09 0620 7 -BH --
12/16/09 0642 -0.6 -VM
12/16/09 0646 7 -BH --
000358
Incrementalordered (mg)* -(RETIRED) Lockouttime (minutes) -(RETIRED) Basalrate(mg/hr) Row Name Pain Assessment Pulse Resp BP SpO2 Pain Scale Pain score Pain location Pain assessment Sedation score 12/16/09 0715 ----------
--
--
6 -VM
--
--
--
0 -VM
-12/16/09 1005 ----Numeric (NRS) (0-10) -MT 7 -MT L hip -MT Nods yes to pain -MT --
12/16/09 0730 90 -MT 18 -MT 126/80 mmHg MT 95 % -MT Numeric (NRS) (0-10) -MT 8 -MT L hip -MT -S - Normal sleep, easy to arouse. -MT 0.2 Hydromorphone 0.2 mg/mL -MT 0.6 -MT
12/16/09 0800 --------S - Normal sleep, easy to arouse. -MT 0.2 Hydromorphone 0.2 mg/mL -MT 0.6 -MT
12/16/09 0917 ----Numeric (NRS) (0-10) -MT 8 -MT L hip -MT Nods yes to pain;Grimacing, frowning -MT --
(RETIRED)PCA(MG) 0.2 (RETIRED) Medication+Conc* Hydromorphone 0.2 mg/mL -MT 0.6 -MT (RETIRED) Incrementalordered (mg)* 6 -MT (RETIRED) Lockouttime (minutes) 0 -MT (RETIRED) Basalrate(mg/hr) -(RETIRED) Attempts -(RETIRED) Injections (incremental)* -(RETIRED) Incrementaldose (mg)CALC -(RETIRED) Bolusdose(mg)* -(RETIRED) Basaldose(mg)* -(RETIRED) TotalPCAdose(mg) CALC
--
--
--
--
6 -MT
6 -MT
--
--
0 -MT ---
0 -MT 11 -MT 4 -MT
----
----
--
2.4 -MT
--
--
----
0 -MT 0 -MT 2.4 -MT
----
----
000359
(RETIRED) TotalPCAvolume (mL)CALC

Row Name Pain Assessment Resp BP
--
--
12 mL -MT
--
--
12/16/09 1030
12/16/09 1200
12/16/09 1212
12/16/09 1407
12/16/09 1600 ---FACES (0-5) -MT asleep 0 -MT --S - Normal sleep, easy to arouse. -MT 0.2 Hydromorphone 0.2 mg/mL -MT 0.6 -MT
---FACES (0-5) MT asleep 0 -MT --1 - Mildly drowsy but awake, slow response to auditory stimuli -MT
---------
SpO2 Pain Scale
18 -MT 118/73 mmHg MT 96 % -MT Numeric (NRS) (0-10) -MT 5 -MT L hip -MT -1 - Mildly drowsy but awake, slow response to auditory stimuli -MT --
---Numeric (NRS) (0-10) -MT 7 -MT L hip -MT Nods yes to pain -MT --
(RETIRED)PCA(MG) -(RETIRED) Medication+Conc*
(RETIRED) Incrementalordered (mg)* (RETIRED) Lockouttime (minutes) (RETIRED) Basalrate(mg/hr) (RETIRED) Attempts (RETIRED) Injections (incremental)* (RETIRED) Incrementaldose (mg)CALC (RETIRED) Bolusdose(mg)* (RETIRED) Basaldose(mg)* (RETIRED) TotalPCAdose(mg) CALC (RETIRED) TotalPCAvolume (mL)CALC
Row Name
--
--
--
--
--
6 -MT
--
--
6 -MT
----
0 -MT 0 -MT 0 -MT
----
----
0 -MT 14 -MT 9 -MT
--
0 -MT
--
--
5.4 -MT
----
0 -MT 0 -MT 0 -MT
----
----
0 -MT 0 -MT 5.4 -MT
--
0 mL -MT
--
--
27 mL -MT
12/16/09 1642
12/16/09 1800
12/16/09 1904
12/16/09 1930
12/16/09 1951
000360
Pain Assessment Pulse Resp BP SpO2 Pain Scale Pain score Pain location Pain assessment Sedation score
80 -MT 18 -MT 95/57 mmHg MT 96 % -MT Numeric (NRS) (0-10) -MT 5 -MT l hips -MT -1 - Mildly drowsy but awake, slow response to auditory stimuli -MT
--------1 - Mildly drowsy but awake, slow response to auditory stimuli -MT 0.2 Hydromorphone 0.2 mg/mL -MT 0.6 -MT
----------
79 -KP 18 -KP 109/62 mmHg KP 98 % -KP Numeric (NRS) (0-10) -KP 8 -KP L hip -KP -0 - Awake, alert, normal response to auditory stimuli. -KP
----Numeric (NRS) (0-10) -KP 8 -KP L hip -KP Nods yes to pain -KP --
-(RETIRED) Incrementalordered (mg)* -(RETIRED) Lockouttime (minutes) -(RETIRED) Basalrate(mg/hr) -(RETIRED) Attempts -(RETIRED) Injections (incremental)* -(RETIRED) Incrementaldose (mg)CALC -(RETIRED) Bolusdose(mg)* -(RETIRED) Basaldose(mg)* -(RETIRED) TotalPCAdose(mg) CALC -(RETIRED) TotalPCAvolume (mL)CALC Row Name 12/16/09 2001 Pain Assessment -Pulse -Resp -BP
--
--
--
--
6 -MT
6 -MT
--
--
0 -MT 3 -MT 2 -MT
0 -MT ---
----
----
1.2 -MT
--
--
--
0 -MT 0 -MT 1.2 -MT
----
----
----
6 mL -MT
--
--
--
12/16/09 2050 -18 -KP --
12/16/09 2200 ----
12/17/09 0000 77 -KP 18 -KP 113/67 mmHg KP
12/17/09 0028 ----
000361
(incremental) * -Pain assessment Numeric (NRS) Pain Scale (0-10) -KP

Row Name OTHER Pain score Pain location Sedation score 12/17/09 0200
Nods yes to pain -KP Numeric (NRS) (0-10) -KP

12/17/09 0300
-Numeric (NRS) (0-10) -KP

12/17/09 0400
---
12/17/09 0409
Nods yes to pain -KP Numeric (NRS) (0-10) -KP 12/17/09 0500 0 -KP -S - Normal sleep, easy to arouse. -KP ---
7 -KP L hip -KP --
6 -KP L hip -KP --
7 -KP L hip -KP 0 - Awake, alert, normal response to auditory stimuli. -KP 22 -KP 14 -KP
7 -KP L hip -KP --
(RETIRED) Attempts (RETIRED) Injections (incremental) * Pain assessment Pain Scale Row Name OTHER Pain score Pain location Sedation score
---
---
---
Nods yes to pain -KP Numeric (NRS) (0-10) -KP
-Numeric (NRS) (0-10) -KP
-Numeric (NRS) (0-10) -KP 12/17/09 0820 8 -BO L hip -BO 1 - Mildly drowsy but awake, slow response to auditory stimuli -BO 0.2 Hydromorphone 0.2 mg/mL -BO 0.6 -BO
Nods yes to pain -KP Numeric (NRS) (0-10) -KP 12/17/09 0840 ----
-FACES (0-5) KP 12/17/09 0955 7 -BO L hip -BO --
12/17/09 0600 6 -KP L hip -KP --
12/17/09 0655 ----
--
--
(RETIRED) Incrementalordered (mg)* (RETIRED) Lockouttime (minutes) (RETIRED) Basalrate(mg/hr) (RETIRED) Attempts (RETIRED) Injections (incremental)* Pain assessment
--
--
0.2 Hydromorphone 0.2 mg/mL -BO 0.6 -BO
--
--
--
--
6 -BO
6 -BO
--
----
-7 -KP 6 -KP
0 -BO ---
0 -BO ---
----
Nods yes to pain -KP
--
--
--
--
000362
Pain Scale
Numeric (NRS) (0-10) -KP 12/17/09 1000 --1 - Mildly drowsy but awake, slow response to auditory stimuli -BO 0.2 Hydromorphone 0.2 mg/mL -BO 0.6 -BO
--
Numeric (NRS) (0-10) -BO 12/17/09 1400 5 -BO L hip -BO --
--
12/17/09 1200 0 -OS -0 - Awake, alert, normal response to auditory stimuli. -OS
12/17/09 1505 --1 - Mildly drowsy but awake, slow response to auditory stimuli -BO 0.2 Hydromorphone 0.2 mg/mL -BO 0.4 -BO
Numeric (NRS) (0-10) -BO 12/17/09 1555 5 -BO L hip -BO 1 - Mildly drowsy but awake, slow response to auditory stimuli -BO --
--
(RETIRED) Incrementalordered (mg)* (RETIRED) Lockouttime (minutes) (RETIRED) Basalrate(mg/hr) (RETIRED) Attempts (RETIRED) Injections (incremental)* (RETIRED) Incrementaldose (mg)CALC (RETIRED) Bolusdose(mg)* (RETIRED) Basaldose(mg)* (RETIRED) TotalPCAdose(mg) CALC (RETIRED) TotalPCAvolume (mL)CALC Pain Scale
--
--
6 -BO
--
6 -BO
10 -BO
--
0 -BO 16 -BO 12 -BO
----
0 -BO 7 -BO 5 -BO
0 -BO ---
----
7.2 -BO
--
3 -BO
--
--
0 -BO 0 -BO 7.2 -BO
----
0 -BO 0 -BO 3 -BO
----
----
36 mL -BO
--
15 mL -BO
--
--
--
Numeric (NRS) (0-10) -OS

12/17/09 1800

12/17/09 1900
--
12/17/09 1700
12/17/09 1930
Numeric (NRS) (0-10) -BO 12/17/09 2000 ----
5 -BO L hip -BO --
5 -BO L hip -BO 0 - Awake, alert, normal response to auditory
5 -BO L hip -BO 1 - Mildly drowsy but awake, slow response
6 -KP L hip -KP 0 - Awake, alert, normal response to auditory
000363
assessment Sedation score SpO2 (RETIRED) O2 method Row Name Vital signs Temp Temp src Pulse BP Resp Pain Scale Pain score Pain location Pain assessment Sedation score
pain -KP --
0 - Awake, alert, normal response to auditory stimuli. -KP --12/17/09 0300 -----Numeric (NRS) (0-10) -KP 6 -KP L hip -KP ---
pain -KP --
--12/17/09 0400 36.9 C (98.4 F) -KP Oral -KP 87 -KP 107/63 mmHg KP 16 -KP Numeric (NRS) (0-10) -KP 7 -KP L hip -KP -0 - Awake, alert, normal response to auditory stimuli. -KP 99 % -KP Room air -KP 12/17/09 0820 37.7 C (99.8 F) -BO Oral -BO 83 -BO 107/66 mmHg BO 16 -BO Numeric (NRS) (0-10) -BO 8 -BO L hip -BO -1 - Mildly drowsy but awake, slow response to auditory stimuli -BO 99 % -BO Room air -BO
0 - Awake, alert, normal response to auditory stimuli. -KP 98 % -KP Room air -KP 12/17/09 0409 -----Numeric (NRS) (0-10) -KP 7 -KP L hip -KP Nods yes to pain -KP --
pain -KP --
--12/17/09 0500 -----FACES (0-5) KP 0 -KP --S - Normal sleep, easy to arouse. -KP --12/17/09 1000 ---------1 - Mildly drowsy but awake, slow response to auditory stimuli -BO ---
SpO2 (RETIRED) O2 method Row Name Vital signs Temp Temp src Pulse BP Resp Pain Scale Pain score Pain location Pain assessment Sedation score
--12/17/09 0615 -----------
--12/17/09 0955 -----Numeric (NRS) (0-10) -BO 7 -BO L hip -BO ---
SpO2 (RETIRED) O2 method Respiratory
---
---
---
000364
(RETIRED) Incentive spirometer TCDB INR/PTT/PLT Platelet Count Glucose Serum glucose Row Name Vital signs Temp Temp src Pulse BP Resp Pain Scale
--
--
educated -BO
--
--
---
-134
Completed -BO --
---
---
-12/17/09 1200 36.8 C (98.2 F) -OS Oral -OS 84 -OS 102/63 mmHg OS 16 -OS Numeric (NRS) (0-10) -OS 0 -OS -0 - Awake, alert, normal response to auditory stimuli. -OS 98 % -OS Room air -OS 12/17/09 1800 -----Numeric (NRS) (0-10) -BO 5 -BO L hip -BO -0 - Awake, alert, normal response to auditory stimuli. -BO
119 12/17/09 1400 -----Numeric (NRS) (0-10) -BO 5 -BO L hip -BO --
-12/17/09 1505 -------
-12/17/09 1555 36.9 C (98.4 F) -BO Oral -BO 79 -BO 105/65 mmHg BO 15 -BO Numeric (NRS) (0-10) -BO 5 -BO L hip -BO 1 - Mildly drowsy but awake, slow response to auditory stimuli -BO 98 % -BO Room air -BO 12/17/09 2126 -----Numeric (NRS) (0-10) -KP 6 -KP L hip -KP Nods yes to pain -KP --
-12/17/09 1700 -----Numeric (NRS) (0-10) -BO 5 -BO L hip -BO --
SpO2 (RETIRED) O2 method Row Name Vital signs Temp Temp src Pulse BP Resp Pain Scale
--12/17/09 1900 -----Numeric (NRS) (0-10) -BO 5 -BO L hip -BO -1 - Mildly drowsy but awake, slow response to auditory stimuli -BO ---
--1 - Mildly drowsy but awake, slow response to auditory stimuli -BO --12/17/09 1930 36.7 C (98.1 F) -KP Oral -KP 87 -KP 134/77 mmHg KP 16 -KP Numeric (NRS) (0-10) -KP 6 -KP L hip -KP -0 - Awake, alert, normal response to auditory stimuli. -KP
--12/18/09 0000 37 C (98.6 F) -KP Oral -KP 85 -KP 110/72 mmHg -KP 16 -KP Numeric (NRS) (0-10) -KP 6 -KP L hip -KP -0 - Awake, alert, normal response to auditory stimuli. -KP 100 % -KP Room air -KP
SpO2 (RETIRED)
---
100 % -KP Room air -KP
---
000365
Pain location Pain assessment SpO2 (RETIRED) O2 method Row Name Vital Signs Temp Temp src Pulse BP Resp Pain Scale Pain score Pain location SpO2 (RETIRED) O2 method Row Name Vital Signs Temp Temp src Pulse BP Resp Pain Scale
L hip -KP -99 % -KP Room air -KP

12/17/09 0955
L hip -KP Nods yes to pain -KP --12/17/09 1200
----12/17/09 1400
L hip -KP Nods yes to pain -KP --12/17/09 1555
L hip -BO -99 % -BO Room air -BO

12/17/09 1700
-----Numeric (NRS) (0-10) -BO 7 -BO L hip -BO --12/17/09 1800 -----Numeric (NRS) (0-10) -BO 5 -BO L hip -BO ---12/18/09 0430 37.2 C (99 F) -KP Oral -KP 84 -KP 111/63 mmHg KP 16 -KP Numeric (NRS) (0-10) -KP 6 -KP
36.8 C (98.2 F) -OS Oral -OS 84 -OS 102/63 mmHg OS 16 -OS Numeric (NRS) (0-10) -OS 0 -OS -98 % -OS Room air -OS 12/17/09 1900 -----Numeric (NRS) (0-10) -BO 5 -BO L hip -BO ---12/18/09 0725 36.9 C (98.4 F) -BO Oral -BO 90 -BO 119/69 mmHg BO 16 -BO Numeric (NRS) (0-10) -BO 7 -BO
-----Numeric (NRS) (0-10) -BO 5 -BO L hip -BO --12/17/09 1930 36.7 C (98.1 F) -KP Oral -KP 87 -KP 134/77 mmHg KP 16 -KP Numeric (NRS) (0-10) -KP 6 -KP L hip -KP -100 % -KP Room air -KP 12/18/09 0745 -----Numeric (NRS) (0-10) -BO 7 -BO
36.9 C (98.4 F) -BO Oral -BO 79 -BO 105/65 mmHg BO 15 -BO Numeric (NRS) (0-10) -BO 5 -BO L hip -BO 98 % -BO Room air -BO 12/17/09 2126 -----Numeric (NRS) (0-10) -KP 6 -KP L hip -KP Nods yes to pain -KP --12/18/09 0815 -----Numeric (NRS) (0-10) -BO 7 -BO
-----Numeric (NRS) (0-10) -BO 5 -BO L hip -BO --12/18/09 0000 37 C (98.6 F) -KP Oral -KP 85 -KP 110/72 mmHg -KP 16 -KP Numeric (NRS) (0-10) -KP 6 -KP L hip -KP -100 % -KP Room air -KP 12/18/09 0835 -----Numeric (NRS) (0-10) -BO 6 -BO
Pain score Pain location Pain assessment SpO2 (RETIRED) O2 method Row Name Vital Signs Temp Temp src Pulse BP Resp Pain Scale
Pain score
000366
Row Name Vital Signs Temp
12/17/09 0409
12/17/09 0500
12/17/09 0600
12/17/09 0820
12/17/09 0955
----Numeric (NRS) (0-10) -KP 7 -KP L hip -KP Nods yes to pain -KP -12/17/09 1200 36.8 C (98.2 F) -OS 84 -OS 102/63 mmHg OS 16 -OS Numeric (NRS) (0-10) -OS 0 -OS -98 % -OS 12/17/09 1900 ----Numeric (NRS) (0-10) -BO 5 -BO L hip -BO --12/18/09 0725 36.9 C (98.4 F) -BO 90 -BO 119/69 mmHg BO 16 -BO Numeric (NRS)
----
----
Pulse BP Resp Pain Scale Pain score Pain location Pain assessment SpO2 Row Name Vital Signs Temp Pulse BP Resp Pain Scale Pain score Pain location SpO2 Row Name Vital Signs Temp Pulse BP Resp Pain Scale Pain score Pain location Pain assessment SpO2 Row Name Vital Signs Temp Pulse BP Resp Pain Scale
--FACES (0-5) -KP Numeric (NRS) (0-10) -KP 0 -KP ---12/17/09 1400 ----Numeric (NRS) (0-10) -BO 5 -BO L hip -BO -12/17/09 1930 36.7 C (98.1 F) -KP 87 -KP 134/77 mmHg KP 16 -KP Numeric (NRS) (0-10) -KP 6 -KP L hip -KP -100 % -KP 12/18/09 0745 ----Numeric (NRS) 6 -KP L hip -KP Nods yes to pain -KP -12/17/09 1555 36.9 C (98.4 F) -BO 79 -BO 105/65 mmHg BO 15 -BO Numeric (NRS) (0-10) -BO 5 -BO L hip -BO 98 % -BO 12/17/09 2126 ----Numeric (NRS) (0-10) -KP 6 -KP L hip -KP Nods yes to pain -KP -12/18/09 0815 ----Numeric (NRS)
37.7 C (99.8 F) -BO 83 -BO 107/66 mmHg BO 16 -BO Numeric (NRS) (0-10) -BO 8 -BO L hip -BO -99 % -BO 12/17/09 1700 ----Numeric (NRS) (0-10) -BO 5 -BO L hip -BO -12/18/09 0000 37 C (98.6 F) -KP 85 -KP 110/72 mmHg KP 16 -KP Numeric (NRS) (0-10) -KP 6 -KP L hip -KP -100 % -KP 12/18/09 0835 ----Numeric (NRS)
----Numeric (NRS) (0-10) -BO 7 -BO L hip -BO --12/17/09 1800 ----Numeric (NRS) (0-10) -BO 5 -BO L hip -BO -12/18/09 0430 37.2 C (99 F) -KP 84 -KP 111/63 mmHg -KP 16 -KP Numeric (NRS) (0-10) -KP 6 -KP L hip -KP -100 % -KP 12/18/09 0850 ----Numeric
000367
WNL -BH -(RETIRED) Group Foley -BH -Method Row Name 12/16/09 1930 12/17/09 0820 (RETIRED) Glasgow coma scale (>2yrs) Spontaneous Spontaneous (RETIRED) BO Eye opening KP Oriented -KP Oriented -BO (RETIRED) Best verbal response Obeys Obeys (RETIRED) commands commands Best motor -KP -BO response 15 -KP 15 -BO (RETIRED) Coma score total (RETIRED) Pupils Brisk -KP Brisk -BO (RETIRED) Right reaction Brisk -KP Brisk -BO (RETIRED) Left reaction 3 -KP 3 -BO Right size 3 -KP 3 -BO Left size (RETIRED) Strength Abnormal -KP Abnormal -BO (RETIRED) Group Moves against Moves against (RETIRED) gravity -KP gravity -BO Left lower (RETIRED) Sensation Abnormal -KP Abnormal -BO (RETIRED) Group Hypersensitive Hypersensitive (RETIRED) -KP -BO Left lower (RETIRED) Skin WNL -KP WNL -BO (RETIRED) Group (RETIRED) Pressure Ulcer No -KP No -BO (RETIRED) Pressure Ulcer Present? (RETIRED) Cardiac WNL -KP WNL -BO (RETIRED) Group (RETIRED) Pulses WNL -KP WNL -BO (RETIRED) Group (RETIRED) Capillary refill WNL -KP WNL -BO (RETIRED) Group: Capillary Refill (RETIRED) Edema
--12/17/09 1930 Spontaneous KP Oriented -KP
Abnormal -MT Foley -MT 12/18/09 0725 Spontaneous BO Oriented -BO
---
Obeys commands -KP 15 -KP
Obeys commands -BO 15 -BO
Brisk -KP
Brisk -BO
Brisk -KP 3 -KP 3 -KP Abnormal -KP Moves against gravity -KP Abnormal -KP Hypersensitive -KP WNL -KP
Brisk -BO 3 -BO 3 -BO Abnormal -BO Moves against gravity -BO Abnormal -BO Hypersensitive -BO WNL -BO
No -KP
No -BO
WNL -KP
WNL -BO
WNL -KP
WNL -BO
WNL -KP
WNL -BO
000368
(RETIRED) Assessment (RETIRED) Action (RETIRED) Traction (RETIRED) Traction type (RETIRED) Braden (RETIRED) Sensory perception (RETIRED) Moisture (RETIRED) Activity (RETIRED) Mobility (RETIRED) Nutrition
----
MT secured -MT
----
----
----
assessed -MT none -MT
(RETIRED) Friction and shear (RETIRED) Braden total (RETIRED) Pressure No -BH Ulcer Present? (RETIRED) SKIN interventions -(RETIRED) S: Surfaces
No impairment BH Rarely moist BH Bedfast -BH Very limited BH Probably inadequate -BH Potential problem -BH 15 -BH
No impairment MT Rarely moist MT Bedfast -MT Slightly limited -MT Probably inadequate -MT Potential problem -MT 16 -MT No -MT
--
--
--
--------
--------
--------
(RETIRED) K: Keep turning
--
-(RETIRED) I: Incontinence/moisture -(RETIRED) N: Nutrition
Not lying on tubing or wires; Wrinkle free support surface-MT Position change in bed every 2-4 hours;Trapeze -MT Urethral catheter -MT Evaluated hydration and nutrition -MT
--
--
--
--
--
--
---
---
---
Row Name 12/16/09 1930 12/17/09 0500 12/17/09 0820 12/17/09 0900 Surgical incision L Hip 12/15/09 (RETIRED) (RETIRED) Location: L Hip -PB Placement Date: 12/15/09 -PB Properties -Dry and intact -(RETIRED) Dressing Dry and intact -KP -BO -0 ml -BO -(RETIRED) Drainage 0 ml -KP amt Falls Risk No -KP -No -BO -History of falls -Yes -BO -Secondary diagnosis No -KP None/bed rest/ -Crutches/cane/ -Ambulatory aid
12/17/09 1300
---
----
000369
IV/Heparin lock Gait/transferring
Mental status
Total falls risk (RETIRED) Diet -(RETIRED) Type -NPO -Meal and percent taken -(RETIRED) Assistance -Calorie count (RETIRED) Nursing Care Completed -KP Therapeutic time -Foley care (RETIRED) Bed type Standard Acute Care (Hill Rom Advanta) -KP (RETIRED) Toileting Bedpan -KP Bedrest -KP Highest activity Part -KP (RETIRED) Activity assist -(RETIRED) Sleep (# hours) Per patient (RETIRED) HOB comfort -KP Yes -KP Suction available x3 -KP Siderails Yes -KP Bed locked On -KP ID band On -KP Allergy band (RETIRED) Precautions No -KP (RETIRED) Immunocompromised (RETIRED) Radiation No -KP (RETIRED) Aspiration No -KP No -KP Carotid Precautions Yes -KP (RETIRED) Fall No -KP (RETIRED) Flight No -KP (RETIRED) Police hold - adult (RETIRED) Protective No -KP Custody - adult No -KP (RETIRED) Seizure No -KP Sternal Precautions No -KP (RETIRED) Suicide (RETIRED) Spinal Precautions Yes -KP (RETIRED) None
wheel chair/ nurse -KP Yes -KP Normal/bed rest/ immobile -KP Oriented to own ability -KP 20 -KP
walker -BO --Yes -BO Impaired -BO -----
-------------5 -KP -------------------
Oriented to own ability -BO 70 -BO -----Completed -BO Completed -BO Standard Acute Care (Hill Rom Advanta) -BO Bedpan -BO Bedrest -BO Full -BO -45 degrees BO Yes -BO x3 -BO Yes -BO On -BO On -BO ----Yes -BO ------Yes -BO
--Meal -BO No -BO reg-75 -BO Part -BO No -BO --------------------------
--Meal -BO No -BO reg-90 -BO Part -BO No -BO --------------------------
000370
(RETIRED) Anti-embolism (RETIRED) Right leg ALP -KP ALP -KP (RETIRED) Left leg (RETIRED) Physical Restrictions (RETIRED) Right arm No restrictions-KP (RETIRED) Right leg No restrictions-KP No restrictions(RETIRED) Left arm -KP Weight bearing (RETIRED) Left leg as tolerated KP Left Posterior Hip Restriction (specify degree in comments) KP (RETIRED) Ortho device abductor (RETIRED) Type pillow-KP (RETIRED) Location between legs KP secured -KP (RETIRED) Assessment assessed -KP (RETIRED) Action (RETIRED) Traction none -KP (RETIRED) Traction type (RETIRED) Braden No impairment (RETIRED) Sensory perception KP (RETIRED) Moisture Rarely moist KP Bedfast -KP (RETIRED) Activity Slightly limite(RETIRED) Mobility d -KP Probably (RETIRED) Nutrition inadequate -KP Potential probl(RETIRED) Friction em -KP and shear 16 -KP (RETIRED) Braden total (RETIRED) Pressure No -KP Ulcer Present? (RETIRED) SKIN interventions Not lying on (RETIRED) S: tubing or wiresSurfaces -KP (RETIRED) K: Keep turning (RETIRED) I:
--------
ALP -BO ALP -BO ----
------
--------
Weight bearing -as tolerated BO Left Posterior -(specify degree in comments) BO abductor -BO between legs BO in place -BO assessed -BO none -BO ------
------
------
------
No impairment BO Rarely moist BO Bedfast -BO Slightly limited -BO Adequate -BO
------
------
----
No apparent problem -BO 18 -BO No -BO
----
----
--
Position -change in bed every 2-4 hours -KP Urethral cathet- --
Wrinkle free -support surface-BO Position -change in bed every 2-4 hours -BO Urethral cathet- --
--
--
--
000371
Temp src Pulse Resp BP Pain Scale Pain score Pain location Pain assessment Sedation score SpO2 Respiratory (RETIRED) O2 method Row Name Vital Signs Temp Temp src Pulse Resp BP Pain Scale
---Numeric (NRS) (0-10) -KP 6 -KP L hip -KP ---
87 -KP 16 -KP 107/63 mmHg KP Numeric (NRS) (0-10) -KP 7 -KP L hip -KP -0 - Awake, alert, normal response to auditory stimuli. -KP 99 % -KP Room air -KP 12/17/09 0955 -----Numeric (NRS) (0-10) -BO 7 -BO L hip -BO --
---Numeric (NRS) (0-10) -KP 7 -KP L hip -KP Nods yes to pain -KP --
----
----
FACES (0-5) -KP Numeric (NRS) (0-10) -KP 0 -KP 6 -KP -L hip -KP -Nods yes to pain -KP S - Normal slee- -p, easy to arouse. -KP --12/17/09 1200 36.8 C (98.2 F) -OS Oral -OS 84 -OS 16 -OS 102/63 mmHg OS Numeric (NRS) (0-10) -OS 0 -OS -0 - Awake, alert, normal response to auditory stimuli. -OS 98 % -OS ---12/17/09 1400 -----Numeric (NRS) (0-10) -BO 5 -BO L hip -BO --
--12/17/09 0820 37.7 C (99.8 F) -BO Oral -BO 83 -BO 16 -BO 107/66 mmHg BO Numeric (NRS) (0-10) -BO 8 -BO L hip -BO 1 - Mildly drowsy but awake, slow response to auditory stimuli -BO 99 % -BO
--12/17/09 1000 -------
SpO2 Respiratory educated -BO (RETIRED) Incentive spirometer Completed -BO TCDB Room air -BO (RETIRED) O2 method (RETIRED) Positioning Supine -BO Position 45 degrees -BO (RETIRED) HOB Row Name 12/17/09 1505 Vital Signs -Temp
---
--1 - Mildly drowsy but awake, slow response to auditory stimuli -BO ---
---
---
---
-Room air -OS
---
--12/17/09 1555 36.9 C (98.4 F) -BO
--12/17/09 1700 --
--12/17/09 1800 --
--12/17/09 1900 --
000372
Temp src Pulse Resp BP Pain Scale Pain score Pain location Sedation score
-------1 - Mildly drowsy but awake, slow response to auditory stimuli -BO --12/17/09 1930 36.7 C (98.1 F) -KP Oral -KP 87 -KP 16 -KP 134/77 mmHg KP Numeric (NRS) (0-10) -KP 6 -KP L hip -KP -0 - Awake, alert, normal response to auditory stimuli. -KP
Oral -BO 79 -BO 15 -BO 105/65 mmHg BO Numeric (NRS) (0-10) -BO 5 -BO L hip -BO 1 - Mildly drowsy but awake, slow response to auditory stimuli -BO 98 % -BO Room air -BO 12/17/09 2126 -----Numeric (NRS) (0-10) -KP 6 -KP L hip -KP Nods yes to pain -KP --
----Numeric (NRS) (0-10) -BO 5 -BO L hip -BO --
----Numeric (NRS) (0-10) -BO 5 -BO L hip -BO 0 - Awake, alert, normal response to auditory stimuli. -BO --12/18/09 0430 37.2 C (99 F) -KP Oral -KP 84 -KP 16 -KP 111/63 mmHg KP Numeric (NRS) (0-10) -KP 6 -KP L hip -KP -0 - Awake, alert, normal response to auditory stimuli. -KP
----Numeric (NRS) (0-10) -BO 5 -BO L hip -BO 1 - Mildly drowsy but awake, slow response to auditory stimuli -BO --12/18/09 0725 36.9 C (98.4 F) -BO Oral -BO 90 -BO 16 -BO 119/69 mmHg -BO Numeric (NRS) (0-10) -BO 7 -BO L hip -BO -0 - Awake, alert, normal response to auditory stimuli. -BO 97 % -BO encouraged BO Completed BO Room air -BO
SpO2 Respiratory (RETIRED) O2 method Row Name Vital Signs Temp Temp src Pulse Resp BP Pain Scale
--12/18/09 0000 37 C (98.6 F) -KP Oral -KP 85 -KP 16 -KP 110/72 mmHg KP Numeric (NRS) (0-10) -KP 6 -KP L hip -KP -0 - Awake, alert, normal response to auditory stimuli. -KP
SpO2 Respiratory (RETIRED) Incentive spirometer TCDB
100 % -KP encouraged -KP
---
100 % -KP --
100 % -KP --
Completed -KP
---
-Room air -KP
-Room air -KP
Room air -KP (RETIRED) O2 method (RETIRED) Positioning Self -KP Position Per patient (RETIRED) comfort -KP HOB Row Name 12/18/09 0745
--12/18/09 0815
--12/18/09 0835
--12/18/09 0850
Supine -BO 45 degrees BO 12/18/09 1210
000373
SpO2 Pain Scale Pain score Pain location Pain assessment Sedation score
-------
-Numeric (NRS) (0-10) -KP 8 -KP L hip -KP -0 - Awake, alert, normal response to auditory stimuli. -KP ---
-Numeric (NRS) (0-10) -KP 8 -KP L hip -KP Nods yes to pain -KP --
98 % -KP Numeric (NRS) (0-10) -KP 6 -KP L Hip -KP -0 - Awake, alert, normal response to auditory stimuli. -KP ---
-------
(RETIRED)PCA(MG) 4 -KP (RETIRED) Attempts 4 -KP (RETIRED) Injections (incremental) * Row Name 12/17/09 0159 Pain Assessment -Pulse -Resp -BP SpO2 Pain Scale Pain score Pain location Pain assessment Sedation score -Numeric (NRS) (0-10) -KP 7 -KP L hip -KP Nods yes to pain -KP --
---
8 -KP 8 -KP
12/17/09 0200 ----Numeric (NRS) (0-10) -KP 7 -KP L hip -KP Nods yes to pain -KP --
12/17/09 0300 ----Numeric (NRS) (0-10) -KP 6 -KP L hip -KP ---
12/17/09 0400 87 -KP 16 -KP 107/63 mmHg KP 99 % -KP Numeric (NRS) (0-10) -KP 7 -KP L hip -KP -0 - Awake, alert, normal response to auditory stimuli. -KP 22 -KP 14 -KP
12/17/09 0409 ----Numeric (NRS) (0-10) -KP 7 -KP L hip -KP Nods yes to pain -KP --
(RETIRED)PCA(MG) -(RETIRED) Attempts -(RETIRED) Injections (incremental) * Row Name Pain Assessment Pulse Resp BP SpO2 Pain Scale Pain score Pain location
---
---
---
12/17/09 0500 ----FACES (0-5) KP 0 -KP --
12/17/09 0600 ----Numeric (NRS) (0-10) -KP 6 -KP L hip -KP
12/17/09 0655 --------
12/17/09 0820 83 -BO 16 -BO 107/66 mmHg BO 99 % -BO Numeric (NRS) (0-10) -BO 8 -BO L hip -BO
12/17/09 0840 --------
000374
Pain assessment Sedation score
-S - Normal sleep, easy to arouse. -KP
Nods yes to pain -KP --
---
-1 - Mildly drowsy but awake, slow response to auditory stimuli -BO 0.2 Hydromorphone 0.2 mg/mL -BO 0.6 -BO
---
--
--
(RETIRED) Incrementalordered (mg)* (RETIRED) Lockouttime (minutes) (RETIRED) Basalrate(mg/hr) (RETIRED) Attempts (RETIRED) Injections (incremental)* Row Name Pain Assessment Pulse Resp BP SpO2 Pain Scale Pain score Pain location Sedation score
--
--
--
--
--
--
6 -BO
6 -BO
----
----
-7 -KP 6 -KP
0 -BO ---
0 -BO ---
12/17/09 0955 ----Numeric (NRS) (0-10) -BO 7 -BO L hip -BO --
12/17/09 1000 -------1 - Mildly drowsy but awake, slow response to auditory stimuli -BO
12/17/09 1200 84 -OS 16 -OS 102/63 mmHg OS 98 % -OS Numeric (NRS) (0-10) -OS 0 -OS -0 - Awake, alert, normal response to auditory stimuli. -OS
12/17/09 1505 -------1 - Mildly drowsy but awake, slow response to auditory stimuli -BO 0.2 Hydromorphone 0.2 mg/mL -BO 0.4 -BO
-(RETIRED) Incrementalordered (mg)* -(RETIRED) Lockouttime (minutes)
--
--
6 -BO
--
6 -BO
10 -BO
000375
(RETIRED) Basalrate(mg/hr) (RETIRED) Attempts (RETIRED) Injections (incremental)* (RETIRED) Incrementaldose (mg)CALC (RETIRED) Bolusdose(mg)* (RETIRED) Basaldose(mg)* (RETIRED) TotalPCAdose(mg) CALC (RETIRED) TotalPCAvolume (mL)CALC Row Name Pain Assessment Pulse Resp BP SpO2 Pain Scale Pain score Pain location Sedation score
----
0 -BO 16 -BO 12 -BO
----
0 -BO 7 -BO 5 -BO
0 -BO ---
--
7.2 -BO
--
3 -BO
--
----
0 -BO 0 -BO 7.2 -BO
----
0 -BO 0 -BO 3 -BO
----
--
36 mL -BO
--
15 mL -BO
--
12/17/09 1555 79 -BO 15 -BO 105/65 mmHg BO 98 % -BO Numeric (NRS) (0-10) -BO 5 -BO L hip -BO 1 - Mildly drowsy but awake, slow response to auditory stimuli -BO
12/17/09 1800 ----Numeric (NRS) (0-10) -BO 5 -BO L hip -BO 0 - Awake, alert, normal response to auditory stimuli. -BO
12/17/09 1900 ----Numeric (NRS) (0-10) -BO 5 -BO L hip -BO 1 - Mildly drowsy but awake, slow response to auditory stimuli -BO
12/17/09 1930 87 -KP 16 -KP 134/77 mmHg -KP 100 % -KP Numeric (NRS) (0-10) -KP 6 -KP L hip -KP 0 - Awake, alert, normal response to auditory stimuli. -KP --
--
(RETIRED) Incrementalordered (mg)* (RETIRED) Lockouttime (minutes) (RETIRED) Basalrate(mg/hr) (RETIRED) Attempts
--
--
--
--
--
--
--
10 -BO
--
--
---
---
0 -BO 2 -BO
---
---
000376
(RETIRED) Injections (incremental)* (RETIRED) Incrementaldose (mg)CALC (RETIRED) Bolusdose(mg)* (RETIRED) Basaldose(mg)* (RETIRED) TotalPCAdose(mg) CALC (RETIRED) TotalPCAvolume (mL)CALC
Row Name Pain Assessment Pulse Resp BP
--
--
1 -BO
--
--
--
--
0.4 -BO
--
--
----
----
0 -BO 0 -BO 0.4 -BO
----
----
--
--
2 mL -BO
--
--
12/17/09 2000
12/17/09 2126
12/18/09 0000
12/18/09 0001
12/18/09 0003 ----------
----------
----Numeric (NRS) (0-10) -KP 6 -KP L hip -KP Nods yes to pain -KP --
SpO2 Pain Scale Pain score Pain location Pain assessment Sedation score
85 -KP 16 -KP 110/72 mmHg KP 100 % -KP Numeric (NRS) (0-10) -KP 6 -KP L hip -KP -0 - Awake, alert, normal response to auditory stimuli. -KP --
----------
(RETIRED)PCA(MG) 0.2 (RETIRED) Medication+Conc* Hydromorphone 0.2 mg/mL -KP -(RETIRED) Incrementalordered (mg)* -(RETIRED) Lockouttime (minutes) -(RETIRED) Basalrate(mg/hr) 1 -KP (RETIRED) Attempts 1 -KP (RETIRED) Injections (incremental)* Row Name Pain Assessment 12/18/09 0400
--
--
--
--
--
0.2 Hydromorphone 0.2 mg/mL -BG 0.4 -BG
--
--
--
10 -BG
----
----
-1 -KP 1 -KP
0 -BG ---
12/18/09 0430
12/18/09 0617
12/18/09 0725
12/18/09 0745
000377
stimuli. -BO (RETIRED) Medication+Conc* -0.2 Hydromorphone 0.2 mg/mL -BO 0.4 -BO
to auditory stimuli -BO --
stimuli. -KP -0.2 Hydromorphone 0.2 mg/mL -KP --
(RETIRED) Incrementalordered (mg)* (RETIRED) Lockouttime (minutes) (RETIRED) Basalrate(mg/hr) (RETIRED) Attempts (RETIRED) Injections (incremental)* (RETIRED) Incrementaldose (mg)CALC (RETIRED) Bolusdose(mg)* (RETIRED) Basaldose(mg)* (RETIRED) TotalPCAdose(mg) CALC (RETIRED) TotalPCAvolume (mL)CALC Pain Scale Row Name OTHER Pain score Pain location Sedation score
--
--
--
--
10 -BO
--
--
--
----
0 -BO 2 -BO 1 -BO
----
----
-1 -KP 1 -KP
--
0.4 -BO
--
--
--
----
0 -BO 0 -BO 0.4 -BO
----
----
----
--
2 mL -BO
--
--
--
Numeric (NRS) (0-10) -BO 12/17/09 2126 6 -KP L hip -KP --
Numeric (NRS) (0-10) -BO 12/18/09 0000 6 -KP L hip -KP 0 - Awake, alert, normal response to auditory stimuli. -KP --
Numeric (NRS) (0-10) -BO 12/18/09 0001 ----
Numeric (NRS) (0-10) -KP 12/18/09 0003 ----
-12/18/09 0400 ----
--
--
-(RETIRED) Incrementalordered (mg)* -(RETIRED) Lockouttime (minutes) -(RETIRED)
--
--
0.2 Hydromorphone 0.2 mg/mL -BG 0.4 -BG
--
--
--
--
10 -BG
--
--
--
0 -BG
--
000378
Basalrate(mg/hr) (RETIRED) Attempts (RETIRED) Injections (incremental)* Pain assessment Pain Scale Row Name OTHER Pain score Pain location Sedation score
---
---
1 -KP 1 -KP
---
1 -KP 1 -KP
Nods yes to pain -KP Numeric (NRS) (0-10) -KP 12/18/09 0430 6 -KP L hip -KP 0 - Awake, alert, normal response to auditory stimuli. -KP
-Numeric (NRS) (0-10) -KP 12/18/09 0617 ----
--12/18/09 0725 7 -BO L hip -BO 0 - Awake, alert, normal response to auditory stimuli. -BO
--12/18/09 0745 7 -BO L hip -BO 0 - Awake, alert, normal response to auditory stimuli. -BO
--12/18/09 0815 7 -BO L hip -BO 0 - Awake, alert, normal response to auditory stimuli. -BO --
--
--
(RETIRED) Incrementalordered (mg)* (RETIRED) Lockouttime (minutes) (RETIRED) Basalrate(mg/hr) (RETIRED) Attempts (RETIRED) Injections (incremental)* Pain Scale
--
--
--
--
--
10 -BO
10 -BO
--
----
-0 -KP 0 -KP
0 -BO ---
0 -BO ---
----
Numeric (NRS) (0-10) -KP

12/18/09 0835
--

12/18/09 1210

12/18/09 1303
12/18/09 0850
Numeric (NRS) (0-10) -BO 12/18/09 1333 4 -BO L hip -BO 1 - Mildly drowsy but awake, slow response to auditory stimuli -BO --
6 -BO L hip -BO --
5 -BO L hip -BO 0 - Awake, alert, normal response to auditory stimuli. -BO
3 -BO L hip -BO 1 - Mildly drowsy but awake, slow response to auditory stimuli -BO --
4 -IC LEFT HIP -IC --
--
0.2 Hydromorp-
--
000379
O2 method Respiratory (RETIRED) Incentive spirometer TCDB Row Name Vital signs Temp Temp src Pulse BP Resp Pain Scale Pain score Pain location Sedation score
--
--
encouraged -KP
--
--
-12/18/09 0430 37.2 C (99 F) -KP Oral -KP 84 -KP 111/63 mmHg KP 16 -KP Numeric (NRS) (0-10) -KP 6 -KP L hip -KP 0 - Awake, alert, normal response to auditory stimuli. -KP 100 % -KP Room air -KP
-12/18/09 0715 ----------
Completed -KP 12/18/09 0725 36.9 C (98.4 F) -BO Oral -BO 90 -BO 119/69 mmHg BO 16 -BO Numeric (NRS) (0-10) -BO 7 -BO L hip -BO 0 - Awake, alert, normal response to auditory stimuli. -BO 97 % -BO Room air -BO
-12/18/09 0745 -----Numeric (NRS) (0-10) -BO 7 -BO L hip -BO 0 - Awake, alert, normal response to auditory stimuli. -BO ---
-12/18/09 0815 -----Numeric (NRS) (0-10) -BO 7 -BO L hip -BO 0 - Awake, alert, normal response to auditory stimuli. -BO ---
SpO2 (RETIRED) O2 method Respiratory (RETIRED) Incentive spirometer TCDB INR/PTT/PLT Platelet Count Glucose Serum glucose Row Name Vital signs Temp Temp src Pulse BP Resp Pain Scale Pain score Pain location Sedation
---
--
--
encouraged -BO
--
--
---
-147
Completed -BO --
---
---
-12/18/09 0835
128
12/18/09 0850
-12/18/09 1210
-12/18/09 1303
-12/18/09 1333
-----Numeric (NRS) (0-10) -BO 6 -BO L hip -BO --
-----Numeric (NRS) (0-10) -BO 5 -BO L hip -BO 0 - Awake, aler-
37 C (98.6 F) -BO Oral -BO 80 -BO 98/57 mmHg BO 16 -BO Numeric (NRS) (0-10) -BO 3 -BO L hip -BO 1 - Mildly drow-
-----Numeric (NRS) (0-10) -IC 4 -IC LEFT HIP -IC --
-----Numeric (NRS) (0-10) -BO 4 -BO L hip -BO 1 - Mildly
000380
Incontinence/moisture er -KP Evaluated (RETIRED) N: hydraNutrition tion and nutrition -KP
--
er -BO Weight recorded within last 7 days -BO
--
--
Row Name 12/17/09 1930 12/18/09 0500 12/18/09 0725 12/18/09 0900 Surgical incision L Hip 12/15/09 (RETIRED) (RETIRED) Location: L Hip -PB Placement Date: 12/15/09 -PB Properties -Dry and intact -(RETIRED) Dressing Dry and intact -BO -KP -0 ml -BO -(RETIRED) Drainage 0 ml -KP amt Falls Risk No -KP -No -BO -History of falls -Yes -BO -Secondary diagnosis Yes -KP Crutches/cane/ -Crutches/cane/ -Ambulatory aid walker -KP walker -BO Yes -KP -Yes -BO -IV/Heparin lock Impaired -KP -Weak -BO -Gait/transferring Oriented to -Oriented to -Mental status own own ability -KP ability -BO 70 -KP -60 -BO -Total falls risk (RETIRED) Diet ---Meal -BO (RETIRED) Type ---No -BO NPO ---reg-90 -BO Meal and percent taken ---Part -BO (RETIRED) Assistance ---No -BO Calorie count (RETIRED) Nursing Care Completed -KP -Completed -BO -Therapeutic time Standard Acute -(RETIRED) Bed type Standard Acute -Care (Hill Rom Care (Hill Rom Advanta) -KP Advanta) -BO -Urinal;Bedpan - -(RETIRED) Toileting Bedpan -KP BO Bedrest -KP -Bedrest -BO -Highest activity Part -KP -Part -BO -(RETIRED) Activity assist -4 -KP --(RETIRED) Sleep (# hours) Per patient -45 degrees -(RETIRED) HOB comfort -KP BO Yes -KP -Yes -BO -Suction available x3 -KP -x3 -BO -Siderails Yes -KP -Yes -BO -Bed locked On -KP -On -BO -ID band On -KP -On -BO -Allergy band (RETIRED) Precautions Yes -KP -Yes -BO -(RETIRED) Fall (RETIRED) Spinal Precautions
12/18/09 1300
---
-------
-Meal -BO No -BO reg-90 -BO Part -BO No -BO --------------
000381
Yes -KP (RETIRED) None (RETIRED) Anti-embolism (RETIRED) Right leg ALP -KP ALP -KP (RETIRED) Left leg (RETIRED) Physical Restrictions Weight bearing (RETIRED) Left leg as tolerated KP Left Posterior Hip Restriction (specify degree in comments) KP (RETIRED) Ortho device abductor (RETIRED) Type pillow-KP (RETIRED) Location between legs KP in place -KP (RETIRED) Assessment assessed -KP (RETIRED) Action (RETIRED) Traction none -KP (RETIRED) Traction type (RETIRED) Braden No impairment (RETIRED) Sensory perception KP (RETIRED) Moisture Rarely moist KP Bedfast -KP (RETIRED) Activity Slightly limited -KP Adequate -KP No apparent problem -KP 18 -KP
------
Yes -BO ALP -BO ALP -BO
----
------
Weight bearing -as tolerated BO Left Posterior -(specify degree in comments) BO abductor -BO between legs BO in place -BO assessed -BO none -BO ------
------
------
---------
(RETIRED) Mobility
(RETIRED) Nutrition (RETIRED) Friction and shear (RETIRED) Braden total (RETIRED) Pressure No -KP Ulcer Present? (RETIRED) SKIN interventions Not lying on (RETIRED) S: tubing or wiresSurfaces -KP (RETIRED) K: Keep turning Position change in bed every 2-4 hours -KP Voids -KP
No impairment BO Rarely moist BO Walks occasionally -BO Slightly limited -BO Excellent -BO No apparent problem -BO 21 -BO No -BO
---------
---------
--
--
(RETIRED) I: Incontinence/moisture Evaluated (RETIRED) N: hydraNutrition tion and nutrition -KP
---
Wrinkle free support surface-BO Position change in bed every 2-4 hours -BO Voids -BO Weight recorded within last 7 days -BO
--
--
--
--
---
---
000382
Pulse Resp BP SpO2 Pain Scale Pain score Pain location Sedation score
---------
84 -KP 16 -KP 111/63 mmHg KP 100 % -KP Numeric (NRS) (0-10) -KP 6 -KP L hip -KP 0 - Awake, alert, normal response to auditory stimuli. -KP
---------
90 -BO 16 -BO 119/69 mmHg BO 97 % -BO Numeric (NRS) (0-10) -BO 7 -BO L hip -BO 0 - Awake, alert, normal response to auditory stimuli. -BO
----Numeric (NRS) (0-10) -BO 7 -BO L hip -BO 0 - Awake, alert, normal response to auditory stimuli. -BO 0.2 Hydromorphone 0.2 mg/mL -BO 0.4 -BO
--
--
(RETIRED) Incrementalordered (mg)* (RETIRED) Lockouttime (minutes) (RETIRED) Basalrate(mg/hr) (RETIRED) Attempts (RETIRED) Injections (incremental)* Row Name Pain Assessment Pulse Resp BP SpO2 Pain Scale Pain score Pain location Sedation score
--
--
--
--
--
--
10 -BO
10 -BO
-1 -KP 1 -KP
----
-0 -KP 0 -KP
0 -BO ---
0 -BO ---
12/18/09 1210 80 -BO 16 -BO 98/57 mmHg BO 95 % -BO Numeric (NRS) (0-10) -BO 3 -BO L hip -BO 1 - Mildly drowsy but awake, slow response to auditory stimuli -BO --
12/18/09 1303 ----Numeric (NRS) (0-10) -IC 4 -IC LEFT HIP -IC --
(RETIRED)PCA(MG) -(RETIRED)
--
0.2 Hydromorp-
--
000383
Medication+Conc* -(RETIRED) Incrementalordered (mg)* -(RETIRED) Lockouttime (minutes) -(RETIRED) Basalrate(mg/hr) -(RETIRED) Attempts -(RETIRED) Injections (incremental)* -(RETIRED) Incrementaldose (mg)CALC -(RETIRED) Bolusdose(mg)* -(RETIRED) Basaldose(mg)* -(RETIRED) TotalPCAdose(mg) CALC -(RETIRED) TotalPCAvolume (mL)CALC Row Name 12/18/09 1333 Pain Assessment Numeric (NRS) Pain Scale (0-10) -BO 4 -BO Pain score Pain location L hip -BO 1 - Mildly drowSedation sy but awake, score slow response to auditory stimuli -BO --
hone 0.2 mg/mL -BO 0.4 -BO
--
--
--
10 -BO
--
--
----
0 -BO 4 -BO 3 -BO
----
----
--
1.2 -BO
--
--
----
0 -BO 0 -BO 1.2 -BO
----
----
--
6 mL -BO
--
--
Nursing Discharge Instructions Row Name 12/18/09 1429 Nursing Discharge Note - Complete after patient discharge - does NOT print on AHS. Date of discharge 12/18/09 -BO Time of discharge 1430 -BO Stable -BO Condition upon discharge Discharge location Sub-acute -BO on file -BO Phone number to reach patient N/A -BO Discharge Instructions Reviewed? N/A -BO Understanding verbalized?
000384
bryan owens Instructions given BO by: Discharge - Complete PRIOR to patient discharge - DOES print on AHS Med Safety Pamph Yes -BO given? Yes -BO Med. instruction given? N/A -BO (AHS) given? After Hospital Summary Belongings/release Yes -BO slip given Meds (with patient N/A -BO on admit) returned Med Reconciliation Row Name 12/16/09 1039 Medication Reconciliation No -JM Meds reconciled? Yes -JM Home med as complete as list can be hx per complete? pt Meds follow- Clarify: Fluoxetine not con't up inpt, also note Norco and Soma on list despite the d/c date pt still does use at home prn JM -- -JM Title Pharm tech JM Audit Information Ref # 1 Row Name IVPB / Flush Amount (mL) Time Taken 12/15/09 2100 Time Recorded 12/16/09 0606 12/16/09 0211 12/16/09 0213 12/16/09 0212 12/16/09 0342 12/16/09 0004 12/16/09 0342 12/16/09 0004 12/16/09 0342 Value 50 100 0 sleeping -- sleeping No Yes Normal/bed rest/immobile Normal/bed rest/immobile 20
-12/16/09 1321
Yes -SH --
md clarified discrepancy -SH
RPh -SH
User BH BH BH BH BH BH BH BH BH
Pain score
12/15/09 2240
Secondary diagnosis
12/16/09 0003
Gait/transferring 12/16/09 0003
Total falls risk
12/16/09 0003
000385
User Key Initials BG SH VM BH MT PB KP IC OS BO JV AB GV LH JM Name Benny Gabriel, RN San Hua, RPH Victoria Marzan, RN Beverly Harrelson, RN Mary Tran, RN Patricia L Bailey, RN Kristine Palaspas, RN Ioan Cristian Coman, RN Okja Sim, RN Bryan Owens Jodi Vergara, RN Attila Bertalan, RN Gita Vaid, RN Laura Heberle Jennifer Mello, PHRMTECH
(r) = User Recd, (t) = User Taken, (c) = User Cosigned Provider Type .NURSE: (RN or LVN) .PHARMACIST .NURSE: (RN or LVN) .NURSE: (RN or LVN) .NURSE: (RN or LVN) .NURSE: (RN or LVN) .NURSE: (RN or LVN) .NURSE: (RN or LVN) .NURSE: (RN or LVN) .NURSE: (RN or LVN) .NURSE: (RN or LVN) .NURSE: (RN or LVN) .NURSE: (RN or LVN) .NURSE: (RN or LVN) PHARM TECH
000386
Admission Information Attending Provider Murali Adusumalli, MD Discharge Date/Time 12/21/09 1930
Unit T4 ENT/INTERNAL MEDICINE
Admitting Provider Joanna Baginski, MD Hospital Service Team 6 Hospitalist

Room/Bed 4661/466102
Admission Type Auth/Cert Status

Referring Provider
MAR MINI-FLOWSHEET DATA Row Name 12/20/09 0350 OTHER Numeric (NRS) Pain Scale (0-10) -EA Pain score Pain location Temp Temp src Row Name OTHER Pain Scale Pain score Pain location Temp Temp src Row Name OTHER Pain Scale Pain score Pain location Temp Temp src Row Name OTHER Pain Scale Pain score Pain location Temp Temp src Acute Vital Signs 2 -EA left hip -EA 36.5 C (97.7 F) -EA Oral -EA 12/20/09 0905 Numeric (NRS) (0-10) -CS 4 -CS left hip-tolerable -CS --12/20/09 1435 Numeric (NRS) (0-10) -CS 0 -CS -37.1 C (98.8 F) -CS -12/21/09 0855 Numeric (NRS) (0-10) -CS 5 -CS tolerable left hip -CS 36.9 C (98.4 F) -CS Oral -CS
12/20/09 0415
12/20/09 0445
12/20/09 0640
12/20/09 0805
Numeric (NRS) (0-10) -EA 0 -EA -36.6 C (97.9 F) -EA Oral -EA 12/20/09 1000 Numeric (NRS) (0-10) -CS 0 -CS ---12/20/09 1610 Numeric (NRS) (0-10) -CS 2 -CS left hip tolerable -CS --12/21/09 1415 Numeric (NRS) (0-10) -CS 3 -CS tolerable left hip -CS 37 C (98.6 F) -CS Oral -CS
Numeric (NRS) (0-10) -EA 0 -EA -36.5 C (97.7 F) -EA Oral -EA 12/20/09 1115 Numeric (NRS) (0-10) -CS 0 -CS -36.6 C (97.9 F) -CS -12/20/09 2000 Numeric (NRS) (0-10) -DA 5 -DA L hip -DA 37 C (98.6 F) -DA Oral -DA
Numeric (NRS) (0-10) -EA 0 -EA -36.7 C (98.1 F) -EA Oral -EA 12/20/09 1146 Numeric (NRS) (0-10) -BK 0 -BK -36.1 C (97 F) -BK Oral -BK 12/21/09 0200 Numeric (NRS) (0-10) -DA 3 -DA L hip -DA 36.9 C (98.4 F) -DA Oral -DA
Numeric (NRS) (0-10) -CS 4 -CS left hip-tolerable -CS 36.5 C (97.7 F) -CS Oral -CS 12/20/09 1200 Numeric (NRS) (0-10) -NS 0 -NS -36.6 C (97.9 F) -NS Oral -NS 12/21/09 0845 Numeric (NRS) (0-10) -CS 5 -CS left hip -CS ---
000387
Row Name Vital signs Temp Temp src Pulse BP Resp Pain Scale Pain score Pain location Sedation score
12/19/09 2245 37.5 C (99.5 F) -EA Oral -EA 75 -EA 105/58 mmHg EA 18 -EA Numeric (NRS) (0-10) -EA 4 -EA left hip -EA 0 - Awake, alert, normal response to auditory stimuli. -EA
12/19/09 2300 ----------
12/19/09 2345 ----------
12/20/09 0020 ----------
12/20/09 0200 37 C (98.6 F) -EA Axillary -EA 78 -EA 121/61 mmHg -EA 18 -EA Numeric (NRS) (0-10) -EA 4 -EA left hip -EA 0 - Awake, alert, normal response to auditory stimuli. -EA 98 % -EA -Room air -EA
SpO2 Rhythm (RETIRED) O2 method Action done Labs
94 % -EA Non-monitored EA Room air -EA
----
----
----
--
-paged MD re: admit, patient arrival -EA Dr Cai -EA
--Dr Cai -EA at bedside ---12/20/09 0350 36.5 C (97.7 F) -EA Oral -EA 73 -EA 110/63 mmHg EA 18 -EA Numeric (NRS) (0-10) -EA 2 -EA left hip -EA S - Normal sleep, easy to arou-
Communications ---
cbc,bmp, type & screen -EA ---
----
Provider
Respiratory Completed -EA -TCDB INR/PTT/PLT --Platelet Count Glucose --Serum glucose Row Name 12/20/09 0231 12/20/09 0250 Vital signs --Temp Temp src Pulse BP Resp Pain Scale Pain score Pain location Sedation score ----Numeric (NRS) (0-10) -EA 4 -EA left hip -EA -------
-207 92 12/20/09 0415 36.6 C (97.9 F) -EA Oral -EA 75 -EA 111/56 mmHg EA 18 -EA Numeric (NRS) (0-10) -EA 0 -EA -S - Normal sleep, easy to arou-
---12/20/09 0445 36.5 C (97.7 F) -EA Oral -EA 69 -EA 98/54 mmHg EA 18 -EA Numeric (NRS) (0-10) -EA 0 -EA -S - Normal slee-
----
000388
se. -EA --Yes -EA ---98 % -EA Room air -EA --
se. -EA 94 % -EA Room air -EA --
SpO2 (RETIRED) O2 method Current pain? Action done Other
p, easy to arouse. -EA 94 % -EA Room air -EA --
--
Row Name Vital signs Temp
12/20/09 0640
followed up blood transfusion -EA spoke with Mary of Blood bank 12/20/09 0805 36.5 C (97.7 F) -CS Oral -CS 70 -CS 103/70 mmHg CS 16 -CS Numeric (NRS) (0-10) -CS 4 -CS left hip-tolerable -CS 0 - Awake, alert, normal response to auditory stimuli. -CS 100 % -CS Room air -CS --
--
--
--
12/20/09 0905
12/20/09 1000
12/20/09 1115
Temp src Pulse BP Resp Pain Scale Pain score Pain location Sedation score
36.7 C (98.1 F) -EA Oral -EA 74 -EA 110/67 mmHg EA 18 -EA Numeric (NRS) (0-10) -EA 0 -EA -0 - Awake, alert, normal response to auditory stimuli. -EA 96 % -EA Room air -EA --
-----Numeric (NRS) (0-10) -CS 4 -CS left hip-tolerable -CS --
-----Numeric (NRS) (0-10) -CS 0 -CS ---
36.6 C (97.9 F) -CS -74 -CS 106/53 mmHg -CS 16 -CS Numeric (NRS) (0-10) -CS 0 -CS -0 - Awake, alert, normal response to auditory stimuli. -CS 97 % -CS Room air -CS 36.6 C -CS
SpO2 (RETIRED) O2 method Temp (Celsius) Respiratory TCDB Row Name Vital signs Temp Temp src Pulse BP Resp Pain Scale Pain score Pain location
----
----
-12/20/09 1146 36.1 C (97 F) -BK Oral -BK 76 -BK 118/68 mmHg BK 18 -BK Numeric (NRS) (0-10) -BK 0 -BK --
Completed -CS 12/20/09 1200 36.6 C (97.9 F) -NS Oral -NS 73 -NS 95/50 mmHg -NS 17 -NS Numeric (NRS) (0-10) -NS 0 -NS --
-12/20/09 1435 37.1 C (98.8 F) -CS -72 -CS 95/56 mmHg -CS 16 -CS Numeric (NRS) (0-10) -CS 0 -CS --
-12/20/09 1610 -----Numeric (NRS) (0-10) -CS 2 -CS left hip tolera-
-12/20/09 2000 37 C (98.6 F) -DA Oral -DA 78 -DA 117/67 mmHg -DA 16 -DA Numeric (NRS) (0-10) -DA 5 -DA L hip -DA
000389
Location Lumen/port type Product type
L forearm -EA SINGLE -EA Red Blood Cells-EA 50 -EA 300 mL -EA
---120 -EA --
------
--Red Blood Cells-CS 125 -CS 350 mL -CS
Rate ml/hr Amount in container does not flow to I & O Amount (mL) -blood -NS Amount (mL)
---
300 ml -EA --
350 ml -CS 200 ml -CS
(Admission) Vital Signs Row Name 12/20/09 0231 Vital Signs -Temp Temp src Pulse BP Resp Pain Scale Pain score Pain location SpO2 (RETIRED) O2 method Row Name Vital Signs Temp Temp (Celsius) Temp src Pulse BP Resp Pain Scale Pain score Pain location SpO2 (RETIRED) O2 method Row Name Vital Signs Temp ----Numeric (NRS) (0-10) -EA 4 -EA left hip -EA --12/20/09 0805 36.5 C (97.7 F) -CS -Oral -CS 70 -CS 103/70 mmHg CS 16 -CS Numeric (NRS) (0-10) -CS 4 -CS left hip-tolerable -CS 100 % -CS Room air -CS 12/20/09 1200 36.6 C (97.9
12/20/09 0350 36.5 C (97.7 F) -EA Oral -EA 73 -EA 110/63 mmHg EA 18 -EA Numeric (NRS) (0-10) -EA 2 -EA left hip -EA 98 % -EA Room air -EA 12/20/09 0905 ------Numeric (NRS) (0-10) -CS 4 -CS left hip-tolerable -CS --12/20/09 1435 37.1 C (98.8
12/20/09 0415 36.6 C (97.9 F) -EA Oral -EA 75 -EA 111/56 mmHg EA 18 -EA Numeric (NRS) (0-10) -EA 0 -EA -94 % -EA Room air -EA 12/20/09 1000 ------Numeric (NRS) (0-10) -CS 0 -CS ---12/20/09 1610 --
12/20/09 0445 36.5 C (97.7 F) -EA Oral -EA 69 -EA 98/54 mmHg -EA 18 -EA Numeric (NRS) (0-10) -EA 0 -EA -94 % -EA Room air -EA 12/20/09 1115 36.6 C (97.9 F) -CS 36.6 C -CS -74 -CS 106/53 mmHg CS 16 -CS Numeric (NRS) (0-10) -CS 0 -CS -97 % -CS Room air -CS 12/20/09 2000 37 C (98.6
12/20/09 0640 36.7 C (98.1 F) -EA Oral -EA 74 -EA 110/67 mmHg -EA 18 -EA Numeric (NRS) (0-10) -EA 0 -EA -96 % -EA Room air -EA 12/20/09 1146 36.1 C (97 F) -BK -Oral -BK 76 -BK 118/68 mmHg -BK 18 -BK Numeric (NRS) (0-10) -BK 0 -BK -97 % -BK Room air -BK 12/21/09 0200 36.9 C (98.4
000390
Date of last BM (RETIRED) Support system Self -EA (RETIRED) Informant's relationship No -EA Interpreter needed
--
--
--
--
--
--
(RETIRED) (Admission) Functional/Mental Row Name 12/20/09 0234 (RETIRED) Mental Status Alert -EA (RETIRED) LOC Person;Place; Orientation Time;Situation -EA Appropriate -EA (RETIRED) Mood/Affect (RETIRED) Independence-Pre-Admit Rating Independent -EA (RETIRED) Grooming Assistance Ambulating Needed -EA Assistance (RETIRED) Transferring Needed -EA Independent -EA (RETIRED) Eating Independent -EA (RETIRED) Toileting (RETIRED) Independence (Adult-Adm) Independent -EA (RETIRED) Grooming Assistance (RETIRED) NeedAmbulating ed -EA Assistance (RETIRED) Transferring Needed -EA Independent -EA (RETIRED) Eating Independent -EA (RETIRED) Toileting Walker -EA Assistive devices (RETIRED) (Admission) Risk Assessment Row Name 12/20/09 0235 12/20/09 0805 Falls Risk -No -CS History of falls -Yes -CS Secondary diagnosis -Crutches/cane/ Ambulatory aid walker -CS
12/20/09 2000 12/21/09 0855
No -DA Yes -DA Crutches/cane/ walker -DA
No -CS Yes -CS Crutches/cane/ walker -CS
000391
IV/Heparin lock Gait/transferring Mental status Total falls risk Nutrition Risk Total-Nutrition Risk (RETIRED) Current/anticipated nutrition support? Tube Feed; TPN; PPN (RETIRED) Persistent nausea/vomiting >or=3days (RETIRED) Persistent diarrhea >or=3days (RETIRED) New onset diabetes (RETIRED) Unintentional wt loss >or=10 lbs in 1 mo (RETIRED) Inadequate intake>or=1 week (RETIRED) Difficulty swallowing (RETIRED) Pressure Ulcer >or=Stage II DVT Risk Pt stay expected <36 hrs? Ambulatory for entire admission? Confined to bed > 3 days PTA? Hospitalized in last 2 mos? Surgery < 2 mos or this admit? Admit Dx infection or sepsis? Current Tx for cancer? Abuse Recently been threatened/injured? (RETIRED) Braden (RETIRED) Sensory perception
----0 -EA No -EA
Yes -CS Weak -CS Oriented to own ability -CS 60 -CS ---
Yes -DA Weak -DA Oriented to own ability -DA 60 -DA ---
Yes -CS Weak -CS Oriented to own ability -CS 60 -CS ---
No -EA
--
--
--
No -EA
--
--
--
No -EA No -EA
---
---
---
No -EA
--
--
--
No -EA
--
--
--
No -EA
--
--
--
No -EA Yes -EA No -EA Yes -EA Yes -EA No -EA No -EA
--------
--------
--------
No -EA
--
--
--
--
No impairment - No impairment - No impairment CS DA CS
000392
-(RETIRED) Moisture (RETIRED) Activity --(RETIRED) Mobility -(RETIRED) Nutrition (RETIRED) Friction -and shear (RETIRED) Braden -total -(RETIRED) Pressure Ulcer Present? (RETIRED) Bleeding Risk Yes -EA (RETIRED) Current bleeding risk?
Rarely moist CS Walks occasionally -CS Slightly limited -CS Adequate -CS No apparent problem -CS 20 -CS No -CS
Rarely moist DA Walks occasionally -DA Slightly limited -DA Adequate -DA No apparent problem -DA 20 -DA No -DA
Rarely moist CS Walks occasionally -CS Slightly limited -CS Adequate -CS No apparent problem -CS 20 -CS No -CS
--
--
--
(RETIRED) Acute/ICU Assessment Row Name 12/19/09 2245 12/20/09 0805 Received unit T4 ENT/Internal -Rec'd unit Medicine -EA from Rosewood rehab facility Height/Weight 1.854 m (6' -Height 1") -EA Reported -EA -Height type 96.253 kg (212 -Weight lb 3.2 oz) -EA -Weight type Actual -EA Standing scale -Weight -EA method 28.1 -EA -BMI 2.23 m2 -EA -BSA (RETIRED) Glasgow coma scale (>2yrs) Spontaneous Spontaneous (RETIRED) CS Eye opening EA Oriented -EA Oriented -CS (RETIRED) Best verbal response Obeys Obeys (RETIRED) commands commands Best motor -EA -CS response 15 -EA 15 -CS (RETIRED) Coma score total (RETIRED) Pupils Brisk -EA -(RETIRED) Right reaction Brisk -EA --
12/20/09 2000 --
12/21/09 0855 --
-------Spontaneous DA Oriented -DA
-------Spontaneous CS Oriented -CS
Obeys commands -DA 15 -DA
Obeys commands -CS 15 -CS
Brisk -DA
--
Brisk -DA
--
000393
(RETIRED) Left reaction 3 -EA Right size 3 -EA Left size (RETIRED) Strength Abnormal -EA (RETIRED) Group Slight weakness(RETIRED) -EA Left lower (RETIRED) Sensation WNL -EA (RETIRED) Group (RETIRED) Skin Abnormal -EA (RETIRED) Group Pale -EA (RETIRED) Color (RETIRED) Pressure Ulcer No -EA (RETIRED) Pressure Ulcer Present? (RETIRED) Cardiac WNL -EA (RETIRED) Group (RETIRED) Pulses Abnormal -EA (RETIRED) Group Weak -EA (RETIRED) Left dorsalis pedis -(RETIRED) Left post tib (RETIRED) Capillary refill WNL -EA (RETIRED) Group: Capillary Refill (RETIRED) Edema Abnormal -EA (RETIRED) Edema ? General -EA Left lower
--Abnormal -CS
3 -DA 3 -DA Abnormal -DA
--Abnormal -CS Slight weakness-CS WNL -CS
Slight weakness- Slight weakness-CS -DA WNL -CS WNL -DA
Abnormal -CS Pale -CS
Abnormal -DA Pale -DA
Abnormal -CS Pale -CS
No -CS
No -DA
No -CS
WNL -CS
WNL -DA
WNL -CS
Abnormal -CS Weak -CS
Abnormal -DA Weak -DA
Abnormal -CS Weak -CS
--
--
Weak -CS
WNL -CS
WNL -DA
WNL -CS
Abnormal -CS General -CS
Abnormal -DA General -DA L hip --
Abnormal -CS General -CS pitting --
General -EA -(RETIRED) left hip Other (RETIRED) Respiratory assessment WNL -EA WNL -CS (RETIRED) Group (RETIRED) Pulmonary secretions WNL -EA WNL -CS (RETIRED) Group (RETIRED) GI WNL -EA WNL -CS (RETIRED) Group
WNL -DA
WNL -CS
WNL -DA
WNL -CS
WNL -DA
WNL -CS
000394
(RETIRED) Urine WNL -EA (RETIRED) Group Method Voids -EA
-- -CS not seen yet Voids -CS
-- -DA haven't viewed yet Voids -DA
-- -CS not seen Voids -CS
(RETIRED) Acute Cares 12/20/09 Row Name 12/19/09 2245 12/20/09 0000 12/20/09 0805 1300 Surgical incision L Hip 12/15/09 (RETIRED) (RETIRED) Location: L Hip -PB Placement Date: 12/15/09 -PB Properties -Dry dressing; --(RETIRED) Action Dressing changed;Cleaned -EA
12/20/09 2000
(RETIRED) Appearance (RETIRED) Dressing (RETIRED) Drainage amt Falls Risk History of falls Secondary diagnosis Ambulatory aid IV/Heparin lock Gait/transferring Mental status
--
---
Dry;Approximated;Staples intact -EA Dry and intact -EA 0 ml -EA
--
--
Dressing changed -DA per report, the MD partic in study changed the dressing --
Dry and intact -CS --
---
Dry and intact -DA --
Total falls risk (RETIRED) Diet -(RETIRED) Type -NPO -Meal and percent taken -(RETIRED) Assistance (RETIRED) Nursing Care Completed Therapeutic time EA Self -EA (RETIRED) Bath assist Self -EA Oral care (RETIRED) Bed type Standard Acute Care (Hill Rom Advanta) -EA (RETIRED) Toileting Bathroom -EA Ambulate with Highest activity assistance -EA
No -EA Yes -EA Crutches/cane/ walker -EA Yes -EA Weak -EA Oriented to own ability -EA 60 -EA
------------
No -CS Yes -CS Crutches/cane/ walker -CS Yes -CS Weak -CS Oriented to own ability -CS 60 -CS Meal -CS -regular 100 CS Self -CS
-------Meal -CS -75 -CS Self -CS
No -DA Yes -DA Crutches/cane/ walker -DA Yes -DA Weak -DA Oriented to own ability -DA 60 -DA -No -DA -Self -DA
-----
Completed CS Self -CS Self -CS Standard Acute Care (Hill Rom Advanta) -CS Bathroom -CS Ambulate ad lib -CS
-----
Completed DA -Self -DA Standard Acute Care (Hill Rom Advanta) -DA Bathroom -DA Ambulate ad lib -DA
---
---
000395
(RETIRED) Activity assist (RETIRED) HOB Suction available Siderails Bed locked ID band
Part -EA Per patient comfort -EA Yes -EA x2 -EA Yes -EA Placed on patient -EA Placed on patient -EA
--------
Self -CS Per patient comfort -CS Yes -CS x2 -CS Yes -CS On -CS On -CS
--------
Self -DA Per patient comfort -DA Yes -DA x2 -DA Yes -DA On -DA On -DA
Allergy band
(RETIRED) Precautions No -EA (RETIRED) Immunocompromised (RETIRED) Radiation No -EA (RETIRED) Aspiration No -EA No -EA Carotid Precautions Yes -EA (RETIRED) Fall No -EA (RETIRED) Flight No -EA (RETIRED) Police hold - adult (RETIRED) Protective No -EA Custody - adult No -EA (RETIRED) Seizure No -EA Sternal Precautions No -EA (RETIRED) Suicide (RETIRED) Spinal Precautions Yes -EA (RETIRED) None (RETIRED) Braden No impairment (RETIRED) Sensory perception EA (RETIRED) Moisture Rarely moist EA Walks (RETIRED) Activity occasionally -EA Slightly limite(RETIRED) Mobility d -EA Adequate -EA (RETIRED) Nutrition No apparent (RETIRED) Friction problem -EA and shear 20 -EA (RETIRED) Braden total (RETIRED) Pressure No -EA Ulcer Present? (RETIRED) SKIN interventions Not lying on (RETIRED) S: tubing or Surfaces wires-EA
--------------
----Yes -CS -------No impairment CS Rarely moist CS Walks occasionally -CS Slightly limited -CS Adequate -CS No apparent problem -CS 20 -CS No -CS
--------------
----Yes -DA -------No impairment DA Rarely moist DA Walks occasionally -DA Slightly limited -DA Adequate -DA No apparent problem -DA 20 -DA No -DA
---
---
------
------
--
Not lying on tubing or wires; Wrinkle free support surface; Assessed
--
Not lying on tubing or wires-DA
000396
Incontinence/moisture Weight (RETIRED) N: recorded Nutrition within last 7 days -CS Blood Admin Row Name 12/20/09 0400 Setup/ assessment Product type Red Blood Cells-EA W035809233646 Unit ID EA B negative -EA Blood type (unit) Begin -EA Begin/end Tylenol 650 mg Pre-meds & Benadryl 25 mg po -EA -Reaction Vital Signs -Temp Pulse BP ---
--
12/20/09 0415 ------
12/20/09 0445 ------
12/20/09 0640
12/20/09 0805
Red Blood Cells- --EA W035809233646 -EA B negative -EA -End -EA ----
-36.6 C (97.9 F) -EA 75 -EA 111/56 mmHg EA 18 -EA -12/20/09 1146 ---
-36.5 C (97.7 F) -EA 69 -EA 98/54 mmHg -EA 18 -EA -12/20/09 1200 ---
No -EA 36.7 C (98.1 F) -EA 74 -EA 110/67 mmHg EA 18 -EA -12/20/09 1435 ---
-36.5 C (97.7 F) -CS 70 -CS 103/70 mmHg -CS 16 -CS -12/20/09 2000 ---
-Resp Blood warmer No -EA Blood warmer Row Name 12/20/09 1115 Setup/ assessment Product type Red Blood Cells-CS W035809245034 Unit ID CS B negative -CS Blood type (unit) Begin -CS Begin/end no-given prior Pre-meds to first unit CS -Reaction Vital Signs 36.6 C (97.9 Temp F) -CS 36.6 C -CS Temp (Celsius) 74 -CS Pulse 106/53 mmHg BP CS 16 -CS Resp Row Name 12/21/09 0200
----
----
-End -CS --
----
-36.1 C (97 F) -BK -76 -BK 118/68 mmHg BK 18 -BK 12/21/09 0855
-36.6 C (97.9 F) -NS --
No -CS 37.1 C (98.8 F) -CS 37.1 C -CS
-37 C (98.6 F) -DA --
73 -NS 72 -CS 78 -DA 95/50 mmHg -NS 95/56 mmHg -CS 117/67 mmHg -DA 17 -NS 16 -CS 16 -DA 12/21/09 1415
000397
Sedation score
0 - Awake, alert, normal response to auditory stimuli. -BK 97 % -BK Non-monitored BK Room air -BK --
--
0 - Awake, alert, normal response to auditory stimuli. -CS 99 % -CS -Room air -CS 37.1 C -CS
ble -CS --
SpO2 Rhythm (RETIRED) O2 method Temp (Celsius) Respiratory TCDB

Row Name Vital signs Temp
98 % -NS -Room air -NS --
-----
0 - Awake, alert, normal response to auditory stimuli. -DA 98 % -DA Non-monitored DA Room air -DA --
-12/21/09 0200
-12/21/09 0550
-12/21/09 0845
-12/21/09 0855
Completed DA 12/21/09 1415 37 C (98.6 F) -CS Oral -CS 70 -CS 105/57 mmHg -CS 16 -CS Numeric (NRS) (0-10) -CS 3 -CS tolerable left hip -CS 0 - Awake, alert, normal response to auditory stimuli. -CS 96 % -CS -Room air -CS
Temp src Pulse BP Resp Pain Scale Pain score Pain location Sedation score
36.9 C (98.4 F) -DA Oral -DA 71 -DA 99/58 mmHg -DA 16 -DA Numeric (NRS) (0-10) -DA 3 -DA L hip -DA S - Normal sleep, easy to arouse. -DA
-------
-----Numeric (NRS) (0-10) -CS 5 -CS left hip -CS --
36.9 C (98.4 F) -CS Oral -CS 75 -CS 105/64 mmHg CS 16 -CS Numeric (NRS) (0-10) -CS 5 -CS tolerable left hip -CS 0 - Awake, alert, normal response to auditory stimuli. -CS 96 % -CS -Room air -CS
----
SpO2 Rhythm (RETIRED) O2 method Respiratory TCDB INR/PTT/PLT Platelet Count Glucose Serum glucose Intake Row Name Blood Type
99 % -DA Non-monitored DA Room air -DA
----
----
---
-232
---
Completed -CS --
---
--
106
--
--
--
12/20/09 0400 Peripheral -EA
12/20/09 0415 --
12/20/09 0640 --
12/20/09 1115 --
000398
Temp (Celsius) Temp src Pulse BP Resp Pain Scale
F) -NS --
F) -CS 37.1 C -CS
--
F) -DA --
F) -DA --
Oral -NS --73 -NS 72 -CS -95/50 mmHg -NS 95/56 mmHg -CS -17 -NS Numeric (NRS) (0-10) -NS 0 -NS -98 % -NS Room air -NS 12/21/09 0845 -----Numeric (NRS) (0-10) -CS 5 -CS left hip -CS --16 -CS Numeric (NRS) (0-10) -CS 0 -CS -99 % -CS Room air -CS 12/21/09 0855 36.9 C (98.4 F) -CS Oral -CS 75 -CS 105/64 mmHg CS 16 -CS Numeric (NRS) (0-10) -CS 5 -CS tolerable left hip -CS 96 % -CS Room air -CS -Numeric (NRS) (0-10) -CS 2 -CS left hip tolerable -CS --12/21/09 1415 37 C (98.6 F) -CS Oral -CS 70 -CS 105/57 mmHg CS 16 -CS Numeric (NRS) (0-10) -CS 3 -CS tolerable left hip -CS 96 % -CS Room air -CS
Oral -DA 78 -DA 117/67 mmHg DA 16 -DA Numeric (NRS) (0-10) -DA 5 -DA L hip -DA 98 % -DA Room air -DA
Pain score Pain location SpO2 (RETIRED) O2 method Row Name Vital Signs Temp Temp src Pulse BP Resp Pain Scale Pain score Pain location SpO2 (RETIRED) O2 method
Oral -DA 71 -DA 99/58 mmHg DA 16 -DA Numeric (NRS) (0-10) -DA 3 -DA L hip -DA 99 % -DA Room air -DA
(Admission) General Row Name 12/20/09 0231 Admission -ID band Allergy band -Advance Directive Yes -EA Advance per pt, copy of directive? advance directive with brother Yes -EA Pt provided info on AD? Miscellaneous Yes -EA Orientation to unit Diet at home Regular -EA None -EA Dentures No problems -EA (RETIRED) Urination 12/19/09 -EA (RETIRED)
12/20/09 0805 On -CS On -CS --
12/20/09 2000 On -DA On -DA --
12/21/09 0855 On -CS On -CS --
--
--
--
------
------
------
000399
(RETIRED) K: Keep turning
Position change in bed every 2-4 hours -EA
--
Voids -EA -(RETIRED) I: Incontinence/moisture Weight -Weight -(RETIRED) N: recorded recorded Nutrition within last 7 within last 7 days -EA days -CS Row Name 12/21/09 0855 12/21/09 1300 Surgical incision L Hip 12/15/09 (RETIRED) (RETIRED) Location: L Hip -PB Placement Date: 12/15/09 -PB Properties -(RETIRED) Dressing Intact -CS Falls Risk No -CS -History of falls -Secondary diagnosis Yes -CS Crutches/cane/ -Ambulatory aid walker -CS Yes -CS -IV/Heparin lock Weak -CS -Gait/transferring -Oriented to Mental status own ability -CS 60 -CS -Total falls risk (RETIRED) Diet Meal -CS Meal -CS (RETIRED) Type regular 75% 75 -CS Meal and percent CS taken Self -CS Self -CS (RETIRED) Assistance (RETIRED) Nursing Care Completed -CS -Therapeutic time Self -CS -(RETIRED) Bath assist Self -CS -Oral care (RETIRED) Bed type Standard Acute -Care (Hill Rom Advanta) -CS (RETIRED) Toileting Bathroom -CS -Ambulate ad -Highest activity lib -CS
bony prominences ; Standard pressure reduction mattress;Other see comments CS pt mobilizes around room Other - see -comments -CS pt moves around in and out of bed on his own Voids -CS --
Other - see comments -DA pt moves around in and out of bed on his own Voids -DA Weight recorded within last 7 days -DA
000400
(RETIRED) Activity assist (RETIRED) HOB
Self -CS Per patient comfort -CS Yes -CS x2 -CS Yes -CS On -CS On -CS
----------
Suction available Siderails Bed locked ID band Allergy band (RETIRED) Precautions Yes -CS (RETIRED) Fall (RETIRED) Braden No impairment (RETIRED) Sensory perception CS (RETIRED) Moisture Rarely moist CS Walks (RETIRED) Activity occasionally -CS Slightly limite(RETIRED) Mobility d -CS Adequate -CS (RETIRED) Nutrition No apparent (RETIRED) Friction problem -CS and shear 20 -CS (RETIRED) Braden total (RETIRED) Pressure No -CS Ulcer Present? (RETIRED) SKIN interventions Not lying on (RETIRED) S: tubing or wires; Surfaces Wrinkle free support surface; Assessed bony prominences ; Standard pressure reduction mattress;Other see comments CS pt up and ambulating independently, moves self around in bed Other - see (RETIRED) K: Keep comments -CS turning independent with activity Voids -CS (RETIRED) I:
--------
--
--
--
000401
Vital Signs Temp Pulse BP Resp
36.9 C (98.4 F) -DA 71 -DA 99/58 mmHg -DA 16 -DA
36.9 C (98.4 F) -CS 75 -CS 105/64 mmHg CS 16 -CS
37 C (98.6 F) -CS 70 -CS 105/57 mmHg CS 16 -CS
(RETIRED) IV Assessment Row Name 12/20/09 0020 12/20/09 0805 12/20/09 2000 12/21/09 0855 Peripheral 12/20/09 0020 L forearm 20 g (RETIRED) Started by: RN -EA Placement Date: 12/20/09 -EA Placement Time: 0020 -EA Location: L Properties forearm -EA (RETIRED) Gauge: 20 g -EA Clean/dry/intacClean/dry/intacClean/dry/intacClean/dry/intac(RETIRED) t -EA t -CS t -DA t -CS Condition Transparent -EA Transparent -CS Transparent -DA Transparent -CS (RETIRED) Dressing type Single -EA Single -CS Single -DA Single -CS (RETIRED) Number lumens/ports IV started;SaliAssumed care Assumed care Assumed care (RETIRED) ne flush;Saline CS DA CS Action lock -EA Nursing Discharge Instructions Row Name 12/21/09 1803 Nursing Discharge Note - Complete after patient discharge - does NOT print on AHS. Date of discharge 12/21/09 -CS Stable -CS Condition upon discharge Discharge location Home -CS Yes -CS Discharge Instructions Reviewed? Yes -CS Understanding verbalized? chris schob, Instructions given rn -CS by: Discharge - Complete PRIOR to patient discharge - DOES print on AHS Med Safety Pamph Yes -CS given? Yes -CS Med. instruction given? Yes -CS (AHS) given? After Hospital Summary Belongings/release Yes -CS slip given Meds (with patient Yes -CS on admit) returned Med Reconciliation Row Name 12/21/09 0912 Medication Reconciliation No -JM Meds 12/21/09 1435 Yes -CD
000402
reconciled? Home med list complete? Meds followup
Title User Key

Initials DA PB BK CS CD NS EA JM
Yes -JM as complete as can be at this time pt readmit 1day after d/c I had done med rec duing initial admit. Upon d/c was sent to a rehab facility with updated medications were not reflected on the pta med list used info from readmit med list to update and made notes, also note pt was d/ on Fragmin study but left meds at rehab center -JM -- -JM Pharm Tech M
Yes -CD
IDS/anticoag rPh f/u on whether pt to be restrted on study drug vs. discharge home based on repeat H/H -CD
RPh -CD
(r) = User Recd, (t) = User Taken, (c) = User Cosigned Provider Type .NURSE: (RN or LVN) .NURSE: (RN or LVN) .NURSE: (RN or LVN) .NURSE: (RN or LVN) .PHARMACIST .NURSE: (RN or LVN) .NURSE: (RN or LVN) PHARM TECH
Name Darcey Arnold, RN Patricia L Bailey, RN Brynne Kessler, RN Christena R Schob, RN Cathy Din, RPH Nonnato Sapico, RN Encarnacion Arenas, RN Jennifer Mello, PHRMTECH
000403
Admission Information Attending Provider Kelly P Owen, MD Discharge Date/Time 01/05/13 2043
Unit EMERGENCY PAVILION
Admitting Provider Hospital Service Emergency Dept Registration

Room/Bed ED CHAIRS1-8/F-CH4
Admission Type Auth/Cert Status Incomplete


Referring Provider
Custom Formula Data Row Name 01/05/13 1751 OTHER 36.8 C -KR Temp (Celsius) -Calculated row for use by alert logic - not for staff use or review (PECARN TBI-KT) Relevant Labs and Vitals 36.8 -KR Temp (in Celsius) Triage Vitals Row Name Triage Vitals BP Pulse Resp Temp Temp src SpO2 O2 Device (Oxygen Therapy) 01/05/13 1751 116/75 mmHg KR 88 -KR 16 -KR 36.8 C (98.2 F) -KR Oral -KR 98 % -KR room air -KR
01/05/13 1758
-15 -KK
--
Focused Exam Row Name 01/05/13 1758 Medical History arthritis, demyRelevant linating polyneMed Hx uropathy -KK Current Medications Home Meds methadone, soma, -KK Focused Exam Normal Except Exam For -KK Status? Glasgow Coma Scale - Adult
000404
Best Eye Response Best Verbal Response Best Motor Response Score (Glasgow Coma Scale) Triage Dispo Row Name Triage Dispo Triage Category Suicide Risk Present Destination Triage Sheet
4-->(E4) spontaneous -KK 5-->(V5) oriented -KK 6-->(M6) obeys commands -KK 15 -KK
01/05/13 1759 4-Urgent -KK no -KK Up Front Care KK Print C Demographic Labels -KK
ED Med Reconciliation Row Name 01/05/13 1842 MD PTA Meds Reconciliation Yes -KO Meds reconciled? Suspected Infection Row Name 01/05/13 1841 Suspected Infection No -KO Suspected Infection? Full Triage Start Row Name 01/05/13 1758 Full Triage Start Triage Start Full Triage KK Start Current Location Row Name 01/05/13 1750 Current Location Waiting Room Current KR Location User Key
Initials KO KR KK Name Kelly P Owen, MD Kelly Rich, RN Kelly Kittle, RN (r) = User Recd, (t) = User Taken, (c) = User Cosigned Provider Type *PHYSICIAN: FACULTY .NURSE: (RN or LVN) .NURSE: (RN or LVN)
000405
Sheri L Groves

Problem List
Noted Resolved
1/19/2006

Encounter Closed By Closed By BAQUERO, VICTOR H Closed Date 06062006 Closed Time 18:15 Mark Amundsen (MRN8081369) Sex Male DOB 9/23/1959
Appointment
Account # 038112613062 Patient Demographics Address 2025 TARBOLTON CIR FOLSOM CA 95630 Selected Appointment 6/5/2006 2:00 PM Provider Mri... Radacc Department Radiology Acc Phone 916-509-0158 (Home) 916-983-4484 (Work) E-mail Address mamundsen@sbcglobal.net
000406
Problem List
1/19/2006

000407
RelayHealth Messages
Messages for this encounter
Medications
Disp Refills Start 30 0 2/19/2008 EFFEXOR XR 75 MG 24 HR CAP Sig - Route: 1 PO DAILY - ORAL Class: Pharmacy 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 240 0 11/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 2/1/2008 NORCO 10 MG-325 MG TAB Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 2/1/2008 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 End 3/20/2008
12/14/2006 6/30/2007 3/2/2008
3/2/2008
Allergies
Allergies FENTANYL; MORPHINE
Problem List
1/19/2006

000408
Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
Allergies
Problem List
1/19/2006

Patient Information

Telephone Encounter
4/30/2008 5:00 PM
Reason for Call

Refill Request
Call Documentation
Cherry Mendoza 4/30/2008 5:00 PM Signed ----- Message # 1 ----From: Amundsen,Mark Sent: 04/30/2008 3:27 PM
000409
Comment: This is a REFILL AUTHORIZATION for prescription number 176027
Allergies
Problem List
1/19/2006

Class: Acute Previous Visit 4/29/2008 10:52 AM
Department Ucd Registration Encounter # 21634183
RH MD Msg
Visit and Patient Information
Visit Information 6/11/2008 5:57 AM
Provider Victor Baquero, MD, MD Department Relayhealth
Encounter # 22183423
MRN 8081369
Sex Male
DOB 9/23/1959
PATIENTPHONE 916-509-0158
Patient Demographics Address 2025 TARBOLTON CIR FOLSOM CA 95630
Phone 916-509-0158 (Home) 916-983-4484 (Work)
000410
Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 242072.last fill - 7/22/08
Allergies
Problem List
1/19/2006

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone
E-mail Address
000411
Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008
Allergies
Problem List
1/19/2006

Patient Information

Telephone Encounter
11/13/2008 2:37 PM
Reason for Call

Refill Request
Call Documentation
Idania E Baca 11/13/2008 2:38 PM Signed Received a faxed refill request from pharmacy, showing last fill date of. 10172008.
Electronically signed by Idania E Baca at 11/13/2008 2:38 PM
000412
Problem List
1/19/2006

Patient Information

Telephone Encounter
2/23/2009 4:29 PM
Reason for Call

Refill Request
Created by
Approved
Disp Refills Start End 100 1 2/23/2009 4/27/2009 SOMA 350 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 Authorizing Provider: Victor Baquero, MD

NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy
000413
for preoperative appointment on . Michael Delacueva

Electronically signed by MICHAEL DELACUEVA, LVN at Thu Sep 17, 2009 10:47 AM
All Flowsheet Templates (all recorded) None

Patient Instructions None Chart Cosign Accepted By Robert Michael Tamurian, MD Accepted On 9/21/2009 2:23 PM
Problem List
1/19/2006


Encounter Closed By Closed By CUEVA, MICHAEL DELA Closed Date 09172009 Closed Time 10:47 Mark Amundsen (MRN 8081369)
Patient History Report

Medical and Surgical History
Medical History Diagnosis NO SIGNIFICANT HISTORY Date
000414
FENTANYL; MORPHINE
Problem List
1/19/2006


Previous Visit 10/5/2009 1:03 PM Department Ucd Pre-Reg Encounter # 28355597
Patient Information

Telephone Encounter
11/2/2009 10:06 AM
Provider Victor Baquero, MD, MD Department Fol Pediatrics
Reason for Call

Refill Request
Routing History
11/2/2009 10:08 AM
From Cory O'Dell To Victor Henrique Baquero, MD Priority Routine
Created by
Cory O'Dell on 11/2/2009 10:06 AM
Approved
Disp 100 Tab Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 hours if needed for pain. - ORAL Refills 1 Start 11/2/2009 End 12/2/2009
000415
Study Drug - Fondaparinux (IRB 200816251) Syringe Sig - Route: Inject 1 Syringe subcutaneously every morning. - SUBCUTANEOUS Class: Historical
Allergies
Problem List
1/19/2006


Anemia Previous Visit 12/9/2009 9:58 AM Department Ucd Registration Encounter # 29220556
Patient Information

Telephone Encounter
12/23/2009 2:05 PM
Reason for Call

Refill Request
000416
Class: Historical 390 Tab 0 12/23/2009 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 13 Tabs by mouth every day. - ORAL 12/21/2009 Oxycodone 20 mg PO Tab Sig - Route: Take 1 Tab by mouth every 3 hours if needed. For pain. - ORAL Class: Historical Pantoprazole (PROTONIX) 40 mg PO Delayed Release Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Historical SENNOSIDES (SENNA PO) Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical Study Drug - Fondaparinux (IRB 200816251) Syringe Sig - Route: Inject 1 Syringe subcutaneously every morning. - SUBCUTANEOUS Class: Historical
1/20/2010
Allergies
Problem List
1/19/2006


000417
Allergies
Problem List
1/19/2006

Class: Acute C. Difficile Diarrhea 5/29/2009 12/19/2009 1/5/2010

Anemia Orthopedic Aftercare for Joint Replacement Previous Visit 2/4/2010 8:37 AM
Appointment
Account # 078548433024
Patient Demographics Address 2025 TARBOLTON CIR FOLSOM CA 95630 Selected Appointment
Phone 916-509-0158 (Home) 916-983-4484 (Work) Provider
Department
000418
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills Start End 60 Tab 0 2/19/2010 3/19/2010 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take by mouth. Maximum of 2 tablets up to 4 times a day - ORAL Class: Handwritten Rx 250 Tab 0 5/24/2010 6/15/2010 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Carisoprodol (SOMA) 350 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical ERGOCALCIFEROL (VITAMIN D PO) Sig - Route: Take by mouth. - ORAL Class: Historical Fluoxetine (PROZAC) 40 mg PO capsule Sig - Route: Take 1 Cap by mouth every day. - ORAL Class: Historical 0 1/8/2010 2/8/2010 Hydrocodone 10 mg/Acetaminophen 325 100 Tab mg (NORCO) 10-325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 300 Tab 0 3/17/2010 4/16/2010 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL 240 0 11/14/2006 5/24/2010 METHADONE 10 MG TAB (Discontinued) Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 100 1 4/27/2009 5/27/2009 NORCO 10 MG-325 MG TAB Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026
Allergies
Problem List
Noted Resolved
000419
1/19/2006


Anemia Orthopedic Aftercare for Joint Replacement Previous Visit 2/22/2010 2:45 PM
Appointment
Account # 038541463105
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Encounter-Level Documents: There are no encounter-level documents. Insurance Information Acct Number 038541463105 1 Payor
000420
Employment History Occupation network administrator Comment: currently unemployed
Employer
Problem List
10/22/2010 1/19/2006 5/26/2006 4/30/2008

See lab


Appointment
Patient Information Patient Name Amundsen, Mark Sex Male Mark Amundsen (MRN8081369) DOB 9/23/1959
000421
Display only: Transcription (11900701) on 2/1/2011 4:57 PM by Xiao Cai, MD Document history: Transcription (11900701) on 2/1/2011 4:57 PM by Xiao Cai, MD Visit Notes BEVERLY MERRIWEATHER Tue Feb 1, 2011 9:23 AM Vital signs taken, allergies verified, screened for pain. Preferred pharmacy verified. Medication refills needed no. The patient smokes: no . Beverly Merriweather, MA II
Electronically signed by BEVERLY MERRIWEATHER at Tue Feb 1, 2011 9:23 AM
All Flowsheet Templates (all recorded) Amb Vitals Group Flowsheet Custom Formula Data Flowsheet

Patient Instructions None Chart Cosign Accepted By Barton Lahn Wise, MD
Accepted On 2/2/2011 6:04 PM
Problem List
10/22/2010 1/19/2006 5/26/2006 4/30/2008

See lab

000422
Class: Pharmacy 100 Tab 1 2/1/2011 5/4/2011 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical 100 Tab 0 2/16/2011 3/19/2011 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 240 Tab 0 2/18/2011 3/20/2011 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL
Orders Chart Cosign

Accepted By Victor Henrique Baquero, MD Accepted On 3/11/2011 4:50 PM
BPA
Encounter Information Date & Time 3/5/2011 5:06 PM Provider Victor Baquero, MD, MD Department Fol Family Practice
Center None
Patient Information Patient Name Amundsen, Mark Patient Demographics Address 2025 TARBOLTON CIR FOLSOM CA 95630
Sex Male
DOB 9/23/1959
SSN xxx-xx-xxxx E-mail Address mamundsen@sbcglobal.net
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Allergies
Allergies as of 3/5/2011 Fentanyl itching Morphine Allergies as of 3/5/2011 Fentanyl itching DELETED: Ibuprofen Hives DELETED: Methadone Malaise, fatigue, hives, constipation Morphine 2/6/2006 Noted 5/1/2006 Type Noted 5/1/2006 Type Date Reviewed: 2/17/2011 Reactions
7/15/2004
Hives Date Reviewed: 2/17/2011 Reactions
7/15/2004
Hives
000423
Immunizations
Immunizations as of 3/5/2011 Cyanocobalamin inj clinic Never Reviewed 11/2/2010
Problem List
Problem List Polyneuropathy CHRONIC PAIN MEDICATION AGREEMENT Codes 356.9 719.45 Priority High High Class Date Reviewed: 7/12/2010 Noted - Resolved 3/29/2011 Present Acute 4/30/2008 Present
Overview Addendum 2/4/2010 12:56 PM by Victor Henrique Baquero, MD
Previous Version ADVANCED OSTEOARTHRITIS OF THE LEFT HIP 726.5 High Chronic 1/19/2006 Present
Overview Addendum 2/4/2010 8:54 AM by Victor Henrique Baquero, MD
Previous Version Vitamin D deficiency Hypertension 268.9 401.9 Medium Medium Chronic Acute 7/12/2010 Present 7/12/2010 Present
Overview Signed 7/12/2010 9:36 AM by Jeffrey Alan Applebaum, MD

Dyslipidemia 272.4 Medium Chronic 2/1/2010 Present
See lab
Other testicular hypofunction Medication refill High arch 257.2 V68.1 755.67 Low Chronic Unknown Present 1/5/2013 Present 7/12/2010 Present

Orthopedic aftercare for joint replacement Anemia DEPRESSIVE DISORDER V54.81 285.9 311 1/5/2010 Present 12/19/2009 Present 5/26/2006 Present
000424
Overview Addendum 5/26/2006 12:00 AM by Victor Baquero, MD

Unspecified backache 724.5 Unknown Present
Overview Addendum 6/6/2006 12:00 AM by Victor Baquero, MD
RESOLVED: Preop testing RESOLVED: C. difficile diarrhea V72.84 008.45 3/29/2011 8/16/2011 5/29/2009 7/12/2010
Overview Addendum 5/29/2009 3:00 PM by Victor Baquero, MD

RESOLVED: Brachial neuritis or radiculitis NOS 723.4 Unknown 10/22/2010
Medications
Disp Refills Start End 30 Tab 1 2/16/2011 3/18/2011 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Pharmacy 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 8 Cap 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. - ORAL Class: Pharmacy 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet 30 Tab Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 100 Tab 1 2/1/2011 5/4/2011 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical 0 2/16/2011 3/19/2011 Hydrocodone 10 mg/Acetaminophen 325 100 Tab mg (NORCO) 10-325 mg Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 240 Tab 0 2/18/2011 3/20/2011 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL 100 1 4/27/2009 5/27/2009 NORCO 10 MG-325 MG TAB Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026
Previous Visit
Department Encounter #
000425
Priority: Low Class: Chronic Brachial neuritis or radiculitis NOS ADVANCED OSTEOARTHRITIS OF THE LEFT HIP Priority: High Class: Chronic DEPRESSIVE DISORDER
10/22/2010 1/19/2006
5/26/2006 4/30/2008

Priority: High Class: Acute C. difficile diarrhea Anemia Orthopedic aftercare for joint replacement Dyslipidemia 5/29/2009 12/19/2009 1/5/2010 2/1/2010 7/12/2010
See lab
Priority: Medium Class: Chronic Vitamin D deficiency Priority: Medium Class: Chronic Hypertension 7/12/2010
7/12/2010

Priority: Medium Class: Acute High arch 7/12/2010 2/17/2011 3/5/2011 3/29/2011 3/29/2011 8/16/2011

DELETED: Weakness DELETED: Demyelinating neuropathy Class: Acute Preop testing Polyneuropathy Priority: High Encounter Closed By Closed By BAQUERO, VICTOR H
Patient Information
Closed Time 18:28

Telephone Encounter
11/19/2012 4:37 PM
Reason for Call

Refill Request
Routing History
11/19/2012 4:39 PM From Clare Jennings, MA To Victor Baquero, MD Priority Routine
000426
GI Hypertension Stroke
Mother Mother Father
IBS
88
Family Status Relation Mother Father Employment History Occupation network administrator Comment: currently unemployed
Problem List
Problem List as of 01/05/2013 Problem Unspecified backache Other testicular hypofunction Priority: Low Class: Chronic Brachial neuritis or radiculitis NOS ADVANCED OSTEOARTHRITIS OF THE LEFT HIP Priority: High Class: Chronic DEPRESSIVE DISORDER Noted Resolved
10/22/2010 1/19/2006
5/26/2006 4/30/2008

See lab
7/12/2010

Priority: Medium Class: Acute High arch 7/12/2010 2/17/2011 3/5/2011 3/29/2011 8/16/2011

DELETED: Weakness DELETED: Demyelinating neuropathy Class: Acute Preop testing
000427
Hypertension Arthritis unspecified Back pain unspecified Depression unspecified Unspecified disorder of thyroid Surgical History Procedure LAP,INGUINAL HERNIA REPR,INITIAL open repair, left TOTAL HIP ARTHROPLASTY Left total hip arthroplasty. REMOVAL OF TONSILS,<12 Y/O
7/12/2010
Date 1986 12/15/2009 1967
Social History
Family and Education Marital Status WIDOWED
Substances and Sexuality Smoking Status Current Everyday Smoker
Amount 1 pack/day for 20 years
Types Cigarettes
Smokeless Tobacco Status Unknown

Tobacco Comment 1 ppd for 19 years
Alcohol Use Amount 1.0 oz per week. 1 Cans of beer, 1 Shots of liquor per week Yes rare. Currently states 1 beer and 1 hard liquor drink per week, denies hx of alcoholism Drug Use Frequency No N/A denies drug use or hx of drug use
Sexually Active Not Currently
Types
Partners N/A
Social Narrative PREVIOUS TREATMENTS: Excellent pain relief was achieved with nerve blocks or injections. Moderate pain relief was achieved with surgery, heat treatment. No pain relief was achieved with traction, nerve blocks or injections, physical therapy.
FAMILY LIVING CIRCUMSTANCES: The patient is currently lives with their roommates
000428
Scan on 1/30/2013 10:50 AM by Antonia G Kramar Scan on 1/6/2013 4:13 PM by Onbase Incoming Interface Scan on 1/6/2013 3:20 PM by Onbase Incoming Interface Scan on 10/26/2012 10:45 PM by Onbase Incoming Interface Scan on 3/18/2012 4:34 PM by Nickie Simone McEachin Scan on 10/20/2011 7:15 AM by Onbase Incoming Interface Scan on 9/24/2011 12:38 PM by Nicole Pope Scan on 8/23/2011 6:27 AM by Onbase Incoming Interface Scan on 5/5/2011 2:11 PM by Onbase Incoming Interface Scan on 5/5/2011 2:11 PM by Onbase Incoming Interface Scan on 11/16/2010 9:32 AM by Heather Allen Scan on 12/23/2009 2:26 PM Scan on 12/23/2009 2:26 PM Scan on 12/15/2009 4:28 AM Scan on 12/15/2009 4:28 AM
Family and Employment History

Family Medical History Problem Arthritis Cancer Asthma GI Hypertension Stroke Family Status Relation Mother Father Employment History Occupation network administrator Comment: currently unemployed
Relation Mother Mother Brother Mother Mother Father Age of Onset
breast and lung

IBS
88
Problem List
1/19/2006
000429
Non-UCD Facility Scan
Encounter-Level Documents - 12/21/2009: Scan on 12/21/2009 by B Vicky Singh : LEFT TOTAL HIP ARTHROPL REHAB

Medical History Diagnosis NO SIGNIFICANT HISTORY Hypertension Arthritis unspecified Back pain unspecified Depression unspecified Unspecified disorder of thyroid Surgical History Procedure LAP,INGUINAL HERNIA REPR,INITIAL open repair, left TOTAL HIP ARTHROPLASTY Left total hip arthroplasty. REMOVAL OF TONSILS,<12 Y/O Date
7/12/2010
Date 1986 12/15/2009 1967
Social History
Types Cigarettes
Smokeless Tobacco Status Unknown Tobacco Comment 1 ppd for 19 years

Alcohol Use Amount 1.0 oz per week. 1 Cans of beer, 1 Shots of liquor per week Yes rare. Currently states 1 beer and 1 hard liquor drink per week, denies hx of alcoholism
Drug Use Frequency No N/A denies drug use or hx of drug use Sexually Active
Types
Partners
000430
Not Currently
N/A

Family Medical History Problem Arthritis Cancer Asthma GI Hypertension Stroke Family Status Relation Mother Father Employment History Occupation network administrator Comment: currently unemployed Relation Mother Mother Brother Mother Mother Father Status Deceased Alive Employer Age of Onset breast and lung IBS 88
Problem List
000431
1/19/2006

Current Meds Ordered Meds Lab Orders Imaging Orders Care Plan Patient Education Patient Instructions Treatment Team BPA Plan of Care BPA MAR View Admit Orders Med Rev Hx

Anemia
QuickLinks
All Inpatient Notes All ED Notes Flowsheets Problem List
Mark Amundsen (MR# 8081369)
This patient is not currently admitted

Only demographic information will be displayed. Please use chart review to access the patient's previous admissions.
Hospital Office Visit

12/19/2009 7:51 PM
Department T4 Ent/Internal Medicine
Admission Information
Attending Provider Murali Adusumalli, MD Discharge Date/Time 12/21/09 1930 Unit T4 ENT/INTERNAL MEDICINE Admitting Provider Joanna Baginski, MD Hospital Service Team 6 Hospitalist Room/Bed 4661/466102 Admission Type Auth/Cert Status Admission Status Discharged (Confirmed) Admission Date/Time 12/19/09 2220 Service Area UCDHS SERVICE AREA Referring Provider
Emergency Department Information

Arrival Information
Patient not seen in ED
Triage Information
None
ED Note Information
All ED Notes
Diagnoses
000432
Anemia Pain in Joint, Pelvic Region and Thigh Enthesopathy of Hip Region Depressive Disorder, not Elsewhere Classified
285.9 719.45 726.5 311
Inpatient Documentation
Problem List as of 12/21/2009
Problem BACKACHE NOS Noted Resolved
TESTICULAR HYPOFUNC NEC BRACHIAL NEURITIS NOS ADVANCED OSTEOARTHRITIS OF THE LEFT HIP 1/19/2006

Class: Acute C. Difficile Diarrhea 5/29/2009 12/19/2009 Date Reviewed: 12/20/2009 Noted 5/1/2006 Type Reactions

Anemia
Allergies as of 12/21/2009
Fentanyl itching Morphine
7/15/2004
Hives
Inpatient Note Information

All Inpatient Notes
All Flowsheet Templates (all recorded)

Acute Vital Signs Flowsheet Intake Flowsheet (RETIRED) Acute/ICU Assessment Flowsheet (RETIRED) IV Assessment Flowsheet (RETIRED) Acute Cares Flowsheet (Admission) Vital Signs Flowsheet (Admission) General Flowsheet (RETIRED) (Admission) Functional/Mental Flowsheet (RETIRED) (Admission) Risk Assessment Flowsheet MAR MINI-FLOWSHEET DATA Flowsheet Blood Admin Flowsheet Med Reconciliation Flowsheet Nursing Discharge Instructions Flowsheet
Link(s) to Care Plan/Patient Education

Plan of Care Report Patient Education
Call MD if fever>101, increased pain not helped by pain meds, increased redness or swelling to incision area, pus like drainage, wound opening. Numbness or tingling develops to leg. Increased dizziness or confusion.
000433
BestPractice Advisories Patient Plan of Care Alerts
Amundsen, Mark [8081369] Amundsen, Mark [8081369]
Medications
Current Medications
Current Medications (as of 12/19/09)
Medication Notes
Carisoprodol (SOMA) 350 mg PO Tablet Jennifer Mello, PHRMTECH 12/21/2009 8:55 AM NOTE: ordered 1 tid at discharge but pta pt was taking only 2 tabs qhs Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet Jennifer Mello, PHRMTECH 12/21/2009 9:10 AM Clarify Not clear if this was d/c'd upon last discharge when Oxycodone was started Methadone (DOLOPHINE) 10 mg PO Tablet Jennifer Mello, PHRMTECH 12/21/2009 8:54 AM Note pt now takes a divided dose 40mg in the am, 40mg at 4pm and 50mg at 10pm Study Drug - Fondaparinux (IRB 200816251) Syringe Jennifer Mello, PHRMTECH 12/21/2009 9:15 AM Therapy to complete on 12-25-09 NOTE: pt left meds at rehab center Jennifer Mello, PHRMTECH 12/21/2009 8:59 AM NOTE: pt left meds at rehab center
Orders
Order Summary
Future Orders DISCHARGE NOTE [DISIN001 Custom] Order #: 48422827 DISCHARGE DIET [DISIN001 Custom] Order #: 48422828 DISCHARGE FLUID RESTRICTIONS [DISIN001 Custom] Order #: 48422829 DISCHARGE ACTIVITY RESTRICTIONS [DISIN001 Custom] Order #: 48422830 Expected By Expires
Lab Orders
TYPE AND SCREEN RED BLOOD CELLS CBC AUTO + REFLEX MANUAL DIFF BASIC METABOLIC PANEL HEMATOCRIT HEMOGLOBIN CBC AUTO + REFLEX MANUAL DIFF BASIC METABOLIC PANEL HEMOGLOBIN Ordered On 12/19/2009 12/19/2009 12/20/2009 12/20/2009 12/20/2009 12/20/2009 12/21/2009 12/21/2009 12/21/2009
Treatment Team
Provider Ru Ya Cai, MD Jia Wang, MD Murali Adusumalli, MD Beverly Harrelson, RN Mary Tran, RN Encarnacion Arenas, RN Christena R Schob, RN Christena R Schob, RN Darcey Arnold, RN Christena R Schob, RN Role Attending Provider Attending Provider Attending Provider Nurse - Primary Nurse - Primary Nurse - Primary Nurse - Shift Nurse - Primary Nurse - Associate Nurse - Shift From 12/19/09 2318 12/20/09 0747 12/21/09 0744 12/19/09 2328 12/19/09 2328 12/19/09 2329 12/20/09 0715 12/20/09 0808 12/20/09 1813 12/21/09 0700 To 12/20/09 0747 12/21/09 0744 N/A 12/20/09 0008 12/20/09 0008 N/A 12/20/09 1915 N/A N/A 12/21/09 1900
Acct Number 050017321477 Financial Class P
000434
1
Plan UCD/B/S HMO
QuickLinks
All Inpatient Notes All ED Notes Flowsheets Problem List Current Meds Ordered Meds Lab Orders Imaging Orders Care Plan Patient Education Patient Instructions Treatment Team BPA Plan of Care BPA MAR View Admit Orders
Med Rev Hx Mark Amundsen (MR# 8081369)


12/19/2009 9:35 AM
Attending Provider Discharge Date/Time 12/21/09 1930 Unit T4 ENT/INTERNAL MEDICINE Admitting Provider Joanna Baginski, MD Hospital Service Team 6 Hospitalist Room/Bed T4EM/T4EM01 Admission Type Urgent Admission Auth/Cert Status Admission Status Discharged (Confirmed) Admission Date/Time 12/19/09 2319 Service Area UCDHS SERVICE AREA Referring Provider

Arrival Information
Triage Information
None
ED Note Information
All ED Notes

See letter April 30, 2008
000435
February 4, 2010 - Comment: discussed gradual reduction of methadone. Plan: decrease by 5mg weekly.
Class: Acute C. Difficile Diarrhea 5/29/2009 12/19/2009 Date Reviewed: 12/20/2009
Noted 5/1/2006 Type Reactions

Anemia
7/15/2004
Hives

All Inpatient Notes

None

None
Medications
Current Medications
Treatment Team
Provider Christena R Schob, RN Beverly Harrelson, RN Encarnacion Arenas, RN Darcey Arnold, RN Mary Tran, RN Role Nurse - Primary Nurse - Primary Nurse - Primary Nurse - Associate Nurse - Primary From 01/15/10 1109 01/15/10 1109 01/15/10 1109 01/15/10 1109 01/15/10 1109 To N/A N/A N/A N/A N/A
1
Plan UCD/B/S HMO
QuickLinks
All Inpatient Notes All ED Notes Flowsheets Problem List Current Meds Ordered Meds Lab Orders Imaging Orders Care Plan Patient Education Patient Instructions Treatment Team BPA Plan of Care BPA MAR View Admit Orders Med Rev Hx

000436
12/15/2009 4:51 PM
Department D14 Orthopedics/Trauma
Attending Provider Robert Michael Tamurian, MD Discharge Date/Time 12/18/09 1430 Unit D14 ORTHOPEDICS/TRAUMA Admitting Provider Robert Michael Tamurian, MD Hospital Service Orthopedics Room/Bed 14787/147871 Admission Type Elective Admission Auth/Cert Status Admission Status Discharged (Confirmed) Admission Date/Time 12/15/09 0717 Service Area UCDHS SERVICE AREA Referring Provider Robert Michael Tamurian, MD

Arrival Information
Triage Information
None
ED Note Information
All ED Notes
Chief Complaint
Hip Injury DJD
Diagnoses
Enthesopathy of Hip Region 726.5


Noted 5/1/2006 Type
Date Reviewed: 12/15/2009

Reactions
7/15/2004
Hives
000437

All Inpatient Notes

(Admission) Vital Signs (SS) Flowsheet (Admission) General Flowsheet (Admission) Functional/Mental Flowsheet (Admission) Risk Assessment Flowsheet (Admission) Discharge Considerations Flowsheet (RETIRED) Acute/ICU Assessment Flowsheet (RETIRED) Acute Cares Flowsheet (RETIRED) PACU Vital Signs Flowsheet (RETIRED) IV Assessment Flowsheet MAR MINI-FLOWSHEET DATA Flowsheet Intake Flowsheet Acute Vital Signs Flowsheet RN Pain Management Flowsheet (Admission) Vital Signs Flowsheet (Admission) General Flowsheet (RETIRED) (Admission) Functional/Mental Flowsheet (RETIRED) (Admission) Risk Assessment Flowsheet (RETIRED) (Admission) Cultural/Religious Flowsheet (Admission) Discharge Considerations Flowsheet Med Reconciliation Flowsheet Transport Flowsheet Nursing Discharge Instructions Flowsheet

None
BestPractice Advisories
The EMR has no record of timely Pneumococcal vaccination for this patient. Please click 'Accept' to order the vaccination, or click a reason why it is not indicated. Indications for Pneumococcal Vaccine
Date 12/18/09 1429 User Bryan Owens Actions Taken Acknowledge: Not High Risk [300005]
Amundsen, Mark [8081369] Inactive
The EMR has no record of timely Influenza vaccination for this patient. Please click 'Accept' to order the vaccination, or click a reason why it is not indicated. Indications for Influenza Vaccine
Date 12/18/09 1429 User Bryan Owens Actions Taken Acknowledge: Not High Risk [300005]
Inactive
Patient Plan of Care Alerts
Amundsen, Mark [8081369]
Medications
Current Medications
Discontinued Medications
Reason for Discontinue ALEVE 220 MG TAB
Orders
Lab Orders
ELECTROLYTES, WHOLE BLOOD (OR) BLD GAS VENOUS BLOOD TYPE VERIFICATION CULTURE SURVEILLANCE, MRSA BASIC METABOLIC PANEL CBC AUTO + REFLEX MANUAL DIFF BASIC METABOLIC PANEL Ordered On 12/15/2009 12/15/2009 12/15/2009 12/15/2009 12/16/2009 12/16/2009 12/17/2009
000438
CBC AUTO + REFLEX MANUAL DIFF BASIC METABOLIC PANEL CBC AUTO + REFLEX MANUAL DIFF
12/17/2009 12/18/2009 12/18/2009
Imaging Orders
PELVIS 1 OR 2 VIEWS Ordered On 12/15/2009
Treatment Team
Provider Robert Michael Tamurian, MD Beverly Harrelson, RN Beverly Harrelson, RN Mary Tran, RN Mary Tran, RN Alison Peters, RN Kristine Palaspas, RN Bryan Owens, RN Kristine Palaspas, RN Bryan Owens, RN Role Attending Provider Nurse - Primary Nurse - Shift Nurse - Shift Nurse - Primary Case Manager Nurse - Shift Nurse - Shift Nurse - Shift Nurse - Shift From 12/15/09 1549 12/15/09 1916 12/15/09 1916 12/16/09 0635 12/16/09 0742 12/16/09 1021 12/16/09 1921 12/17/09 0641 12/17/09 1853 12/18/09 0724 To N/A N/A 12/16/09 0700 12/16/09 1900 N/A N/A 12/17/09 0700 12/17/09 1900 12/18/09 0700 12/18/09 1900
1
Plan UCD/B/S HMO

7/12/2010
Date 1986 12/15/2009 1967
Social History
000439
Types Cigarettes
Tobacco Comment 1 ppd for 19 years Alcohol Use Amount 1.0 oz per week. 1 Cans of beer, 1 Shots of liquor per week Yes rare. Currently states 1 beer and 1 hard liquor drink per week, denies hx of alcoholism
Drug Use Frequency No N/A denies drug use or hx of drug use Types
Partners N/A

Family Medical History Problem Arthritis Cancer Asthma GI Hypertension Relation Mother Mother Brother Mother Mother Age of Onset breast and lung IBS
000440
4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy Authorizing Provider: Gertrudes Perlas Montemayor, MD

Disp Refills Start End 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 100 Tab 1 6/4/2010 9/4/2010 Carisoprodol (SOMA) 350 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Pharmacy Fluoxetine (PROZAC) 40 mg PO capsule Sig - Route: Take 1 Cap by mouth every day. - ORAL Class: Historical 100 Tab 0 6/4/2010 7/12/2010 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet (Discontinued) Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 200 Tab 0 7/1/2010 7/31/2010 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL 30 Tab 3 7/12/2010 7/12/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy

COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630

7/12/2010
Date 1986 12/15/2009 1967
Social History
Family and Education
000441
Marital Status WIDOWED
Types Cigarettes

Drug Use Frequency No N/A denies drug use or hx of drug use Sexually Active Not Currently
Types
Partners N/A

Family Medical History Problem Arthritis Relation Mother Age of Onset
000442
Cancer Asthma GI Hypertension Stroke
Mother Brother Mother Mother Father Status Deceased Alive
breast and lung
IBS 88
Family Status Relation Mother Father Employment History Occupation network administrator Comment: currently unemployed
Employer
Problem List
Noted Resolved
1/19/2006

See lab

000443
30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 100 Tab 1 2/1/2011 5/4/2011 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical 100 Tab 0 1/21/2011 2/21/2011 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 240 Tab 0 1/24/2011 2/23/2011 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Class: Handwritten Rx

NEUROLOGY CLINIC REFERRAL (64591070)
Ordered On 2/4/2011

7/12/2010
Date 1986
12/15/2009 1967
Social History
Types Cigarettes
Smokeless Tobacco Status
000444
Unknown Tobacco Comment 1 ppd for 19 years

Drug Use Frequency No N/A denies drug use or hx of drug use Sexually Active Not Currently
Types
Partners N/A
FAMILY LIVING CIRCUMSTANCES: The patient is currently lives with their roommates Scan on 1/30/2013 10:50 AM by Antonia G Kramar Scan on 1/6/2013 4:13 PM by Onbase Incoming Interface Scan on 1/6/2013 3:20 PM by Onbase Incoming Interface Scan on 10/26/2012 10:45 PM by Onbase Incoming Interface Scan on 3/18/2012 4:34 PM by Nickie Simone McEachin Scan on 10/20/2011 7:15 AM by Onbase Incoming Interface Scan on 9/24/2011 12:38 PM by Nicole Pope Scan on 8/23/2011 6:27 AM by Onbase Incoming Interface Scan on 5/5/2011 2:11 PM by Onbase Incoming Interface Scan on 5/5/2011 2:11 PM by Onbase Incoming Interface Scan on 11/16/2010 9:32 AM by Heather Allen Scan on 12/23/2009 2:26 PM Scan on 12/23/2009 2:26 PM Scan on 12/15/2009 4:28 AM Scan on 12/15/2009 4:28 AM

Family Medical History Problem Arthritis Cancer Asthma GI Hypertension Stroke Family Status Relation Mother Father
Relation Mother Mother Brother Mother Mother Father Age of Onset
breast and lung

IBS
88
Status Deceased Alive
000445
04/28/11 1208 Unit UCD PRE-REG
Diagnostic Radiology Room/Bed Admission Status Hospital Outpatient Visit (Completed)
UCDHS SERVICE AREA Referring Provider Andrew Kim Oh, MD

Arrival Information
Triage Information
None
ED Note Information
All ED Notes
Problem Unspecified backache Other testicular hypofunction Class: Chronic Brachial neuritis or radiculitis NOS ADVANCED OSTEOARTHRITIS OF THE LEFT HIP Class: Chronic DEPRESSIVE DISORDER Noted Resolved
10/22/2010 1/19/2006 5/26/2006 4/30/2008

See lab

Class: Acute High arch 7/12/2010 2/17/2011 3/5/2011 3/29/2011 3/29/2011 Date Reviewed: 3/24/2011
Noted 5/1/2006 Type Reactions

7/15/2004
Hives

All Inpatient Notes

None
000446

None
Medications
Current Medications
Treatment Team
Not on file
1
Plan UCD/B/S HMO
QuickLinks


4/28/2011 1:00 PM
Provider Fluor2 Diagxr Department Radiology Davis Tower
Attending Provider Admitting Provider Admission Type Admission Date/Time 04/28/11 1209
Discharge Date/Time 04/28/11 2359

Unit RADIOLOGY DAVIS TOWER
Hospital Service
Room/Bed
Auth/Cert Status
Admission Status Hospital Outpatient Visit (Completed)
Service Area UCDHS SERVICE AREA

Referring Provider

Arrival Information
Triage Information
None
ED Note Information
All ED Notes
000447
Problem Unspecified backache Other testicular hypofunction Class: Chronic Brachial neuritis or radiculitis NOS ADVANCED OSTEOARTHRITIS OF THE LEFT HIP Class: Chronic DEPRESSIVE DISORDER Noted Resolved
10/22/2010 1/19/2006 5/26/2006 4/30/2008

See lab

Class: Acute High arch 7/12/2010 2/17/2011 3/5/2011 3/29/2011 3/29/2011 Date Reviewed: 3/24/2011 Noted 5/1/2006 Type Reactions

7/15/2004
Hives

All Inpatient Notes

None

None
Medications
Current Medications
Treatment Team
000448
Body
I have not received any contact or info from Neuro HQ. In discussing case with Dr. Baquero, we came to conclusion that trying steroids for 2 weeks to assess impact would have minimal consequences. I am hoping you would concur with this conclusion. I have not contacted Neuro HQ due to loss of contact data. Please forward contact info, and opinion on steroid trial. Thanks, Mark Amundsen
Encounter Messages Read Composed Y 6/30/2011 9:58 AM Y 6/30/2011 5:56 AM Y 6/29/2011 6:02 PM Y 6/29/2011 8:06 AM
From Andrew Kim Oh, MD Mark Amundsen Andrew Kim Oh, MD Mark Amundsen
To Mark Amundsen Andrew Kim Oh, MD Mark Amundsen Andrew Kim Oh, MD
Subject RE: Non-urgent Medical Advice Question
RE: Non-urgent Medical Advice Question RE: Non-urgent Medical Advice Question Non-urgent Medical Advice Question
Created by Andrew Kim Oh, MD on 6/29/2011 6:01 PM

7/12/2010
Date 1986 12/15/2009 1967
Social History
Substances and Sexuality Smoking Status Current Everyday
Types Cigarettes
000449
Smoker Smokeless Tobacco Status Unknown

Alcohol Use Amount 1.0 oz per week. 1 Cans of beer, 1 Shots of liquor per week Yes rare. Currently states 1 beer and 1 hard liquor drink per week, denies hx of alcoholism Drug Use Frequency No N/A denies drug use or hx of drug use
Types
Partners N/A

Family Medical History Problem Arthritis Cancer Asthma GI Hypertension Stroke Family Status Relation Mother Mother Brother Mother Mother Father Age of Onset
breast and lung
IBS 88
000450
Orthopedic aftercare for joint replacement Dyslipidemia
1/5/2010 2/1/2010
See lab

Class: Acute High arch 7/12/2010 2/17/2011 3/5/2011 3/29/2011 3/29/2011
Closed Time 14:22

DELETED: Weakness DELETED: Demyelinating neuropathy Class: Acute Preop testing Polyneuropathy Encounter Closed By Closed By BAQUERO, VICTOR H
Appointment
Account # 078661756060 Patient Demographics Address 2025 TARBOLTON CIR FOLSOM CA 95630 Selected Appointment 6/17/2011 2:39 PM
Department Ucd Registration Phone 916-509-0158 (Home) 916-983-4484 (Work) E-mail Address mamundsen@sbcglobal.net
Plan UCD/B/S HMO
Financial Class P
Plan Number B72
Plan Phone 916-734-0739
000451
He requested that I make another appointment on Sept 27 to re-discuss my case. Unfortunately, I cannot wait any more for answers in this matter. I am currently 2 months behind on my mortgage, and state disability ended on May 30. I am applying for social security disability, but am told it may take from 3 months to 2 years to be approved. The only chance I have to save my house is to go back to work. I am inquiring if it would be possible to test steriod efficacy without approval from Neurology. While I realize that approval from Neuro would be optimal, I do not feel I can wait any longer without trying to alleviate my symptoms, and get back to productivity. Please let me know what you think about this proposal. Regards, Mark Amundsen
Previous Version Electronically signed by Stephanie L Esparza, LVN at 8/19/2011 8:39 AM Electronically signed by Stephanie L Esparza, LVN at 8/19/2011 8:39 AM Routing History
8/19/2011 8:40 AM From Stephanie L Esparza, LVN To Victor Henrique Baquero, MD Priority Routine
Created by Stephanie L Esparza, LVN on 8/19/2011 8:39 AM
Orders
Chart Cosign Accepted By Victor Henrique Baquero, MD

Medical History Diagnosis NO SIGNIFICANT HISTORY Hypertension Arthritis unspecified Back pain unspecified Depression unspecified Unspecified disorder of thyroid Surgical History Procedure LAP,INGUINAL HERNIA REPR,INITIAL open repair, left TOTAL HIP ARTHROPLASTY
Date
7/12/2010
Date 1986
12/15/2009
000452
Left total hip arthroplasty. REMOVAL OF TONSILS,<12 Y/O
1967
Social History
Types Cigarettes
Partners N/A
000453

Family Medical History Problem Arthritis Cancer Asthma GI Hypertension Stroke Family Status Relation Mother Father Employment History Occupation network administrator Comment: currently unemployed Relation Mother Mother Brother Mother Mother Father Status Deceased Alive Employer Age of Onset breast and lung
IBS
88
Problem List
10/22/2010 1/19/2006 5/26/2006 4/30/2008

See lab


DELETED: Weakness DELETED: Demyelinating neuropathy
000454
Medications
Current Medications
Ordered Medications
Methadone (DOLOPHINE) 10 mg Tablet Take 3 tablets by mouth every 8 hours. - ORAL
Disp 18 tablet Refills 0 Start 1/5/2013 End 1/7/2013
Treatment Team
Provider Kelly P Owen, MD Christena R Schob, RN Beverly Harrelson, RN Encarnacion Arenas, RN Darcey Arnold, RN Mary Tran, RN Role Attending Provider Nurse - Primary Nurse - Primary Nurse - Primary Nurse - Associate Nurse - Primary From 01/05/13 1834 01/05/13 1828 01/05/13 1828 01/05/13 1828 01/05/13 1828 01/05/13 1828 To N/A N/A N/A N/A N/A N/A
1
Plan UCD/B/S HMO

7/12/2010
Date 1986 12/15/2009 1967
Social History
000455
Types Cigarettes
Partners N/A

Family Medical History Problem Arthritis Cancer Asthma Relation Mother Mother Brother Age of Onset
breast and lung
000456
... '.., .. m~ IS MEDICAL GROUP, FOLS.O~n
['
Adult Health Questionnaire MR#_: _
Patient Name: !Jl?{/iV'{JJ::1J,t I1;4IC K
This questionnaire will help your physician obtain a largeamount of information while still being able to focus on your important problems. Pleaseanswer all questions as best you can. If you are uncertain about a question your physicianwill.help you. All questions will be kept confidential. Sex: _M __ Age:_L./:l. _ Date of Birth: 9 - .;l :5- S 9' Home phone: _ Work phone:.
933- 2S-J<t 91t:?- 7/9'- ('US '/

.
? 1&7
Current Medical Problems (for example: asthma, diabetes,high blood pressure, heart murmur, epilepsy, cancer, depression, etc.) Q None
l' (JIJGK
'1 /II,'?
/"1\>/,<..)
2 ----------------3
----_._---------
~_------------5 --------------6
Past Medical Problems (for example: asthma, diabetes,high blood pressure, heart murmur, epilepsy, cancer, depression,~tc.).. '" _.... . . . 'QNone.,
"' ...
"
1 , .0ffo0SStllJ 2
l!efCIJ II!
Len- '>/d
3
4
8 9 10
Operations (for example: Tonsillectomy, appendix, gallbladder,hernia, cesarean seelion, hysterectomy, etc.) QNone 1 7O!JSILL
!3C/OM
~1'
Date Date Date
/9G8
4 5
Date Date Date
2 NtJX!./u M,' . , . 3 .
/987
Serious Injuries (for example: automobile accident, headinjuries, fractures, burns, gunshot wounds, etc.) QNone
000457
U.C.DAVIS MEDICAL GROUP, FOLSOM

Adult Health Questionnaire
Patient Name: Medi~ations
M M'1-\(
AMlJ'N'()jl}.)
MR#:
list all medications you currently take including prescriptions, cold medications, ; IlNon~
aspirin, vitamins, and birth control pills. Please list all medication dosages and frequency taken.
1.
P ((0 L.. f\ c,
f)S!'1 f--ltJ
LlO MS
5 6
7
3 'YL0-D\,
4
Allergies to Medications Medication
8
(list all medications that you cannot take or have had a reaction to.) Reaction
aNone
---.l: I LIt>'" , !Znc. /4
Health Habits
Yes
p o
~
No
fi
~
/il
0
~
Do you drink alcohol? Do you smoke? Did you smoke in the past? Do you use caffeine? Have you used illegal drugs? Do you use seatbelts reqularly?
amount?
1-.
per day/~mOnlh(cirCle
one)
amount? ~er day # of years how much-?-,-q-ui-t -w-he-n-?-\ /1 PA<Xr-;-PA-Y- ICflI how much? list type what type? YflYfJlJJ(,~JL when last checked?
-------
~ f;P
0 0
, (for example: I.V. drug use, multiple sexual partners, 'unprotected intercou'rse sex with gay/bisexual male) . ' Health Maintena'nce Last complete physical Sigmoidoscopy Immunizations Last tetanus shot Last flu shot Pneumonia vaccine
"
Do you exercise? how often? -Do you have smoke detector in your horne? Do you have any risk factors for AIDS or HIV infection?
Date Date
IqC'f::1
Cholesterol screen Last prostate check
Date ).. OC,;L Date
/qqq
_
--------'~-----------ahq4.xlS
Date ----Date ----Date -Page 2
Hepatitis B series Date MMR Date -----(Measles, mumps, and rubella vaccine)
000458
U.\'.UAVIS MEDICAL GROUP, FOLSOM
'i
Patient Name:
""
Adult Health Questionnaire MR#:
-fJ.J,IC/(
IJ "'())Vt:J~
_
Gynecological HistorY. (Women Only) last Pap smear Date Last mammogram Date' Last menstrual period Date ----Type of birth control Age of menopause Social Historv Marital status (check one) Occupation (check one)
Number of pregnancies Number of miscarriages Number of abortions Number of children
~married o widow(er) 0 separated 0 divorced o retired Cl student p;employed as: 7,l,'5Z::1G-;A!J@ CCJN~uV Cl unemployed Livinq Situation (check) o alone j)with spouse/partner [] with children # _ [] other _ --, ----------------Hlqhest'level of education j). Hobbies Plt>/I/,,<-6/ ~~~~ S".c-/ ~ Family Health Histo!y (Blood-relatives) Mother's age now].3 (or at death) Father's age now 7 S (or at death) ---Has any lrnrnediate family member (parents, brothers .slster, grandparents children) had: Yes No ,Cgo Cancer -'-/'i,_t'{;"'--~ _ o ~ -Heart attack in close relative; if yes, give age
o single
_ p
.pp oft-
_ 0
0 0
Elevated cholesterol High blood pressureh Stroke Diabetes
_------------~---------__o_~_"'_c-
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p
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o
o- ~
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o 'JY
.-J!.
Asthma _" --------------------Depression !1{YillaJt Suicide _" Alcoholism Drug problem Sickle cell anemia Tuberculosis --=_'-Other illness/condition that runs in your family
~_
Body Systems Review: Yes No Uncertain 0j? 0 00 you tire easily? 0 1 0 0 2 Ji'F Have you lost or gained 10 or more pounds in the last year without trying? 3 0 0 ~ Have you noticed any major changes in your skin (moles, rashes, etc.)? }B; 0 4 0 Do you have trouble with your eyes or ears (other than needing glasses)? 0 0 5 Are you short of breath, hoarse, or prone to wheezing and coughing? 0 0 6 Do you ever have chest pain, discomfort, heaviness or frequent palpitations? 0 Are your feet or ankles often swoDen? 0 7
fa
-~"
ahq4_>:'s
Page 3
000459
U.C.DAVIS MEDICAL GROUP, FOLSOM

Adult Health Questionnaire Patient Name: MR#:
Body Systems Review: (continued) Yes No Uncertain Do you have trouble with swallowing, heartbum, stomach pain, or ulcers? ~ 0 0 8 o )SI 0 9 Have you noticed any blood or recent changes in your bowel movements? o ;S 0 10 Do you have any sexual problems you wish to discuss? o ;:[ 0 11 Have you or your partner had any trouble with infertility? o /);J 0 12 Do you have difficulty urinating, holdi~rine or do you get up often at night to urinate? ~ 7(1185- ;J jJ /c, I \
;&
o
13 Do you have back, joint, or muscle problemsthat interferes with work or life? o u 14 Do you often have a problem with severe or frequent headaches? o ~ 15 Do you get dizzy often? I o )t 16 Have you fallen in the past year? 0 17 Do you have trouble sleeping? Additional Comments:
0 0 0 0
9r
I
Women Only: 0 0 0 0 0 18 '19
1
0 0 Men Onlv: 0
Do you have breast lumps, lumps in your armpit, diSCharg~or bleeding from your nipples? Do you have any menstrual or vaginal problems?
)(
~!O Do you have any testicular lumps, lesions on the penis or bisCharge from the penis?
Do you have any other health concerns at this time? If so, please describe
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Physician's Comments:
---------
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Physician'sSignature
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ahq4.xls
Page 4
000460
.~
BURGER
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._.-.-_.~---~_._----------------
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.:1 ST
C3'EVA\..UATE & TREAT Modaljt"~s As Needed Exercise

Work Cond.uoning Aquatic
Tnerapeuuc

Exercise 1 herapy Capacuy Assessment
Home
Program
Back Educati<:)n P(ogr~m FunctiDnal
i'lanlJal Therapy
E.rgonOmlc. As sessrnent
Pr.o- T"lerapy
I Conser
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000461
-"':::-::=:::::::0::=:====-=========
U.pVIS
PATIENT NAME:
.rr-
MEDI~AL GROUP, FOLS0rt

"MR#:;
-------------_
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----
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medrfl7.xls:JA
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MEDICATIOt'o!i REFILL RECORD
000462
-----------------------
P'ATIEUT 11..11 lit _~ SIP
DATE
~
I 0'0
i ;6-1/ere..0 HONE
REASON(S)
FOR VISIT
?3~
(CHIEF
II's
#1
l.-ou/
Ad/- Ii%Y&<4
ElM COOING lOCATION QUALITY SEVERrTY
DURATION
COMPLAINT)
"
\" )'-
CURR
UEOS
ONo
lIMING CONTEXT MOD1FY1NG FACTORS ASSOC. 51GNSlSXS BRIEF;:> 13 99201-99202 9921299213 EXT." >4 99203-99205 9921'3-99215 ~EVIEW OF SYSTEMS Positive Responsu
Nat Applicable
Const,\u\\ona\ 0 Negative Eyes 0 Negative ENT I Mouth 0 Negative Cardiovasc. 0 Negative
9'12011 '11212 One Sy:;tem 99202 I 99213

29 Syslems
Skin
Neurological Psychiatric
Endooine Genital I Uro
Respiratory
Neqattve
99203 I 91214 >10 SySlems 99205.99214 99215

Nat Applicable
GI 0 Negative Moscutosket. 0 Neqatrve

PAST tllSTORY Illnesses I Injunes I Operat~)ns Ilmmunizalluns
Heme/Lymph
Allergilmmun.
SOCIAL
o Neqanve o Negative o Negabve o Negative o Negative o Negative o Neqanve
Positive ResPOns".
;vi",/>.?I
9t201 J 99202 99212199213 99203 /99214 23 Areas 99215 99204, 99205
J FAMILY HISTORY -Jemeoote family I Man\al S!atus.1 Emp\otmeI\\ Tobacco/Alcohol I Education I Sexual HISlcwy
tPHYSICAL
EXAM (check
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PER
INENT fiNDINGS
'0 Appearance
J'l'NormaIN.40J
.51'3#I'I:J
Oy~r.
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1 5 Eterneru
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Cardiovascular Chest (Breasts)
0 Normal
0 Normal
99201/9921 Exp. Prob.

G eterrems
[0
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Normal
9920219921
t)e\alled
\0 Respiratory
0 Normal'
0 Normal 0 Normal
o o
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o Abdomen o Genitourinary o Lymphabc o Museuloskel. o Skin
12 ererneras 10 syst I areas 9920)19921

Comprehensl e
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o Neuroloqtc o Psychiatric
9. sysl/ area 9920419920

AS~~~~~ATMENTPLANS
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SiGNATURE
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TOTAL TIME w PT:
COUNSEliNG TIME:
UCDMG FOLSOM
-~--------------~----_._,. ----~-~~-._--_. __ ._---_.______ 1_-----------------
PROGRESS NO~
000463
raise bilaterally. In fact, it feels better when his leg is raised to 50 on the left. Neurologic exam shows 2+ quad and Achilles tendon reflexes. Normal strength for all modalities and sensation through all the dermatomes.
A/P: 1) New patient, establish. 2) Lumbar pain, possible disc symptoms.
Radiating tendinous
left posterior lateral pain, worse with lumbar flexion as well as a component at the insertion of the quads on the left in the proximal
ALLERGIC TO on a p.r.n.
anterior thigh. Referred to physical therapy. Started on Meclomen. IBUPROFEN but not other NSAIDs. Was given Vicodin to take at nighttime
basis. Lumbar x-rays were ordered. He will followup with me in several weeks after physical therapy. With his chronic radiating pain exacerbated by flexion, consider a chronic disc. Consider MRI if not improving. 3) Chronic Prozac. Suspect Prozac
poop out. borderline. Asked him to taper the Prozac off and consider alternative SSRI if he is
symptomatic.
41
Health care maintenance.
Cholesterol was recently checked and was
He is to give me the value.
&--
Vlctor Baq~,
M.D., UCDMG, Folsom/sb
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9/13/02 MARK AMUNDSEN DOB: 9/23/59 Mark is here as a new patient. He has a history of depression in the past with difficulty coping and several other physical manifestations for which he was started
s:
on Prozac 20 mg seven years working and .ic was increased Symptomatically he is okay. after he gained some weight
ago. A couple of years later he felt like it wasn't to 40 but without any effect. He is still on it. His main concern is lumbar and hip pain. It started after stopping cigarette smoking years ago. He began
exercising and it seemed to get worse, particularly with sit-ups. He saw a doctor four years ago, x-rays were done and he was put on anti-inflammatories. He had been
fairly stable but present until about a month ago when it started to get a little
worse. Symptoms are exacerbated by prolonged sitting and bending forward. He has posterior lateral gluteal pain that radiates down to the knee on the left side. No weakness or paresthesia. Also has focal sharp tenderness over the proximal, anterior and medial thigh. Has a history of left inguinal hernia repair a few years ago and focal stabbing tenderness over the area of the left greater trochanter. 0: Vitals: Normal and noted. General: Well-nourished, well-developed, pleasant male, no apparent distress. Affect ls appropriate, good amplitude. HEENT-extraocular movements intact. Pupils equal and react to light and accommodation. Oral mucosa is pink. Mildly overweight. Musculoskeletal exam shows no paraspinal tenderness. No 3I joint discomfort. No left greater trochanteric tenderness. Range of motion is slightly decreased bilaterally at the hips. With hip flexion, he feels the tenderness over the proximal left thigh anteriorly. Has negative straight leg
000465
, AMUNDSEN .MARK I 09/2311959 M 808136B

79-406336119 08139 BAQUE'nO, $10 VI
o DAVIS TOWER
2315 Stockton Blvd-, (916) 703-2100 (916) .703-2254 (lax) Services: GI, GU, Fluoro, Pediatric, Nuclear Medicine, Ultrasound, Vascular Lab, Plain Film UCDHS MED REC# PATIENT PREGNANT:
0 0
UNIVERSITY OF CALIFORNIA, MEDICAL CENTER SACRAMENTO, CALIFORNIA DIAGNostiC IMAGIN1'lJ!EJf0:f$T3D J, ElLlS~V
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Ambulatory Care Center -,. "I, 4860 Y Street! Suite 050QVIF:l ,_C~! Ret:.ofill (916) 734-0655, (916) 734-0650 (fax) Services Low~r Level: Mammo, Ultrasound MR, Nuclear Medicine, Vascular Lab, CT Services' First Floor: Plain Film
'mIb1=0-~
SOCIAL. SECURITY #
0
FOR HOURS OF SERVICE OR IF YOU NEED FURTHER INFORMATION -+-DOB:(Req) Yes

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_ _
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Vel'
No
Unknown / BREAST-FEEDING:
TYPE OF EXAM(S) REQUESTED:
m R:l.
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Yes
0
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i
I
Yes
No
CLINICAL HISTORY/SUSPECTED DIAGNOSIS:
Lr--
fLcLto.t,rt-L.r,
---REFERRING CLINIC/PCN: APPOINTMENT DATE & TIME: REFERRING PHYSICIAN SIGNATURE: 4.-~------PHYSICIAN PHYSICIAN BEEPER:
ICD-9# CONTACT:
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AUTH #
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State
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_ PHONE RESULTS:
0
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2:115 Sloc~lon Blvd.
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UNIVE:ASlTY OF CALIFORNIA,
MEDICAL CENTER SACRAMIiNTO. CAUFORNIA
DIAGNOSTIC IMAGING RIiOUEST
1I1fl..8S3-2MII "OME
91e71 11>-2030WORK'
servlCee; GI, GU, FluQlo, Ped1etl1o, Nucl8ar "'.diclne, UllrasO\ll1d, Vascular Lab. PIaiJl Film
LAWRENCE J. ELUSON Ambllialory Care Cenlsr 4860 V Slt88t, Sulle 0500 (915) 734-ll655, (916) 734-0&50 ('pI Ser'll_ l.4I_ LavIlI:Mamma,Ullmsound MR, Nuclear MllCIIdne. Vascular Lab. cr Sel'llcesF1111 ROOI': Plilln Film OOa:(Req) No LMP:
0
CALL FOR HOURS OF SERVICE OR IF YOU NEED FURTHER INFORMATION PATIENT'S NAME~
(AIM"L...-
UCDHSMEDRECI
fur IJ(P '7

0
qI J..3 /59_
_
0
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AGE:
.SOC/Ill SECURITY II
0 ves 0 No 0
PATIENT PREGNANT:
Q
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KNOWN ALLERGIES:
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Yes
OF EXAM(Sj REQUESTED:
m R:i:" Q w.Jo-DIAGNOSIS,
ba.
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Yes
No
CLINICAl
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PREVIOUS UCDMC PATIENT: ,:e'Yes
No PREVIOUS COMPARISON FILMS;
P Yes
No ADDRESSILOCATION OF PREVIOUS ALMS:
1//;..r7rL
RADIOLOOIST NOTES" Po OL
I
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000467
~-------------._-_._,---------~~-DATE:
DOCTOR:
ViCTOR 8AGUERO, M.D
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SIGNATURE
I I
DATE
TIME
SIGNATURE
DATE
TIME
SIGNATURE
000468
[lATE:
DOCTOR:
TIME'"
----
ViCTOR 8I-\GUi:RO, M.G
li!1':.;il~~~
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DEC' g 2002
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Teresa Nuno, CMA r{ESI'ONSE

DATE TIME
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..._--------------
. SIGNATURE
. .
000469
,USE PAT!ENT PLATE
:tlli':N1r:pA
, UC Davis
8081369
: 1',MUNDSEN,
Health
Ord:
MARK
System
80 UCDMGFO
UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER, SACRAMENTO, CALIFORNIA
, ~I
09-23-59
0ccount
#:
80-122002 0394_6_2_5_1_5_12_1
MAGNETIC RESONANCE IMAGING (MRI ~; PATIENT SCHEDULING INFORMATION
Appointment Patient's
=-. "D:=ar:te~!!!!--CIl1~"!!'!!!!!iiI=::--L -----------
Time
Name
Day
Home Phone # Referring Ph
Phone/Pager

e:
Are you pregnant? Have you ever had a MRI scan? Have you ever had a C.T. (CAT) scan? Do you have previous CT. or MRI films available for comparison? Have you ever had brain surgery in which aneurysm clips were used? Have you ever had metal fragments or other foreign bodies in your eyes? Are you a previous or current metal worker? Have you ever had a pacemaker or neurostimulator device? Have you ever had cardiac surgery, which included a heart valve prosthesis? Do you feel uneasy in confined or closed places?
Yes Yes Yes Yes Yes Yes Yes Yes Yes
0 0 0 0 0 0 0 0 0 0
r
NO~:"'-_ No [)( NOR! No.Qit No
Dt'
NOft'" No~' No' No
lSr
'#
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Exam Requested: of Special
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.. >
questions: Arm
.-",."."""",,,,,,,-.,,...,--~
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needed?
Yes
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backLl~lease,ask,theJ9110wing
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~=
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Yes 0
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SIGNATURE
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000472

REFERRINGM~EN. MARK
UCDa~is Health System '1 Out-Patient Consultation Request
VICTOR BAQUERO, M.D,

. . ------~
VI,
D~te: AU~HORIZATION #
MEj. RECORD#
FI
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AMUND.>
09/23/;
9;8 M 8081369
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Insurance Tvoe: o Health Net Se'\i.0!ity + o Secure Horjzol6Vl~di o BC Senior CaJ o Blue Shield 65 0 Prucare of California 0 WHA 0 WHA . GMC
0 0 Other:
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o '-f>atienfto make appt. o Specialty to call patient Dept, and Physician
PCP office to make appt. To Physician Relerral Center
Dept. Contact Name
Referred to:
tlJ~7
To BE COMPLETEDBy PHYSICIANONLY 0
I'I I
Contracted Community Provider
Please contact me if requested MD is not available 0 Urgent (within 1-2 days) 01'fOirtine
Requested Time Frame for Appt: Primary Reason for Consult: Reason(s) for Requested
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DOME/Orthotics -. 1 2 3
(attach copy of prescription)
, 0 ' Follow-up Visits included with referral (circle one) Olher: PHYSICIAN'SREQUESTFORNOTIFICATION:
0 Additional FlU VISitS:require prior authorization .

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Direct Phone#: . Fax#: E-mail: . VOice!Mail#:
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Please contact me via phone ASAP to discuss, Please FAX your report to me when available, Please MAil your written report when available,
Pager#:
_ _
_
PATIENT INFORMATION: 0 Med, Records wilh pt. 0 Pertinent Med, Records attached ADDITIONAL PATIENT iNFORMATION: c urrent treatment: ----------
0 Med, R~cord ProVid~on
Previous treatme :._
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Previous diagnostic testinq:
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71463728 (9/991
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peN ro~~or.
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,
UNIVERSITY OF CALIFORNIA DAVIS MEDICALCENTER, 21 SACRAMENTO, CALIFORNIA
USE PATIEN"B~f3TE AMUNDSEN

11
13 b g If
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39-462515006
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08139 P BLU[ 12/03
09/23/59
BAQUERO. VIelO SHl[LO-UCDCAP
916-983-2589
110
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HISTORY & PHYSICAL

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Physician you are here to)see:_~O~~~_~f.,~~~'IJ_v_5<=o.=tIV Referring physician: /2 4/JQ.,U~7Z0 Address: Other physicians involved in your medical care (names and addresses):
_ _ _
Chief complaint/main concern for which you visit us today:
IOU/tf7L Moe
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If injury, please provide date and brief description of events:
Education: 0 Grade school 0 Middle school 0 Colle e 0 Graduate school Marital status: OSingle )8l\narried Separate OWidow(er) ODivorced Currently employed~es, full-time 0 Yes,-part-!iine 0 No 0 Disabled 0 Retired If yes, occupation: (=/ flP /{lVvl ""cIlTc'
Do you currently smoke? 0 Did you preViously smoke?
0 ) If Yes,
If yes
19'.1-
packs/day, How long7 packs/day. How long? / Ii
Do you drink alcoholic beverages? (Y N) If yes, glasses/cans of per (day week month) Have you abused any drug? 0 Yes 0 No If yes, prescription drug:==~~==cc--,Recreational drug: ~caine OCrack OHeroin OLSD OMarijuana OMethamphetamine OOther: ) Worker's compensation case? Yes No Employer: Past medical history:
'lDl--B iLiS011"J'1\'/
bj-OtHlJ C 1<1J(;u11'JlL- J L PEL .stO:.)
Please list all prior major illnesses or injuries:
3 7!.11iJ5 , ,404e,
~.r
J W'~'J"
l:i~'.J1il1 l'O,JC/Lln s
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i
Please list hosplt I ar IZ alions and surgeries . In the pastf rve years: Date Reason hospitalized
Surnerv
Please complete regarding current medications: e rca ton name osage 11

v_ -
How often do you take it? Il1(. Y ~ -. .'.
What is it for?
Is it
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000476
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Allergies
describe reaction:
to medications,
'
anesthetics,
?!"?
x-ray 1 --
dyes or foods? I I J
Familv history Father Mother Sibling(s) Children Recent x-rays,
Alive/
Dead
Age
Aae death
Cause
of death
Other
siunltlcant
diseases
in familv
( )NJ(
/ll.JW/ Aiu(.(f 4(gj'J1,

CT scans, MRls (including
OhJO
7~
7:
(J/VK
7S
(JIJY
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Please
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dates):
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ttlCr
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?n
check
the symptoms
that best describe
your condition.
CONSTITUTIONAL SYMPTOMS Fever Night sweat Weight loss Loss of sleep
o o o
CARDIOVASCULAR Shortness of Breath Chest Pain Irregular heart beat Palpitations Irregular heart beat High/low blood
o o o o o o
o
o o o o o
D O
GENITO-URINARY Any burning of urinat.on Painful urination Dark or discolored urine Blood in urine Difficulty startlng/endtng Urine
stream
o o o o o o o
HEMATOLOGIC/LYMPHATIC Swollen lymph nodes Easy brUising Nose bleeds Prolonged bleeding from
cuts
Nose bleeds
o
D
pressure
Poor control of bladder Any type of sexual dysfunction Inability to obtain/ maintain erection
Loss of sensation,
ALLERGIC/IMMUNOLOGIC Body Rash Hay fever MUSCULOSKELETAL Swelling Masses Neck pain Neck spasm bLCramps )21. Abnormal arm or leg feelings
o o o o o o o o o o o o o o o D o o
Poor circulation Rapid heart beat Swelling of ankles

Varicose veins
o o o D o o o o o o o o o o
D
genitals Loss of libido
o o o o
RESPIRATORY Chronic cough Productive cough Coughing blood Asthma Emphysema Bronchitis Shortness of breath
ENDOCRINE Discharge from nipples Poor appetite Excessive hunger Excessive thirst Cold intolerance
Heat intolerance
Loss of body half Weight gain
PSYCHIATRtC Depression Disonentation Hallucination Euphoria Anxiety Panic attacks

Restlessness Nervousness
WOMEN Breast lump Hot flashes Abnormal Pap smear Bleeding between periods
Extreme menstrual pain Painful intercourse menstrual periods
o o o o o o o
Back pain Weakness Loss of control of arms or legs MUltiple broken bones Poor coordination Numbness Tingling Loss of sensation Loss of muscle bulk
Arm or leg weakness
o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o D o o o o
NEUROLOGICAL Fainting
Poor Vision
Blurry vision Double vision Visual flashes or halos Loss of hearing (one or both ears)
RingIng In ears
Numbness in face Decreased ability to smell Decreased ability to

taste
Droopy face or eye

Hoarseness
Difficulty speaking Difficulty swallowing Slurred speech Headache Forgetfulness Dizziness Seizures
o o
SKIN Dry skin Skin rashes or eruptions
Cessation of
o o o o
MEN Breast lump Lump in testicle Penile discharge

Sore on penis
GASTRO-INTESTINAL Poor appetite Nausea Vomiting lndiqestion Difficulty swallowinq Hernia Abdominal pain Abdominal distention Gas Abdominal mass or lumps Rectal bleeding
Hemorrhoids
Date of last Pap smear:

Date of last period: Are you pregnant?
# of crutdren: __
Ages:. ans~red,
_ _ _ _ and understand
Blood in stool Dark colored stool Diarrhea Constipation
"My signature
Patient/guardian
signifies
that I have ~
re~uthfully .'/r
signafure:
,'N~
fhe above Date:
;2-.i.Z1-7
000477
information."
USE PATIE~T PLATE
. 808
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AIIUNDS[I'I
13 b9 4
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'A DOG";:
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02
UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER, 2 I a>~CRAMENTO, CALIFORNIA
09/23/59 916-983-2589 08139 BAQUERO. VICTO
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12/03
BLUE
$H!ELD-UCDCAP
PCN fOLSOM
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HISTORY & PHYSICAL
Where is your pain? Please shade in the area(s) where you feel pain.
r
~~I. I -I
Mark an "X" on the line to represent
-I
___
Ii
How long have you had back/neck pain? How long have you had leg/arm pain?
'1
I ~
Years Years
the intensity
of your pain.
___ ___
Months Months
____
Weeks Weeks
~eiJ(jOO)II
~~~~=MJ~
~~(!1l~
000478
This questionnaire has been designed to give the doctor information as to how your pain has affected your ability to manage in everyday life. Please answer every section, and mark in each section only the one box that applies to you. We realize you may consider that two of the statements in anyone section relate to you, but please Just mark the box which most closely describes your problem. Section 1 Pain Intensity Section 6 Standing o 1 can tolerate the pain I have without having to use o I can stand as long as I want without extra pain. pain killers. o I can stand as I want but it gives me extra pain. 0. Pain prevents me from standing for more than 1 hour. o The pain is bad but I manage without taking pain killers. )'S Pain prevents me from standing for more than 30 o Pain killers give complete relief from pain. minutes. )!'t Pain killers give moderate relief from pain. o Pain prevents me from standing for more than 10 ID Pain killers give very liltle relief from pain. minutes. o Pain killers have no effect on the pain and I do not o Pain prevents me from standing at all. o use them. Section 7 Sleeping Section 2 Personal Care (washina, dressing, etc.) o Pain does not prevent me from sleeping well. ~ I can look after myself normally Without causing extra o I can sleep well only by using tablets. pain. ~ Even when I take tablets I have less than 6 hours sleep. o I can look after myself normally but it causes extra o Even when I take tablets I have less than 4 hours sleep pain. o Even when I take tablets I have less than 2 hours sleep. o It is painful to look after myself and I am slow and o Pain prevents me from sleeping at all. careful. Section 8 Sex Life o I need some help but manage most of my personal care. o My sex life is normal and causes no extra pain. o I need help every day in most aspects of sell-care. o My sex life is normal but increases the degree of pain. o I do not get dressed, wash with difficulty and stay in ~ My sex life is nearly normal but is very painful. bed. o My sex life is nearly absent because at pain. Section 3 Lifting o Pain prevents any sex life at all. o I can lift heavy weights without extra pain. Section 9 Social Life }olJ I can lift heavy weights but it gives extra pain. o My social life is normal and give me no extra pain. o Pain prevents me from lifting heavy weights off the ). My social life is normal but increases the degree of floor, but I can manage if they are conveniently pain. positioned. i.e. on a table. o Pain has no significant effect on my social life apart o Pain prevents me from lifting heavy weights but I can from limiting my more energetic interests, i.e. manage light to medium weights if they are dancing, etc. conveniently positioned. o Pain has restricted my social life and I do not go out o I can lift only very light weights. as often. o I cannot lift or carry anything at all. o Pain has restricted my social life to my home. Section 4 Walking o I have no social life because of pain. ~ Pain does not prevent me walking any distance. Section 10 Traveling o Pain prevents me walking more than 1 mile. o I can travel anywhere without extra pain. o Pain prevents me walking more than V, mile. o I can travel anywhere but it gives me extra pain. o Pain prevents me walking more than y., mile. Pain is bad but I manage journeys over 2 hours. Section 5 Sitting o Pain restricts me to journeys of less than 1 hour. o I can sit in any chair as long as I like. o Pain restricts me to short necessary journeys under O. I can only sit in my favorite chair as long as I like. 30 mmutes. ~ Pain prevents me from Silting more than V, hour. o Pain prevents me from traveling except to the doctor o Pain prevents me from silting more than 10 minutes. or hospital. o Pain prevents me from silting at all.
Please read:
Neurological Surgery Patient Questionnaire - History
AI-
'My signature signifies that I have read2 PatienVguardian signature: ~~
~!\!J!J ansjYered,
P'~J';-----
and understand the above information." _Date:_.;) c:J1-O J
000479
DATE:
TIME:
DOCTOR:
VICTOR BAQUERO; M.D.
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Dr.2. II\J~~
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RESPONSEZ
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DATE
I TIME
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..:
000480
e
DATE: DOCTOR: . ~-----~----TIME:
VICTOR BAQUERO;M.J.
RESPONSE
DATE
TIME
SIGNATURE
FOLLOWUP ..
"'
~'lD~AT~E
'ST:,M E
1 O\.:j:3
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-SIGNATURE.
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000481
DATE: DOCTOR:
TIME:
. V\C:fOR BAQUERO~M.J ..
CALLER:
PTNAME:<;
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PHON~'~;J:l?%\q~ ~o!bi: '.

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INSURANCE;:i
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. PHARMACY
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MESSAGE
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?-Jo lD-03 ~O
DATE TIME ~NATURE
RESPONSE
FOLLOW-UP'
r*;.
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4-DATE
~LI(\~
~
&
SIGNATURE
TF!FflHnNF nwnllNTFR
000482

REFERRINGMD P,~TIEN'
I
I
toavls He~lth System ' I Out-PatientConsultation Request
fECEJVED
V1c;rOR BAQUERO, M.D. ,._---------M
Date: AUTHORIZATION_
MED. RECOR~R __
AMUNDSEN .MARJ<
. 0912311959'
Patient
Parenti
-aoB [369'
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2_1_2003 __ !vte',,"'dICll Records

o o o o o o o o 'I' Health Net PacillCa<e BC Celifornia Care Blue Shield/HMO Blue Cross GMC CIGNA Medicare MediCal Phone .
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79406336119 UCD/S/S HMO
08139 S, QUERO. VI
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91698?:2,589 9167192030 HOME WORK
DOB: " ,
Insurance Tvpe: o Health Net Seniority + o Secure Horizons o BC Senior o Blue Shield 65 o Prucare of California
Addres : Home I.. o o

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Patiennornarle"apPl;---"""O -r-r-c.r-omce-ro make appt. Specially to call patient 10 To Physician Referral Center Referred to:
ti,\y.,llI;'""". r: ,l 'ili:!ni~I" ,. ,~o""/
o o
WHAGMC
o Other: Dept. Contact Name
o Please contact me if requested

Requested Time Frame for Appt: Primary Reason for Consult: Reason(s) for Requested
Dept. and Phyalclan
AO BE COMI!LETEDBy V0.-..::.. c.~ IL

MD is not available
PHYSICIANONLY
Contracted Community Pr?Vider
-> 0'Rou\\ne
Pro~lem ,/' _ _
1- :9-4-
0 Urgent
Problem
(within 1:~ days) ae:?niC
0 New
Service:
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REFERRAL REQUEST:
On-going management of condition within your field of expertise. (Subjecl to Utilization Review amI Authorization) Confirmation of Diagnoses
Second Opinion
0 0
..... 1
Recommendation(s) lor OxfTreatment oPtionsl
Evaluation of abnormallinding: Procedure: .________
0 Lab
0 X-ray
2 3
0 Physical Finding
0 Additional
0 Olher
\
DMElOrthotics (attach copy of prescription)
Follo,w-upVisits included with referral (circle one)
FlU Visits require prior authorization
o o o
Other: PHYSICIAN'SREQUESTFORNOTIFICATION: Please contact me via plhone ASAP to discuss. Please FAX your report 10 me When available. Please MAIL your wrilleri report when available. Direcl Phone#l: Fax#l: E-mail:
I '
_ _
Pager#l: Voice Mall#l:_I
I
I
\
PATIENT'INFORMATION:
0 Meld. Records with pt. 0 Pertinent Med. Records attached 0 Med. Record provide~~req~s~.
Previous trealment:
AllDlTIONAL PATIENT INFORMATION: Cunenl Imalmen\: -----------
~.j.{
II ['({7
I
Prior Consultants: Prllvious diagnostic lesting: _, _
-----------------------
//~V\ _____Y~l .... ,.
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000483 ... J.
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NURSES PROGRESS NOTES PAIN MANAGEMENT CENTER

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NEW PATIENT FOLLOW-UP ATIENDING FELLOW
PATIENT WEIGHT
:293/
DYES DYES IN LAST 7 DAYS
NURSE/MA
l ~
PROCEDURES ONLY
NPO DRIVER NSAIDS IN LAST 3 DAYS ASNWARFARIN CONSENT NEEDLE SIZE PROCEDURE PROCEDURE PROCEDURE START TIME END TIME
o NO o NO
DNO DNO INITIAL FLUORO DYES
DYES DYES SITE SALINE LOCK/IV
~O{Le.-o NO
VITAL SIGNS TIME PRE-PROC.! ADMIT PAIN 0/10
/ A r.:';l:,
6 7J /0
I
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B/P
PULSE
?/f
RESP.
02 SAT.
17 Ju
POST-PROC.
ASSESSMENT:
STATU~.COMMUNI~:rION .~ HENSIVE CONFUSED ORIENTED COLOR FLUSHED PALE COOL LANGUAGE BARRIER DEVELOPMENTALLY DELAYED ?P/CONDITION DRY DIAPHORETIC OTHER RI;.SPIRATORY cYNLABDRED MINIMUM DISTRESS OXYGEN @ MOBILITY
TAl ALERT
--~
RASH OTHER: __ .... _ _
l./MIN COMMENTS
~AL
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W/ASSIST WHEELCHAIR
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PATIENT EDUCATION ASSESSED INFORMATION GIVEN BARRIERS TO LEARNING: SEE ABOVE (Communication) INDICATED UNDERSTANDING VERBALIZED RETURN DEMO INITIAL __
~/J;P* .
~ ~ 0 NO 0 YES 5YES ~~_ UNDERSTANDING," 000484
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PHYSICIAN PROGRESS NOTES
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I was present and directed to Dr. __ "" Assessment and Recommendations.
~_' '~; ~~
for the history and physical exam, and
The history obtained by Dr. was reviewed and verified with the patient. The physical examination was repeated. The Assessment and Recommendations were developed with the Resident/Fellow/N P.
Go-r.eu,"4v
The patient was seen and examined by the Attending Physician or Nurse practitioner.. See dictation for details.
Chief Complaint HPI~(keye~:ments) ~OliO vII-. '3. 1-/ 10
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1. 2. 3.
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~ecords 0 -Jrn age Report l ~ Image Viewed 0 - EMG/EKG Report 0 - EMG/EKG Viewed 0 _ Lab Result
L - f4<::..c2-1- cvrK
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5.
0 .. Discussed with another physIcian
1/z~A3
Date
000485
USE PATIENT PLATE
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PATIENT EDUCATION
"
APPOINTMENT DATE: _
Return
to clinic
in:
Physician:
~l;tlJb cY"Z' PbJ1f!J Z/J

No
Follow up :KYes 0 No
Days / Weeks / Months
APPOINTM~N NEED AUT INITIALS: -,
: NO ,
o o
Follow Other
up
0 Extended
0 Complex
Reeval
0 TriplicatiRx. 0 Referral
FLUOROSCOPY:
o Axillary Nerve Block o Bier Block o Blood Patch o Cervical Epidural Steroid o Caudal Epidural Steroid o Cryoablation o Celiac Plexus Block o Discogram o Facet Nerve Block o Gen-Fem Nerve Block o Hypogastric Nerve Block
OIDET
o Impar Ganglion Block o Intercostal Nerve Block o Ilioinguinal Nerve Block o Lidocaine Infusion o Lidocaine Push o lumbar Sympathetic Block
116 lumbar
Epidural Steriodt:L
o Medial Branch Block o Occipital Nerve Block o PNT o Phosphenytoin Infusion o Phentolamine Infusion
o Piriformis o Pulsed Radiofrequency o Pump Refill o Radiofrequency o SI Joint Injection o StimTrial o Stellate Ganglion Block o Selective Nerve Block o Third Occipital Nerve Block o Thoracic Epidural Steroid o Trigger Point Injections o Tens
INSTRUCTIONS:
IFYOU ARE lZl' Nothing to Nothing to JZl You MUST )21 No aspirin
ii1
SCHEDULED FOR A PROCEDURE, PLEASE FOllOW BELOW eat for eight (8) hours before procedure. drink for four (4) hours before procedure. have someone drive you home. You cannot use a taxi or bus. or aspirin drugs ~or seyen (7) da~rior to procedure,
r.
ri Other Instructions:
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.:3
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12/-ocedu/I.L (
IFYOU RECEIVED A PROCEDURE TODAY, PLEASE FOllOW BELOW INSTRUCTIONS: Notify our office (@ 916-734-7246) if you experience any bleeding or swelling at injection site, signs of infectic (increased oral temperature, drainage or redness at injection site), severe pain, severe headache, numbness, itchin or rash. Do not take a bath, swim or use Jacuzzi for 24 hours after procedure, a shower is fine. . ACTIVITY
o No restrictions
L1MITATIO/lS
Iti No driving
AFTER TODAYS PROC for
!Lhrs
DURE: . ited-aGtivl for z..4hrs t keep your appointment, please ca
For further questions plea us 48 hours in advance. Ttl nk you. PATIENT~~
NURSE Authorization
~Q:
J?rH. ~ V -'l'YV1notes:
Details/Coordinators
000486
808 13 bC1
M
09/23/59
.~HuMasr:~ , HARK
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08139
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39-462515006" 916~9B3-25B9
rOlSOH
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072105
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"" ~UNIVERSITY
.i
61
OF CALIFORNIA DAVIS MEDICAL CENTER, SACRAMENTO, CALIFORNIA
',12/0:1, :iDAfE 711 \\

TIME IN TIME OUT ALLERGIES:
BLUE
CROSS
POl
02::>
OAQUrno.
PBP
YIerO
HO
'.
NEW PATIENT 0 0 ( ) jA~ ~ FOLLOW-UP ATIENDING FELLOW NURSE/MA
I''L L.\ 0
1: bU prO~'D
..wu
~
l,JAlh~
LI,,J(
_
PATIENT WEIGHT PROCEDURES ONLY
NPO DRIVER NSAIDS IN LAST 3 DAYS ASA/WARFARIN IN LAST 7 DAYS ONSN NE LE SIZE PROCEDURE 2. S~IV
~ mES 0 YES 0 YES SITE
ONO
0!:l0
0N0
cf NO
INITIAL~ __ ONO
1/ E::? *1.. (
2 C::r
t;L, ""C
PROCEDURE START TIME PROCEDURE END TIME
13 t a 3 ?O
PAIN
FLUORO ~YES
PREPROC.! ADMIT
,;Zy
TIME
S-
0/7
L)
VITAL SIGNS
D
D
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B/P
PULSE
RESP.
7'7
6j
Ie...
1::2-
02 SAT.
?;?
9JL
POST-PROC.
----'.1::'
'4)
--I
'-=3 /,
15"6/'17
f '-Irrv
ASSESSMENT: MENTAL STATUS COMMUNICATION GUAGE BARRIER DEVELOPMENTALLY DELAYED TEMP/CONDITION
3/10
c:WlD ~ APPREHENSIVE
CONFUSED ORIENTED COLOR
c=
RESPIRATORY
SKIN
ONLAB~RE~ ~ MINIMUM DISTRESS RASH OXYGEN OTHER: @ UMIN
.+-~
INITIALS ~
FLUSHED PALE COOL
:JiBD
. DIAPHORETIC OTHER _
MOBILITY ,-.MOVES WEW W/ASSIST WHEELCHAIR
PATIENT EDUCATION ASSESSED ~ INFORMATION GIVEN ~o BARRIERS TO LEARNING: 0 YES IDO SEE ABOVE (Communication) INDICATED UNDERSTANDIN 0 NC 000487 VERBALIZED UNDERSTANDING RETURN DEMO INITIAL _ {J,j\/
7)0
e
Return to clinic Physician:
~.,2' of
UNIVERSITYOF CALIFORNIADAVIS MEDICALCENTER, SACRAMENTO, CALIFORNIA
PATIENT EDUCATION
~eJ~
~es
in:
'-\-
'
up
Days @s
/ Months
t:n-JC'/
Follow
o Follow
o
Other
up
0 Extended
0 Complex
Reeval
0 Triplicat/Rx
0 Referral
FLUOROSCOPY:
0 No
e
e
o Axillary Nerve Block o Bier Block o Blood Patch o Cervical Epidural Steroid o Caudal Epidural Steroid o Cryoablation o Celiac Plexus Block o Discogram o Facet Nerve Block o Gen-Fem Nerve Block o Hypogastric Nerve Block o IDET
YOU ARE 'Nothing to Nothing to You MUST No aspirin
o Impar Ganglion Block o Intercostal Nerve Block o Ilioinguinal Nerve Block o Lidocaine Infusion o Lidocaine Push o Lumbar Sympathetic Block-
o Piriformis o Pulsed Radiofrequency o Pump Refill o Radiofrequency o SI Joint Injection o Stirn Trial
Ganglion Block
IX!'Lumbar Epidural Steri~d VS;D\Steliate
o Medial Branch Block 5~lective Nerve Block o Occipital Nerve Block o Third Occipital Nerve Block o PNT o Thoracic Epidu'ral Steroid o Phosphenytoin Infusion o Trigger Point Injections o Phentolamine Infusion o Tens
ej
eJE!,
SCHEDULED FOR A PROCEDURE, PLEASE FOLLOW BELOW INSTRUCTIONS: eat for eight (8) hours before procedure. drink for four (4) hours before procedure. have someone drive you home. You cannot use a taxi or bus. or aspirin like drugs for seven (7) days prior to pro edu e.
Other Instructions:
~o' rJ'S~:5
-;.
;p
i,
IF YOU RECEIVED A PROCEDURE TODAY, PLEASE FOLLOW BELOW INSTRUCTIONS: I Notify our office (@ 916-734-7246) if you experience any bleeding or swelling at injection site, signs of infection i (increased oral temperature, drainage or redness at injection site), severe pain, severe headache, numbness, itching! or rash. Do not take a bath, swim or use Jacuzzi for 24 hours after procedure, a shower is fine. ' ACTIVITY
o No restrictions
LIMITATIONS ~
AFTER TODJ\YS PROCE,,9.URE: driving for
_2:_:lf-_ hrs
.0'l..imited
activity for ~
For further questions
please call 916-734-7246
OR 1-800-770-9269.11 you cannot keep your appointment, MD ~ ~
us 48 hour PATIENT NURSE
in advance. Thank you. ~~
rJft
hrs please call:
L
n Details/Coordinators notes:
:
,
000488
The purpose of this form is to advise. you of important information
;~ ;ou. PLEAS'
I authorize
regatding
the operation
or procedurets) as associates
tt~~yoqr doctor has recommended .

or assistants to perform the following
RE D THE E TIRJ;1FORM CAREFULLY BHORE

~ ~
SIGNING IT.
/1 I
JIJ/t.r.
,
.
.D., and those who he/she may designate
operation or meaical pr
Z~/iM-57
7
. .
~
-
as well as any related
or incidental I understand
qiagnostic or therapeutic
that I will be mfortued
procedures
that they believe
may be necessary. to refuse substiturion.
of any-substitution
of the doctor named above and will be given the opportunity
.
I ACKNOWLEDGE
(a) The purpose
h/,"&'(<(S
THAT THE FOLLOWING

benefits
INFORMATION
operation
HAS BEEN EXPLAINED TO ME:

described above;
and expected
of the proposed
or procedure
(b) significant risks ,or possible complications (hat are known to be associated with it; (c) reasonable alternative methods of treatment '(If any): .(d) The possible effects to my health if I should refuse to undergo the operation or procedure; (e) research or economic interests (if any) that. are related to the performance of this operation
and or procedure.
rr~
Gporl~~~ Ji..... --:T";1/;

/J
&- ~
~1"''/1.2
'1Y1 .
BLOOD TRANSFUSIONS
understand that unless a medical emergency exists, or it was determined to be medically inadvisable, my doctor wi a e inrormed me if there was .a reasonable possibility that a transfusion or blood or blood components may be necessary. T understand that there are various options available to me regari::ling blood transfusion, including the right to refuse blood or blood components. [ understand that refusing transfusions that arc recommended by my doctorts) may result in life-threatening consequences to me . 1 .un~erstand that certain risks and complications' may be associated with blood transfusions, including, but not limited to transmission of . infectious diseases and transfusion reaction.
ANESTHESIA
[ authorize the administration of anesthesia if It is determined risks and complications may be associated with anesthesia .alternative choices of anesthesia (If any), to be necessary to assure my safety and comfort. I understand that certain use and that they have been discussed with me, as well as reasonable
.AUTHORIZATION
AND CONSENT:
that: the nature and purpose of this or guarantees
(0
By my signature below, I confirm (I) I have read this form;
. (2) I have been given the opportunity' to discuss with my doctor(s) any questions that T may have regarding operation or procedure, and my quesnons have been answered fuJJy and to my satisfaction; ,(3) I understand that the operation or procedure may not accomplish have been made to me as to the result or cure; and the desired purpose
and that no promises
of any kind
(4) I understand that extra services such as laboratory studies or x-rays may be ordered if determined by my doctor(s) (5) I ,have the right to consent or to refuse any proposed operation or procedure prior to its performance,
be necessary:
PATHOLOGY SERVICES
I authorize the hospital may be removed.during pathologist, at his or her discretion. to retain, preserve, or dispose the procedure subject to the following conditions (if any), of any tissues, organs or medical devices that
NO INFORMATION REQUESTED:
Although given the opportunity to have tlus information explained to me, I specifically d~cline to be advised of the nature, benefit, risks'
.~nd Date
tz:
.
ol3roposed
operatlOn/procedurea~::;~;::s~_ ~IENT . OF OR PATIENT'S LEGAL REPRESENTATIVE AND RELATIONSHIP TO THE PATIENT
000489

fl
Z:2..~
D~IS
FA nElfT IF.'M1l. Y EDUCATION ASSESSMENT PBllort I Fsrrii,' ~Nee<i3lrlonli5od? BarrierI? -0 None O,~ ~? ~ertIalimd 00."0 CotmwntII MllIoria SIGW.l1JRE -/
O~.
YES
0 NO
Pain? Intenslty~
eYes
P"VLA.
[J N~
In, ",n..
I~
.10
@JI ~~~
~--;.
\\ew~tV\.V\)\ct:6 / --~ / __. L) ~'~ti

..
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f&
;> So'/.
cp /-
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" wi
( II
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/VI1P
2o~._
~~Ale-l<...
y
__
3~
p;(,,;~,,- f
fJ~d
en
'{A ~
C-L~'
C~/S~
Q.'00'
,
~ .. -
dJ ry} ~
fVl..J.u
0..; ~
ccyJ.
-------------
000490
I
PATIENT NAME:
DAVIS MEDICAL GROUP,FOLS(

MR #: _-_' Date: Dr(sign):;y, Sig:same 0 denrea 0 ChngO: . Quant: ~ #refs.(p Comments: Last filled: Pharm: Phone: Sign: Date/time: '_
4'/H.n~L, ~q~K:Date:
"e/lz/~'
bile;,.
Date Dr.tsiqn):
11113/03
DateO.
\ -,
,,\\3
Meo
cranes gen.namesDr(sign): /0 ~
,</<-A:o
Sig:same 0 den-eo 0 Sig:same 0 denied 0 chngo: ,chngo' , Quant: #refs:# Quant: #refs:
Sig
-i-;Po (i.?:/I Comments:
.1E2.
I.
Cl!2..
6)
Dr.(slgn) rN' Siq.sarne 0 den lea 0 chngo_ _ Quant: V#refs:2:..-
tv
Comments:
'_
Comments:
Quantity: Ox.
o~o
---
[\?
Comments:
. l'l'\1O-z.
) 2
Mea. crane
Sig~~Q,
;;;;{i;iii t -:.!:!: ".':":':':". O:~~\. GiL <fl.v ()~

~S I
'f:
Date:Q
Date: Dr (siqn): Srq.sarne 0 denred 0 cnng 0 . Quantt.2#refsComments. _ Last filled: Pharm: Phone. Sign: Date/time Date: Dr (sign). Siqsarne 0 denied 0 chngo' Ouant #refs. Comments:
Date.
Dr.isiqn):
0'1
Date4:qQ04Dr ts.qn I Siq.sarne 0 denied 0 chngO----rQuant: #refs'
""'IIi"Ci.i
Dr.tsrqn): Siq.sarne 0 ceruec 0 :: :. '. ~hng 0 :

_'
-..,k-
Siq.sarne 0 ceruec 0 chngo' Quant:
#refs
\,,>5 #refs
J3.
Quantity Ox' Comments
,:ti!cr:.;
.. ' . :.:
.-'!-. .: .. :.",.
. .
D~~ntS
Comments .. Last filled: ----Pharm: ----Phone: Sign.: Date/time: Date:

Dr.rsiqn):
Comments: Last filled: Pharm: Phone: _ Sign' Datelt Date' Dr.tsiqn) Sig'sameo chngo' : Quant:
flll~d: F;tie'rm: 'Phone'
:~l
----
2'
Sign ~ Date/timi.C:ft\:O~ Date' '2.-'

~. bra no & oen names Dr.(sign):
'
1-,,0'2:;>
-f1J In ~
V'D
#refs({}
Sig:same 0 denied 0
cnnsta
slg-T
ffi0\:)
tsO
Quant: (~ Comments:
Sig:same 0 denledo chngo' Quant. #refs. Comments:

I
denied 0 #refs:
Comments'
Last filled: Pharm Phone. Sign Date/time. Date'
Quantity' Ox: Comments.
Last filled. \ \,.00;. Last fillea: Pharm: Pharm: I Phone.j, 3'5'k114Phone: Sign: (' Sign'
J'Jr\e-s,
t.ast filled: Pharrn: Phone: Sign: Elate/time: Date' Dr.tsiqn): , , Sig:sameo chngo' Quant: Comments: Last filled. Pharm: Phone: , Sign: Date/time: denred 0 #refs
Date/time: Date: Med:

brana & gen names
". Date/tune. 1L.--' OQ

_ denied 0 #refs: Date:
Dr.tsiqn).
Dr.istqn): Sig:sameo
cnnsrr
Slg: Quantity.
Ox.
Quant: Comments:
Siq.sarne 0 denred 0 chngo' Quant: #refs: Commeiits:
Dr.tsiqn): Sig:sameo chngo ouanr : Comments'
denred 0 #refs:
Comments:
Last filled: Pharm: Phone: Sign' Date/time.
Last filled: Pharm: Phone: Sign: Date/time:
, Last filled: Pharrn , Phone' Sign' . Date/time:
mearil7 XIS JA 1/96
MEDICATION REFILL RECORD
000491
090803
UCD PAIN MANAGEMENT CENTER PROCEDURE VISIT (TREtlMENT)
Diagnosis: Medications
Current
AntIdepressant
Date .---l.---l_ nme _:_

Refilled today
Brief Chronological Description (Previous Encounter To Presenl

New medication (s) _ %
_ __ Overall improvement
Anticonvulsants
NSAIDS
Block #1 Block #2 Block #3 Relaxants
Opiotds
Muscle
Pain score after last block ~1 Complications

---' Overall improvement after procedure
0 for __
hours __
days _
_
Other
Procedure
Risk, benefits, alternatives of procedure explained to patient Indication 0 yes 0 no
(please
see Nursing
Notes f~r detailed
description
of vital signs)
The patient understands and consents
0 yes 0 no Approach ,~edi' D oblique
o LBP o cervicalqra o RS9;\, ;:: ()
.E..WtiQD.
full
~d(ne alcohol gown,jtptib:ctie
c.0,-,
I~r,/
r.
0 s,tung ~e 0 lettlateral 0 rightlateral ~ves ~e
supine
~k,
I.2>ll! '
Lido ________
+%
o o hebaclens o intradiscal cetazonn

/
El rrudtrne
(9
L>
with epl_":'_",cc % _cc
~pue Intersoace/Location DT~LS-: ,.a;:c>R to air D LOR to saline DC__ 0 hanging dcop Cnasstqnac's tubercle anterior-lateral portion of ~oscopy I ~ omnipaqu~ ---L-cc's vertebral bodies L __
5.(
1.<Jb
Active ~Qent _~mclnolone hyaruronan D saline Dabs alcohol
Needle/catheter sizEt". 1~ gauge ~ Touhy 0 Op site 20 0 25 gauge _inch Chlba 0 tape , 22 0 25 gauge _Inch sPina~1 D Racz catheter and needle
o o o
f/
...4::gec. 10~;
U I, ~mg __ units __ ml ml
fI"-'fUL,
Interventiona! Procedures 0 lotrequency temp for __ inutes 0 cryoana\ges tor minutes
ecat Eauromenl
C eedles
D5cm
(small)
o 10cm o 15cm
Complications Cd qono_
o blood aspirated
paresthesia D near syncope
Cyroprobes
o 1H3
D CSF aspirated
Pump Refill/lnt~rr'ogation
Old
New
o o Bactcten/day o Cronidine/day
Next refill date __
D Oplord/day Local/day
LofL(27Cvv\ ~ 5~J. c;
Stimulator' Adjustment
Old
New
S~perage
Frequency
1__
1__
Pulse-width
Pump bolus calculation worksheet - 8709 or 8703W catheters Total drug volume = inches of Implanted tubmg x .0056 + volume of pump tubing [0.26 rnl (low to high concentration) or 0.36 mJ (high to low concentration)] Bolus dose = total drug volume x new drug concentration - 1 ~ ~ Duration = total drug volume x old concentration I new hourly rate If It ISsame drug or L.--U I~ TU~ Duration = total drug volume x old concentration I old hourly rate if different drug L _
---L_~
c:s
Attending Note: (check one box) was physically present for the entire procedure. I was physically present for the key portion(s) of the ~ rocedure and, during other times, was immediately. available to return to the procedure, Billing guidelines not met.
i:ii~O 3'fz., AI-/"""1~ou.l

W..
' gnature: (C) Printed Name,--:
.Description of key portlons(s):
~~ .
u....
'. .~
'. '/01
10
~~~ .~-
l s-~ _tI .-L.
+: t
k~
d::"~I
000492
USE P
'I' .
"..
~808 13 b~ It
>;,
'lENT PLATE
"':"':~
~
Na::r
.~ UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER, SACRAMENTO, CALIFORNIA
AMUNOSN,
lURK
39-46U1506'6~
',~,'
090903,
DATE
:~qliI_o:=.~
/3 ?>'D
08139 BIIQU[RO. VICTO, i1D '.\ ~,p D1.U[ SH 1[LO-UCOCAp }' J!~ 12/03 peN rOlSOM ' /.. ti '
r'M t
09/23/59
916-983~2~~~ :"'"
?,

,r
NEW PATIENT FOLLOW-UP ATTENDING FELLOW NURSE/MA
0 0
TIME IN TIME OUT
ALLERGIES:;
~&.e..v.. -
II:}~ D
~1!4---,~ __
C t'\l
&Hk"1~
\;
"-S~
PATIENT WEIGHT
J- I '3
Ib,
PROCEDURES ONLY VERIFIED WITH PATIENT 0 NO 0 NO 6E(S)
NPO DRIVER NSAIDS IN LAST 3 DAYS ASAIWARFARIN CONSENT NEEDLE SIZ~:y? PROCEDUR~'5 PROCEDURE PROCEDURE START TIME END TIME IN LAST 7 DAYS
~ES ~ 0 YES 0 YES SITE
lliJ ----SEDATION 0 YES
[I] ----0 NO RECORD,
g--r:j'0
141<0
(IF YES) SEE SEDATION PROCEDURE INITIAL _ FLU ORO f$YES 0 NO
SALINE LOCK/IV
VS
I:?:. 5..S itt /0
~Q,
VITAL SIGNS TIME PRE-PROC.! ADMIT PAIN 0/10
Lot
PULSE
7'0
RESP.
6
/1.-
7'
02 SAT.
POST-PROC,
97
.7
ASSESSMENT:
~STATUS APPREHENSIVE CONFUSED ORIENTED COLOR -LNORMAU FLUSHED PALE COOL
-::)
COMMUNICATION LANGUAGE DELAYED BARRIER
....-t!NlABOSW
OXYGEN
@.
RESPIRATORY MINIMUM DISTRESS UMIN
SKIN
~
RASH OTHER: _
DEVELOPMENTALLY
TEMP/CONDITION
MOBILITY ~VESWELL:> IASSIST
f!S~ETIC OTHER _
WHEELCHAIR
INITIALS
NQ,
PATIENT EDUCATION ASSESSED ~ Ai INFORMATION GIVEN SOP 1X-:_~(JtfI/, BARRIERS TO LEARNING: 0 YES 12l"'YES
j~
NO' 0 NO
SEE ABOVE (Communication) INDICATED UNDERSTANDING VERBALIZED UNDERSTANDING INITIAL RETURN DEMO
000493
'.
BrlorI? :.0
~ PaIlert!/ Fa:ri!y~ VOlIbaIized IdenIifiod1 . Cl'r'Es 0 NO
Colmwntt , MaloIlals:
SIGIIAl'JRll
i
0 O"""''''aW
Pain? ~es 0 IntenSlty~~~
0:.
:3
000494
DOe
7-}- J-5
ES:
?_
I OATE/
IlP
f2 PAnENTIF~~YED TIONASSESSMENT'/ Pallen! I F anily E Needo Idotuinod? 0'Yes CJ NO
TJ)
rot' ~'"
NOf.If.I<NOWN
NONE
J_ j-0,-s,
I
_
j
Barrien? .
Na>eJr.:
/-
Pain?
)(Ves 0 N~
~? EfY",taIizod COntrentlI MlI1orlab: )

SIGNATURE
Olloool<lJ.W
-------------,,"",
Intenslty~
\2.4otl;
------------------
000495
USE PI\TIENT PLAi F
"
808 13 bC,
AHUHOSt.1
'" P
O~/2~/~~ OUH
916-9GJ2569 , OS13S 9~QU[R6. vtcro "0

SH 1 tlO-I,IC(}c.~?
."'AAI<
\f
3S-46U1SOO&'
':l
Ii I 0 s GUCD PAIN MANAGEMENT

CENTER PROCEDURE VISIT (TREATMENT) Date.--.J.,.,.,.-J_ T~'re_:_
I ~ r ":"
DiagnQsis: Medications
Antidepressant
Pi:: N r 0 t, $.0 II
(lJ ~c,IM
Current
J>
',
"'-~~"*lRefilled today
Brief Chronological Description (Previous EncounterTo Presen1

New medication (s) _
%
Anticonvulsants NSAIDS Opioids Muscle Relaxants Other
Overall improvement Block #1 Block #2 Block #3 _ _
Pain score after last block -J10 for __ Complications Overall Improvement after procedure
hours __
days _ _
Procedu
Risk, benefits, alter Indication ives f procedure explained to palien
L.., -5,
,),
Ji~.k
r
~1 ~
!f>lease see Nursing Notes for detailed descnptlon
of Vital signs)
.e:(yes 0 no
The patient understands and consents .J21Yes 0 no
J2!'lBP
DRSD
EQm1iQn
o cervrcalqra
o
o left lateral
,2"P"rone
o sitting
fujv
~~~e _
~ 0 right lateral 0 supine
o gloves
0
.0"'hetadine .r:xiIcohol gown, armtnonc
o hebaclens o mtrarnscat cetazolin

D L; ./ L.>
o .er
0
size
Approach midline ..E?ramedian oblique
_
~g' Op site tape I ~andal;
~
UdO~%~iCC ________ % _cc
Active
agent
o hyaluronan o saline
g(
Dabs
l;a'-triamcinolone
__ __ __
ID
~nlervenlional procedures mg 0 radiofrequency temp _oC units for __ minutes ml 0 cryoanalgesia x __
Technique Intersoace/Locatlon LOR to air 0 LOA to saline OeD T oging drop Chassignac's tubercle j2J"~roscopy ../ anterior-lateral portion of % ommpaque 240 .Jl.0.cc's ~rwbral bOdlet L__
o o
o o
.s; r
b.vi~ 18 020
~edle/catheter
gauge _,nch
Touhy
'(.V
~ \J;:) . ...r WJ
:020 025 gauge -=7t-fCh Chlba ~2 0 25 gauge~h spinal 0 Racz catheter and needle 0 _
rnollcatt n one 0 blood aspirated 0 CSF aspirated
6-i3--{ ,I
alcohOl
~ml '\;>V-[l'1
'i). S ... ~',,-p.t
for ---rln~s
>< <V
SpeCial EQUlpme~ RF needles SMK 05 cm 010cm 15cm Cyroprobes 1H3 (small) 0 2T10 (large)
o paresthesia
0
D near syncope
Pump Refill / Interrogation

Old New
~/
Stimulator Adjustment
o Local/day o Baclotervday o Olonldlne/dey

Next refilt date __
o Opfoid/day
9'p~\U1
Old Amperage Frequency
New
I}
V101-
..-.--
-3
1__
1__
Pulse-WIdth
10
Lv
'I
Pump bolus calculation worksbeet . 8709 or 8703W catheters Total drug volume = inches of implanted tubing x .0056 + volume of pump tubing [0.26 ml (low to high concentration) or 0.36 ml (high to low concentratrom] Bolus dose = total drug volume x new drug concentration Duration = total drug volume x old concentrenon I new hourly rate jf It IS same drug or Duration = total drug volume x old concentranon / old hourly rate If different drug
o I was physically
o
Attending Note: (check one box) present for the entire procedure. I was physically present for the key portion(s) of the rocedure and, during other times. was immediately availabie to return to the procedure. Billing guidelines not met.
000496
UNIVERSITYOF CALIFORNIADAVIS MEDICAL CENTER, SACRAMENTO, CALIFORNIA
Return to clinic in: __ ~~- __ ~
DISCHARGE INSTRUCTIONS
'l'.~:~~ .. ,
.
#,
APPOINTMENT DATE: APPOINTMENT TIME:
DaYS/QI
Months
NEED AUTH INITIALS:
Physician:
Ji'~~
up 0 Extended
~
Follow up 0 Complex Reeval 0 TriplicatlRx
o
o
Follow Other
0 Referral ~es 0 No
FLUOROSCOPY:
o Axillary Nerve Block o Bier Block o Blood Patch o Cervical Epidural Steroid o Caudal Epidural Steroid o Cryoablation o Celiac Plexus Block
4D,isCO!lram
,k
.r.\
r I
o Impar Ganglion Block o Intercostal Nerve Block o Ilioinguinal Nerve Block o Lidocaine Infusion o Lidocaine Push o Lumbar Sympathetic Block o Lumbar Epidural Steriod o Medial Branch Block o PNT o Ph os phenytoin Infusion o Phentolamine Infusion
I
I
')!f Facet +ieI've Slo~L't
-:{'!L _II!J Occipital Nerve Block
o Gen-Fem Nerve Block o Hypogastric Nerve Block

OIDET
o Piriformis o Pulsed Radiofrequency o Pump Refill o Radiofrequency o SI Joint Injection o Slim Trial o Stellate Ganglion Block o Selective Nerve Block o Third Occipital Nerve Block o Thoracic Epidural Steroid o Trigger Point Injections o Tens
I
INSTRUCTIONS:
IF OU ARE SCHEDULED FOR A PROCEDURE, PLEASE FOLLOW BELOW IXJ)lothing to eat for eight (8) hours before procedure. 0'May have ~LEAR liquids up to 2 hours before procedure. r;;r:You MUST have someone drive you home. You-cannot use a taxi or bus. 0' No aspirin or aspirin like drugs for seven (7) days prior to procedure. 1J1l0 NSAID (Nonsteroidal Anti Inflammatory Drugs) 3 days prior to procedure. DOther Instructions:
IF YOU RECEIVED A PROCEDURE TODAY, PLEASE FOLLOW BELOW INSTRUCTIONS: Notify our office (@ 916-734-7246) if you experience any bleeding or swelling at injection site, signs of infectio~ (increased oral temperature, drainage or redness at injection site), severe pain, severe headache, numbness, itching or rash. Do not take a bath, swim or use Jacuzzi for 24 hours after procedure, a shower is fine. : ACTIVITY
o No restrictions
LIMITATIONS
AFTER TODAYS PROCEDURE: fuimited activity for ~ hrs pointment, please call
E1No driving for ---..lYhrs
For further questions please call 916-734-7246 OR 1-800-770-9269. If you cannot keel> us 48 hours in advance. Tha ou: PATIENT NURSE Authorizati
_
~~
MD
000497
--l
------------------_
USE FlA!Jf?NT

~ ~
"\if' ,
PLATE-~
C'JI
808 13 b<1 ~
P
Ofl13S
I'
DATE' TIME'IN": TIMEOUT ALLERGIES:
I
,
AHUNDSOI ,HARK H 09/23/59 91&-983-2589
\2(03
BLUr. SHIELD-ucoeAP
!':'AQU(RO.
v r.c ro
o I 05
110
IHNURSES PROGRESS NOTES PAIN MANAGEMENT CENTER
/3q:;c;;;:~
I ~
peH
fF
~&i
rOLSOM
'
"
NEW PATIENT FOLLOW-UP ATIENDING FELLOW NURSE/MA
$I4.ifz
PATIENT WEIGHT PROCEDURES ONLY NPO DRIVER NSAIDS IN LAST 3 DAYS ARFARIN IN LAST 7 DA~YES .... CON NEEDLE SIZE PROCEDURE SA~ IV SITE "" ~' r9'YES 0 YES 0 NO 0 Ny ~(S) ~ -----0 YES 0 NO SEDATION VERIFIED WITH P~
CY'N"s..----'
~
(IF YES) SEE SEDATION PROCEDURE RECORD .
if5>
Z- 7-{".--
INITIAL~ FLUORO 0 YES 0 NO
PROCEDURE START TIME PROCEDURE END TIME
/ ~
ILl , S:SVITAL SIGNS TIME B/P PULSE RESP. 02 SAT.
d-O
PRE-PROC.! ADMIT
/3~
/7-'1 , s '-t
<;]-7
ICc
q7
POST-PROC,
1c.l5"'~
mj49
WPIRA"T~
~LABOR~' MINIMUM DISTRESS OXYGEN @ UMIN
0d
(INTACT ~ RASH OTHER:
/b
705
ASSESSMENT:
f1
_
ENT STATUS~C LERr ~REHENSIVE CONFUSED ORIENTED
~/A
NICATION
-----:;:..SKIN~
LANGUAGE BARRIER
DEVELOPMENTALLY DELAYED TEMP/CONDITION
COMMENTS W/ASSIST
PALE COOL
~
DIAPHORETIC OTHER _
WHEELCHAIR
~~
INITIALS
eLl
PATIENT EDUCATION ASSESS~E INFORMATION GIVE~ ~~~~ BARRIERS TO LEARNING: 0 YES SEE ABOVE (Communication)
~( __
. 0' ,
INDICATED UNDERSTANDING ~ 0 NC 000498 VERBALIZED UNDERSTANDING ~ A R..:..ET__ U=_R:...:N DEMO INITIAL, -1e'.~_
\TIENT
ooe
/l-~l1IL.
!VI MIL-
1z.>k1~
:~"
~I-rtfv
;ASON(S)
FOR VISIT (CHIEF COMPLAINn NURSING SIGNATURE " 0 NEW PRoaLEM Cl EXISTING PROBLEM ElM CODING, LOCATION QUAllT'{'
SEVER~TY
'NT
2-
2-'1
Il'!-
'1'1
Iv
.
'15 yo rl' h1~ /rr 1M vp /!MiL ("'tAN. J/.-J( kt':JJ"/ II- 1~/t/;-;(11S,1Y'1At /1v0&f /rv / ;.I!L.
~I_ PROaL-EM iil1
AOomONAL
HISTORY OR MEDI
ONo
.roo,? /
(:<I"'N4;
fed< K)1M"~{
/Tl/c;N,j
jl!fY'C,
Ii, '" j1""'/N fi'l

<':',M';"'
I ;'w<'Ff':"~' I/Ik,,,,,,
/O/J", "f'/s- pi/Is -.1.,7., Wt"O 4/

pTUCr,I'ttf
9-""
OURATION
Tao<ING cDmEXT MODIFYING
FACTORS
/10
,,,. .-fA.
IP,I2(c;.
1M-v..
if .r""ft:~f ,.1.{' c&uj.
by sl/hVyJ' t,J,yfr Pv> . CA"'I'&<~rI< ,?v, 'P"'HW';' Mn/h "'1kM.j1 JJC'KI1('
ASSOC .. SJGNSiSXS. BRIEF" 1,) 8920199202 . 99212-99213 EXT." >4 992O}-99205 99213-99215
EVI EW OF SYSTEMS
~onstltutional
,yes
o Negative
positIve Responses
Nol Aopllcable 99m 199212 One: System' 992U2'/'9921:" 2-9 Systems' 99203.1 98214 >10 Systems 99Z0S. 99214 5921-5
,NT I Mouth ~ardloYasc. ,esplratory 31 'o1usculoskel.

AST HISTORY
o Negative o Negative o Negative o Negative o Negative o Negative
Skin Neurological Psychlatr1c Endocrine Genftall Uro HemeILymph Allerg/lmmun.
o Negative
o Negative o Negative o Negative
Positive Responses
o Negative o Negative
o Negative
Immedlale family I Marital stetus / Employment Tobacco/Alcohol t Educallon t Sexual History
- Illnesses Ilnjut1es / OperEltlcn50 1 Immunizations
SOCIAL I FAMILY HISTORY Not Applicable 992D11 &9202 99lUt 99213,

99200 I &9214
99204, &9205
HYSICAL EXAM [check If exam]
~ ~
2 -3 Areas
PERTINENT FINDINGS
J Appearance J Eyes J ENT I Mouth J Neck J Cardiovascular J Chest (Breasts)
0 Normal 0 Normal 0 Normal 0 Normal .-.._",-.-.-.--'---'-,,0 Nonmal 0 Nonmal
Prob. Focused 1 - 5 Elements 9&2011 99212 Elq:i,.Prob.

6'" elements
o Abdomen o Genitourinary o Lymphatic

eurologlc
PERTINENt
FINDINGS
0 Normal 0 Nonmal 0 Nanmal
J"ResplF.3tory=D'No'nmal==c-='--,-,.-
9~199213 usculoskel. 0 Nanmal Detailed .. 6 sy5lEiffiSlarea5 '[J'Skln~~==.E1,Normal." 'oN w2 elements

12
"'!~' __ ~ft'!.t..!J;-"rlY..1;"I"l..t
:J
f
sysS/.areas "'92U3'1 99214 Comprelienslvlt 9+ syst / areas

99:204 / 99205
eernerse
"
In 2t
o Psychiatric
0 Nonmal 0 Normal
f;'~til",'"flwr .
5Iv'"til-I~
fj,
LtJ
.SSESSMENT
l.Vt>ttcl< eM.v'v }
c.i-,-t;!rJIl. It
I TREATMENT
PLANS
N~t iJ~{(
tHllvcw"L.
2.
JPu(d""d';'J
~
COMMENTS:
3.
ADDITIONAL
"OI~k fUJ!-' of", I S;.; I/-tJtl 10 0. uvch Yv ..1.0
a,
h Orltw
,Hu/
,r.d .
.J:",ech;",J
Iv.ve.
_ 0 Demonstrated
p neNT 1 FAMILY EOUCAnON'ASSESSMENT
Patient I Faml~tm Barriers? ~None 0 _ UnderstandIng? ~lIzed

Comments
SIGNATURE
Needs Identified?
I Materials:
7JLtIr-
./1 <dE :PROGRESS NOTE
"''''''''1\1
TI~U:: '"
CIT.
r.nlINRl=I.1N(;
TIME:
UCDMG - FOLSOM
000499
000500
I{
_'ll:)1\O,,: , ( ~ID' _ ~:.Jrm.H' rJlhH
) 1o(K~i1
1 ,
\ tv\
!
,
I
190<6-~qll
'
I:
tppr oved
_D(O\\"tl
Date:
Ef:~~.;Ye:
C om::1~:1I;:
--~I\
. To: ---_.
. Sizaarure: . I ,I \:
I
\ Decision
, I:
I '
i (
\
~t\J.r.-.:"\ ~~t)n1.~~
'
000501
mmm ,"
,,
3S-G,)oolooo~1
03020,
.~
'
PHYSICIAN PROGRESS NOTES

r
jor~;~:.;
__ ,,('"
"
. _t1.~~
",:' .~
.1was present and directed to Dr. Assessment and Recommendations. The history obtained by Dr. PhYSiffxamination ResidenV e 0 /NP. The patien
(q
~he
was repeated. The Assessment and Recommendations were developed with the
CoUh5
for the hisiory and 'physical exam, and . was reviewed and verified with the patient.
as seen and examined by the Attending Physician or Nurse practitioner.. See dictation for detaiis.
Chief Complaint
./'
~,
o - Image Viewed
o - EMG/EKG o - EMG/EKG o-
o - Image Report
Old Records
Report Viewed
0'- Lab Result Discussed with another physician
000502
,l~ USE PATIEN:r PLATE . 808 13 bCJ 4
~i/(
39-G90al0005~ 916-983-2599 rOlSO~ ~
A I1UNOS(N
"09/23/~9
Ol/O~
DATE TIME IN TIMEOUT ALLERGIE~uptciel1
HARK
03 02 0 It SACRAMENTO,
UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER, CALIFORNIA
00139 ~AQU[RO, vIero "0 ~ BLue SHftLO-UCOCAP !
;qW
-J/J/O
n
peN
NURSES PROGRESS NOTES PAIN MANAGEMENT CENTER >,;';

--, ,!:it'~~1 )'1j ~ .. ~
. (if .,;
cj
NEW PATIENT FOLLOW-UP ATIENDING FELLOW NURS~72
"j:t
0 _
CWd~//~
WITH PATIENT
/I
/7
PATIENT WEIGHT
r:1J.,~
PROCEDURES ONLY 0 YES 0 YES 0 YES 0 YES SITE 0 NO 0 NO 0 NO 0 NO
NPO DRIVER NSAIDS IN LAST 3 DAYS ASAIWARFARIN IN LAST 7 DAYS CONSENT NEEDLE SIZE PROCEDURE PROCEDURE START TIME PROCEDURE END TIME
o SITE(S) VERIFIED
SEDATION
lliJ------ IIJ----0 YES 0 NO
(IF YES) SEE SEDATION PROCEDURE RECORD. INITIAL FLUORO _ 0 YES 0 NO
SALINE LOCK/IV
VITAL SIGNS
PRE-PROCJ ADMIT
.s
PAl
0110
POST-PROC.
ASSESSMENT:
TAL STATUS ~MMUNICATION ALER N/A ~ EHENSIVE AGE BARRIER CONFUSED DEVELOPMENTALLY DELAYED
c-::::uNlJ\B~
~OMDisJl:lESS OXYGEN
@
RESPIRATORY
RASH OTHER: UMIN
e
ORIENTED NORM HED PALE COOL
:o
~~NDITION
~
DIAPHORETIC OTHER WHEELCHAIR _
O21JS
J --_
vdlfli4L-NO
PATIENT EDU -' O~~' INFORMATION GIVE BARRIERS TO LEARNIN : 0 YES SEE ABOVE (Communication)
INDICATED UNDERSTAN~2S/ 0 NC VERBALIZED UNDERSTAN G ' 000503 RETURN DEMO INITIAL -'
/-,"
: 808-13-69-1
39-690810005
09/23/1959
, AMUNDSEN .MARl<
M
,1
. p
01/05
03/02/04 674/PMC
UNIVERSITY OF CALIFORNIA, MEDICAL CENTER SACRAMENTO, CALIFORNIA DIAGNOSTIC

,/
916-983-2589
MD
aB139 BAOUERa.VIera BLUE SHIELa-UCOCAP
IMAGING
REQUEST
HOSPITAL '2315 Stockton Blvd. (916) 703-2100 .::; (916) 703-2254 (fax) Services: Angio/lnterventional,CT,MR
o MAIN
o DAVIS
TOWER 2315 Stockton Blvd. (916) 7032100 (916) 703-2254 (fax) Services: GI, GU, Fluoro, Pediatric, Nuclear Medicine, Ultrasound, Vascular Lab, Plain Film
o LAWRENCE
J. ELLISON Ambulatory Care Center 4860 Y Street, Suite 0500 (916) 7340655, (916) 7340650 (fax) Services Lower Level: Mammo, Ultrasound MR, Nuclear Medicine, Vascular Lab, cr Services First Floor: Plain Film
CALL FOR HOURSOF SERVICE OR IF YOU NEED FURTHER INFORMATION PATIENT'S NAME AGE: SOCIAL SECURITY #
0
UCDHS MED REC# PATIENT PREGNANT:

0 0
DOB:(Req) Yes
0
_ _
No LMP:
0
KNOWN ALLERGIES:
Yes
No
Yes
;t1IT DIAGNOSIS:
(f.)
.s 12 0~
I
Weft
No / DOES PT. NEED INTERPRETER: LANGUAGE SPOKEN:
Yes
No _
CLINICAL ~ISTORY/SUSPECTED
q cj ,v. ""
Lk-5w<- Do!). lJ: c I~~~"!' t 7)~G t-:.. (b Sio~ Si(. &~ L" h ~ C; 1> I Jh~ G J "iJ" 'J- ICD9#
REFERRING CLiNIC/PCN: APPOINTMENT DATE & TIME: ----CONTACT:
c /IY &!1: h.ud '. Q ,5,. M(&~A. S"

L
IU~ I P
AUTH # : BACK LINE PHONE #
_ _
_ ~: 2l)
REFERRING PHYSICIAN SIGNATURE: PHYSICIAN BEEPER:
S IL, 3
IL
PHYSICIAN ~
Type:
/, PI--
'l'//.
1--'1--\,
.0. PHYSICIAN PI #
LXv ~ /~
Street Address
;ti 0 ?
City
PHONE #
C~
ie
Stale
Zip Gode!
FOR NUC MEO USE ONL Y RECENT ISOTOPE PROCEOURE
Date: PHONE RESULTS:

0
STAT
0 0
TODAY Yes
0
ADDITIONAL COPIES TO: No PREVIOUS COMPARISON FILMS:

0
_ Yes
0
No ADDRESS/LOCATION OF PREVIOUS FILMS:
RADIOLOGIST NOTES & PROTOCOL
000504
USE PATIENT PLATE
WARNING:
UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER SACRAMENTO, CALIFORNIA Ord: 252
'DC Davis Health

'8081369
System DCDPMC
AMUNDSEN,MARK
M 09-23-59 252-030504 Account #: 039690810039
PATIENT QUESTIONNAIRE (MRI)
Certain Implants, devices. or objects may be hazardous to you and/or may Interfere with the MR procedure (I e . MRI, MR angiography, functional MRI, MR spectres Do not enter the MR system room or MR environment If you have any question or concern regarding an Implant, cevce. or object Consult the MRI Technologist or Radiologist
BEFORE entermg the MR system room. The MR system magnet is ALWAYS on.
Name: Patient Weight: DOB:
Medical Record Number: _ Date:
_ _
PATIENT QUESTIONAIRE
PRIOR TO MRI EXAMINATION

DYes DYes DYes DYes DYes DYes DYes DYes DYes DYes DYes DYes DYes DYes DYes .,g,'es
1. 2. 3 4. 5. 6.
Are you weanng a heanng aid? Do you have implanted electronic devices, cochlear Implants, Spinal column stimulator, infusion pumps, other implants? Do you have or have you ever had a pacemaker or Implanted defibrillator? Do you have Sickle Cell Anemia? Have you ever had metal fragments or other foreign bodies in your eye? Do you have any of the following in your body: Aneurysm clips Heart valve prosthesis, vascular stent, or coil Swan Ganz Catheter? IUD? Penile implant? Inferior Vena Cava Filter? Any other type of prosthesis
0I<Ib
ffio
.QN"0 .eJ1\io Ja1'fo
~o ..e:lNo ,PNo
7 8. 9. 10.
11.
Do you have a history of gunshot wound(s) Do you have any removable dentures or dental work? Have you ever had a reaction to MRI contrast media? Have you removed all body piercing jewelry? Do you have other metallic objects? Specify: Please contact MRI at 4-7959.
.-flNb
-910
.0No DNo
.910
.er:Jo
2No
If any of the above is "Yes" it may prevent MRI performance.
Reason for MRI and/or Symptoms: Region being imaged:. Where

IS
_ _
the pain?
DRight Days,
DLeft _ Was
DLeg
DArm
DBack
How long have you had pain?
Weeks,
DNo
Months
Have you had any previous surgeries?
What was the surgery, and when was the surgery performed? Do you have any metal skin staples in p~01l01~~~nt Signature of person completing form.-'l" /
~/I\;A
/
DYes Date:
sur~?
~7~
"'DO
NOT WRITE BELOW THIS L1NERADIOLOGY
STAFF ONLY'"
_ _ Date:. ~
Was the patient approved by this Radiologist? Radiologist contacted: Radiologist's Signature:
000505
'ftl"
r 1 nl1li1
11
-...mnr",,,,
'nnd'nn.-
PA'llElIT
HT
Pain?
s ONo
'ntenSlty~
>
-'.'.-
'.,
_~_~~-/=--r-<
-----------=-------. .' '
~--<-->'
--' -----------------
000506
,,,"
;:
UCDMG - CanirichaellM Progress NOl \:
WI;
~~
~
~-------------:--------------------,
: I AMUNDSEN ,MARK
M :Name'-8081389
,
,
I
,--'I
Dale:,
0912311959
I'
~
~~3
T:
r;;
1/
8P: MAlnttials:4~
79-636570024 BAClU/ORO,VICTOfl $15
HI:
Pulse:
RR:
'?4
- : DOB:~ UCD/B/S HMO
,--!
916983~2589Work916-337-3680
,.----,
,
,
:
Allergles:,~
:
Patient barriers to learning As~ed ( J YU: Infonnation g~n ( ] Yes: DemDnstrate; understanding [ ]
@ , 1 :30 AM JAM/OS R/OSSL/OR,PA

04/09/04
!: j
: p.;n1IrM;-'""~L-on ~<
J~
:'
Yl!!;
--
.~
.
000507
Prnnr",o:::o::: I\Infpc:'
USE PATIENT
PLATE
T oday's Date:
AMUNDSEN
8081369 79-636570024 M
,MARK
09/23/1959
BAQUERO, VICTOR H
UCD/B/S HMO
$15
UNIVERSITY OF CALIFORNIA, DAVIS MEDICAL CENTER, SACRAMENTO, CALIFORNIA
916-983-2589
Work 916-337-3680
ORTHOPAEDIC PROGRESS REPORT
04/09/04 @ 11 :30 AM
JAMES RESSLER, PA
-'d - 9 -0 <f
''------
Please complete this questionnaire. This information will assist your doctor and the outpatient staff to evaluate and treat your problem. This questionnaire is confidential and will be made a part of your medical record. Birthdate: Name of person completing form: Referring MD: Address: Primary Care physician. if different than referring physician:
University of California, Davis Medical Center, Sacramento Orthopaedic Outpatient Service OPD Progress Records
9 -:2)' - .>9'
/1;o1C
/C
If:'
6JJy
(/&0,5&?IJ
0 IC
Phone:
State your main complaint or problem:
Ii /;to
/ON.o
(f,<JCk;
/"./I/A/
IN~
rr1lltuT
What do you expecl your visit to accornpllsh?;
When did your problem begin?' How did your problem start? (If injury, please describe):
Describe any treatments, up to now,give dates, and treating surgeons:
e:'t'l
0(}R,1ll.
000508
. l;Sf ~ A n:.JH PLA rt:.
W~,
c.
1 N(XtCO
-.
ORTHOPAEDIC PROGRESS REPORe
Is the problem getting better, worse, or staying the same? (circle one) What makes It worse? What makes it better?
H,$):)"
Ala~ X
C~I\t-l61tJl. I . O~/lJlIJ6
What can't you do because of this problem?
30
SIT
Do LVi,)
MItJI.J~
Yes No If not, when did you last work?
Currently employed:
Q P(tll..
) ;}.003
Please complete the following information It your problem is the result ot an on-the-job Injury or If you have retained a lawyer because of this problem or if you expect to receive disability or workmen's compensation. Work-related Date of injury: Employer at time of injury: Name: Address. Injuries: Location: _ _
Phone #: Insurance company: Name: Address:
Phone #: Adjuster Case #: Any litigation pendinq>: Yes _ No _
It yes, describe:
Are you applying for disability benettts>: From whorn?;
._~5~O~I.~
Yes
y"
No
_
000509
0986-2 (8196)
ORTHOPAEDIC SUITE QUESTIONNAIRE ADULT-page 2
USE FATll::NT PLATE
PAST HISTORY:
Have you ever had or do you now have: high blood pressure Diabetes or problem with sugar blood clots in your blood stream asthma, or hayfever with wheezing tuberculosis Disease of your: blood liver kidney heart Cancer Part of body other diseases we should know about: -------------------------
List all your current medications: Name
Dose
M ,suotoWlll-1l![(
'-IDr A,., to. 'fJ (?a.Ol:A-C
WORm
10 'Yo 3-as
How Often
A4
'FA IJ.'-I
0/\ J L'/
DAli
.-::?
,Ah0-
List all your current allergies to: Medications
other-:
~~
Do you have or suspect latex sensitivity? Are you a smoker? Substance,________ Have you used street drugs? Substance, -------Have you ever had a blood transfusion? When?: When did you last have a tetanus shot?. date
Yes Yes __ Amount: Yes___ Amount: Yes
No
J0 46 UI1f! L Dec..'' >fi No)(

How long: NO~ _ How long:
1/
No---2LWhy?:
-------------------
:~:..-------
-----------
-@ffiff~~~~
------------
000510
-~
uSE :JAltE;..n PLATE
Q. tSfAj(l.
ORTHOPAEDIC PROGRESS REPOR.
Please list all surgeries you have had and the dates:
H rsnIJIQ
TOIJSil Pf..;TrM'1
I"l
ca
L~
SIP"
1c)~7
))(,7
7
,
,
Please list all iruunes. broken bones, etc., with dates and treatments:
-RLhk"T
--l to?T
ANlCL~ F'Llt.lli'
l3~
1.\
)\tJt::S
l\~
13~
l(r1~ ) Iq?>l. lc/(}4
\'1ill
I <j qCo
Have you ever sought treatment for stress or have you ever been treated for a psychological disorder?
FAMIL Y HISTORY: If alive: If deceased:
Father: Mother: Siblings:
Age: Age: Age: Age: Age: Aqe:
77
1.\,
(JlJlL
HEALTH: (circle one) HEALTH: (circle one) HEALTH: (circle one) HEALTH: (circle one) HEALTH: (circle one) HEALTH: (circle one) good good good fair fair poor poor poor poor poor poor Age: Cause: Age: Age: Cause: Age: Cause: fair fair Age: Cause: good Age: Cause:
1'5
~
fair
Cause: l-UIJ6
3~
~
good
Cause:
Have your blood relatives had any of the following? (circle): High blood pressure, heart disease, heart attacks, strokes, diabetes, tuberculosis, epilepsy, alcoholism~kidney or Bright's disease, rheumatic fever, bleeding tendency, arthritis and/or gout, asthma, dropsy, nervous breakdown.
ORTHOPAEDIC SUITE QUESTIONNAIRE ADULT-page 4
000511
,....
".
.'"\
..
USE PArlENT PLA re
SOCIAL BACKGROUND: Highest education:
\;;. T\l-
Yes
<:lIIof
Have you ever lived outside the United States? It yes, state where and for how long.
No _
Military service: Yes --If yes, rank and type of discharge: l:'5 Are you: married Are you sharing a residence": If yes, is that person's health: Where do you live?: location: residence: phone:
_k--
-("
No
:lOl\"l Th r'tga"n)
divorced Yes good
)<.
single No fair
widowed poor
Cln.
FQl.$.OM
)<:
I (,,-
house
qSl~_d-_5_&_"I
apartment
I other
CA
9 5(030
_
_
Miles to nearest family or friends' Number of children ~_
---1------. _ NO HOW LONG?.:;l HOW LONG? HOW LONG? HOW LONG? HOWLONG? HOW LONG? HOW LONG? HOW LONG? HOW LONG? HOW LONG? HOW LONG? HOW LONG? HOW LONG? HOW LONG? HOW HOW HOW HOW HOW HOW HOW HOW HOW HOW LONG? LONG? LONG? LONG? LONG? LONG? LONG? LONG? LONG? LONG?
_
'tlflla.s
_ _ _ _ _ .
and their ages:
ROS: Are you easily fatigued? Unexplained weight loss or gain? (Circle One) Do you have a fever? Do you have chills? Do you have unexplained decreased appetite? Do you have an Irregular heart rate? Have you ever had a heart murmur? Do you have difficulty excercising due to weakness? Do you have chest pains? Do your ankles swell constantly? Do you feel like you might tamt or feel light-headed? Do you have unusual headaches? Have you ever had a seizure? Have you ever been paralized? Do you feel short of breath? Do you have trouble breathrnq with any excercise? Do you have a cough? Ale you coughing up blood? Do you have a cold? Do you have pain when you urinate? Do you have or have you had blood in your urine? Are you urinating too often? Do you feel like you have to urinate all the time? Are you unable to control your urine?
~
YES YES YES YES YES YES YES
i
NO
?. 'ft9lIl:2._
_ _ _ _ _ _ _ _ _ _ _ _ _ _
YES
YES
~
YES YES YES YES YES YES YES YES
@
NO
000512

Do you feel sick to your stomach? Have you thrown up, had diarrhea, 'or constipation recently? Have you passed blood with bowel movements? Have you ever had tarry stools? Have you ever had ulcers? Have you ever been jaundice? Have you ever had gallstones? Do you have difficulty moving any limb? Do you have weakness in any limb? Are any of your muscles wasting?
YE Y S ~ YES YES YES YES

YES
LONG? LONG??o LONG? LONG? LONG? LONG? LONG? "~(l,> _ _ _ _ _
HOW HOW HOW HOW HOW HOW HOW
YES YES
HOW LONG? HOW LONG? HOW LONG?
.'

D986-5 (8196) _____ 1
ORTHOPAEDIC; SUITE QUESTIONNAIRE ADUL I-page 6 _
000513
-t
Phone h DRUG ALLERGIES OR REACTIONS DATE
~.
UC DAVIS MEDICAL GROUP

\ DOB
ffi~~t~m~Wl~~
(w)
~~-D~~~ WI
ICD9
Sex
PCP~}',1e,to Clinic
f;fj
YEAR
\\)~X2.IlliV\
low hack.
rAn
PROBLEM LIST
@~
Q"n~'
SURGERY/HOSP/PROC
--
.. 1
<3 t
HEALTH MAINTENANCE
H&P Petvrc/Prostate Mammog/PSA Sigmoid/Colon Hemoccult Lipids Immun: Tetanus/Td Family Hx Tobacco:
RISK FACTORS
Current
j,1..I;k-9<...
Never
tp;ior1
Alcohol/Drugs
Hep B
Pneumovax:
MMR
Social Hx
Advance Dir
-.1-_-_-_-_-_-_-_-_-_-_-_-_-_--'"_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_---""'-------
70000-261
(10/98)
PROBLEM LIST
000514
VICTORt.QUERO, M.D.
REFERRINGMD PATIENT'SPCP AMUNDSEN' 8081369 ~ M \'0912311959 't _ -6570~24 BIQUERO, VICTOS Patient's Name:'. 7963 :. UCD/BISHMO $15 ~al Parent's Name: . .. (If pt Is a minor) DOB: Address: Home Ph: __ o o
J
k--t)
Date:
:MARK '/
JECl21VED
1__
'll~
AUTHORIZATION #
MED. RECORD #
_.
----LL 0 "[""I r. ,;;./}=..r::;.-
Rec<lUIiJ
_.a..
'I
.>
U //..../
Insurance Tvpe: . 0 Health Net Seniority + 0 Secure Horizons , 0 BC Senior
o Health Net
o PaclfiCare
916-983-2589Work 918-337-3680 . ., 02113/04@ 01:45 PM VICTORBAQUERO

_. _
81\16 Sh.'eld 65
o Prucare of Oaiitorn.a o WHA o WHA - GMC
o o o o o o
BC California Can Blue Shield/HMO Blue Cross GMC CiGNA Medicare M'ediCal
\ . to ma~,e~_t-"I"' .--Q-r~rulllce'w-ma Panent

Specialty to call patient 0
o Other: Dept. Contact Nam~
e app . To Physician Referral Center ~
r8'?hO~:;=ti
:
To BE COMPLETEDBy PHYSICIANONLY
o Please contact me If requested

Requested Time Frame for Appt: Primary Reason lor Consult: Reason(s) for Requested
Dept. and Physician
Referred to:
>;~~
C
---rJContracted Cornrnunlty Provld~r
MD rs not available
Urgent (Within 1-2 days)
~tine
New Problem ~c
Service:
C~
Problem
.< -;
/7
-~
/ ~ :
~
(f)1~/l
\VU ':~
,e/m/by
RE~A-[REQIJEST: ~
'
On-going management of condition within your field of expertise. (SUbjectto Utilization Heview and Authorization) Confirmation of Diagnoses
o o
Second Opinion
o o
o
Evaluation of abnormal finding: Procedure:
0 Lab
--t
0 0 0
Recommendation(s) for DxfTreatment options X-ray
0
3
Physical Finding
Other
DME/Orthotics (attach copy of prescr.ptlon) 2
Follow-up Visits included with referral (circle one)
0 Additional F/U Vi~lts require
prior futhonzatlon
o o o
Other: __ PHYSICIAN'SREQUESTFORNOTIFICATION: Please contact me via phone ASAP to discuss. Please FAX your report to me when available. Please MAIL your written report when available. Direct Phone#: Fax#: E-mail: Voice Mail#: Pager#: _ _ _
PATIENTINFORMATION: 0 Med. Recards With pt. ADDITIONALPA.TIENT INFORMATION: Current treatment: _ _
0 Pertinent Med. Records attached 0 Med. Record provided , on request

Previous treatment: _ _
Previous diagnostic testing:
Pnor Consullants: __
__
71463728 (9199)
//' Physici<lff'S Signature

OUTPATIENT CONSULTATION REQUEST -
I
1#
I_Date
MR
00/89~32
SLUE - BLUE - BLUE -
BLUE - BLU're- BLUE 000515
04 ill 04,..
UCD PAIN MANAGEMENT CENTER PROCEDURE VISIT (TREATMENT)
Diagnosis:
4wd),& ~~tc;
Procedure: o<."1-! J1' S'N/x-S Medications List: See Dictation Allergies: l1H"" 'l'jJ"P iI
Risk, benefits, alternatives of procedure explained to patle~yes 0 no
Last Procedure Results

Name of Procedure: Date of Last Procedure: VAS post block: 110 x _ hours _ Complications: % Improvement after procedure:
The patient understands of vital signs) and consents
_ _ days _ _
k1 yes
0 no
(please see Nursmq Notes for detailed descnpnon Indication ODDD Facet Arth. "p('Radlculitis Position sitting lateral 0 right lateral 0 supine ~rilitY drape
o o o
o o left o
~prone
__
mask v -[jgown
Kf gloves
Prep 1\(betadine
o alcohol o hrbiclens o __
OL __
o midline o
Approach
~o
Local
% ----=-1-- ml
LJ
~ paramedian 0 Other oblique 3ZI HCO, 0 _

Dressing
ml
Technique LOR to air 0 LOR to sallne@_cm hanging drop
Interspace/Location
Needle/Catheter Size
OC_~OT
~Iuoroscopy Contrast
o Sacral Hiatus o Mtyle(S\ injected Ili . S., SPQ..f!>
__
[jl'Omnipaque Ji!l-18011J 300 o Gadodiarnine__ ml
:l.f
ml Sedation ~None
0 Versed 0 Fentanyl _.. mg micrograms
o Level
o
Dye Spread 0 MIdline 0 A 0 L of spread
017018020 0 2.~/g _ inch Tuohy OOp Site . o 20 0 22J!{25 9 1.l-"1nch Spinal 0 tape o 20 0 22 0 25 9 _ Inch Ctuba G1N>andaid o 20 0 22 9 _cm SMKlRFK o 20 0 22 0 24 9 _ Inch Stlmuplex Complications o 20 0 22 9 _ Inch Huber Jl!'none o Bent tip 0 Straight tip o CSF aspirated o 199 0 20g Catheter near syncope
Active agent
(ittnamcinolone
mg
@ __
#s,tes
o Cont RF
0 Pulsed RF
'C volts
o paresthesia o weakness
(
betamethasone __ __ ml ')21 (). '1;;' % buptv ~ % lido __
o saline o __
mg @ __
ssltes
Radrotrequency temp __ lor __ minutes
Before After
VAS
X/10 1-<{
~ l,)
o Other
ml@_I_#sites
ml @ __ #sites
o Crvoablation
for __
Oryoanalqesra x __
minutes
Right
Temp
o Phenol
C1other
Antibiotic 0 Aocephin __ 0 Ancet 0 Alcohol _ % __ ml
Left
Temp
o Botox 0
r<
A 0 B __ ()w",; '\(/\>
A.:
"
units
<is
p ump R ell! f I Interroaation o Opioid/day o Local/day o Baclofen/day

Next refill date Medications Old Rate NeWRa~
Plan:
o Clcnidme/cay
g
Description
):ig' Procedure
f.'1 l!:J 1:/ SIJICf3
o Flu Visit o Complex
in
4..' ~th r: .
_ _ __
ODIC
Reeval to PCP
0 Referral_. 0 Imaging 0 Labs
Fellow/PA Printed Name
c/o cJ~~-~C(YI'"
Attending Note: (check one box) I was physically present for the ejJ.tire procedure. 01' was physically present for the key portion(s) of the procedure and, during other times, was immediately available to return to the procedure Billing guidelines were not met.
of key portiones): )~f/lO
~V~
J) "f@ I
SfIJ({f) c 7.-C;f1/~ CjJf oUt- C f&v;) l V(AtA rr~"-O< ~ frJrt?-'f ? fO 0'7~(-----/ I. f 0.1.) (. '6~f /oI
(!)S r
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'/
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rc
(firw'-'" I '300
000516
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USE PATIENT
Il;-ATE
~t~g08 13 b'\ 4
P
AHUNOSEN ,HARK 11 Otj23/~9 916-~83-2~89

01/0~ peN
04 29 04
O~139 a_QU[~o. ~I,CTO HO BLUr. SHILD-UCOCAP

~OLSO"
,~~,J,INURSES PROGRESS NOTES . ~~,
PAIN MANAGEMENT CENTER
DATE TIME IN
(.E;(P
TIME OUT ALLERGIES:
oAJ1..-.l,I'\,
~Cz'::~
~S ~S DYES YES ITE SALINE L CKJIV ,:', -:.-' \ I D NO ~O 0 NO
.~
NEW' PA'r1ENT' 'D FOLLOWUP ATTENDING ~~~L~:MA
'9Jt~~i!;;; )
. T
L
JA.rJ:.A V
PATIENT WEIGHT PROCEDURES ONLY NPO DRIVER NSAIDS IN LAST 3 DAYS ASAIWARFARIN IN LAST 7 DAYS ~ NEEDLE SIZE PROCEDUR PROCEDURE START TIME PROCEDURE END TIME
r&J
~ITE(S) SEDATION
VERIFIED W~TH P. D YES NO
(IF YES) SEE SEDATION PROCEDURE RECORD.
veA7!::-~ INITIAL ~
61Jk.A
FLUORO ~ES D NO
S. tv c~ '.:>. e:;a;
t~le_\O __
VITAL SIGNS TIME PREPROC.! ADMIT
~s=
PAIN 0/1 (
3,-"\
ItJ
\ ~\ 1,'2.Cos.B/P. PULSE
It
9'7
02 SAT.
POST,PROC,
-tt~
<:r;JlC:)
COMMUNICATION
1.5] 10
~~'tI 1>Jd
(0/
1G._-tt~
-."
ASSESSMENT:
~ATUS APPREHENSIVE CONFUSED ORIENTED COLOR
LANGUAGE BARRIER DEVELOPMENTALLY DELAYED
MINIMUM DISTRESS OXYGEN

@
~6~
SKIN
CINIAt:I")
RASH OTHER: ~_.
UMIN
~NDITION
FLUSHED PALE
~~
WIASSIST DIAPHORETIC OTHER SIGNA1J!.!ir WHEELCHAIR _
COOL INITI~
v ~M -
C~~'cf2-vJ
--_._--------------~
PATIENT EDUCATION ASSESSED INFORMATION GIVEN <:::::.. "_ BARRIERS TO LEARNING: DYES SEE ABOVE (Communication) INDICATED L!,NDERsrANDIN'G~ES <:"'83BALIZED UNDERS~ RETURN DEMO INITIAL 0 , D NO
000517 ..J\
~~
USE PATIEF>LATE ~ ... .
o
o
Other
f~1t
<
',!. :",
-:
-.
. (tU Rl(
-',
.:. '
'~c"
- I HUMonN
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01,.0($., ~tI.O\JCOCAj)
peN
04 2bfSCHARGE INSTRUCTIONS
Return to clinic in: Physician: MIA _
.- -4
.J:
"
''.If'
\./ .
"'l!
Ol/e,
rO~$O"
Days
.t..A~F;'
0 No
.; .----
Q
k
.v............
.. ,
~.
.-; ';,.
APPOINTMENTDATE: APPOINTMENT TIME: NEEDAUT,! ~ i/O
A,a.ll rPDlltriM"
~/e:-
lJI.I!{yf
----
rf'l
Mon th s
(JlL. ~
INITIALS: -~-~-0 Referral
Follow up 0 Extended Follow up 0 Complex Reeval 0 TriplicatlRx
FLUOROSCOPY: ){ Yes
o Axillary Nerve Block o Bier Block o Blood Patch o Cervical Epidural Steroid o Caudal Epidural Steroid o Cryoablation o Celiac Plexus Block o Discogram o Facet Nerve Block o Gen-Fem Nerve Block o Hypogastric Nerve Block
OIDET
o Impar Ganglion Block o Intercostal Nerve Block o Ilioinguinal Nerve Block o Lidocaine Infusion o Lidocaine Push o lumbar Sympathetic Block o lumbar Epidural Steriod o Medial Branch Block o Occipital Nerve Block o PNT o Phosphenytoin Infusion o Phentolamine Infusion
o Piriformis o Pulsed Radiofrequency o Pump Refill o Radiofrequency o SI Joint Injection o StimTrial o Stellate Ganglion Block
. ~Selective Nerve Block
~.
(LJ
o Third Occipital Nerve Block o Thoracic Epidural Steroid o Trigger Point Injections o Tens
I I
U ARE SCHEDULED FOR A PROCEDURE, PLEASE FOLLOW BELOW INSTRUCTIONS: thing to eat for eight (6) hours before procedure. ~ IT!lIJayhave CLEAR liquids up to 2 hours before procedure. !2rYou MUST have someone drive you home. You cannot use a taxi or bus. .!"fJ:lo aspirin or aspirin like drugs for seven (7) days prior to procedure. ffNo NSAID (Nonsteroidal nti InflamlTlatory.Drugs)3 c::tays prior to procedure. JX>ther Instructions:
~<.-~..... h:vi-
IF YOU RECEIVED A PROCEDURE TODAY, PLEASE FOLLOW BELOW INSTRUCTIONS: Notify our office (@ 916-734-7246)if you experience any bleeding or swelling at injection site, signs of infectior (increased oral temperature, drainage or redness at injection site), severe pain, severe headache, numbness, itchin~ or rash. Do not take a bath, swim or use Jacuzzi for 24 hours after procedure, a shower is fine. ACTIVITY LIMITATIONS AFTER TODAYS PROCEDURE:
o No restrictions
.!&No driving for
For further questions please C@!>-734-72460R....1-600-770-9269.J/oucannot us 46 hour~in vance.Thank Yao.~. PATIENT

~b~_
----/
IV. hrs .0 Limited activity
for
.!2J.j-
hrs tment, please call
NURSE Authorization Details/Coordinators notes:
4s?0i""
MD
~
000518
USE PATIENT pfrE . kilt . '~},
'~ffl-
,",',
",,~;,
':
i,
",
--
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+.
't'..
Physician:
. ,: BOa .1:] bq If,

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~
"
i' 1
p '~VE '~I,~lQ.utDcAPl . \/""< fO' ~:"ll

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'Ei
'C",_.YNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER, " SACRAMENTO, CALIFORNIA
"
'DISCI'fARGE
(1" /\,
'
t\,~
INSTRUCTIONS
',,~:
'l"",
,~\.
,.
e,
~:r.;
....
'
"APPOINTME.tjTDATE':jar)ti'i
,r;:t'
M
11/ ,/
fl~~"-I
!y~., Return to clinic in: __ -_7'_'

I,
~,Jl!A
/ :t'<l. (k uays .
' ""APPOINTMENTTIME:
IW ee kIM s
ont h s NEEDAUTH YES INITIALS:_~ _ eferral 0
3.10
IV-
n Follow
up 0 ExtendeiFollow /' 0 No
up 0 Complex Reeval 0 TriplicatlRx
Other
1J7~
FLUOROSCOPY: ~
o Axillary Nerve Block o Bier Block o Blood Patch o Cervical Epidural Steroid o Caudal Epidural Steroid o Cryoablation o Celiac Plexus Block o Discogram
I
o Piriformis o Impar Ganglion Block o Intercostal Nerve Block o Pulsed Radiofrequency o Ilioinguinal Nerve Block o Pump Refill o Lidocaine Infusion o Radiofrequency o Lidocaine Push o SI Joint Injection o Lumbar Sympathetic Block o StimTrial o Lumbar Epidural Steriod o Stellate Ganglion Block ~ o Medial Branch Block ~Iective Nerve Block (L)
/
'
0 Facet Nerve Block
0 Occipital Nerve Block
0 Third Occipital Nerve Block
o Gen-FemNerve Block o Hypogastric Nerve Block

DIDET I
-I
I
o PNT o Phosphenytoin Infusion o Phentolamine Infusion
o Thoracic Epidural Steroid o Trigger Point Injections o Tens
I
I
F 'ou ARE SCHEDULED FOR A PROCEDURE, PLEASE FOLLOW BELOW INSTRUCTIONS: Nothing to eat for eight (8) hours before procedure. /) /YJ1L7J"" ~ '~ay have CLEAR liquids up to 2 hours before procedure. ///I\....!.. :,~ou MUSThave someone drive you home.You cannot use a taxi or bus. J.)'Jl)'-J ~~o aspirin or aspirin like drugs for seven (7) days prior to procedure, '1- II ,t:J No NSAID(Nonsteroidal Anti Inflammatory Drugs) 3 days prior to procedure.~ 'I o Other Instructions: ,
0' 3'
s::,;<()
~--1~
_Cj~
:3 !lO
''
IF YOU RECEIVED A PROCEDURE TODAY, PLEASE FOLLOW BELOW INSTRUCTIONS: $ /I!f5 i Notify our office (@ 916-734-7246) if you experience any bleeding or swelling at injection site, signs of lntectlon (increased oral temperature, drainage or redness at injection site), severe pain, severe headache,numbness, itching or rash. Do not take a bath, swim or use Jacuzzi for 24 hours after procedure, a shower is fine, , ACTIVITY LIMITATIONS AFTER TODAYS PRO~DURE:
o No restrictions
j6No
driving for
-L2-ms I
Limited activity for
hrs I kee
For further questions please call 916-734-7246 OR 1-800-770-9269, If you can us 48 hour ' advance,Thank you. PATIENT _ MD NURS Authoriz tion Details/Coordinators notes:
'1/ //' _'
'I PJ
~_
~
000519
--'-------------
000520
.,
'.
f ~: ';
.
PLATE
USE PAtENT
.' 808
~ . fj).'P "
~ I1UNOSE'I
13 b9 If
i
HARK
~S-69081000IL
UNIVERSITYOF CALIFORNIA DAVIS MEDICAL CENTER, SACRAMENTO, CALIFORNIA
09/2J/~9
,.(.
OA1J9
r~,;: Ol/O~
IRETURN APPOINTMENT:I
Doctor Week __ DAY: M LENGTH:
..
E1LUC SH t (LO-UCOC4P
91&-58~-2589 84QU(RO. VIero "0

rOLSO"
~
'1 ~:..
08 3 I 04
ORTHOPAEDIC CLINIC
PCN
.'
Beeper# Physician Beeper# / Resident Name _ _
IA)ANG ,
T W 15 min
Month __ TH
Service PRN __ F
7fuJ~
am/pm PI# _
_ . _ . __ Attending
TIME:
30 min
45 min (circle one)
TEST RESULTS: Bone Scan/EMG/MRI/TOMO Other RADIOLOGY:
0 Routine
0 URGENT
_
Title
with X-Ray / with X-Ray OOP X-ray requested
CAST ROOM VISIT: (NOTE: schedule early in day) CASTTYPE: _ TIME NEEDED PRE-OP VISIT (2 TO 4 HRS) SURGERY DATE PROCEDURE POST-OP VISIT _ _ _ _ _
o o o
Chest X-ray MRI Bone Density/DEXA
-rlu
ons:
-ICD-9: _
LABORATORY
TEST DIAGNOSIS: IGENERAL CHEMISTRY! Rheumatoid Factor see alpha list TSH (Sensitive) see alpha list Anti-Nuclear Antibody (ANA)
IGENERAL CHEMISTRY! Comprehensive Chem Panel (CCP) Basic Chem Panel (BCP) Eiectrolyte Panel see alpha list
o o o
o o o
see alpha list
IHEMATOLOGY AND HEMOSTASISI APTI Studies CBC, no diff (Blood Count) GBC with auto dlff Prothrombin Time (PT) Sed Rate Westergren Synovial Fluid + Crystals Synovial Fiuid Analysis Complete (WBC & RBC counts, differential
o o o o o o o
IURINE CHEMISTRYI Pregnancy Urine (UPT) Urinalysis-complete (UA) Clean Catch 0 Catheter Other
o o o o
!Miscellaneousl C-Reactive Protein (special send out) IMICROBIOLOGYI

Source
IBLOOD BANKI ABO/Rh Blood Type Type & Screen Type & Crossmatch Autologous Directed Donor Leukopheresrs (Granulocytes) Packed Cells - Adults Packed Cells - Psd.atnc RH immune Globulin Whole Blood Number of Units
o o o
o o o o o o o
o Synoviat Fluid Analysis (limited) o Synovral Flurd Crystal Exam

see alpha list see alpha list
Crystals, mucin clot, viscosity) see alpha list
(WBC & RBC counts, differential
o Culture, Routine
(Inciudes Anaerobic & Gram Stain if appropriate) Culture, Mycology (fungal) Gram Stain Culture Smear, AFB
IORDER SETI Pre-Op Labs (Includes: CBC, with auto diff, BCP, Chem7, Type & Screen. PT, APTI, UA)
o o o
Blood Transfusion Advisement
Release of Medical Information
000521
\.
Current
.808
11
AI1UNDS[1l
l:1 bq 4
09/23/~9 ~16-ge3-2~e9 OQ139 BAQU[RO, vlCTO 110
M~R It
03 2~ G5~PATIENT QUESTIONNAIRE
02/06
SLur
$HILO-UCOCAP
PCN rOLSOM
PREVIOUS MEDICAL HISTORY:

Age
I
Height
Lf'l
GI
C/I
Weight _
,;).76
Medication
Allergies
I(30PRoF&J
(i.e, Diabetes. Heart Disease. etc):
Other Allergies
Medical
ProblemJl
Lofl,(jK.
Jd@Q'/7J;;JJ)JAJ54__ ._L.
C6~'TIOA./
Medications:
Name
~%~:
Dosage
Name
Dosage
Do you take aspirin/lbuprofen/Motrin? List all previous surgery I hospitalizations Procedure:
No Date
A/&:M'4 ..Rd,olk
7OA!SI?6H4VhY
j
Do you currently smoke? If yes, number of packs per day? Number of years? Do you~. k alcohol? Type - *bee J *wine I mixed orin How muc per day: Do you use recreational drugs? If yes what? Do you work outside the home? Occupation: Are you retired? Previous Occupation: Yes _
SOCIAL HISTORY
@
_
ES: ~
If no. have you smoked in the past? If yes, date you quit: tJ I I
0I
N0
otryer:
No
If no. have you drunk in the past? If es. date you quit: Yes / No / No
9 d-
1/dYes
If no, have you used them in the past? Yes If yes, what?
CJtlt.+1i.J1'I& 'T17
@
Yes
bf C()I...CU
iJA'tJf
_
No
FAMILY HISTORY
Are there diseases that run in your family? (i.e .. Cancer, Diabetes, Heart disease. Bleeding disorders) RelationshIP (Family member) Disease
,M(tllil9(
C~~
. CoI'.P, , EJ1F/'I Y S/:P'V;'A
000522
39-'H20:'8007~
RESPIRATORY Daily chronic cough Sputum, phlegm or mucus production Yes No Do Not Know
03 U QS
PATIENT QUESTIONNAIRE
PLEASE CHECK ANY OF THE FOLLOWING WHICH YOU HAVE HAD

GASTROINTESTINAL Hiatal hernia, heartburn Ulcers, vomiting blood Hepatitis, jaundice Yes No Do Not Know
Asthma, wheezing Bronchitis, Emphysema, COPD Tuberculosis (TBl Can you walk up 2 flights of stairs without stopping to take a breath? CARDIOVASCULAR Chest pain, angina, heart attack Leg swelling, CHF (congestive heart failure) Shortness of breath Sleep on more than 2 pillows or wake up at night short of breath? High blood pressure, hypertension
0 ~ 0 ~ 0 li'L 0 ~ 0 ~
~
A
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0
Liver disease, cirrhosis

GENITOURINARY Could you be pregnant? Difficulty passing unne At risk for AIDS or venereal disease (VD) Kidney Disease MUSCULOSKELETAL Physical limitations or prosthes.s (artificial leg, eye) Arthritis Uaw, neck, back) NEUROLOGICALJ PSYCHIATRIC
0 0 0
0
~ ~ ~
0 0 0 0 0 0 0 0 0 0
0 ~ 0 54 0
~ ~
0 0 0 0
J)il 0
l:ll
?'
0
0 ;;il 'il
Heart murmur, rheumatic fever

Cramping in legs when walking Phlebitis (blood clots) ENDOCRINE Diabetes, high or low blood sugar Thyroid problems, heat or cold intolerance HEMATOLOGIC Bleeding problems Anemia DERMATOLOGIC Skin Cancer
0 li'l 0 0 ~ 0 ~
J6.
0
Depression Seizures, convulsions, fainting,

epilepsy Stroke, fleeting blindness or
"ISI
0 0
}l
0 0 0 0 0 0
r&
weakness
Paralysis Psychiatric treatment
:8)
&
0 0 0
0 0
:
0
GENERAL Headaches, unexplained weight loss, fatigue
}6.
0 ~
other
Patient Signature:_~~
Physician Signature:
PI #
Date:
,
,'"' ~(!W'l'J ~~~
Iit@DfJ<WfJ
000523
~~
,
".',
uSE P~IEHT PLATE
~!.k
UNIVERSITY OF CALIFORNIA, DAVIS MEDICALCENTER SACRAMENTO, CALIFORNIA MUSCULOSKELETAL QUESTIONNAIRE . ~-;. ::"... - -._Page 1 of 7
Name of person completing form: __ Referring MD:
--
S_A_Me"
0 e,
Referring MD Address:
;:t.Sl
BA G,<J @.O
71letV
Pi K( De, '"c?:tOl1l
Phone:---9'/('o-
98:5- C}Mo
_ _
Primary Care Physician (if different than referring physicianl: PCP Address: State your main complaint or problem: Phone:

Ii
I~XTM) rJ 11\J6
00 (J hJ UA.lW
'-DUm
(!,ACJ( TIlM UGM:
Li)=r_S_I~OI5~
LG:G
What do you expect your visit to accomplish?
C'7l0)
I
~
ell 1-1 I lJWJO lJ
0f
ell r I\J
When did your problem begin? How did your problem start?
'1ID\~
t\6D
\
fl>t(JL
PJ\lrJ
I:lPPflD'1.
3
Where
tQ YeA~ &:> (}.)WIW [1..lM,~1\.G-' "~e<; ASh WI1)t N') APtIliU'n)[ CItlIl4( is your pain located? LOW @l ~IKk. ) I Sol ~
Of injury, please describe):
l.DUa
QN~
S'16!J1P'k:ftt>V\.\
IllORmvro
)
err
I f:T=r
,,6
If your pain spreads to other areas, please describe where:
LEFT
LE.B
What does your pain feel like? 'I1lBurning j:"(Sharp
o Throbbing
o Pressure
o Pins/Needles o Cramping o Most

of the Time
o Numbness o DUll/Aching o Occasionally
~Electric-Like
o Other o Rarely
I
How often do you have this pain?
;5:A1I
t~l:;'~H~
the time (constantly)
~tm~o~.W~
~Q@\ 000524
USE PATIENT
j:)lATE
'UNIVERSITY OF CALIFORNIA, OAVIS MEDICAL CENTER SACRAMENTO, CALIFORNIA
MUSCULOSKELETAL QUESTIONNAIRE Page 2 01 7
Relieving and aggravating factors:

Decreases the Pain No Change
Increases the Pain
Lying down Resting Sitting Standing Walking Exercising Lilting Bending Coughing/Sneezing Bowel Movements Functional Limitations:
'Il!l .~
o
~ ~
o o o o
o o o o
During the past month, place a check mark next to the activities that you avoided because 01 pain: ~ Going to Work
0 Perlorming Household Chores

)( Participating in Recreation
. "' I
0 Yard Work
~Exercising
0 Shopping
~ocialiZing
with Friends
Previous & Current Treatments:
Please check all 01 the treatments you have tried lor your pain and then complete the appropriate column at the right to the best 01 your ability. Approx. No Moderate Excellent Treatment Date Relief Relief Relief 0 Physical therapy/exercise 0 0 ~ 0 Pool therapy 0 0 0 0 Heat treatment 0 0 ~ 0 Ice 0 0 0 Traction 0 0 0 TENS 0 0 0 0 Chiropractic '0 . 0 0 0 Bioleedbac k/meditation 0 0 0 0 Psychotherapy O "0 0 0 Steroid injections/ Epidural injections l~ '(" 0 0 ~ J.,c. 0 Surgery '0' 0 0
y.
0 0
Acupuncture Other
~t
50
4- ~ -
q.
0
Comments:
0 0
0 0
~
Previous Diagnostic Studies (Please indicate approximate date and results, if known): MRI
X.
CT
X-Rays ---------------------------------~---------
EMG
Allergies:
A46732 12/02)
&. I L P!VfliTR
MUSCULOSKELETAL QUESTIONNAIRE - DEPT. OF PM&R
MR#07/90-91
000525
,._
USE
.t. -pJuu::m
PLATE
UNIVERSITY OF CALIFORNIA, DAVIS MEDICAL CENTER SACRAMENTO, CALIFORNIA
MUSCULOSKELETAL QUESTIONNAIR Page 3 of 7 Current Medications: Name Dose How Often Does it Relieve Pain?, No Relief
Moderate
Excellent
j1erlID 00
_FLOC> X ID'~ly{~_- %
B/:lv\t) t,
,?,>OM6
\O/3?S
t16
----O_b.I_L'i "/."-.. OA l
_
\"'1'
~
0 0
)(
\,I''1@')rQbl.1i'
{oc.m>M.WfI~
X4-. S"
~~
Ol\ll,'t
Jd.,
'J.
0 0 0 0
0 0 0 0 0 0
IV~PROt.tM2 Soo.O,vl ~r\lOQDGa
dJO MG
ro ~
Xi'
O~\IN ~1." 't
!J:.
0 0
0"
Past Medical History: Aside from your pain problem, how is your general health? (Please check one) Exc"ellent ~Minor health problems only 0
Major health problems
Have you ever had any of the following health problems: High blood pressure 0 Diabetes or high blood sugar Angina or chest pain 0 Heart attack Asthma or wtieezing '0 Chronic 'cough o Stroke 0 Seizure or epilepsy o Cancer Please specify what type of cancer:
o o
0 0 0 0 0
Kidney disease Liver disease Arthritis Bleeding Thyroid disease ,_, , _ _
Other: Please Specify:
ALL Surgeries (approximate date and type of operation)
)O.~(!ILL~Y ~\ilA
R,~MQ ..
Family, History Father: Mother: Siblings: If Alive Age: Age: Age: Age: Age: Age: _ good good Health (circle one I fair poor fair fair fair fair fair poor poor poor poor poor
1-\8
+1
8
good good
000526
USE PATIENT
PLATE
MUSCULOSKELETAL
QUESTIONNAIRE
Page 4 of 7 Family History (Continued)' Have your blood relatives had any of the following? High blood pressure Tuberculosis Rheumatic Fever Nervous Breakdown SOCIAL BACKGROUND Currently Employed: Yes If yes, what type of work? _ (circle) Heart attacks Alcoholism Arthritis andlor Gout Kidney or Bright's Disease Stroke ~anc~ Asthma
Heartdisease
, Epilepsy Bleeding tendency Diabetes
If not, when did you last work and what type of work did you do 7
~ral L
COMP~
tJ~QK
Af)MIJjlb'17MnOtJ
Please complete the following information if your problem is the result of an on-the-job injury or if you have retained a lawyer because of this problem or it.vou expect to receive disability or workmen's compensation. Work-related injuries: Date of injury: Employer at the time of injury: Name: Address: _ ___ _ _
Location:
Phone #: Insurance Company: Name: Address:
_ _ _
Phone #: Adjuster: Case #:
_
_
Any litigation pending? Yes
----------------------------_
No
If yes, describe:
Are you applying for di~ability benefits?: From whom?: _ ~
C/HA FoMJrJ:l \
Yes Amount:
No
01f
d-
Serli&1
Do you have or suspect any latex sensitivity: Do you drink alcohol? Have you ever smoked? Substance: 3ltlBllCCO
No No
e'
D/WJI'S
Iluw
How long:
~.
Amount: MUSCULOSKELETAL
How long: - DEPT. OF PM&R
A4673-4
12/021
, QUESTIONNAIRE
iliJ
-r 1f
II
"ftmRb
MRH07/9091
000527
USE PATIENT
PLATE
'.
UNIVERSITYOF CALIFORNIA,DAVIS MEDiCALCENTER SACRAMENTO,CALIFORNIA MUSCULOSKELETAL QUESTIONNAIRE Page 5 of 7
Social Background (Continued) Have you used street drugs? Substance: Yes, No ,Amount: Yes .. How long: _
Have you ever had a biood transfusion? When? 'Why? When did you iast have a tetanus shot? Highest education:
No
---------,----------
hI)(, ~(D~a~t~e~) --~-~LI'J--,-+,,~~.
----kl- \RH
SC&k1L
Q,Pi.oM1l
Have you ever lived outside the United States?,_ If yes, state where and for how long: ;;.
<0
,.~
f'0{)ttp'\

Ii
Military Service: No If yes, rank and type of discharge: Are you (circle' one): Are you sharing a residence: Married Yes
G>
Divorced
Single
If yes, is that person's health (circle one): location: residence: phone: Miles to nearest family or friends: Number of children: ROS
Good
Poor
Where do you live:
:JC>\1
Apartment,
R>\.;~
Other
CA
'tS/o 30
--------
9'S
and their ages:
Are you easily fatigued? Unexplain'ed weight loss or gain? (Circle one) Do you have a fever? Do you have chills? Do you have an unexplained decreased appetite? Do you have an irregular heart rate? Have you ev'er had a heart murmur? Do you have difficulty exercising due to weakness? Do you have chest pains? Do your ankles swell constantly? Do you feel,like you might faint or feet light-headed? Do you have unusual headaches? Have you ever had a seizure? ' Have vouever been paralyzed? Do you feel short of breath? Do you have trouble breathing with any exercise? Do you have a cough? Are you coughing up blood? Do you have a cold? Do you have pain when you urinate? Do you have or have you had blood in your urine? Are you urinating too often?_ Do you feel like you have to unnate all the time' Are you unabie to control your urine?
@
YES YES YES YES YES . YES
YES
YES YES YES YES YES
-, "=
YES YES YES YES YES YES 'YES YES
HOW HOW HOW HOW HOW HOW HOW HOW HOW HOW HOW HOW HOW HOW HOW HOW HOW HOW HOW HOW HOW HOW HOW HOW
LONG? LONG? LONG? LONG? LONG? LONG? LONG?LONG? LONG? LONG? LONG? LONG? LONG? LONG? LONG? lb '~ LONG? LONG? LONG? LONG?LONG? LONG? LONG?LONG? LONG?
\{es:
:>-
"/{fIl$!S
'i~~
'lib"!>
000528
USE PATIENT Pl.ATE
MUSCULOSKELETAL
QUESTIONNAIR
Page 6 of 7
ROS (Continued) Do you ever lose control of yo~r bowels? Do you feel sick to your stomach? I, .(L(;L'I-/d Have you thrown up, had diarrhea bS.r~l;bpat(o'n~cently? Have you passed blood with bowel movements? Have you ever had tarry stools? Have you ever had ulcers? Have you ever been jaundice? Have you ever had gallstones? Do you have djfficulty moving any limb? Do you-have weakness in any limb? Are any of your muscles wasting? Do you have morning stiffness? Do you have joint swelling, redness or pain? Is your pain worse at night or awaken you from sleep? EQUIPMENT: Do you have any equipment needs? (wheelchair, braces, assisnve devices) If yes, what are they: YES _. __ . YES YES HOW LONG? NO HOW LONG? HOW LONG?ItJ'rHt,M1Tl>Ji1.)r '. HOW HOW HOW HOW HOW HOW HOW HOW HOW HOW HOW LONG? LONG? LONG? _ LONG? LONG? LONG?_______ LONG? j). - "i~ LONG? _ LONG? C. 'I \1ll\f, LONG? :: 'i~ LONG? ~ ~ _
, _ .
YES
YES YES YES YES YES
44 \.IQI\~
@
~
YE>
<@)
NO
NO NO
NOY
_
FUNCTIONAL: Are there any functional activities of daily living (dressing, mobility, transfers, bathing, cleaning, self-hygiene) that 'you need assistance performing? Y'ES ' NO'
'I:.
If yes, explain:
Patient Signature
Date Completed
MR#07/9091
A46736
12/021
MUSC'ULOSKELETAL
QUESTiONNAIRE,
DEPT, OF PM&R
000529
USE: PATIEtH
PLATE
SHOW BY MARKING AND DRAWING HAVING MOST OF YOUR: .
UNIVERSITY OF CALIFORNIA, DAVIS MEDICAL CENTER SACRAMENTO, CALIFORNIA MUSCULOSKELETAL QUESTIONNAIRE
Page 7 of 7
ON THE BACK AND FRONT OF THE FIGURES BELOW WHERE YOU ARE
xxx XX
Aching or pain: xxxxx Numbness or tingling:
xxxxx
***** Pins and needles: ..........
00000 00000 00000
Cramping:
*****
Draw arrows where pain goes or shoots)
AAAAA AAAAA AAAAA

(RIGHT)
:
i
) ii (

(LEFT)
(LEFT)
(RIGHT)
o 0
(FRONT)
-'
...
"":-.>--
(BACK)
000530
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9 1 6 - 'l f! :3--~ ~ 89
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0321.
os
(/
UNIVERSITY OF CALIFORNIA, MEDICAL CENTER, SACRAMENTO
DAVIS
08139 BA~UERO. VICTO P BLUE SHIELD-UCOCAP 02/06 PCN fOLSOM
HO
.-< .-- .\/ I J .P ,OPD<PROGRESS
t.',""
...
. .s.~
-\ 1.\
RECORDS
Date of Surgef)'(within 30 days 10 6 months) Reason for VISII;
\:;?
Sr'-' .:x\
- Pal
.
Yes
t:I
Education Needs Assessed
pa,~eenlng/A.sessmenl
No
_b.\'.. ~_~\
.
Allerqres~~:~~~"'Late~NO _ Ye If lnterp neede , la guage (Fnday tumor pts) kg. Ht __ Weigh! (new Medicare pts)
Location ~ Not area of specIalty ___ 1 yr To 3 yr (0-11 scare) ___ ___ Premature 10 1 mo. (O-iscale) _ Yes, seeing MD for this pain _ No, not being tx _ flu With PCP/other MD _ ENT tx _Urgent _ ER referral/speciality/PCP _ENTtx
_ 7 yrs 10 adult (1-10 scale) 3 yrs to 7 yrs (0-5) scale
b ~Q!b
Patient
ci2i'." '0
_ Pt /Famlly
Info~a\lOri gWEin---Yes,-see
Iearrunq?
note
No . ves _ VISion _ Hearing _ Reading _ Psychological ~ Other Indicated understanding _ Cultural
It ...: Inch
_ No' urqent _ ENT tX-bsame_day
T __
8IP
P __
R __
RNILVNIMASrqnat
~;ht--V->
~
_ Re,u~ vrsr
~vertJahzed
_ Lp te ad,ngISign
.-
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ReadlllglWntlng _ Return demo ._ nstructions to parent/caretaker _ Handout/brochurelvideo given
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----
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000531
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UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER, .;, SACRAMENTO, CALIFORNIA
Va
~v-e.....
PHYSICIAN'S DISCHARGE ORDERS RY LOGY CLINIC
02106
rOLSO".~.:!
. All Labs need ICD 9'ibode ALLERGEN TEST (seesheet) Drugs Food
I> J'),
~ 0
Need';i:i'l'in & ICD9 codes & attending name Most of these will need auth/send notes to discharge. M/cal needs Tar & Rx Faculty ICD9 code Diaqnosls/justrncation CARDIOLOGY o EKG 0 Threadmill PI # _ _
_
a a ese:w II need auth/send notes to discharge. Mlcal needs Tar & Rx . _ AUDIOLOGY
o o MRAST $ (writeIn)
o AUdiogram
oABR oENG oHAE o Posturography o Other
o Impedance
IR/ENG oOAE o VAT _
o RAST region 9W Prof 1&2 (writeIn) BLOOD CHEMISTRY o ANA$' o Electrolyte Panel Basic Metabolic Panel Hepatic Function Panel Comprehensive Metabolic Panel o Heterophile Antibody - Mono o HIV (need consent) Immune Profile w subclass $ Rheumatoid Factor * o SyphiliS Serology RPR (ck both) o Syphilis Serology TPPA o Thyroid Panel Free T4 oTSH' o Other
CONSULTS Manage care pts needs ref from PCP o FNA at Ca Center call 4-5954 o Heme One 0 Rad One 0 Sleep Study o Ref to other departments _ ELECTROENCEPHALOGRAM oEEG ELECTRODIAGNOTIC LAB o EMG ot NUCLEAR MED & RADIOLOGY o CXR PA & Lat 0 Other
o o o
o o
DENTAL ICD9 0802.30 fx man 0749.2 cleff o 524.4 rnalocclusron 0 524.60 TMJ o Ceph Xray o Occlusal oPA Panorex
o Consult for:
_ _ _ _
o
_
_
o Prosthesis
_ o Splint to' o TMJ Eval o Other
to:
o CT of
o MRI of
0 routine 0 asap 0 stat 0 after
CROSS MATCH Need Pt blood adv form signed OR date o T&C RBC -_units (1 slip for ea) o T&S if OR longer than 3 days Autologous/Donor Desrqnatad form need form signed by physician
o PET Scan of (need PET quest) o Barium Swallow o Bone Scan o Thyroid Scan (use protocol If on synthroid) o Ultrasound gUided bx of thyroid (labs)
NEED HAR & blood work (ebe/basle matab panel/ptlaptt)
(need rnn quest) 0 child need sedation
o Blood Count o Hemoglobin

o o o o
HEMATOLOGY 0 w auto diff $ 0 Hematocrit Erythrocyte Sedimentation Rate $ PT (prothrombin time) check both APTI (active Partl Thrombo Time) Other
send to surgery desk

o Anqro 0 Embo 0 Balloon Occlu o Pre & Post Specs o CT Guided FNA to lungs
SPEECH PATHOLOGY swallow o Eval for speech/language Swallow clinical/beside o Tracheo-Esoph puncture sp o Laryngeal EMG Pulmonary Screening D Velopharyngeal Incompetence D Voice Clmic include PFT,videostrobe, acoustrc.LF'S o Voice/Stroboscopy o Other _
o Dynamic
_ NEXT F/U VISIT Appt In; Need' o days 015 min. D weeks D 30 min o months 0 45 min. o year 060 min. D.RJischarged C!f flu after ~o/etc 0 speech/etc 0 dental o angio/etc 0 C 0 MRI 0 nuc med o labs 0 at _ D OK to overbook 0 OK to extend time Procedure planned _
o Ultrasound
gUided bx to lung/llver/abd
METABOLIC o Super TSH Other
PM&R CONSULT
o Vestibular o Complete
oABG
o Physical Therapy Rehab FUNCTION
MISCELLANEOUS (write in) oCANCA$ o FISH rio VCF High Resolution Chromosome
PULMONARY
w/bronchodrtator
TOXICOLOGY & DRUG ANALYSIS
o Screening
o Carotid Artery duplex ultrasound o Artenal duplex ultrasound

Discharge Coordinator _
VASCULAR
LAB
URINE/FLUID/FECES Test o SweatChlorideTestcall apt 4-1152 Tues$ Unnalysis - complete $ Urinalysis - chemical only o Other _
o Pregnancy
o Need xray film for next visit.

o Need medical
records/film from outside
(need release of Info Signed by pt.) Ordering Phystcran
o o
ICD9 code
000532
.r: .'.
~R-::tf SOC?
)iJb
o MAIN
.~ /.-s -
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UNIVERSITY OF CALIFORNIA, MEDICAL CENTER SACRAMENTO, CALIFORNIA DIAGNOSTIC IMAGING REQUEST
UcD L::A'? o DAVIS TOWER

2315 Stock1onBlvd. (916) 703-2100 (916) 703-2254 (fax) Services: GI, GU, Fluoro, Pediatric, Nuclear Medicine, Ultrasound, Vascular Lab, Plain Film
HOSPITAL 2315 Stockton Blvd. (916) 703-2100 (916) 703-2254 (fax) Services: Angio/lnterventional,CT,MR
LAWRENCE J. ELLISON Ambulatory Care Center 4860 Y Street, Suite 0500 (916) 734-0655, (916) 7340650 (fax) Services Lower Level: Mammo, Ultrasound MR, Nuclear Medicine, Vascular Lab, CT Services First Floor: Plain Film
PATIENTS NAME AGE:
JhvjM,rwt~U1 tvtuxr
SOCIAL SECURITY #
0
CALL FOR HOURS OF SERVICE OR IF YOU NEED FURTHER INFORMATION UCDHS MED REC# PATIENT PREGNANT:
0 0
DOB:(Req) Yes
0
_ _
No lMP:
0
KNOWN ALLERGIES:
Yes
No
Yes
Yes
No _
, ~;'4:
\:"
~
ICD9# CONTACT:
. A:"\o
AUTH
#-5b2J "1D 11r"]

_
REFERRING CLiNIC/PCN: \
APPOINTMENT DATE & TIME:1F\ REFERRING PHYSICIAI~ SIGNATURE: PHYSICIAN BEEPER:
13 1;WOes-
BACK LINE PHONE #
Q... \0-: Ot> 1'1\,MD. PHYSICIAN PI #
%%
City
PHONE #
Street Address
State
FOR NUC MEO USE ONL y RECENT ISOTOPE PROCEDURE
Type:
Date:
Cr
PHONE RESULTS:
STAT
TODAY
0
ADDITIONAL COPIES TO: No PREVIOUS COMPARISON FilMS:

0
_ Yes
0
PREVIOUS UCDMC PATIENT: DYes
No ADDRESS/LOCATION
OF PREVIOUS FilMS: I
FAXED
MAR 3 1 Z005
000533
'u;;.;",,: Pil2~;:Nt p; iJ.T~'";
AMUNDSEN
8081369 M
,MARK
09/23/1959 BAQUERO. $15 ViCTOR H
78-080963024
I. AETNA-PPO/POS ~~"i-.
916-983-2589 02/13/06
i
Clinic Arrival
lVERSITY OF CALIFORNIA, DAVIS--' MEDICAL CENTER SACRAMENTO, CALIFORNIA
I
Work 916-337-3680
OPO PROGRESS REPORT

-Time: -----------_
@ 11 :30 AM
I
I Appt. TimyC
Pain?/O Yes
~
II I
H D MOEHRING
No
S
T
Intensity
0LoI \(p
Level/Location
IOFC
Faculty
Do you need refills? Nursing Signatur
0 Yes
No
Medications
ASSESSMENT OF PATIENT/FAMilY EDUCATION EEDSCOMPLETED AND NEEDS IDENTIFIED? , DYES DNO
o Teaching Protocol used.L o Handouts given. o Safe medication use o Safe use of medical equipment, o Cost issues discussed
MPER and Collaborative path used? DYes DNo If no, please complete the following section: 1. Motivation to learn? DYes DNo 2. Best learning method? 0 Verbal 0 Audio Demo Audiovisual Written 3. Barriers to learning: DNONE Visual DHearing DReading Cultural/Religious Physiological 4. Patient declines information? Yes
TODAY THE PATIENT WAS EDUCATED ABOUT:
_ _
supplies
Total
encounter of time
time: spent counseling?
o food and drug interactions and modified diet o Rehabilitation techniques o Community resources, lis..' _ o How/when to obtain further treatment? o Self care o Pre and post op standardized teaching o Communication to other organizationS/services responsible for care?
UNDERSTANDING
,
PATIENT/FAMilY
Majority
'~~'
0 Yes
0 No
o Verbalizes 0 Return demonstration o Unable to comprehend D Needs further instructions

, 000534 .
--
I
I
-~~~ofP''
.
0328 06
PHYSICIAN PROGRESS NOTES ~. ~wlA-i+ Chief Complaint HPI: (key eleme~ts)
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P ysical Exam: (key elements)
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,. '.
:.,ga fljTlage
ellmage
P.i0-
.Z) Old
Records -
~'-11#
Report , Viewed
o EMGIEKG Report M"~9 -~ 1;; s. o EMG/EKG Viewed" liJIJ6 o Lab Result Reviewed ,{ '7d-" '2iI3f, o Discussed wi another Health
Provider:
Provider Name, _
//&j:y4;:J '1/c;~ J pV/l>t I Lb- 10y

IZ
Provider & Dates
r-
o Counseling
Of the
Session minutes spent with
the patient, greater than 50% was spent counseling the patient regarding
AR 181 (3/04)
PAIN MANAGEMENT ATTENDING PHYSICIAN DOCUMENTATION
000535
MR#08100569
USE PATIENT PLATE
808 13 bCl ,
",,.,UNOsrN
p
-
:3e-11261:300~~
,lURK
"
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O~/2:3/~9
09139
916-99:3-2589 BAQU(RO~ vIeTO HO

Pi"N
DATE
TIME IN" ALLERGIES>?
/j EJ'luloll
PATIENT WEIGHT
/2- ~ TIMEPUT __ ~ __ ~~ /1 t? r JJ/V/I ( ...L,?CI ,) rCJ rltJ
t""
AtTNA-PPO
fOLSOM
3-oZt'-Q; ,NEWPATIENT ;;,

,:FOLLOW-UP ATIENDING FELLO~J.':{' NURSE~
.1
03
as
06
NURSES PROGRESS NOTES PAIN MANAGEMENT CENTER ,Zi.

D
It'
02,f!J
0,;
I':'
MEDICATIONS YES NO D D NPO lml Triamcinolone 40malcc D D 10mlSaline DRIVER 10ml Bupivacaine 0.25% D NSAIDS LAST 3 DAYS D 10ml Buolvacalne 0.75% D D ASA LAST 7 DAYS 30m I Lidocaine 1% WARFARIN LAST 7 DAYS D D 5ml Lidocaine 2% D CONSENT D 2ml Lidocaine 5% Botox A 100units D D FLUORO 2ml Hvalqan D SALINE LOCK/IV D 2 mgGlycopyrolate (Robinul) SEDATION D D (IF YES, SEE SEDATION PROCEDURE RECORD) D PRE-OP: SITE VERIFICATION WITH PATIENTAND CONSENT. II] DlliJ VERIFIED WITH SURGICAL X AND VERISITE STICKER. D INTRA OP: SITE VERTIFICATION RE-VERIFIED. D N/A IF NO STAFF CHANGE. D SURGICAL / PROCEDURE PAUSE IV NEEDLE SIZE SITE PROCEDURE PROCEDURE START TIME: PROCEDURE END TIME: INITIAL
~1
Remainder Wasted
D D D D D D D D D D D D
PRE-PROC.! ADMIT POST-PROC.
12?u
JAy;7
TIME
VITAL SIGNS
JI tJ
PAI~10
Sd',:Q F
i~L I '1'
<
PULSE
grO
RrC
!JSAT.
ASSESSMENT: MEN;l'I([ STATUS arALERT D APPREHENSIVE D CONFUSED D ORIENTED
C01l\MUNICATION
urN/A
D LANGUAGE BARRIER D DEVELOPMENTALLY DELAYED ~~NDITION
coL01f
RES.emATORY Iid1JNLABORED D MINIMUM DISTRESS D OXYGEN @ ----UMIN MO~, crMOVES WELL D W/ASSIST D WHEELCHAIR
SKI!:!---"
G31NTACT D RASH D OTHER: _
D"NORMAL
COMMENTS
D FLUSHED D PALE D COOL 1NIT1l
~~'
D DIAPHORETIC DOTHER SIGNATURE / , _
f}/htua--
PATIENT EDUCATION AS~E$SI'D INFORMATION GIVEN U (( BARRIERS TO LEARNING: DYES )S:NO SEE ABOVE (Communication) INDICATED UNDERSTANDING g-YES D NC VERBALIZED UNDERSTANDING 11 RETURN DEMO INITIAL tQJIiL 000536
Ii L.;.Bf6_
;1-_
'03 Z8 06
UNIVERSITY OF CALIFORNIADAVIS MEDICALCENTER, SACRAMENTO, CALIFORNIA
DISCHARGE INSTRUCTIONS
Retu rn to clinic Phys ician:
in:
L-.Jer,
-f>
o o
If Days I Weeks <: T6~II.e.,:;./ \jt:-"\

~ r: .171 ::c0 No' ~
IM
ths
APPOINTMENT DATE: APPOINTMENTTIME: NEED AUTH INITIALS' YES~ /~JT ,
-slz:;tolp
I q :'DO
,
Fo lIow up '~xtend~tollow .#; Ot her

0 Yes
0 Complex Reeval 0 TriplicatlRx /<7 - /:( /' Referral
FLUO ROSCOPY:
o Axillary Nerve Block o Bier Block o Blood Patch o Cervical Epidural Steroid o Caudal Epidural Steroid o Cryoablation o Celiac Plexus Block o Discogram o Facet Block
DC DT DL
2'?'L~J2, ~4
'if}
DC
o Impar Ganglion Block o Intercostal Nerve Block o Ilioinguinal Nerve Block o Lidocaine Infusion o Lidocaine Push o Lumbar Sympathetic Block o Lumbar Epidural Steroid o Medial Branch Block
DT 0 L
aA~l'Vlr
. ~d
c/:'?.:.
~ 1"45 ~
___
f,W><
Y1
0 Piriformis
of "',~~
o Pump Refill o Radiofrequency o Pulsed

DC DT DL
DC
o SI Joint Injection o StimTrial o Stellate Ganglion Block o Selective Nerve Block

DT DL
o Gen-Fem Nerve Block o Hypogastric Nerve Block

DIDET
o Greater Occipital Nerve Block o PNT o Phosphenyloin Infusion o Phentolamine Infusion

FOLLOW
o Third Occipital Nerve Block o Thoracic Epidural Steroid o Trigger Point Injections o Tens
BELOW INSTRUCTIONS:
IF YOU ARE SCHEDULED FOR A PROCEDURE, PLEASE o Nothing to eat for eight (8) hours before procedure.
II
,I
o o o Other
o You MUST have someone

Instructions: __
o May have CLEAR
liquids up to 2 hours before procedure. Black coffee NO creamers or dairy additives. drive you home. You cannot use a taxi or bus. No aspirin or aspirin like drugs for seven (7) days prior to procedure. No NSAID (Nonsteroidal Anti Inflammatory Drugs) 3 days prior to procedure. ~ 48 hours after your procedure may result in rescheduling to a later date. ,
Traveling
out of town within
IF YOU RECEIVED A PROCEDURE TODAY, PLEASE FOLLOW BELOW INSTRUCTIONS: Notify our office (@ 916-734-7246) if you experience any bleeding or swelling at injection site, signs of infection (increased oral temperature, drainage or redness at injection site), severe pain, severe headache, numbness, itching or rash. Do not take a bath, swim or use Jacuzzi for 24 hours after procedure, a shower is fine. I
cfiP' No restrictions
PATIENT NURS ~
ACTIVITY
LIMITATIONS
AFTER TODAYS PROCEDURE: hrs
0, No driving for __
0 Limited activity for __

OR 1-800-770-9269. MD(
hrs please call

I
For further questions please call 916-734-7246 us 48 ho rs in advance. Than!<..you. ~
If you cannot keep your appointment, ;...-.---; ~ ~.::

3?
ht.-\ ,vt1 ~
./
I
AR2054 (9/05)
PAIN MANAGEMENT
DISCHARGE
INSTRUCTIONS I
000537
MROI/OS33<
,808-13-EI9-"\
38-112613005
'l, M "3
P
03/07
03/28/06 674/PMC
--~WAMUNDSEN ,MARK
AETNA-PPO
0912311959 916-983-2589 OB139BAQUERO. VIeTO -o
.0
MAIN ':O,SPITAL
2315 Stockton 'Blvd (916) 703-2100 _, (916) 703-2254 (fax)~' Services: Angio!lntelVenlronal,CT,MR
o DAVIS TOWER
2315 Stockton Blvd. (916) 703-2100 (916) 703-2254 (fax) Services: GI, GU. Fluoro, Ped,atric, Nuclear Med,c,ne, Ultrasound, Vascular Lab, Plain Film
o LAWRENCE
J. ELLISON
Ambulatory Care Center 4860 Y Street, Suite 0500 (916) 734-0655. (916) 734-0650 (fax) Services Lower Level: Mammo, Ultrasound MR, Nuclear Medicine, Vascular Lab, CT Services Firsl Floor: Plain F,lm
CALL FOR HOURS OF SERVICE OR IF YOU NEED FURTHER INFORMATION PATIENTS NAME---l)m AGE:
un elk."
CI Yes 0
Mtiflv
UCDHS MED REC# PATIENT PREGNANT: DYes

0 0
DOB:(Req) Yes
0
_ _
SOCIAL SECURITY # No
0
No LMP:
0
KNOWN ALLERGIES:
.1J/41A:::
,&{d to
1/2/
Yes
o No _
(L)Ct,'p ~,
CLINICAL HISTORY/SUSPECTED
DIAGNOSIS:
C~/
IfltI/5CU{rfY
'tiJtutl
ICD-9# ________ ~~ _
;1; t{'rJc/t/~ Ifi. irT: oJ'Y'1i/surirJulO
f0vv /
REFERRING CLiNIC/PCN: APPOINTMENT DATE & TIME:
PA3:;J
.
CiPI/
. MD
slu/t
BACK LINE PHONE #
REFERRING PHYSICIAN SIGNATUR PHYSICIAN BEEPER:

FOR NUC MEa USE ONL II RECENT ISOTOPE PROCEOURE
{lYe.{
PHYSICIAN PI #
0/1--;;3
City
PHONE #
_ ~
PHYSICIAN ADDRESS:
Street Address Type: Date:
Slale
PHONE RESULTS:
STAT
0 0
TODAY Yes
0
ADDITIONAL COPIES TO: No PREVIOUS COMPARISON FILMS:

0
_ Yes
0
No ADDRESS/LOCATION
OF PREVIOUS FILMS:
000538
09:44
PRIN CLINIC ~ 32254
916 734 5078
NO. 406
[,)01
.-~'
-
,..808'::1389-4\.3
. p
03/28/06 38-11261~I006 03107 874/PMC
--
--
--".
UNIVERSITY OF CALIFORNIA,
MEDICAL CENTER
,.
AMUNDSEN ,MARK
AfTW,-FPO
Wl39'~
M 0012311969 918983-2689
I/ItTO 1'(l
,.
SACRAMENTO,
CALIFORNIA
o MAIN HOSPITAL
2315 Stockton Blvd. (916) 7032100 (916) 703-2254 {lllX) liefVlC118: AngioilnlelVonl"nal,CT,MR
, ~. ('.. ."... ~ o DAVIS TOWER

2315 Stockton Blvd,
DIAGNOSTIC IMAGING REQUEST LA~CE

bu~tOlY
J. EllISON
S Cent~~OO 6 (fall)
( 16) 7 MR,
ommo. Ultrasound
Vascular Lab. CT
SsMceo
oar: PlainFIlm
CALL FOR HOURS OF SERVICE OR IF YOU NEED FURTHER INFORMATION PAT-lENT'SNAME_Am un
Osc-9\., I .Mtt.rlv
UCOHS Men REC# PATIENT PREGNANT:

0 0
O.O,B:(Raq) ves
0
_ _
0
L TYPE OF EXAM(S) REQUESTED:
AGE:
4f,
SOCIAL SECURITY /I
0
No LMP:-No
KNOWN ALLERGIES: C Ye6
No o Unknown / BREAST-FEEDING: o viis
No {
1/21
ooss PT. NEED INTERPRETER: 0 Ves LANGUAGE SPOKEN:

~I'
(L) tt'e
REFERRING CLINIC/PCN: APPOINTMENT DATE & TIME: REFERRING PHVSICI.~N SIGNATU \....... PHVSICIAN BEEPER:.
FOR NUC liED lISE! ONI. Y RECENT ISOTOPE I'I/D{.'EOURE
L(ft~ __PHYSICIAN AOD1'lESS;

Type, - ."
PHONE RESULTS: "STAT PREVIOUS UCDMC PIHIENT:
lJ 0
TODAY Yes
D
ADDITIONAL COPIES TO;
'~{' ... ,.X:i r':J<~!:".i' ,.-;<\.~. .'1.:.1
~li
L
,":'Ij . .,:<a~,~~ ~-Y'n ~:~,I# . _ \.i.~, ' ~':~' ~'r"'}1 . '''',,;~. '" n.:: ...t, ..~ ..",+ '0::h4:; "r:~"1t f'
~"': ~iUt.~.
.f>-~~.!"!,.,,
< ,il
iiJ
.f
~~.
No PREVIOUS COMP.ARISON FILMS:

, I
.. ,....., -- i~ej
._ .... ~,~.\~'.~ . '~,.--"'7. ~~,,~:~

! .;, ....,...,,:". '" -..........
i:l
vei
No ADO.RESSfLOCAnoN
':"1 '., t.... ' . ! . ~

'_.1
m~ ,
'~"Ji
tV].
.',' .
-:
b1J' of PREviOUS
'\
, "
-,
FILMS
oc
. -"
~-~...,
..-.y
", \"
-.";".~'
'} ';':. t: ',','
~~~ ~~.
\
, , ,.
000539
~
AMUNDSEN
BOB1369 M
,MARK
09/23/1959 BAQUERO, $15
7B-080963057
VICTOR H
AETNA-PPO/POS
lAP t. Time: Pain? Intensi
UNIVERSITY OF CALIFORNIA, DAVIS MEDICAL CENTER .' SACRAMENTO, CALIFORNIA
OPD PROGRESS REPORT

Clinic Arrival Time: -----------~ Yes -----
916-983-2589 06/01/06 PHD
Work 916-33i-3680
@ 01 :45 PM
MOEHRING
II
No Allergies:
Level I Location
IOFC
Faculty
CC:

Total encounter time: Majority of time spent counseling?
Do you need refills? Nursing Signatur
Medications
ASSESSMENT OF PATIENT/FAMILY EDUCATION NEEDS COMPLETED AND NEEDS IDENTIFIED? DYES oNO
MPERand Collaborativepath used? DYes oNo If no, pleasecompletethe following section: 1, Motivation to learn? DYes ONo 2, Best learning method? 0 Verbal 0 Audio Demo 0 Audiovisual 0 Written 3, Barriersto learning: ONONE o Visual oHearing DReading 0 CulturallReiigious 0 Physiological
4. Patient declines information? Yes TODAY THE PATIENT WAS EDUCATED ABOUT: Teaching Protocol use,d"~
o
o o
o o Food and drug interactions and modified diet o Rehabilitation techniques o Community resources, Iist.~ o How/when to obtain further treatment?' o Self care o Pre and post op standardized teaching o Communication to other organizations/services responsible for care?
Cost issues discussed
o Safe use of medical equipment,
Handoutsgiven, Safe medication use
_
supplies
s.
~~E~)
0 Yes 0 No
MD PI#
,0 Verbalizes 0 Return demonstration
PATIENT/FAMILY
UNDERSTANDING
o Unable to comprehend
B
,
:
0 Needs
further instructions
@}fD)
[f:m:~~:-~ ~:;}~,;.~~" '0 '>;~.
I,
=/l;)"'ID. 000540
Ii
USE PATIENT PLATE
UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER SACRAMENTO, CALIFORNIA
UC Davis Health System
8081389 Sex: M
PAIN CLINIC CC Ace: 477249

Date: 06105/2006
563
AMUNDSEN,MARK
09/23/1959
Acct# 038112613062
WARNING: Cenaln Implants, devices, or objects may be hazardous to you and'or may Interfere wiltlltla MA procedure (i.e., MAl, MR angiography, functional MRI, MR spectra 00 nolentel' 1M MR system room or MR environment If you have any question or concern regarding an Implant, device, or object. Consult the MAl TechnologlF>\or Radiologis
BEFORE en19ring the MRI system room.
The MR system magnet Is ALWAYS on.
Name:j1t4( PatienlWeighl:
AM(J'{()$J .d..I.'5_ __DOB:~-;;'J-/95'1
Medical Record Number:
to~ /3
DYes DYes DYes
DYes
G9 '-I
Date:Ja=~')~-~~
1. 2. I"'"' 3. 4. 5. 6.
Are you wearing a hearing aid?

~o
Do you have implanted electronic devices, cochlear implants, Spinal column stimulator, infusion pumps, other implants? 00 you have or have you ever had a pacemaker 00 you have Sickle Cell Anemia? or implanted defribrillator?
Have you ever had metal fragments or other 10reign bodies in your eye? 00 you have any 01 the following in your body: Aneurysm clips Heart valve prosthesis, vascular stent, or coil Swan Ganz Catheter
DYes
DYes
~o J:liiI'lo ~ ~o ~o 0Hv
~:
DYes
DYes
IUD?
Penile implant? Inferior Vena Cava Filter? Any other type of prosthesis
-,..-.
7. 8.
Do you have a history of gunshot wound(s) Do you have any removable dentures or dental work? Have you ever had a reaction to MRI contrast media? Have you removed all body piercing jewelry? Do you have other metallic objects? Specify: Please contact MRI at 4-7959
g.
10. 11.
UYes DYes DYes DYes DYes DYes DYes ~s
I1lIro
~ ~o QIfllo ~~ DNo
If any of the above is ''Yes'' it may prevent MAl performance.
Reason 10r MAl and/or Symptoms: Region being imaged: Where Is the pain? DRight Oays ~es _
~efl
_
DLeg Weeks_
DNa
nArm
DBack
Months
What was the surgery, and when was the surgery performed?
If~
surgery? DYes
Do you have any melal skin staples in~cenl

Signature of person completing form:
~~Ji;ft.'
Date: ~-
5" -Ot;:;
"'00
Radiologist contacted: Radiologist's Signature
NOT WRITE BELOW THIS LINE-RADIOLOGY STAFF ONLY'"

_
Was the patient approved by this Radiologist?
_ White - Medical Records
_ __ Yellow - Patient Copy
Date:
1II2.2I$S~g.)f ,
!IliZ!Il41";.6"".'L~1 ~:;:gcqI4.fP' ~!IiII"'I~1ii ~11!!I"j"
"r-"",~.".
000541
USE PATIENT PLATE
UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER SACRAMENTO, CALIFORNIA
~~i._
UC Davis Health System 8081369 AMUNDSEN,MARK
-,,
UCDMG-FOlSOM Ace: 345854 . Date; 04/21/2006
Sex; M
09
I
I
Acct#
038112613047
/23/1959
WARNING:.Certainimplants, devices, or objects may be hazardous to you and/or may interfere with the MR procedure (i.e., MRI, MR angiography, functionalMRI, MR spectrosc Do not enter the MA system room or MR environment jf you have any question or concern regarding an implant, device, or object. Consult the MRI Technologist or Radiologisl BEFORE entering the MRI system room.
The MR system magnet is ALWAYS on.
_~
~_,-
Medical Record Number:.~
~:2~X>~ __ ~_~~
~
DYes _ DYes DYes DYes DYes DYes DYes DYes DYes DYes DYes DYes DYes
~ __
~
.,;J;a!'lo
Are you wearing a hearing aid?
Do you have implanted electronic devices, cochlear implants, Spinal column stimulator, infusion pumps, other implants? Do you have or have you ever had a pacemaker or implanted defribrillator? Do you have Sickle Cell Anemia? Have you ever had metal fragments or other foreign bodies in your eye? . Do you have any of the following in your body; Aneurysm clips
~o
~
-B'iro .,..8lIfo

~o
Heart valve prosthesis, vascular stent, or coil Swan Ganz Catheter IUD? Penile implant? Inferior Vena Cava Filter? Any other type of prosthesis Do you have a history of gunshot wound(s) Do you have any removable dentures or dental work? Have you ever had a reaction to MRI contrast media? Have you removed all body piercing jewelry? Do you have other metallic objects? Specify; If any of the above is "Yes" it may prevent MRI performance. ~ ~
.0JO
9do
-I8I'JO
.;l;3I\Io
.~
B'JO
~.
_ DYes
l8l>J'0 .' ~ 0
Reason for MRI and/or Symptoms: Region being Imaged; __ Where is the pain? . ~ __ DRight
hl{2 (fY>=-~ ~ft ~ __ ~ DLeg
Please contact MRI at 4-7959
~ DArm _ DBack
tb,f
Days _~____ ~
Weeks DNo
~
__ ~
to
\.,6
I
~ __ ~-,
What was the surgery, and when was the surgery performed?
.YOU
have any meta.I ski.n .. sta.pies in
~~&~@~MOrPJ-~~~~---~~--***00
Radiologist contacted: Radiologist's Signature White - Medical Records
-l-bAACl, iz:vJS ~ ",",=-/-}~~<-L=~'-DYes~'
e ~w~ng
re~~ry?
/' Date; ~
"1
NOT WRITE BELOW THIS LINE-RADIOLOGY

~
STAFF QNLY***
/~~
Was the patient approved by this Radiologist?
Yellow - Patient Copy .
"'-
./--
Date; _~_~_~_~~
71463-265 (2/04)
I"
MAGNETIC RESONANCE IMAGING (MRI) PATIENT QUESTIONNAIRE
:
,
000542 MR 00/895
916 734 51378 14:513
PRIN CLINIC ~ 40684
NO. 676
{;I01
J'''
aoa-13-69.-4\
M 3
03128106
38.11Z61~00S 03101 874fPMC
AMUNDSEN ."ARK
P 4Erw.-PPO
0912$11959 91 S.9a321;89 00l.3S BAOJORU "rem
I"D
o MAIN
Services:
HOSPITAL 2315 Stockton 8M ..

(916) 7032100
(916) 703-2254 Ilax)
o DAVIS
AngIoIlnt.",entional.CT.MA
;
TOWER 2315 siockton Blvd. (916) 7032100 (916) 1032254 (lax) sentlees: Gl. GU. Fluoro. PedIatric, Nuclear Medicine, Ultrasound, VasC1Jlar l.ab, Plain Film
o LAWRENCE
J. ELLISON Amhulatory Care Center 4860 Y Street. Suite 0500 (916) 734-0655. (916) 73"0650 (fax) Servlce9 Lower Le",t: Memmo, Ulttasound MR. Nuclear Medicine. Vascular. Lab. CT Service. Ats! Floor: Plain Film
CAll PATIENrS NAME--1}(.'h.'{' AGE: .KNOWN
FOR HO~RS OF SERVICE OR IF

I
vou
NEED FURTHER INFORMATION ._DOB:(Aeq)--_

tl
elSe , 11-llir1v
UCDHS MED REC#_~~ ~PATIENT PREGNANT: Yes

0
SOCIAL SECURITY #_~ 0 Unknown I BREASTfEEDING:
No LMP:
ALLERGIES' tl Yes 0 No
tA
de:I
I,
.0>1
'"
o Yes 0 No 1 DOES PT. NEED INTERPRETER: tl Yes o No LANGUAGE SPOKEN: _
1/2/ G') fAli'

.
'/l1
CLINICAL HISTORY/SUSPECTED DIAGNO~S:
{.fv
j;
Gff
./
REFERRING CLiNIC/PCN:
,!tMv,r / yVf,;sad4v!i.) ?A"i/'v:

BEEPER:
G
tr'C{Vf,-'C/zl/ I
';..1
41: [" T/ IfftIJ5L~(((}1'- gQdU,lJf. ~ .'

I
,..,..-/
\L
'
I r.
r:
lude!:}
(l~ ~..;.ryijYJ N.,W"'-. 1(/7 r.

~U
tfh's,d{i-v'
/2$v'
~7 ICD-9#
ru.l...;
-q:!(J ~/t-/~A1?TH
;11/2 S-(i.t(~
PHYSICIAN PI #
IIMCltp-
PY,l-I$14t.Y vlJP--v
# .
fj.tf/j
_ _
APPOINTMENT DATE & TIME
a&for;; WI
,
. _'_PHYSICIAN ADDRESS:
TYPf'
CONTACT:
BACK LINE PHONE #
REFERRING PHYSICIAN SIGNATURe:::d:,..,/1/
Il), M.D
CYlt3
Cit\!
PHONE #
-----~
Stare
VPHYSrCIAN
Street Address
Zip Cat
FOR NVe MED US. all( Y

RECENT ISOTOPE PROCEOURE
PHONE RESULTS. a STAT PREVIOUS UCDMC PATIENT:
0 tl
TODAY Yes
0
I I
Oat.: ADDITIONA~ COPIES TO:
No PREVIOUS COMPARISON FILMS: eVes
---------------------
c No ADDAESSILOCATION OF PREVIOUS FILi
RADIOLOGIST
NOres & PROTOCOL
I
,
000543
02/20/2013
t
01:15:13
PM
Page 1
Last
First:
AMUNDSEN,
MARK UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER, SACRAMENTO, CALIFORNIA
MULTIDISCIPLINARY
SECTION I EDUCAnON -HECK AU:'I1<A~'APP~Y, MonvATIONAL LEVEL
PATIENT EDUCATION RECORD

FAMILY
. _ ..
ASSESSMENT
--
'PI(IIENT
.
--
,.
~ ~ks que~seeks Information seems Intereltealpual0J8 llsten(ng o Dentes need
o Asks questfonslseeks
el~
Information o Seems Intt18S18dlpU8He listening o Denies need Uneoopenltlve Information needed:
LEARNING HEEDSIBEST LEARHIllQ METHODS 1. wnat Information does the patlentltamlly
In1ormallon needed:
--
stele tney need?

learn
2. By wh81 mvthod dOESthe plltlenlnamlly
btnt1
MeU1od' V&rb6Ilnstruc\1on [J Engflsll ott "
M_: o verbal InstNctlon Other o EngrlSh
o Roacfmg D English [J -~nslratlon
Other
elRo_
a Engl~n
Olh8r
--
o .AudloVl$U8f
POTENTIAL PHYSICAC BARRIERS ro ~EARNING: V1610NJHEAR1NGJSPEECH
No problems av_lIy_'"
a GlaSS88
,DR
Heanng Impaired o Hearing aJd Olsposl~Ofl o Speech normal [) Other
DispooflJon
o Cantact
tn,
I'M
CHem OR al OR o i,
o Budslde
a VJsuolly lmpalrtd OR ell o Contact lens G1 I HearinG impaired OR o i
o Demonstration o Audio~suaJ o No protiems
c a
o Other
o Bedslee a H0f!'l8 o AphasJc o Aphonic
poteNTIAL
BARRIERS 10 LEARNING
lEnxt.'Y,..... !;."",""Ilimlla""n.
o
JnlnIU&ea Fallguelweaknesl o.ase process Cvlturelrvllglan
--
nsory lOSS 0 Memo'Y 10$8 &han term 0 Unable 10 read
o PhysloaJ Rmltatlons:
C Unable 10 read [JCultu_~
o MXiuty/stress
The MPER Is lnlliated when the patient enters the system and oontinues to be utilized as appropriate throughOut Ihe continuum of care limited to, Inpatienl, ambulatory oare primary cere netwol1<, and hOme care settings, Progress toward completion of MPER will procee patient outcomes. SEcnON II Use the following key to complete Method 01 Teaching, Response, and'Lea,ner.
METHOD OF TEACHING AV Au<lkMsUlli W WrlUen V Verbel o Oemonstrallon
I Int8fl)ns\er
INTERPRETER:
DATE: INTERPRETER: DATE: INTERPRETER: DATE:
iMOn
RESPONSE (Rl 1 Verl)ollasllndicate.

/00cu1wmt ~
LEARNER (ll understandlt\9

tneIt1lnt In SIctIon It~
p. PatIent
2 Further JF'l&tl'lletion needed 3 Demonstrates lask 4 - UnaDla 10comprehend
F Family
II
1\
5 Refuses any informallon on topIC
,I',"
'J,
'l'Ac,
MULTIDISCIPLINARY PATIENT EDUCATION RECORD
1""1. 000544 Mf.1/107 ~7j'J
101
01:15:13
PM
Page 2 of
, TOPIClSKlLL
:
_ ...
..... .
...
1. Provide Unit Orlenlltlon:

A. VlsltingHours
-1 1 ,.- -- I - ..
om
WillI<
..MOl
COMMENTS: If barriers 10 IeamIng 819 nDI &bit to be
easIy overt:emeor fUrtl'l8r
In8tNCIiJn
IS
>lllI
108cHng ,_ a Nu";ng (NCP). If lelrning "4:I&ds are Id_ntJfled at discharge, Incfcatw ~ on !he Nursing
ean._
""
~ean.l-"_
-.' ..
...
--
-.
..
B. Unit Roulines:
1. Screening ChDdren for

In!",,1Ions & Expos.re.
2. Unit Entry Procedures
3. Exclusions ',om Untt

C. Smoking Polity
D. to Band - reason for
E. Phone
F. Call1lghl system
G. H.
Meal times MO RoundsITeams
I. BalhlOOnVShowerlTub
J. Bed
K. T.V. L. Day/Dining Bccm- (Eas1 5 only); Playroomlteen room (Oa'll8 7 only) M. Noise and lights
2. explain ",pon for adml lon

to tho UnK
A.
B. C. O.
3. Explain unit equipment and
A. B. C.
monitoring
O.
E. F.
I,
000545
----~~----
02/20/2013
MRN: 8081369, Patient Last, First: AMUNDSEN, MAR~_K
01:15:13 PM
Page 3
_
Section 11
Use the key on page 1 to complete l.llemer, Method 01leaching (MOl), and Reaponse.
TOPIC!SKILL
_ ... 17 --...
'"""'"
WrIteN U
"'"
MOl
,."
..
4. Dlscu8$-the .nliHJd- to ldentlfy-a prlnolple IpOke.person, If

applleablll Name Phcne (ti) Phone (W)
11 - 1'"""'"
MOl
"'"
COMMENTS:
If barriers Ie I8Bmlng ani not able to be
easiy overcome or ful'lhel' lnSIruction Is neeDed after iVee teactllng sessiOnS, Jl'litiale 8 Nul3ing Care ProCIem (NCP). discherge, lrdcate needs CIllh9 Nursing OlschargwHome Care IrlStruetlons shtet
11loemln; needs are Iden1\l\ed at
1~~Il' -
~ -
,-
S. Provide family Infot'matlon re:

support services that are
available:
A. Family conference Chaplain C. Social Services O. Interpreters
a.
F.
E. Discharge Planners
6- Explain lite PrecautlonlJ necessary to mlnlmtu th., rlsk8 of:

A.. Falls
B. C, D. E.
Pressure scree Accidental dislodgement Infant abducllon Infection transmission
QI devices
Isolation catego!'Y:
1.
Olscuu
Pain 8. a normal consequence 01 eurge'Y,lnJury, &lor IlIne
A. Explain pain scale B. EXp"

Pt!AI
0- /
''il/J 7v/I
NlI"'/
'7.od'~~on reg~j lIN d l..),
/Jev-oceJ-I-Zp/..., !-ZW 4'1 f4NLt!,'21i II ~A')"'n t;l?r.

\~d A?t"'"n
ij>-fXft' "';'(11' 1'1
~/if#-
I~
"1
v liP
'
9. Discuss proceGure(s) and explain physlcsl chrmges related to the procedure(s):
ATIENT EDUCATION RECORD
000546 ""~' of
'.If,
ocr
!17.3 9
MHN:
8081369,
Patient
Last,
First:
AMUNDSEN,
MARK
02/20/2013
01,15,13 _
PM
Page 4
Section
II
Uss the key on page 1 to complete
'MfOB NAif
TOPIC/SKILL
"'"
9. See Collaboratlvt.Ca,. entitled:
Pith
- 17 - 7
""""
MOl
Loamer, Msthod ofTeschlng
""'"
I40I
a. __ .
1_
7
,"
(MOT), and Response. COMMENTS,
""'"
"'"
It barr1er8 to leamlng are not ablo to be easily overcome or lurther Il'l$tnJ(:tlon Is { needed after three teaching MSSionS, Initiate a Nursing Care Problem (NCP) If learning needs are identified al
diaCt'lllrge. IndiCate needs Ql'1the Nutl!llng
DIschargeIHome cere,_
.
I
10. Unit Specltl. T Mng

A. Medication:
Proylde Instruction as applicable aenon,

side effects,
and administration. ~
~r e1!:;;?:/l:tlon,
2:~f}did
5.
handout
I~/,
}!f'
~~
if available,
VIP
I'I~
~.?&'hetlUlij=
B. ~
1-
informational handouts
and Review Information with
patienVfamily:
2.
3. 4.
I I
,
1'.
see
Additional
MPER for:
12. Proyide hom. car. IllIlrucn as 'd'ntllt'd by MD S NursingDI harg,lHome
CarelMtructlon Form
1itz?" 'H~f' 'lCt-r,

I~ section III/ SIGNATURE SIGNATURE' SIGNATURE,
13. Unit SpeclflclOltler Teeohlng
o/:;t
-
t fll'
""
Kf!alt:.ww R;.J . i
..I
INmALS, INmALS, ~ INmALS,
J
SIGNATURE:
INITIALS'
INITIALS:
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RECORD
tJ;\(J' -l 000547
r:/U)IJ7"j.
02/20/2013
MRN:
01,15,13
PM
page 8 of
=------ ---8081369,
Patient
Last.
First:
AMUNDSEN,
MARK
UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER, SACRAMENTO, CALIFQBNIA
Ag
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USE PATIENT PLATE
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02/20/2013
MRN:
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USE PATIENT PLATE
01:15:13
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Page 9 of
8081369
Patient
Last,
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AMUNDSEN,
MARK UNIVERSITY OF CALIFORNIA DAVIS
Ctl.eck One Sax:
,.
MEDICAL CENTER,
SACRAMENTO, CALIFORNIA
ANESTHESIA PERIOPERATIVE NOTES
Signatures
provider Involvement. I provided direction
o o
CRNA anesthesia
o o
I was physically present for the entire procedure Medicare Billing Guidelines not met
Single Case. I W8! physically present for the key por1;on(s) of the procedure and. durIng other times, was Immedlatery available to return to the procedure. The key portions of the procedure are documented below. Two Four Concurrent CasBS. I was physically present for ltle key portion(s) of lhe procedure and, durIng other tImes, was Immediately available to return to the procedure. The key partion(s) of 1he procedure are documented below. During the time in which my physical presence was not required, a deslgnaled backup teaching anesthesiologist was Immediately available. Name of designated back-up anesthesiologtst _
Kelt
Portions:
Signature -----------------__ --,M.D. ,M.D.
o Induction
o Emergence
o Other Key Portions
Signature
,M.D.
I was physically present for these procedures'
o
o
Placement Placemant Plaoemenl
Or Regional BlOck of ArterIal Une Df CVP
o o c:J o
Placemont 0' Pa Cart!

Placement of Pain Epidural
See Procedure
or Physician
Transesophageal Echo
Fiberoptic Bronch~coPV
Progress Notes for Details
The information contained on this form Is true and correct to the best of my knowledge. Further,. understand that" I misrepresent, falsify or conce.llnlonnation regarding my participation in the profession.1 service described above, I may be SUbject to fine. imprisonment, or civU penalty under applicable federallawa.
000549
02/20/2013
MRN: 8081369, patient Last, First: AMUNDSEN, MARK
01:15:13 PM
Page 7 of
UNIVERSIlY OF CALIFORNIA,DAVIS MEDICALCENTER SACRAMENTO.CALIFORNIA
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02/20/2013 MRN:
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01,15,13
PM
Page 10 of
8081369,
Patient
Last,
First:
AMUNDSEN,
MARK
---------------------.--
ANESTHESIA PERIOPERATIVE NOTES
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000551
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ANESTHESIA
PERIOPERATIVE
NOTES PG. 3 of 3
0212012013
MRliJ:' 8081369,
01:15:13
PM
page
Patient
Last,
First:
AMUNDSEN, MARK
",P~~J~9
tJaJrJsW;M!
!X1UNDSE~, MRRK
DNH,HRRJ'K
. 2IIS/tS
UNIVERSITY OF CALIFORNIA, DAVIS MEDICAL CENTER SACRAMENT O. CAliFORNIA
NURSES PROGRESS RECORD
IDENTIFICATION
Date~2lt>9Start Tlms: 78f2"'

INITIALS OF DIRECT CARE PERSONNEL
Eyre.
,. 2, 3, 4. 5, Site marl<ed 10 is confirmed by two sources. MRN, oOB, Name or other Surgical procedure verified w.!J!iponsel1L.. (procedure): / EFT Site: _
An..
OR S
lt6PT
(Y)
-n:>..../+Ir-' ""'~,
(NIA)
""'*"w"""
) (N)
N) (NIA)
~tt : I'f\OY~ ~
~';\E.~ROCEOURE 6, 7.
\PL""~rIV-?l CHECKLIST I' t~ r ~

U'OJ
(Y) all (N) (N)
Consent is current, available and cons; teWh documentation and studies Sterilization permit needed
8.
9.
Hi&1ory and Physical is current, available a~onsistent with ali documentation and studies ((YV (N) (N/A) -
Other relevant documentation (Y) (Y)
10. Blood Products available 11. Relevant images a

12. Intraop position:
13. implants available

14. Special equipment available Specify
&> (N)
(Y) (N) _
15. Patient care data reviewed on "OR RN Summary Report"
71431-698 (2/09) PREOPERATIVE CHECK LIST ~D-~D-R~-~-RED-~D-Rro-RED-RED-RED-~D_A~_R~_MD_REO_RED_R~-~O-RW-~
MR1I<l2/09,,"
000552
02/20/2013
MRN: 8081369, Pat.ient Last, First: AMUNDSE~!1AR~~~~_~ ._. ~~~
01,15,13
PM
~
Page 1 oj
_
Use
I.
Pa'RIilR il'~~311S59
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91'1016886878 ADM: 12115/09
UNIVERSITY OF CALIFORNIA, DAVIS MEDICAL CENTER SACRAMENTO, CALIFORNIA PATIENT PROPERTY RECORD Sale Access Hours gam - 6pm Monday - Friday
WAIVEROF RESPONSIBILITY
All p.,,"n_' belOnging_ and valulbl.s should be unt hom. with a famIly m.mber or I pmls"t "presentatlve. The University of CalifornIa. Davis. Metical CII'I101lUCCMCl accepts no rnpon$ibllilyfOr the lOSe or damage of any personal belongings lracludlng, but not limited 10, clOthing, footwear. medlc,J dsvas, hearing all!OS, dentures or omer dental appliances, glasses and other optical aida or olh&r personal belongings retained by the patient or brought
In aller admisalon. UCDt.4C MAINTAINS A FIREPROOF SAfE FOR THE USE OF ITS PATIENTS TO KEEP ANY SMALL ITEMS OF PERSONAL OR MONETARY VAlUE (SUCH AS MONEY, JEWEI.RY. DOCUMENTS, ETC.). UCDMC WIU NOT ae RESPONSIBLE FOR THE LOSS OA DAMAGE OF SUCH ITEMS UNLESS DEPOSITED IN THE FIREPROOF SAFE. UCDMC's liabiftty for ltle IOaS of or damallG to a patient's personal property shall be strictly
012t(" '''' '/.

II,
limited as slit forth In California CivIl Code sections 1~ and 1860. All property of nominal value left after discharge, not claimed within 90 days and all other valuables laft after discharge, not claJm&d wtIhln 180 days, WlU be disposed Of at the dlsore~o" Of UCOMC. f, It'te undersigned, have read and accept the Ierms of the above.
ttf1AVtJ./P
WITNESS (P~nt)
,1t0Pl!M'Y PAOPER1Y IROOM GIVEN TO: ADMISSIONS GIVEN TO;
(l.II~
DATEff~
D!8CAnDEtl
DATE PNrIENT'S SIGNATURE INVENTORY

VALUA8l.11 (Oftor1bel CASHAMQU
A:.
I cs;
100_'
DENTURES GLASSESK)ONTACTS
CHECK(S) AMOUNT $ ___ WAL.l.ET COIN POURSE
DRESS
P/WrS
$WEA1ER SHIFITIBLOUSE NIGHT CLOTHES UNDER CLOTHI;S PAPeRS JACKETICOAT
PTf1. l!OT11C5
KEYS
POCKET KNIFE WATCH HEARING AID MISCELLANEOUS EARRrNGIl NECKLACe, RING4J BRACELET ,
FOOlWEAR PURSE
SUITCASE WALKER WHEELCHAIR
I L-wro.p
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l'o'ledlclllon
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WITH FAMILY WITH PATIENT

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"!i""fl>J'~. P , J
(Pltflll) wrrNESS ' Davis .
WITNESS
'2/1.
(Ptlnt)
OATITIME
'PRINT}
III.
A.
ReleAse OF PROPERTY
AE1.!A$E OF PA.TIENT'S PROPERTY

of ttl e Ihrms. I r.11!1lS&the University 01 California Medical Cente. IUCDMCI
I acknowIDd~& racelpl of perannal property. By aecepting PO"8ssion lrom !h"" IBipOn,ltllllly of any SUbBBqUent 10M or damage.
r'liiJ
PATIEN iiHELAllvElAEsPONSIB\.E B.
IlIELEASE OF PATlENrS '
PERSON
OATEITIME
VALUABLES
'w~lrirN"'E"S"S~IP~'"",""'I---------------CD"A=TEIT=''-M=E1release tne Universtty of California ' Davis MEldlcal Center (UCDMCI
I oet',OWladue rll,ce!/Jt of par50nal valuables. ey accepting po5l!lession of these lIem" rom t 8 ,"pons bility of any aubsaQuent loss or damage.
PATIENliHElAnVEIRESPONsrBlE
PERSON
OATEJTIME
WITNESS
(Prinl)
DATEJrIME
1118 illIfi"
PATIENT PROPI:RTY RECORD

Green-Patlent Vullow-Patlent Chart
Pg. T 01""2 PInk-Property Bag
MFlOOf89418
----------------------------------------
Whtte--P.tlerrt yel. blll Envelope-Medic" Recon:b
000553
Goldenrod-CJnlt
01:15:13
PM
Page 2
UNIVERSITY OF CALIFORNIA. DAVIS MEDICAL CENTER SACRAMENTO, CALIFORNIA PATIENT PROPERTY RECORD
DATE: ITEMS RELEASED' __ ~ _
Signatures:
, __ Pa1ienURepresentative ~_~ , _ ~
Wrtness (Print) -
----
--
-----
DATE: ,_~
ITEMS RELEASED: __
---~ -- -- ~_.-.-
~,---------- ---,-----e
-----.. _.
-'
-" I acknowledge
responslb1l1t)' ot these Itema and Igree 10 Indemnify UCDIIC for eny Ihlblllty related to any lOas or damage to such property.
(he receipt of the ebOve-lnventorled
-~ - -,,-'. -"
---- -- --_.- ~._-- ------- ---------_._,,--, _----- -------IICc.pdng poesea.fan rei, ,he
IlemS. By .. of this property, I UCDMC of
Signatures~ PatientJRepresentative DATE: ITEMS RELEASED: __ ~_, _
------
Wi!nells (Print)
-- -- -
-- -~-
I acknowledge
relpon"bIlKV
,,~ -~-- ----,------~-,----"--------e

the receipt of the above-Invenlo"" Iteml, By accepting possession of this property, 1 ,.Ie t UCDUC of 1he 01 these Itema and 89' to Inde",nlfy I)CDIIC for any lIeblltty ""ated 10 any 10 or dam_g_ to .uch propertY.
-'- --,----------- ------------_._-"--- --,--,------~
Signatures:
PatientJRepresen'tative -
DATE:_~ _ ITEMS ADDED:
that 0". 'l)(lVO' .R' "tfo"'., d .ckn.." h,d!11i1 UCOMC.
it",,.,,.
hal;
~t:r:l'l ~dd;d to-th,.pill.,nl
p;;;Perty ,~,,--; ntQ-'V ~;d I,In
the
.;'.k;-;pl~g~,
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RECORD
Pg.20fZ
PATIENT PROPERTY
000554
02/20/2013
01:15:13 PM
Page 1 af
CNOl
UNlVERSITT
OP C~~IFORNIA.
CALIFORNIA
DAVTS
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DOC1JIIUIln'ATIDN FOR. I.Err I
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ASS2SSH2NT
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CHECK
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000555
01:15:13
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page 2 0
. -
ONIVEJ!ITY
9081369 lU'lIJNCSEN MARK
OF CALIFORNIA,
CALIFORNIA
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10-016806879
PATIENT
LEF1' TOTAL HIP ARTHROPlJ,S1Y
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PAGE :2 OF .)
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02/20/2013
MRN: 8081369, Patient Last, First: AMUNDSEN,_ MARK __
01,15,13
PM
Page 3
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AMUNDSEN MARK
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UNIVERSITY OF CALIFORRIA, 0 MBIlICA.1. C&NTBIt SACRAMENTO, PA71VT CAI.IFORNIA RtCORD
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f
1 1 1 1__
1 1 1 I 1 1 1 1 I I 1__
1 1 1 I 1 1 1 1 1 1 1
TO B! TAOOHT.l
-----------
row
Tl!:ACHING NUMtiER
(WRITE THE NUMBER OF J OATS
SPECIFIC
TOPIC/SKI!.L
TOPIC
I SKILL
________________
I__
jINITIALI ~OT
1
r __
r __
f __
I~
COMMENTS
I
r
-----------~--~I_I
SECTION IV
StGNATURt, SlGNA'lVRS, . 3IGNA1'UltE'
I I I
r
I I
I
I 1 I 1 1 1 1 1 1 1
1
I 1 1 1 I I I I 1 1
I
I 1 1 I 1
1 1 1 1 I 1
f
1 I
f
1 1 I
1
1 1 1 1 1 1 1
r
1 1
r
1 1 1 1
__
1 1 1 1
I 1 1 I
1 1 1 1
I__ I__ I_I~-__ ~_-------------~--
IHITIA~
_
~
_
SIGNATVRB,
SIGNATURE,
---------------
INITIAt.S INITIALS. INITIALS, _ _

NU1l.SING
IHI1'IJU.5,
----------------------------RED
INITlALS,
INITIALB,
_
_
SIGNA.TURE,
SrGNAT{]RE,
."Tm<'-'
~ING
Lot2U2oG6
INJTIALS,
RED
RED
REO
RBO
RED
REO
RED
I1,DO 1:1/14/0'
nOM LS17.CPHSRGn
PATIENT EOUCATrON RECORD
aEO
000557
MRN:
8081369,
patient
Last,
First:
-------------------~-----_._-----AMUNDSEN, MARK
02/20/2013
01:15:13 PM
Page 1 of
I.
UNIVERSITY OF CALIFORNIA, DAVIS MEDICAL CENTER SACRAMENTO, CALIFORNIA PATIENT PROPERTY RECORD Bam 6pm Monday Friday
WAIVER OF RESPONSIBILITY
AU personal belOflllllng. lind vatuables shoold be sent home w1th 1!I famll, mll!mber or a patient represenillUYe. The University or Call1omta. Davis, Medicl!ll Cenft!'r (UCOMC) accepts no r"POnsibility for the loss or damage of any persona~bfflongtng$lncludlng, but not limited 10,dothlng, footwear, medical devices. hearing aldl'ls. csnturss or o1tler dental eppl19noes, glasses and other optical alds Dr other personal oolonglngs I1ltalned by the Pf.1ient or brought in lifter Ildmi~ion. UCOMC MAINTAINS A FIREPROOF SAFE FOR THe use OF ITS PATIENTS TO KEEp ANY SMALL ITEMS OF PERSONAL OR MONETARY VALUE (SUCH AS MONEY, JEWELRY. DOCUMENTS, ETC.), UCDMC Will NOT BE RESPONSIBLE FOR THE LOSS OR DAMAGE OF SUCH ITEMS UNLESS DEPOSITED IN mE FIREPROOF SAFE. UCDMC'a lIablllly for the loss of or damage to a patierll's personal property shall be strIcUy limited at set forth In Callfomia 0/1111 Code sections 1859 and 1860. All property or nominal value left after disdlarga, not claimed within 90 days and all ether valuables ett arter dlschWlle, not claimed within 180 days, wlll be lfIsposed 01 al Ina dlscrellon of UCDMC I, the: U~dersigned, have ad and accept Itle terfn& of the abcwe. ~
Sale Access Hours
o N. 801.n.'ng.
1;)-~jJPI 77~lf'IW~
ADMISSIONS
"'-"
~ . ./ ~
4'. _ _
~Aj
WITNESS (Pri~
/'Yttj-M
DATEITIME
DlBCAIlDl!O
II.
DATE INVENTORY
PATIENTS SIGNATURE
01'IENlUr
,......
VALu.IIlU!!lI
)
CASH AMOUNT $ ~ CHeCK(Sj WALllCT COIN PURSE AMOUNT
11"lJO
$___
'-I
PflOl'ERTY DRESS
PJlQPEATV AOOM
OlVENTO:
DENTURES
GL.t.SSESIlCQNTACTS
).,~
PANTS SWEATER
KEYS
POCKET
KNIFE
SHIATtBlOUSE NIGHT CLOTHES UNDER CLOTHES
J 'l\ "3 I
-
W4TCH
HEAR'NGAID
MISCELLANEOUS
PAPERS
JACKETICOAT
FocrrweAR
EARRING NECKLACe
11 II
PURSE SUITCASE WALKER
RING' BRACELET ,
Medication
, boales
Sen!:
o HOME
WHEELCHAIR
WITH FAMILY
~ro PHARMACY
o TO FLOOR WJTH PATIENT

Of>
and the dleposlUon of said Itema
PfASOH
I a" . with abov.'nventory

PAT1ENTIAElAT1VI!IRESPONStBLE
,.AI u:ru UNAIILr: ro
5KfflI
DATEffIMe
p4VELOPE I
III.
A,
ISK~dln
(PRINt)
_ {&aO:NA.TUfl:El
RELEASE OF PROPERTY
fromIh. reapanl~~~
Ji;~?~~~~':~~:~~;I~:;;;~"M Ih"""~~';=~'~I~.' ""'''mi. D"'.;~~e}

RELEASEOF PATIENT'S VALUABLES DATEfTIME ~ 1kr:.{~tIV!IRESPONSIBLE PERSON OATEiTIME ~W~II~N-E~SS~-(p-"-"~I --~----------~D-'-J-ElT-,.-eValuable Envelop&oUedlcal Record, Green-Patient Yellow-Petleot Chert
~~-A'~ - ~lA"tlVEiRiiPONSIl:JlE
RELEASE OF PATlENl'S PROPERTY ~ /0 I acnOwl&dga r.c~'P1 oll'fll'SOn.lll property By acceptlng poB'SG8SlOn Of lI'Iese Items. I retease lhe U
5Ubs,ulilnt lOBSor dlUYlage
/kJ-r ~
PERSON
f2;2t-.2?:Yt
DATEITlME
r----~---------PA'T1E:mTrppRRCoii'piEl:1iRflTnrfRRiiEC'6o'iiRDFii'i-,P
Whtt.Pttiem
i:". lj";~;i"2---'---;;M;;;ROOIB94;;;;n;;;;;:'.;;------;1 000558

Pink-property Beg Goldenrod~Unlt
01:15:13
PM
Page 2 of
UNIVERSITY OF CAliFORNIA, DAVIS MEDICAL CENTER SACRAMENTO, CALIFORNIA PATIENT PROPERTY RECORD
DATE: ITEMS RELEASED: _ -----------------
----------------.-
---_._--------------------
-';k;'owledge the receipt of the abovg.lnventorled Items. By accllptlns po.uulon of this property, I release UCDMCof the responsibility 0' these items and agree to Indemnify UCDMC for any liability related to any 108&or damage 10 such property.
Signatures: _ . Patie ntlAepresehtative DATE: ITEMS RELEASED: _ .
Witness (Print)
I .cknowledge the receIpt of tho above-Inventoried Item,. By accepting posHaaion of thl' property, I releue UCDMCof the rtJ~pon.lbllll)' 01 ttUlI.1!! ItemB end agree to indemnify UCDMC ror Iny liability relaled to any 10.8 or damage to such property.
Signatures:
PatienVRepresentative
DATE: ITEMS RELEASED: _
Witness (Print)
-I
I ecknowledge the receipt of the above-Invantoricd items. By accepting po ten of this property, I release UCDIIC of the resptmslblllty 0' the Items and agree to indemnify UCDMC for any liability related to eny laa. or damage to such property.
--_._-------_.,
Signatures:
_ PatientIRepresentative
Witness (Print)
,..1..;,
DATE; ITEMS ADDED;
Signatures:
_ _ . ".. __ PatientiPepres13ntative
._
~.
_-'
Wltnesl' ;Orin'l.)
.w
Pa.20'2
PATIENT PROPERTY RECORD
000559
02/20/2013 01:15:13 PM
Page 1 0
MULTIDISCIPLINARY
SEcnON I EDUCATION ASSESSMENT
eCK-ALL "'AT APPlV. quealklnslseeks
. PATIENT
. FAMILY-,"cc"
"",,-cc" "'_
C SHme In181l8tedlpasalve Ilster.1no
lnformatlon
c unoooperalJlie
,. What Infonnatlon does the paUentlfflml1y state they need?
o Denies need
Information o seama inll1lSt~Nive 1I.slflnlng o DenIes need o Uncooperative
o Asks ques1Ionslseeks
RNING NEEOSIBEST ~HODS
lEARNING
Informa1ionoeeded:
Information
needed:
2. 8V what me1hod does the pa11enVlamily
learn best?
~~-...InI1ruct1on w ~;~ Otl\er
MethOd:
:z:
D
_
_
o Verbal
n English
InstnlctlDn
Other Other
_ _
~I'"
"Sl
0Ih"
o Rudirlg o English
~lllt1on
o Demonstration
(] Audiovisual
D Aud""'U81
POTENTIAL. PHYSICAL. BARRIERS TO

LEARNING: V'ISIONIHEARING/SPEECH
~rOblom& o ViGUailyImpaired . 0 A 0 L
o No problems
C GIa&SI8 OI8cmtaon
o HearlngImpaired
o Hellr1ng aId CIsposIlloo o Speech normal o OItler
0 cantaet lens 0 Home 0 BedsIde

C 0 0 0
R 0 l R 0 L Momo 0 Bedside Aphasic 0 A&ltlonlc _
o Vl$uslly impaired 0 A 0 L o Gf88ses 0 ConTact lena 0 R 0 l o Heli'ngImpolrod 0thM
POTENTIAL BARRIERS TO lEARNING
Disease process
o CulNrelrellglcn
llgue/WUkness
.u_
stress
o Sensory 1018 o Memory loIS short o Unable to read
tl Physical limitations
o ArIxlety!5tress
term
o Phy8Ic.alllmIta1Ian~
o Unable to reed o CulturelrefiJJlon
The MPER Lainitiated when the pallsnt entefS the syJtem ar./j oontinues 10 be utilized 8$ approprlat& throughout the continuum 01 care limited to, Inpatient, ambulatory care primary cars network, and hOme care settings. Progress toward completion of MPER will procee
patient outcomes. SECTION"
Useth. follOWing key to campi Method OITeachlng, R ponse, end Learner.

METHOD OF TEACHING (MOT') AV Audiovisual RESPONSE (R)
, Verballz8llln13leatos
(Documenl~
I INTERPRETER: DATE: INTERPRETER:

DATE: INTERPRETER: DATE:
LEARNER (ll
unlferstMding
IRd*IlI kl SdDn Ill)
w Written
V Verbal
D Oemcnslfalion I - Interpreter
P - Pa11ent F Faml~
:2 Further 1l181nJclion neecfed

3 Dernonstndu tBslt
4 Unable 10 comprehend
5 Refuses atr/Infonnetlon on topic
,: -
"., ,,",u,
--
MULTIDISCIPLINARY
PATIENT EDUCATION RErORD

~
p,", ".j 000560 MRI'UI/4/J!!
02/20/2013
MRN: 8081369, Patient Last, First: AMUNDSEN, MARK.
01,15,13
_
PM
page
"'
TOPICISKILL
_ ..,
""
1. Provide Unit Orientation:
7 / .""""
,-
"'" '"'-
-MllI
LMIlIIl
17 MOl
EOMMENl"S: If barrlenllO leamlng Bi'e I'lDI ablB 10 be easily overoome or further lnstrt.r:llon iii
needed __
a NuBIng Care Problem (NCP) ____

r. Idtnll11ed .,
Of!
"""''v
,.....
II learnlrl!iJ need
""""Ya,
NUI8Ing
Dlo::ha_ca",\_~
. A. VJSiting Hours. B. Unit Routines:

1. SCreening Children for Infections & Exposures
'Yj~ '1'1/1
)
./
:
/'
'."
.. ..
2. Unit Entry Procedufee

3. ExclusIons from Unit C. Smoking Policy O. 10 Band reason for E. Phone F. Gall light system
./
/
I
.
./
-:
a. Meal
),
tImes
H. MO RoundsITeams
./
./
/'
Ba1hroomlShowerfTub Bad
vr J .
.'
K. T.V. L. Day/Dining Room (East 5 only);
-:
./
Piayroornlteen room (Davis 7 only)
M. NON and lights I , 2. ExplaIn on for _1oo10n

to tho Unit
./
/
I
.
A. B.
C.
D.
3. Explain unit equipment and
monitoring
A. B.
C.
.
D. E. F.
,
,
000561
01:15:13
PM
Page 3 0
""'tlon
II
Use the key on page 1 to complete Leamer, MBlhod of Teaching (MOT), and Response.
OPICISKILL
W,lIeWoD
-_. ?
"
LWw
...
"'" au-
Discuss the need to ktentlty a princIple epokesperaon.1f applicable
11- II
""""
.."'"
!:oMMENTS: Itlante" to Ie8mIngare nol able 10be ~ 0'NC0tn8 01'turther instruction ttl jn;liate.-"lI
after three
,_.
f learning needs are Idenllfled at
eo p",_ INCF'),
teachirYlil
sessiOllS,
~'
Inill
"' _an !he_ argaIHOme Cal'B 1l'lStl\.dlOrtSSheet
am.
-ione (H)
tone (W)
Provide family Information support services that are re:
.
available:
Family conference Chaplain Social Services Interpreters
Discharge Planners
Explain the Precautions necessary to mlnlmlte 1M risks of:
Falls
Pressure sores Accidental dislodgement Infant abduction Infection transmission ~at\on cat9g0TY:
of devices
Discuas Pain a. a normal conaBql,.lence of 8urgery, InJory, &lor illness.

. Explain pain scale
Explain medication regimes
Discuss procedure(s) and explaIn physical changes reblted
to the procedure(.):
'
..
,,-
-"
...
MULTIDISCIPLINARY PATIENT EDUCATION RECORD
"HNl),I'J,."'JL
."~";
J,,,f; 000562
02/20/2013
01,15,13
PM
page 4 c
Section II
,en d R pon Use the key on pe e , to complete Leamer, Method 01Tea chi ng (MOT)
Wl'Il8NAII
TOPICISKILL
..
V
"."..
""""
""'"
'17 17 --
""""
"'"
'""'"
"'"
barriers to teaming are not &bIa to be ~Iy werecme orl\.lrtheJ InBtrul:1lonIs
fOMMENTS'
mad after tt1l'(l9 teaching sessions,

illata B Nursing Cere Problem (NCP) . I teaming needs are Idantlfllld at
9. See CoUabo'ollve Cere Path entltlocl:
--
~,
."'".
Indi::at9 needs on the Nucslng arne care InsrructionS sheet.
10. Unll Specific T cldng ProvldtlnstruCiloft allpplfclble A. Medication: action. side effects,
and administration. ~
for each medication, 1. 2. 3. 4.
handout
if available.
5.
informational handouts B. ~ end Review information witfl patlentlfamily; 1.
2.
3. 4. 11.
see
Additional
MPER for:
12. PrDvlde hom. car. llll\ clion Idanllll.d
by MO
S" Nursing Dlscharg,lHame
Care Instruction form
'3. Unll Specl'lciOlhe, T.achlng
c
/-V"
_ _
Section III
SIGNATURE:. SIGNATURE: SIGNATURe:
fl~w./
iIlJ
. INITIALS'
INITIALS: INITIALS:
. SIGNATUBE, SIGNATURE: SIGNATURe, _
_INmALS' INITIAlS, ---INITIALS, ----
L__
""31
0')\)'00
MULTIDISCIPLINARY
000563
Po'),40f4 ',1RrrlJ, '17) l2
MRN: , Patient
Last,
F_i_r_s_t_:_,
02/20/2013
01:15:13
PM
Page 1 of,
---------------
univer81ry of C4J1lornla, Vallis Meanh ::t)'Slem 2315 StocktonBlvd.,SFmenlo, CA95817 Department 01 PathOlogy, TnmsfusJor. .. lees, AalPn Green, MD, Olfeetor
W035809233646 Patient Name: Medical Rec #: Birthdate: Patient Type: Unit: Type: Unit #: Exp Date:
UNIT CROSSMATCH & TRANSFUSION RECORD FORM
AMUNDSEN ,MARK 8081369

09/23/59
Location: Specimen #: Iasued by:

Product:
T4EM 1220:BBOOO12R Date PCAS Y 12/20/09 0326 {B. KC> Tiroe
[B NEG)
[B NEG) W035809233646
01/14/10 2359
('om.atible:
I cenlfy that the donor unit number The pati~nrs tl me and-identlftcaf ~ , Tr nsfusionlst (Person A) Date Date
ABO group and on this form are identical with these 00 the blood container label. ~mber on this form a .. ~nU~ 10 ]119 patIent's .'riStband. R D:
Rh
fiJ18rift8r l(<<.v<
~
ku<..
(Person
Transfusion Start: TransfusionEnd: 81 Used: Yes. Warmer 10#: Warmer's NO
Jg..-'~nme
lE-2t~
Time
.
-' .'()
lfQV
TransfusedVolume:
rmer Documentation
(Circle) C; Irntials: 'C; lnitials:.
TransfusionReaction:
Yes
:?n ~l)
(ClrcJe)
If yes. Immediatetystop the tran~ and notify TransfusionServiceaf 4-2870 tor furtherinstructions.
Warmer's Pre Trans', Temp:

Post Transf. Temp:
_
_ Whit Chan Copy
---~---,._-~-
000564
----
MRN: , Patient
Last,
---------------University of califOmla, Davis Health System

2315 Stockton Blvd.. Sacramonto, CA 9S81h Department of pathology, Transfusion Services, Ralph GUll
.
.:
First:
02/20/2013
I
01,15,13
PM
page
1 of,
(
W035809245034 p. ti~nt Name: l1ed1,al Ire, #: Birthdate: Patient Type: Unit Type: Unit #: Exp Date:
\tD, Declof
.--
UNIT CROSSMATCH & TRANSFUSION RECORD FORM
Al1\lNDSEN,l1ARK 8081369 09/23/59 (B NEG) [B NEG] W035809245034 01/14/10 2359
Locat1on: Spe,imen #: Issued by: Product:
T4EM 1220:BBOOO12R Date PCAS Time
C'"m~,at1ble: Y 12/20/09 0326 <B.KC>
I ~t1itythat the donor uni1 number, ABO group and Rh on this form afe identical with those on the blood container label. T~epatient's name and-IdentificatIon number on ttlis form are identical to t~epatie~ . srband.
C:?e.Q.
Qb
1";'.\.'D:
.
NLJ1
Transtusionist(Person A)~"
2nd Verifier (Person B)
Transfusion S1art Transfusion End: :lJsed' Y..
Dale
Oa18
I"'-~-O(hmell : I~ 11,-lkS'! Time N3
.Tran'fusedVolume:
Transfusion Reaetfon: Yes
BI8Qd Warmer Oocumentlltfon
(.;J
f,~o) (Circle)
(C;rcle)
_
!Warmer IDI;_'V>L_,Warmer's Pre Transf., temp: Warmer's Post Transf. Temp:
If yes, Immediately stop the tran~n and Qotlfy Transfusion Service at 4-2870 for further instructloM. _ White - Chart Copy
~C; Initials;
'C; Inffials:
000565
[;
USE PATIENT PU,TE
,. 808
~
P
13 b9 I.f
09/23/~9
,I\}.R K O~IJq BLUE
''1 ~S-41;2~ 1':>00& '
'Ai
NEUROLOGICAL SURlfIe.W8tdNI( 0221 03

AM UNO Sf: tI
SAQUERO. VICTa SM.:'!"-UCDCAP
916-S83-2~B9 rOL~O~
1'10
PHYSICIAN'S ORDERS
DATE
12/0)
peN
PHYSICIAN/RESIDENT
SIGNATURE
PA/RN SIGNATURE
DX:
Accident or Injury Related ---~ --- ---- - - --- ------RETURN APPT: Weeks: Months: PRN: _
APPT, TIME:
j _~O~]_O
TIME:
_
_
0 Yes
0 No
ARRIVAL
TIME:
DEPARTURE -
1:J'O)
f.Z
----------------------
- -
- - - - --- -
- - - - - - - - - -- - - - - - - - - _
Departure Time:
\/
ORDERS: LAB: LEVELS: CULTURES: RADIOLOGY: OTHER: NURSING: CLERICAL: CBC Di/antin Blood Angiogram EMG/NCV Suture/Staple BCP CCP UA Tegretol Wound Xray Other Other Other Other Other Dsg Change Old Records Pt. Education Old Films _ _ _ _
Phenobarbital CSF CT Urine MRI
Nuclear Medicine Removal
Release of Information
-- -
-------------------1:
- .- - - - - - - .- - - - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - .'
CONSULTATIONS:
2:
3:
-------~---------------------------------------------------------------------~
Diagnostic Summary Updated Release of Information
000566
None
Ordered By Admitting Provider Authorized By ANDREW KIM OH [10912] PCP Victor Baquero, MD
Lab Collection Information

Collection Date and Time 2/17/2011 0918
Patient Information
Patient Name Amundsen, Mark Unit NEUCAR MRN 8081369 Sex Male DOB 9/23/1959
Order Details
Order ID 65131614
Order Information
Quantity Ordering Quantity 1
POC OCCULT BLOOD FECES (Order 40076037)
Patient Information Patient Name Amundsen, Mark Unit FAMFOL
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Order Information
Electronically Signed By/Authorizing Victor Baquero, MD
Additional Pended Order Information POC OCCULT BLOOD FECES (Order#40076037) on 5/26/09Pended History Ordering Department Abbreviation Name FAMFOL
Account Information Acct Number 078438665057 Order Providers Authorizing Provider (08139) Victor Baquero, MD
Encounter Provider (08139) Victor Baquero, MD
000567
--
02/20/2013 8081369, Patient Last, First: AMUNDSEN, MARK
01,15,13 PM
Page 1 of
MEN:
UNIVERSITY OF CAUFORNIA, DAVIS MEDICAL CENTER SACRAMENTO, CALIFORNIA PHYSICIANS ORDERS

/ I
-ItT
, ,,
Jr\
NursotAnclIfafy Stamp
MDSuamp
Ordering PhyIidan Signature Attendiag Physicioln Name
/2
V
.M.D. Pol.Ii ,M.O_ 1'.1. II
B~r:
/It/ ... v
."
Beeper:
DATE
HOUR
USEBAU. POINT PEN Patilent Wl:
MD Siamp
Orderins A1ylician Signalure AtiendiltJ Physfcian N.me
.M.D. P.I.'
.M.D. P.I.#
PH',$ICIAN$ ORDERS ':"" 18 000568
111i321iREV
\' 1:[1}
01:15:13
PM
Page 2 of
PHYSICIAN'S ORDERS
DATEITIME:
~:g::~~~~::IO
2. 3.'
I
USE BALL.POINTPEN 4.
~kil~~ ~Si:r,~i~
(d_a_le_lt_im_e)
clJt!,IM(
G'tfood
~
0 Fair 0 Poor
5. 6.
_ _
3.
RehabilitationPotej)li!ll:
4. CPR Status:
5.
~esuscitate
0 Do Not Resuscitate
SupportiveDocurnentetlcrtjerrndin: 0 ProgressNoles Summary 0 H&P Decisional Capacity: ffHas capacity 0 Lacks capacity to understand and sign admission agreement, to partlelpate in plan of care, and to make health care decisions due to diagnosis of;
015Ic
,-
6.
Patient has been informed of medical condition/diagnosis. 0 No If no, who was notified: ~ 7. ResponsibleParty/Conserval'll"~ Phone: (O!j,,) 7'iS'" Allergies: ~,.)L, ~L Reaction: 1f2tbN<r 9. Isolation tyj)l</ L.ocalion: 10. Diet: l<J'I'legular 0 No Added Sodium 02 gm Sodium 0 Pureed DADA Calories 0 Mechanica'Soft 0 olher: FeedingTube: 0 GT 0 NGT 0 Continuous cenr: 0 Bolus: cc q Formula (or equivalent):~ Total of cc/24 nrs and Flush tube with _cc..,..WAter q hr~ /J J..L 11.Activity ReslJ,ictions: 0 None .rather: ~ CL/':""!:, I'()jTf:/tt<ll lfl,o
0fes
e.
.+vt.u'''''lluv
'i'.:n
------
J/ii){...s.
_ .hr cc/hr; /J
!fir'
mce.-'fl;i)~ '-'7'
I_At-
Q1?T E1"OT 0 ST (evaluationand treatrnent/s) Res~tory evaluation 0 PulseOx and Incentive Spirometry 13. Laboratory: ;~-----Follow-up result!1Je7 14 IV Therapy -0'None 0 PICC 0 Peripheral 0 Central 0 Other: Fluids:
12. Therapies:
_ _ _
ii"'Bootine (q shift x 3 days. then weekly) 0 Other: 16. Weight: 0"'Jld(ltine (on admission. l,h.e)' m9nlhiy) 0 Other: 17. TB screen: Chest x-ray (Datedone:1"110/,;, ) 0 PPD (Datedone: _ 18. Type of restraint used in acute c~; 0 None TypeJs: 19. Wound Care: 0 None l2rOther: '( 0 'l2>L
15. Vilal Signs:
o o Antibiotic:
__
--------------------------
..e:r
6-
hI-<SStN
20. Bowel re: EfRoutlne 0 Other: 21. Fol -up appointments: 0 Primarycare: UCDMC specialityclinic:At1A-~' 0: -." Dialysis clinic (name/H): ' 22. Medications and Treatments: (Use separate order sheet)
--
/1'/
#IIo//P!/:J
crt
WSC'i,e.,$
"13 <t-d-?1iJ
Days of week (circle): MTWTHF
--Routme and PRN medicarions require a dfagnO$i6 and duration of therapy for 8Bc/r NO DOSAGE RANGE "Psychotropic feqwre SpecIfic far"et behaviors and
Tytenol 650 mg. PO Q CRN

Attending
Physician Name: Ordering Physician's Signature:
l .m.(/~
nama of person giving ;ntorm~ consenl mild pain, headache 0 Yes 0 No MD P.I.H _ Beeper # .
000569
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..c.DAVIS M.EDICAL GROUP
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000571
Class: Historical 90 INDOCIN 25 MG ORAL CAP (Taking) Sig - Route: 1 CAPSULE 3 TIMES DAILY - ORAL Class: Historical 90 NEURONTIN 300 MG ORAL CAP (Taking) Sig - Route: 1 CAPSULE 3 TIMES DAILY - ORAL Class: Historical NORCO 10 MG-325 MG ORAL TAB (Discontinued) 28 Sig - Route: 1 CAPSULE EVERY 4 HOURS AS NEEDED - ORAL Class: Historical 30 PROZAC 40 MG ORAL CAP (Taking) Sig - Route: 1 CAPSULE EVERY MORNING - ORAL Class: Historical
6/23/2004

CVS/PHARMACY #9923 | 1005 E BIDWELL | FOLSOM | CA | 95630
Abstract
Noted
Resolved
TESTICULAR HYPOFUNC NEC BRACHIAL NEURITIS NOS
Allergies
Allergies as of 5/25/2004 Noted Ibuprofen Type Never Reviewed Reactions
Medications
Outpatient Current Meds as of 5/25/2004 ALEVE 220 MG ORAL TAB (Taking/Discontinued) AMBIEN 10 MG ORAL TAB (Taking/Discontinued) ANDROGEL 1 % (25 MG) TD GLPK (Taking/Discontinued) FLEXERIL 10 MG ORAL TAB (Taking/Discontinued) INDOCIN 25 MG ORAL CAP (Taking/Discontinued) NEURONTIN 300 MG ORAL CAP (Taking/Discontinued) NORCO 10 MG-325 MG ORAL TAB (Taking/Discontinued) 1 TABLET EVERY 12 HOURS AS NEEDED 1 TABLET AT BEDTIME AS NEEDED 2 PACKETS DAILY 1 TABLET 3 TIMES DAILY 1 CAPSULE 3 TIMES DAILY 1 CAPSULE 3 TIMES DAILY 1 CAPSULE EVERY 4 HOURS AS NEEDED
000572
Amundsen, Mark (MRN~.69)

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11 38 AM
Department Fel Fam Prac/lnt Med Provtder Noted low back pam
DAVIS HEALTH SYS,TEM 1C

Abstract
[late 0512512004
VICTOR BAQUERO, M.D., MD
Problem List as of 0512512004
Problem
Resolved
BACKACHE NOS[724 5J
Comment
TESTICULAR HYPOFUNC NEC[257.2] BRACHIAL NEURITIS NOS[723 4)
2:::~Ii0.l~~srt1'r~~\!!!g~;I'Jlii~~,J~.:,=;;Si;$:VI!Q~;}~
Allergies as of 0512512004
~gent
IBUPROFEN
Date Reviewed: None
Noted
Fype
Reactlorus]
Not Noted
tr,:~~"~'"'1I1'::~~j :-;'I'IM,m~. atl """"IIir..,,~ri!1'!""" \I ,,' :i>j,,'f I' )"""'-;;;;;;:~'~'iF.' ~ n:.in!'Jl!i!J!ii.i!!fuLd:.l!ltt~~.J~LL1!/!;:'~~,~ ;.~~'-!~!a 'O!l/;"Jli'1t~~ ;i:'IlL' I~"~':~:' .~, ,., -..ij\.~JJ~,;.!!t:,;,::;.; ,,1.-;
Current Meds as of 0512512004 Prescriptions FLEXERIL 10 MG ORAL TAB AMBIEN 10 MG ORAL TAB NORCO 10 MG-325 MG ORAL TAB INDOCIN 25 MG ORAL CAP ALEVE 220 MG ORAL TAB NEURONTIN 300 MG ORAL CAP ANDROGEL 1 % (25 MG) TO GLPK PROZAC 40 MG ORAL CAP 1 TABLET 3 TIMES DAILY 1 TABLET AT BEDTIME AS NEEDED 1 CAPSULE EVERY 4 HOURS AS NEEDED 1 CAPSULE 3 TIMES DAILY 1 TABLET EVERY 12 HOURS AS NEEDED 1 CAPSULE 3 TIMES DAILY 2 PACKETS DAILY 1 CAPSULE EVERY MORNING
_1
CONFIDENTIAL
----------------
- EMR COPY --- Printed by Shaw, Jessica J 5/25/04 1147
Page 1 of 1
000573
Class: Historical 90 0 NEURONTIN 300 MG ORAL CAP Sig - Route: 1 CAPSULE 3 TIMES DAILY - ORAL Class: Historical 135 0/0 6/23/2004 NORCO 10 MG-325 MG ORAL TAB Sig - Route: 1-2 CAPSULES Q6-8 HRS PRN PAIN. MAX 4&1/2 CAPS DAILYAND 135 PER MONTH - ORAL Class: Pharmacy 30 0 PROZAC 40 MG ORAL CAP Sig - Route: 1 CAPSULE EVERY MORNING - ORAL Class: Historical
Orders Chart Cosign

Patient Information

Telephone Encounter
6/23/2004 9:57 AM
Provider Victor Baquero, MD, MD Department Fol Fam Prac/Int Med
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed >> JESSICA J SHAW Wed Jun 23, 2004 9:59 AM Encounter initiated.
Created by
Approved
Disp Refills Start End 30 0 6/23/2004 8/3/2004 FLUOXETINE HCL 40 MG ORAL CAP Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Authorizing Provider: Gertrudes Perlas Montemayor 135 0/0 6/23/2004 7/9/2004 NORCO 10 MG-325 MG ORAL TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1-2 CAPSULES Q6-8 HRS PRN PAIN. MAX 4&1/2 CAPS DAILYAND 135 PER MONTH - ORAL Class: Pharmacy Authorizing Provider: Gertrudes Perlas Montemayor

Disp 60 ALEVE 220 MG ORAL TAB (Taking) Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 AMBIEN 10 MG ORAL TAB (Taking) Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 60 ANDROGEL 1 % (25 MG) TD GLPK (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Historical 90 FLEXERIL 10 MG ORAL TAB (Taking) Sig - Route: 1 TABLET 3 TIMES DAILY - ORAL Refills 0 Start End
000574
Center None
Patient Information

Telephone Encounter
6/24/2004 8:53 AM
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed >> JESSICA J SHAW Thu Jun 24, 2004 4:37 PM this was a repeat.me >> JESSICA J SHAW Thu Jun 24, 2004 8:54 AM Encounter initiated.
Created by

Disp Refills 60 0 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 0 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 60 0 ANDROGEL 1 % (25 MG) TD GLPK Sig - Route: 2 PACKETS DAILY - Transdermal Class: Historical 90 0 FLEXERIL 10 MG ORAL TAB Sig - Route: 1 TABLET 3 TIMES DAILY - ORAL Class: Historical 30 0 FLUOXETINE HCL 40 MG ORAL CAP Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 90 0 INDOCIN 25 MG ORAL CAP Sig - Route: 1 CAPSULE 3 TIMES DAILY - ORAL Start End
6/23/2004
000575
Plan UCD/B/S HMO
Financial Class P
Plan Number B72
Plan Phone 916-734-0739
Diagnoses BACKACHE NOS - Primary Reason for Visit Back Pain Level of Service OFFICE VISIT, EST PT, DETAILED MOD COMPLEXITY [99214]
724.5
Medications
Medications at Start of Encounter Disp Refills Start 60 0 ALEVE 220 MG ORAL TAB (Taking) Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 0 AMBIEN 10 MG ORAL TAB (Taking) Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 60 0 ANDROGEL 1 % (25 MG) TD GLPK (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Historical 90 0 FLEXERIL 10 MG ORAL TAB (Discontinued) Sig - Route: 1 TABLET 3 TIMES DAILY - ORAL Class: Historical 30 0 6/23/2004 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 90 0 INDOCIN 25 MG ORAL CAP (Discontinued) Sig - Route: 1 CAPSULE 3 TIMES DAILY - ORAL Class: Historical 90 0 NEURONTIN 300 MG ORAL CAP (Discontinued) Sig - Route: 1 CAPSULE 3 TIMES DAILY - ORAL Class: Historical 135 0/0 6/23/2004 NORCO 10 MG-325 MG ORAL TAB End
7/9/2004
7/9/2004
7/9/2004
7/9/2004
000576
(Discontinued) Sig - Route: 1-2 CAPSULES Q6-8 HRS PRN PAIN. MAX 4&1/2 CAPS DAILYAND 135 PER MONTH ORAL Class: Pharmacy 30 0 7/9/2004 PROZAC 40 MG ORAL CAP (Discontinued) Sig - Route: 1 CAPSULE EVERY MORNING - ORAL Class: Historical Ordered Medications ROBAXIN-750 750 MG ORAL TAB (Discontinued) take 1 - 2 pill hs prn - ORAL Discontinued Medications Reason for Discontinue INDOCIN 25 MG ORAL CAP PROZAC 40 MG ORAL CAP NEURONTIN 300 MG ORAL CAP NORCO 10 MG-325 MG ORAL TAB FLEXERIL 10 MG ORAL TAB Medication Review History Med Rev Hx Medication Administration Report for Amundsen, Mark All administrations No administration data available Pharmacy Selected For Prescriptions CVS/PHARMACY #9923 | 1005 E BIDWELL | FOLSOM | CA | 95630
Orders
Order Summary SPINE PROGRAM REFERRAL [100072 Custom] Order #: 3016801
Immunizations
Visit Summary
Vitals Recorded in This Encounter 07/09/2004 1058 102.059 kg (225 lb) Weight: 72 Pulse: 14 Resp: 110/78 mmHg BP: 5 Pain Score: BACK Pain Loc: N Excl. in GC?: Medications Given (Excluding those documented in Imm/Injections Activity) No data found.
000577

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FOLSOM, CA 9500
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000578
Management Folsom
Patient Information

Telephone Encounter
8/3/2004 10:11 AM
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed >> AMANDA S RANEY Tue Aug 3, 2004 10:11 AM Encounter initiated.
Created by
Approved
Disp Refills Start End 30 6 8/3/2004 1/11/2005 FLUOXETINE HCL 40 MG ORAL CAP Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Authorizing Provider: Victor Baquero

Disp Refills Start End 60 0 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 0 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 60 3 7/15/2004 ANDROGEL 1 % (25 MG) TD GLPK (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy 10 0 7/15/2004 FENTANYL 25 MCG/HR TD PT72 (Taking) Sig - Route: apply q 3 days. - Transdermal 30 0 6/23/2004 8/3/2004 FLUOXETINE HCL 40 MG ORAL CAP (Discontinued) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 135 0 7/19/2004 NORCO 10 MG-325 MG ORAL TAB (Taking) Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 ORAL Class: Pharmacy 60 3 7/9/2004 ROBAXIN-750 750 MG ORAL TAB (Taking) Sig - Route: take 1 - 2 pill hs prn - ORAL Class: Pharmacy

Appointment
Orders
000579
Plan UCD/B/S HMO
Financial Class P
Plan Number B72
Plan Phone 916-734-0739
Center None
Patient Information

Telephone Encounter
8/11/2004 4:34 PM
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed >> JESSICA J SHAW Wed Aug 11, 2004 4:34 PM Encounter initiated.
Created by
Approved
Disp Refills Start End 135 0/0 8/11/2004 9/14/2004 NORCO 10 MG-325 MG ORAL TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 ORAL Class: Pharmacy Authorizing Provider: Victor Baquero

Disp 60 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical Refills 0 Start End
000580
60 3 7/15/2004 ANDROGEL 1 % (25 MG) TD GLPK (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy 10 0 7/15/2004 FENTANYL 25 MCG/HR TD PT72 (Taking) Sig - Route: apply q 3 days. - Transdermal 30 6 8/3/2004 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 0 7/19/2004 8/11/2004 NORCO 10 MG-325 MG ORAL TAB (Discontinued) 135 Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 ORAL Class: Pharmacy 60 3 7/9/2004 ROBAXIN-750 750 MG ORAL TAB (Taking) Sig - Route: take 1 - 2 pill hs prn - ORAL Class: Pharmacy

Appointment
Orders
DOB 9/23/1959
Department
Center None
000581
BAQUERO, VICTOR H
Patient Information
09142004
10:53
MRN 8081369 Sex Male DOB 9/23/1959 PATIENTPHONE 916-509-0158
Telephone Encounter
9/10/2004 12:21 PM
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed >> PAULA DORN Fri Sep 10, 2004 12:30 PM LAST REFILL 8/17/04
Created by
Approved
Disp Refills Start End 30 0 9/10/2004 10/7/2004 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: LAST REFILL 8/17/04 Authorizing Provider: Victor Baquero

Disp Refills Start End 60 0 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 0 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 60 3 7/15/2004 ANDROGEL 1 % (25 MG) TD GLPK (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy 10 0 7/15/2004 FENTANYL 25 MCG/HR TD PT72 (Taking) Sig - Route: apply q 3 days. - Transdermal 30 6 8/3/2004 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 135 0/0 8/11/2004 NORCO 10 MG-325 MG ORAL TAB (Taking) Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 ORAL Class: Pharmacy 60 3 7/9/2004 ROBAXIN-750 750 MG ORAL TAB (Taking) Sig - Route: take 1 - 2 pill hs prn - ORAL Class: Pharmacy

Appointment
Orders
000582
last refill 9/14/04
Created by
Approved
Disp Refills Start End 135 0/0 10/7/2004 11/1/2004 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: LAST REFILL 9/14/04 Authorizing Provider: Victor Baquero

Disp Refills Start End 60 0 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 0 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 60 3 7/15/2004 ANDROGEL 1 % (25 MG) TD GLPK (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy 10 0 7/15/2004 FENTANYL 25 MCG/HR TD PT72 Sig - Route: apply q 3 days. - Transdermal 30 6 8/3/2004 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 30 0 9/10/2004 10/7/2004 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB (Discontinued) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: LAST REFILL 8/17/04 90G 1 9/14/2004 KETOCONAZOLE 2 % TOP CREA (Taking) Sig - Route: apply by topical route once daily to the affected area(s) - TOPICAL Class: Pharmacy 135 0/0 9/14/2004 10/14/2004 NORCO 10 MG-325 MG ORAL TAB (Taking) Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 ORAL Class: Pharmacy 60 3 7/9/2004 ROBAXIN-750 750 MG ORAL TAB (Taking) Sig - Route: take 1 - 2 pill hs prn - ORAL Class: Pharmacy

Appointment
Orders
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
000583
Created by
Approved
Disp Refills Start End 135 0/0 11/1/2004 11/23/2004 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: LAST REFILL 9/14/04 Authorizing Provider: Victor Baquero

Disp Refills Start End 60 0 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 0 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 60 3 7/15/2004 ANDROGEL 1 % (25 MG) TD GLPK (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy 10 0 7/15/2004 FENTANYL 25 MCG/HR TD PT72 Sig - Route: apply q 3 days. - Transdermal 30 6 8/3/2004 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 135 0/0 10/7/2004 11/1/2004 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB (Discontinued) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: LAST REFILL 9/14/04 90G 1 9/14/2004 KETOCONAZOLE 2 % TOP CREA (Taking) Sig - Route: apply by topical route once daily to the affected area(s) - TOPICAL Class: Pharmacy 135 0/0 9/14/2004 10/14/2004 NORCO 10 MG-325 MG ORAL TAB (Taking) Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 ORAL Class: Pharmacy 60 3 7/9/2004 ROBAXIN-750 750 MG ORAL TAB (Taking) Sig - Route: take 1 - 2 pill hs prn - ORAL Class: Pharmacy

Orders Patient Information
DOB 9/23/1959
Telephone Encounter
10/7/2004 9:37 AM
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed >> PAULA DORN Thu Oct 7, 2004 9:39 AM
000584
Authorizing Provider: Victor Baquero 60 3 11/23/2004 2/25/2005 CYCLOBENZAPRINE HCL 10 MG ORAL TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 tablet (10mg) by oral route 2 times per day - ORAL Class: Pharmacy Comment: LAST FILLED 11/2/04 Authorizing Provider: Victor Baquero

Disp Refills Start End 60 0 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 0 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 60 3 7/15/2004 ANDROGEL 1 % (25 MG) TD GLPK (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy 10 0 7/15/2004 FENTANYL 25 MCG/HR TD PT72 Sig - Route: apply q 3 days. - Transdermal 30 6 8/3/2004 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 135 0/0 11/1/2004 11/23/2004 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB (Discontinued) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: LAST REFILL 9/14/04 90G 1 9/14/2004 KETOCONAZOLE 2 % TOP CREA (Taking) Sig - Route: apply by topical route once daily to the affected area(s) - TOPICAL Class: Pharmacy 135 0/0 9/14/2004 10/14/2004 NORCO 10 MG-325 MG ORAL TAB (Taking) Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 ORAL Class: Pharmacy 60 3 7/9/2004 ROBAXIN-750 750 MG ORAL TAB (Taking) Sig - Route: take 1 - 2 pill hs prn - ORAL Class: Pharmacy

DOB 9/23/1959
Telephone Encounter
11/1/2004 10:52 AM
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed >> TRINIDAD RAYA-ROWE Mon Nov 1, 2004 10:52 AM Encounter initiated.
000585
Plan UCD/B/S HMO
Financial Class P
Plan Number B72
Plan Phone 916-734-0739
Center None
Patient Information

Telephone Encounter
12/20/2004 2:58 PM
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed >> SHERI L GROVES Mon Dec 20, 2004 2:59 PM Encounter initiated.
Created by
Approved
Disp Refills Start End 135 0/0 12/20/2004 1/10/2005 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: LAST REFILL 9/14/04 LAST FILLED 11/01/04 LAST FILLED 11/23/04 Authorizing Provider: Victor Baquero

Disp 60 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Refills 0 Start End
000586
Class: Historical 60 3 7/15/2004 ANDROGEL 1 % (25 MG) TD GLPK (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy 60 3 11/23/2004 CYCLOBENZAPRINE HCL 10 MG ORAL TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route 2 times per day - ORAL Class: Pharmacy Comment: LAST FILLED 11/2/04 10 0 7/15/2004 FENTANYL 25 MCG/HR TD PT72 Sig - Route: apply q 3 days. - Transdermal 30 6 8/3/2004 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 135 0/0 11/23/2004 12/20/2004 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB (Discontinued) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: LAST REFILL 9/14/04 LAST FILLED 11/01/04 90G 1 9/14/2004 KETOCONAZOLE 2 % TOP CREA (Taking) Sig - Route: apply by topical route once daily to the affected area(s) - TOPICAL Class: Pharmacy 135 0/0 9/14/2004 10/14/2004 NORCO 10 MG-325 MG ORAL TAB (Taking) Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 ORAL Class: Pharmacy 60 3 7/9/2004 ROBAXIN-750 750 MG ORAL TAB (Taking) Sig - Route: take 1 - 2 pill hs prn - ORAL Class: Pharmacy

DOB 9/23/1959
Telephone Encounter
11/23/2004 11:49 AM
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed >> SHERI L GROVES Tue Nov 23, 2004 11:49 AM Encounter initiated.
Created by
Approved
Disp Refills Start End 135 0/0 11/23/2004 12/20/2004 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: LAST REFILL 9/14/04 LAST FILLED 11/01/04
000587
60 0 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 0 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 60 3 7/15/2004 ANDROGEL 1 % (25 MG) TD GLPK (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy 60 3 11/23/2004 CYCLOBENZAPRINE HCL 10 MG ORAL TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route 2 times per day - ORAL Class: Pharmacy Comment: LAST FILLED 11/2/04 10 0 7/15/2004 FENTANYL 25 MCG/HR TD PT72 Sig - Route: apply q 3 days. - Transdermal 30 6 8/3/2004 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 0/0 12/20/2004 1/10/2005 135 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB (Discontinued) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: LAST REFILL 9/14/04 LAST FILLED 11/01/04 LAST FILLED 11/23/04 90G 1 9/14/2004 KETOCONAZOLE 2 % TOP CREA (Taking) Sig - Route: apply by topical route once daily to the affected area(s) - TOPICAL Class: Pharmacy 135 0/0 9/14/2004 10/14/2004 NORCO 10 MG-325 MG ORAL TAB (Taking) Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 ORAL Class: Pharmacy 60 3 7/9/2004 ROBAXIN-750 750 MG ORAL TAB (Taking) Sig - Route: take 1 - 2 pill hs prn - ORAL Class: Pharmacy

Appointment
Orders
DOB 9/23/1959
000588

Problem List
TESTICULAR HYPOFUNC NEC BRACHIAL NEURITIS NOS Encounter Closed By Closed By BAQUERO, VICTOR H
Patient Information
Closed Time 14:28

Telephone Encounter
1/11/2005 10:53 AM
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed >> HELEN BEVAN Tue Jan 11, 2005 10:54 AM Encounter initiated.
Created by
Approved
Disp Refills Start End 30 6 1/11/2005 7/10/2005 FLUOXETINE HCL 40 MG ORAL CAP Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Authorizing Provider: Victor Baquero

Disp 60 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 60 ANDROGEL 1 % (25 MG) TD GLPK (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy 60 CYCLOBENZAPRINE HCL 10 MG ORAL Refills 0 Start End
7/15/2004
11/23/2004
000589
TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route 2 times per day - ORAL Class: Pharmacy Comment: LAST FILLED 11/2/04 10 0 7/15/2004 FENTANYL 25 MCG/HR TD PT72 Sig - Route: apply q 3 days. - Transdermal 30 6 8/3/2004 1/11/2005 FLUOXETINE HCL 40 MG ORAL CAP (Discontinued) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 135 0/0 1/10/2005 2/9/2005 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB (Taking) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: LAST REFILL 9/14/04 LAST FILLED 11/01/04 LAST FILLED 11/23/04 LAST FILLED 12/20/04 90G 1 9/14/2004 KETOCONAZOLE 2 % TOP CREA (Taking) Sig - Route: apply by topical route once daily to the affected area(s) - TOPICAL Class: Pharmacy 135 0/0 9/14/2004 10/14/2004 NORCO 10 MG-325 MG ORAL TAB (Taking) Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 ORAL Class: Pharmacy 60 3 7/9/2004 ROBAXIN-750 750 MG ORAL TAB (Taking) Sig - Route: take 1 - 2 pill hs prn - ORAL Class: Pharmacy

DOB 9/23/1959
Telephone Encounter
1/10/2005 4:24 PM
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed >> SHERI L GROVES Mon Jan 10, 2005 4:29 PM Encounter initiated.
Created by
Approved
Disp Refills Start End 135 0/0 1/10/2005 2/3/2005 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: LAST REFILL 9/14/04 LAST FILLED 11/01/04 LAST FILLED 11/23/04 LAST FILLED 12/20/04 Authorizing Provider: Victor Baquero

Disp Refills Start End
000590
Orders
Patient Information Patient Name Amundsen, Mark Sex Male DOB 9/23/1959
Account # 039942058023
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Center None
Patient Information

Telephone Encounter
2/3/2005 11:54 AM
Reason for Call

Refill Request
000591
Call Documentation
SYSTEM Signed >> SHERI L GROVES Thu Feb 3, 2005 11:55 AM LAST FILLED 12/15/04 LAST FILLED 1/10/05
Created by
Approved
Disp Refills Start End 300.00 3 2/3/2005 8/22/2005 ANDROGEL 1 % (25 MG) TD GLPK Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. Authorizing Provider: Victor Baquero 135 0/0 2/3/2005 2/25/2005 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1031752. Authorizing Provider: Victor Baquero

Disp Refills Start End 30 6 1/11/2005 7/10/2005 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 60 0 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 0 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 3 7/15/2004 2/3/2005 ANDROGEL 1 % (25 MG) TD GLPK (Discontinued) 60 Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy 60 3 11/23/2004 CYCLOBENZAPRINE HCL 10 MG ORAL TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route 2 times per day - ORAL Class: Pharmacy Comment: LAST FILLED 11/2/04 10 0 7/15/2004 FENTANYL 25 MCG/HR TD PT72 Sig - Route: apply q 3 days. - Transdermal 135 0/0 1/10/2005 2/3/2005 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB (Discontinued) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: LAST REFILL 9/14/04 LAST FILLED 11/01/04 LAST FILLED 11/23/04 LAST FILLED 12/20/04 90G 1 9/14/2004 KETOCONAZOLE 2 % TOP CREA (Taking) Sig - Route: apply by topical route once daily to the affected area(s) - TOPICAL Class: Pharmacy 135 0/0 9/14/2004 10/14/2004 NORCO 10 MG-325 MG ORAL TAB (Taking) Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 ORAL Class: Pharmacy 60 3 7/9/2004 ROBAXIN-750 750 MG ORAL TAB (Taking) Sig - Route: take 1 - 2 pill hs prn - ORAL Class: Pharmacy

000592
Sex Male
DOB 9/23/1959
Account # 039942058031 Patient Demographics Address 2025 TARBOLTON CIR FOLSOM CA 95630 Selected Appointment 3/16/2005 2:29 PM Provider Doctor Staff Department Ucd Registration Phone 916-509-0158 (Home) 916-983-4484 (Work) E-mail Address mamundsen@sbcglobal.net
Plan UCD/B/S HMO
Financial Class P
Plan Number B72
Plan Phone 916-734-0739
Center None
Patient Information

Telephone Encounter
2/25/2005 11:31 AM Provider Victor Baquero, MD, MD Department Fol Family Practice
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed
000593
>> TARA L SHAVER Fri Feb 25, 2005 11:33 AM Encounter initiated.
Created by
Approved
Disp Refills Start End 135 0/0 2/25/2005 3/21/2005 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1031752. last fill date2/3/05 Authorizing Provider: Victor Baquero 60 3 2/25/2005 5/4/2005 CYCLOBENZAPRINE HCL 10 MG ORAL TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 tablet (10mg) by oral route 2 times per day - ORAL Class: Pharmacy Comment: LAST FILLED 11/2/04 This is a REFILL AUTHORIZATION for prescription number 1030339 last fill date 2/3/05 Authorizing Provider: Victor Baquero

Disp Refills Start End 30 6 1/11/2005 7/10/2005 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 60 0 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 0 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 300.00 3 2/3/2005 5/4/2005 ANDROGEL 1 % (25 MG) TD GLPK (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 60 3 11/23/2004 2/25/2005 CYCLOBENZAPRINE HCL 10 MG ORAL TAB (Discontinued) Sig - Route: take 1 tablet (10mg) by oral route 2 times per day - ORAL Class: Pharmacy Comment: LAST FILLED 11/2/04 10 0 7/15/2004 FENTANYL 25 MCG/HR TD PT72 Sig - Route: apply q 3 days. - Transdermal 135 0/0 2/3/2005 2/25/2005 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB (Discontinued) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1031752. 90G 1 9/14/2004 KETOCONAZOLE 2 % TOP CREA (Taking) Sig - Route: apply by topical route once daily to the affected area(s) - TOPICAL Class: Pharmacy 135 0/0 9/14/2004 10/14/2004 NORCO 10 MG-325 MG ORAL TAB (Taking) Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 ORAL Class: Pharmacy 60 3 7/9/2004 ROBAXIN-750 750 MG ORAL TAB (Taking) Sig - Route: take 1 - 2 pill hs prn - ORAL Class: Pharmacy

Appointment
000594
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed >> SHERI L GROVES Mon Mar 21, 2005 4:36 PM LAST FILLED 2/25/05
Created by
Approved
Disp Refills Start End 135 0/0 3/21/2005 4/12/2005 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1031752. last fill date2/3/05 Authorizing Provider: Victor Baquero

Disp Refills Start End 30 6 1/11/2005 7/10/2005 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 60 0 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 0 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 300.00 3 2/3/2005 5/4/2005 ANDROGEL 1 % (25 MG) TD GLPK (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 60 3 2/25/2005 5/26/2005 CYCLOBENZAPRINE HCL 10 MG ORAL TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route 2 times per day - ORAL Class: Pharmacy Comment: LAST FILLED 11/2/04 This is a REFILL AUTHORIZATION for prescription number 1030339 last fill date 2/3/05 10 0 7/15/2004 FENTANYL 25 MCG/HR TD PT72 Sig - Route: apply q 3 days. - Transdermal 135 0/0 2/25/2005 3/21/2005 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB (Discontinued) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1031752. last fill date2/3/05 90G 1 9/14/2004 KETOCONAZOLE 2 % TOP CREA (Taking) Sig - Route: apply by topical route once daily to the affected area(s) - TOPICAL Class: Pharmacy 135 0/0 9/14/2004 10/14/2004 NORCO 10 MG-325 MG ORAL TAB (Taking) Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 ORAL Class: Pharmacy 60 3 7/9/2004 ROBAXIN-750 750 MG ORAL TAB (Taking) Sig - Route: take 1 - 2 pill hs prn - ORAL Class: Pharmacy

Appointment
Orders
000595
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Center None
Patient Information

Telephone Encounter
4/12/2005 9:47 AM
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed >> SHERI L GROVES Tue Apr 12, 2005 9:48 AM Encounter initiated.
Created by
Approved
Disp Refills Start End 135 0/0 4/12/2005 5/4/2005 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1031752. last fill date 3/21/05 Authorizing Provider: Victor Baquero

Disp Refills 30 6 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 60 0 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 0 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 300.00 3 ANDROGEL 1 % (25 MG) TD GLPK (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 60 3 CYCLOBENZAPRINE HCL 10 MG ORAL TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route 2 times per day - ORAL Start 1/11/2005 End 7/10/2005
2/3/2005
5/4/2005
2/25/2005
5/26/2005
000596
Class: Pharmacy Comment: LAST FILLED 11/2/04 This is a REFILL AUTHORIZATION for prescription number 1030339 last fill date 2/3/05 10 0 7/15/2004 FENTANYL 25 MCG/HR TD PT72 Sig - Route: apply q 3 days. - Transdermal 135 0/0 3/21/2005 4/12/2005 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB (Discontinued) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1031752. last fill date2/3/05 90G 1 9/14/2004 KETOCONAZOLE 2 % TOP CREA (Taking) Sig - Route: apply by topical route once daily to the affected area(s) - TOPICAL Class: Pharmacy 135 0/0 9/14/2004 10/14/2004 NORCO 10 MG-325 MG ORAL TAB (Taking) Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 ORAL Class: Pharmacy 60 3 7/9/2004 ROBAXIN-750 750 MG ORAL TAB (Taking) Sig - Route: take 1 - 2 pill hs prn - ORAL Class: Pharmacy

Appointment
Orders
DOB 9/23/1959
Encounter-Level Documents: There are no encounter-level documents. Insurance Information Acct Number 039942058049 1 Payor UCD Patient Insurance ID XEHJ00044785 Group Number PH0010 Plan UCD/B/S HMO Plan Number B72 Plan Address PO BOX 179001 SACRAMENTO, Plan Phone 916-734-0739 PreAuth Phone 916-734-0739 Financial Class P
000597
Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 300.00 3 2/3/2005 5/4/2005 ANDROGEL 1 % (25 MG) TD GLPK (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 60 3 2/25/2005 5/4/2005 CYCLOBENZAPRINE HCL 10 MG ORAL TAB (Discontinued) Sig - Route: take 1 tablet (10mg) by oral route 2 times per day - ORAL Class: Pharmacy Comment: LAST FILLED 11/2/04 This is a REFILL AUTHORIZATION for prescription number 1030339 last fill date 2/3/05 10 0 7/15/2004 FENTANYL 25 MCG/HR TD PT72 Sig - Route: apply q 3 days. - Transdermal 135 0/0 4/12/2005 5/4/2005 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB (Discontinued) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1031752. last fill date 3/21/05 90G 1 9/14/2004 KETOCONAZOLE 2 % TOP CREA (Taking) Sig - Route: apply by topical route once daily to the affected area(s) - TOPICAL Class: Pharmacy 135 0/0 9/14/2004 10/14/2004 NORCO 10 MG-325 MG ORAL TAB (Taking) Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 ORAL Class: Pharmacy 60 3 7/9/2004 ROBAXIN-750 750 MG ORAL TAB (Taking) Sig - Route: take 1 - 2 pill hs prn - ORAL Class: Pharmacy

Orders Only
DOB 9/23/1959
Date 4/13/2005 Provider Yoav Hahn, MD Department Ent Physicians

Disp Refills 30 6 FLUOXETINE HCL 40 MG ORAL CAP Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 60 0 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 0 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 300.00 3 ANDROGEL 1 % (25 MG) TD GLPK Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 60 3 CYCLOBENZAPRINE HCL 10 MG ORAL TAB Sig - Route: take 1 tablet (10mg) by oral route 2 times per day - ORAL Class: Pharmacy Start 1/11/2005 End 7/10/2005
2/3/2005
5/4/2005
2/25/2005
5/26/2005
000598
Comment: LAST FILLED 11/2/04 This is a REFILL AUTHORIZATION for prescription number 1030339 last fill date 2/3/05 10 0 7/15/2004 FENTANYL 25 MCG/HR TD PT72 Sig - Route: apply q 3 days. - Transdermal 135 0/0 4/12/2005 5/12/2005 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1031752. last fill date 3/21/05 90G 1 9/14/2004 KETOCONAZOLE 2 % TOP CREA Sig - Route: apply by topical route once daily to the affected area(s) - TOPICAL Class: Pharmacy 135 0/0 9/14/2004 10/14/2004 NORCO 10 MG-325 MG ORAL TAB Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 ORAL Class: Pharmacy 60 3 7/9/2004 ROBAXIN-750 750 MG ORAL TAB Sig - Route: take 1 - 2 pill hs prn - ORAL Class: Pharmacy

CT SINUS LTD (5808386) Ordered On 4/11/2005
Encounter Closed By
Appointment
Account # 039942058049
Phone 916-509-0158 (Home) 916-983-4484 (Work) Provider Ct.... Radacc
Department Radiology Acc
000599
Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1031752. 90G 1 9/14/2004 KETOCONAZOLE 2 % TOP CREA (Taking) Sig - Route: apply by topical route once daily to the affected area(s) - TOPICAL Class: Pharmacy 135 0/0 9/14/2004 10/14/2004 NORCO 10 MG-325 MG ORAL TAB (Taking) Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 ORAL Class: Pharmacy 60 3 7/9/2004 ROBAXIN-750 750 MG ORAL TAB (Taking) Sig - Route: take 1 - 2 pill hs prn - ORAL Class: Pharmacy

DOB 9/23/1959
Telephone Encounter
5/4/2005 4:52 PM
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed >> SHERI L GROVES Wed May 4, 2005 4:53 PM Encounter initiated.
Created by
Approved
Disp Refills Start End 60 3 5/4/2005 9/8/2005 CYCLOBENZAPRINE HCL 10 MG ORAL TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 tablet (10mg) by oral route 2 times per day - ORAL Class: Pharmacy Comment: LAST FILLED 11/2/04 This is a REFILL AUTHORIZATION for prescription number 1030339. Authorizing Provider: Victor Baquero 135 0/0 5/4/2005 5/31/2005 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1031752. Authorizing Provider: Victor Baquero

Disp Refills 30 6 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 60 0 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 0 AMBIEN 10 MG ORAL TAB Start 1/11/2005 End 7/10/2005
000600
Sig - Route: take 1 - 2 pill hs prn - ORAL Class: Pharmacy

DOB 9/23/1959
Telephone Encounter
5/31/2005 8:27 AM
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed >> SHERI L GROVES Tue May 31, 2005 8:27 AM Encounter initiated.
Created by
Approved
Disp Refills Start End 135 0/0 5/31/2005 6/20/2005 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1031752. Authorizing Provider: Victor Baquero

Disp Refills Start 30 6 1/11/2005 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 60 0 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 0 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 300.00 3 2/3/2005 ANDROGEL 1 % (25 MG) TD GLPK (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 60 3 5/4/2005 CYCLOBENZAPRINE HCL 10 MG ORAL TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route 2 times per day - ORAL Class: Pharmacy Comment: LAST FILLED 11/2/04 This is a REFILL AUTHORIZATION for prescription number 1030339. 10 0 7/15/2004 FENTANYL 25 MCG/HR TD PT72 Sig - Route: apply q 3 days. - Transdermal 135 0/0 5/4/2005 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB (Discontinued) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL End 7/10/2005
5/4/2005
8/2/2005
5/31/2005
000601
MRN 8081369
Sex Male
DOB 9/23/1959
Telephone Encounter
6/20/2005 4:47 PM
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed >> SHERI L GROVES Mon Jun 20, 2005 4:48 PM Encounter initiated.
Created by
Approved

Disp Refills Start End 30 6 1/11/2005 7/10/2005 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 60 0 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 0 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 300.00 3 2/3/2005 5/4/2005 ANDROGEL 1 % (25 MG) TD GLPK (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 60 3 5/4/2005 8/2/2005 CYCLOBENZAPRINE HCL 10 MG ORAL TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route 2 times per day - ORAL Class: Pharmacy Comment: LAST FILLED 11/2/04 This is a REFILL AUTHORIZATION for prescription number 1030339. 10 0 7/15/2004 FENTANYL 25 MCG/HR TD PT72 Sig - Route: apply q 3 days. - Transdermal 135 0/0 5/31/2005 6/20/2005 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB (Discontinued) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1031752. 90G 1 9/14/2004 KETOCONAZOLE 2 % TOP CREA (Taking) Sig - Route: apply by topical route once daily to the affected area(s) - TOPICAL Class: Pharmacy 135 0/0 9/14/2004 10/14/2004 NORCO 10 MG-325 MG ORAL TAB (Taking) Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 ORAL Class: Pharmacy 60 3 7/9/2004 ROBAXIN-750 750 MG ORAL TAB (Taking)
000602
HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1043578. Authorizing Provider: Victor Baquero

Disp Refills Start End 30 6 1/11/2005 7/10/2005 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 60 0 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 0 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 300.00 3 2/3/2005 5/4/2005 ANDROGEL 1 % (25 MG) TD GLPK (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 60 3 5/4/2005 8/2/2005 CYCLOBENZAPRINE HCL 10 MG ORAL TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route 2 times per day - ORAL Class: Pharmacy Comment: LAST FILLED 11/2/04 This is a REFILL AUTHORIZATION for prescription number 1030339. 10 0 7/15/2004 FENTANYL 25 MCG/HR TD PT72 Sig - Route: apply q 3 days. - Transdermal 30 6 7/12/2005 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 135 0/0 6/20/2005 7/12/2005 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB (Discontinued) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1042273. 90G 1 9/14/2004 KETOCONAZOLE 2 % TOP CREA (Taking) Sig - Route: apply by topical route once daily to the affected area(s) - TOPICAL Class: Pharmacy 135 0/0 9/14/2004 10/14/2004 NORCO 10 MG-325 MG ORAL TAB (Taking) Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 ORAL Class: Pharmacy 60 3 7/9/2004 ROBAXIN-750 750 MG ORAL TAB (Taking) Sig - Route: take 1 - 2 pill hs prn - ORAL Class: Pharmacy

DOB 9/23/1959
Telephone Encounter
7/12/2005 9:11 AM
000603
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed >> AMANDA S RANEY Tue Jul 12, 2005 9:12 AM Encounter initiated.
Created by
Approved
Disp Refills Start End 30 6 7/12/2005 1/2/2006 FLUOXETINE HCL 40 MG ORAL CAP Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. Authorizing Provider: Victor Baquero

Disp Refills Start End 30 6 1/11/2005 7/10/2005 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 60 0 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 0 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 300.00 3 2/3/2005 5/4/2005 ANDROGEL 1 % (25 MG) TD GLPK (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 60 3 5/4/2005 8/2/2005 CYCLOBENZAPRINE HCL 10 MG ORAL TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route 2 times per day - ORAL Class: Pharmacy Comment: LAST FILLED 11/2/04 This is a REFILL AUTHORIZATION for prescription number 1030339. 10 0 7/15/2004 FENTANYL 25 MCG/HR TD PT72 Sig - Route: apply q 3 days. - Transdermal 135 0/0 6/20/2005 7/20/2005 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB (Taking) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1042273. 90G 1 9/14/2004 KETOCONAZOLE 2 % TOP CREA (Taking) Sig - Route: apply by topical route once daily to the affected area(s) - TOPICAL Class: Pharmacy 135 0/0 9/14/2004 10/14/2004 NORCO 10 MG-325 MG ORAL TAB (Taking) Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 ORAL Class: Pharmacy 60 3 7/9/2004 ROBAXIN-750 750 MG ORAL TAB (Taking) Sig - Route: take 1 - 2 pill hs prn - ORAL Class: Pharmacy

000604
Sig - Route: apply q 3 days. - Transdermal 30 6 7/12/2005 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 135 0/0 8/3/2005 8/22/2005 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB (Discontinued) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1043578. 90G 1 9/14/2004 KETOCONAZOLE 2 % TOP CREA (Taking) Sig - Route: apply by topical route once daily to the affected area(s) - TOPICAL Class: Pharmacy 135 0/0 9/14/2004 10/14/2004 NORCO 10 MG-325 MG ORAL TAB (Taking) Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 ORAL Class: Pharmacy 60 3 7/9/2004 ROBAXIN-750 750 MG ORAL TAB (Taking) Sig - Route: take 1 - 2 pill hs prn - ORAL Class: Pharmacy

DOB 9/23/1959
Telephone Encounter
8/3/2005 9:36 AM
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed >> SHERI L GROVES Wed Aug 3, 2005 9:36 AM Encounter initiated.
Created by
Approved

Disp Refills 30 6 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 60 0 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Start 1/11/2005 End 7/10/2005
000605
Class: Historical 10 0 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 300.00 3 2/3/2005 5/4/2005 ANDROGEL 1 % (25 MG) TD GLPK (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 60 3 5/4/2005 8/2/2005 CYCLOBENZAPRINE HCL 10 MG ORAL TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route 2 times per day - ORAL Class: Pharmacy Comment: LAST FILLED 11/2/04 This is a REFILL AUTHORIZATION for prescription number 1030339. 10 0 7/15/2004 FENTANYL 25 MCG/HR TD PT72 Sig - Route: apply q 3 days. - Transdermal 30 6 7/12/2005 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 0/0 7/12/2005 8/3/2005 135 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB (Discontinued) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1043578. 90G 1 9/14/2004 KETOCONAZOLE 2 % TOP CREA (Taking) Sig - Route: apply by topical route once daily to the affected area(s) - TOPICAL Class: Pharmacy 135 0/0 9/14/2004 10/14/2004 NORCO 10 MG-325 MG ORAL TAB (Taking) Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 ORAL Class: Pharmacy 60 3 7/9/2004 ROBAXIN-750 750 MG ORAL TAB (Taking) Sig - Route: take 1 - 2 pill hs prn - ORAL Class: Pharmacy

DOB 9/23/1959
Telephone Encounter
7/12/2005 9:49 AM
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed >> SHERI L GROVES Tue Jul 12, 2005 9:50 AM Encounter initiated.
Created by
Approved
Disp 135 Refills 0/0 Start 7/12/2005 End 8/3/2005
000606

DOB 9/23/1959
Telephone Encounter
8/22/2005 4:59 PM
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed >> SHERI L GROVES Mon Aug 22, 2005 4:59 PM Encounter initiated.
Created by
Approved
Disp Refills Start End 300.00 3 8/22/2005 12/8/2005 ANDROGEL 1 % (25 MG) TD GLPK Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. Authorizing Provider: Victor Baquero 135 0/0 8/22/2005 9/8/2005 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1043578. Authorizing Provider: Victor Baquero

Disp Refills Start 30 6 1/11/2005 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 60 0 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 0 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 3 2/3/2005 ANDROGEL 1 % (25 MG) TD GLPK (Discontinued) 300.00 Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 60 3 5/4/2005 CYCLOBENZAPRINE HCL 10 MG ORAL TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route 2 times per day - ORAL Class: Pharmacy Comment: LAST FILLED 11/2/04 This is a REFILL AUTHORIZATION for prescription number 1030339. 10 0 7/15/2004 FENTANYL 25 MCG/HR TD PT72 End 7/10/2005
8/22/2005
8/2/2005
000607
Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1043578 Authorizing Provider: Victor Baquero

Disp Refills Start End 30 6 1/11/2005 7/10/2005 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 60 0 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 0 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 300.00 3 8/22/2005 11/20/2005 ANDROGEL 1 % (25 MG) TD GLPK (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 60 3 9/8/2005 12/7/2005 CYCLOBENZAPRINE 10 MG TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route 2 times per day - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1030339. 10 0 7/15/2004 FENTANYL 25 MCG/HR TD PT72 Sig - Route: apply q 3 days. - Transdermal 30 6 7/12/2005 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 135 0/0 9/8/2005 10/3/2005 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Discontinued) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1043578. 90G 1 9/14/2004 KETOCONAZOLE 2 % TOP CREA (Taking) Sig - Route: apply by topical route once daily to the affected area(s) - TOPICAL Class: Pharmacy 135 0/0 9/14/2004 10/14/2004 NORCO 10 MG-325 MG ORAL TAB (Taking) Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 ORAL Class: Pharmacy 60 3 7/9/2004 ROBAXIN-750 750 MG ORAL TAB (Taking) Sig - Route: take 1 - 2 pill hs prn - ORAL Class: Pharmacy

DOB 9/23/1959
Telephone Encounter
9/8/2005 10:54 AM
Reason for Call

Refill Request
000608
Call Documentation
SYSTEM Signed >> SHERI L GROVES Thu Sep 8, 2005 10:55 AM Encounter initiated.
Created by
Approved
Disp Refills Start End 135 0/0 9/8/2005 10/3/2005 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1043578. Authorizing Provider: Victor Baquero 60 3 9/8/2005 1/3/2006 CYCLOBENZAPRINE 10 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 tablet (10mg) by oral route 2 times per day - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1030339. Authorizing Provider: Victor Baquero

Disp Refills Start End 30 6 1/11/2005 7/10/2005 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 60 0 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 0 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 300.00 3 8/22/2005 11/20/2005 ANDROGEL 1 % (25 MG) TD GLPK (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 60 3 5/4/2005 9/8/2005 CYCLOBENZAPRINE HCL 10 MG ORAL TAB (Discontinued) Sig - Route: take 1 tablet (10mg) by oral route 2 times per day - ORAL Class: Pharmacy Comment: LAST FILLED 11/2/04 This is a REFILL AUTHORIZATION for prescription number 1030339. 10 0 7/15/2004 FENTANYL 25 MCG/HR TD PT72 Sig - Route: apply q 3 days. - Transdermal 30 6 7/12/2005 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 135 0/0 8/22/2005 9/8/2005 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB (Discontinued) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1043578. 90G 1 9/14/2004 KETOCONAZOLE 2 % TOP CREA (Taking) Sig - Route: apply by topical route once daily to the affected area(s) - TOPICAL Class: Pharmacy 135 0/0 9/14/2004 10/14/2004 NORCO 10 MG-325 MG ORAL TAB (Taking) Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 ORAL Class: Pharmacy 60 3 7/9/2004 ROBAXIN-750 750 MG ORAL TAB (Taking) Sig - Route: take 1 - 2 pill hs prn - ORAL Class: Pharmacy
000609
10 0 7/15/2004 FENTANYL 25 MCG/HR TD PT72 Sig - Route: apply q 3 days. - Transdermal 30 6 7/12/2005 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 135 0/0 10/24/2005 10/31/2005 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Discontinued) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1043578 90G 1 9/14/2004 KETOCONAZOLE 2 % TOP CREA (Taking) Sig - Route: apply by topical route once daily to the affected area(s) - TOPICAL Class: Pharmacy 135 0/0 9/14/2004 10/14/2004 NORCO 10 MG-325 MG ORAL TAB (Taking) Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 ORAL Class: Pharmacy 60 3 7/9/2004 ROBAXIN-750 750 MG ORAL TAB (Taking) Sig - Route: take 1 - 2 pill hs prn - ORAL Class: Pharmacy

DOB 9/23/1959
Telephone Encounter
10/24/2005 10:03 AM
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed >> MANUELA NUNEZ Mon Oct 24, 2005 10:04 AM Encounter initiated.
Created by
Approved
Disp Refills Start End 135 0/0 10/24/2005 10/31/2005 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1043578 Authorizing Provider: Victor Baquero

Disp Refills 30 6 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 60 0 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Start 1/11/2005 End 7/10/2005
000610
Class: Historical 10 0 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 300.00 3 8/22/2005 11/20/2005 ANDROGEL 1 % (25 MG) TD GLPK (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 60 3 9/8/2005 12/7/2005 CYCLOBENZAPRINE 10 MG TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route 2 times per day - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1030339. 10 0 7/15/2004 FENTANYL 25 MCG/HR TD PT72 Sig - Route: apply q 3 days. - Transdermal 30 6 7/12/2005 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 135 0/0 10/3/2005 10/24/2005 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Discontinued) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1043578 90G 1 9/14/2004 KETOCONAZOLE 2 % TOP CREA (Taking) Sig - Route: apply by topical route once daily to the affected area(s) - TOPICAL Class: Pharmacy 135 0/0 9/14/2004 10/14/2004 NORCO 10 MG-325 MG ORAL TAB (Taking) Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 ORAL Class: Pharmacy 60 3 7/9/2004 ROBAXIN-750 750 MG ORAL TAB (Taking) Sig - Route: take 1 - 2 pill hs prn - ORAL Class: Pharmacy

DOB 9/23/1959
Telephone Encounter
10/3/2005 4:19 PM Provider Victor Baquero, MD, MD Department Fol Family Practice
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed >> SHERI L GROVES Mon Oct 3, 2005 4:20 PM Encounter initiated.
Created by
Approved
HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB
000611
Sig - Route: apply by topical route once daily to the affected area(s) - TOPICAL Class: Pharmacy 135 0/0 9/14/2004 10/14/2004 NORCO 10 MG-325 MG ORAL TAB (Taking) Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 ORAL Class: Pharmacy 60 3 7/9/2004 ROBAXIN-750 750 MG ORAL TAB (Taking) Sig - Route: take 1 - 2 pill hs prn - ORAL Class: Pharmacy

DOB 9/23/1959
Telephone Encounter
10/31/2005 11:24 AM
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed >> SHERI L GROVES Mon Oct 31, 2005 11:25 AM Encounter initiated.
Created by
Approved

Disp Refills 30 6 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 60 0 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 0 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 300.00 3 ANDROGEL 1 % (25 MG) TD GLPK (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 60 3 CYCLOBENZAPRINE 10 MG TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route 2 times per day - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1030339. Start 1/11/2005 End 7/10/2005
8/22/2005
11/20/2005
9/8/2005
12/7/2005
000612
DOB 9/23/1959
Telephone Encounter
11/17/2005 10:30 AM
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed >> SHERI L GROVES Thu Nov 17, 2005 10:30 AM Encounter initiated.
Created by
Approved

Disp Refills 30 6 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 60 0 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 0 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 300.00 3 ANDROGEL 1 % (25 MG) TD GLPK (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 60 3 CYCLOBENZAPRINE 10 MG TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route 2 times per day - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1030339. 10 0 FENTANYL 25 MCG/HR TD PT72 Sig - Route: apply q 3 days. - Transdermal 30 6 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 135 0/0 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Discontinued) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1049713 90G 1 KETOCONAZOLE 2 % TOP CREA (Taking) Start 1/11/2005 End 7/10/2005
8/22/2005
11/20/2005
9/8/2005
12/7/2005
7/15/2004 7/12/2005
10/31/2005
11/17/2005
9/14/2004
000613
Comment: This is a REFILL AUTHORIZATION for prescription number 1049713 / 1052502. Last filled 11/17/05 Authorizing Provider: Victor Baquero

Disp Refills Start End 30 6 1/11/2005 7/10/2005 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 60 0 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 0 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 300.00 3 12/8/2005 3/8/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 60 3 9/8/2005 12/7/2005 CYCLOBENZAPRINE 10 MG TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route 2 times per day - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1030339. 10 0 7/15/2004 FENTANYL 25 MCG/HR TD PT72 Sig - Route: apply q 3 days. - Transdermal 30 6 7/12/2005 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 135 0/0 12/8/2005 12/12/2005 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Discontinued) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1049713 90G 1 9/14/2004 KETOCONAZOLE 2 % TOP CREA (Taking) Sig - Route: apply by topical route once daily to the affected area(s) - TOPICAL Class: Pharmacy 135 0/0 9/14/2004 10/14/2004 NORCO 10 MG-325 MG ORAL TAB (Taking) Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 ORAL Class: Pharmacy 60 3 7/9/2004 ROBAXIN-750 750 MG ORAL TAB (Taking) Sig - Route: take 1 - 2 pill hs prn - ORAL Class: Pharmacy

DOB 9/23/1959
Telephone Encounter
12/8/2005 10:00 AM
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed
000614
>> SHERI L GROVES Thu Dec 8, 2005 10:01 AM Encounter initiated.
Created by
Approved
Disp Refills Start End 300.00 3 12/8/2005 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. Authorizing Provider: Victor Baquero 135 0/0 12/8/2005 12/12/2005 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy DAW: No Comment: This is a REFILL AUTHORIZATION for prescription number 1049713 Authorizing Provider: Victor Baquero

Disp Refills Start End 30 6 1/11/2005 7/10/2005 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 60 0 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 0 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 3 8/22/2005 12/8/2005 ANDROGEL 1 % (25 MG) TD GLPK (Discontinued) 300.00 Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 60 3 9/8/2005 12/7/2005 CYCLOBENZAPRINE 10 MG TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route 2 times per day - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1030339. 10 0 7/15/2004 FENTANYL 25 MCG/HR TD PT72 Sig - Route: apply q 3 days. - Transdermal 30 6 7/12/2005 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 135 0/0 11/17/2005 12/8/2005 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Discontinued) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1049713 90G 1 9/14/2004 KETOCONAZOLE 2 % TOP CREA (Taking) Sig - Route: apply by topical route once daily to the affected area(s) - TOPICAL Class: Pharmacy 135 0/0 9/14/2004 10/14/2004 NORCO 10 MG-325 MG ORAL TAB (Taking) Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 ORAL Class: Pharmacy 60 3 7/9/2004 ROBAXIN-750 750 MG ORAL TAB (Taking) Sig - Route: take 1 - 2 pill hs prn - ORAL Class: Pharmacy

000615
Sig - Route: apply by topical route once daily to the affected area(s) - TOPICAL Class: Pharmacy 135 0/0 9/14/2004 10/14/2004 NORCO 10 MG-325 MG ORAL TAB (Taking) Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 ORAL Class: Pharmacy 60 3 7/9/2004 ROBAXIN-750 750 MG ORAL TAB (Taking) Sig - Route: take 1 - 2 pill hs prn - ORAL Class: Pharmacy

DOB 9/23/1959
Contacts
12/12/2005 1:39 PM Type Phone (Incoming Fax) Contact Amundsen, Mark (Self) Phone
Telephone Encounter
12/12/2005 1:39 PM
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed >> FALISHA L CLAY Mon Dec 12, 2005 1:43 PM Dr. Baquero it's has been done. I received another request. So this a error. >> FALISHA L CLAY Mon Dec 12, 2005 1:41 PM Encounter initiated.
Created by

Disp Refills 30 6 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 60 0 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 0 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 300.00 3 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 60 3 CYCLOBENZAPRINE 10 MG TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route 2 times per day - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1030339. 10 0 FENTANYL 25 MCG/HR TD PT72 Start 1/11/2005 End 7/10/2005
12/8/2005
3/8/2006
9/8/2005
12/7/2005
7/15/2004
000616
Sig - Route: apply q 3 days. - Transdermal 30 6 7/12/2005 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 135 0/0 12/8/2005 12/12/2005 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Discontinued) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1049713 135 0/0 12/12/2005 1/11/2006 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1049713 / 1052502. Last filled 11/17/05 90G 1 9/14/2004 KETOCONAZOLE 2 % TOP CREA (Taking) Sig - Route: apply by topical route once daily to the affected area(s) - TOPICAL Class: Pharmacy 135 0/0 9/14/2004 10/14/2004 NORCO 10 MG-325 MG ORAL TAB (Taking) Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 ORAL Class: Pharmacy 60 3 7/9/2004 ROBAXIN-750 750 MG ORAL TAB (Taking) Sig - Route: take 1 - 2 pill hs prn - ORAL Class: Pharmacy
Orders Chart Cosign

Patient Information

Contacts
12/12/2005 10:03 AM
Type Phone (Incoming Fax) Contact Amundsen, Mark (Self) Phone
Telephone Encounter
12/12/2005 10:03 AM
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed >> FALISHA L CLAY Mon Dec 12, 2005 10:04 AM Encounter initiated.
Created by
Approved
Disp Refills Start End 135 0/0 12/12/2005 1/3/2006 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy DAW: No
000617
Class: Pharmacy 135 0/0 9/14/2004 10/14/2004 NORCO 10 MG-325 MG ORAL TAB (Taking) Sig - Route: take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 ORAL Class: Pharmacy 60 3 7/9/2004 ROBAXIN-750 750 MG ORAL TAB (Taking) Sig - Route: take 1 - 2 pill hs prn - ORAL Class: Pharmacy

Appointment
Orders
DOB 9/23/1959
Provider Doctor Staff Department Ucd Registration Phone 916-509-0158 (Home) 916-983-4484 (Work) E-mail Address mamundsen@sbcglobal.net
Plan AETNA PPO
Financial Class P
Plan Number A06
Plan Phone 888-632-3862
Center None
000618
Patient Information

Telephone Encounter
1/2/2006 2:26 PM
Provider Gertrudes Perlas Montemayor, MD Department Fol Family Practice
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed >> KIRA RYCROFT Mon Jan 2, 2006 2:26 PM Encounter initiated.
Created by
Approved
Disp Refills Start End 30 6 1/2/2006 1/19/2006 FLUOXETINE 40 MG CAP Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. Authorizing Provider: Victor Baquero

Disp Refills Start 30 6 1/11/2005 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 60 0 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 0 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 300.00 3 12/8/2005 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 60 3 9/8/2005 CYCLOBENZAPRINE 10 MG TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route 2 times per day - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1030339. 10 0 7/15/2004 FENTANYL 25 MCG/HR TD PT72 Sig - Route: apply q 3 days. - Transdermal 30 6 7/12/2005 FLUOXETINE HCL 40 MG ORAL CAP (Discontinued) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 135 0/0 12/12/2005 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1049713 / 1052502. Last filled 11/17/05 90G 1 9/14/2004 KETOCONAZOLE 2 % TOP CREA (Taking) End 7/10/2005
3/8/2006
12/7/2005
1/2/2006
1/11/2006
000619
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Provider Lana Louie Wania-Galicia, MD
Center None
Patient Information

Telephone Encounter
3/24/2006 3:21 PM
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed >> SHERI L GROVES Fri Mar 24, 2006 3:22 PM Encounter initiated.
Created by
000620
Approved

Disp Refills 300.00 3 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 BACLOFEN 10 MG TAB (Taking) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 0 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 250 0/0 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Discontinued) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1043578. 250 0 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Start 2/27/2006 End
1/19/2006
2/18/2006
1/19/2006
2/24/2006
3/2/2006
3/24/2006
2/6/2006
3/8/2006

Appointment
Orders
Sex Male
DOB 9/23/1959
000621
Appointment
Sex Male

DOB 9/23/1959
Account # 038112613047 Patient Demographics Address 2025 TARBOLTON CIR FOLSOM CA 95630 Selected Appointment 4/21/2006 5:00 PM Provider Mri... Radacc Department Radiology Acc Phone 916-509-0158 (Home) 916-983-4484 (Work) E-mail Address mamundsen@sbcglobal.net
Plan AETNA PPO
Plan Number A06
Plan Phone 888-632-3862
Center None
Patient Information

Telephone Encounter
4/14/2006 4:05 PM
Reason for Call

Refill Request
000622
Call Documentation
SYSTEM Signed >> SHERI L GROVES Fri Apr 14, 2006 4:15 PM Encounter initiated.
Created by
Approved
Disp Refills Start End 250 0 4/14/2006 5/1/2006 NORCO 10 MG-325 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Authorizing Provider: Victor Baquero, MD 90 2 4/18/2006 5/18/2006 BACLOFEN 10 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 tablet oralley 3 times a day as needed - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1056944. Authorizing Provider: Victor Baquero, MD

Disp Refills 300.00 3 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 BACLOFEN 10 MG TAB (Discontinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 0 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 250 0/0 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 250 0 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Start 2/27/2006 End
1/19/2006
4/18/2006
1/19/2006
2/24/2006
3/24/2006
4/23/2006
2/6/2006
4/14/2006

Appointment
Orders
DOB 9/23/1959
Account # 038112613047 Patient Demographics
000623
Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 60 0 5/1/2006 METHADONE 5 MG TAB Sig - Route: 1 po BID - ORAL 250 0 2/6/2006 NORCO 10 MG-325 MG TAB (Taking/Disco ntinued) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy 250 0 5/1/2006 NORCO 10 MG-325 MG TAB Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy 90 0 5/1/2006 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy 20 0 5/1/2006 TORADOL ORAL 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4-6 hours as needed not to exceed 40mg per 24 hours - ORAL Class: Pharmacy
6/1/2006 4/14/2006
5/31/2006
5/31/2006
5/31/2006

Orders Chart Cosign

Appointment
Provider Mri... Radacc Department Radiology Acc Phone 916-509-0158 (Home) 916-983-4484 (Work) E-mail Address mamundsen@sbcglobal.net
Plan
Financial Class P
Plan Number
Plan Address
Plan Phone
PreAuth Phone
000624
AETNA PPO
A06
PO BOX 14089 LEXINGTON, KY 40512-4089
888-632-3862
800-840-2925
Center None
Orders Only
Patient Information

Date 5/14/2006 Provider Jason M Miller, MD Department Pain Clinic Acc

Disp Refills 300.00 3 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 BACLOFEN 10 MG TAB (Taking/Discontinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 0 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 250 0/0 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 250 0 NORCO 10 MG-325 MG TAB (Taking/Disco ntinued) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Start 2/27/2006 End
1/19/2006
4/18/2006
1/19/2006
2/24/2006
3/24/2006
4/23/2006
2/6/2006
4/14/2006

ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking/Discontinued) BACLOFEN 10 MG TAB (Taking/Discontinued) FLUOXETINE 40 MG CAP (Taking/Discontinued) GLUCOSAMINE 1,000 MG TAB (Taking/Discontinued) HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking/Discontinued) NORCO 10 MG-325 MG TAB (Taking/Discontinued)
Encounter Closed By
Appointment
000625
[99213]
Medications
Medications at Start of Encounter Disp Refills Start End 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 1/19/2006 4/18/2006 BACLOFEN 10 MG TAB (Taking/Disco ntinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 1/19/2006 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 250 0/0 5/23/2006 6/22/2006 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 0 5/1/2006 5/26/2006 METHADONE 5 MG TAB (Discontinued) 60 Sig - Route: 1 po BID - ORAL 0 2/6/2006 4/14/2006 250 NORCO 10 MG-325 MG TAB (Taking/Discontinued) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy 250 0 5/23/2006 6/22/2006 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy 90 0 5/23/2006 6/22/2006 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy 20 0 5/1/2006 5/26/2006 TORADOL ORAL 10 MG TAB (Discontinued) Sig - Route: take 1 tablet (10mg) by oral route every 4-6 hours as needed not to exceed 40mg per 24 hours - ORAL Class: Pharmacy Ordered Medications Disp 60 CYMBALTA 30 MG CAP 1 po qam for 1 week then bid thereafter - ORAL 30 CYMBALTA 60 MG CAP (Discontinued) 1 PO DAILY - ORAL 40 DILAUDID 2 MG TAB take 1-2 by oral route every 4-6 hours as needed - ORAL Discontinued Medications Reason for Discontinue METHADONE 5 MG TAB Refills 0 6 0 Start 5/26/2006 5/26/2006 5/26/2006 End 6/25/2006 7/21/2006 6/25/2006
000626
Plan AETNA PPO
Financial Class P
Plan Number A06
Plan Phone 888-632-3862
Center None
Appointment
Account # 038112613054 Patient Demographics Address 2025 TARBOLTON CIR FOLSOM CA 95630 Selected Appointment 6/5/2006 1:00 PM Provider Scanr1 Mrirad Department Mri Main Hospital Phone 916-509-0158 (Home) 916-983-4484 (Work) E-mail Address mamundsen@sbcglobal.net
000627
Plan AETNA PPO
Plan Number A06
Plan Phone 888-632-3862
Provider Mri... Radacc
Center None
Center None
Orders Only
Patient Information

Date 6/5/2006 Provider Jason M Miller, MD Department Pain Clinic Acc

Disp Refills 300.00 3 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 2 90 BACLOFEN 10 MG TAB (Taking/Discontinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 0 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 250 0/0 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking/Discontinued) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 60 0 METHADONE 5 MG TAB (Discontinued) Sig - Route: 1 po BID - ORAL 250 0 NORCO 10 MG-325 MG TAB (Taking/Disco ntinued) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy 250 0 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy 90 0 SOMA 350 MG TAB (Discontinued) Start 2/27/2006 End
1/19/2006
4/18/2006
1/19/2006
2/24/2006
3/24/2006
5/23/2006
5/1/2006 2/6/2006
5/26/2006 4/14/2006
5/1/2006
5/23/2006
5/1/2006
5/23/2006
000628
Sig - Route: 1 po tid - ORAL Class: Pharmacy 0 5/1/2006 5/26/2006 20 TORADOL ORAL 10 MG TAB (Discontinued) Sig - Route: take 1 tablet (10mg) by oral route every 4-6 hours as needed not to exceed 40mg per 24 hours - ORAL Class: Pharmacy

ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking/Discontinued) BACLOFEN 10 MG TAB (Taking/Discontinued) FLUOXETINE 40 MG CAP (Taking/Discontinued) GLUCOSAMINE 1,000 MG TAB (Taking/Discontinued) HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking/Discontinued) NORCO 10 MG-325 MG TAB (Taking/Discontinued)
Encounter Closed By
Appointment
Plan AETNA PPO
Financial Class P
Plan Number A06
Plan Phone 888-632-3862
Center None
000629
250 NORCO 10 MG-325 MG TAB Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy 90 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy
6/6/2006
7/6/2006
5/23/2006
6/22/2006

Orders Chart Cosign

Accepted By Victor Baquero, MD Accepted On 6/9/2006 9:31 AM
Office Visit
Plan AETNA PPO
Financial Class P
Plan Number A06
Plan Phone 888-632-3862
Diagnoses ENTHESOPATHY OF HIP - Primary Reason for Visit Pain Level of Service OFFICE/OUTPT VISIT,EST,LEVL III [99213]
726.5
Medications
Medications at Start of Encounter Disp Refills 60 0 CYMBALTA 30 MG CAP Sig - Route: 1 po qam for 1 week then bid thereafter - ORAL Class: Pharmacy 40 0 DILAUDID 2 MG TAB Sig - Route: take 1-2 by oral route every 4-6 hours as needed - ORAL 300.00 3 ANDROGEL 1 % (25 MG) Start 5/26/2006 End 6/25/2006
5/26/2006 2/27/2006
6/25/2006
000630
TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 1/19/2006 BACLOFEN 10 MG TAB (Taking/Disco ntinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 5/26/2006 CYMBALTA 60 MG CAP Sig - Route: 1 PO DAILY - ORAL 30 6 1/19/2006 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 250 0/0 3/24/2006 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking/Discontinued) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 250 0/0 5/23/2006 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 250 0 2/6/2006 NORCO 10 MG-325 MG TAB (Taking/Discontinued) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy 250 0 5/23/2006 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy 90 0 5/23/2006 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Medication Review History Med Rev Hx Medication Administration Report for Amundsen, Mark All administrations No administration data available Pharmacy Selected For Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630
4/18/2006
11/22/2006
5/23/2006
6/22/2006
4/14/2006
6/6/2006
6/22/2006
Immunizations
Visit Summary
Vitals Recorded in This Encounter
000631
DEPRESSIVE DISORDER
5/26/2006

Previous Visit 6/2/2006 2:58 PM
RH MD Msg
Visit Information 6/7/2006 5:26 PM
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Medications at Start of Encounter Disp Refills Start 60 0 5/26/2006 CYMBALTA 30 MG CAP Sig - Route: 1 po qam for 1 week then bid thereafter - ORAL Class: Pharmacy 40 0 5/26/2006 DILAUDID 2 MG TAB Sig - Route: take 1-2 by oral route every 4-6 hours as needed - ORAL 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 1/19/2006 BACLOFEN 10 MG TAB (Taking/Disco ntinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 5/26/2006 CYMBALTA 60 MG CAP Sig - Route: 1 PO DAILY - ORAL 30 6 1/19/2006 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. End 6/25/2006
6/25/2006
4/18/2006
11/22/2006
000632
0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 0/0 3/24/2006 250 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking/Discontinued) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 250 0/0 5/23/2006 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 250 0 2/6/2006 NORCO 10 MG-325 MG TAB (Taking/Discontinued) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy 250 1 6/6/2006 NORCO 10 MG-325 MG TAB Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy 90 0 5/23/2006 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy
5/23/2006
6/22/2006
4/14/2006
7/6/2006
6/22/2006
Allergies
Problem List
1/19/2006

Patient Information
000633
MRN 8081369
Sex Male
DOB 9/23/1959
Contacts
Type Contact 06/07/2006 3:56 PM Phone (Incoming) Amundsen, Mark (Self) 06/07/2006 4:32 PM Phone (Outgoing) sheri i tried to reach but he could not hear me and hung up. i tried to call back and it was busy. Phone 916-337-0490 (W)
Telephone Encounter
6/7/2006 3:54 PM
Reason for Call

Medication Problem
Call Documentation
SYSTEM Signed >> BRENDA J FALLON Wed Jun 7, 2006 3:56 PM Patient states perscription that was sent to pharmacy yesterday , the pharmacisit is hesitating on filling it. Please advise.
Created by

Disp Refills 60 0 CYMBALTA 30 MG CAP Sig - Route: 1 po qam for 1 week then bid thereafter - ORAL Class: Pharmacy 40 0 DILAUDID 2 MG TAB Sig - Route: take 1-2 by oral route every 4-6 hours as needed - ORAL 300.00 3 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 2 90 BACLOFEN 10 MG TAB (Taking/Discontinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 CYMBALTA 60 MG CAP Sig - Route: 1 PO DAILY - ORAL 30 6 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 0 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 250 0/0 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking/Discontinued) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 250 0/0 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 250 0 NORCO 10 MG-325 MG TAB (Taking/Disco ntinued) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Start 5/26/2006 End 6/25/2006
5/26/2006 2/27/2006
6/25/2006
1/19/2006
4/18/2006
5/26/2006 1/19/2006
11/22/2006
2/24/2006
3/24/2006
5/23/2006
5/23/2006
6/22/2006
2/6/2006
4/14/2006
000634
1/19/2006

RH Office Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Medications at Start of Encounter Disp Refills 60 0 CYMBALTA 30 MG CAP Sig - Route: 1 po qam for 1 week then bid thereafter - ORAL Class: Pharmacy 40 0 DILAUDID 2 MG TAB Sig - Route: take 1-2 by oral route every 4-6 hours as needed - ORAL 300.00 3 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Start 5/26/2006 End 6/25/2006
5/26/2006 2/27/2006
6/25/2006
000635
Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 2 1/19/2006 BACLOFEN 10 MG TAB (Discontinued) 90 Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 5/26/2006 CYMBALTA 60 MG CAP Sig - Route: 1 PO DAILY - ORAL 30 6 1/19/2006 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 250 0/0 3/24/2006 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking/Discontinued) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 250 0/0 5/23/2006 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 0 2/6/2006 250 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy 250 1 6/6/2006 NORCO 10 MG-325 MG TAB Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy 90 0 5/23/2006 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy
4/18/2006
11/22/2006
5/23/2006
6/22/2006
4/14/2006
7/6/2006
6/22/2006
Allergies
Problem List
Noted Resolved
1/19/2006
000636
Allergies
Problem List
1/19/2006

RH MD Msg
Visit Information 6/8/2006 7:09 PM Provider Victor Baquero, MD, MD Department Relayhealth
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
000637
Medications at Start of Encounter Disp Refills Start 60 0 5/26/2006 CYMBALTA 30 MG CAP Sig - Route: 1 po qam for 1 week then bid thereafter - ORAL Class: Pharmacy 40 0 5/26/2006 DILAUDID 2 MG TAB Sig - Route: take 1-2 by oral route every 4-6 hours as needed - ORAL 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 1/19/2006 BACLOFEN 10 MG TAB (Taking/Disco ntinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 5/26/2006 CYMBALTA 60 MG CAP Sig - Route: 1 PO DAILY - ORAL 30 6 1/19/2006 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 0/0 3/24/2006 250 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking/Discontinued) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 250 0/0 5/23/2006 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 250 0 2/6/2006 NORCO 10 MG-325 MG TAB (Taking/Discontinued) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy 250 1 6/6/2006 NORCO 10 MG-325 MG TAB Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy 90 0 5/23/2006 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy End 6/25/2006
6/25/2006
4/18/2006
11/22/2006
5/23/2006
6/22/2006
4/14/2006
7/6/2006
6/22/2006
Allergies
Problem List
000638
Medications
Ordered Medications
Disp Refills 120 0 METHADONE 10 MG TAB (Discontinued) take 1 tablet (10mg) by oral route every 6 hours as directed - ORAL Start 6/15/2006 End 6/29/2006

Disp Refills Start 60 0 5/26/2006 CYMBALTA 30 MG CAP Sig - Route: 1 po qam for 1 week then bid thereafter - ORAL Class: Pharmacy 40 0 5/26/2006 DILAUDID 2 MG TAB Sig - Route: take 1-2 by oral route every 4-6 hours as needed - ORAL 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 1/19/2006 BACLOFEN 10 MG TAB (Taking/Disco ntinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 5/26/2006 CYMBALTA 60 MG CAP Sig - Route: 1 PO DAILY - ORAL 30 6 1/19/2006 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 0/0 3/24/2006 250 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Discontinued) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 250 0/0 5/23/2006 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 250 0 2/6/2006 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy 250 1 6/6/2006 NORCO 10 MG-325 MG TAB Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy 90 0 5/23/2006 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy End 6/25/2006
6/25/2006
4/18/2006
11/22/2006
5/23/2006
6/22/2006
4/14/2006
7/6/2006
6/22/2006
000639
916-983-4484 (Work) Provider Victor Baquero, MD, MD Department Fol Family Practice
Encounter-Level Documents: There are no encounter-level documents. Insurance Information Acct Number 078080963065 1 Payor AUSHC Patient Insurance ID W142637665 Group Number 620229011 Plan AETNA PPO Plan Number A06 Plan Address PO BOX 14089 LEXINGTON, KY 40512-4089 Plan Phone 888-632-3862 PreAuth Phone 800-840-2925
Financial Class P
Center None
Patient Information

Telephone Encounter
6/21/2006 4:34 PM
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed >> SHERI L GROVES Wed Jun 21, 2006 4:34 PM Encounter initiated.
Created by
Approved
Disp Refills Start End 90 0 6/21/2006 7/19/2006 SOMA 350 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1 po tid - ORAL
000640
Class: Pharmacy Authorizing Provider: Victor Baquero, MD

Disp Refills 60 0 CYMBALTA 30 MG CAP Sig - Route: 1 po qam for 1 week then bid thereafter - ORAL Class: Pharmacy 40 0 DILAUDID 2 MG TAB Sig - Route: take 1-2 by oral route every 4-6 hours as needed - ORAL 300.00 3 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 BACLOFEN 10 MG TAB (Taking/Discontinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 CYMBALTA 60 MG CAP Sig - Route: 1 PO DAILY - ORAL 30 6 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 0 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 250 0/0 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 120 0 METHADONE 10 MG TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route every 6 hours as directed - ORAL 250 1 NORCO 10 MG-325 MG TAB Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy 90 0 SOMA 350 MG TAB (Discontinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy Start 5/26/2006 End 6/25/2006
5/26/2006 2/27/2006
6/25/2006
1/19/2006
4/18/2006
5/26/2006 1/19/2006
11/22/2006
2/24/2006
5/23/2006
6/22/2006
6/15/2006 6/6/2006
7/15/2006 7/6/2006
5/23/2006
6/21/2006

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
000641
RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Ordered Medications Disp Refills 1 250 NORCO 10 MG-325 MG TAB (Discontinued) 1-2 po q 6 hours. Max 8 per day. - ORAL 0 180 METHADONE 10 MG TAB (Discontinued) take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL Discontinued Medications Reason for Discontinue NORCO 10 MG-325 MG TAB METHADONE 10 MG TAB Medications at Start of Encounter Disp Refills Start 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 1/19/2006 BACLOFEN 10 MG TAB (Taking/Disco ntinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 5/26/2006 CYMBALTA 60 MG CAP Sig - Route: 1 PO DAILY - ORAL 30 6 1/19/2006 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical End Start 6/29/2006 6/29/2006 End 7/19/2006 7/26/2006
4/18/2006
11/22/2006
000642
Route: ORAL 120 0 6/15/2006 METHADONE 10 MG TAB (Discontinued) Sig - Route: take 1 tablet (10mg) by oral route every 6 hours as directed - ORAL 1 6/6/2006 250 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy 90 0 6/21/2006 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Pharmacy Selected For Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630
6/29/2006
6/29/2006
7/21/2006
Allergies
Problem List
Noted Resolved
1/19/2006

Appointment
Account # 078080963065 Patient Demographics Address 2025 TARBOLTON CIR Phone 916-509-0158 (Home) E-mail Address mamundsen@sbcglobal.net
000643
Dr. Patient. Requesting norco ten days early. >> CORY O'DELL Wed Jul 19, 2006 8:15 AM Encounter initiated.
Created by
Approved
Disp Refills Start End 30 6 7/19/2006 1/18/2007 FLUOXETINE 40 MG CAP Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. Authorizing Provider: Victor Baquero, MD 90 0 7/19/2006 8/9/2006 SOMA 350 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1068605. Last date filled 06/22/06. Authorizing Provider: Victor Baquero, MD 250 1 7/19/2006 8/29/2006 NORCO 10 MG-325 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1069118. Last date filled 06/29/06. Authorizing Provider: Victor Baquero, MD

Disp Refills 300.00 3 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 2 90 BACLOFEN 10 MG TAB (Taking/Discontinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 CYMBALTA 60 MG CAP Sig - Route: 1 PO DAILY - ORAL 30 6 FLUOXETINE 40 MG CAP (Discontinued) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 0 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 180 0 METHADONE 10 MG TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 250 1 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy 90 0 SOMA 350 MG TAB (Discontinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy Start 2/27/2006 End
1/19/2006
4/18/2006
5/26/2006 1/19/2006
11/22/2006 7/19/2006
2/24/2006
6/29/2006 6/29/2006
7/29/2006 7/19/2006
6/21/2006
7/19/2006

RH Office Msg
Visit Information
000644
RH MD Msg
Visit Information 7/20/2006 11:21 AM Provider Victor Baquero, MD, MD Department Relayhealth
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Discontinued Medications Reason for Discontinue CYMBALTA 60 MG CAP Medications at Start of Encounter
Disp Refills Start End 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 1/19/2006 4/18/2006 BACLOFEN 10 MG TAB (Taking/Disco ntinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 6 5/26/2006 7/21/2006 CYMBALTA 60 MG CAP (Discontinued) 30 Sig - Route: 1 PO DAILY - ORAL 30 6 7/19/2006 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 180 0 6/29/2006 7/29/2006 METHADONE 10 MG TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 250 1 7/19/2006 8/18/2006 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL
000645
Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1069118. Last date filled 06/29/06. 90 0 7/19/2006 8/18/2006 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1068605. Last date filled 06/22/06.
Allergies
Problem List
1/19/2006

Patient Information

Telephone Encounter
7/19/2006 8:12 AM
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed >> JULIE STEWART Thu Jul 20, 2006 11:15 AM Patient request refills go to Costco, Folsom >> CORY O'DELL Wed Jul 19, 2006 9:53 AM
000646
FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 180 0 7/26/2006 8/25/2006 METHADONE 10 MG TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 250 1 7/19/2006 8/18/2006 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1069118. Last date filled 06/29/06. 0 7/19/2006 8/9/2006 90 SOMA 350 MG TAB (Discontinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1068605. Last date filled 06/22/06.

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Ordered Medications Disp Refills 180 0 METHADONE 10 MG TAB (Discontinued) take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL Discontinued Medications Reason for Discontinue METHADONE 10 MG TAB Medications at Start of Encounter
Disp 300.00 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Refills 3 Start 2/27/2006 End
Start 7/26/2006
End 8/17/2006
000647
Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 1/19/2006 4/18/2006 BACLOFEN 10 MG TAB (Taking/Disco ntinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 7/19/2006 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 180 0 6/29/2006 7/26/2006 METHADONE 10 MG TAB (Discontinued) Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 250 1 7/19/2006 8/18/2006 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1069118. Last date filled 06/29/06. 90 0 7/19/2006 8/18/2006 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1068605. Last date filled 06/22/06.
Allergies
Problem List
1/19/2006

000648
1/19/2006

Patient Information

Telephone Encounter
8/9/2006 2:18 PM
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed >> SHERI L GROVES Wed Aug 9, 2006 2:19 PM Encounter initiated.
Created by
Approved
Disp Refills Start End 90 0 8/9/2006 8/29/2006 SOMA 350 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 172531. Authorizing Provider: Victor Baquero, MD

Disp Refills 300.00 3 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 BACLOFEN 10 MG TAB (Taking/Discontinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 Start 2/27/2006 End
1/19/2006
4/18/2006
7/19/2006
000649
Disp Refills Start End 90 0 8/29/2006 9/20/2006 SOMA 350 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 174296 Authorizing Provider: Victor Baquero, MD 250 1 8/29/2006 9/18/2006 NORCO 10 MG-325 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 172532. Authorizing Provider: Victor Baquero, MD

Disp Refills Start End 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 2 1/19/2006 4/18/2006 90 BACLOFEN 10 MG TAB (Taking/Discontinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 7/19/2006 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 180 0 8/17/2006 9/16/2006 METHADONE 10 MG TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 250 1 7/19/2006 8/29/2006 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1069118. Last date filled 06/29/06. 90 0 8/9/2006 8/29/2006 SOMA 350 MG TAB (Discontinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 172531.

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
000650
Medications
Ordered Medications
METHADONE 10 MG TAB Medications at Start of Encounter Disp Refills Start End 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 1/19/2006 4/18/2006 BACLOFEN 10 MG TAB (Taking/Disco ntinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 7/19/2006 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 0 7/26/2006 8/17/2006 180 METHADONE 10 MG TAB (Discontinued) Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 250 1 7/19/2006 8/18/2006 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1069118. Last date filled 06/29/06. 90 0 8/9/2006 9/8/2006 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 172531.
Allergies
Problem List
000651

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Ordered Medications Disp Refills 180 0 METHADONE 10 MG TAB (Discontinued) take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL Discontinued Medications Reason for Discontinue METHADONE 10 MG TAB Medications at Start of Encounter Disp Refills Start End 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 1/19/2006 4/18/2006 BACLOFEN 10 MG TAB (Taking/Disco ntinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 7/19/2006 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 180 0 8/17/2006 9/11/2006 METHADONE 10 MG Start 9/11/2006 End 10/2/2006
000652
TAB (Discontinued) Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 250 1 8/29/2006 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 172532. 90 0 8/29/2006 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 174296
9/28/2006
9/28/2006
Allergies
Problem List
1/19/2006

Patient Information

Telephone Encounter
8/29/2006 9:44 AM
Reason for Call

Refill Request
Created by
Approved
000653
250 1 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 0 90 SOMA 350 MG TAB (Discontinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 174296
9/18/2006
10/18/2006
8/29/2006
9/20/2006

DOB 9/23/1959
Telephone Encounter
Reason for Call

Refill Request
Created by
Approved
Disp Refills Start End 250 1 9/18/2006 10/5/2006 NORCO 10 MG-325 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Authorizing Provider: Victor Baquero, MD

Disp Refills Start End 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 1/19/2006 4/18/2006 BACLOFEN 10 MG TAB (Taking/Discontinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 7/19/2006 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 180 0 9/11/2006 10/11/2006 METHADONE 10 MG TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 250 1 8/29/2006 9/18/2006 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 172532. 90 0 8/29/2006 9/28/2006 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 174296
000654
1/19/2006

Patient Information

Telephone Encounter
9/20/2006 11:51 AM
Reason for Call

Refill Request
Created by
Approved
Disp Refills Start End 90 0 9/20/2006 10/5/2006 SOMA 350 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 Authorizing Provider: Victor Baquero, MD

Disp Refills Start End 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 1/19/2006 4/18/2006 BACLOFEN 10 MG TAB (Taking/Discontinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 7/19/2006 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 180 0 9/11/2006 10/11/2006 METHADONE 10 MG TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL
000655
Medications
Ordered Medications
METHADONE 10 MG TAB Medications at Start of Encounter Disp Refills Start End 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 1/19/2006 4/18/2006 BACLOFEN 10 MG TAB (Taking/Disco ntinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 7/19/2006 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 0 9/11/2006 10/2/2006 180 METHADONE 10 MG TAB (Discontinued) Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 250 1 9/18/2006 10/18/2006 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 0 9/20/2006 10/20/2006 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
Allergies
Problem List
000656
10/12/2006 3:17 PM
Appointment
Encounter-Level Documents: There are no encounter-level documents. Insurance Information Acct Number 078080963107 1 Payor SELF Patient Insurance ID NA Plan SELF PAY Plan Number 100 Financial Class T
Center None
RH MD Msg
Patient Information Patient Name
MRN
Sex
DOB
PATIENTPHONE
000657
Amundsen, Mark
8081369
Male
9/23/1959
916-509-0158
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills Start End 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 1/19/2006 4/18/2006 BACLOFEN 10 MG TAB (Taking/Disco ntinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 7/19/2006 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 180 0 10/2/2006 11/1/2006 METHADONE 10 MG TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 1 9/18/2006 10/5/2006 250 NORCO 10 MG-325 MG TAB (Taking/Discontinued) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 0 9/20/2006 10/5/2006 SOMA 350 MG TAB (Taking/Disco ntinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
Allergies
Problem List
000658
ENTHESOPATHY OF HIP
1/19/2006

Encounter Closed By Closed By BAQUERO, VICTOR H Closed Date 10272006 Closed Time 18:01 Mark Amundsen (MRN 8081369)
RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Ordered Medications
Discontinued Medications Reason for Discontinue METHADONE 10 MG TAB Medications at Start of Encounter Disp Refills Start 250 1 10/5/2006 NORCO 10 MG-325 MG TAB Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 177788 90 0 10/5/2006 SOMA 350 MG TAB Sig - Route: take 1 tabket 3 times a day - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1178084 End 11/4/2006
11/4/2006
000659
300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 1/19/2006 4/18/2006 BACLOFEN 10 MG TAB (Taking/Disco ntinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 7/19/2006 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 180 0 10/2/2006 10/23/2006 METHADONE 10 MG TAB (Discontinued) Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 1 9/18/2006 10/5/2006 250 NORCO 10 MG-325 MG TAB (Taking/Discontinued) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 0 9/20/2006 10/5/2006 SOMA 350 MG TAB (Taking/Disco ntinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
Allergies
Problem List
1/19/2006

Previous Visit
000660
Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
Allergies
Problem List
1/19/2006

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
000661
Medications
Medications at Start of Encounter Disp Refills Start End 250 1 10/5/2006 11/4/2006 NORCO 10 MG-325 MG TAB Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 177788 90 0 10/5/2006 11/4/2006 SOMA 350 MG TAB Sig - Route: take 1 tabket 3 times a day - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1178084 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 1/19/2006 4/18/2006 BACLOFEN 10 MG TAB (Taking/Disco ntinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 7/19/2006 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 240 0 10/23/2006 11/22/2006 METHADONE 10 MG TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 250 1 9/18/2006 10/5/2006 NORCO 10 MG-325 MG TAB (Taking/Discontinued) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 300 1 10/27/2006 11/26/2006 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 0 9/20/2006 10/5/2006 SOMA 350 MG TAB (Taking/Disco ntinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 90 3 10/27/2006 11/26/2006 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
Allergies
Allergies
000662
90 3 10/27/2006 SOMA 350 MG TAB (Discontinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 Pharmacy Selected For Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630
11/16/2006
Allergies
Problem List
1/19/2006

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
000663
Medications
Ordered Medications
METHADONE 10 MG TAB Medications at Start of Encounter Disp Refills Start End 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 1/19/2006 4/18/2006 BACLOFEN 10 MG TAB (Taking/Disco ntinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 7/19/2006 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 240 0 10/23/2006 11/14/2006 METHADONE 10 MG TAB (Discontinued) Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 250 1 9/18/2006 10/5/2006 NORCO 10 MG-325 MG TAB (Taking/Discontinued) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 300 1 10/27/2006 11/26/2006 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 0 9/20/2006 10/5/2006 SOMA 350 MG TAB (Taking/Disco ntinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 90 3 10/27/2006 11/26/2006 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL
000664
Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 Pharmacy Selected For Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630
Allergies
Problem List
1/19/2006

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
000665
Medications
Ordered Medications Disp Refills Start 3 11/16/2006 90 SOMA 350 MG TAB (Discontinued) 1 po tid - ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176027 1 11/16/2006 300 NORCO 10 MG-325 MG TAB (Discontinued) 1-2 po q 6 hours. Max 8 per day. - ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Discontinued Medications Reason for Discontinue SOMA 350 MG TAB NORCO 10 MG-325 MG TAB Medications at Start of Encounter Disp Refills Start End 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 1/19/2006 4/18/2006 BACLOFEN 10 MG TAB (Taking/Disco ntinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 7/19/2006 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 240 0 11/14/2006 12/14/2006 METHADONE 10 MG TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 250 1 9/18/2006 10/5/2006 NORCO 10 MG-325 MG TAB (Taking/Discontinued) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 300 1 10/27/2006 11/16/2006 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 0 9/20/2006 10/5/2006 SOMA 350 MG TAB (Taking/Disco ntinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 End 12/8/2006
12/6/2006
000666
Medications
Ordered Medications Disp Refills Start 240 0 12/6/2006 METHADONE 10 MG TAB (Discontinued) take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 1 12/6/2006 NORCO 10 MG-325 MG TAB (Discontinued) 1-2 po q 4 hours. Max 10 per day. - ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Discontinued Medications Reason for Discontinue METHADONE 10 MG TAB NORCO 10 MG-325 MG TAB Medications at Start of Encounter Disp Refills Start End 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 1/19/2006 4/18/2006 BACLOFEN 10 MG TAB (Taking/Disco ntinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 7/19/2006 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 240 0 11/14/2006 12/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 250 1 9/18/2006 10/5/2006 NORCO 10 MG-325 MG TAB (Taking/Discontinued) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 300 1 11/16/2006 12/6/2006 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 0 9/20/2006 10/5/2006 90 SOMA 350 MG TAB (Taking/Disco ntinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 90 3 11/16/2006 12/16/2006 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL End 12/28/2006 12/28/2006
000667
Pharmacy Selected For Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630
Allergies
Problem List
1/19/2006

Patient Information

Telephone Encounter
12/8/2006 3:53 PM
Reason for Call

Refill Request
Created by
Approved

000668
0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 2 1/19/2006 4/18/2006 90 BACLOFEN 10 MG TAB (Taking/Discontinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 7/19/2006 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 240 0 12/6/2006 1/5/2007 METHADONE 10 MG TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 1 9/18/2006 10/5/2006 250 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 300 1 12/6/2006 1/5/2007 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1-2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 0 9/20/2006 10/5/2006 90 SOMA 350 MG TAB (Discontinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 90 3 11/16/2006 12/8/2006 SOMA 350 MG TAB (Discontinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
000669
Appointment
Sex Male

DOB 9/23/1959
Account # 078199740016 Patient Demographics Address 2025 TARBOLTON CIR FOLSOM CA 95630 Selected Appointment 1/16/2007 2:54 PM Department Ucd Pre-Reg Phone 916-509-0158 (Home) 916-983-4484 (Work) E-mail Address mamundsen@sbcglobal.net
Payor SELF Patient Insurance ID NA Plan SELF PAY Plan Number 100 Financial Class T
Center None
RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Patient Demographics
000670
Address 2025 TARBOLTON CIR FOLSOM CA 95630
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Ordered Medications Disp Refills Start 300 1 12/28/2006 NORCO 10 MG-325 MG TAB (Discontinued) 2 po q 4 hours. Max 10 per day. - ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176026 0 12/28/2006 240 METHADONE 10 MG TAB (Discontinued) Take 2 po every 6 hours (max 8 daily) - ORAL Discontinued Medications
End 1/18/2007
1/18/2007
NORCO 10 MG-325 MG TAB METHADONE 10 MG TAB Medications at Start of Encounter

Disp Refills Start End 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 1/19/2006 4/18/2006 BACLOFEN 10 MG TAB (Taking/Disco ntinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 7/19/2006 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 240 0 12/6/2006 12/28/2006 METHADONE 10 MG TAB (Discontinued) Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 1 12/6/2006 12/28/2006 300 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: 1-2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 12/8/2006 1/7/2007 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
000671
BACKACHE NOS
1/19/2006

Department Ucd Pre-Reg Encounter # 15859090
RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Medications at Start of Encounter Disp Refills Start 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. End
000672
30 6 7/19/2006 FLUOXETINE 40 MG CAP Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB Class: Historical Route: ORAL 250 0/0 5/23/2006 6/22/2006 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 240 0 11/14/2006 12/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 240 0 12/28/2006 1/27/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 300 1 12/28/2006 1/27/2007 NORCO 10 MG-325 MG TAB Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 12/8/2006 1/7/2007 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
Allergies
Problem List
1/19/2006

000673
Fentanyl, dilaudid.
1/19/2006

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Ordered Medications Disp Refills Start End 300 1 1/18/2007 2/6/2007 NORCO 10 MG-325 MG TAB (Discontinued) 2 po q 4 hours. Max 10 per day. - ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176026 240 0 1/18/2007 2/6/2007 METHADONE 10 MG TAB (Discontinued) Take 2 po every 6 hours (max 8 daily) - ORAL 90 3 1/18/2007 2/6/2007 SOMA 350 MG TAB (Discontinued) 1 po tid - ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176027 30 6 1/18/2007 2/27/2007 FLUOXETINE 40 MG CAP (Discontinued) take 1 capsule (40mg) by oral route once daily in the morning - ORAL Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954.
000674
Last date filled 06/26/2006. Discontinued Medications Reason for Discontinue NORCO 10 MG-325 MG TAB METHADONE 10 MG TAB SOMA 350 MG TAB FLUOXETINE 40 MG CAP Medications at Start of Encounter Disp Refills Start End 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 1/19/2006 4/18/2006 BACLOFEN 10 MG TAB (Taking/Disco ntinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 7/19/2006 1/18/2007 FLUOXETINE 40 MG CAP (Discontinued) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 0 12/28/2006 1/18/2007 240 METHADONE 10 MG TAB (Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 1 12/28/2006 1/18/2007 300 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 12/8/2006 1/18/2007 SOMA 350 MG TAB (Discontinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 Pharmacy Selected For Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630
Allergies
Problem List
000675
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills Start End 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 1/19/2006 4/18/2006 BACLOFEN 10 MG TAB (Taking/Disco ntinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 1/18/2007 8/18/2007 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 240 0 1/18/2007 2/17/2007 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 300 1 1/18/2007 2/17/2007 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 1/18/2007 2/17/2007 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
Allergies
Problem List
Noted Resolved
low back pain - chronic. Tried Methadone, Hydrocodone, Baclofen, Soma, Oxycodone, Tramadol, Toradol, MSContin,
000676
RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Ordered Medications METHADONE 10 MG TAB (Discontinued) Take 2 po every 6 hours (max 8 daily) - ORAL Discontinued Medications
Reason for Discontinue Disp 240 Refills 0 Start 2/9/2007 End 2/14/2007
METHADONE 10 MG TAB Medications at Start of Encounter

Disp Refills Start End 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 1/19/2006 4/18/2006 BACLOFEN 10 MG TAB (Taking/Disco ntinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 1/18/2007 8/18/2007 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL
000677
240 0 1/18/2007 METHADONE 10 MG TAB (Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 300 1 1/18/2007 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 1/18/2007 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
2/6/2007
2/17/2007
2/17/2007
Allergies
Problem List
1/19/2006

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
000678
Patient Information

Telephone Encounter
2/6/2007 12:57 PM
Reason for Call

Refill Request
Created by
Approved
Disp Refills Start End 90 3 2/9/2007 2/27/2007 SOMA 350 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 Authorizing Provider: Victor Baquero, MD 300 1 2/9/2007 2/27/2007 NORCO 10 MG-325 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Authorizing Provider: Victor Baquero, MD

Disp Refills Start End 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 2 1/19/2006 4/18/2006 90 BACLOFEN 10 MG TAB (Taking/Discontinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 1/18/2007 8/18/2007 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 240 0 1/18/2007 2/6/2007 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 240 0 2/9/2007 3/11/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 300 1 1/18/2007 2/6/2007 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 3 1/18/2007 2/6/2007 90 SOMA 350 MG TAB (Discontinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027

000679
2/20/2007 8:53 AM
Ucd Pre-Reg
16279633
Patient Information

Telephone Encounter
2/27/2007 10:24 AM
Reason for Call

Refill Request
Created by
Approved
Disp Refills Start End 90 3 2/27/2007 3/22/2007 SOMA 350 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 Authorizing Provider: Victor Baquero, MD 300 1 2/27/2007 3/22/2007 NORCO 10 MG-325 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Authorizing Provider: Victor Baquero, MD 30 6 2/27/2007 3/22/2007 FLUOXETINE 40 MG CAP Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. Authorizing Provider: Victor Baquero, MD

Disp Refills Start End 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 30 6 1/18/2007 2/27/2007 FLUOXETINE 40 MG CAP (Discontinued) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 240 0 2/9/2007 2/14/2007 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 300 1 2/9/2007 2/27/2007 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 2/9/2007 2/27/2007 SOMA 350 MG TAB (Discontinued) Sig - Route: 1 po tid - ORAL
000680
Problem List
1/19/2006

Previous Visit 2/20/2007 8:53 AM Department Ucd Pre-Reg Encounter # 16279633
RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Ordered Medications METHADONE 10 MG TAB (Discontinued) Take 2 po every 6 hours (max 8 daily) - ORAL Medications at Start of Encounter
000681
Disp Refills Start End 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 30 6 2/27/2007 9/27/2007 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 240 0 2/9/2007 2/14/2007 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 300 1 2/27/2007 3/29/2007 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 2/27/2007 3/29/2007 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
Allergies
Problem List
Noted Resolved
1/19/2006

Previous Visit
Department Encounter #
000682
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Ordered Medications METHADONE 10 MG TAB (Discontinued) Take 2 po every 6 hours (max 8 daily) - ORAL Discontinued Medications
Reason for Discontinue Disp 120 Refills 0 Start 3/24/2007 End 4/6/2007
METHADONE 10 MG TAB Medications at Start of Encounter Disp Refills Start End 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 30 6 2/27/2007 9/27/2007 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 240 0 2/9/2007 2/14/2007 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 0 3/2/2007 3/22/2007 240 METHADONE 10 MG TAB (Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 300 1 2/27/2007 3/29/2007 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 2/27/2007 3/29/2007 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
Allergies
000683
Plan UCD/B/S HMO
Financial Class P
Plan Number B72
Plan Phone 916-734-0739
Center None
Patient Information
Telephone Encounter
Reason for Call

Refill Request
Created by
Approved
SOMA 350 MG TAB
000684
Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 Authorizing Provider: Victor Baquero, MD 300 1 3/22/2007 3/29/2007 NORCO 10 MG-325 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Authorizing Provider: Victor Baquero, MD 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. Authorizing Provider: Victor Baquero, MD

Disp Refills Start End 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 30 6 2/27/2007 3/22/2007 FLUOXETINE 40 MG CAP (Discontinued) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 240 0 2/9/2007 2/14/2007 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 120 0 3/24/2007 4/7/2007 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 300 1 2/27/2007 3/22/2007 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 3 2/27/2007 3/22/2007 90 SOMA 350 MG TAB (Discontinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
000685
03/29/2007 3:35 PM
Phone (Incoming)
Amundsen, Mark (Self)
203-5604
Telephone Encounter
Reason for Call

Medication Problem
Call Documentation
Jasvir K Bhele 3/29/2007 3:37 PM Signed Pt states that phar has rx for Fluoxetine and Soma but not the Norco.Can you call it in and let pt know Electronically signed by Jasvir K Bhele at 3/29/2007 3:37 PM
Created by
Approved
Disp Refills Start End 300 1 3/29/2007 8/1/2007 NORCO 10 MG-325 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Authorizing Provider: Victor Baquero, MD

Disp Refills Start End 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 0 2/9/2007 2/14/2007 240 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 120 0 3/24/2007 4/7/2007 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 300 1 3/22/2007 3/29/2007 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 3/22/2007 4/21/2007 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027

Appointment
Orders
DOB 9/23/1959
000686
Class: Historical Route: ORAL 0 240 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 0 120 METHADONE 10 MG TAB (Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 300 1 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
2/9/2007 3/24/2007 3/29/2007
2/14/2007 4/6/2007 4/28/2007
3/22/2007
4/21/2007
Orders Chart Cosign

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills Start End 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal
000687
Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 0 2/9/2007 240 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 120 0 3/24/2007 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 300 1 3/29/2007 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 3/22/2007 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
2/14/2007
4/7/2007 4/28/2007
4/21/2007
Allergies
Problem List
1/19/2006

Patient Information

Contacts
Type Contact Phone
000688


Patient Information
Closed Time 14:32

Contacts
04/06/2007 3:46 PM Type Phone (Incoming) Contact Amundsen, Mark (Self) Phone 916-983-2589 (H)
Telephone Encounter
4/6/2007 3:45 PM
Reason for Call

Refill Request
Call Documentation
Teri L Rhodewalt 4/6/2007 4:46 PM Signed Patient will pick up prescription Electronically signed by Teri L Rhodewalt at 4/6/2007 4:46 PM Victor Baquero, MD, MD 4/6/2007 4:44 PM Signed Triplicate written. Please notify patient. Electronically signed by Victor Baquero, MD at 4/6/2007 4:44 PM Julie Stewart 4/6/2007 4:27 PM Signed Patient stating he will be out of methadone tomorrow and needs rx today. Please call as soon as done. Electronically signed by Julie Stewart at 4/6/2007 4:27 PM
Created by
Approved
Disp Refills Start End 240 0 4/6/2007 4/20/2007 METHADONE 10 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL Class: Normal Authorizing Provider: Victor Baquero, MD

Disp Refills Start End 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking)
000689
Sig - Route: take 1 tablet (40mg) by oral route once daily - ORAL Class: Pharmacy 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 0 2/9/2007 2/14/2007 240 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 300 0 5/4/2007 6/3/2007 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical 300 1 3/29/2007 4/28/2007 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 3/22/2007 4/21/2007 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Medications at Start of Encounter Disp 30 Refills 2 Start 4/20/2007 End 6/20/2007
000690
CELEXA 40 MG TAB (Taking) Sig - Route: take 1 tablet (40mg) by oral route once daily - ORAL Class: Pharmacy 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 240 0 2/9/2007 2/14/2007 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 300 0 5/4/2007 6/3/2007 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical 300 1 3/29/2007 4/28/2007 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 3/22/2007 4/21/2007 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
Allergies
Problem List
1/19/2006
000691
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Medications at Start of Encounter Disp Refills Start End 30 2 4/20/2007 6/20/2007 CELEXA 40 MG TAB (Taking) Sig - Route: take 1 tablet (40mg) by oral route once daily - ORAL Class: Pharmacy 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 250 0/0 4/24/2007 5/24/2007 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 240 0 2/9/2007 2/14/2007 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 300 0 5/4/2007 6/3/2007 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical 300 1 3/29/2007 4/28/2007 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 3/22/2007 4/21/2007 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
000692
Allergies
Problem List
1/19/2006

Previous Visit 4/20/2007 8:32 AM Department Ucd Registration Encounter # 17032099
Patient Information

Contacts
04/24/2007 6:34 PM Type Phone (Incoming) Contact fax Phone
Telephone Encounter
4/24/2007 6:32 PM
Reason for Call

Refill Request
Created by
Approved
Disp Refills Start End 250 0/0 4/24/2007 5/18/2007 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 Authorizing Provider: Victor Baquero, MD

CELEXA 40 MG TAB (Taking)
000693
Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1-2 tablet by oral route every 4 hours as needed for pain, may take up to 10 daily. - ORAL Class: Pharmacy DAW: No Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 Authorizing Provider: Victor Baquero, MD 90 3 5/18/2007 8/24/2007 SOMA 350 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 Authorizing Provider: Victor Baquero, MD

Disp Refills Start End 30 2 4/20/2007 6/20/2007 CELEXA 40 MG TAB (Taking) Sig - Route: take 1 tablet (40mg) by oral route once daily - ORAL Class: Pharmacy 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 250 0/0 4/24/2007 5/18/2007 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Discontinued) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 0 2/9/2007 2/14/2007 240 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 300 0 5/4/2007 6/3/2007 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical 300 1 3/29/2007 4/28/2007 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 3/22/2007 5/18/2007 SOMA 350 MG TAB (Discontinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027

RH MD Msg
Patient Information
000694
RH Prov Init
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Medications at Start of Encounter Disp Refills Start End 30 2 4/20/2007 6/20/2007 CELEXA 40 MG TAB Sig - Route: take 1 tablet (40mg) by oral route once daily - ORAL Class: Pharmacy 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 300 0/0 5/18/2007 6/17/2007 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB Sig - Route: take 1-2 tablet by oral route every 4 hours as needed for pain, may take up to 10 daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB Class: Historical Route: ORAL 240 0 11/14/2006 12/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/4/2007 6/3/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL
000695
Class: Historical 300 1 3/29/2007 NORCO 10 MG-325 MG TAB Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 5/18/2007 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
4/28/2007
6/17/2007
Allergies
Problem List
1/19/2006

Patient Information

Telephone Encounter
5/18/2007 2:13 PM
Reason for Call

Refill Request
Created by
Approved
HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB
000696
RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Ordered Medications METHADONE 10 MG TAB (Discontinued) Take 2 po every 6 hours (max 10 daily) - ORAL Discontinued Medications Reason for Discontinue METHADONE 10 MG TAB Medications at Start of Encounter Disp Refills Start End 30 2 4/20/2007 6/20/2007 CELEXA 40 MG TAB (Taking) Sig - Route: take 1 tablet (40mg) by oral route once daily - ORAL Class: Pharmacy 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 300 0/0 5/18/2007 6/17/2007 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking) Sig - Route: take 1-2 tablet by oral route every 4 hours as needed for pain, may take up to 10 daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 0 10/27/2006 ALEVE 220 MG TAB (Taking)
000697
Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 240 0 2/9/2007 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 0 5/4/2007 300 METHADONE 10 MG TAB (Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical 300 1 3/29/2007 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 5/18/2007 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
2/14/2007
5/31/2007
4/28/2007
6/17/2007
Allergies
Problem List
1/19/2006

000698
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills Start End 30 2 4/20/2007 6/20/2007 CELEXA 40 MG TAB Sig - Route: take 1 tablet (40mg) by oral route once daily - ORAL Class: Pharmacy 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 300 0/0 5/18/2007 6/17/2007 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB Sig - Route: take 1-2 tablet by oral route every 4 hours as needed for pain, may take up to 10 daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB Class: Historical Route: ORAL 240 0 11/14/2006 12/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 6/30/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 3/29/2007 4/28/2007 NORCO 10 MG-325 MG TAB Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 5/18/2007 6/17/2007 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
Allergies
000699
Problem List
1/19/2006

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills 30 2 CELEXA 40 MG TAB Sig - Route: take 1 tablet (40mg) by oral route once daily - ORAL Class: Pharmacy 30 6 FLUOXETINE 40 MG CAP Start 4/20/2007 End 6/20/2007
3/22/2007
10/20/2007
000700
Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 300 0/0 5/18/2007 6/17/2007 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB Sig - Route: take 1-2 tablet by oral route every 4 hours as needed for pain, may take up to 10 daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB Class: Historical Route: ORAL 240 0 11/14/2006 12/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 6/30/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 3/29/2007 4/28/2007 NORCO 10 MG-325 MG TAB Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 5/18/2007 6/17/2007 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
Allergies
Problem List
1/19/2006
000701
Created by

Disp Refills Start End 30 2 4/20/2007 6/20/2007 CELEXA 40 MG TAB (Taking) Sig - Route: take 1 tablet (40mg) by oral route once daily - ORAL Class: Pharmacy 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 300 0/0 5/18/2007 6/17/2007 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking) Sig - Route: take 1-2 tablet by oral route every 4 hours as needed for pain, may take up to 10 daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 0 2/9/2007 2/14/2007 240 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 0 5/4/2007 5/31/2007 300 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical 300 1 3/29/2007 4/28/2007 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 5/18/2007 6/17/2007 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027

Orders Chart Cosign

RH Office Msg
MRN 8081369
Sex Male
DOB 9/23/1959
000702
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Medications at Start of Encounter Disp Refills Start End 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB Class: Historical Route: ORAL 240 0 11/14/2006 12/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 6/30/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 6/22/2007 7/22/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 3/29/2007 4/28/2007 NORCO 10 MG-325 MG TAB Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 250 1 6/13/2007 7/13/2007 NORCO 10 MG-325 MG TAB Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 201184. Last date filled 09/23/1959 90 3 5/18/2007 6/17/2007 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
Allergies
Allergies
000703
FENTANYL; MORPHINE
Problem List
1/19/2006

Patient Information

Telephone Encounter
6/13/2007 9:20 AM
Reason for Call

Refill Request
Created by
Approved
Disp Refills Start End 250 1 6/13/2007 8/1/2007 NORCO 10 MG-325 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 201184. Last date filled 09/23/1959 Authorizing Provider: Victor Baquero, MD

Disp Refills Start End 30 2 4/20/2007 6/20/2007 CELEXA 40 MG TAB (Taking) Sig - Route: take 1 tablet (40mg) by oral route once daily - ORAL Class: Pharmacy 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006.
000704
NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 250 1 6/13/2007 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 201184. Last date filled 09/23/1959 90 3 5/18/2007 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
7/13/2007
6/17/2007

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Medications at Start of Encounter Disp Refills Start End 30 2 4/20/2007 6/20/2007 CELEXA 40 MG TAB (Taking) Sig - Route: take 1 tablet (40mg) by oral route once daily - ORAL Class: Pharmacy 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 300 0/0 5/18/2007 6/17/2007 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking) Sig - Route: take 1-2 tablet by oral route every 4 hours as needed for pain, may take up to 10 daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical
000705
300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 0 2/9/2007 2/14/2007 240 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 300 0 5/4/2007 5/31/2007 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical 300 0 6/22/2007 7/22/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 3/29/2007 4/28/2007 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 250 1 6/13/2007 7/13/2007 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 201184. Last date filled 09/23/1959 90 3 5/18/2007 6/17/2007 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
Allergies
Problem List
1/19/2006

Previous Visit
000706

Disp Refills Start End 30 2 4/20/2007 6/20/2007 CELEXA 40 MG TAB (Taking) Sig - Route: take 1 tablet (40mg) by oral route once daily - ORAL Class: Pharmacy 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 300 0/0 5/18/2007 6/17/2007 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking) Sig - Route: take 1-2 tablet by oral route every 4 hours as needed for pain, may take up to 10 daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 240 0 2/9/2007 2/14/2007 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 300 0 5/4/2007 5/31/2007 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical 300 0 7/16/2007 8/15/2007 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical 1 3/29/2007 8/1/2007 300 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 250 1 8/1/2007 8/1/2007 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 201184. Last date filled 09/23/1959 90 3 5/18/2007 6/17/2007 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027

DOB 9/23/1959
Telephone Encounter
8/1/2007 8:32 AM
Reason for Call

Refill Request
Created by
000707
Electronically signed by Cherry Mendoza at 7/18/2007 2:03 PM

Created by

Disp Refills Start End 30 2 4/20/2007 6/20/2007 CELEXA 40 MG TAB (Taking) Sig - Route: take 1 tablet (40mg) by oral route once daily - ORAL Class: Pharmacy 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 300 0/0 5/18/2007 6/17/2007 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking) Sig - Route: take 1-2 tablet by oral route every 4 hours as needed for pain, may take up to 10 daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 0 2/9/2007 2/14/2007 240 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 0 5/4/2007 5/31/2007 300 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical 300 0 7/16/2007 8/15/2007 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical 300 1 3/29/2007 4/28/2007 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 250 1 6/13/2007 7/13/2007 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 201184. Last date filled 09/23/1959 90 3 5/18/2007 6/17/2007 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
Orders Chart Cosign

Patient Information

Contacts
07/16/2007 11:07 AM Type Phone (Incoming) Contact Amundsen, Mark (Self) Phone 916-983-2589 (H)
000708
MD
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills Start End 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB Class: Historical Route: ORAL 240 0 11/14/2006 12/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 6/30/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 7/16/2007 8/15/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical 300 1 3/29/2007 4/28/2007 NORCO 10 MG-325 MG TAB Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 250 1 6/13/2007 7/13/2007 NORCO 10 MG-325 MG TAB Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 201184. Last date filled 09/23/1959 90 3 5/18/2007 6/17/2007 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy
000709
Allergies
Problem List
1/19/2006

Patient Information

Telephone Encounter
7/18/2007 1:52 PM
Call Documentation
Cherry Mendoza 7/18/2007 2:03 PM Signed ----- Message # 1 ----From: Amundsen,Mark Sent: 07/15/2007 1:17 PM Hi Dr BaqueroI am currently out of Methadone, due to some stomach issues last week. The stomach issues have mostly subsided, but as a result, I lost a few days worth of Methadone. If you could write a prescription ASAP on Monday, I would really appreciate it. The stomach issues are very similar to the ones I have a few months ago - however, I do not currently have the money to perform the blood tests, so I guess I will have to wait on that- I atill have the form for it, however. Thanks for all your help. Mark Amundsen
000710
Approved
Disp Refills Start End 250 1 8/1/2007 8/1/2007 NORCO 10 MG-325 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 201184. Last date filled 09/23/1959 Authorizing Provider: Victor Baquero, MD

Disp Refills Start End 30 2 4/20/2007 6/20/2007 CELEXA 40 MG TAB (Taking) Sig - Route: take 1 tablet (40mg) by oral route once daily - ORAL Class: Pharmacy 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 300 0/0 5/18/2007 6/17/2007 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking) Sig - Route: take 1-2 tablet by oral route every 4 hours as needed for pain, may take up to 10 daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 0 2/9/2007 2/14/2007 240 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 300 0 5/4/2007 5/31/2007 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical 300 0 7/16/2007 8/15/2007 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical 300 1 3/29/2007 4/28/2007 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 250 1 6/13/2007 8/1/2007 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 201184. Last date filled 09/23/1959 90 3 5/18/2007 6/17/2007 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027

RH MD Msg
Visit Information 7/31/2007 6:06 PM Provider Victor Baquero, MD, Department Relayhealth
000711
Patient Information
Telephone Encounter
8/7/2007 8:27 AM
Reason for Call

Refill Request
Call Documentation
Cherry Mendoza 8/8/2007 8:29 AM Signed Note transferred to Relay Health. Electronically signed by Cherry Mendoza at 8/8/2007 8:29 AM Victor Baquero, MD, MD 8/7/2007 5:35 PM Signed Triplicate written. Please notify patient.
Electronically signed by Victor Baquero, MD at 8/7/2007 5:35 PM
Created by
Approved

Disp Refills Start End 30 2 4/20/2007 6/20/2007 CELEXA 40 MG TAB (Taking) Sig - Route: take 1 tablet (40mg) by oral route once daily - ORAL Class: Pharmacy 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 300 0/0 5/18/2007 6/17/2007 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking) Sig - Route: take 1-2 tablet by oral route every 4 hours as needed for pain, may take up to 10 daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL
000712
240 0 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 0 300 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical 300 0 METHADONE 10 MG TAB (Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical 300 1 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
2/9/2007 5/4/2007
2/14/2007 5/31/2007
7/16/2007
8/7/2007
8/1/2007
8/31/2007
5/18/2007
6/17/2007
Orders Chart Cosign

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills Start End 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG)
000713
TRANSDERMAL PACKET Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB Class: Historical Route: ORAL 240 0 11/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 8/7/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 8/1/2007 NORCO 10 MG-325 MG TAB Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 5/18/2007 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
12/14/2006 6/30/2007 9/6/2007 8/31/2007
6/17/2007
Allergies
Problem List
1/19/2006

Patient Information

000714
Disp Refills Start End 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB Class: Historical Route: ORAL 240 0 11/14/2006 12/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 6/30/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 8/7/2007 9/6/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 8/1/2007 8/31/2007 NORCO 10 MG-325 MG TAB Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 5/18/2007 6/17/2007 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
Allergies
Problem List
1/19/2006
000715
Problem List
1/19/2006

Patient Information

Telephone Encounter
8/24/2007 12:06 PM
Reason for Call

Refill Request
Created by
Approved

Disp Refills 30 2 CELEXA 40 MG TAB (Taking) Sig - Route: take 1 tablet (40mg) by oral route once daily - ORAL Class: Pharmacy 30 6 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Start 4/20/2007 End 6/20/2007
3/22/2007
10/20/2007
000716
Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 300 0/0 5/18/2007 6/17/2007 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking) Sig - Route: take 1-2 tablet by oral route every 4 hours as needed for pain, may take up to 10 daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 0 2/9/2007 2/14/2007 240 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 0 5/4/2007 5/31/2007 300 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical 300 0 8/7/2007 9/6/2007 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 8/1/2007 8/31/2007 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 5/18/2007 8/24/2007 SOMA 350 MG TAB (Discontinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027

RH Prov Init
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
000717
8/29/2007 5:43 PM
Department Relayhealth
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Medications at Start of Encounter Disp Refills Start End 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB Class: Historical Route: ORAL 240 0 11/14/2006 12/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 6/30/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 8/7/2007 9/6/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 8/1/2007 8/31/2007 NORCO 10 MG-325 MG TAB Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 8/24/2007 9/23/2007 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
Allergies
000718
Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 0 240 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 0 300 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical 300 0 METHADONE 10 MG TAB (Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 1 300 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
2/27/2006
2/24/2006
2/9/2007 5/4/2007
2/14/2007 5/31/2007
9/28/2007 8/1/2007
9/18/2007 9/18/2007
9/14/2007
10/14/2007

Orders Chart Cosign

Accepted By Victor Baquero, MD Accepted On 9/18/2007 2:12 PM Mark Amundsen (MRN8081369)
Patient Information
Telephone Encounter
9/14/2007 5:22 PM
Reason for Call

Refill Request
Created by
Approved
Disp Refills Start End 90 3 9/14/2007 10/10/2007 SOMA 350 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 Authorizing Provider: Victor Baquero, MD 300 0 9/28/2007 9/18/2007 METHADONE 10 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Normal Authorizing Provider: Victor Baquero, MD
000719
Disp Refills Start End 30 2 4/20/2007 6/20/2007 CELEXA 40 MG TAB (Taking) Sig - Route: take 1 tablet (40mg) by oral route once daily - ORAL Class: Pharmacy 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 300 0/0 5/18/2007 6/17/2007 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking) Sig - Route: take 1-2 tablet by oral route every 4 hours as needed for pain, may take up to 10 daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 240 0 2/9/2007 2/14/2007 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 300 0 5/4/2007 5/31/2007 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical 0 8/30/2007 9/14/2007 300 METHADONE 10 MG TAB (Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 8/1/2007 8/31/2007 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 3 8/24/2007 9/14/2007 90 SOMA 350 MG TAB (Discontinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
000720
Medications
Disp Refills Start End 30 2 4/20/2007 6/20/2007 CELEXA 40 MG TAB (Taking) Sig - Route: take 1 tablet (40mg) by oral route once daily - ORAL Class: Pharmacy 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 300 0/0 5/18/2007 6/17/2007 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking) Sig - Route: take 1-2 tablet by oral route every 4 hours as needed for pain, may take up to 10 daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 0 2/9/2007 2/14/2007 240 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 0 5/4/2007 5/31/2007 300 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical 300 0 8/30/2007 9/29/2007 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 8/1/2007 8/31/2007 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 8/24/2007 9/23/2007 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
Allergies
Problem List
000721
Medications
Medications at Start of Encounter Disp Refills Start End 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB Class: Historical Route: ORAL 240 0 11/14/2006 12/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 6/30/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 9/18/2007 10/18/2007 NORCO 10 MG-325 MG TAB Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 9/14/2007 10/14/2007 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
Allergies
Problem List
Noted Resolved
1/19/2006
000722
BRACHIAL NEURITIS NOS ENTHESOPATHY OF HIP
1/19/2006

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills Start End 30 2 4/20/2007 6/20/2007 CELEXA 40 MG TAB (Taking) Sig - Route: take 1 tablet (40mg) by oral route once daily - ORAL Class: Pharmacy 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 300 0/0 5/18/2007 6/17/2007 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking) Sig - Route: take 1-2 tablet by oral route every 4 hours as needed for pain, may take up to 10 daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318
000723
0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 240 0 2/9/2007 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 0 5/4/2007 300 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical 300 1 9/18/2007 NORCO 10 MG-325 MG TAB (Taking/Discontinued) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 9/14/2007 SOMA 350 MG TAB (Taking/Disco ntinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
2/14/2007
5/31/2007
10/10/2007
10/10/2007
Allergies
Problem List
1/19/2006

Previous Visit Department Encounter #
000724
Amundsen, Mark
8081369
Male
9/23/1959
916-509-0158
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills Start 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB Class: Historical Route: ORAL 240 0 11/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 10/22/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 10/10/2007 NORCO 10 MG-325 MG TAB Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 10/10/2007 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 End
12/14/2006 6/30/2007 10/12/2007 11/9/2007
11/9/2007
Allergies
Problem List
Noted Resolved
TESTICULAR HYPOFUNC NEC
000725
Problem List
1/19/2006

Patient Information

Telephone Encounter
10/22/2007 8:27 AM
Reason for Call

Refill Request
Call Documentation
Cherry Mendoza 10/23/2007 9:36 AM Signed Note transferred to Relay Health. Electronically signed by Cherry Mendoza at 10/23/2007 9:36 AM Victor Baquero, MD, MD 10/22/2007 5:13 PM Signed Triplicate written. Please notify patient.
Created by
Approved

000726
30 2 4/20/2007 6/20/2007 CELEXA 40 MG TAB (Taking) Sig - Route: take 1 tablet (40mg) by oral route once daily - ORAL Class: Pharmacy 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 300 0/0 5/18/2007 6/17/2007 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking) Sig - Route: take 1-2 tablet by oral route every 4 hours as needed for pain, may take up to 10 daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 240 0 2/9/2007 2/14/2007 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 300 0 5/4/2007 5/31/2007 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical 300 1 9/18/2007 10/10/2007 NORCO 10 MG-325 MG TAB (Taking/Disco ntinued) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 300 1 10/10/2007 11/9/2007 NORCO 10 MG-325 MG TAB Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 9/14/2007 10/10/2007 SOMA 350 MG TAB (Taking/Discontinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 90 3 10/10/2007 11/9/2007 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
Orders Chart Cosign

RH MD Msg
MRN
Sex
DOB
PATIENTPHONE
000727

Visit Information 10/23/2007 9:42 AM Provider Victor Baquero, MD, MD Department Relayhealth Encounter # 19272467
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Medications at Start of Encounter Disp Refills Start 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB Class: Historical Route: ORAL 240 0 11/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 10/22/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 10/10/2007 NORCO 10 MG-325 MG TAB Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 10/10/2007 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 End
12/14/2006 6/30/2007 10/12/2007 11/9/2007
11/9/2007
Allergies
000728
Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB Class: Historical Route: ORAL 240 0 11/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 10/22/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 10/10/2007 NORCO 10 MG-325 MG TAB Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 10/10/2007 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
12/14/2006 6/30/2007 10/12/2007 11/9/2007
11/9/2007
Allergies
Problem List
1/19/2006

Previous Visit 4/20/2007 8:32 AM
RH Prov Init
000729
0 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 3 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET 300.00 Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 GLUCOSAMINE 1,000 MG TAB Class: Historical Route: ORAL
10/27/2006
2/27/2006
2/24/2006

DOB 9/23/1959
Telephone Encounter
11/16/2007 12:08 PM
Reason for Call

Refill Request
Call Documentation
Cherry Mendoza 11/16/2007 4:22 PM Signed Patient notified. Electronically signed by Cherry Mendoza at 11/16/2007 4:22 PM Victor Baquero, MD, MD 11/16/2007 2:44 PM Signed Triplicate written. Please notify patient.
Created by
Approved

Disp Refills Start End 30 2 4/20/2007 6/20/2007 CELEXA 40 MG TAB (Taking) Sig - Route: take 1 tablet (40mg) by oral route once daily - ORAL Class: Pharmacy 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 300 0/0 5/18/2007 6/17/2007 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking) Sig - Route: take 1-2 tablet by oral route every 4 hours as needed for pain, may take up to 10 daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical
000730
300.00 3 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 240 0 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 300 0 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical 0 300 METHADONE 10 MG TAB (Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 NORCO 10 MG-325 MG TAB (Taking/Disco ntinued) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 3 90 SOMA 350 MG TAB (Taking/Discontinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
2/27/2006
2/24/2006
2/9/2007 5/4/2007
2/14/2007 5/31/2007
10/22/2007 9/18/2007
11/16/2007 10/10/2007
9/14/2007
10/10/2007
Orders Chart Cosign

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills Start 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL End
000731
RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills Start 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB Class: Historical Route: ORAL 240 0 11/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 11/16/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 12/10/2007 NORCO 10 MG-325 MG TAB Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 10/10/2007 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL End
12/14/2006 6/30/2007 11/6/2007 1/9/2008
11/9/2007
000732
Allergies
Problem List
1/19/2006

Patient Information

Telephone Encounter
12/10/2007 4:15 PM
Reason for Call

Refill Request
Created by
Approved

000733
Victor Baquero, MD, MD 12/13/2007 12:42 PM Signed Triplicate written. Please notify patient.
Created by
Approved

Disp Refills 0 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 3 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET 300.00 Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 GLUCOSAMINE 1,000 MG TAB Class: Historical Route: ORAL 300 1 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Start 10/27/2006 End
2/27/2006
2/24/2006
12/10/2007
1/9/2008
Orders Chart Cosign

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
000734
Medications
12/14/2006 6/30/2007 12/3/2007 1/9/2008
11/9/2007
Allergies
Problem List
1/19/2006
000735
Call Documentation
Victor Baquero, MD, MD 1/9/2008 5:22 PM Signed Prescription called in already.

Created by

Disp Refills 0 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 3 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET 300.00 Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 GLUCOSAMINE 1,000 MG TAB Class: Historical Route: ORAL 300 0 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Start 10/27/2006 End
2/27/2006
2/24/2006
12/13/2007 1/7/2008
12/3/2007 2/6/2008

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills Start 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical End
000736
300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB Class: Historical Route: ORAL 240 0 11/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 12/13/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 1/7/2008 NORCO 10 MG-325 MG TAB Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 10/10/2007 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
12/14/2006 6/30/2007 12/3/2007 2/6/2008
11/9/2007
Allergies
Problem List
1/19/2006

Patient Information
Patient Name MRN Sex

DOB PATIENTPHONE
000737
Amundsen, Mark
8081369
Male
9/23/1959
916-509-0158
Telephone Encounter
1/7/2008 12:24 PM
Reason for Call

Refill Request
Created by
Approved

Disp Refills 0 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 3 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET 300.00 Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 GLUCOSAMINE 1,000 MG TAB Class: Historical Route: ORAL 300 0 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Start 10/27/2006 End
2/27/2006
2/24/2006
12/13/2007 12/10/2007
12/3/2007 1/7/2008

DOB 9/23/1959
Telephone Encounter
12/13/2007 9:58 AM
Reason for Call

Refill Request
Call Documentation
Cherry Mendoza 12/14/2007 4:57 PM Signed Note transferred to Relay Health.

000738
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
12/14/2006 6/30/2007 12/31/2007 2/6/2008
11/9/2007
Allergies
Problem List
000739
1/19/2006

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills Start 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB Class: Historical Route: ORAL 240 0 11/14/2006 METHADONE 10 MG TAB End
12/14/2006
000740
Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 1/10/2008 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 1/7/2008 NORCO 10 MG-325 MG TAB Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 10/10/2007 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
6/30/2007 12/31/2007 2/6/2008
11/9/2007
Allergies
Problem List
Noted Resolved
1/19/2006

Patient Information
Telephone Encounter
Reason for Call

Refill Request
000741
1/10/2008 8:16 AM
Victor Baquero, MD, MD
Fol Family Practice
Reason for Call

Refill Request
Call Documentation
Cherry Mendoza 1/15/2008 10:12 AM Signed Patient picked up prescription already.

Electronically signed by Cherry Mendoza at 1/15/2008 10:12 AM
Created by
Approved

Disp Refills 0 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 3 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET 300.00 Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 GLUCOSAMINE 1,000 MG TAB Class: Historical Route: ORAL 0 300 METHADONE 10 MG TAB (Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Start 10/27/2006 End
2/27/2006
2/24/2006
12/13/2007 1/7/2008
1/10/2008 2/6/2008
Orders Chart Cosign

Required By Victor Baquero, MD
RH MD Msg
Patient Information
000742
Problem BACKACHE NOS
Noted
Resolved
1/19/2006

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Medications at Start of Encounter Disp Refills Start 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy End
000743
Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB Class: Historical Route: ORAL 240 0 11/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 1/10/2008 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 1/7/2008 NORCO 10 MG-325 MG TAB Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 10/10/2007 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
12/14/2006 6/30/2007 12/31/2007 2/6/2008
11/9/2007
Allergies
Problem List
1/19/2006

Patient Information

Telephone Encounter
Provider Department
000744
1/29/2008 11:24 PM
Relayhealth
20437765
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills Start 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB Class: Historical Route: ORAL 240 0 11/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 1/10/2008 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 1/7/2008 NORCO 10 MG-325 MG TAB Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 10/10/2007 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 End
12/14/2006 6/30/2007 12/31/2007 2/6/2008
11/9/2007
Allergies
Problem List
000745


Patient Information
Closed Time 17:42

Telephone Encounter
2/1/2008 9:07 AM
Reason for Call

Refill Request
Call Documentation
Clare Jennings, MA 2/1/2008 9:08 AM Signed Patient has refills, but it is 8 days early.
Electronically signed by Clare Jennings, MA at 2/1/2008 9:08 AM
Created by
Approved
Disp Refills Start End 300 1 2/1/2008 3/5/2008 NORCO 10 MG-325 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Authorizing Provider: Victor Baquero, MD 90 3 2/1/2008 4/4/2008 SOMA 350 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 Authorizing Provider: Victor Baquero, MD

Disp Refills 0 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 3 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET 300.00 Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 GLUCOSAMINE 1,000 MG TAB Class: Historical Route: ORAL 300 0 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Start 10/27/2006 End
2/27/2006
2/24/2006
1/10/2008 2/1/2008 1/7/2008
1/30/2008 2/29/2008 2/1/2008
000746
Created by
Approved
Disp Refills Start End 100 0 2/21/2008 3/3/2008 HYDROMORPHONE 4 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 tablet (4 mg) by oral route every 4-6 hours as needed - ORAL Class: Normal Authorizing Provider: Victor Baquero, MD 300 0 2/21/2008 3/12/2008 METHADONE 10 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Normal Authorizing Provider: Victor Baquero, MD

Disp Refills 30 0 EFFEXOR XR 75 MG 24 HR CAP (Taking) Sig - Route: 1 PO DAILY - ORAL Class: Pharmacy 0 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300 0 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 Start 2/19/2008 End 3/20/2008
10/27/2006
1/10/2008 2/1/2008
1/30/2008 3/2/2008
2/1/2008
3/2/2008
Orders Chart Cosign

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
000747
Chart Cosign
RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Medications at Start of Encounter Disp Refills Start 30 0 2/19/2008 EFFEXOR XR 75 MG 24 HR CAP Sig - Route: 1 PO DAILY - ORAL Class: Pharmacy 300 0 2/21/2008 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 240 0 11/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 2/1/2008 NORCO 10 MG-325 MG TAB Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 2/1/2008 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 End 3/20/2008
3/12/2008
12/14/2006 6/30/2007 3/2/2008
3/2/2008
Allergies
000748
Class: Pharmacy 300 0 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 0 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 0 300 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
2/21/2008 10/27/2006
3/12/2008
1/10/2008 3/5/2008
1/30/2008 4/4/2008
2/1/2008
3/2/2008
Orders Chart Cosign

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills Start 30 0 2/19/2008 EFFEXOR XR 75 MG 24 HR CAP Sig - Route: 1 PO DAILY - ORAL Class: Pharmacy 300 0 2/21/2008 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 240 0 11/14/2006 METHADONE 10 MG TAB End 3/20/2008
3/12/2008
12/14/2006
000749
Cherry Mendoza 3/12/2008 3:42 PM Signed ----- Message # 1 ----From: Amundsen,Mark Sent: 03/12/2008 3:25 PM Hi Dr Baquero and Cherry= It's about time for another refill- I will be out of Methadone on Monday, so hopefully I can pick up a scrip before then. Also, I'm about due on a refll on Effexor XR - Dr Baquero was going to up it from 75MG's to 150 MG's, so a new prescription will have to be called in. Thanks for all your assistance... Mark Amundsen
Created by
Approved
Disp Refills Start End 30 3 3/12/2008 4/30/2008 EFFEXOR XR 150 MG 24 HR CAP Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1 po daily - ORAL Class: Normal Authorizing Provider: Victor Baquero, MD 300 0 3/12/2008 4/4/2008 METHADONE 10 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Normal Authorizing Provider: Victor Baquero, MD

Disp Refills 30 0 EFFEXOR XR 75 MG 24 HR CAP (Taking) Sig - Route: 1 PO DAILY - ORAL Class: Pharmacy 300 0 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 0 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300 0 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 Start 2/19/2008 End 3/20/2008
2/21/2008 10/27/2006
3/12/2008
1/10/2008 3/5/2008
1/30/2008 4/4/2008
2/1/2008
3/2/2008
Orders Chart Cosign

RH MD Msg
Visit Information 3/12/2008 3:26 PM Provider Victor Baquero, MD, Department Relayhealth
000750
MD
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills Start 30 0 2/19/2008 EFFEXOR XR 75 MG 24 HR CAP Sig - Route: 1 PO DAILY - ORAL Class: Pharmacy 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 30 3 3/12/2008 EFFEXOR XR 150 MG 24 HR CAP Sig - Route: 1 po daily - ORAL 240 0 11/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 3/12/2008 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 3/5/2008 NORCO 10 MG-325 MG TAB Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 2/1/2008 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 End 3/20/2008
6/12/2008 12/14/2006 6/30/2007 4/1/2008 4/4/2008
3/2/2008
Allergies
Problem List
Noted Resolved
low back pain - chronic. Tried Methadone, Hydrocodone, Baclofen, Soma, Oxycodone, Tramadol, Toradol, MSContin,
000751
1/19/2006

Patient Information

Telephone Encounter
4/2/2008 10:44 AM
Reason for Call

Refill Request
Call Documentation
Cherry Mendoza 4/8/2008 11:38 AM Signed Patient was notified through Relay Health and patient picked up prescription.
Created by
Approved
Disp Refills Start End 300 1 4/2/2008 4/30/2008 NORCO 10 MG-325 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Authorizing Provider: Victor Baquero, MD 300 0 4/4/2008 4/23/2008 METHADONE 10 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Normal Authorizing Provider: Victor Baquero, MD 90 3 4/4/2008 4/30/2008 SOMA 350 MG TAB
000752
Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 Authorizing Provider: Victor Baquero, MD

Disp Refills 30 0 EFFEXOR XR 75 MG 24 HR CAP (Taking) Sig - Route: 1 PO DAILY - ORAL Class: Pharmacy 300 0 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 0 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 30 3 EFFEXOR XR 150 MG 24 HR CAP (Taking) Sig - Route: 1 po daily - ORAL 0 300 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 0 300 METHADONE 10 MG TAB (Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 1 300 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 3 90 SOMA 350 MG TAB (Discontinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 Start 2/19/2008 End 3/20/2008
2/21/2008 10/27/2006
3/12/2008
3/12/2008 1/10/2008 3/12/2008 3/5/2008
6/12/2008 1/30/2008 4/4/2008 4/2/2008
2/1/2008
4/4/2008

Orders Chart Cosign

Patient Information

Telephone Encounter
Reason for Call

Refill Request
Call Documentation

Victor Baquero, MD, MD 3/12/2008 5:20 PM Signed Triplicate written. Please notify patient. Effexor 150 called in.
000753
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills Start 30 0 2/19/2008 EFFEXOR XR 75 MG 24 HR CAP (Taking) Sig - Route: 1 PO DAILY - ORAL Class: Pharmacy 300 0 2/21/2008 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 30 3 3/12/2008 EFFEXOR XR 150 MG 24 HR CAP (Taking) Sig - Route: 1 po daily - ORAL 0 1/10/2008 300 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 4/4/2008 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 4/2/2008 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 4/4/2008 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 End 3/20/2008
3/12/2008
6/12/2008
1/30/2008
4/24/2008 5/2/2008
5/4/2008
Allergies
Problem List
Noted Resolved
000754
30 3 EFFEXOR XR 150 MG 24 HR CAP (Taking) Sig - Route: 1 po daily - ORAL 0 300 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 0 300 METHADONE 10 MG TAB (Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
3/12/2008 1/10/2008 4/4/2008 4/2/2008
6/12/2008 1/30/2008 4/23/2008 5/2/2008
4/4/2008
5/4/2008

Orders Chart Cosign

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills Start 30 0 2/19/2008 EFFEXOR XR 75 MG 24 HR CAP (Taking) Sig - Route: 1 PO DAILY - ORAL Class: Pharmacy 300 0 2/21/2008 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical End 3/20/2008
3/12/2008
000755
30 3 3/12/2008 EFFEXOR XR 150 MG 24 HR CAP (Taking) Sig - Route: 1 po daily - ORAL 0 1/10/2008 300 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 4/4/2008 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 4/23/2008 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 4/2/2008 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 4/4/2008 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
6/12/2008
1/30/2008
4/24/2008 5/13/2008 5/2/2008
5/4/2008
Allergies
Problem List
1/19/2006

RH MD Msg
000756
February 4, 2010 - Comment: discussed gradual reduction of methadone. Plan: decrease by 5mg weekly.
Class: Acute Encounter Closed By Closed By BAQUERO, VICTOR H Closed Date 04302008 Closed Time 14:24 Mark Amundsen (MRN8081369) Sex Male DOB 9/23/1959
Appointment
Encounter-Level Documents: There are no encounter-level documents. Insurance Information Acct Number 078319305047 1 Payor SELF Patient Insurance ID NA
Plan SELF PAY Plan Number 100
Financial Class T
Center None
RH MD Msg
000757
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills Start 30 0 2/19/2008 EFFEXOR XR 75 MG 24 HR CAP (Taking) Sig - Route: 1 PO DAILY - ORAL Class: Pharmacy 300 0 2/21/2008 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 30 3 3/12/2008 EFFEXOR XR 150 MG 24 HR CAP (Taking) Sig - Route: 1 po daily - ORAL 0 1/10/2008 300 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 4/23/2008 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 4/2/2008 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 4/4/2008 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 End 3/20/2008
3/12/2008
6/12/2008
1/30/2008
5/13/2008 5/2/2008
5/4/2008
Allergies
Problem List
Noted Resolved
000758
Hi Dr Baquero- While I was in today, I forgot to request a refill for Soma along with the refill for Norco- could you please call that one in as well? Thanks a million!!! Mark
Created by
Approved

Disp Refills 30 6 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40 mg) by oral route once daily in the morning - ORAL Class: Pharmacy 75 0 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 0 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300 0 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 METHADONE 10 MG TAB (Taking) Sig - Route: Take 12 daily (120mg) - ORAL Class: Historical 100 1 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 3 90 SOMA 350 MG TAB (Discontinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 Start 4/30/2008 End 10/30/2008
4/25/2008 10/27/2006
5/2/2008
4/23/2008 4/30/2008
5/13/2008 5/2/2008
4/30/2008
5/30/2008
4/4/2008
4/30/2008

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
000759
Medications
Disp Refills Start 30 6 4/30/2008 FLUOXETINE 40 MG CAP Sig - Route: take 1 capsule (40 mg) by oral route once daily in the morning - ORAL Class: Pharmacy 75 0 4/25/2008 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 240 0 11/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 4/23/2008 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 4/30/2008 METHADONE 10 MG TAB Sig - Route: Take 12 daily (120mg) - ORAL Class: Historical 100 1 4/30/2008 NORCO 10 MG-325 MG TAB Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 4/30/2008 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 End 10/30/2008
5/2/2008
12/14/2006 6/30/2007 5/13/2008 5/2/2008
5/30/2008
8/1/2008
Allergies
Problem List
1/19/2006
000760
100 1 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
4/30/2008
5/30/2008
4/30/2008
8/1/2008
Orders Chart Cosign

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Medications at Start of Encounter Disp Refills Start 30 6 4/30/2008 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40 mg) by oral route once daily in the morning - ORAL Class: Pharmacy 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300 0 4/23/2008 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 4/30/2008 METHADONE 10 MG TAB (Taking) Sig - Route: Take 12 daily (120mg) - ORAL Class: Historical 100 1 4/30/2008 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 4/30/2008 SOMA 350 MG TAB (Taking) End 10/30/2008
5/13/2008 5/2/2008
5/30/2008
8/1/2008
000761
Medications
Medications at Start of Encounter Disp Refills Start 30 6 4/30/2008 FLUOXETINE 40 MG CAP Sig - Route: take 1 capsule (40 mg) by oral route once daily in the morning - ORAL Class: Pharmacy 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 240 0 11/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 4/23/2008 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 6/6/2008 METHADONE 10 MG TAB Sig - Route: Take 12 daily (120mg) - ORAL 100 1 4/30/2008 NORCO 10 MG-325 MG TAB Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 4/30/2008 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 End 10/30/2008
12/14/2006 6/30/2007 5/13/2008 6/8/2008 5/30/2008
8/1/2008
Allergies
Problem List
1/19/2006

000762
Allergies
Problem List
1/19/2006

Patient Information

Telephone Encounter
6/6/2008 4:24 PM
Reason for Call

Refill Request
Call Documentation
Julie Stewart 6/9/2008 9:20 AM Signed Left message that written rx is ready for pick up.
Electronically signed by Julie Stewart at 6/9/2008 9:20 AM
000763
Created by
Approved
Disp Refills Start End 300 0 6/6/2008 6/26/2008 METHADONE 10 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: Take 12 daily (120mg) - ORAL Class: Normal Authorizing Provider: Victor Baquero, MD

Disp Refills 30 6 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40 mg) by oral route once daily in the morning - ORAL Class: Pharmacy 0 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300 0 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 METHADONE 10 MG TAB (Discontinued) Sig - Route: Take 12 daily (120mg) - ORAL Class: Historical 100 1 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 Start 4/30/2008 End 10/30/2008
10/27/2006
4/23/2008 4/30/2008
5/13/2008 6/6/2008
4/30/2008
5/30/2008
4/30/2008
8/1/2008
Orders Chart Cosign

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
000764
RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills Start 30 6 4/30/2008 FLUOXETINE 40 MG CAP Sig - Route: take 1 capsule (40 mg) by oral route once daily in the morning - ORAL Class: Pharmacy 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 240 0 11/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 4/23/2008 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 6/6/2008 METHADONE 10 MG TAB Sig - Route: Take 12 daily (120mg) - ORAL 100 1 4/30/2008 NORCO 10 MG-325 MG TAB Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 4/30/2008 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 End 10/30/2008
12/14/2006 6/30/2007 5/13/2008 6/8/2008 5/30/2008
8/1/2008
000765
Medications
Disp Refills Start 30 6 4/30/2008 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40 mg) by oral route once daily in the morning - ORAL Class: Pharmacy 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300 0 4/23/2008 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 6/6/2008 METHADONE 10 MG TAB (Taking) Sig - Route: Take 12 daily (120mg) - ORAL 100 1 4/30/2008 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 4/30/2008 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 End 10/30/2008
5/13/2008 6/8/2008 5/30/2008
8/1/2008
Allergies
Problem List
1/19/2006

Class: Acute
000766
Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
4/30/2008
8/1/2008

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Medications at Start of Encounter Disp Refills Start 30 6 4/30/2008 FLUOXETINE 40 MG CAP Sig - Route: take 1 capsule (40 mg) by oral route once daily in the morning - ORAL Class: Pharmacy 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 240 0 11/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 4/23/2008 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 6/6/2008 METHADONE 10 MG TAB Sig - Route: Take 12 daily (120mg) - ORAL 100 1 4/30/2008 NORCO 10 MG-325 MG TAB Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 4/30/2008 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy End 10/30/2008
12/14/2006 6/30/2007 5/13/2008 6/8/2008 5/30/2008
8/1/2008
000767
1/19/2006

Patient Information

Telephone Encounter
6/24/2008 4:04 PM
Provider Victor Baquero, MD, MD Department Fol Internal Medicine
Reason for Call

Refill Request
Created by
Approved
Disp Refills Start End 100 1 6/24/2008 8/19/2008 NORCO 10 MG-325 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Authorizing Provider: Victor Baquero, MD

Disp Refills 30 6 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40 mg) by oral route once daily in the morning - ORAL Class: Pharmacy 0 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300 0 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 METHADONE 10 MG TAB (Taking) Sig - Route: Take 12 daily (120mg) - ORAL 100 1 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Start 4/30/2008 End 10/30/2008
10/27/2006
4/23/2008 6/6/2008 4/30/2008
5/13/2008 6/8/2008 6/24/2008
000768
Patient Information

Telephone Encounter
6/26/2008 9:12 AM
Reason for Call

Refill Request
Call Documentation
Mandy Chilson 6/27/2008 11:02 AM Addendum Patient notified via RH.
Victor Baquero, MD, MD 6/27/2008 9:01 AM Signed Triplicate written. Please notify patient.
Electronically signed by Victor Baquero, MD at 6/27/2008 9:01 AM
Mandy Chilson 6/26/2008 9:14 AM Signed Dr. Baquero, please check the amount, according to the patient, he states that you guys upped the amount to the 390 from 300. He said he will be out on Monday. Thank you
Electronically signed by Mandy Chilson at 6/26/2008 9:14 AM
Created by
Approved

Disp Refills 30 6 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40 mg) by oral route once daily in the morning - ORAL Class: Pharmacy 0 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300 0 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 METHADONE 10 MG TAB (Discontinued) Sig - Route: Take 12 daily (120mg) - ORAL 100 1 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 Start 4/30/2008 End 10/30/2008
10/27/2006
4/23/2008 6/6/2008 6/24/2008
5/13/2008 6/26/2008 7/24/2008
4/30/2008
8/1/2008
RH MD Msg
000769
Visit Information 6/26/2008 5:48 AM Provider Victor Baquero, MD, MD Department Relayhealth Encounter # 22367432
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Medications at Start of Encounter Disp Refills Start 30 6 4/30/2008 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40 mg) by oral route once daily in the morning - ORAL Class: Pharmacy 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300 0 4/23/2008 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 6/6/2008 METHADONE 10 MG TAB (Taking) Sig - Route: Take 12 daily (120mg) - ORAL 100 1 6/24/2008 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 4/30/2008 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 End 10/30/2008
5/13/2008 6/8/2008 7/24/2008
8/1/2008
Allergies
Problem List
Noted Resolved
000770
7/17/2006 3:08 PM
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Medications at Start of Encounter Disp Refills Start 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 30 6 5/26/2006 CYMBALTA 60 MG CAP Sig - Route: 1 PO DAILY - ORAL 30 6 1/19/2006 FLUOXETINE 40 MG CAP Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB Class: Historical Route: ORAL 250 0/0 5/23/2006 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 180 0 6/29/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 250 1 6/29/2006 NORCO 10 MG-325 MG TAB Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy 90 0 6/21/2006 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy End
11/22/2006
6/22/2006
7/29/2006 7/29/2006
7/21/2006
Allergies
000771
Created by
Approved
Disp Refills Start End 90 0 7/22/2008 8/19/2008 SOMA 350 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 Authorizing Provider: Gertrudes Perlas Montemayor, MD

Disp Refills 30 6 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40 mg) by oral route once daily in the morning - ORAL Class: Pharmacy 0 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300 0 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 390 0 METHADONE 10 MG TAB (Taking) Sig - Route: Take 12 daily (120mg) - ORAL 100 1 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 SOMA 350 MG TAB (Discontinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 Start 4/30/2008 End 10/30/2008
10/27/2006
4/23/2008 6/26/2008 6/24/2008
5/13/2008 6/28/2008 7/24/2008
4/30/2008
7/22/2008

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
000772
Disp Refills Start 30 6 4/30/2008 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40 mg) by oral route once daily in the morning - ORAL Class: Pharmacy 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300 0 4/23/2008 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 390 0 6/26/2008 METHADONE 10 MG TAB (Taking) Sig - Route: Take 12 daily (120mg) - ORAL 100 1 6/24/2008 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 4/30/2008 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 90 0 7/22/2008 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
End 10/30/2008
5/13/2008 6/28/2008 7/24/2008
8/1/2008
10/23/2008
Allergies
Problem List
Noted Resolved
1/19/2006

Class: Acute Previous Visit Department Encounter #
000773
RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Ordered Medications METHADONE 10 MG TAB (Discontinued) Take 12 daily (120mg) - ORAL Discontinued Medications Reason for Discontinue METHADONE 10 MG TAB Medications at Start of Encounter Disp Refills Start 30 6 4/30/2008 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40 mg) by oral route once daily in the morning - ORAL Class: Pharmacy 300 0 7/23/2008 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300 0 4/23/2008 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 390 0 6/26/2008 METHADONE 10 MG TAB (Discontinued) Sig - Route: Take 12 daily (120mg) - ORAL 100 1 6/24/2008 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 0 7/22/2008 SOMA 350 MG TAB (Taking) End 10/30/2008 Disp 390 Refills 0 Start 8/11/2008 End 9/3/2008
7/25/2008
5/13/2008 8/11/2008
7/24/2008
10/23/2008
000774
1/19/2006

Patient Information

Telephone Encounter
8/19/2008 2:43 PM
Provider Gertrudes Perlas Montemayor, MD Department Fol Family Practice
Reason for Call

Refill Request
Created by
Approved
Disp Refills Start End 90 0 8/19/2008 9/18/2008 SOMA 350 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 242072.last fill - 7/22/08 Authorizing Provider: Victor Baquero, MD

Disp Refills 30 6 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40 mg) by oral route once daily in the morning - ORAL Class: Pharmacy 300 0 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical 0 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300 0 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 390 0 METHADONE 10 MG TAB (Taking) Start 4/30/2008 End 10/30/2008
7/23/2008
7/25/2008
10/27/2006
4/23/2008 8/11/2008
5/13/2008 8/13/2008
000775
Sig - Route: Take 12 daily (120mg) - ORAL 100 1 NORCO 10 MG-325 MG TAB (Taking/Disco ntinued) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 0 SOMA 350 MG TAB (Discontinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
6/24/2008
8/19/2008
7/22/2008
8/19/2008

DOB 9/23/1959
Telephone Encounter
8/19/2008 11:27 AM
Reason for Call

Refill Request
Created by
Approved

Disp Refills 30 6 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40 mg) by oral route once daily in the morning - ORAL Class: Pharmacy 300 0 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical 0 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300 0 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 390 0 METHADONE 10 MG TAB (Taking) Sig - Route: Take 12 daily (120mg) - ORAL 100 1 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 0 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 Start 4/30/2008 End 10/30/2008
7/23/2008
7/25/2008
10/27/2006
4/23/2008 8/11/2008 6/24/2008
5/13/2008 8/13/2008 8/19/2008
7/22/2008
10/23/2008
000776
Amundsen, Mark
8081369
Male
9/23/1959
916-509-0158
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills Start End 30 6 4/30/2008 10/30/2008 FLUOXETINE 40 MG CAP Sig - Route: take 1 capsule (40 mg) by oral route once daily in the morning - ORAL Class: Pharmacy 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 240 0 11/14/2006 12/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 6/30/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 390 0 9/9/2008 10/7/2008 METHADONE 10 MG TAB Sig - Route: Take 12 daily (120mg) - ORAL 100 1 8/19/2008 9/18/2008 NORCO 10 MG-325 MG TAB Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 0 8/19/2008 11/20/2008 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 242072.last fill - 7/22/08
Allergies
Problem List
Noted Resolved
1/19/2006
000777
Comment: This is a REFILL AUTHORIZATION for prescription number 242072.last fill - 7/22/08 Authorizing Provider: Victor Baquero, MD

Disp Refills Start 30 6 4/30/2008 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40 mg) by oral route once daily in the morning - ORAL Class: Pharmacy 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 390 0 9/9/2008 METHADONE 10 MG TAB (Taking) Sig - Route: Take 12 daily (120mg) - ORAL 0 8/19/2008 90 SOMA 350 MG TAB (Discontinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 242072.last fill - 7/22/08 End 10/30/2008
10/7/2008 9/18/2008

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills Start 30 6 4/30/2008 FLUOXETINE 40 MG CAP Sig - Route: take 1 capsule (40 mg) by oral route once daily in the morning - ORAL Class: Pharmacy 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 240 0 11/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 390 0 9/9/2008 METHADONE 10 MG TAB Sig - Route: Take 12 daily (120mg) - ORAL End 10/30/2008
12/14/2006 6/30/2007 10/7/2008
000778
100 1 8/19/2008 9/18/2008 NORCO 10 MG-325 MG TAB Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 0 8/19/2008 11/20/2008 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 242072.last fill - 7/22/08
Allergies
Problem List
1/19/2006

RH MD Msg
MRN
Sex
DOB
PATIENTPHONE
000779
Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 242072.last fill - 7/22/08
Orders Chart Cosign

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Medications at Start of Encounter Disp Refills Start End 30 6 4/30/2008 10/30/2008 FLUOXETINE 40 MG CAP Sig - Route: take 1 capsule (40 mg) by oral route once daily in the morning - ORAL Class: Pharmacy 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 240 0 11/14/2006 12/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 6/30/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 390 0 10/6/2008 11/3/2008 METHADONE 10 MG TAB Sig - Route: Take 12 daily (120mg) - ORAL 100 1 8/19/2008 9/18/2008 NORCO 10 MG-325 MG TAB Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 0 9/18/2008 10/18/2008 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 242072.last fill - 7/22/08
000780
Allergies
Problem List
1/19/2006

Patient Information

Telephone Encounter
9/18/2008 11:39 AM
Reason for Call

Refill Request
Created by
Approved
Disp Refills Start End 90 0 9/18/2008 10/17/2008 SOMA 350 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1 po tid - ORAL Class: Pharmacy
000781
2025 TARBOLTON CIR FOLSOM CA 95630
916-509-0158 (Home) 916-983-4484 (Work)
mamundsen@sbcglobal.net
Medications
Disp Refills Start End 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 240 0 11/14/2006 12/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 6/30/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 390 0 10/6/2008 11/3/2008 METHADONE 10 MG TAB Sig - Route: Take 12 daily (120mg) - ORAL 100 1 10/17/2008 11/16/2008 NORCO 10 MG-325 MG TAB Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 0 10/17/2008 11/16/2008 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 242072.last fill - 7/22/08
Allergies
Problem List
1/19/2006

000782
30 6 4/30/2008 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40 mg) by oral route once daily in the morning - ORAL Class: Pharmacy 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 390 0 10/6/2008 METHADONE 10 MG TAB (Discontinued) Sig - Route: Take 12 daily (120mg) - ORAL 100 1 10/17/2008 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 0 10/17/2008 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 242072.last fill - 7/22/08
10/30/2008
11/3/2008 11/16/2008
11/16/2008
RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Medications at Start of Encounter Disp Refills Start 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 240 0 11/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 390 0 10/6/2008 METHADONE 10 MG TAB Sig - Route: Take 12 daily (120mg) - ORAL 100 1 10/17/2008 NORCO 10 MG-325 MG TAB Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 0 10/17/2008 SOMA 350 MG TAB End
12/14/2006 6/30/2007 11/3/2008 11/16/2008
11/16/2008
000783
Created by
Approved
Disp Refills Start End 90 0 11/13/2008 12/12/2008 SOMA 350 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 Authorizing Provider: Victor Baquero, MD

Disp Refills Start 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 390 0 11/3/2008 METHADONE 10 MG TAB Sig - Route: Take 12 daily (120mg) - ORAL 100 1 10/17/2008 NORCO 10 MG-325 MG TAB Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 0 10/17/2008 SOMA 350 MG TAB (Discontinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 242072.last fill - 7/22/08 End
12/1/2008 11/16/2008
11/13/2008

DOB 9/23/1959
Telephone Encounter
11/3/2008 8:23 AM
Reason for Call

Refill Request
Call Documentation
Created by
Approved

000784

CHRONIC PAIN MEDICATION AGREEMENT 4/30/2008
RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Medications at Start of Encounter Disp Refills Start 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 240 0 11/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 390 0 11/3/2008 METHADONE 10 MG TAB Sig - Route: Take 12 daily (120mg) - ORAL 100 1 10/17/2008 NORCO 10 MG-325 MG TAB Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 0 11/13/2008 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy End
12/14/2006 6/30/2007 12/1/2008 11/16/2008
12/13/2008
000785
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills Start End 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 240 0 11/14/2006 12/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 6/30/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 390 0 11/3/2008 12/1/2008 METHADONE 10 MG TAB Sig - Route: Take 12 daily (120mg) - ORAL 100 1 10/17/2008 11/16/2008 NORCO 10 MG-325 MG TAB Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 0 11/13/2008 12/13/2008 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008
Allergies
Problem List
1/19/2006
000786
100 1 12/12/2008 2/23/2009 SOMA 350 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 Authorizing Provider: Victor Baquero, MD

Disp Refills Start 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 390 0 12/1/2008 METHADONE 10 MG TAB (Taking) Sig - Route: Take 12 daily (120mg) - ORAL 0 11/13/2008 90 SOMA 350 MG TAB (Discontinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 End
12/29/2008 12/12/2008

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Ordered Medications METHADONE 10 MG TAB (Discontinued) Take 12 daily (120mg) - ORAL Discontinued Medications
Disp 390
Refills 0
Start 12/1/2008
End 12/22/2008

000787
390 0 11/3/2008 12/1/2008 METHADONE 10 MG TAB (Discontinued) Sig - Route: Take 12 daily (120mg) - ORAL 90 0 11/13/2008 12/13/2008 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008
Allergies
Problem List
1/19/2006

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
000788
Sig - Route: Take 12 daily (120mg) - ORAL 100 1 12/12/2008 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008
1/11/2009
Orders Chart Cosign

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Medications at Start of Encounter Disp Refills Start End 100 1 12/12/2008 1/11/2009 NORCO 10 MG-325 MG TAB Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 240 0 11/14/2006 12/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 6/30/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 390 0 12/22/2008 1/19/2009 METHADONE 10 MG TAB Sig - Route: Take 12 daily (120mg) - ORAL 100 1 12/12/2008 1/11/2009 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008
000789
Allergies
Problem List
1/19/2006

Patient Information

Telephone Encounter
12/12/2008 11:53 AM
Reason for Call

Refill Request
Created by
Approved
000790


RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Medications at Start of Encounter Disp Refills Start 100 1 12/12/2008 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 390 0 12/22/2008 METHADONE 10 MG TAB (Taking) Sig - Route: Take 12 daily (120mg) - ORAL 100 1 12/12/2008 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy End 1/11/2009
1/19/2009 1/11/2009
000791
1/19/2009 7:02 PM
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Medications at Start of Encounter Disp Refills Start End 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 240 0 11/14/2006 12/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 6/30/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 390 0 12/22/2008 1/19/2009 METHADONE 10 MG TAB Sig - Route: Take 12 daily (120mg) - ORAL 100 1 12/12/2008 1/11/2009 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008
Allergies
Problem List
Noted Resolved
1/19/2006
000792
FENTANYL; MORPHINE
Problem List
1/19/2006

Patient Information

Telephone Encounter
2/11/2009 12:06 PM
Reason for Call

Refill Request
Call Documentation
Mandy Chilson 2/13/2009 9:17 AM Signed Notified via Relay Health.

Victor Baquero, MD, MD 2/13/2009 9:02 AM Signed Let him know the triplicate will be ready to pick up Tuesday morning.
Mandy Chilson 2/11/2009 12:06 PM Signed
000793
Hi Dr Baquero and AmandaIt's about time for another refill. I won't be out until next Tuesday, but I thought I would give you plenty of time, since there is so many holidays in the next week. Thanks for all your assistance... Mark Amundsen
Electronically signed by Mandy Chilson at 2/11/2009 12:06 PM
Created by
Approved

Disp Refills Start 100 1 12/12/2008 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 390 0 1/20/2009 METHADONE 10 MG TAB (Discontinued) Sig - Route: Take 12 daily (120mg) - ORAL Class: Handwritten Rx 100 1 12/12/2008 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 End 1/11/2009
2/11/2009
1/11/2009
Orders Chart Cosign

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
000794
Medications
Disp Refills Start End 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 240 0 11/14/2006 12/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 6/30/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 390 0 2/17/2009 3/17/2009 METHADONE 10 MG TAB Sig - Route: Take 12 daily (120mg) - ORAL 100 1 12/12/2008 1/11/2009 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008
Allergies
Problem List
1/19/2006

000795
Comment: This is a REFILL AUTHORIZATION for prescription number 176026 0 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 390 0 METHADONE 10 MG TAB (Taking) Sig - Route: Take 12 daily (120mg) - ORAL 100 1 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026
10/27/2006
2/17/2009 2/13/2009
3/17/2009 3/15/2009

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Medications at Start of Encounter Disp Refills Start 100 1 12/12/2008 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 390 0 2/17/2009 METHADONE 10 MG TAB (Taking) Sig - Route: Take 12 daily (120mg) - ORAL 100 1 2/13/2009 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 End 1/11/2009
3/17/2009 3/15/2009
Allergies
Allergies
000796
FENTANYL; MORPHINE
Problem List
1/19/2006

Appointment
Account # 078438665024
Phone 916-509-0158 (Home) 916-983-4484 (Work) Provider Xray0 Radfol
Encounter-Level Documents: There are no encounter-level documents. Insurance Information Acct Number
000797


Patient Information

Telephone Encounter
3/12/2009 12:29 PM
Reason for Call

Refill Request
Call Documentation
Created by
Approved

Disp Refills 100 1 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 0 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 0 390 METHADONE 10 MG TAB (Discontinued) Sig - Route: Take 12 daily (120mg) - ORAL 100 1 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 100 1 SOMA 350 MG TAB (Taking) Start 12/12/2008 End 1/11/2009
10/27/2006
2/17/2009 2/13/2009
3/12/2009 3/15/2009
2/23/2009
3/25/2009
000798
Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008
RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills Start End 100 1 12/12/2008 1/11/2009 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 390 0 2/17/2009 3/17/2009 METHADONE 10 MG TAB (Taking) Sig - Route: Take 12 daily (120mg) - ORAL 390 0 3/12/2009 4/9/2009 METHADONE 10 MG TAB Sig - Route: Take 12 daily (120mg) - ORAL 100 1 2/13/2009 3/15/2009 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 100 1 2/23/2009 3/25/2009 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008
Allergies
000799
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills Start End 100 1 12/12/2008 1/11/2009 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 390 0 3/12/2009 4/9/2009 METHADONE 10 MG TAB (Taking) Sig - Route: Take 12 daily (120mg) - ORAL 100 1 2/13/2009 3/15/2009 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 100 1 2/23/2009 3/25/2009 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008
Allergies
Problem List
1/19/2006
000800
Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: Take 12 daily (120mg) - ORAL Class: Handwritten Rx Authorizing Provider: Martina Dobrovodska Randolph, MD

Disp Refills Start 100 1 12/12/2008 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 0 3/12/2009 390 METHADONE 10 MG TAB (Discontinued) Sig - Route: Take 12 daily (120mg) - ORAL 100 1 2/13/2009 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 100 1 2/23/2009 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 End 1/11/2009
4/9/2009 3/15/2009
3/25/2009
RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills Start 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 240 0 11/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 390 0 4/9/2009 METHADONE 10 MG TAB End
12/14/2006 6/30/2007 5/7/2009
000801
Sig - Route: Take 12 daily (120mg) - ORAL Class: Handwritten Rx 100 1 2/13/2009 3/15/2009 NORCO 10 MG-325 MG TAB Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 100 1 2/23/2009 3/25/2009 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008
Allergies
Problem List
1/19/2006

RH MD Msg
000802
4/13/2009 12:14 AM
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Medications at Start of Encounter Disp Refills Start End 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 240 0 11/14/2006 12/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 6/30/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 390 0 4/9/2009 5/7/2009 METHADONE 10 MG TAB Sig - Route: Take 12 daily (120mg) - ORAL Class: Handwritten Rx 100 1 2/13/2009 3/15/2009 NORCO 10 MG-325 MG TAB Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 100 1 2/23/2009 3/25/2009 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008
Allergies
Problem List
TESTICULAR HYPOFUNC NEC
000803
2/18/2009 8:56 AM
Patient Information

Telephone Encounter
4/27/2009 11:51 AM
Reason for Call

Refill Request
Created by
Approved
Disp Refills Start End 100 1 4/27/2009 6/3/2011 NORCO 10 MG-325 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Authorizing Provider: Victor Baquero, MD 100 1 4/27/2009 6/23/2009 SOMA 350 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 Authorizing Provider: Victor Baquero, MD

Disp Refills Start 100 1 12/12/2008 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 390 0 4/9/2009 METHADONE 10 MG TAB (Taking) Sig - Route: Take 12 daily (120mg) - ORAL Class: Handwritten Rx 100 1 2/13/2009 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 100 1 2/23/2009 SOMA 350 MG TAB (Discontinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 End 1/11/2009
5/7/2009
4/27/2009
4/27/2009

RH MD Msg
Visit Information
000804
Mark Amundsen
Created by
Approved

Disp Refills Start 100 1 12/12/2008 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 0 4/9/2009 390 METHADONE 10 MG TAB (Discontinued) Sig - Route: Take 12 daily (120mg) - ORAL Class: Handwritten Rx 100 1 4/27/2009 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 100 1 4/27/2009 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 End 1/11/2009
5/7/2009
5/27/2009
5/27/2009
Orders Chart Cosign

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
000805
Medications
Allergies
Problem List
1/19/2006

Class: Acute Previous Visit
000806
Class: Historical 390 0 5/7/2009 METHADONE 10 MG TAB (Discontinued) Sig - Route: Take 13 daily (130mg) - ORAL 100 1 4/27/2009 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 100 1 4/27/2009 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008
6/2/2009 5/27/2009
5/27/2009
Orders Chart Cosign

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills Start 42 0 5/28/2009 Metronidazole (FLAGYL) 500 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth 3 times daily. No alcohol - ORAL Class: Pharmacy 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 390 0 6/2/2009 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 13 Tabs by mouth every day. - ORAL 390 0 5/7/2009 METHADONE 10 MG TAB (Taking) Sig - Route: Take 13 daily (130mg) - ORAL 100 1 4/27/2009 NORCO 10 MG-325 MG TAB (Taking) End 6/11/2009
6/30/2009
6/4/2009 5/27/2009
000807
Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 100 1 4/27/2009 5/27/2009 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008
Allergies
Problem List
1/19/2006


Patient Information

Telephone Encounter
5/28/2009 8:10 AM
Reason for Call
000808

Patient Information

Contacts
06/29/2009 1:50 PM
Type Phone (Incoming) Contact Amundsen, Mark (Self) Phone 916-337-0490 (W)
Telephone Encounter
6/23/2009 11:20 AM
Reason for Call

Refill Request
Created by
Approved
Disp Refills Start End 100 1 6/23/2009 8/26/2009 Carisoprodol (SOMA) 350 mg PO Tablet Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 Authorizing Provider: Victor Baquero, MD

Disp Refills Start 42 0 5/28/2009 Metronidazole (FLAGYL) 500 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth 3 times daily. No alcohol - ORAL Class: Pharmacy 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 390 0 6/2/2009 Methadone (DOLOPHINE) 10 mg PO Tablet (Taking) Sig - Route: Take 13 Tabs by mouth every day. - ORAL 100 1 4/27/2009 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 100 1 4/27/2009 SOMA 350 MG TAB (Discontinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 End 6/11/2009
6/30/2009
5/27/2009
6/23/2009

Orders Chart Cosign

000809
Created by

Disp Refills Start 42 0 5/28/2009 Metronidazole (FLAGYL) 500 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth 3 times daily. No alcohol - ORAL Class: Pharmacy 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 100 1 6/23/2009 Carisoprodol (SOMA) 350 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 390 0 6/26/2009 Methadone (DOLOPHINE) 10 mg PO Tablet (Taking) Sig - Route: Take 13 Tabs by mouth every day. - ORAL 100 1 4/27/2009 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 End 6/11/2009
7/23/2009
7/24/2009
5/27/2009
Orders Chart Cosign

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Ordered Medications Methadone (DOLOPHINE) 10 mg PO Tablet (Discontinued) Take 13 Tabs by mouth every day. - ORAL
000810
Discontinued Medications Reason for Discontinue Methadone (DOLOPHINE) 10 mg PO Tablet Medications at Start of Encounter Disp Refills Start End 42 0 5/28/2009 6/11/2009 Metronidazole (FLAGYL) 500 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth 3 times daily. No alcohol - ORAL Class: Pharmacy 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 100 1 6/23/2009 7/23/2009 Carisoprodol (SOMA) 350 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 0 6/2/2009 6/26/2009 390 Methadone (DOLOPHINE) 10 mg PO Tablet (Discontinued) Sig - Route: Take 13 Tabs by mouth every day. - ORAL 100 1 4/27/2009 5/27/2009 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026
Allergies
Problem List
1/19/2006

000811
RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Medications at Start of Encounter Disp Refills Start End 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 1 6/23/2009 7/23/2009 Carisoprodol (SOMA) 350 mg PO Tablet 100 Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 390 0 7/23/2009 8/20/2009 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 13 Tabs by mouth every day. - ORAL 240 0 11/14/2006 12/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 6/30/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 100 1 4/27/2009 5/27/2009 NORCO 10 MG-325 MG TAB Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026
Allergies
Problem List
000812
100 1 7/28/2009 9/28/2009 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10325 mg PO Tablet Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: Take 1 Tab by mouth every 4 hours if needed for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Authorizing Provider: Victor Baquero, MD

Disp Refills Start 42 0 5/28/2009 Metronidazole (FLAGYL) 500 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth 3 times daily. No alcohol - ORAL Class: Pharmacy 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 100 1 6/23/2009 Carisoprodol (SOMA) 350 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 390 0 7/23/2009 Methadone (DOLOPHINE) 10 mg PO Tablet (Taking) Sig - Route: Take 13 Tabs by mouth every day. - ORAL 100 1 4/27/2009 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 End 6/11/2009
7/23/2009
8/20/2009
5/27/2009

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
000813
1 6/23/2009 7/23/2009 Carisoprodol (SOMA) 350 mg PO Tablet 100 Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 390 0 7/23/2009 8/20/2009 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 13 Tabs by mouth every day. - ORAL 240 0 11/14/2006 12/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 6/30/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 100 1 4/27/2009 5/27/2009 NORCO 10 MG-325 MG TAB Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026
Allergies
Problem List
Noted Resolved
1/19/2006


Patient Information
000814
MRN 8081369
Sex Male
DOB 9/23/1959
Telephone Encounter
7/23/2009 2:15 PM
Reason for Call

Refill Request
Call Documentation
Leah Reyes, MOSC 7/24/2009 2:46 PM Signed Patient notified

Electronically signed by Leah Reyes, MOSC at 7/24/2009 2:46 PM
Mandy Chilson 7/23/2009 2:15 PM Signed Patient will be out Monday

Created by
Approved
Disp Refills Start End 390 0 7/23/2009 8/20/2009 Methadone (DOLOPHINE) 10 mg PO Tablet Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: Take 13 Tabs by mouth every day. - ORAL Class: Normal Authorizing Provider: Victor Baquero, MD

Disp Refills Start 42 0 5/28/2009 Metronidazole (FLAGYL) 500 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth 3 times daily. No alcohol - ORAL Class: Pharmacy 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 100 1 6/23/2009 Carisoprodol (SOMA) 350 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 390 0 6/26/2009 Methadone (DOLOPHINE) 10 mg PO Tablet (Discontinued) Sig - Route: Take 13 Tabs by mouth every day. - ORAL 100 1 4/27/2009 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 End 6/11/2009
7/23/2009
7/23/2009
5/27/2009
Orders Chart Cosign

000815
Sig - Route: Take 1 Tab by mouth every 4 hours if needed for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 390 0 Methadone (DOLOPHINE) 10 mg PO Tablet (Taking) Sig - Route: Take 13 Tabs by mouth every day. - ORAL 100 1 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026
7/23/2009
8/20/2009
4/27/2009
5/27/2009

ORTHOPEDIC-GENERAL REFERRAL (42845692) Ordered On 8/3/2009
Chart Cosign
RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills Start 42 0 5/28/2009 Metronidazole (FLAGYL) 500 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth 3 times daily. No alcohol - ORAL Class: Pharmacy 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 100 1 6/23/2009 Carisoprodol (SOMA) 350 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Pharmacy End 6/11/2009
7/23/2009
000816
Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 1 7/28/2009 8/27/2009 Hydrocodone 10 mg/Acetaminophen 325 100 mg (NORCO) 10-325 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth every 4 hours if needed for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 390 0 7/23/2009 8/20/2009 Methadone (DOLOPHINE) 10 mg PO Tablet (Taking) Sig - Route: Take 13 Tabs by mouth every day. - ORAL 100 1 4/27/2009 5/27/2009 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026
Allergies
Problem List
1/19/2006


Appointment
Patient Information Patient Name Sex
Mark Amundsen (MRN8081369) DOB
000817
Amundsen, Mark
Male
9/23/1959
Account # 078438665073 Patient Demographics Address 2025 TARBOLTON CIR FOLSOM CA 95630 Selected Appointment 7/31/2009 10:57 AM Department Ucd Pre-Reg Phone 916-509-0158 (Home) 916-983-4484 (Work) E-mail Address mamundsen@sbcglobal.net
Plan UCD/B/S HMO
Financial Class P
Plan Number B72
Plan Phone 916-734-0739
Center None
Patient Information
Telephone Encounter
7/28/2009 3:21 PM
Reason for Call

Refill Request
Created by
Approved
000818
RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Ordered Medications Methadone (DOLOPHINE) 10 mg PO Tablet Take 2 Tabs by mouth every 6 hours. - ORAL Discontinued Medications
Disp 250 Tab
Refills 0
Start 5/24/2010
End 6/15/2010

Disp Refills Start End 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 1 8/26/2009 9/25/2009 Carisoprodol (SOMA) 350 mg PO Tablet 100 Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 1 7/28/2009 8/27/2009 Hydrocodone 10 mg/Acetaminophen 325 100 mg (NORCO) 10-325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 hours if needed for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 390 0 8/20/2009 9/17/2009 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 13 Tabs by mouth every day. - ORAL
Allergies
000819
Problem List
1/19/2006


Patient Information

Telephone Encounter
8/26/2009 2:27 PM
Reason for Call

Refill Request
Created by
Approved
Disp Refills Start End 100 1 8/26/2009 11/2/2009 Carisoprodol (SOMA) 350 mg PO Tablet Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 Authorizing Provider: Victor Baquero, MD
000820
Disp Refills Start 42 0 5/28/2009 Metronidazole (FLAGYL) 500 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth 3 times daily. No alcohol - ORAL Class: Pharmacy 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 100 1 6/23/2009 Carisoprodol (SOMA) 350 mg PO Tablet (Discontinued) Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 100 1 7/28/2009 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth every 4 hours if needed for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 390 0 8/20/2009 Methadone (DOLOPHINE) 10 mg PO Tablet (Taking) Sig - Route: Take 13 Tabs by mouth every day. - ORAL 100 1 4/27/2009 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026
End 6/11/2009
8/26/2009
8/27/2009
9/17/2009
5/27/2009

Appointment
Orders
DOB 9/23/1959
Account # 038541463089
Phone 916-509-0158 (Home) 916-983-4484 (Work) Department Ucd Pre-Reg
Payor UCD Patient Insurance ID XEHJ00044785 Financial Class P
000821
weekly.

Encounter Closed By Closed By TAMURIAN, ROBERT Closed Date 09162009 Closed Time 11:45 Mark Amundsen (MRN8081369)
Appointment
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Center None
Patient Information

000822
Telephone Encounter
Reason for Call

Refill Request
Call Documentation
Melanie McLaughlin 9/15/2009 3:00 PM Signed I have attempted to contact the patient: left message to return my call on answering machine.
Electronically signed by Melanie McLaughlin at 9/15/2009 3:00 PM
Created by
Approved

Disp Refills Start 42 0 5/28/2009 Metronidazole (FLAGYL) 500 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth 3 times daily. No alcohol - ORAL Class: Pharmacy 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 100 1 8/26/2009 Carisoprodol (SOMA) 350 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 100 1 7/28/2009 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth every 4 hours if needed for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 390 0 8/20/2009 Methadone (DOLOPHINE) 10 mg PO Tablet (Discontinued) Sig - Route: Take 13 Tabs by mouth every day. - ORAL 100 1 4/27/2009 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 End 6/11/2009
9/25/2009
8/27/2009
9/15/2009
5/27/2009
Orders Chart Cosign

000823
9/17/2009 10:36 AM
Robert Michael Tamurian, MD
Ortho Clinic Acc
Medications
Medications at Start of Encounter Disp Refills Start End 42 0 5/28/2009 6/11/2009 Metronidazole (FLAGYL) 500 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth 3 times daily. No alcohol - ORAL Class: Pharmacy 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 100 1 8/26/2009 9/25/2009 Carisoprodol (SOMA) 350 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 1 7/28/2009 8/27/2009 Hydrocodone 10 mg/Acetaminophen 325 100 mg (NORCO) 10-325 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth every 4 hours if needed for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 390 0 9/15/2009 10/13/2009 Methadone (DOLOPHINE) 10 mg PO Tablet (Taking) Sig - Route: Take 13 Tabs by mouth every day. - ORAL 100 1 4/27/2009 5/27/2009 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Medication Review History Med Rev Hx Medication Administration Report for Amundsen, Mark All administrations No administration data available
Immunizations
Visit Summary
Vitals Recorded in This Encounter No data found. Medications Given (Excluding those documented in Imm/Injections Activity) No data found. Visit Notes MICHAEL DELACUEVA, LVN Thu Sep 17, 2009 10:47 AM I processed the HAR for this patient's surgery on 1/12/2010 for Left Total Hip Arthoplasty (27130) with a Diagnosis of Hip Degenerative Joint Disease ICD9 (715.15). Patient will return
000824
Patient Insurance ID XEHJ00044785 Group Number PH0010 Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Center None
Patient Information
Telephone Encounter
Reason for Call

Refill Request
Created by
Approved
Disp Refills Start End 100 1 9/28/2009 11/2/2009 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10325 mg PO Tablet Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: Take 1 Tab by mouth every 4 hours if needed for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Authorizing Provider: Victor Baquero, MD

Disp Refills Start 42 0 5/28/2009 Metronidazole (FLAGYL) 500 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth 3 times daily. No alcohol - ORAL Class: Pharmacy 0 10/27/2006 ALEVE 220 MG TAB (Discontinued) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 100 1 8/26/2009 Carisoprodol (SOMA) 350 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 1 7/28/2009 100 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet (Discontinued) Sig - Route: Take 1 Tab by mouth every 4 hours if needed for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 390 0 9/15/2009 Methadone (DOLOPHINE) 10 mg PO Tablet (Taking) Sig - Route: Take 13 Tabs by mouth every day. - ORAL End 6/11/2009
12/15/2009
9/25/2009
9/28/2009
10/13/2009
000825
100 1 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026
4/27/2009
5/27/2009
Inpatient 9/28/2009
Cefazolin (KEFZOL, ANCEF) 1 g Class: Inpatient Normal Route: IV Diazepam (VALIUM) 5 mg Class: Inpatient Normal Route: IV Diazepam (VALIUM) 5 mg Class: Inpatient Normal Route: IV Methadone (DOLOPHINE) Tablet 40 mg Class: Inpatient Normal Route: ORAL Vancomycin (VANCOCIN) . Class: Inpatient Normal Route: IV Vancomycin (VANCOCIN) . Class: Inpatient Normal Route: IV Vancomycin (VANCOCIN) . Class: Inpatient Normal Route: IV Bisacodyl (DULCOLAX) Suppository 10 mg (Discontinued) Class: Inpatient Normal Route: RECTALLY Carisoprodol (SOMA) Tablet 350 mg (Discontinued)
Dose 1g Frequency EVERY 8 HOURS NOW Start 12/15/2009 End 12/16/2009
5 mg
ONE TIME ONLY
12/15/2009
12/15/2009
5 mg
ONE TIME ONLY
12/15/2009
12/15/2009
40 mg
ONE TIME ONLY
12/18/2009
12/18/2009
1,000 mg
ONCALL TO OR
12/15/2009
12/15/2009
1,000 mg
EVERY 12 HOURS NOW
12/15/2009
12/16/2009
1,000 mg
ONE TIME ONLY
12/16/2009
12/16/2009
10 mg
EVERY 12 HOURS IF NEEDED
12/15/2009
12/18/2009
350 mg
12/15/2009
12/18/2009
Sig: Take 1 Tab by mouth every 8 hours if needed for muscle spasm. Class: Inpatient Normal Route: ORAL 1g Cefazolin (KEFZOL, ANCEF) 1 g (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued D5 / 0.45% NaCl 1,000 mL with Potassium Chloride 20 mEq (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued 5-10 mg Diazepam (VALIUM) Tablet 5-10 mg (Discontinued) Class: Inpatient Normal Route: ORAL DiphenhydrAMINE (BENADRYL) 25-50 mg (Discontinued) Class: Inpatient Normal Route: IV Docusate (COLACE) Capsule 100 mg (Discontinued) Class: Inpatient Normal Route: ORAL Fentanyl (SUBLIMAZE) 50 mcg (Discontinued)
ONCALL TO OR
12/15/2009
12/15/2009
CONTINUOUS INFUSION
12/15/2009
12/18/2009
12/16/2009
12/18/2009
25-50 mg
12/15/2009
12/18/2009
100 mg
TWO TIMES DAILY
12/15/2009
12/18/2009
50 mcg
EVERY 5
12/15/2009
12/15/2009
000826
MINUTES IF NEEDED Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued Ferrous Sulfate (FERATAB) Tablet 300 mg (Discontinued) Class: Inpatient Normal Route: ORAL Fluoxetine (PROZAC) Capsule 40 mg (Discontinued) Class: Inpatient Normal Route: ORAL Hydromorphone (DILAUDID) 0.4-0.6 mg (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued Hydromorphone (DILAUDID) 0.4-2 mg (Discontinued) Class: Inpatient Normal Route: IV Hydromorphone (DILAUDID) 0.4-2 mg (Discontinued) Class: Inpatient Normal Route: IV Hydromorphone (DILAUDID) 0.4-3 mg (Discontinued) Class: Inpatient Normal Route: IV Hydromorphone 0.2 mg/mL (DILAUDID) PCA 50 mL (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued Lactated Ringers (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued Magnesium Hydroxide (MILK OF MAGNESIA) Liquid 30 mL (Discontinued) Class: Inpatient Normal Route: ORAL Meperidine (DEMEROL) 12.5 mg (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued Methadone (DOLOPHINE) Injection 100 mg (Discontinued) Class: Inpatient Normal Route: IV Methadone (DOLOPHINE) Tablet 130 mg (Discontinued) Sig: Take 13 Tabs by mouth every day. Class: Inpatient Normal Route: ORAL Methadone (DOLOPHINE) Tablet 40 mg (Discontinued) Sig: Take 13 Tabs by mouth every day. Class: Inpatient Normal Route: ORAL Methadone (DOLOPHINE) Tablet 40 mg (Discontinued) Class: Inpatient Normal
300 mg
THREE TIMES DAILY
12/15/2009
12/18/2009
40 mg
DAILY MORNING
12/16/2009
12/18/2009
0.4-0.6 mg
EVERY 15 MINUTES IF NEEDED
12/15/2009
12/15/2009
0.4-2 mg
EVERY 1 HOUR IF NEEDED
12/15/2009
12/16/2009
0.4-2 mg
12/17/2009
12/18/2009
0.4-3 mg
12/16/2009
12/17/2009
PCA
12/15/2009
12/18/2009
CONTINUOUS INFUSION
12/15/2009
12/15/2009
30 mL
12/15/2009
12/18/2009
12.5 mg
PRN
12/15/2009
12/15/2009
100 mg
ONE TIME ONLY
12/15/2009
12/15/2009
130 mg
DAILY MORNING
12/16/2009
12/17/2009
40 mg
DAILY MORNING
12/18/2009
12/18/2009
40 mg
DAILY AT 1700
12/17/2009
12/18/2009
000827
Route: ORAL Methadone (DOLOPHINE) Tablet 50 mg (Discontinued) Class: Inpatient Normal Route: ORAL Naloxone (NARCAN) 0.1 mg (Discontinued) Class: Inpatient Normal Route: IV Ondansetron (ZOFRAN) 4 mg (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued Ondansetron (ZOFRAN) 4 mg (Discontinued) Class: Inpatient Normal Route: IV Oxycodone (OXYCONTIN) SR Tablet 20 mg (Discontinued)
50 mg
DAILY AT 2100
12/17/2009
12/18/2009
0.1 mg
PRN
12/15/2009
12/18/2009
4 mg
PRN
12/15/2009
12/15/2009
4 mg
12/15/2009
12/18/2009
20 mg
12/17/2009
12/17/2009
Class: Inpatient Normal Comment: q 3 hrs prn breakthrough pain and 60 minutes prior to PT Route: ORAL Reason for Discontinue: Duplicate Order 20 mg Oxycodone (ROXICODONE) Tablet 20 mg (Discontinued) Class: Inpatient Normal Route: ORAL Oxycodone (ROXICODONE) Tablet 20 mg (Discontinued) Class: Inpatient Normal Route: ORAL Oxycodone 5 mg/Acetaminophen 325 mg (PERCOCET) Tablet 1-2 Tab (Discontinued) Class: Inpatient Normal Route: ORAL Oxycodone 5 mg/Acetaminophen 325 mg (PERCOCET) Tablet 1-2 Tab (Discontinued) Class: Inpatient Normal Route: ORAL Reason for Discontinue: Discontinued Promethazine (PHENERGAN) 12.5 mg (Discontinued)
12/17/2009
12/18/2009
20 mg
PRN
12/17/2009
12/18/2009
1-2 tablet
12/15/2009
12/16/2009
1-2 tablet
EVERY 4 HOURS NOW
12/16/2009
12/17/2009
12.5 mg
12/15/2009
12/15/2009
Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued 2 tablet DAILY AT Sennosides (SENOKOT) Tablet 2 BEDTIME Tab (Discontinued) Class: Inpatient Normal Route: ORAL 2.5 mg DAILY Study Drug - Fondaparinux (IRB 200816251) MORNING Syringe 2.5 mg (Discontinued) Class: Inpatient Normal Comment: Question: call Jose Bosque 4-6291 or 762-5821 Fill from pyxis Route: SUBCUTANEOUS
12/17/2009
12/18/2009
12/16/2009
12/18/2009

Nursing/Ancillary Staff
Orders
Selected Appointment Provider
Department
000828
MORNING Syringe 2.5 mg (Discontinued) Class: Inpatient Normal Comment: Question: call Jose Bosque 4-6291 or 762-5821 Fill from pyxis Route: SUBCUTANEOUS
Orders Chart Cosign

Accepted By Victor Baquero, MD Accepted On 10/12/2009 12:17 PM Mark Amundsen (MRN8081369)
Patient Information
Telephone Encounter
10/9/2009 8:40 AM
Reason for Call

Advice
Call Documentation
Clare Jennings, MA 10/9/2009 4:39 PM Signed Message left that RX was at the front desk
Electronically signed by Clare Jennings, MA at 10/9/2009 4:39 PM
Victor Baquero, MD, MD 10/9/2009 4:35 PM Signed Triplicate written. Please notify patient. Ready on Monday.
Clare Jennings, MA 10/9/2009 8:40 AM Signed

Hi Dr Baquero- It's about time for another refill on Methadone - I'll be out next Monday or Tuesday. If you could have someone call or email when it is ready, that would be great! Thank, Mark Amundsen
Created by
Approved

Disp 42 Metronidazole (FLAGYL) 500 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth 3 times daily. No alcohol - ORAL Class: Pharmacy ALEVE 220 MG TAB (Discontinued) Refills 0 Start 5/28/2009 End 6/11/2009
10/27/2006
12/15/2009
000829
Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 100 1 8/26/2009 Carisoprodol (SOMA) 350 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 100 1 9/28/2009 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth every 4 hours if needed for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 0 9/15/2009 390 Methadone (DOLOPHINE) 10 mg PO Tablet (Discontinued) Sig - Route: Take 13 Tabs by mouth every day. - ORAL 100 1 4/27/2009 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026
9/25/2009
10/28/2009
10/9/2009
5/27/2009
Inpatient 10/9/2009
5 mg
ONE TIME ONLY
12/15/2009
12/15/2009
5 mg
ONE TIME ONLY
12/15/2009
12/15/2009
40 mg
ONE TIME ONLY
12/18/2009
12/18/2009
1,000 mg
ONCALL TO OR
12/15/2009
12/15/2009
1,000 mg
EVERY 12 HOURS NOW
12/15/2009
12/16/2009
1,000 mg
ONE TIME ONLY
12/16/2009
12/16/2009
10 mg
12/15/2009
12/18/2009
350 mg
12/15/2009
12/18/2009
Sig: Take 1 Tab by mouth every 8 hours if needed for muscle spasm. Class: Inpatient Normal Route: ORAL 1g Cefazolin (KEFZOL, ANCEF) 1 g (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued D5 / 0.45% NaCl 1,000 mL with Potassium Chloride 20 mEq (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued 5-10 mg Diazepam (VALIUM) Tablet 5-10
ONCALL TO OR
12/15/2009
12/15/2009
CONTINUOUS INFUSION
12/15/2009
12/18/2009
EVERY 6
12/16/2009
12/18/2009
000830
mg (Discontinued) Class: Inpatient Normal Route: ORAL DiphenhydrAMINE (BENADRYL) 25-50 mg (Discontinued) Class: Inpatient Normal Route: IV Docusate (COLACE) Capsule 100 mg (Discontinued) Class: Inpatient Normal Route: ORAL Fentanyl (SUBLIMAZE) 50 mcg (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued Ferrous Sulfate (FERATAB) Tablet 300 mg (Discontinued) Class: Inpatient Normal Route: ORAL Fluoxetine (PROZAC) Capsule 40 mg (Discontinued) Class: Inpatient Normal Route: ORAL Hydromorphone (DILAUDID) 0.4-0.6 mg (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued Hydromorphone (DILAUDID) 0.4-2 mg (Discontinued) Class: Inpatient Normal Route: IV Hydromorphone (DILAUDID) 0.4-2 mg (Discontinued) Class: Inpatient Normal Route: IV Hydromorphone (DILAUDID) 0.4-3 mg (Discontinued) Class: Inpatient Normal Route: IV Hydromorphone 0.2 mg/mL (DILAUDID) PCA 50 mL (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued Lactated Ringers (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued Magnesium Hydroxide (MILK OF MAGNESIA) Liquid 30 mL (Discontinued) Class: Inpatient Normal Route: ORAL Meperidine (DEMEROL) 12.5 mg (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued Methadone (DOLOPHINE) Injection 100 mg (Discontinued) Class: Inpatient Normal Route: IV
HOURS IF NEEDED
25-50 mg
12/15/2009
12/18/2009
100 mg
TWO TIMES DAILY
12/15/2009
12/18/2009
50 mcg
12/15/2009
12/15/2009
300 mg
THREE TIMES DAILY
12/15/2009
12/18/2009
40 mg
DAILY MORNING
12/16/2009
12/18/2009
0.4-0.6 mg
12/15/2009
12/15/2009
0.4-2 mg
12/15/2009
12/16/2009
0.4-2 mg
12/17/2009
12/18/2009
0.4-3 mg
12/16/2009
12/17/2009
PCA
12/15/2009
12/18/2009
CONTINUOUS INFUSION
12/15/2009
12/15/2009
30 mL
12/15/2009
12/18/2009
12.5 mg
PRN
12/15/2009
12/15/2009
100 mg
ONE TIME ONLY
12/15/2009
12/15/2009
000831
Methadone (DOLOPHINE) Tablet 130 mg (Discontinued) Sig: Take 13 Tabs by mouth every day. Class: Inpatient Normal Route: ORAL Methadone (DOLOPHINE) Tablet 40 mg (Discontinued) Sig: Take 13 Tabs by mouth every day. Class: Inpatient Normal Route: ORAL Methadone (DOLOPHINE) Tablet 40 mg (Discontinued) Class: Inpatient Normal Route: ORAL Methadone (DOLOPHINE) Tablet 50 mg (Discontinued) Class: Inpatient Normal Route: ORAL Naloxone (NARCAN) 0.1 mg (Discontinued) Class: Inpatient Normal Route: IV Ondansetron (ZOFRAN) 4 mg (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued Ondansetron (ZOFRAN) 4 mg (Discontinued) Class: Inpatient Normal Route: IV Oxycodone (OXYCONTIN) SR Tablet 20 mg (Discontinued)
130 mg
DAILY MORNING
12/16/2009
12/17/2009
40 mg
DAILY MORNING
12/18/2009
12/18/2009
40 mg
DAILY AT 1700
12/17/2009
12/18/2009
50 mg
DAILY AT 2100
12/17/2009
12/18/2009
0.1 mg
PRN
12/15/2009
12/18/2009
4 mg
PRN
12/15/2009
12/15/2009
4 mg
12/15/2009
12/18/2009
20 mg
12/17/2009
12/17/2009
Class: Inpatient Normal Comment: q 3 hrs prn breakthrough pain and 60 minutes prior to PT Route: ORAL Reason for Discontinue: Duplicate Order 20 mg Oxycodone (ROXICODONE) Tablet 20 mg (Discontinued) Class: Inpatient Normal Route: ORAL Oxycodone (ROXICODONE) Tablet 20 mg (Discontinued) Class: Inpatient Normal Route: ORAL Oxycodone 5 mg/Acetaminophen 325 mg (PERCOCET) Tablet 1-2 Tab (Discontinued) Class: Inpatient Normal Route: ORAL Oxycodone 5 mg/Acetaminophen 325 mg (PERCOCET) Tablet 1-2 Tab (Discontinued) Class: Inpatient Normal Route: ORAL Reason for Discontinue: Discontinued Promethazine (PHENERGAN) 12.5 mg (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued Sennosides (SENOKOT) Tablet 2 Tab (Discontinued) Class: Inpatient Normal Route: ORAL Study Drug - Fondaparinux (IRB 200816251) Syringe 2.5 mg (Discontinued)
12/17/2009
12/18/2009
20 mg
PRN
12/17/2009
12/18/2009
1-2 tablet
12/15/2009
12/16/2009
1-2 tablet
EVERY 4 HOURS NOW
12/16/2009
12/17/2009
12.5 mg
12/15/2009
12/15/2009
2 tablet
DAILY AT BEDTIME
12/17/2009
12/18/2009
2.5 mg
DAILY MORNING
12/16/2009
12/18/2009
000832
Class: Inpatient Normal Comment: Question: call Jose Bosque 4-6291 or 762-5821 Fill from pyxis Route: SUBCUTANEOUS
Orders Chart Cosign

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Medications at Start of Encounter Disp Refills Start End 42 0 5/28/2009 6/11/2009 Metronidazole (FLAGYL) 500 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth 3 times daily. No alcohol - ORAL Class: Pharmacy 0 10/27/2006 12/15/2009 ALEVE 220 MG TAB (Discontinued) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 100 1 8/26/2009 9/25/2009 Carisoprodol (SOMA) 350 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 1 9/28/2009 10/28/2009 Hydrocodone 10 mg/Acetaminophen 325 100 mg (NORCO) 10-325 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth every 4 hours if needed for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 390 0 9/15/2009 10/13/2009 Methadone (DOLOPHINE) 10 mg PO Tablet (Taking)
000833
Sig - Route: Take 13 Tabs by mouth every day. - ORAL 390 0 10/9/2009 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 13 Tabs by mouth every day. - ORAL 100 1 4/27/2009 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Inpatient 10/9/2009 Cefazolin (KEFZOL, ANCEF) 1 g Class: Inpatient Normal Route: IV Diazepam (VALIUM) 5 mg Class: Inpatient Normal Route: IV Diazepam (VALIUM) 5 mg Class: Inpatient Normal Route: IV Vancomycin (VANCOCIN) . Class: Inpatient Normal Route: IV Vancomycin (VANCOCIN) . Class: Inpatient Normal Route: IV Bisacodyl (DULCOLAX) Suppository 10 mg (Discontinued) Class: Inpatient Normal Route: RECTALLY Carisoprodol (SOMA) Tablet 350 mg (Discontinued)
Dose 1g Frequency EVERY 8 HOURS NOW Start 12/15/2009
11/6/2009
5/27/2009
End 12/16/2009
5 mg
ONE TIME ONLY
12/15/2009
12/15/2009
5 mg
ONE TIME ONLY
12/15/2009
12/15/2009
1,000 mg
ONCALL TO OR
12/15/2009
12/15/2009
1,000 mg
EVERY 12 HOURS NOW
12/15/2009
12/16/2009
10 mg
12/15/2009
12/18/2009
EVERY 8 HOURS IF NEEDED Sig: Take 1 Tab by mouth every 8 hours if needed for muscle spasm. Class: Inpatient Normal Route: ORAL 1g ONCALL TO Cefazolin (KEFZOL, ANCEF) 1 OR g (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued CONTINUOUS D5 / 0.45% NaCl 1,000 mL with INFUSION Potassium Chloride 20 mEq (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued 5-10 mg EVERY 6 Diazepam (VALIUM) Tablet 5-10 HOURS IF mg (Discontinued) NEEDED Class: Inpatient Normal
350 mg
12/15/2009
12/18/2009
12/15/2009
12/15/2009
12/15/2009
12/18/2009
12/16/2009
12/18/2009
000834
Route: ORAL DiphenhydrAMINE (BENADRYL) 25-50 mg (Discontinued) Class: Inpatient Normal Route: IV Docusate (COLACE) Capsule 100 mg (Discontinued) Class: Inpatient Normal Route: ORAL Fentanyl (SUBLIMAZE) 50 mcg (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued Ferrous Sulfate (FERATAB) Tablet 300 mg (Discontinued) Class: Inpatient Normal Route: ORAL Hydromorphone (DILAUDID) 0.4-0.6 mg (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued Hydromorphone (DILAUDID) 0.4-2 mg (Discontinued) Class: Inpatient Normal Route: IV Hydromorphone (DILAUDID) 0.4-3 mg (Discontinued) Class: Inpatient Normal Route: IV Hydromorphone 0.2 mg/mL (DILAUDID) PCA 50 mL (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued Lactated Ringers (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued Magnesium Hydroxide (MILK OF MAGNESIA) Liquid 30 mL (Discontinued) Class: Inpatient Normal Route: ORAL Meperidine (DEMEROL) 12.5 mg (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued Methadone (DOLOPHINE) Injection 100
25-50 mg
12/15/2009
12/18/2009
100 mg
TWO TIMES DAILY
12/15/2009
12/18/2009
50 mcg
12/15/2009
12/15/2009
300 mg
THREE TIMES 12/15/2009 DAILY
12/18/2009
0.4-0.6 mg
12/15/2009
12/15/2009
0.4-2 mg
12/15/2009
12/16/2009
0.4-3 mg
12/16/2009
12/17/2009
PCA
12/15/2009
12/18/2009
CONTINUOUS 12/15/2009 INFUSION
12/15/2009
30 mL
12/15/2009
12/18/2009
12.5 mg
PRN
12/15/2009
12/15/2009
100 mg
ONE TIME
12/15/2009
12/15/2009
000835
mg (Discontinued) Class: Inpatient Normal Route: IV Methadone (DOLOPHINE) Tablet 130 mg (Discontinued) Sig: Take 13 Tabs by mouth every day. Class: Inpatient Normal Route: ORAL Naloxone (NARCAN) 0.1 mg (Discontinued) Class: Inpatient Normal Route: IV Ondansetron (ZOFRAN) 4 mg (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued Ondansetron (ZOFRAN) 4 mg (Discontinued) Class: Inpatient Normal Route: IV Oxycodone 5 mg/Acetaminophen 325 mg (PERCOCET) Tablet 1-2 Tab (Discontinued) Class: Inpatient Normal Route: ORAL Oxycodone 5 mg/Acetaminophen 325 mg (PERCOCET) Tablet 1-2 Tab (Discontinued) Class: Inpatient Normal Route: ORAL Reason for Discontinue: Discontinued Promethazine (PHENERGAN) 12.5 mg (Discontinued)
ONLY
130 mg
DAILY MORNING
12/16/2009
12/17/2009
0.1 mg
PRN
12/15/2009
12/18/2009
4 mg
PRN
12/15/2009
12/15/2009
4 mg
12/15/2009
12/18/2009
1-2 tablet
12/15/2009
12/16/2009
1-2 tablet
EVERY 4 HOURS NOW
12/16/2009
12/17/2009
12.5 mg
12/15/2009
12/15/2009
Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued 2.5 mg DAILY 12/16/2009 Study Drug - Fondaparinux (IRB MORNING 200816251) Syringe 2.5 mg (Discontinued) Class: Inpatient Normal Comment: Question: call Jose Bosque 4-6291 or 762-5821 Fill from pyxis Route: SUBCUTANEOUS
12/18/2009
Allergies
Problem List
Noted Resolved
000836
1/19/2006


Appointment
Account # 038541463105
Phone 916-509-0158 (Home) 916-983-4484 (Work) Department Ucd Pre-Reg
Payor UCD
Financial Class P
000837
Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Authorizing Provider: Victor Henrique Baquero, MD 100 Tab 1 11/2/2009 Carisoprodol (SOMA) 350 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 8 hours if needed for muscle spasm. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 Authorizing Provider: Victor Henrique Baquero, MD
12/2/2009

Disp Refills 0 ALEVE 220 MG TAB (Discontinued) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 390 0 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 13 Tabs by mouth every day. - ORAL Start 10/27/2006 End 12/15/2009
10/9/2009
11/6/2009

DOB 9/23/1959
Contacts
10/12/2009 8:27 AM Type Phone (Incoming) Contact vi Phone 817-6533
Telephone Encounter
10/12/2009 8:27 AM
Reason for Call

Refill Request
Call Documentation
Andrea A Tinsey 10/12/2009 9:12 AM Signed Pharmacist notified. Andrea A Tinsey,MA

Electronically signed by Andrea A Tinsey at 10/12/2009 9:12 AM
Victor Baquero, MD, MD 10/12/2009 9:02 AM Signed Ok to fill early.

Jasvir K Bhele 10/12/2009 8:28 AM Signed Vi pharmacist calling wanting to know if it's ok to fill Methadone 5 days early since patient is leaving to go out of town.Pt is waiting at the phar
Electronically signed by Jasvir K Bhele at 10/12/2009 8:28 AM
Created by

Disp 42 Metronidazole (FLAGYL) 500 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth 3 times daily. No alcohol - ORAL Class: Pharmacy Refills 0 Start 5/28/2009 End 6/11/2009
000838
0 10/27/2006 ALEVE 220 MG TAB (Discontinued) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 100 1 8/26/2009 Carisoprodol (SOMA) 350 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 100 1 9/28/2009 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth every 4 hours if needed for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 390 0 10/9/2009 Methadone (DOLOPHINE) 10 mg PO Tablet (Taking) Sig - Route: Take 13 Tabs by mouth every day. - ORAL 100 1 4/27/2009 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026
12/15/2009
9/25/2009
10/28/2009
11/6/2009
5/27/2009
Inpatient 10/12/2009
5 mg
ONE TIME ONLY
12/15/2009
12/15/2009
5 mg
ONE TIME ONLY
12/15/2009
12/15/2009
40 mg
ONE TIME ONLY
12/18/2009
12/18/2009
1,000 mg
ONCALL TO OR
12/15/2009
12/15/2009
1,000 mg
EVERY 12 HOURS NOW
12/15/2009
12/16/2009
1,000 mg
ONE TIME ONLY
12/16/2009
12/16/2009
10 mg
12/15/2009
12/18/2009
350 mg
12/15/2009
12/18/2009
Sig: Take 1 Tab by mouth every 8 hours if needed for muscle spasm. Class: Inpatient Normal Route: ORAL 1g Cefazolin (KEFZOL, ANCEF) 1 g (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued D5 / 0.45% NaCl 1,000 mL with Potassium Chloride 20 mEq (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued
ONCALL TO OR
12/15/2009
12/15/2009
CONTINUOUS INFUSION
12/15/2009
12/18/2009
000839
Diazepam (VALIUM) Tablet 5-10 mg (Discontinued) Class: Inpatient Normal Route: ORAL DiphenhydrAMINE (BENADRYL) 25-50 mg (Discontinued) Class: Inpatient Normal Route: IV Docusate (COLACE) Capsule 100 mg (Discontinued) Class: Inpatient Normal Route: ORAL Fentanyl (SUBLIMAZE) 50 mcg (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued Ferrous Sulfate (FERATAB) Tablet 300 mg (Discontinued) Class: Inpatient Normal Route: ORAL Fluoxetine (PROZAC) Capsule 40 mg (Discontinued) Class: Inpatient Normal Route: ORAL Hydromorphone (DILAUDID) 0.4-0.6 mg (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued Hydromorphone (DILAUDID) 0.4-2 mg (Discontinued) Class: Inpatient Normal Route: IV Hydromorphone (DILAUDID) 0.4-2 mg (Discontinued) Class: Inpatient Normal Route: IV Hydromorphone (DILAUDID) 0.4-3 mg (Discontinued) Class: Inpatient Normal Route: IV Hydromorphone 0.2 mg/mL (DILAUDID) PCA 50 mL (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued Lactated Ringers (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued Magnesium Hydroxide (MILK OF MAGNESIA) Liquid 30 mL (Discontinued) Class: Inpatient Normal Route: ORAL Meperidine (DEMEROL) 12.5 mg (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued Methadone (DOLOPHINE) Injection 100 mg (Discontinued) Class: Inpatient Normal
5-10 mg
12/16/2009
12/18/2009
25-50 mg
12/15/2009
12/18/2009
100 mg
TWO TIMES DAILY
12/15/2009
12/18/2009
50 mcg
12/15/2009
12/15/2009
300 mg
THREE TIMES DAILY
12/15/2009
12/18/2009
40 mg
DAILY MORNING
12/16/2009
12/18/2009
0.4-0.6 mg
12/15/2009
12/15/2009
0.4-2 mg
12/15/2009
12/16/2009
0.4-2 mg
12/17/2009
12/18/2009
0.4-3 mg
12/16/2009
12/17/2009
PCA
12/15/2009
12/18/2009
CONTINUOUS INFUSION
12/15/2009
12/15/2009
30 mL
12/15/2009
12/18/2009
12.5 mg
PRN
12/15/2009
12/15/2009
100 mg
ONE TIME ONLY
12/15/2009
12/15/2009
000840
Route: IV Methadone (DOLOPHINE) Tablet 130 mg (Discontinued) Sig: Take 13 Tabs by mouth every day. Class: Inpatient Normal Route: ORAL Methadone (DOLOPHINE) Tablet 40 mg (Discontinued) Sig: Take 13 Tabs by mouth every day. Class: Inpatient Normal Route: ORAL Methadone (DOLOPHINE) Tablet 40 mg (Discontinued) Class: Inpatient Normal Route: ORAL Methadone (DOLOPHINE) Tablet 50 mg (Discontinued) Class: Inpatient Normal Route: ORAL Naloxone (NARCAN) 0.1 mg (Discontinued) Class: Inpatient Normal Route: IV Ondansetron (ZOFRAN) 4 mg (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued Ondansetron (ZOFRAN) 4 mg (Discontinued) Class: Inpatient Normal Route: IV Oxycodone (OXYCONTIN) SR Tablet 20 mg (Discontinued)
130 mg
DAILY MORNING
12/16/2009
12/17/2009
40 mg
DAILY MORNING
12/18/2009
12/18/2009
40 mg
DAILY AT 1700
12/17/2009
12/18/2009
50 mg
DAILY AT 2100
12/17/2009
12/18/2009
0.1 mg
PRN
12/15/2009
12/18/2009
4 mg
PRN
12/15/2009
12/15/2009
4 mg
12/15/2009
12/18/2009
20 mg
12/17/2009
12/17/2009
Class: Inpatient Normal Comment: q 3 hrs prn breakthrough pain and 60 minutes prior to PT Route: ORAL Reason for Discontinue: Duplicate Order 20 mg Oxycodone (ROXICODONE) Tablet 20 mg (Discontinued) Class: Inpatient Normal Route: ORAL Oxycodone (ROXICODONE) Tablet 20 mg (Discontinued) Class: Inpatient Normal Route: ORAL Oxycodone 5 mg/Acetaminophen 325 mg (PERCOCET) Tablet 1-2 Tab (Discontinued) Class: Inpatient Normal Route: ORAL Oxycodone 5 mg/Acetaminophen 325 mg (PERCOCET) Tablet 1-2 Tab (Discontinued) Class: Inpatient Normal Route: ORAL Reason for Discontinue: Discontinued Promethazine (PHENERGAN) 12.5 mg (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued Sennosides (SENOKOT) Tablet 2 Tab (Discontinued) Class: Inpatient Normal Route: ORAL Study Drug - Fondaparinux (IRB 200816251)
12/17/2009
12/18/2009
20 mg
PRN
12/17/2009
12/18/2009
1-2 tablet
12/15/2009
12/16/2009
1-2 tablet
EVERY 4 HOURS NOW
12/16/2009
12/17/2009
12.5 mg
12/15/2009
12/15/2009
2 tablet
DAILY AT BEDTIME
12/17/2009
12/18/2009
2.5 mg
DAILY
12/16/2009
12/18/2009
000841
Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 100 Tab 1 11/2/2009 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 hours if needed for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 0 10/27/2006 ALEVE 220 MG TAB (Discontinued) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 0 10/9/2009 390 Methadone (DOLOPHINE) 10 mg PO Tablet (Discontinued) Sig - Route: Take 13 Tabs by mouth every day. - ORAL
12/2/2009
12/15/2009
11/5/2009
RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills Start End 1 11/2/2009 12/2/2009 Carisoprodol (SOMA) 350 mg PO Tablet 100 Tab Sig - Route: Take 1 Tab by mouth every 8 hours if needed for muscle spasm. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 1 11/2/2009 12/2/2009 Hydrocodone 10 mg/Acetaminophen 325 100 Tab mg (NORCO) 10-325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 hours if needed for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 250 Tab 0 5/24/2010 6/15/2010 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL 0 10/27/2006 12/15/2009 ALEVE 220 MG TAB (Discontinued) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical Carisoprodol (SOMA) 350 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL
000842
Class: Historical Fluoxetine (PROZAC) 40 mg PO capsule Sig - Route: Take 1 Cap by mouth every day. - ORAL Class: Historical Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 hours if needed. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources or less as directed by your doctor. ** ORAL Class: Historical 390 0 10/9/2009 11/6/2009 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 13 Tabs by mouth every day. - ORAL 0 11/14/2006 5/24/2010 240 METHADONE 10 MG TAB (Discontinued) Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 6/30/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 100 1 4/27/2009 5/27/2009 NORCO 10 MG-325 MG TAB Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Inpatient 11/4/2009 Cefazolin (KEFZOL, ANCEF) 1 g Class: Inpatient Normal Route: IV Diazepam (VALIUM) 5 mg Class: Inpatient Normal Route: IV Diazepam (VALIUM) 5 mg Class: Inpatient Normal Route: IV Methadone (DOLOPHINE) Tablet 40 mg Class: Inpatient Normal Route: ORAL Vancomycin (VANCOCIN) . Class: Inpatient Normal Route: IV Vancomycin (VANCOCIN) . Class: Inpatient Normal Route: IV Vancomycin (VANCOCIN) . Class: Inpatient Normal Route: IV Bisacodyl (DULCOLAX) Suppository 10 mg (Discontinued) Class: Inpatient Normal
5 mg
ONE TIME ONLY
12/15/2009
12/15/2009
5 mg
ONE TIME ONLY
12/15/2009
12/15/2009
40 mg
ONE TIME ONLY
12/18/2009
12/18/2009
1,000 mg
ONCALL TO OR
12/15/2009
12/15/2009
1,000 mg
EVERY 12 HOURS NOW
12/15/2009
12/16/2009
1,000 mg
ONE TIME ONLY
12/16/2009
12/16/2009
10 mg
12/15/2009
12/18/2009
000843
EVERY 8 HOURS IF NEEDED Sig: Take 1 Tab by mouth every 8 hours if needed for muscle spasm. Class: Inpatient Normal Route: ORAL 1g ONCALL TO Cefazolin (KEFZOL, ANCEF) 1 OR g (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued CONTINUOUS D5 / 0.45% NaCl 1,000 mL with INFUSION Potassium Chloride 20 mEq (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued EVERY 6 5-10 mg Diazepam (VALIUM) Tablet 5-10 HOURS IF mg (Discontinued) NEEDED Class: Inpatient Normal Route: ORAL EVERY 6 25-50 mg DiphenhydrAMINE (BENADRYL) 25-50 HOURS IF mg (Discontinued) NEEDED Class: Inpatient Normal Route: IV 100 mg TWO TIMES Docusate (COLACE) Capsule 100 DAILY mg (Discontinued) Class: Inpatient Normal Route: ORAL 50 mcg EVERY 5 Fentanyl (SUBLIMAZE) 50 mcg MINUTES IF (Discontinued) NEEDED Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued 300 mg THREE TIMES Ferrous Sulfate (FERATAB) Tablet 300 DAILY mg (Discontinued) Class: Inpatient Normal Route: ORAL 40 mg DAILY Fluoxetine (PROZAC) Capsule 40 MORNING mg (Discontinued) Class: Inpatient Normal Route: ORAL EVERY 15 0.4-0.6 mg Hydromorphone (DILAUDID) 0.4-0.6 MINUTES IF mg (Discontinued) NEEDED Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued 0.4-2 mg EVERY 1 Hydromorphone (DILAUDID) 0.4-2 HOUR IF mg (Discontinued) NEEDED Class: Inpatient Normal Route: IV
Route: RECTALLY Carisoprodol (SOMA) Tablet 350 mg (Discontinued)
350 mg
12/15/2009
12/18/2009
12/15/2009
12/15/2009
12/15/2009
12/18/2009
12/16/2009
12/18/2009
12/15/2009
12/18/2009
12/15/2009
12/18/2009
12/15/2009
12/15/2009
12/15/2009
12/18/2009
12/16/2009
12/18/2009
12/15/2009
12/15/2009
12/15/2009
12/16/2009
000844
Hydromorphone (DILAUDID) 0.4-2 mg (Discontinued) Class: Inpatient Normal Route: IV Hydromorphone (DILAUDID) 0.4-3 mg (Discontinued) Class: Inpatient Normal Route: IV Hydromorphone 0.2 mg/mL (DILAUDID) PCA 50 mL (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued Lactated Ringers (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued Magnesium Hydroxide (MILK OF MAGNESIA) Liquid 30 mL (Discontinued) Class: Inpatient Normal Route: ORAL Meperidine (DEMEROL) 12.5 mg (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued Methadone (DOLOPHINE) Injection 100 mg (Discontinued) Class: Inpatient Normal Route: IV Methadone (DOLOPHINE) Tablet 130 mg (Discontinued) Sig: Take 13 Tabs by mouth every day. Class: Inpatient Normal Route: ORAL Methadone (DOLOPHINE) Tablet 40 mg (Discontinued) Sig: Take 13 Tabs by mouth every day. Class: Inpatient Normal Route: ORAL Methadone (DOLOPHINE) Tablet 40 mg (Discontinued) Class: Inpatient Normal Route: ORAL Methadone (DOLOPHINE) Tablet 50 mg (Discontinued) Class: Inpatient Normal Route: ORAL Naloxone (NARCAN) 0.1 mg (Discontinued) Class: Inpatient Normal Route: IV
0.4-2 mg
12/17/2009
12/18/2009
0.4-3 mg
12/16/2009
12/17/2009
PCA
12/15/2009
12/18/2009
12/15/2009
30 mL
12/15/2009
12/18/2009
12.5 mg
PRN
12/15/2009
12/15/2009
100 mg
ONE TIME ONLY
12/15/2009
12/15/2009
130 mg
DAILY MORNING
12/16/2009
12/17/2009
40 mg
DAILY MORNING
12/18/2009
12/18/2009
40 mg
DAILY AT 1700
12/17/2009
12/18/2009
50 mg
DAILY AT 2100
12/17/2009
12/18/2009
0.1 mg
PRN
12/15/2009
12/18/2009
000845
Ondansetron (ZOFRAN) 4 mg (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued Ondansetron (ZOFRAN) 4 mg (Discontinued) Class: Inpatient Normal Route: IV Oxycodone (OXYCONTIN) SR Tablet 20 mg (Discontinued)
4 mg
PRN
12/15/2009
12/15/2009
4 mg
12/15/2009
12/18/2009
20 mg
12/17/2009
12/17/2009
Class: Inpatient Normal Comment: q 3 hrs prn breakthrough pain and 60 minutes prior to PT Route: ORAL Reason for Discontinue: Duplicate Order EVERY 3 20 mg Oxycodone (ROXICODONE) Tablet 20 HOURS IF mg (Discontinued) NEEDED Class: Inpatient Normal Route: ORAL PRN 20 mg Oxycodone (ROXICODONE) Tablet 20 mg (Discontinued) Class: Inpatient Normal Route: ORAL EVERY 4 1-2 tablet Oxycodone 5 mg/Acetaminophen 325 HOURS IF mg (PERCOCET) Tablet 1-2 NEEDED Tab (Discontinued) Class: Inpatient Normal Route: ORAL 1-2 tablet EVERY 4 Oxycodone 5 mg/Acetaminophen 325 HOURS NOW mg (PERCOCET) Tablet 1-2 Tab (Discontinued) Class: Inpatient Normal Route: ORAL Reason for Discontinue: Discontinued EVERY 4 12.5 mg Promethazine (PHENERGAN) 12.5 HOURS IF mg (Discontinued) NEEDED Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued 2 tablet DAILY AT Sennosides (SENOKOT) Tablet 2 BEDTIME Tab (Discontinued) Class: Inpatient Normal Route: ORAL 2.5 mg DAILY Study Drug - Fondaparinux (IRB MORNING 200816251) Syringe 2.5 mg (Discontinued) Class: Inpatient Normal Comment: Question: call Jose Bosque 4-6291 or 762-5821 Fill from pyxis Route: SUBCUTANEOUS
12/17/2009
12/18/2009
12/17/2009
12/18/2009
12/15/2009
12/16/2009
12/16/2009
12/17/2009
12/15/2009
12/15/2009
12/17/2009
12/18/2009
12/16/2009
12/18/2009
Allergies
Allergies
000846
Chart Cosign
Patient Information

Telephone Encounter
12/2/2009 8:23 AM
Created by

Disp Refills Start 100 Tab 1 11/2/2009 Carisoprodol (SOMA) 350 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 8 hours if needed for muscle spasm. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 100 Tab 1 11/2/2009 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 hours if needed for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 0 10/27/2006 ALEVE 220 MG TAB (Discontinued) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 390 Tab 0 11/5/2009 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 13 Tabs by mouth every day. - ORAL End 12/2/2009
12/2/2009
12/15/2009
12/3/2009
Orders Chart Cosign

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
000847
Medications
Medications at Start of Encounter Disp Refills Start End 1 11/2/2009 12/2/2009 Carisoprodol (SOMA) 350 mg PO Tablet 100 Tab Sig - Route: Take 1 Tab by mouth every 8 hours if needed for muscle spasm. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 1 11/2/2009 12/2/2009 Hydrocodone 10 mg/Acetaminophen 325 100 Tab mg (NORCO) 10-325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 hours if needed for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 250 Tab 0 5/24/2010 6/15/2010 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL 0 10/27/2006 12/15/2009 ALEVE 220 MG TAB (Discontinued) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical Carisoprodol (SOMA) 350 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical Fluoxetine (PROZAC) 40 mg PO capsule Sig - Route: Take 1 Cap by mouth every day. - ORAL Class: Historical Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 hours if needed. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources or less as directed by your doctor. ** ORAL Class: Historical 390 Tab 0 11/5/2009 12/3/2009 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 13 Tabs by mouth every day. - ORAL 240 0 11/14/2006 5/24/2010 METHADONE 10 MG TAB (Discontinued) Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 6/30/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 100 1 4/27/2009 5/27/2009 NORCO 10 MG-325 MG TAB Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Inpatient 12/1/2009 Cefazolin (KEFZOL, ANCEF) 1 g Class: Inpatient Normal Route: IV Diazepam (VALIUM) 5 mg Class: Inpatient Normal Route: IV Dose 1g Frequency EVERY 8 HOURS NOW Start 12/15/2009 End 12/16/2009
5 mg
ONE TIME ONLY
12/15/2009
12/15/2009
000848
Diazepam (VALIUM) 5 mg Class: Inpatient Normal Route: IV Methadone (DOLOPHINE) Tablet 40 mg Class: Inpatient Normal Route: ORAL Vancomycin (VANCOCIN) . Class: Inpatient Normal Route: IV Vancomycin (VANCOCIN) . Class: Inpatient Normal Route: IV Vancomycin (VANCOCIN) . Class: Inpatient Normal Route: IV Bisacodyl (DULCOLAX) Suppository 10 mg (Discontinued) Class: Inpatient Normal Route: RECTALLY Carisoprodol (SOMA) Tablet 350 mg (Discontinued)
5 mg
ONE TIME ONLY
12/15/2009
12/15/2009
40 mg
ONE TIME ONLY
12/18/2009
12/18/2009
1,000 mg
ONCALL TO OR
12/15/2009
12/15/2009
1,000 mg
EVERY 12 HOURS NOW
12/15/2009
12/16/2009
1,000 mg
ONE TIME ONLY
12/16/2009
12/16/2009
10 mg
12/15/2009
12/18/2009
EVERY 8 HOURS IF NEEDED Sig: Take 1 Tab by mouth every 8 hours if needed for muscle spasm. Class: Inpatient Normal Route: ORAL ONCALL TO 1g Cefazolin (KEFZOL, ANCEF) 1 OR g (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued CONTINUOUS D5 / 0.45% NaCl 1,000 mL with INFUSION Potassium Chloride 20 mEq (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued 5-10 mg EVERY 6 Diazepam (VALIUM) Tablet 5-10 HOURS IF mg (Discontinued) NEEDED Class: Inpatient Normal Route: ORAL 25-50 mg EVERY 6 DiphenhydrAMINE (BENADRYL) 25-50 HOURS IF mg (Discontinued) NEEDED Class: Inpatient Normal Route: IV 100 mg TWO TIMES Docusate (COLACE) Capsule 100 DAILY mg (Discontinued) Class: Inpatient Normal Route: ORAL 50 mcg EVERY 5 Fentanyl (SUBLIMAZE) 50 mcg
350 mg
12/15/2009
12/18/2009
12/15/2009
12/15/2009
12/15/2009
12/18/2009
12/16/2009
12/18/2009
12/15/2009
12/18/2009
12/15/2009
12/18/2009
12/15/2009
12/15/2009
000849
(Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued Ferrous Sulfate (FERATAB) Tablet 300 mg (Discontinued) Class: Inpatient Normal Route: ORAL Fluoxetine (PROZAC) Capsule 40 mg (Discontinued) Class: Inpatient Normal Route: ORAL Hydromorphone (DILAUDID) 0.4-0.6 mg (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued Hydromorphone (DILAUDID) 0.4-2 mg (Discontinued) Class: Inpatient Normal Route: IV Hydromorphone (DILAUDID) 0.4-2 mg (Discontinued) Class: Inpatient Normal Route: IV Hydromorphone (DILAUDID) 0.4-3 mg (Discontinued) Class: Inpatient Normal Route: IV Hydromorphone 0.2 mg/mL (DILAUDID) PCA 50 mL (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued Lactated Ringers (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued Magnesium Hydroxide (MILK OF MAGNESIA) Liquid 30 mL (Discontinued) Class: Inpatient Normal Route: ORAL Meperidine (DEMEROL) 12.5 mg (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued Methadone (DOLOPHINE) Injection 100 mg (Discontinued) Class: Inpatient Normal
MINUTES IF NEEDED
300 mg
THREE TIMES 12/15/2009 DAILY
12/18/2009
40 mg
DAILY MORNING
12/16/2009
12/18/2009
0.4-0.6 mg
12/15/2009
12/15/2009
0.4-2 mg
12/15/2009
12/16/2009
0.4-2 mg
12/17/2009
12/18/2009
0.4-3 mg
12/16/2009
12/17/2009
PCA
12/15/2009
12/18/2009
12/15/2009
30 mL
12/15/2009
12/18/2009
12.5 mg
PRN
12/15/2009
12/15/2009
100 mg
ONE TIME ONLY
12/15/2009
12/15/2009
000850
Route: IV Methadone (DOLOPHINE) Tablet 130 mg (Discontinued) Sig: Take 13 Tabs by mouth every day. Class: Inpatient Normal Route: ORAL Methadone (DOLOPHINE) Tablet 40 mg (Discontinued) Sig: Take 13 Tabs by mouth every day. Class: Inpatient Normal Route: ORAL Methadone (DOLOPHINE) Tablet 40 mg (Discontinued) Class: Inpatient Normal Route: ORAL Methadone (DOLOPHINE) Tablet 50 mg (Discontinued) Class: Inpatient Normal Route: ORAL Naloxone (NARCAN) 0.1 mg (Discontinued) Class: Inpatient Normal Route: IV Ondansetron (ZOFRAN) 4 mg (Discontinued) Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued Ondansetron (ZOFRAN) 4 mg (Discontinued) Class: Inpatient Normal Route: IV Oxycodone (OXYCONTIN) SR Tablet 20 mg (Discontinued)
130 mg
DAILY MORNING
12/16/2009
12/17/2009
40 mg
DAILY MORNING
12/18/2009
12/18/2009
40 mg
DAILY AT 1700
12/17/2009
12/18/2009
50 mg
DAILY AT 2100
12/17/2009
12/18/2009
0.1 mg
PRN
12/15/2009
12/18/2009
4 mg
PRN
12/15/2009
12/15/2009
4 mg
12/15/2009
12/18/2009
20 mg
12/17/2009
12/17/2009
Class: Inpatient Normal Comment: q 3 hrs prn breakthrough pain and 60 minutes prior to PT Route: ORAL Reason for Discontinue: Duplicate Order 20 mg EVERY 3 Oxycodone (ROXICODONE) Tablet 20 HOURS IF mg (Discontinued) NEEDED Class: Inpatient Normal Route: ORAL 20 mg PRN Oxycodone (ROXICODONE) Tablet 20 mg (Discontinued) Class: Inpatient Normal Route: ORAL EVERY 4 1-2 tablet Oxycodone 5 mg/Acetaminophen 325 HOURS IF mg (PERCOCET) Tablet 1-2 NEEDED Tab (Discontinued) Class: Inpatient Normal Route: ORAL 1-2 tablet EVERY 4 Oxycodone 5 mg/Acetaminophen 325 HOURS NOW mg (PERCOCET) Tablet 1-2
12/17/2009
12/18/2009
12/17/2009
12/18/2009
12/15/2009
12/16/2009
12/16/2009
12/17/2009
000851
Tab (Discontinued) Class: Inpatient Normal Route: ORAL Reason for Discontinue: Discontinued Promethazine (PHENERGAN) 12.5 mg (Discontinued)
12.5 mg
12/15/2009
12/15/2009
Class: Inpatient Normal Route: IV Reason for Discontinue: Discontinued 2 tablet DAILY AT 12/17/2009 Sennosides (SENOKOT) Tablet 2 BEDTIME Tab (Discontinued) Class: Inpatient Normal Route: ORAL DAILY 12/16/2009 2.5 mg Study Drug - Fondaparinux (IRB MORNING 200816251) Syringe 2.5 mg (Discontinued) Class: Inpatient Normal Comment: Question: call Jose Bosque 4-6291 or 762-5821 Fill from pyxis Route: SUBCUTANEOUS
12/18/2009
12/18/2009
Allergies
Problem List
Noted Resolved
1/19/2006


000852
200816251) Syringe Sig - Route: Inject 1 Syringe subcutaneously every morning. - SUBCUTANEOUS Class: Historical
Allergies
Problem List
1/19/2006


RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
000853
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills Start End Carisoprodol (SOMA) 350 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical Diazepam (VALIUM) 5 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 8 hours if needed. - ORAL Class: Historical DiphenhydrAMINE (BENADRYL) 25 mg PO Capsule Sig - Route: Take 1 Cap by mouth every 6 hours if needed. - ORAL Class: Historical Docusate (COLACE) 100 mg PO Capsule Sig - Route: Take 1 Cap by mouth 2 times daily. - ORAL Class: Historical Ferrous Sulfate (FERATAB) 300 mg (60 mg Iron) PO Tablet Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Historical Fluoxetine (PROZAC) 40 mg PO capsule Sig - Route: Take 1 Cap by mouth every day. - ORAL Class: Historical Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 hours if needed. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources or less as directed by your doctor. ** ORAL Class: Historical 0 12/2/2009 12/23/2009 390 Tab Methadone (DOLOPHINE) 10 mg PO Tablet (Discontinued) Sig - Route: Take 13 Tabs by mouth every day. - ORAL Number of times this order has been changed since signing: 1 Order Audit Trail 12/21/2009 Oxycodone 20 mg PO Tab Sig - Route: Take 1 Tab by mouth every 3 hours if needed. For pain. - ORAL Class: Historical Pantoprazole (PROTONIX) 40 mg PO Delayed Release Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Historical SENNOSIDES (SENNA PO) Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical
000854
Chart Cosign
RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Medications at Start of Encounter Disp Refills Start End Carisoprodol (SOMA) 350 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical Diazepam (VALIUM) 5 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 8 hours if needed. - ORAL Class: Historical DiphenhydrAMINE (BENADRYL) 25 mg PO Capsule Sig - Route: Take 1 Cap by mouth every 6 hours if needed. - ORAL Class: Historical Docusate (COLACE) 100 mg PO Capsule Sig - Route: Take 1 Cap by mouth 2 times daily. - ORAL Class: Historical Ferrous Sulfate (FERATAB) 300 mg (60 mg Iron) PO Tablet Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Historical Fluoxetine (PROZAC) 40 mg PO capsule Sig - Route: Take 1 Cap by mouth every day. - ORAL Class: Historical Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 hours if needed. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources or less as directed by your doctor. ** ORAL
000855
Appointment
Sex Male

DOB 9/23/1959
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Center None
RH MD Msg
MRN
Sex
DOB
PATIENTPHONE
000856
Amundsen, Mark
8081369
Male
9/23/1959
916-509-0158
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills Start End Carisoprodol (SOMA) 350 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical Diazepam (VALIUM) 5 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 8 hours if needed. - ORAL Class: Historical DiphenhydrAMINE (BENADRYL) 25 mg PO Capsule Sig - Route: Take 1 Cap by mouth every 6 hours if needed. - ORAL Class: Historical Docusate (COLACE) 100 mg PO Capsule Sig - Route: Take 1 Cap by mouth 2 times daily. - ORAL Class: Historical Ferrous Sulfate (FERATAB) 300 mg (60 mg Iron) PO Tablet Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Historical Fluoxetine (PROZAC) 40 mg PO capsule Sig - Route: Take 1 Cap by mouth every day. - ORAL Class: Historical Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 hours if needed. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources or less as directed by your doctor. ** ORAL Class: Historical 390 Tab 0 12/23/2009 1/20/2010 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 13 Tabs by mouth every day. - ORAL 12/21/2009 Oxycodone 20 mg PO Tab Sig - Route: Take 1 Tab by mouth every 3 hours if needed. For pain. - ORAL Class: Historical Pantoprazole (PROTONIX) 40 mg PO Delayed Release Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Historical SENNOSIDES (SENNA PO) Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical Study Drug - Fondaparinux (IRB
000857
Problem List
1/19/2006


Department Orthopaedics Encounter # 29493709
Patient Information

Telephone Encounter
1/8/2010 2:48 PM
Reason for Call

Refill Request
Routing History
1/8/2010 2:48 PM
From Clare Jennings, MA
To Victor Henrique Baquero, MD
Priority Routine
Created by
Clare Jennings, MA on 1/8/2010 2:48 PM
Approved
Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10Disp 100 Tab Refills 0 Start 1/8/2010 End 6/4/2010
000858
325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy Authorizing Provider: Victor Henrique Baquero, MD

Disp Refills Start End Carisoprodol (SOMA) 350 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical Diazepam (VALIUM) 5 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 8 hours if needed. - ORAL Class: Historical DiphenhydrAMINE (BENADRYL) 25 mg PO Capsule Sig - Route: Take 1 Cap by mouth every 6 hours if needed. - ORAL Class: Historical Docusate (COLACE) 100 mg PO Capsule Sig - Route: Take 1 Cap by mouth 2 times daily. - ORAL Class: Historical Ferrous Sulfate (FERATAB) 300 mg (60 mg Iron) PO Tablet Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Historical Fluoxetine (PROZAC) 40 mg PO capsule Sig - Route: Take 1 Cap by mouth every day. - ORAL Class: Historical 1/8/2010 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet (Discontinued) Sig - Route: Take 1 Tab by mouth every 4 hours if needed. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources or less as directed by your doctor. ** - ORAL Class: Historical 390 Tab 0 12/23/2009 1/20/2010 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 13 Tabs by mouth every day. - ORAL 12/21/2009 Oxycodone 20 mg PO Tab Sig - Route: Take 1 Tab by mouth every 3 hours if needed. For pain. - ORAL Class: Historical Pantoprazole (PROTONIX) 40 mg PO Delayed Release Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Historical SENNOSIDES (SENNA PO) Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical Study Drug - Fondaparinux (IRB 200816251) Syringe Sig - Route: Inject 1 Syringe subcutaneously every morning. - SUBCUTANEOUS Class: Historical

Appointment
Orders
DOB 9/23/1959
Account # 038541463105
Patient Demographics
000859
Class: Historical 100 Tab 0 1/8/2010 2/8/2010 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 0 12/23/2009 1/20/2010 390 Tab Methadone (DOLOPHINE) 10 mg PO Tablet (Discontinued) Sig - Route: Take 13 Tabs by mouth every day. - ORAL 12/21/2009 Oxycodone 20 mg PO Tab Sig - Route: Take 1 Tab by mouth every 3 hours if needed. For pain. - ORAL Class: Historical Pantoprazole (PROTONIX) 40 mg PO Delayed Release Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Historical SENNOSIDES (SENNA PO) Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical Study Drug - Fondaparinux (IRB 200816251) Syringe Sig - Route: Inject 1 Syringe subcutaneously every morning. - SUBCUTANEOUS Class: Historical
Orders Chart Cosign

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Medications at Start of Encounter Disp Refills 250 Tab 0 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Start 5/24/2010 End 6/15/2010
000860
Carisoprodol (SOMA) 350 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical Diazepam (VALIUM) 5 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 8 hours if needed. - ORAL Class: Historical DiphenhydrAMINE (BENADRYL) 25 mg PO Capsule Sig - Route: Take 1 Cap by mouth every 6 hours if needed. - ORAL Class: Historical Docusate (COLACE) 100 mg PO Capsule Sig - Route: Take 1 Cap by mouth 2 times daily. - ORAL Class: Historical Ferrous Sulfate (FERATAB) 300 mg (60 mg Iron) PO Tablet Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Historical Fluoxetine (PROZAC) 40 mg PO capsule Sig - Route: Take 1 Cap by mouth every day. - ORAL Class: Historical 0 1/8/2010 2/8/2010 Hydrocodone 10 mg/Acetaminophen 325 100 Tab mg (NORCO) 10-325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 390 Tab 0 1/20/2010 2/17/2010 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 13 Tabs by mouth every day. - ORAL 0 11/14/2006 5/24/2010 240 METHADONE 10 MG TAB (Discontinued) Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 6/30/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 100 1 4/27/2009 5/27/2009 NORCO 10 MG-325 MG TAB Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 12/21/2009 Oxycodone 20 mg PO Tab Sig - Route: Take 1 Tab by mouth every 3 hours if needed. For pain. - ORAL Class: Historical Pantoprazole (PROTONIX) 40 mg PO Delayed Release Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Historical SENNOSIDES (SENNA PO) Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical Study Drug - Fondaparinux (IRB 200816251) Syringe Sig - Route: Inject 1 Syringe subcutaneously every morning. - SUBCUTANEOUS Class: Historical
Allergies
000861
Plan UCD/B/S HMO
Financial Class P
Plan Number B72
Plan Phone 916-734-0739
Center None
RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Patient Demographics Address 2025 TARBOLTON CIR
Phone 916-509-0158 (Home)
000862
FOLSOM CA 95630
916-983-4484 (Work)
Medications
Disp Refills Start End 250 Tab 0 5/24/2010 6/15/2010 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Carisoprodol (SOMA) 350 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical Diazepam (VALIUM) 5 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 8 hours if needed. - ORAL Class: Historical DiphenhydrAMINE (BENADRYL) 25 mg PO Capsule Sig - Route: Take 1 Cap by mouth every 6 hours if needed. - ORAL Class: Historical Docusate (COLACE) 100 mg PO Capsule Sig - Route: Take 1 Cap by mouth 2 times daily. - ORAL Class: Historical Ferrous Sulfate (FERATAB) 300 mg (60 mg Iron) PO Tablet Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Historical Fluoxetine (PROZAC) 40 mg PO capsule Sig - Route: Take 1 Cap by mouth every day. - ORAL Class: Historical 0 1/8/2010 2/8/2010 Hydrocodone 10 mg/Acetaminophen 325 100 Tab mg (NORCO) 10-325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 390 Tab 0 1/20/2010 2/17/2010 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 13 Tabs by mouth every day. - ORAL 240 0 11/14/2006 5/24/2010 METHADONE 10 MG TAB (Discontinued) Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 6/30/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 12/21/2009 Oxycodone 20 mg PO Tab Sig - Route: Take 1 Tab by mouth every 3 hours if needed. For pain. - ORAL Class: Historical Pantoprazole (PROTONIX) 40 mg PO Delayed Release Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Historical SENNOSIDES (SENNA PO) Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical
000863
Study Drug - Fondaparinux (IRB 200816251) Syringe Sig - Route: Inject 1 Syringe subcutaneously every morning. - SUBCUTANEOUS Class: Historical
Allergies
Problem List
1/19/2006


Department Orthopaedics Encounter # 29493709
Patient Information

Telephone Encounter
1/20/2010 9:30 AM
Reason for Call

Refill Request
000864



RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Medications at Start of Encounter Disp Refills 250 Tab 0 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Carisoprodol (SOMA) 350 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical Fluoxetine (PROZAC) 40 mg PO capsule Sig - Route: Take 1 Cap by mouth every day. - ORAL Class: Historical Start 5/24/2010 End 6/15/2010
000865
0 1/8/2010 2/8/2010 Hydrocodone 10 mg/Acetaminophen 325 100 Tab mg (NORCO) 10-325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 390 Tab 0 1/20/2010 2/17/2010 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 13 Tabs by mouth every day. - ORAL 0 11/14/2006 5/24/2010 240 METHADONE 10 MG TAB (Discontinued) Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 6/30/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 100 1 4/27/2009 5/27/2009 NORCO 10 MG-325 MG TAB Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026
Allergies
Problem List
1/19/2006


000866
RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Medications at Start of Encounter Disp Refills Start End 250 Tab 0 5/24/2010 6/15/2010 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Carisoprodol (SOMA) 350 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical Fluoxetine (PROZAC) 40 mg PO capsule Sig - Route: Take 1 Cap by mouth every day. - ORAL Class: Historical 0 1/8/2010 2/8/2010 Hydrocodone 10 mg/Acetaminophen 325 100 Tab mg (NORCO) 10-325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 390 Tab 0 1/20/2010 2/17/2010 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 13 Tabs by mouth every day. - ORAL 240 0 11/14/2006 5/24/2010 METHADONE 10 MG TAB (Discontinued) Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 6/30/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 100 1 4/27/2009 5/27/2009 NORCO 10 MG-325 MG TAB Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026
000867
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Medications at Start of Encounter Disp Refills Start End 60 Tab 0 2/19/2010 3/19/2010 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take by mouth. Maximum of 2 tablets up to 4 times a day - ORAL Class: Handwritten Rx Carisoprodol (SOMA) 350 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical Fluoxetine (PROZAC) 40 mg PO capsule Sig - Route: Take 1 Cap by mouth every day. - ORAL Class: Historical 0 1/8/2010 2/8/2010 Hydrocodone 10 mg/Acetaminophen 325 100 Tab mg (NORCO) 10-325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 390 Tab 0 1/20/2010 2/17/2010 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 13 Tabs by mouth every day. - ORAL
Allergies
Problem List
Noted Resolved
1/19/2006
000868
Amundsen, Mark
8081369
Male
9/23/1959
916-509-0158
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills Start End 60 Tab 0 2/19/2010 3/19/2010 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take by mouth. Maximum of 2 tablets up to 4 times a day - ORAL Class: Handwritten Rx 250 Tab 0 5/24/2010 6/15/2010 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Carisoprodol (SOMA) 350 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical ERGOCALCIFEROL (VITAMIN D PO) Sig - Route: Take by mouth. - ORAL Class: Historical Fluoxetine (PROZAC) 40 mg PO capsule Sig - Route: Take 1 Cap by mouth every day. - ORAL Class: Historical 0 1/8/2010 2/8/2010 Hydrocodone 10 mg/Acetaminophen 325 100 Tab mg (NORCO) 10-325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 240 0 11/14/2006 5/24/2010 METHADONE 10 MG TAB (Discontinued) Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 6/30/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 100 1 4/27/2009 5/27/2009 NORCO 10 MG-325 MG TAB Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026
Allergies
Problem List
000869
BACKACHE NOS
1/19/2006


Anemia Orthopedic Aftercare for Joint Replacement Previous Visit 2/22/2010 2:45 PM Department Ucd Registration Encounter # 30139902
Appointment
Encounter-Level Documents: There are no encounter-level documents. Insurance Information Acct Number 038541463022 Financial Class P
000870
916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills Start End 250 Tab 0 5/24/2010 6/15/2010 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Carisoprodol (SOMA) 350 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical ERGOCALCIFEROL (VITAMIN D PO) Sig - Route: Take by mouth. - ORAL Class: Historical Fluoxetine (PROZAC) 40 mg PO capsule Sig - Route: Take 1 Cap by mouth every day. - ORAL Class: Historical 0 1/8/2010 2/8/2010 Hydrocodone 10 mg/Acetaminophen 325 100 Tab mg (NORCO) 10-325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 250 Tab 0 4/14/2010 5/14/2010 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL 0 11/14/2006 5/24/2010 240 METHADONE 10 MG TAB (Discontinued) Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 100 1 4/27/2009 5/27/2009 NORCO 10 MG-325 MG TAB Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026
Allergies
Problem List
Noted Resolved
1/19/2006
MRI 2006
000871
Electronically signed by Victor Henrique Baquero, MD at 5/12/2010 8:53 AM
Routing History
5/12/2010 8:53 AM 5/11/2010 2:59 PM From Victor Henrique Baquero, MD Teri L Rhodewalt To P FOL MA FP Victor Henrique Baquero, MD Priority Routine Routine
Created by
Teri L Rhodewalt on 5/11/2010 2:59 PM
Approved
Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Class: Normal Authorizing Provider: Victor Henrique Baquero, MD

Disp Refills Start End Carisoprodol (SOMA) 350 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical ERGOCALCIFEROL (VITAMIN D PO) Sig - Route: Take by mouth. - ORAL Class: Historical Fluoxetine (PROZAC) 40 mg PO capsule Sig - Route: Take 1 Cap by mouth every day. - ORAL Class: Historical 100 Tab 0 1/8/2010 2/8/2010 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 250 Tab 0 4/14/2010 5/11/2010 Methadone (DOLOPHINE) 10 mg PO Tablet (Discontinued) Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL
Orders Chart Cosign

RH Prov Init
MRN 8081369
Sex Male
DOB 9/23/1959
Phone
E-mail Address
000872
916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills Start End 250 Tab 0 5/24/2010 6/15/2010 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Carisoprodol (SOMA) 350 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical ERGOCALCIFEROL (VITAMIN D PO) Sig - Route: Take by mouth. - ORAL Class: Historical Fluoxetine (PROZAC) 40 mg PO capsule Sig - Route: Take 1 Cap by mouth every day. - ORAL Class: Historical 0 1/8/2010 2/8/2010 Hydrocodone 10 mg/Acetaminophen 325 100 Tab mg (NORCO) 10-325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 250 Tab 0 4/14/2010 5/14/2010 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL 0 11/14/2006 5/24/2010 240 METHADONE 10 MG TAB (Discontinued) Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 100 1 4/27/2009 5/27/2009 NORCO 10 MG-325 MG TAB Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026
Allergies
Problem List
Noted Resolved
1/19/2006
MRI 2006
000873
See lab

Class: Acute High arch 7/12/2010 2/17/2011

Weakness Encounter Closed By Closed By OH, ANDREW
Patient Information
Telephone Encounter
2/16/2011 2:09 PM
Routing History
2/16/2011 2:10 PM From Michele Melendez To Victor Henrique Baquero, MD Priority Routine
Created by
Michele Melendez on 2/16/2011 2:09 PM
Approved
Disp Refills Start End 100 Tab 0 2/16/2011 3/18/2011 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10325 mg Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy Authorizing Provider: Victor Henrique Baquero, MD 30 Tab 1 2/16/2011 3/18/2011 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Pharmacy Authorizing Provider: Victor Henrique Baquero, MD

Disp Refills Start End 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 100 Tab 1 2/1/2011 5/4/2011 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical 100 Tab 0 1/21/2011 2/16/2011 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet (Discontinued)
000874
Not on file
1
Plan UCD/B/S HMO
Orders Only
Patient Information

Date 4/28/2011 Provider Susan Carbognin Department Carm Neurology

Disp Refills Start End 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 100 Tab 1 2/1/2011 5/4/2011 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical 100 Tab 0 3/18/2011 4/18/2011 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 240 Tab 0 4/7/2011 5/7/2011 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Class: Handwritten Rx

CULTURE CSF (INCLUDES GS), BACTI (68126522) Ordered On 5/1/2011
Encounter Closed By
Closed By INTERFACE, LAB RESULTS Closed Date 05012011 Closed Time 16:03
Orders Only
Patient Information
Mark Amundsen (MRN 8081369) DOB 9/23/1959 PATIENTPHONE 916-509-0158
Date 4/28/2011 Provider Andrew Kim Oh, MD Department Carm Neurology
000875

Disp Refills Start End 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 100 Tab 1 2/1/2011 5/4/2011 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical 240 Tab 0 4/7/2011 5/7/2011 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Class: Handwritten Rx

SYPHILIS TEST CSF (VDRL) (68033292) Ordered On 4/28/2011
Encounter Closed By
Orders Only
Patient Information

Disp Refills Start End 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 100 Tab 1 2/1/2011 5/4/2011 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical
000876
240 Tab Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Class: Handwritten Rx
4/7/2011
5/7/2011

GLUCOSE CSF (68032995) PROTEIN CSF (68032996) Ordered On 4/28/2011 4/28/2011
Encounter Closed By
Orders Only
Patient Information



LYME(B.BURGDORFERI) AB, CSF (68032994)
Ordered On 4/28/2011
Encounter Closed By
Orders Only
Patient Information

000877


CELL COUNT, CSF (68032993) Ordered On 4/28/2011
Encounter Closed By
Appointment
Account # 078661756045
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Encounter-Level Documents: There are no encounter-level documents. Insurance Information Acct Number
Financial Class
000878
078661756045 1 Payor UCD Patient Insurance ID XEHJ00044785 Group Number PH0010 Plan UCD/B/S HMO Plan Number B72
Plan Phone 916-734-0739
Center None
Appointment
000879
Patient Information

Telephone Encounter
4/29/2011 3:08 PM
Reason for Call

Refill Request
Routing History
4/29/2011 3:09 PM From Clare Jennings, MA To Victor Henrique Baquero, MD Priority Routine
Created by
Approved
Disp Refills Start 100 Tab 0 4/29/2011 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10325 mg Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. - ORAL Class: Pharmacy Authorizing Provider: Victor Henrique Baquero, MD End 5/30/2011

Disp Refills Start End 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 100 Tab 1 4/29/2011 7/30/2011 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Pharmacy 240 Tab 0 4/7/2011 5/7/2011 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Class: Handwritten Rx

WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630
DOB 9/23/1959
Telephone Encounter
4/29/2011 8:29 AM
Provider Victor Baquero, MD, MD Department Fol General Surgery
000880
Reason for Call

Refill Request
Routing History
4/29/2011 8:31 AM 4/29/2011 8:30 AM
From Cory O'Dell Cory O'Dell
To Victor Henrique Baquero, MD Victor Henrique Baquero, MD
Priority Routine Routine
Created by
Cory O'Dell on 4/29/2011 8:29 AM
Approved
Disp 100 Tab Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Pharmacy Authorizing Provider: Victor Henrique Baquero, MD Refills 1 Start 4/29/2011 End 8/16/2011

Disp Refills Start End 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 100 Tab 1 2/1/2011 4/29/2011 Carisoprodol (SOMA) 350 mg Tablet (Discontinued) Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical 240 Tab 0 4/7/2011 5/7/2011 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Class: Handwritten Rx

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4/28/2011 10:53 AM Department Ucd Pre-Reg
Attending Provider Discharge Date/Time Admitting Provider Andrew Kim Oh, MD Hospital Service Admission Type Auth/Cert Status Admission Date/Time 04/28/11 0600 Service Area
000881

Disp Refills Start End 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 100 tablet 1 1/25/2012 2/24/2012 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet Sig - Route: Take 1 tablet by mouth every 4 to 6 hours if needed. - ORAL Class: Pharmacy 30 Tab 11 11/4/2011 11/3/2012 Levothyroxine (SYNTHROID) 75 mcg Tablet Sig - Route: Take 1 Tab by mouth every morning before a meal. take on an empty stomach - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 100 Tab 1 8/16/2011 11/16/2011 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Pharmacy 270 tablet 0 1/25/2012 2/24/2012 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx
Orders Chart Cosign

Patient Information

Telephone Encounter
1/25/2012 11:08 AM
Reason for Call

Refill Request
Routing History
1/25/2012 11:08 AM
From Yelena Tsvirinko
To Victor Baquero, MD
Priority Routine
Created by
Yelena Tsvirinko on 1/25/2012 11:08 AM
Approved
Disp 100 tablet Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10325 mg Tablet Sig - Route: Take 1 tablet by mouth every 4 to 6 hours if needed. - ORAL Class: Pharmacy Authorizing Provider: Victor Baquero, MD Refills 1 Start 1/25/2012 End 2/24/2012

Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule
Disp 8 Cap Refills 1 Start 7/12/2010 End 5/24/2012
000882
Reason for Call

Refill Request
Call Documentation
Joseph Jernigan 5/30/2012 4:15 PM Signed
Pt picked up prescription
Electronically signed by Joseph Jernigan at 5/30/2012 4:15 PM
Routing History
5/30/2012 9:33 AM From Yelena Tsvirinko To Victor Baquero, MD Priority Routine
Created by
Yelena Tsvirinko on 5/30/2012 9:32 AM
Approved
Disp 60 tablet Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 tablets by mouth every day at bedtime. - ORAL Class: Pharmacy Authorizing Provider: Victor Baquero, MD Refills 0 Start 5/30/2012 End 7/19/2012

Disp Refills Start End 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 11 11/4/2011 11/3/2012 Levothyroxine (SYNTHROID) 75 mcg Tablet Sig - Route: Take 1 Tab by mouth every morning before a meal. take on an empty stomach - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 60 tablet 0 2/21/2012 5/30/2012 Carisoprodol (SOMA) 350 mg Tablet (Discontinued) Sig - Route: Take 2 tablets by mouth every day at bedtime. - ORAL Class: Pharmacy 100 tablet 0 5/29/2012 6/28/2012 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet Sig - Route: Take 1 tablet by mouth every 4 to 6 hours if needed for pain. - ORAL Class: Pharmacy 270 tablet 0 5/29/2012 6/28/2012 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx

DOB 9/23/1959
Telephone Encounter
5/29/2012 3:33 PM
000883
11/19/2012 4:38 PM
Clare Jennings, MA
Victor Baquero, MD
Routine
Created by
Approved
Disp Refills 60 tablet 0 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 tablets by mouth every day at bedtime. - ORAL Class: Pharmacy Authorizing Provider: Victor Baquero, MD 0 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO 10) 10- 100 tablet 325 mg per tablet Sig - Route: Take 1 tablet by mouth every 4 to 6 hours if needed for pain. - ORAL Class: Pharmacy Authorizing Provider: Victor Baquero, MD Start 11/19/2012 End 2/19/2013
11/19/2012
12/21/2012

Disp Refills Start End 60 tablet 0 8/22/2012 11/22/2012 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 tablets by mouth every day at bedtime. - ORAL Class: Pharmacy 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 60 tablet 0 10/22/2012 11/19/2012 Carisoprodol (SOMA) 350 mg Tablet (Discontinued) Sig - Route: Take 2 tablets by mouth every day at bedtime. - ORAL Class: Pharmacy 100 tablet 0 10/22/2012 11/19/2012 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO 10) 10-325 mg per tablet (Discontinued) Sig - Route: Take 1 tablet by mouth every 4 to 6 hours if needed for pain. - ORAL Class: Pharmacy 270 tablet 0 10/23/2012 11/22/2012 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx

DOB 9/23/1959
Contacts
11/19/2012 11:32 AM
Type Phone (Incoming) Contact Amundsen, Mark (Self) Phone 509-0158
Telephone Encounter
11/19/2012 11:32 AM
Reason for Call
000884
Letter (Out)
Orders
Letters Letter Information BAQUERO, VICTOR H on 12/28/2012
Status Sent
Routing Information
Patient Information
DOB 9/23/1959
Telephone Encounter
12/21/2012 10:11 AM
Reason for Call

Refill Request
Routing History
12/21/2012 12:08 PM 12/21/2012 10:15 AM 12/21/2012 10:13 AM From Victor Baquero, MD Maria Mason, MA Maria Mason, MA To P FOL MA FP Victor Baquero, MD Victor Baquero, MD Priority Routine Routine Routine
Created by
Maria Mason, MA on 12/21/2012 10:11 AM
Approved
Disp Refills 0 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO 10) 10- 100 tablet 325 mg per tablet Sig - Route: Take 1 tablet by mouth every 4 to 6 hours if needed for pain. - ORAL Class: Normal Authorizing Provider: Victor Baquero, MD 100 tablet 1 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 1 tablet by mouth 3 times daily. - ORAL Class: Pharmacy Authorizing Provider: Victor Baquero, MD Start 12/21/2012 End 1/20/2013
12/21/2012
1/20/2013

Disp Refills Start End 60 tablet 0 8/22/2012 11/22/2012 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 tablets by mouth every day at bedtime. - ORAL Class: Pharmacy 60 tablet 0 11/19/2012 2/19/2013 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 tablets by mouth every day at bedtime. - ORAL Class: Pharmacy 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL
000885
Orders Chart Cosign

Orders Only
Patient Information

Date 1/7/2013 Provider Miriam Munoz, RN Department Cdm Folsom

Disp Refills Start End 60 tablet 0 8/22/2012 11/22/2012 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 tablets by mouth every day at bedtime. - ORAL Class: Pharmacy 60 tablet 0 11/19/2012 2/19/2013 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 tablets by mouth every day at bedtime. - ORAL Class: Pharmacy 100 tablet 1 12/21/2012 1/20/2013 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 1 tablet by mouth 3 times daily. - ORAL Class: Pharmacy 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 100 tablet 0 12/21/2012 1/20/2013 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO 10) 10-325 mg per tablet Sig - Route: Take 1 tablet by mouth every 4 to 6 hours if needed for pain. - ORAL 18 tablet 0 1/5/2013 1/7/2013 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 3 tablets by mouth every 8 hours. - ORAL 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 270 tablet 0 1/2/2013 2/1/2013 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx

HEALTHY LIVING WITH CHRONIC PAIN (93612015) REDUCING RISKS ACHIEVING A HEALTHY WEIGHT CLASS (93612016) SMOKING CESSATION CLASS (93612017) Ordered On 1/7/2013 1/7/2013 1/7/2013
Clinical Documentation
Received message without any documentation. Please verify
000886
Appointment
Sex Male

DOB 9/23/1959
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Center None
Patient Information

Contacts
01/11/2013 1:36 PM Left Message Type Phone (Outgoing) Contact Amundsen, Mark (Self) Phone
Telephone Encounter
1/11/2013 1:35 PM
Provider Cari J Shulkin, RN Department Cdm Acc (Ellison)
000887
Reason for Call

Tobacco Abuse
Call Documentation
Cari J Shulkin, RN 1/11/2013 1:37 PM Signed
LVM for patient to return call for smoking cessation options

Electronically signed by Cari Shulkin, RN at 1/11/2013 1:37 PM
Routing History
1/11/2013 1:37 PM
From Cari Shulkin, RN To Victor Baquero, MD Priority Routine
Created by
Cari Shulkin, RN on 1/11/2013 1:35 PM

Orders Chart Cosign

Patient Information

Contacts
01/08/2013 2:57 PM Type Phone (Outgoing) Contact Amundsen, Mark (Self) Phone 916-509-0158 (H)
000888
Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #9923 | 1005 E BIDWELL | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 7/9/2004 11:21 AM Electronically Signed By/Authorizing Ilya L Khamishon, MD On 1/19/06 0933 Department Fol Fam Prac/Int Med Reason None
This Order Has Been Discontinued Order Status By Ernestine Taylor Discontinued Isolation No Isolation Order Details Frequency None Duration None
Priority Routine
Order Class Pharmacy
Provider Information Ordering User Ilya L Khamishon

PCP Victor Baquero
Ordering Provider Ilya L Khamishon
Authorizing Provider Ilya L Khamishon
Ordering Provider KHAMISHON, ILYA L [06399] Patient Information Patient Name Amundsen, Mark Unit IMFFOL MRN 8081369
Pager 916-762-9522 Sex Male DOB 9/23/1959
Account Information Acct Number 079636570073 Visit CSN CSN Number: 6307327
Medication
Medication Detail
FLUOXETINE HCL 40 MG ORAL CAP (Order 2873129) Start 6/23/2004 End 8/3/2004
Quantity Refills 30 0 FLUOXETINE HCL 40 MG ORAL CAP (Discontinued) Sig : take 1 capsule (40mg) by oral route once daily in the morning Route: ORAL
000889
Class: Pharmacy All Administrations of FLUOXETINE HCL 40 MG ORAL CAP Warnings Override History for FLUOXETINE HCL 40 MG ORAL CAP [2873129] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #9923 | 1005 E BIDWELL | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 6/23/2004 1:46 PM Released By JESSICA J SHAW [084117753] VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero Discontinued On 8/3/04 1052
Status Pended Pended
Electronically Signed By/Authorizing Gertrudes Perlas Montemayor
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Wed Jun 23, 2004 1018 Wed Jun 23, 2004 0959 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Provider Information Ordering User Gertrudes Perlas Montemayor

PCP Victor Baquero
Ordering Provider Gertrudes Perlas Montemayor
Authorizing Provider Gertrudes Perlas Montemayor
Ordering Provider MONTEMAYOR, GERTRUDES PERLAS [06400] Patient Information Patient Name Amundsen, Mark Unit IMFFOL MRN 8081369
Visit CSN
000890
CSN Number: 6170331
Medication
Medication Detail
NORCO 10 MG-325 MG ORAL TAB (Order 2873346) Start 6/23/2004 End 7/9/2004
Quantity Refills 135 0/0 NORCO 10 MG-325 MG ORAL TAB (Discontinued) Sig : 1-2 CAPSULES Q6-8 HRS PRN PAIN. MAX 4&1/2 CAPS DAILYAND 135 PER MONTH Route: ORAL Class: Pharmacy All Administrations of NORCO 10 MG-325 MG ORAL TAB Warnings Override History for NORCO 10 MG-325 MG ORAL TAB [2873346] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #9923 | 1005 E BIDWELL | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 6/23/2004 1:46 PM Electronically Signed By/Authorizing Gertrudes Perlas Montemayor
Released By GERTRUDES P MONTEMAYOR [889077681] This Order Has Been Discontinued Order Status By Carol A Paton Discontinued
On 7/9/04 1119 Status Pended Reason None Reason
Signed and Held / Pended Order History Pending User Date/Time Wed Jun 23, 2004 1018 Isolation No Isolation Order Details Frequency None
Duration None Priority Routine
Order History Order Date/Time 06/23/04 1346 05/25/04 1143 Provider Information Ordering User Gertrudes Perlas Montemayor
PCP Victor Baquero
User Gertrudes Perlas Montemayor Jessica J Shaw
Action Current Order Reordered from
Order ID 2873346 2607920
Ordering Provider Gertrudes Perlas Montemayor
Authorizing Provider Gertrudes Perlas Montemayor
000891
Ordering Provider MONTEMAYOR, GERTRUDES PERLAS [06400] Patient Information Patient Name Amundsen, Mark
Unit IMFFOL
MRN 8081369
Visit CSN CSN Number: 6170331
000892
View Encounter Order Info Date and Time 7/15/2004 9:38 AM This Order Has Been Discontinued Order Status By Victor Baquero Discontinued Isolation No Isolation Order Details Frequency None Duration None Priority Routine Order Class Normal Electronically Signed By/Authorizing Victor Baquero, MD On 2/24/06 0807 Department Fol Fam Prac/Int Med Reason None
Provider Information Ordering User Victor Baquero

PCP Victor Baquero
Ordering Provider Victor Baquero
Authorizing Provider Victor Baquero
Ordering Provider BAQUERO, VICTOR [08139]
Pager 916-762-2086
Patient Information Patient Name Amundsen, Mark Unit IMFFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail ROBAXIN-750 750 MG ORAL TAB (Discontinued) Sig : take 1 - 2 pill hs prn Route: ORAL Class: Pharmacy
ROBAXIN-750 750 MG ORAL TAB (Order 3016766) Quantity 60 Refills 3 Start 7/9/2004 End 1/19/2006
All Administrations of ROBAXIN-750 750 MG ORAL TAB No Administrations Recorded Warnings Override History for ROBAXIN-750 750 MG ORAL TAB [3016766] No Warning History Available
000893
None
None
Routine
Pharmacy
Provider Information Ordering User Victor Baquero PCP Victor Baquero
Pager 916-762-2086 MRN 8081369 Sex Male DOB 9/23/1959
Medication
Medication Detail ANDROGEL 1 % (25 MG) TD GLPK (Discontinued) Sig : 2 PACKETS DAILY Route: Transdermal Class: Pharmacy
ANDROGEL 1 % (25 MG) TD GLPK (Order 3071334)

Quantity 60 Refills 3 Start 7/15/2004 End 2/3/2005
All Administrations of ANDROGEL 1 % (25 MG) TD GLPK No Administrations Recorded Warnings Override History for ANDROGEL 1 % (25 MG) TD GLPK [3071334] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info

On 2/3/05 1255
Department Fol Fam Prac/Int Med Reason None
This Order Has Been Discontinued Order Status By Victor Baquero Discontinued Isolation
000894
No Isolation Order Details Frequency None Duration None Priority Routine Order Class Pharmacy
Order History Order Date/Time 07/15/04 0932 05/25/04 1143 Provider Information Ordering User Victor Baquero PCP Victor Baquero
User Victor Baquero Jessica J Shaw

Order ID 3071334 2607924
Ordering Provider BAQUERO, VICTOR [08139] Patient Information Patient Name Amundsen, Mark
Unit IMFFOL
Medication
Medication Detail FENTANYL 25 MCG/HR TD PT72 (Discontinued) Sig : apply q 3 days. Route: Transdermal
FENTANYL 25 MCG/HR TD PT72 (Order 3071378) Quantity 10 Refills 0 Start 7/15/2004 End 2/24/2006
All Administrations of FENTANYL 25 MCG/HR TD PT72 No Administrations Recorded Warnings Override History for FENTANYL 25 MCG/HR TD PT72 [3071378] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter
000895
Unit FAMFOL
Medication
Medication Detail
Quantity Refills 135 0 NORCO 10 MG-325 MG ORAL TAB (Discontinued) Sig : take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 Route: ORAL Class: Pharmacy All Administrations of NORCO 10 MG-325 MG ORAL TAB Warnings Override History for NORCO 10 MG-325 MG ORAL TAB [3106182] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 7/19/2004 12:35 PM
Released By VICTOR H BAQUERO [886764315]
This Order Has Been Discontinued Order Status By Victor Baquero Discontinued
On 8/11/04 1721
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Mon Jul 19, 2004 1121 Isolation No Isolation Order Details Frequency Duration Priority
Order Class
000896
CSN Number: 6610233
Medication
Medication Detail
Quantity Refills 30 6 FLUOXETINE HCL 40 MG ORAL CAP (Discontinued) Sig : take 1 capsule (40mg) by oral route once daily in the morning Route: ORAL Class: Pharmacy All Administrations of FLUOXETINE HCL 40 MG ORAL CAP
Warnings Override History for FLUOXETINE HCL 40 MG ORAL CAP [3252429] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 8/3/2004 10:52 AM
On 1/11/05 1423 Status Pended
Reason None Reason
Signed and Held / Pended Order History Pending User Date/Time Tue Aug 3, 2004 1011 Isolation No Isolation Order Details Frequency None
Order History Order Date/Time 08/03/04 1052 06/23/04 1346 Provider Information Ordering User Victor Baquero
PCP Victor Baquero
User Victor Baquero Gertrudes Perlas Montemayor
Order ID 3252429 2873129
000897
Encounter View Encounter Order Info Date and Time 9/10/2004 1:07 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero Discontinued On 10/7/04 1011
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Fri Sep 10, 2004 1230 Isolation No Isolation Order Details Frequency None
Unit FAMFOL
Medication
Medication Detail
Quantity Refills 135 0/0 NORCO 10 MG-325 MG ORAL TAB (Discontinued) Sig : take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 Route: ORAL Class: Pharmacy All Administrations of NORCO 10 MG-325 MG ORAL TAB
000898
Warnings Override History for NORCO 10 MG-325 MG ORAL TAB [3336159] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 8/11/2004 5:21 PM
Reason None Reason
Signed and Held / Pended Order History Pending User Date/Time Wed Aug 11, 2004 1634 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
User Victor Baquero Victor Baquero

Order ID 3336159 3106182
Unit FAMFOL
Visit CSN
000899
Order Details Frequency None
Duration None
Priority Routine
Order History Order Date/Time 09/14/04 0856 08/11/04 1721 07/19/04 1235 Provider Information Ordering User Victor Baquero
PCP Victor Baquero
User Victor Baquero Victor Baquero Victor Baquero

Action Current Order Reordered from Reordered from
Order ID 3659473 3336159 3106182
Unit FAMFOL
Medication
Medication Detail
HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB (Order 3628204) Start 9/10/2004 End 10/7/2004
Quantity Refills 30 0 HYDROCODONE-ACETAMINOPHEN 10 MG325 MG ORAL TAB (Discontinued) Sig : take 1 tablet by oral route every 4-6 hours as needed for pain, Route: ORAL Comment: LAST REFILL 8/17/04 Class: Pharmacy
All Administrations of HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB Warnings Override History for HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB [3628204] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE
000900
Unit FAMFOL
Medication
Medication Detail
KETOCONAZOLE 2 % TOP CREA (Order 3659487) Refills 1 Start 9/14/2004 End 2/24/2006
Quantity 90G KETOCONAZOLE 2 % TOP CREA (Discontinued) Sig : apply by topical route once daily to the affected area(s) Route: TOPICAL Class: Pharmacy All Administrations of KETOCONAZOLE 2 % TOP CREA No Administrations Recorded
Warnings Override History for KETOCONAZOLE 2 % TOP CREA [3659487] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 9/14/2004 8:59 AM This Order Has Been Discontinued Order Status By Victor Baquero Discontinued Isolation No Isolation Order Details Frequency None Duration None Priority Routine Order Class Pharmacy Electronically Signed By/Authorizing Victor Baquero, MD On 2/24/06 0807 Department Fol Family Practice Reason None
Provider Information Ordering User
Ordering Provider
Authorizing Provider
000901
Victor Baquero PCP Victor Baquero
Victor Baquero
Victor Baquero
Medication
Medication Detail
NORCO 10 MG-325 MG ORAL TAB (Order 3659473)

Start 9/14/2004 End 1/19/2006
Quantity Refills 0/0 135 NORCO 10 MG-325 MG ORAL TAB (Discontinued) Sig : take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 Route: ORAL Class: Pharmacy
All Administrations of NORCO 10 MG-325 MG ORAL TAB No Administrations Recorded Warnings Override History for NORCO 10 MG-325 MG ORAL TAB [3659473] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info

On 1/19/06 0938
Department Fol Family Practice Reason None
This Order Has Been Discontinued Order Status By Ernestine Taylor Discontinued Isolation No Isolation
000902
CSN Number: 7327259
Medication
Medication Detail
Quantity Refills 135 0/0 HYDROCODONE-ACETAMINOPHEN 10 MG325 MG ORAL TAB (Discontinued) Sig : take 1 tablet by oral route every 4-6 hours as needed for pain, Route: ORAL Comment: LAST REFILL 9/14/04 Class: Pharmacy
All Administrations of HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB Warnings Override History for HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB [3897847] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 10/7/2004 10:11 AM
Reason None Reason
Signed and Held / Pended Order History Pending User Date/Time Thu Oct 7, 2004 0939 Isolation No Isolation Order Details Frequency None
PCP Victor Baquero
Order ID 3897847 3628204
000903
On 12/20/04 1827
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Tue Nov 23, 2004 1151 Tue Nov 23, 2004 1149 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order History Order Date/Time 11/23/04 1223 11/01/04 1210 10/07/04 1011 09/10/04 1307 Provider Information Ordering User Victor Baquero PCP Victor Baquero
User Victor Baquero Victor Baquero Victor Baquero Victor Baquero Ordering Provider Victor Baquero
Action Current Order Reordered from Reordered from Reordered from
Order ID 4372141 4149230 3897847 3628204
Medication
Medication Detail
HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB (Order 4149230)

Start 11/1/2004 End 11/23/2004
Quantity Refills 0/0 135 HYDROCODONE-ACETAMINOPHEN 10 MG325 MG ORAL TAB (Discontinued) Sig : take 1 tablet by oral route every 4-6 hours as needed for pain, Route: ORAL Comment: LAST REFILL 9/14/04 Class: Pharmacy
All Administrations of HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB
000904
Warnings Override History for HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB [4149230] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 11/1/2004 12:10 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero Discontinued
Signed and Held / Pended Order History Pending User Date/Time Trinidad Raya-Rowe Mon Nov 1, 2004 1052 Isolation No Isolation Order Details Frequency None
Order History Order Date/Time 11/01/04 1210 10/07/04 1011 09/10/04 1307 Provider Information Ordering User Victor Baquero PCP Victor Baquero
Order ID 4149230 3897847 3628204
Visit CSN
000905
PCP Victor Baquero
Medication
Medication Detail
CYCLOBENZAPRINE HCL 10 MG ORAL TAB (Order 4372155)

Refills 3 Start 11/23/2004 End 2/25/2005
Quantity 60 CYCLOBENZAPRINE HCL 10 MG ORAL TAB (Discontinued) Sig : take 1 tablet (10mg) by oral route 2 times per day Route: ORAL Comment: LAST FILLED 11/2/04 Class: Pharmacy
All Administrations of CYCLOBENZAPRINE HCL 10 MG ORAL TAB Warnings Override History for CYCLOBENZAPRINE HCL 10 MG ORAL TAB [4372155] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 11/23/2004 12:23 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero Discontinued On 2/25/05 1227
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Tue Nov 23, 2004 1151 Isolation No Isolation
000906
Duration None
Priority Routine
Medication
Medication Detail

Start 11/23/2004 End 12/20/2004
Quantity Refills 0/0 135 HYDROCODONE-ACETAMINOPHEN 10 MG325 MG ORAL TAB (Discontinued) Sig : take 1 tablet by oral route every 4-6 hours as needed for pain, Route: ORAL Comment: LAST REFILL 9/14/04 LAST FILLED 11/01/04 Class: Pharmacy
All Administrations of HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB Warnings Override History for HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB [4372141] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 11/23/2004 12:23 PM Released By SHERI L GROVES [518416631] VICTOR H BAQUERO [886764315] Electronically Signed By/Authorizing Victor Baquero, MD Department Fol Family Practice
000907
Medication
Medication Detail

Start 12/20/2004 End 1/10/2005
Quantity Refills 135 0/0 HYDROCODONE-ACETAMINOPHEN 10 MG325 MG ORAL TAB (Discontinued) Sig : take 1 tablet by oral route every 4-6 hours as needed for pain, Route: ORAL Comment: LAST REFILL 9/14/04 LAST FILLED 11/01/04 LAST FILLED 11/23/04 Class: Pharmacy
All Administrations of HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB Warnings Override History for HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB [4636774] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero Discontinued On 1/10/05 1634
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Mon Dec 20, 2004 1459 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order History Order Date/Time 12/20/04 1827 11/23/04 1223 11/01/04 1210 10/07/04 1011 09/10/04 1307 Provider Information Ordering User Victor Baquero
User Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Ordering Provider Victor Baquero
Action Current Order Reordered from Reordered from Reordered from Reordered from
Order ID 4636774 4372141 4149230 3897847 3628204
000908
Signed and Held / Pended Order History Pending User Date/Time Tue Jan 11, 2005 1054 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Status Pended
Reason
User Victor Baquero Victor Baquero Gertrudes Perlas Montemayor

Order ID 4837034 3252429 2873129
Unit FAMFOL
Medication
Medication Detail
Quantity Refills 135 0/0 HYDROCODONE-ACETAMINOPHEN 10 MG325 MG ORAL TAB (Discontinued) Sig : take 1 tablet by oral route every 4-6 hours as needed for pain, Route: ORAL Comment: LAST REFILL 9/14/04 LAST FILLED 11/01/04 LAST FILLED 11/23/04 LAST FILLED 12/20/04 Class: Pharmacy
All Administrations of HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB Warnings Override History for HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB [4829473] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630
000909
Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info

Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Mon Jan 10, 2005 1629 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order History Order Date/Time 01/10/05 1634 12/20/04 1827 11/23/04 1223 11/01/04 1210 10/07/04 1011 09/10/04 1307 Provider Information Ordering User Victor Baquero PCP Victor Baquero
User Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 4829473 4636774 4372141 4149230 3897847 3628204
Unit FAMFOL
000910
Order Date/Time 02/03/05 1255 01/10/05 1634 12/20/04 1827 11/23/04 1223 11/01/04 1210 10/07/04 1011 09/10/04 1307 Provider Information Ordering User Victor Baquero
PCP Victor Baquero
User Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Ordering Provider Victor Baquero
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 5086755 4829473 4636774 4372141 4149230 3897847 3628204
Ordering Provider BAQUERO, VICTOR [08139] Patient Information Patient Name Amundsen, Mark Unit FAMFOL MRN 8081369
Medication
Medication Detail
Quantity Refills 30 6 FLUOXETINE HCL 40 MG ORAL CAP Sig : take 1 capsule (40mg) by oral route once daily in the morning Route: ORAL Class: Pharmacy All Administrations of FLUOXETINE HCL 40 MG ORAL CAP
Warnings Override History for FLUOXETINE HCL 40 MG ORAL CAP [4837034] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 1/11/2005 2:23 PM
000911
Order Info Date and Time 2/25/2005 12:27 PM

Reason None Reason
Signed and Held / Pended Order History Pending User Date/Time Fri Feb 25, 2005 1133 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order History Order Date/Time 02/25/05 1227 02/03/05 1255 01/10/05 1634 12/20/04 1827 11/23/04 1223 11/01/04 1210 10/07/04 1011 09/10/04 1307 Provider Information Ordering User Victor Baquero PCP Victor Baquero
User Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 5320784 5086755 4829473 4636774 4372141 4149230 3897847 3628204
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail ANDROGEL 1 % (25 MG) TD GLPK (Discontinued)
ANDROGEL 1 % (25 MG) TD GLPK (Order 5086754) Quantity 300.00 Refills 3 Start 2/3/2005 End 8/22/2005
000912
Sig : 2 PACKETS DAILY Route: Transdermal Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. Class: Pharmacy All Administrations of ANDROGEL 1 % (25 MG) TD GLPK Warnings Override History for ANDROGEL 1 % (25 MG) TD GLPK [5086754] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 2/3/2005 12:55 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero Discontinued
Signed and Held / Pended Order History Pending User Date/Time Thu Feb 3, 2005 1155 Isolation No Isolation Order Details Frequency None
User Victor Baquero Victor Baquero Jessica J Shaw
Order ID 5086754 3071334 2607924
Pager 916-762-2086
Patient Information
000913

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity Refills 135 0/0 HYDROCODONE-ACETAMINOPHEN 10 MG325 MG ORAL TAB (Discontinued) Sig : take 1 tablet by oral route every 4-6 hours as needed for pain, Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 1031752. Class: Pharmacy
All Administrations of HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB Warnings Override History for HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB [5086755] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Date and Time 2/3/2005 12:55 PM Released By VICTOR H BAQUERO [886764315]
On 2/25/05 1227
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Thu Feb 3, 2005 1155 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order History
000914
10/07/04 1011 09/10/04 1307
Victor Baquero Victor Baquero
Reordered from Reordered from Authorizing Provider Victor Baquero
3897847 3628204
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
CYCLOBENZAPRINE HCL 10 MG ORAL TAB (Order 5320785) Start 2/25/2005 End 5/4/2005
Quantity Refills 3 60 CYCLOBENZAPRINE HCL 10 MG ORAL TAB (Discontinued) Sig : take 1 tablet (10mg) by oral route 2 times per day Route: ORAL Comment: LAST FILLED 11/2/04 This is a REFILL AUTHORIZATION for prescription number 1030339 last fill date 2/3/05 Class: Pharmacy All Administrations of CYCLOBENZAPRINE HCL 10 MG ORAL TAB
Warnings Override History for CYCLOBENZAPRINE HCL 10 MG ORAL TAB [5320785] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 2/25/2005 12:27 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero Discontinued Signed and Held / Pended Order History On 5/4/05 1657 Reason None Electronically Signed By/Authorizing Victor Baquero, MD Department Fol Family Practice
000915
Pending User
Date/Time Fri Feb 25, 2005 1133
Status Pended
Reason
Isolation No Isolation Order Details Frequency None Duration None Priority Routine Order Class Pharmacy
Action Current Order Reordered from Authorizing Provider Victor Baquero
Order ID 5320785 4372155

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity Refills 0/0 135 HYDROCODONE-ACETAMINOPHEN 10 MG325 MG ORAL TAB (Discontinued) Sig : take 1 tablet by oral route every 4-6 hours as needed for pain, Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 1031752. last fill date2/3/05 Class: Pharmacy
All Administrations of HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB Warnings Override History for HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB [5320784] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter
000916
CSN Number: 8849293
Medication
Medication Detail
Quantity Refills 135 0/0 HYDROCODONE-ACETAMINOPHEN 10 MG325 MG ORAL TAB (Discontinued) Sig : take 1 tablet by oral route every 4-6 hours as needed for pain, Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 1031752. last fill date2/3/05 Class: Pharmacy
All Administrations of HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB Warnings Override History for HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB [5578864] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 3/21/2005 5:10 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero Discontinued
Signed and Held / Pended Order History Pending User Date/Time Mon Mar 21, 2005 1636 Isolation No Isolation Order Details Frequency None
Order History Order Date/Time 03/21/05 1710 02/25/05 1227 02/03/05 1255 01/10/05 1634 12/20/04 1827 11/23/04 1223 11/01/04 1210
User Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Order ID 5578864 5320784 5086755 4829473 4636774 4372141 4149230
000917
Order History Order Date/Time 05/04/05 1657 04/12/05 1015 03/21/05 1710 02/25/05 1227 02/03/05 1255 01/10/05 1634 12/20/04 1827 11/23/04 1223 11/01/04 1210 10/07/04 1011 09/10/04 1307 Provider Information Ordering User Victor Baquero PCP Victor Baquero
User Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 6071504 5812750 5578864 5320784 5086755 4829473 4636774 4372141 4149230 3897847 3628204
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity Refills 135 0/0 HYDROCODONE-ACETAMINOPHEN 10 MG325 MG ORAL TAB (Discontinued) Sig : take 1 tablet by oral route every 4-6 hours as needed for pain, Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 1031752. last fill date 3/21/05 Class: Pharmacy
All Administrations of HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB Warnings Override History for HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB [5812750] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630
000918

Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Tue Apr 12, 2005 0948 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order History Order Date/Time 04/12/05 1015 03/21/05 1710 02/25/05 1227 02/03/05 1255 01/10/05 1634 12/20/04 1827 11/23/04 1223 11/01/04 1210 10/07/04 1011 09/10/04 1307 Provider Information Ordering User Victor Baquero
PCP Victor Baquero
User Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero
Order ID 5812750 5578864 5320784 5086755 4829473 4636774 4372141 4149230 3897847 3628204
MRN 8081369
Sex Male
DOB 9/23/1959
Visit CSN
000919
CSN Number: 9332663
Medication
Medication Detail
CYCLOBENZAPRINE HCL 10 MG ORAL TAB (Order 6071503) Start 5/4/2005 End 9/8/2005
Quantity Refills 60 3 CYCLOBENZAPRINE HCL 10 MG ORAL TAB (Discontinued) Sig : take 1 tablet (10mg) by oral route 2 times per day Route: ORAL Comment: LAST FILLED 11/2/04 This is a REFILL AUTHORIZATION for prescription number 1030339. Class: Pharmacy All Administrations of CYCLOBENZAPRINE HCL 10 MG ORAL TAB No Administrations Recorded
Warnings Override History for CYCLOBENZAPRINE HCL 10 MG ORAL TAB [6071503] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Wed May 4, 2005 1653 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order History Order Date/Time 05/04/05 1657 02/25/05 1227 11/23/04 1223 Provider Information Ordering User

Order ID 6071503 5320785 4372155
000920
Victor Baquero PCP Victor Baquero
Victor Baquero

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
All Administrations of HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB No Administrations Recorded Warnings Override History for HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB [6071504] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 5/4/2005 4:57 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero Discontinued
Signed and Held / Pended Order History Pending User Date/Time Wed May 4, 2005 1653 Isolation
000921
None
None
Routine
Pharmacy
Order History Order Date/Time 06/20/05 1718 05/31/05 1402 05/04/05 1657 04/12/05 1015 03/21/05 1710 02/25/05 1227 02/03/05 1255 01/10/05 1634 12/20/04 1827 11/23/04 1223 11/01/04 1210 10/07/04 1011 09/10/04 1307 Provider Information Ordering User Victor Baquero PCP Victor Baquero
User Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero
Order ID 6609044 6365983 6071504 5812750 5578864 5320784 5086755 4829473 4636774 4372141 4149230 3897847 3628204

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
All Administrations of HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB Warnings Override History for HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB [6365983] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies
000922
FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 5/31/2005 2:02 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero Discontinued On 6/20/05 1718
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Tue May 31, 2005 0827 Isolation No Isolation Order Details Frequency None
Order History Order Date/Time 05/31/05 1402 05/04/05 1657 04/12/05 1015 03/21/05 1710 02/25/05 1227 02/03/05 1255 01/10/05 1634 12/20/04 1827 11/23/04 1223 11/01/04 1210 10/07/04 1011 09/10/04 1307 Provider Information Ordering User Victor Baquero PCP Victor Baquero
User Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 6365983 6071504 5812750 5578864 5320784 5086755 4829473 4636774 4372141 4149230 3897847 3628204

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Visit CSN
000923
Victor Baquero
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
All Administrations of HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB Warnings Override History for HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB [6609044] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 6/20/2005 5:18 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero Discontinued
Signed and Held / Pended Order History Pending User Date/Time Mon Jun 20, 2005 1648 Isolation No Isolation Order Details Frequency
Duration Priority
Order Class
000924
None
None
Routine
Pharmacy
Order History Order Date/Time 08/03/05 1316 07/12/05 1002 06/20/05 1718 05/31/05 1402 05/04/05 1657 04/12/05 1015 03/21/05 1710 02/25/05 1227 02/03/05 1255 01/10/05 1634 12/20/04 1827 11/23/04 1223 11/01/04 1210 10/07/04 1011 09/10/04 1307 Provider Information Ordering User Victor Baquero
PCP Victor Baquero
User Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero
Order ID 7109645 6852954 6609044 6365983 6071504 5812750 5578864 5320784 5086755 4829473 4636774 4372141 4149230 3897847 3628204
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
FLUOXETINE HCL 40 MG ORAL CAP (Order 6852182)

Start 7/12/2005 End 1/2/2006
Quantity Refills 30 6 FLUOXETINE HCL 40 MG ORAL CAP (Discontinued) Sig : take 1 capsule (40mg) by oral route once daily in the morning Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. Class: Pharmacy
All Administrations of FLUOXETINE HCL 40 MG ORAL CAP Warnings Override History for FLUOXETINE HCL 40 MG ORAL CAP [6852182] No Warning History Available Pharmacy Selected For Faxed Prescriptions
000925
CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Tue Jul 12, 2005 0912 Isolation No Isolation Order Details Frequency None Duration None Priority Routine

PCP Victor Baquero
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Start 7/12/2005 End 8/3/2005
Quantity Refills 0/0 135 HYDROCODONE-ACETAMINOPHEN 10 MG325 MG ORAL TAB (Discontinued) Sig : take 1 tablet by oral route every 4-6 hours as needed for pain, Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 1043578.
000926
Class: Pharmacy All Administrations of HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB Warnings Override History for HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB [6852954] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 7/12/2005 10:02 AM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero Discontinued On 8/3/05 1316
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Tue Jul 12, 2005 0950 Isolation No Isolation Order Details Frequency None
Order History Order Date/Time 07/12/05 1002 06/20/05 1718 05/31/05 1402 05/04/05 1657 04/12/05 1015 03/21/05 1710 02/25/05 1227 02/03/05 1255 01/10/05 1634 12/20/04 1827 11/23/04 1223 11/01/04 1210 10/07/04 1011 09/10/04 1307 Provider Information Ordering User Victor Baquero
PCP
User Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 6852954 6609044 6365983 6071504 5812750 5578864 5320784 5086755 4829473 4636774 4372141 4149230 3897847 3628204
000927
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity Refills 0/0 135 HYDROCODONE-ACETAMINOPHEN 10 MG325 MG ORAL TAB (Discontinued) Sig : take 1 tablet by oral route every 4-6 hours as needed for pain, Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 1043578. Class: Pharmacy
All Administrations of HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB No Administrations Recorded Warnings Override History for HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB [7109645] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 8/3/2005 1:16 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero Discontinued On 8/22/05 1755
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Wed Aug 3, 2005 0936 Isolation No Isolation Order Details Frequency Duration Priority
Order Class
000928
02/25/05 1227 02/03/05 1255 01/10/05 1634 12/20/04 1827 11/23/04 1223 11/01/04 1210 10/07/04 1011 09/10/04 1307
Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero
5320784 5086755 4829473 4636774 4372141 4149230 3897847 3628204
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
ANDROGEL 1 % (25 MG) TD GLPK (Order 7342723) Start 8/22/2005 End 12/8/2005
Quantity Refills 300.00 3 ANDROGEL 1 % (25 MG) TD GLPK (Discontinued) Sig : 2 PACKETS DAILY Route: Transdermal Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. Class: Pharmacy All Administrations of ANDROGEL 1 % (25 MG) TD GLPK No Administrations Recorded Warnings Override History for ANDROGEL 1 % (25 MG) TD GLPK [7342723] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
000929
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Mon Aug 22, 2005 1659 Isolation No Isolation Order Details Frequency None
User Victor Baquero Victor Baquero Victor Baquero Jessica J Shaw
Action Current Order Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero
Order ID 7342723 5086754 3071334 2607924
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
All Administrations of HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB No Administrations Recorded
000930
Warnings Override History for HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG ORAL TAB [7342724] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 8/22/2005 5:55 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero Discontinued
Signed and Held / Pended Order History Pending User Date/Time Mon Aug 22, 2005 1659 Isolation No Isolation Order Details Frequency None
Order History Order Date/Time 08/22/05 1755 08/03/05 1316 07/12/05 1002 06/20/05 1718 05/31/05 1402 05/04/05 1657 04/12/05 1015 03/21/05 1710 02/25/05 1227 02/03/05 1255 01/10/05 1634 12/20/04 1827 11/23/04 1223 11/01/04 1210 10/07/04 1011 09/10/04 1307 Provider Information Ordering User Victor Baquero PCP Victor Baquero
User Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero
Order ID 7342724 7109645 6852954 6609044 6365983 6071504 5812750 5578864 5320784 5086755 4829473 4636774 4372141 4149230 3897847 3628204
000931
Order History Order Date/Time 10/03/05 1642 09/08/05 1621 08/22/05 1755 08/03/05 1316 07/12/05 1002 06/20/05 1718 05/31/05 1402 05/04/05 1657 04/12/05 1015 03/21/05 1710 02/25/05 1227 02/03/05 1255 01/10/05 1634 12/20/04 1827 11/23/04 1223 11/01/04 1210 10/07/04 1011 09/10/04 1307 Provider Information Ordering User Victor Baquero PCP Victor Baquero
User Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 7878961 7548614 7342724 7109645 6852954 6609044 6365983 6071504 5812750 5578864 5320784 5086755 4829473 4636774 4372141 4149230 3897847 3628204
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
CYCLOBENZAPRINE 10 MG TAB (Order 7548615)

Start 9/8/2005 End 1/3/2006
Quantity Refills 60 3 CYCLOBENZAPRINE 10 MG TAB (Discontinued) Sig : take 1 tablet (10mg) by oral route 2 times per day Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 1030339. Class: Pharmacy
All Administrations of CYCLOBENZAPRINE 10 MG TAB No Administrations Recorded Warnings Override History for CYCLOBENZAPRINE 10 MG TAB [7548615] No Warning History Available
000932
Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 9/8/2005 4:21 PM
Reason None Reason
Signed and Held / Pended Order History Pending User Date/Time Thu Sep 8, 2005 1055 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
User Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Order ID 7548615 6071503 5320785 4372155

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Order 7548614)
000933
Medication Detail Quantity Refills 0/0 135 HYDROCODONE-ACETAMINOPHEN 10 MG325 MG TAB (Discontinued) Sig : take 1 tablet by oral route every 4-6 hours as needed for pain, Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 1043578. Class: Pharmacy Start 9/8/2005 End 10/3/2005
All Administrations of HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB [7548614] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 9/8/2005 4:21 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero Discontinued On 10/3/05 1642
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Thu Sep 8, 2005 1055 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order History Order Date/Time 09/08/05 1621 08/22/05 1755 08/03/05 1316 07/12/05 1002 06/20/05 1718 05/31/05 1402 05/04/05 1657 04/12/05 1015 03/21/05 1710
User Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 7548614 7342724 7109645 6852954 6609044 6365983 6071504 5812750 5578864
000934

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Order 7878961) Start 10/3/2005 End 10/24/2005
Quantity Refills 135 0/0 HYDROCODONE-ACETAMINOPHEN 10 MG325 MG TAB (Discontinued) Sig : take 1 tablet by oral route every 4-6 hours as needed for pain, Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 1043578 Class: Pharmacy
All Administrations of HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB [7878961] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 10/3/2005 4:42 PM
Reason None Reason
Signed and Held / Pended Order History Pending User Date/Time Mon Oct 3, 2005 1620 Isolation No Isolation Order Details Frequency None
000935
08/22/05 1755 08/03/05 1316 07/12/05 1002 06/20/05 1718 05/31/05 1402 05/04/05 1657 04/12/05 1015 03/21/05 1710 02/25/05 1227 02/03/05 1255 01/10/05 1634 12/20/04 1827 11/23/04 1223 11/01/04 1210 10/07/04 1011 09/10/04 1307
Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
7342724 7109645 6852954 6609044 6365983 6071504 5812750 5578864 5320784 5086755 4829473 4636774 4372141 4149230 3897847 3628204

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
All Administrations of HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB [8160306] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies
000936
FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 10/24/2005 10:08 AM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero Discontinued On 11/1/05 0803
Status Pended
Reason None
Reason
Order History Order Date/Time 10/24/05 1008 10/03/05 1642 09/08/05 1621 08/22/05 1755 08/03/05 1316 07/12/05 1002 06/20/05 1718 05/31/05 1402 05/04/05 1657 04/12/05 1015 03/21/05 1710 02/25/05 1227 02/03/05 1255 01/10/05 1634 12/20/04 1827 11/23/04 1223 11/01/04 1210 10/07/04 1011 09/10/04 1307 Provider Information Ordering User Victor Baquero PCP Victor Baquero
User Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero
Order ID 8160306 7878961 7548614 7342724 7109645 6852954 6609044 6365983 6071504 5812750 5578864 5320784 5086755 4829473 4636774 4372141 4149230 3897847 3628204
Patient Information
000937
Medication
Medication Detail

Start 10/31/2005 End 11/17/2005
All Administrations of HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB [8267787] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Mon Oct 31, 2005 1125 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order History Order Date/Time 11/01/05 0803 10/24/05 1008 10/03/05 1642 09/08/05 1621
Order ID 8267787 8160306 7878961 7548614
000938
02/25/05 1227 02/03/05 1255 01/10/05 1634 12/20/04 1827 11/23/04 1223 11/01/04 1210 10/07/04 1011 09/10/04 1307
Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero
5320784 5086755 4829473 4636774 4372141 4149230 3897847 3628204
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Date and Time 11/17/2005 12:47 PM
000939
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Thu Nov 17, 2005 1030 Isolation No Isolation Order Details Frequency None
Order History Order Date/Time 11/17/05 1247 11/01/05 0803 10/24/05 1008 10/03/05 1642 09/08/05 1621 08/22/05 1755 08/03/05 1316 07/12/05 1002 06/20/05 1718 05/31/05 1402 05/04/05 1657 04/12/05 1015 03/21/05 1710 02/25/05 1227 02/03/05 1255 01/10/05 1634 12/20/04 1827 11/23/04 1223 11/01/04 1210 10/07/04 1011 09/10/04 1307 Provider Information Ordering User Victor Baquero PCP Victor Baquero
User Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 8518074 8267787 8160306 7878961 7548614 7342724 7109645 6852954 6609044 6365983 6071504 5812750 5578864 5320784 5086755 4829473 4636774 4372141 4149230 3897847 3628204

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
000940
07/12/05 1002 06/20/05 1718 05/31/05 1402 05/04/05 1657 04/12/05 1015 03/21/05 1710 02/25/05 1227 02/03/05 1255 01/10/05 1634 12/20/04 1827 11/23/04 1223 11/01/04 1210 10/07/04 1011 09/10/04 1307
Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero
6852954 6609044 6365983 6071504 5812750 5578864 5320784 5086755 4829473 4636774 4372141 4149230 3897847 3628204
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Order 8793771) Start 12/8/2005 End 2/27/2006
Quantity Refills 3 300.00 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Discontinued) Sig : 2 PACKETS DAILY Route: Transdermal Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. Class: Pharmacy All Administrations of ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET No Administrations Recorded
Warnings Override History for ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET [8793771] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter
000941
View Encounter Order Info Date and Time 12/8/2005 11:42 AM

Reason None Reason
Signed and Held / Pended Order History Pending User Date/Time Thu Dec 8, 2005 1001 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order History Order Date/Time 12/08/05 1142 08/22/05 1755 02/03/05 1255 07/15/04 0932 05/25/04 1143 Provider Information Ordering User Victor Baquero PCP Victor Baquero
User Victor Baquero Victor Baquero Victor Baquero Victor Baquero Jessica J Shaw
Order ID 8793771 7342723 5086754 3071334 2607924
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity Refills 135 0/0 HYDROCODONE-ACETAMINOPHEN 10 MG325 MG TAB (Discontinued) Sig : take 1 tablet by oral route every 4-6 hours as needed for pain,
000942
Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 1049713 Class: Pharmacy All Administrations of HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB [8793772] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Thu Dec 8, 2005 1001 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order History Order Date/Time 12/08/05 1142 11/17/05 1247 11/01/05 0803 10/24/05 1008 10/03/05 1642 09/08/05 1621 08/22/05 1755 08/03/05 1316 07/12/05 1002 06/20/05 1718 05/31/05 1402 05/04/05 1657 04/12/05 1015 03/21/05 1710
User Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Order ID 8793772 8518074 8267787 8160306 7878961 7548614 7342724 7109645 6852954 6609044 6365983 6071504 5812750 5578864
000943
Medication
Medication Detail

Start 12/12/2005 End 1/3/2006
Quantity Refills 135 0/0 HYDROCODONE-ACETAMINOPHEN 10 MG325 MG TAB (Discontinued) Sig : take 1 tablet by oral route every 4-6 hours as needed for pain, Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 1049713 / 1052502. Last filled 11/17/05 Class: Pharmacy
All Administrations of HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB Warnings Override History for HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB [8841530] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Date and Time 12/12/2005 12:33 PM
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Falisha L Clay Mon Dec 12, 2005 1004 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order ID 8841530 8793772 8518074 8267787 8160306 7878961 7548614 7342724 7109645
000944
Encounter View Encounter Order Info Date and Time 1/3/2006 4:25 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero Discontinued On 2/24/06 0807
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Tue Jan 3, 2006 1553 Isolation No Isolation Order Details Frequency None
Order History Order Date/Time 01/03/06 1625 09/08/05 1621 05/04/05 1657 02/25/05 1227 11/23/04 1223 Provider Information Ordering User Victor Baquero
PCP Victor Baquero
User Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Order ID 9109594 7548615 6071503 5320785 4372155
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
FLUOXETINE 40 MG CAP (Order 9092524)

Start 1/2/2006 End 1/19/2006
Quantity Refills 30 6 FLUOXETINE 40 MG CAP (Discontinued) Sig : take 1 capsule (40mg) by oral route once daily in the morning
000945
Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. Class: Pharmacy All Administrations of FLUOXETINE 40 MG CAP No Administrations Recorded Warnings Override History for FLUOXETINE 40 MG CAP [9092524] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info

On 1/19/06 0938
This Order Has Been Discontinued Order Status By Ernestine Taylor Discontinued Isolation No Isolation Order Details Frequency None
Duration None
Priority Routine
PCP Victor Baquero
Order ID 9092524 6852182
MRN 8081369
Sex Male
DOB 9/23/1959
000946
CSN Number: 11569605
Medication
Medication Detail
Quantity Refills 135 0/0 HYDROCODONE-ACETAMINOPHEN 10 MG325 MG TAB Sig : take 1 tablet by oral route every 4-6 hours as needed for pain, Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 1049713 / 1052502. Last filled 11/17/05 Class: Pharmacy
Released By VICTOR H BAQUERO [886764315] Signed and Held / Pended Order History Pending User Date/Time Tue Jan 3, 2006 1553 Isolation No Isolation Order Details Frequency None Duration None Priority Routine Order Class Pharmacy
Status Pended Reason
Order ID 9109593 8841530 8793772 8518074 8267787 8160306 7878961 7548614 7342724
000947
08/03/05 1316 07/12/05 1002 06/20/05 1718 05/31/05 1402 05/04/05 1657 04/12/05 1015 03/21/05 1710 02/25/05 1227 02/03/05 1255 01/10/05 1634 12/20/04 1827 11/23/04 1223 11/01/04 1210 10/07/04 1011 09/10/04 1307
Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
7109645 6852954 6609044 6365983 6071504 5812750 5578864 5320784 5086755 4829473 4636774 4372141 4149230 3897847 3628204

PCP Victor Baquero
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
CYCLOBENZAPRINE 10 MG TAB (Order 9109594)

Start 1/3/2006 End 2/24/2006
Quantity Refills 60 3 CYCLOBENZAPRINE 10 MG TAB (Discontinued) Sig : take 1 tablet (10mg) by oral route 2 times per day Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 1030339. Class: Pharmacy
All Administrations of CYCLOBENZAPRINE 10 MG TAB No Administrations Recorded Warnings Override History for CYCLOBENZAPRINE 10 MG TAB [9109594] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE
000948
08/11/04 1721 07/19/04 1235
Victor Baquero Victor Baquero
Reordered from Reordered from Authorizing Provider Victor Baquero
3336159 3106182
Patient Information Patient Name Amundsen, Mark Unit PEDFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail BACLOFEN 10 MG TAB (Discontinued) Sig : 1 PO TID PRN Route: ORAL Class: Pharmacy All Administrations of BACLOFEN 10 MG TAB No Administrations Recorded Warnings Override History for BACLOFEN 10 MG TAB [9329933] No Warning History Available Quantity 90
BACLOFEN 10 MG TAB (Order 9329933) Refills 2 Start 1/19/2006 End 4/18/2006
Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info

On 4/18/06 1716
This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued Isolation No Isolation Order Details Frequency None
Duration None
Priority Routine
000949

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Account # 078080963016 Account Information Acct Number 078080963016 Visit CSN CSN Number: 11569605
Medication
Medication Detail

Start 1/19/2006 End 7/19/2006
Quantity Refills 6 30 FLUOXETINE 40 MG CAP (Discontinued) Sig : take 1 capsule (40mg) by oral route once daily in the morning Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. Class: Pharmacy
All Administrations of FLUOXETINE 40 MG CAP No Administrations Recorded Warnings Override History for FLUOXETINE 40 MG CAP [9329993] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
This Order Has Been Discontinued
000950
Order Status Discontinued Isolation No Isolation Order Details Frequency None
By Victor Baquero, MD
On 7/20/06 1229
Reason None
Duration None
Priority Routine

Order ID 9329993 9092524 6852182
MRN 8081369
Sex Male
DOB 9/23/1959
Account # 078080963016
Medication
Medication Detail METHADONE 5 MG TAB (Discontinued) Sig : take 1 po bid Route: ORAL All Administrations of METHADONE 5 MG TAB No Administrations Recorded Quantity 60
METHADONE 5 MG TAB (Order 9329931) Refills 0 Start 1/19/2006 End 2/6/2006
Warnings Override History for METHADONE 5 MG TAB [9329931] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630
000951


On 2/6/06 1704
This Order Has Been Discontinued Order Status By Victor Baquero Discontinued Isolation No Isolation Order Details Frequency None
Duration None
Priority Routine
Order Class Normal
MRN 8081369
Sex Male
DOB 9/23/1959
Account # 078080963016
Medication
Medication Detail
NORCO 10 MG-325 MG TAB (Order 9329992) Start 1/19/2006 End 2/6/2006
Quantity Refills 135 0/0 NORCO 10 MG-325 MG TAB (Discontinued) Sig : take 1 to 2 tabs every 6-8 hours as needed for pain, maximum 4 1/2 tabs per day/135 tabs per month last ref 6.24.04 Route: ORAL Class: Pharmacy All Administrations of NORCO 10 MG-325 MG TAB No Administrations
000952
Recorded Warnings Override History for NORCO 10 MG-325 MG TAB [9329992] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 1/19/2006 9:38 AM This Order Has Been Discontinued Order Status By Victor Baquero Discontinued Isolation No Isolation Order Details Frequency None Duration None Priority Routine Order Class Pharmacy Electronically Signed By/Authorizing Victor Baquero, MD On 2/6/06 1705 Department Fol Family Practice Reason None
Order ID 9329992 3659473 3336159 3106182

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Account # 078080963016 Account Information Acct Number 078080963016 Visit CSN
000953
Unit FAMFOL
Account # 078080963024
Medication
Medication Detail NORCO 10 MG-325 MG TAB (Discontinued) Sig : 1-2 po q 6 hours. Max 8 per day. Route: ORAL Class: Pharmacy All Administrations of NORCO 10 MG-325 MG TAB No Administrations Recorded Quantity 250
NORCO 10 MG-325 MG TAB (Order 9590661) Refills 0 Start 2/6/2006 End 4/14/2006
Warnings Override History for NORCO 10 MG-325 MG TAB [9590661] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 2/6/2006 5:05 PM Electronically Signed By/Authorizing Victor Baquero, MD On 4/18/06 1716 Department Fol Pediatrics Reason None
This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued Isolation No Isolation Order Details Frequency None Duration None
Priority Routine
Order History Order Date/Time 02/06/06 1705 01/19/06 0938 09/14/04 0856
Order ID 9590661 9329992 3659473
000954
Unit FAMFOL
Medication
Medication Detail
GLUCOSAMINE 1,000 MG TAB (Order 9843212) Quantity Refills 0 Start 2/24/2006 End 2/19/2008
GLUCOSAMINE 1,000 MG TAB (Discontinued) Route: ORAL Class: Historical All Administrations of GLUCOSAMINE 1,000 MG TAB No Administrations Recorded
Warnings Override History for GLUCOSAMINE 1,000 MG TAB [9843212] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 2/24/2006 8:21 AM Electronically Signed By/Authorizing Victor Baquero, MD On 2/19/08 1349 Department Fol Family Practice Reason None
Duration None
Priority Routine
Order Class Historical
MRN 8081369
Sex Male
DOB 9/23/1959
000955
09/10/04 1307
Victor Baquero
Reordered from
3628204

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Order 9885161) Start 2/27/2006 End 2/19/2008
Quantity Refills 3 300.00 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Discontinued) Sig : 2 PACKETS DAILY Route: Transdermal Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. Class: Pharmacy All Administrations of ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET No Administrations Recorded
Warnings Override History for ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET [9885161] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 2/27/2006 5:30 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued Signed and Held / Pended Order History On 2/19/08 1349 Reason None Electronically Signed By/Authorizing Victor Baquero, MD Department Fol Family Practice
000956
Pending User
Date/Time Mon Feb 27, 2006 1620
Status Pended
Reason
Order History Order Date/Time 02/27/06 1730 12/08/05 1142 08/22/05 1755 02/03/05 1255 07/15/04 0932 05/25/04 1143 Provider Information Ordering User Victor Baquero PCP Victor Baquero
User Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Jessica J Shaw
Order ID 9885161 8793771 7342723 5086754 3071334 2607924
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity Refills 135 0/0 HYDROCODONE-ACETAMINOPHEN 10 MG325 MG TAB (Discontinued) Sig : take 1 tablet by oral route every 4-6 hours as needed for pain, Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 1043578. Class: Pharmacy
All Administrations of HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB [9885162] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630
000957

Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Mon Feb 27, 2006 1620 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order History Order Date/Time 02/27/06 1730 08/03/05 1316 07/12/05 1002 06/20/05 1718 05/31/05 1402 05/04/05 1657 04/12/05 1015 03/21/05 1710 02/25/05 1227 02/03/05 1255 01/10/05 1634 12/20/04 1827 11/23/04 1223 11/01/04 1210 10/07/04 1011 09/10/04 1307 Provider Information Ordering User Victor Baquero
PCP Victor Baquero
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero
Order ID 9885162 7109645 6852954 6609044 6365983 6071504 5812750 5578864 5320784 5086755 4829473 4636774 4372141 4149230 3897847 3628204
MRN 8081369
Sex Male
DOB 9/23/1959
000958
This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued
On 5/23/06 0925
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Fri Mar 24, 2006 1522 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order History Order Date/Time 03/24/06 1534 03/02/06 1734 02/27/06 1730 08/03/05 1316 07/12/05 1002 06/20/05 1718 05/31/05 1402 05/04/05 1657 04/12/05 1015 03/21/05 1710 02/25/05 1227 02/03/05 1255 01/10/05 1634 12/20/04 1827 11/23/04 1223 11/01/04 1210 10/07/04 1011 09/10/04 1307 Provider Information Ordering User Victor Baquero PCP Victor Baquero
User Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Order ID 10258228 9940824 9885162 7109645 6852954 6609044 6365983 6071504 5812750 5578864 5320784 5086755 4829473 4636774 4372141 4149230 3897847 3628204
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
000959
Quantity Refills 250 0/0 HYDROCODONE-ACETAMINOPHEN 10 MG325 MG TAB (Discontinued) Sig : take 1 tablet by oral route every 4-6 hours as needed for pain, Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 1043578. Class: Pharmacy
Start 3/2/2006
End 3/24/2006
All Administrations of HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB [9940824] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 3/2/2006 5:34 PM This Order Has Been Discontinued Order Status By Victor Baquero Discontinued Isolation No Isolation Order Details Frequency None Duration None Priority Routine Order Class Pharmacy Electronically Signed By/Authorizing Victor Baquero, MD On 3/24/06 1534 Department Fol Family Practice Reason None
Order History Order Date/Time 03/02/06 1734 02/27/06 1730 08/03/05 1316 07/12/05 1002 06/20/05 1718 05/31/05 1402 05/04/05 1657 04/12/05 1015 03/21/05 1710 02/25/05 1227 02/03/05 1255 01/10/05 1634 12/20/04 1827 11/23/04 1223 11/01/04 1210 10/07/04 1011
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 9940824 9885162 7109645 6852954 6609044 6365983 6071504 5812750 5578864 5320784 5086755 4829473 4636774 4372141 4149230 3897847
000960
04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235 Provider Information Ordering User Victor Baquero, MD
PCP Victor Baquero, MD
Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero, MD
10549668 9590661 9329992 3659473 3336159 3106182
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Start 3/24/2006 End 5/23/2006
Quantity Refills 0/0 250 HYDROCODONE-ACETAMINOPHEN 10 MG325 MG TAB (Discontinued) Sig : take 1 tablet by oral route every 4-6 hours as needed for pain, Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 Class: Pharmacy
000961
Amundsen, Mark Unit FAMFOL
8081369
Male
9/23/1959
Medication
Warnings Override History for NORCO 10 MG-325 MG TAB [10549668] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Released By SHERI L GROVES [518416631] VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued On 5/1/06 1427
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Tue Apr 18, 2006 1540 Fri Apr 14, 2006 1615 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order History Order Date/Time
User
Action
Order ID
000962
Medication
Medication Detail
BACLOFEN 10 MG TAB (Order 10594165)

Start 4/18/2006 End 5/18/2006
Quantity Refills 90 2 BACLOFEN 10 MG TAB Sig : take 1 tablet oralley 3 times a day as needed Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 1056944. Class: Pharmacy
All Administrations of BACLOFEN 10 MG TAB No Administrations Recorded Warnings Override History for BACLOFEN 10 MG TAB [10594165] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 4/18/2006 5:16 PM
Signed and Held / Pended Order History Pending User Date/Time Tue Apr 18, 2006 1540 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Status Pended
Reason
Order History Order Date/Time 04/18/06 1716 01/19/06 0936 Provider Information Ordering User Victor Baquero, MD PCP Victor Baquero, MD
User Victor Baquero, MD Victor Baquero

Authorizing Provider Victor Baquero, MD
Order ID 10594165 9329933
MRN
Sex
DOB
000963
User Victor Baquero, MD Victor Baquero, MD

Order ID 11099064 10770668

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail METHADONE 5 MG TAB (Discontinued) Sig : 1 po BID Route: ORAL All Administrations of METHADONE 5 MG TAB No Administrations Recorded Quantity 60
Warnings Override History for METHADONE 5 MG TAB [10770667] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 5/1/2006 2:26 PM Electronically Signed By/Authorizing Victor Baquero, MD On 5/26/06 1450 Department Fol Family Practice Reason None
This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued Isolation No Isolation Order Details Frequency
Duration
Priority
Order Class
000964
None
None
Routine
Normal
Provider Information Ordering User Victor Baquero, MD PCP Victor Baquero, MD

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail NORCO 10 MG-325 MG TAB (Discontinued) Sig : 1-2 po q 6 hours. Max 8 per day. Route: ORAL Class: Pharmacy All Administrations of NORCO 10 MG-325 MG TAB No Administrations Recorded
Quantity 250
NORCO 10 MG-325 MG TAB (Order 10770690)

Warnings Override History for NORCO 10 MG-325 MG TAB [10770690] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info

On
Department Fol Family Practice Reason
This Order Has Been Discontinued Order Status By
000965
Discontinued
Victor Baquero, MD
5/23/06 1218
None
Isolation No Isolation Order Details Frequency None

Duration None Priority Routine Order Class Pharmacy
Order History Order Date/Time 05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235 Provider Information Ordering User Victor Baquero, MD PCP Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Order ID 10770690 10549668 9590661 9329992 3659473 3336159 3106182

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail SOMA 350 MG TAB (Discontinued) Sig : 1 po tid Route: ORAL Class: Pharmacy All Administrations of SOMA 350 MG TAB No Administrations Recorded Warnings Override History for SOMA 350 MG TAB [10770668]
Quantity 90
SOMA 350 MG TAB (Order 10770668)

000966
No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 5/1/2006 2:26 PM Electronically Signed By/Authorizing Victor Baquero, MD On 5/23/06 1218 Department Fol Family Practice Reason None
Priority Routine
Provider Information Ordering User Victor Baquero, MD

MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
TORADOL ORAL 10 MG TAB (Order 10770666) Start 5/1/2006 End 5/26/2006
Quantity Refills 0 TORADOL ORAL 10 MG TAB (Discontinued) 20 Sig : take 1 tablet (10mg) by oral route every 4-6 hours as needed not to exceed 40mg per 24 hours
000967
Route: ORAL Class: Pharmacy All Administrations of TORADOL ORAL 10 MG TAB No Administrations Recorded Warnings Override History for TORADOL ORAL 10 MG TAB [10770666] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Electronically Signed By/Authorizing Victor Baquero, MD On 5/26/06 1450
Duration None
Reason None
Priority Routine
MRN 8081369
Sex Male
DOB 9/23/1959
Account # 078080963057
000968

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Start 5/23/2006 End 4/24/2007
Quantity Refills 0/0 250 HYDROCODONE-ACETAMINOPHEN 10 MG325 MG TAB (Discontinued) Sig : take 1 tablet by oral route every 4-6 hours as needed for pain, Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 Class: Pharmacy
000969
Order Status Discontinued Isolation No Isolation Order Details Frequency None
On 4/25/07 1252
Reason None
Duration None
Priority Routine
Order History Order Date/Time 05/23/06 0925 03/24/06 1534 03/02/06 1734 02/27/06 1730 08/03/05 1316 07/12/05 1002 06/20/05 1718 05/31/05 1402 05/04/05 1657 04/12/05 1015 03/21/05 1710 02/25/05 1227 02/03/05 1255 01/10/05 1634 12/20/04 1827 11/23/04 1223 11/01/04 1210 10/07/04 1011 09/10/04 1307 Provider Information Ordering User Victor Baquero, MD
User Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero, MD
Order ID 11096396 10258228 9940824 9885162 7109645 6852954 6609044 6365983 6071504 5812750 5578864 5320784 5086755 4829473 4636774 4372141 4149230 3897847 3628204
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail NORCO 10 MG-325 MG TAB (Discontinued) Sig : 1-2 po q 6 hours. Max 8 per day.
Quantity 250

000970
Route: ORAL Class: Pharmacy All Administrations of NORCO 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for NORCO 10 MG-325 MG TAB [11099075] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued On 6/6/06 1509
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Tue May 23, 2006 1055 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order History Order Date/Time 05/23/06 1218 05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235 Provider Information Ordering User Victor Baquero, MD PCP Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero, MD
Order ID 11099075 10770690 10549668 9590661 9329992 3659473 3336159 3106182
000971
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail SOMA 350 MG TAB (Discontinued) Sig : 1 po tid Route: ORAL Class: Pharmacy All Administrations of SOMA 350 MG TAB No Administrations Recorded Warnings Override History for SOMA 350 MG TAB [11099064] No Warning History Available Quantity 90
SOMA 350 MG TAB (Order 11099064) Refills 0 Start 5/23/2006 End 6/21/2006
Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 5/23/2006 12:18 PM Released By JULIE A WILSON [950085480] VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued On 6/22/06 0802
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Tue May 23, 2006 1055 Tue May 23, 2006 1054 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
000972
Ordering User Victor Baquero, MD

MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail CYMBALTA 30 MG CAP Sig : 1 po qam for 1 week then bid thereafter Route: ORAL Class: Pharmacy All Administrations of CYMBALTA 30 MG CAP No Administrations Recorded
Quantity 60
CYMBALTA 30 MG CAP (Order 11156827)

Warnings Override History for CYMBALTA 30 MG CAP [11156827] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info

PCP
000973
Victor Baquero, MD
MRN 8081369
Sex Male
DOB 9/23/1959
Account # 078080963057
Medication
Medication Detail Quantity 40 DILAUDID 2 MG TAB Sig : take 1-2 by oral route every 4-6 hours as needed Route: ORAL All Administrations of DILAUDID 2 MG TAB No Administrations Recorded Warnings Override History for DILAUDID 2 MG TAB [11156945] No Warning History Available
DILAUDID 2 MG TAB (Order 11156945) Refills 0 Start 5/26/2006 End 6/25/2006
Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 5/26/2006 3:06 PM Isolation No Isolation Order Details Frequency None Duration None Priority Routine Order Class Normal Electronically Signed By/Authorizing Victor Baquero, MD Department Fol Family Practice
000974

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail CYMBALTA 60 MG CAP (Discontinued) Sig : 1 PO DAILY Route: ORAL All Administrations of CYMBALTA 60 MG CAP No Administrations Recorded
Quantity 30
CYMBALTA 60 MG CAP (Order 11156842)

Warnings Override History for CYMBALTA 60 MG CAP [11156842] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info

On 7/21/06 1302
Priority Routine
Order Class Normal
000975
RH
Medication
Medication Detail NORCO 10 MG-325 MG TAB (Discontinued) Sig : 1-2 po q 6 hours. Max 8 per day. Route: ORAL Class: Pharmacy All Administrations of NORCO 10 MG-325 MG TAB No Administrations Recorded
Quantity 250

Warnings Override History for NORCO 10 MG-325 MG TAB [11298702] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 6/6/2006 3:09 PM Electronically Signed By/Authorizing Victor Baquero, MD
On 6/29/06 1909

Reason None
Priority Routine
Order History Order Date/Time 06/06/06 1509 05/23/06 1218 05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235 Provider Information
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Order ID 11298702 11099075 10770690 10549668 9590661 9329992 3659473 3336159 3106182
000976

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
METHADONE 10 MG TAB (Order 11423903) Start 6/15/2006 End 6/29/2006
Quantity Refills 120 0 METHADONE 10 MG TAB (Discontinued) Sig : take 1 tablet (10mg) by oral route every 6 hours as directed Route: ORAL All Administrations of METHADONE 10 MG TAB No Administrations Recorded Warnings Override History for METHADONE 10 MG TAB [11423903] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 6/15/2006 8:05 AM Electronically Signed By/Authorizing Victor Baquero, MD
On 6/29/06 1909
Reason None
Priority Routine
Order Class Normal

Patient Information Patient Name Amundsen, Mark Unit
MRN 8081369
Sex Male
DOB 9/23/1959
000977
Medication Detail SOMA 350 MG TAB (Discontinued) Sig : 1 po tid Route: ORAL Class: Pharmacy All Administrations of SOMA 350 MG TAB No Administrations Recorded Warnings Override History for SOMA 350 MG TAB [11514417] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 6/22/2006 8:02 AM
Quantity 90
Refills 0
Start 6/21/2006
End 7/19/2006
Reason None Reason
Signed and Held / Pended Order History Pending User Date/Time Wed Jun 21, 2006 1634 Isolation No Isolation Order Details Frequency None
Order History Order Date/Time 06/22/06 0802 05/23/06 1218 05/01/06 1426 Provider Information Ordering User Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 11514417 11099064 10770668
Patient Information
000978
Order Status Discontinued
On 8/9/06 1629
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Wed Jul 19, 2006 0953 Wed Jul 19, 2006 0945 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order History Order Date/Time 07/20/06 1229 06/22/06 0802 05/23/06 1218 05/01/06 1426 Provider Information Ordering User Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero, MD
Order ID 11883695 11514417 11099064 10770668
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
METHADONE 10 MG TAB (Order 11628480)

Start 6/29/2006 End 7/26/2006
Quantity Refills 180 0 METHADONE 10 MG TAB (Discontinued) Sig : take 1 tablet (10mg) by oral route every 4 hours as directed Route: ORAL
All Administrations of METHADONE 10 MG TAB No Administrations Recorded Warnings Override History for METHADONE 10 MG TAB [11628480] No Warning History Available Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies
000979
FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 6/29/2006 7:09 PM Electronically Signed By/Authorizing Victor Baquero, MD On 7/26/06 1703 Department Relayhealth Reason None
Priority Routine
Order Class Normal
User Victor Baquero, MD Victor Baquero, MD

Order ID 11628480 11423903
Patient Information Patient Name Amundsen, Mark Unit RH
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Warnings Override History for NORCO 10 MG-325 MG TAB [11628479] No Warning History Available
000980
Pharmacy Selected For Faxed Prescriptions CVS/PHARMACY #3950 | 2790 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 6/29/2006 7:09 PM Electronically Signed By/Authorizing Victor Baquero, MD On 7/20/06 1229 Department Relayhealth Reason None
Priority Routine
Order History Order Date/Time 06/29/06 1909 06/06/06 1509 05/23/06 1218 05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235 Provider Information Ordering User Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero, MD
Order ID 11628479 11298702 11099075 10770690 10549668 9590661 9329992 3659473 3336159 3106182
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
000981
Order Info Date and Time 7/26/2006 5:03 PM Electronically Signed By/Authorizing Victor Baquero, MD On 8/17/06 1256 Department Relayhealth Reason None
Priority Routine
Order Class Normal
Order History Order Date/Time 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information Ordering User Victor Baquero, MD PCP Victor Baquero, MD

Order ID 11994381 11628480 11423903
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
FLUOXETINE 40 MG CAP (Order 11881347) Start 7/19/2006 End 1/18/2007
Quantity Refills 30 6 FLUOXETINE 40 MG CAP (Discontinued) Sig : take 1 capsule (40mg) by oral route once daily in the morning Route: ORAL Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. Class: Pharmacy All Administrations of FLUOXETINE 40 MG CAP No Administrations Recorded Warnings Override History for FLUOXETINE 40 MG CAP [11881347] No Warning History Available
000982
Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 7/20/2006 12:29 PM
Released By CORY O'DELL [778869065] CORY O'DELL [778869065] VICTOR H BAQUERO [886764315]
On 1/18/07 1253 Status Pended Pended Pended
Reason None Reason
Signed and Held / Pended Order History Pending User Date/Time Wed Jul 19, 2006 0953 Wed Jul 19, 2006 0945 Wed Jul 19, 2006 0815 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order History Order Date/Time 07/20/06 1229 01/19/06 0938 01/02/06 1618 07/12/05 0933 Provider Information Ordering User Victor Baquero, MD
User Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero
Action Current Order Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero, MD
Order ID 11881347 9329993 9092524 6852182
MRN 8081369
Sex Male
DOB 9/23/1959
Visit CSN
000983
Medication
Medication Detail
Quantity Refills 250 1 NORCO 10 MG-325 MG TAB (Discontinued) Sig : 1-2 po q 6 hours. Max 8 per day. Route: ORAL Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1069118. Last date filled 06/29/06. Class: Pharmacy All Administrations of NORCO 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for NORCO 10 MG-325 MG TAB [11883905] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 7/20/2006 12:29 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued On 8/29/06 1221
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Wed Jul 19, 2006 0953 Isolation No Isolation Order Details Frequency None
Order History Order Date/Time 07/20/06 1229 06/29/06 1909 06/06/06 1509 05/23/06 1218 05/01/06 1427 04/18/06 1716
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 11883905 11628479 11298702 11099075 10770690 10549668
000984
02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235
Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero, MD
9590661 9329992 3659473 3336159 3106182
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
SOMA 350 MG TAB (Order 11883695) Start 7/19/2006 End 8/9/2006
Quantity Refills 90 0 SOMA 350 MG TAB (Discontinued) Sig : 1 po tid Route: ORAL Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1068605. Last date filled 06/22/06. Class: Pharmacy All Administrations of SOMA 350 MG TAB No Administrations Recorded Warnings Override History for SOMA 350 MG TAB [11883695] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Released By CORY O'DELL [778869065] VICTOR H BAQUERO [886764315] This Order Has Been Discontinued
000985
Discontinued
Victor Baquero, MD
8/29/06 1221
Status Pended
None
Reason
Signed and Held / Pended Order History Pending User Date/Time Wed Aug 9, 2006 1419 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order History Order Date/Time 08/09/06 1629 07/20/06 1229 06/22/06 0802 05/23/06 1218 05/01/06 1426 Provider Information Ordering User Victor Baquero, MD PCP Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero, MD
Order ID 12188977 11883695 11514417 11099064 10770668

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity Refills 180 0 METHADONE 10 MG TAB (Discontinued) Sig : take 1 tablet (10mg) by oral route every 4 hours as directed Route: ORAL All Administrations of METHADONE 10 MG TAB No Administrations Recorded Warnings Override History for METHADONE 10 MG TAB [11994381] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter
000986
08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information Ordering User Victor Baquero, MD PCP Victor Baquero, MD
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Current Order Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero, MD
12308313 11994381 11628480 11423903

Unit RH
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity Refills 0 90 SOMA 350 MG TAB (Discontinued) Sig : 1 po tid Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 172531. Class: Pharmacy All Administrations of SOMA 350 MG TAB No Administrations Recorded Warnings Override History for SOMA 350 MG TAB [12188977] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 8/9/2006 4:29 PM
On
Reason
000987
05/01/06 1426
Victor Baquero, MD
Reordered from
10770668

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity Refills 0 180 METHADONE 10 MG TAB (Discontinued) Sig : take 1 tablet (10mg) by oral route every 4 hours as directed Route: ORAL All Administrations of METHADONE 10 MG TAB No Administrations Recorded Warnings Override History for METHADONE 10 MG TAB [12308313] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 8/17/2006 12:55 PM Electronically Signed By/Authorizing Victor Baquero, MD On 9/11/06 0843
Department Relayhealth Reason None
Priority Routine
Order Class Normal
User
Action
Order ID
000988
On 10/2/06 1038
Reason None
Priority Routine
Order Class Normal
Order ID 12648793 12308313 11994381 11628480 11423903
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity Refills 250 1 NORCO 10 MG-325 MG TAB (Discontinued) Sig : 1-2 po q 6 hours. Max 8 per day. Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 172532. Class: Pharmacy All Administrations of NORCO 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for NORCO 10 MG-325 MG TAB [12474895] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630
000989

Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Tue Aug 29, 2006 0945 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order History Order Date/Time 08/29/06 1221 07/20/06 1229 06/29/06 1909 06/06/06 1509 05/23/06 1218 05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235 Provider Information Ordering User Victor Baquero, MD PCP Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Order ID 12474895 11883905 11628479 11298702 11099075 10770690 10549668 9590661 9329992 3659473 3336159 3106182
MRN 8081369
Sex Male
DOB 9/23/1959
000990
Medication
Medication Detail

Start 8/29/2006 End 9/20/2006
Quantity Refills 90 0 SOMA 350 MG TAB (Discontinued) Sig : 1 po tid Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 174296 Class: Pharmacy
All Administrations of SOMA 350 MG TAB No Administrations Recorded Warnings Override History for SOMA 350 MG TAB [12474894] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Status Pended
Reason None
Reason
Order History Order Date/Time 08/29/06 1221 08/09/06 1629 07/20/06 1229 06/22/06 0802 05/23/06 1218
Order ID 12474894 12188977 11883695 11514417 11099064
000991
Order Date/Time 09/18/06 1301 08/29/06 1221 07/20/06 1229 06/29/06 1909 06/06/06 1509 05/23/06 1218 05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235 Provider Information Ordering User Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero, MD
Order ID 12755804 12474895 11883905 11628479 11298702 11099075 10770690 10549668 9590661 9329992 3659473 3336159 3106182
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Start 9/11/2006 End 10/2/2006
All Administrations of METHADONE 10 MG TAB No Administrations Recorded Warnings Override History for METHADONE 10 MG TAB [12648793] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 9/11/2006 8:43 AM Electronically Signed By/Authorizing Victor Baquero, MD Department Relayhealth
000992

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity Refills 250 1 NORCO 10 MG-325 MG TAB (Discontinued) Sig : 1-2 po q 6 hours. Max 8 per day. Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Class: Pharmacy All Administrations of NORCO 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for NORCO 10 MG-325 MG TAB [12755804] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 9/18/2006 1:01 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued
Reason None Reason
Signed and Held / Pended Order History Pending User Date/Time Mon Sep 18, 2006 1048 Isolation No Isolation Order Details Frequency None
Order History
000993
No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info

On 10/23/06 0822
Duration None
Priority Routine
Order Class Normal
Order History Order Date/Time 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information Ordering User Victor Baquero, MD PCP Victor Baquero, MD
Order ID 12961787 12648793 12308313 11994381 11628480 11423903

Unit RH
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail SOMA 350 MG TAB (Discontinued) Sig : 1 po tid Route: ORAL Quantity 90
000994
Comment: This is a REFILL AUTHORIZATION for prescription number 176027 Class: Pharmacy All Administrations of SOMA 350 MG TAB No Administrations Recorded Warnings Override History for SOMA 350 MG TAB [12795068] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Wed Sep 20, 2006 1152 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order History Order Date/Time 09/21/06 0905 08/29/06 1221 08/09/06 1629 07/20/06 1229 06/22/06 0802 05/23/06 1218 05/01/06 1426 Provider Information Ordering User Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero, MD
Order ID 12795068 12474894 12188977 11883695 11514417 11099064 10770668
Patient Information
000995
10/6/2006 4:26 PM Released By VICTOR H BAQUERO [886764315]
Victor Baquero, MD
Fol Family Practice
Signed and Held / Pended Order History Pending User Date/Time Thu Oct 5, 2006 1149 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Status Pended
Reason
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 13020752 12795068 12474894 12188977 11883695 11514417 11099064 10770668

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity Refills 180 0 METHADONE 10 MG TAB (Discontinued) Sig : take 1 tablet (10mg) by oral route every 4 hours as directed Route: ORAL All Administrations of METHADONE 10 MG TAB No Administrations Recorded Warnings Override History for METHADONE 10 MG TAB [12961787]
000996
Amundsen, Mark Unit RH
8081369
Male
9/23/1959
Medication
Medication Detail
Quantity Refills 250 1 NORCO 10 MG-325 MG TAB Sig : 1-2 po q 6 hours. Max 8 per day. Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 177788 Class: Pharmacy All Administrations of NORCO 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for NORCO 10 MG-325 MG TAB [13020751] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Released By VICTOR H BAQUERO [886764315] Signed and Held / Pended Order History Pending User Date/Time Thu Oct 5, 2006 1149 Isolation No Isolation Order Details Frequency None Duration None Priority Routine Order Class Pharmacy
Order ID 13020751 12755804 12474895 11883905
000997
06/29/06 1909 06/06/06 1509 05/23/06 1218 05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
11628479 11298702 11099075 10770690 10549668 9590661 9329992 3659473 3336159 3106182

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity Refills 90 0 SOMA 350 MG TAB Sig : take 1 tabket 3 times a day Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 1178084 Class: Pharmacy All Administrations of SOMA 350 MG TAB No Administrations Recorded Warnings Override History for SOMA 350 MG TAB [13020752] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time Electronically Signed By/Authorizing
Department
000998
Medication
Medication Detail

Start 10/23/2006 End 11/14/2006
All Administrations of METHADONE 10 MG TAB No Administrations Recorded Warnings Override History for METHADONE 10 MG TAB [13301080] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 10/23/2006 8:22 AM Electronically Signed By/Authorizing Victor Baquero, MD On 11/14/06 1334 Department Relayhealth Reason None
Duration None
Priority Routine
Order Class Normal
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero, MD
Order ID 13301080 12961787 12648793 12308313 11994381 11628480 11423903
MRN
Sex
DOB
000999

Unit RH
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
ALEVE 220 MG TAB (Order 13399311) Start 10/27/2006 End 12/15/2009
Quantity Refills 0 ALEVE 220 MG TAB (Discontinued) Sig : take 1 tablet (220mg) by oral route every 12 hours as needed Route: ORAL Class: Historical All Administrations of ALEVE 220 MG TAB No Administrations Recorded Warnings Override History for ALEVE 220 MG TAB [13399311] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 10/27/2006 9:36 AM This Order Has Been Discontinued Order Status By Jonathan G Discontinued Eastman, MD Isolation No Isolation Order Details Frequency None Duration None Priority Routine Electronically Signed By/Authorizing Victor Baquero, MD On 12/15/09 1540
001000
MRN 8081369
Sex Male
DOB 9/23/1959
Account # 078080963107
Medication
Medication Detail
Quantity Refills 300 1 NORCO 10 MG-325 MG TAB (Discontinued) Sig : 1-2 po q 6 hours. Max 8 per day. Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Class: Pharmacy All Administrations of NORCO 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for NORCO 10 MG-325 MG TAB [13399312] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 10/27/2006 9:36 AM Electronically Signed By/Authorizing Victor Baquero, MD On 11/16/06 1902
Priority Routine
001001
Order History Order Date/Time 10/27/06 0936 09/18/06 1301 08/29/06 1221 07/20/06 1229 06/29/06 1909 06/06/06 1509 05/23/06 1218 05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235 Provider Information Ordering User Victor Baquero, MD PCP Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Order ID 13399312 12755804 12474895 11883905 11628479 11298702 11099075 10770690 10549668 9590661 9329992 3659473 3336159 3106182

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Account # 078080963107
Medication
Medication Detail

Start 10/27/2006 End 11/16/2006
All Administrations of SOMA 350 MG TAB No Administrations Recorded Warnings Override History for SOMA 350 MG TAB [13399309]
001002
No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 10/27/2006 9:36 AM Electronically Signed By/Authorizing Victor Baquero, MD On 11/16/06 1902 Department Fol Family Practice Reason None
Priority Routine
Order ID 13399309 12795068 12474894 12188977 11883695 11514417 11099064 10770668

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Account # 078080963107 Account Information Acct Number 078080963107
001003
Medication
Medication Detail
Quantity Refills 240 0 METHADONE 10 MG TAB (Discontinued) Sig : take 1 tablet (10mg) by oral route every 4 hours as directed Route: ORAL All Administrations of METHADONE 10 MG TAB No Administrations Recorded Warnings Override History for METHADONE 10 MG TAB [13748358] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 11/14/2006 1:34 PM This Order Has Been Discontinued Order Status By Victor Henrique Discontinued Baquero, MD Isolation No Isolation Order Details Frequency None Duration None Priority Routine Electronically Signed By/Authorizing Victor Baquero, MD On 5/24/10 1406
Order Class Normal
Order ID 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
Patient Information
001004
05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235
Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
10770690 10549668 9590661 9329992 3659473 3336159 3106182

Unit RH
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity Refills 1 300 NORCO 10 MG-325 MG TAB (Discontinued) Sig : 1-2 po q 6 hours. Max 8 per day. Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Class: Pharmacy All Administrations of NORCO 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for NORCO 10 MG-325 MG TAB [13806608] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 11/16/2006 7:02 PM This Order Has Been Discontinued Order Status By Electronically Signed By/Authorizing Victor Baquero, MD On
Department Relayhealth Reason
001005
Discontinued
Victor Baquero, MD
12/6/06 1654
None

Order History Order Date/Time 11/16/06 1902 10/27/06 0936 09/18/06 1301 08/29/06 1221 07/20/06 1229 06/29/06 1909 06/06/06 1509 05/23/06 1218 05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235 Provider Information Ordering User Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 13806608 13399312 12755804 12474895 11883905 11628479 11298702 11099075 10770690 10549668 9590661 9329992 3659473 3336159 3106182
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Start 11/16/2006 End 12/8/2006
All Administrations of SOMA 350 MG TAB
001006
No Administrations Recorded Warnings Override History for SOMA 350 MG TAB [13806607] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 11/16/2006 7:02 PM Electronically Signed By/Authorizing Victor Baquero, MD On 12/8/06 1636 Department Relayhealth Reason None
Priority Routine
Order History Order Date/Time 11/16/06 1902 10/27/06 0936 09/21/06 0905 08/29/06 1221 08/09/06 1629 07/20/06 1229 06/22/06 0802 05/23/06 1218 05/01/06 1426 Provider Information Ordering User Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero, MD
Order ID 13806607 13399309 12795068 12474894 12188977 11883695 11514417 11099064 10770668
MRN 8081369
Sex Male
DOB 9/23/1959
Visit CSN
001007
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Fri Dec 8, 2006 1554 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 14222418 13806607 13399309 12795068 12474894 12188977 11883695 11514417 11099064 10770668
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail METHADONE 10 MG TAB (Discontinued)
Quantity 240

001008
Sig : take 1 tablet (10mg) by oral route every 4 hours as directed Route: ORAL All Administrations of METHADONE 10 MG TAB No Administrations Recorded Warnings Override History for METHADONE 10 MG TAB [14176752] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Duration None
Reason None
Priority Routine
Order Class Normal
Order History Order Date/Time 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information Ordering User Victor Baquero, MD PCP Victor Baquero, MD
Order ID 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

Unit RH
MRN 8081369
Sex Male
DOB 9/23/1959
001009
Medication
Medication Detail

Start 12/6/2006 End 12/28/2006
Quantity Refills 1 300 NORCO 10 MG-325 MG TAB (Discontinued) Sig : 1-2 po q 4 hours. Max 10 per day. Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Class: Pharmacy
All Administrations of NORCO 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for NORCO 10 MG-325 MG TAB [14176753] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/6/2006 4:54 PM Electronically Signed By/Authorizing Victor Baquero, MD
On 12/28/06 0803
Reason None
Priority Routine
Order ID 14176753 13806608 13399312 12755804 12474895 11883905 11628479 11298702 11099075
001010
08/29/06 1221 07/20/06 1229 06/29/06 1909 06/06/06 1509 05/23/06 1218 05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
12474895 11883905 11628479 11298702 11099075 10770690 10549668 9590661 9329992 3659473 3336159 3106182

MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Start 12/8/2006 End 1/18/2007
001011
COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info

On 2/6/07 1743
Duration None
Priority Routine
Order History Order Date/Time 01/18/07 1253 12/08/06 1636 11/16/06 1902 10/27/06 0936 09/21/06 0905 08/29/06 1221 08/09/06 1629 07/20/06 1229 06/22/06 0802 05/23/06 1218 05/01/06 1426 Provider Information Ordering User Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 14957272 14222418 13806607 13399309 12795068 12474894 12188977 11883695 11514417 11099064 10770668
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
001012
Medication Detail METHADONE 10 MG TAB (Discontinued) Sig : Take 2 po every 6 hours (max 8 daily) Route: ORAL All Administrations of METHADONE 10 MG TAB No Administrations Recorded Warnings Override History for METHADONE 10 MG TAB [14565826] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/28/2006 8:03 AM Electronically Signed By/Authorizing Victor Baquero, MD On 1/18/07 1253 Department Relayhealth Reason None Quantity 240 Refills 0 Start 12/28/2006 End 1/18/2007
Duration None
Priority Routine
Order Class Normal
Order History Order Date/Time 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information Ordering User Victor Baquero, MD PCP Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
Patient Information
001013

Unit RH
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity Refills 300 1 NORCO 10 MG-325 MG TAB (Discontinued) Sig : 2 po q 4 hours. Max 10 per day. Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Class: Pharmacy All Administrations of NORCO 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for NORCO 10 MG-325 MG TAB [14565825] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/28/2006 8:03 AM Electronically Signed By/Authorizing Victor Baquero, MD On 1/18/07 1253
Priority Routine
Order ID 14565825 14176753 13806608 13399312 12755804
001014
2/6/2007 5:43 PM Released By VICTOR H BAQUERO [886764315]
Victor Baquero, MD
Fol Family Practice
On 3/2/07 0817
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Tue Feb 6, 2007 1258 Isolation No Isolation Order Details Frequency None
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 15336224 14957272 14222418 13806607 13399309 12795068 12474894 12188977 11883695 11514417 11099064 10770668

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail FLUOXETINE 40 MG CAP (Discontinued) Quantity 30
FLUOXETINE 40 MG CAP (Order 14957273) Refills 6 Start 1/18/2007 End 2/27/2007
001015
Sig : take 1 capsule (40mg) by oral route once daily in the morning Route: ORAL Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. Class: Pharmacy All Administrations of FLUOXETINE 40 MG CAP No Administrations Recorded Warnings Override History for FLUOXETINE 40 MG CAP [14957273] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Duration None
Reason None
Priority Routine
Order History Order Date/Time 01/18/07 1253 07/20/06 1229 01/19/06 0938 01/02/06 1618 07/12/05 0933 Provider Information Ordering User Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero
Order ID 14957273 11881347 9329993 9092524 6852182
MRN 8081369
Sex Male
DOB 9/23/1959
001016
Medication
Medication Detail METHADONE 10 MG TAB (Discontinued) Sig : Take 2 po every 6 hours (max 8 daily) Route: ORAL All Administrations of METHADONE 10 MG TAB No Administrations Recorded
Quantity 240

Warnings Override History for METHADONE 10 MG TAB [14957271] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info

On 2/6/07 1736
Priority Routine
Order Class Normal
Order History Order Date/Time 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information Ordering User
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider
Order ID 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
001017
Victor Baquero, MD PCP Victor Baquero, MD
Victor Baquero, MD

Unit RH
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity Refills 300 1 NORCO 10 MG-325 MG TAB (Discontinued) Sig : 2 po q 4 hours. Max 10 per day. Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Class: Pharmacy All Administrations of NORCO 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for NORCO 10 MG-325 MG TAB [14957270] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 1/18/2007 12:53 PM Electronically Signed By/Authorizing Victor Baquero, MD On 2/6/07 1743
Priority Routine
001018
Order History Order Date/Time 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/16/06 1902 10/27/06 0936 09/18/06 1301 08/29/06 1221 07/20/06 1229 06/29/06 1909 06/06/06 1509 05/23/06 1218 05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235 Provider Information Ordering User Victor Baquero, MD PCP Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Order ID 14957270 14565825 14176753 13806608 13399312 12755804 12474895 11883905 11628479 11298702 11099075 10770690 10549668 9590661 9329992 3659473 3336159 3106182
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Start 1/18/2007 End 2/6/2007
All Administrations of SOMA 350 MG TAB No Administrations Recorded Warnings Override History for SOMA 350 MG TAB [14957272] No Warning History Available Pharmacy Selected For Faxed Prescriptions
001019
Signed and Held / Pended Order History Pending User Date/Time Tue Feb 27, 2007 1025 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Status Pended
Reason
Order History Order Date/Time 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/08/06 1636 11/16/06 1902 10/27/06 0936 09/21/06 0905 08/29/06 1221 08/09/06 1629 07/20/06 1229 06/22/06 0802 05/23/06 1218 05/01/06 1426 Provider Information Ordering User Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero, MD
Order ID 15747350 15336224 14957272 14222418 13806607 13399309 12795068 12474894 12188977 11883695 11514417 11099064 10770668
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail METHADONE 10 MG TAB (Discontinued) Sig : Take 2 po every 6 hours (max 8 daily) Route: ORAL All Administrations of METHADONE 10 MG TAB No Administrations Recorded Quantity 240
001020
Warnings Override History for METHADONE 10 MG TAB [15343963] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 2/6/2007 5:36 PM Electronically Signed By/Authorizing Victor Baquero, MD
On 2/14/07 0903
Reason None
Priority Routine
Order Class Normal
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
MRN 8081369
Sex Male
DOB 9/23/1959
001021
Medication
Medication Detail

Start 2/9/2007 End 2/27/2007
Quantity Refills 300 1 NORCO 10 MG-325 MG TAB (Discontinued) Sig : 2 po q 4 hours. Max 10 per day. Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Class: Pharmacy
All Administrations of NORCO 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for NORCO 10 MG-325 MG TAB [15336225] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 2/6/2007 5:43 PM
On 3/2/07 0817
Status Pended
Reason None
Reason
Order ID 15336225 14957270 14565825 14176753 13806608 13399312 12755804 12474895 11883905
001022
06/29/06 1909 06/06/06 1509 05/23/06 1218 05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
11628479 11298702 11099075 10770690 10549668 9590661 9329992 3659473 3336159 3106182

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity Refills 3 90 SOMA 350 MG TAB (Discontinued) Sig : 1 po tid Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176027 Class: Pharmacy All Administrations of SOMA 350 MG TAB No Administrations Recorded Warnings Override History for SOMA 350 MG TAB [15336224] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time Electronically Signed By/Authorizing
Department
001023
02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Start 2/27/2007 End 3/22/2007
Quantity Refills 30 6 FLUOXETINE 40 MG CAP (Discontinued) Sig : take 1 capsule (40mg) by oral route once daily in the morning Route: ORAL Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. Class: Pharmacy
All Administrations of FLUOXETINE 40 MG CAP No Administrations Recorded Warnings Override History for FLUOXETINE 40 MG CAP [15747352] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
001024
Status Pended
Reason None
Reason
Order History Order Date/Time 03/02/07 0817 01/18/07 1253 07/20/06 1229 01/19/06 0938 01/02/06 1618 07/12/05 0933 Provider Information Ordering User Victor Baquero, MD PCP Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero
Order ID 15747352 14957273 11881347 9329993 9092524 6852182
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity Refills 300 1 NORCO 10 MG-325 MG TAB (Discontinued) Sig : 2 po q 4 hours. Max 10 per day. Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176026
001025
Class: Pharmacy All Administrations of NORCO 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for NORCO 10 MG-325 MG TAB [15747351] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Status Pended
Reason None
Reason
Order History Order Date/Time 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/16/06 1902 10/27/06 0936 09/18/06 1301 08/29/06 1221 07/20/06 1229 06/29/06 1909 06/06/06 1509 05/23/06 1218 05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 15747351 15336225 14957270 14565825 14176753 13806608 13399312 12755804 12474895 11883905 11628479 11298702 11099075 10770690 10549668 9590661 9329992
001026
09/14/04 0856 08/11/04 1721 07/19/04 1235
Victor Baquero Victor Baquero Victor Baquero
Reordered from Reordered from Reordered from
3659473 3336159 3106182

MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Start 2/27/2007 End 3/22/2007
All Administrations of SOMA 350 MG TAB No Administrations Recorded Warnings Override History for SOMA 350 MG TAB [15747350] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 3/2/2007 8:17 AM
On 3/22/07 1012
Reason None
001027

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Warnings Override History for METHADONE 10 MG TAB [15816970] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info

On 3/22/07 0813
Priority Routine
Order Class Normal
Order History Order Date/Time 03/02/07 0820
User Victor Baquero, MD
Action Current Order
Order ID 15816970
001028
RH
Medication
Medication Detail

Start 3/22/2007 End 10/20/2007
Quantity Refills 30 6 FLUOXETINE 40 MG CAP Sig : take 1 capsule (40mg) by oral route once daily in the morning Route: ORAL Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. Class: Pharmacy
All Administrations of FLUOXETINE 40 MG CAP No Administrations Recorded Warnings Override History for FLUOXETINE 40 MG CAP [16234617] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 3/22/2007 10:12 AM
Signed and Held / Pended Order History Pending User Date/Time Thu Mar 22, 2007 0949 Isolation No Isolation Order Details Frequency None
Status Pended
Reason
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero
Order ID 16234617 15747352 14957273 11881347 9329993 9092524
001029
07/12/05 0933
Victor Baquero
Reordered from
6852182

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity Refills 1 300 NORCO 10 MG-325 MG TAB (Discontinued) Sig : 2 po q 4 hours. Max 10 per day. Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Class: Pharmacy All Administrations of NORCO 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for NORCO 10 MG-325 MG TAB [16234616] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 3/22/2007 10:12 AM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued Signed and Held / Pended Order History Pending User Date/Time On 3/29/07 1715
Status
Reason None
Reason
001030
Thu Mar 22, 2007 0949
Pended

Order History Order Date/Time 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/16/06 1902 10/27/06 0936 09/18/06 1301 08/29/06 1221 07/20/06 1229 06/29/06 1909 06/06/06 1509 05/23/06 1218 05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235 Provider Information Ordering User Victor Baquero, MD PCP Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Order ID 16234616 15747351 15336225 14957270 14565825 14176753 13806608 13399312 12755804 12474895 11883905 11628479 11298702 11099075 10770690 10549668 9590661 9329992 3659473 3336159 3106182

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail SOMA 350 MG TAB (Discontinued) Quantity 90
001031
Sig : 1 po tid Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176027 Class: Pharmacy All Administrations of SOMA 350 MG TAB No Administrations Recorded Warnings Override History for SOMA 350 MG TAB [16234615] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Thu Mar 22, 2007 0949 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 16234615 15747350 15336224 14957272 14222418 13806607 13399309 12795068 12474894 12188977 11883695 11514417 11099064 10770668
001032
Order History Order Date/Time 03/29/07 1715 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/16/06 1902 10/27/06 0936 09/18/06 1301 08/29/06 1221 07/20/06 1229 06/29/06 1909 06/06/06 1509 05/23/06 1218 05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235 Provider Information Ordering User Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero, MD
Order ID 16392919 16234616 15747351 15336225 14957270 14565825 14176753 13806608 13399312 12755804 12474895 11883905 11628479 11298702 11099075 10770690 10549668 9590661 9329992 3659473 3336159 3106182
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail METHADONE 10 MG TAB (Discontinued) Sig : Take 2 po every 6 hours (max 8 daily) Route: ORAL Quantity 120
001033
All Administrations of METHADONE 10 MG TAB No Administrations Recorded Warnings Override History for METHADONE 10 MG TAB [16231762] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 3/22/2007 8:13 AM Electronically Signed By/Authorizing Victor Baquero, MD On 4/6/07 1644 Department Relayhealth Reason None
Priority Routine
Order Class Normal
Order History Order Date/Time 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information Ordering User Victor Baquero, MD PCP Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
MRN 8081369
Sex Male
DOB 9/23/1959
001034

MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Start 3/29/2007 End 8/1/2007
All Administrations of NORCO 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for NORCO 10 MG-325 MG TAB [16392919] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Thu Mar 29, 2007 1549 Isolation
001035
METHADONE 10 MG TAB (Discontinued) Sig : Take 2 po every 6 hours (max 8 daily) Route: ORAL All Administrations of METHADONE 10 MG TAB No Administrations Recorded
Quantity 240
Refills 0
Start 4/6/2007
End 4/20/2007
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Fri Apr 6, 2007 1546 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order Class Normal
Order History Order Date/Time 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
001036
Pending User
Date/Time Tue Apr 24, 2007 1836
Status Pended
Reason
Order History Order Date/Time 04/25/07 1252 05/23/06 0925 03/24/06 1534 03/02/06 1734 02/27/06 1730 08/03/05 1316 07/12/05 1002 06/20/05 1718 05/31/05 1402 05/04/05 1657 04/12/05 1015 03/21/05 1710 02/25/05 1227 02/03/05 1255 01/10/05 1634 12/20/04 1827 11/23/04 1223 11/01/04 1210 10/07/04 1011 09/10/04 1307 Provider Information Ordering User Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero, MD
Order ID 16913151 11096396 10258228 9940824 9885162 7109645 6852954 6609044 6365983 6071504 5812750 5578864 5320784 5086755 4829473 4636774 4372141 4149230 3897847 3628204
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail CELEXA 40 MG TAB Quantity 30
CELEXA 40 MG TAB (Order 16827160) Refills 2 Start 4/20/2007 End 6/20/2007
001037
Sig : take 1 tablet (40mg) by oral route once daily Route: ORAL Class: Pharmacy All Administrations of CELEXA 40 MG TAB No Administrations Recorded Warnings Override History for CELEXA 40 MG TAB [16827160] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info

MRN 8081369
Sex Male
DOB 9/23/1959
Account # 078199740040
Medication
Medication Detail
001038
Victor Baquero, MD
MRN 8081369
Sex Male
DOB 9/23/1959
Account # 078199740040
Medication
Medication Detail
All Administrations of HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB [16913151] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 4/25/2007 12:52 PM
This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued Signed and Held / Pended Order History
On 5/18/07 1823
Reason None
001039
On 8/24/07 1248
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Fri May 18, 2007 1414 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order History Order Date/Time 05/18/07 1823 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/08/06 1636 11/16/06 1902 10/27/06 0936 09/21/06 0905 08/29/06 1221 08/09/06 1629 07/20/06 1229 06/22/06 0802 05/23/06 1218 05/01/06 1426 Provider Information Ordering User Victor Baquero, MD PCP Victor Baquero, MD
Order ID 17408551 16234615 15747350 15336224 14957272 14222418 13806607 13399309 12795068 12474894 12188977 11883695 11514417 11099064 10770668
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail METHADONE 10 MG TAB (Discontinued) Quantity 300
001040
Sig : Take 2 po every 6 hours (max 10 daily) Route: ORAL Class: Historical All Administrations of METHADONE 10 MG TAB No Administrations Recorded Warnings Override History for METHADONE 10 MG TAB [16827161] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Duration None
Reason None
Priority Routine
Order History Order Date/Time 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information Ordering User Victor Baquero, MD PCP
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero, MD
Order ID 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
001041
5/31/2007 8:00 PM This Order Has Been Discontinued Order Status By Victor Henrique Discontinued Baquero, MD Isolation No Isolation Order Details Frequency None
Duration None
Victor Baquero, MD On 2/24/10 1725
Relayhealth Reason None
Priority Routine
Order Class Normal
Order History Order Date/Time 05/31/07 2000 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information Ordering User Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Quantity 300 Refills 0/0 Start 5/18/2007 End 6/17/2007
HYDROCODONE-ACETAMINOPHEN 10 MG-
001042
325 MG TAB Sig : take 1-2 tablet by oral route every 4 hours as needed for pain, may take up to 10 daily. Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 Class: Pharmacy All Administrations of HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB [17408550] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Released By VICTOR H BAQUERO [886764315] Signed and Held / Pended Order History Pending User Date/Time Fri May 18, 2007 1414 Isolation No Isolation Order Details Frequency None Duration None Priority Routine Order Class Pharmacy
Order History Order Date/Time 05/18/07 1823 04/25/07 1252 05/23/06 0925 03/24/06 1534 03/02/06 1734 02/27/06 1730 08/03/05 1316 07/12/05 1002 06/20/05 1718 05/31/05 1402 05/04/05 1657 04/12/05 1015 03/21/05 1710 02/25/05 1227 02/03/05 1255
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Order ID 17408550 16913151 11096396 10258228 9940824 9885162 7109645 6852954 6609044 6365983 6071504 5812750 5578864 5320784 5086755
001043
01/10/05 1634 12/20/04 1827 11/23/04 1223 11/01/04 1210 10/07/04 1011 09/10/04 1307
Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
4829473 4636774 4372141 4149230 3897847 3628204

MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Start 5/18/2007 End 8/24/2007
All Administrations of SOMA 350 MG TAB No Administrations Recorded Warnings Override History for SOMA 350 MG TAB [17408551] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 5/18/2007 6:23 PM
001044
Frequency None
Duration None
Priority Routine
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Order ID 17907222 11298702 11099075 10770690 10549668 9590661 9329992 3659473 3336159 3106182
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Quantity 300

Warnings Override History for METHADONE 10 MG TAB [17662191] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time Electronically Signed By/Authorizing Department
001045

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity Refills 250 1 NORCO 10 MG-325 MG TAB (Discontinued) Sig : 1-2 po q 6 hours. Max 8 per day. Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 201184. Last date filled 09/23/1959 Class: Pharmacy All Administrations of NORCO 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for NORCO 10 MG-325 MG TAB [17907222] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 6/13/2007 4:03 PM
Reason None Reason
Signed and Held / Pended Order History Pending User Date/Time Cherry Mendoza Wed Jun 13, 2007 0921 Isolation No Isolation Order Details
001046
On 8/7/07 1735
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Cherry Mendoza Mon Jul 16, 2007 1121 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order History Order Date/Time 07/16/07 1512 06/22/07 1112 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information Ordering User Kurt J Slapnik, MD PCP Victor Baquero, MD
User Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Authorizing Provider Kurt J Slapnik, MD
Order ID 18553324 18102039 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
001047
Medication Detail METHADONE 10 MG TAB (Discontinued) Sig : Take 2 po every 6 hours (max 10 daily) Route: ORAL All Administrations of METHADONE 10 MG TAB No Administrations Recorded Warnings Override History for METHADONE 10 MG TAB [18102039] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Quantity 300
Refills 0
Start 6/22/2007
End 7/16/2007
Electronically Signed By/Authorizing Martina Dobrovodska Randolph

On 7/16/07 1512
This Order Has Been Discontinued Order Status By Kurt J Slapnik, MD Discontinued Isolation No Isolation Order Details Frequency None Duration None
Priority Routine
Order Class Normal
User Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Martina Dobrovodska Randolph, MD
Order ID 18102039 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
Provider Information Ordering User Martina Dobrovodska Randolph, MD
001048
05/23/06 1218 05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero, MD
11099075 10770690 10549668 9590661 9329992 3659473 3336159 3106182
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail METHADONE 10 MG TAB (Discontinued) Sig : Take 2 po every 6 hours (max 10 daily) Route: ORAL Class: Historical All Administrations of METHADONE 10 MG TAB No Administrations Recorded Quantity 300
Warnings Override History for METHADONE 10 MG TAB [18553324] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Electronically Signed By/Authorizing Kurt J Slapnik, MD
001049
04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Start 8/1/2007 End 8/1/2007
Quantity Refills 250 1 NORCO 10 MG-325 MG TAB (Discontinued) Sig : 1-2 po q 6 hours. Max 8 per day. Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 201184. Last date filled 09/23/1959 Class: Pharmacy
All Administrations of NORCO 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for NORCO 10 MG-325 MG TAB [18878848] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter
001050

Reason None Reason
Signed and Held / Pended Order History Pending User Date/Time Cherry Mendoza Wed Aug 1, 2007 0833 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order History Order Date/Time 08/01/07 0907 06/13/07 1603 06/06/06 1509 05/23/06 1218 05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235 Provider Information Ordering User Victor Baquero, MD PCP Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Order ID 18878848 17907222 11298702 11099075 10770690 10549668 9590661 9329992 3659473 3336159 3106182
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
001051
NORCO 10 MG-325 MG TAB (Order 18888360) Medication Detail

Quantity Refills 300 1 NORCO 10 MG-325 MG TAB (Discontinued) Sig : 2 po q 4 hours. Max 10 per day. Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Class: Pharmacy Start 8/1/2007 End 9/18/2007
All Administrations of NORCO 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for NORCO 10 MG-325 MG TAB [18888360] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 8/1/2007 1:27 PM Electronically Signed By/Authorizing Victor Baquero, MD
On 9/18/07 1306

Reason None
Priority Routine
Order ID 18888360 16392919 16234616 15747351 15336225 14957270 14565825 14176753 13806608 13399312 12755804 12474895 11883905 11628479 11298702
001052
8081369
Male
9/23/1959
Medication
Warnings Override History for METHADONE 10 MG TAB [18998255] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 8/7/2007 5:35 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued
Signed and Held / Pended Order History Pending User Date/Time Cherry Mendoza Tue Aug 7, 2007 0827 Isolation No Isolation Order Details Frequency None
Order Class Normal
04/20/07 0919
User Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD
Order ID 18998255 18553324 18102039 16827161
001053
08/07/07 1735 07/16/07 1512 06/22/07 1112 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
18998255 18553324 18102039 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity Refills 90 3 SOMA 350 MG TAB (Discontinued) Sig : 1 po tid Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176027 Class: Pharmacy All Administrations of SOMA 350 MG TAB No Administrations Recorded Warnings Override History for SOMA 350 MG TAB [19378248] No Warning History Available Pharmacy Selected For Faxed Prescriptions
001054
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Fri Aug 24, 2007 1207 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order History Order Date/Time 08/24/07 1248 05/18/07 1823 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/08/06 1636 11/16/06 1902 10/27/06 0936 09/21/06 0905 08/29/06 1221 08/09/06 1629 07/20/06 1229 06/22/06 0802 05/23/06 1218 05/01/06 1426 Provider Information Ordering User Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero, MD
Order ID 19378248 17408551 16234615 15747350 15336224 14957272 14222418 13806607 13399309 12795068 12474894 12188977 11883695 11514417 11099064 10770668
MRN
Sex
DOB
001055
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Warnings Override History for METHADONE 10 MG TAB [19493600] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 8/31/2007 8:09 AM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued On 9/17/07 1803
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Cherry Mendoza Thu Aug 30, 2007 0823 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order Class Normal
Order ID 19493600
001056
02/06/07 1743 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/16/06 1902 10/27/06 0936 09/18/06 1301 08/29/06 1221 07/20/06 1229 06/29/06 1909 06/06/06 1509 05/23/06 1218 05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
15336225 14957270 14565825 14176753 13806608 13399312 12755804 12474895 11883905 11628479 11298702 11099075 10770690 10549668 9590661 9329992 3659473 3336159 3106182

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity Refills 90 3 SOMA 350 MG TAB (Discontinued) Sig : 1 po tid Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176027 Class: Pharmacy All Administrations of SOMA 350 MG TAB No Administrations Recorded Warnings Override History for SOMA 350 MG TAB [19830238] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630
001057

Released By CHERRY MENDOZA [955898341] VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued On 10/16/07 1736
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Cherry Mendoza Fri Sep 14, 2007 1725 Cherry Mendoza Fri Sep 14, 2007 1723 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order History Order Date/Time 09/17/07 1803 08/24/07 1248 05/18/07 1823 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/08/06 1636 11/16/06 1902 10/27/06 0936 09/21/06 0905 08/29/06 1221 08/09/06 1629 07/20/06 1229 06/22/06 0802 05/23/06 1218 05/01/06 1426 Provider Information Ordering User Victor Baquero, MD PCP Victor Baquero, MD
Order ID 19830238 19378248 17408551 16234615 15747350 15336224 14957272 14222418 13806607 13399309 12795068 12474894 12188977 11883695 11514417 11099064 10770668
001058

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity Refills 300 1 NORCO 10 MG-325 MG TAB (Discontinued) Sig : 2 po q 4 hours. Max 10 per day. Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Class: Pharmacy All Administrations of NORCO 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for NORCO 10 MG-325 MG TAB [19897779] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 9/18/2007 1:06 PM Electronically Signed By/Authorizing Victor Baquero, MD On 10/16/07 1736
Priority Routine
Order ID 19897779 18888360 16392919 16234616 15747351
001059
10/16/07 1736 09/17/07 1803 08/24/07 1248 05/18/07 1823 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/08/06 1636 11/16/06 1902 10/27/06 0936 09/21/06 0905 08/29/06 1221 08/09/06 1629 07/20/06 1229 06/22/06 0802 05/23/06 1218 05/01/06 1426 Provider Information Ordering User Victor Baquero, MD
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero, MD
20401029 19830238 19378248 17408551 16234615 15747350 15336224 14957272 14222418 13806607 13399309 12795068 12474894 12188977 11883695 11514417 11099064 10770668
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Quantity 300

Warnings Override History for METHADONE 10 MG TAB [19830274] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter
001060
View Encounter Order Info Date and Time 9/17/2007 6:03 PM

Reason None Reason
Signed and Held / Pended Order History Pending User Date/Time Cherry Mendoza Fri Sep 14, 2007 1725 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order Class Normal
Order History Order Date/Time 09/17/07 1803 08/31/07 0809 08/07/07 1735 07/16/07 1512 06/22/07 1112 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information Ordering User Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero, MD
Order ID 19830274 19493600 18998255 18553324 18102039 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
Patient Information
001061
12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Start 10/10/2007 End 12/10/2007
All Administrations of NORCO 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for NORCO 10 MG-325 MG TAB [20400950] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 10/16/2007 5:36 PM Electronically Signed By/Authorizing Victor Baquero, MD Department Fol Family Practice
001062
Released By CHERRY MENDOZA [955898341] VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued On 12/10/07 1736
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Cherry Mendoza Wed Oct 10, 2007 1700 Cherry Mendoza Wed Oct 10, 2007 1657 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order History Order Date/Time 10/16/07 1736 09/18/07 1306 08/01/07 1327 03/29/07 1715 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/16/06 1902 10/27/06 0936 09/18/06 1301 08/29/06 1221 07/20/06 1229 06/29/06 1909 06/06/06 1509 05/23/06 1218 05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235 Provider Information Ordering User Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero, MD
Order ID 20400950 19897779 18888360 16392919 16234616 15747351 15336225 14957270 14565825 14176753 13806608 13399312 12755804 12474895 11883905 11628479 11298702 11099075 10770690 10549668 9590661 9329992 3659473 3336159 3106182
MRN
Sex
DOB
001063
8081369
Male
9/23/1959
Medication
Medication Detail
Quantity Refills 3 90 SOMA 350 MG TAB (Discontinued) Sig : 1 po tid Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176027 Class: Pharmacy All Administrations of SOMA 350 MG TAB No Administrations Recorded Warnings Override History for SOMA 350 MG TAB [20401029] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Cherry Mendoza Wed Oct 10, 2007 1700 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
User
Action
Order ID
001064
Medication
Quantity 300

Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Cherry Mendoza Mon Oct 22, 2007 0836 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order Class Normal
Order History Order Date/Time 10/22/07 1713 09/17/07 1803 08/31/07 0809 08/07/07 1735 07/16/07 1512 06/22/07 1112 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 20658809 19830274 19493600 18998255 18553324 18102039 16827161 16546809 16231762 15816970 15343963 14957271 14565826
001065
06/06/06 1509 05/23/06 1218 05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
11298702 11099075 10770690 10549668 9590661 9329992 3659473 3336159 3106182

MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Quantity 300

Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued On 12/13/07 1239 Reason None
001066
Signed and Held / Pended Order History Pending User Date/Time Cherry Mendoza Fri Nov 16, 2007 1211 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Status Pended
Reason
Order Class Normal
04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero, MD
Order ID 21267173 20658809 19830274 19493600 18998255 18553324 18102039

16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
001067
Order History Order Date/Time 12/13/07 1239 11/16/07 1444 10/22/07 1713 09/17/07 1803 08/31/07 0809 08/07/07 1735 07/16/07 1512 06/22/07 1112 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information Ordering User Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero, MD
Order ID 21876329 21267173 20658809 19830274 19493600 18998255 18553324 18102039 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Start 12/10/2007 End 1/7/2008
Quantity Refills 300 1 NORCO 10 MG-325 MG TAB (Discontinued) Sig : 2 po q 4 hours. Max 10 per day. Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176026
001068
Class: Pharmacy All Administrations of NORCO 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for NORCO 10 MG-325 MG TAB [21797037] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Mon Dec 10, 2007 1616 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order ID 21797037 20400950 19897779 18888360 16392919 16234616 15747351 15336225 14957270 14565825 14176753 13806608 13399312 12755804 12474895 11883905 11628479
001069
02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235
Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
9590661 9329992 3659473 3336159 3106182
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Warnings Override History for METHADONE 10 MG TAB [21876329] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/13/2007 12:39 PM Electronically Signed By/Authorizing Victor Baquero, MD On 1/10/08 1229 Department Fol Family Practice Reason None
Priority Routine
Order Class Normal
001070
10/22/07 1713 09/17/07 1803 08/31/07 0809 08/07/07 1735 07/16/07 1512 06/22/07 1112 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
20658809 19830274 19493600 18998255 18553324 18102039 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity Refills 300 1 NORCO 10 MG-325 MG TAB (Discontinued) Sig : 2 po q 4 hours. Max 10 per day. Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Class: Pharmacy All Administrations of NORCO 10 MG-325 MG TAB No Administrations Recorded
001071
Warnings Override History for NORCO 10 MG-325 MG TAB [22349333] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 1/9/2008 12:50 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued
Signed and Held / Pended Order History Pending User Date/Time Cherry Mendoza Mon Jan 7, 2008 1224 Isolation No Isolation Order Details Frequency None
Order History Order Date/Time 01/09/08 1250 12/10/07 1736 10/16/07 1736 09/18/07 1306 08/01/07 1327 03/29/07 1715 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/16/06 1902 10/27/06 0936 09/18/06 1301 08/29/06 1221 07/20/06 1229 06/29/06 1909 06/06/06 1509 05/23/06 1218 05/01/06 1427 04/18/06 1716
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 22349333 21797037 20400950 19897779 18888360 16392919 16234616 15747351 15336225 14957270 14565825 14176753 13806608 13399312 12755804 12474895 11883905 11628479 11298702 11099075 10770690 10549668
001072
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Warnings Override History for METHADONE 10 MG TAB [22429171] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 1/10/2008 12:29 PM
Reason None Reason
Signed and Held / Pended Order History Pending User Date/Time Cherry Mendoza Thu Jan 10, 2008 0816 Isolation No Isolation Order Details Frequency None
Order Class Normal
Order ID 22429171 21876329 21267173
001073

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Quantity 300

Warnings Override History for METHADONE 10 MG TAB [22904790] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 1/30/2008 12:51 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued On 2/19/08 1349
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Cherry Mendoza Wed Jan 30, 2008 0955 Isolation No Isolation
001074
Duration None
Priority Routine
Order Class Normal
Order History Order Date/Time 01/30/08 1251 01/10/08 1229 12/13/07 1239 11/16/07 1444 10/22/07 1713 09/17/07 1803 08/31/07 0809 08/07/07 1735 07/16/07 1512 06/22/07 1112
04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 22904790 22429171 21876329 21267173 20658809 19830274 19493600 18998255 18553324 18102039
16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
001075
Quantity Refills 300 1 NORCO 10 MG-325 MG TAB (Discontinued) Sig : 2 po q 4 hours. Max 10 per day. Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Class: Pharmacy All Administrations of NORCO 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for NORCO 10 MG-325 MG TAB [22961591] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 2/1/2008 1:07 PM
Released By CLARE JENNINGS [250243482] VICTOR H BAQUERO [886764315]
Start 2/1/2008
End 3/5/2008
On 3/5/08 0811 Status Pended Pended
Reason None Reason
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Fri Feb 1, 2008 0913 Clare Jennings, MA Fri Feb 1, 2008 0908 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order ID 22961591 22349333 21797037 20400950 19897779 18888360 16392919 16234616 15747351 15336225
001076
01/18/07 1253 12/28/06 0803 12/06/06 1654 11/16/06 1902 10/27/06 0936 09/18/06 1301 08/29/06 1221 07/20/06 1229 06/29/06 1909 06/06/06 1509 05/23/06 1218 05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
14957270 14565825 14176753 13806608 13399312 12755804 12474895 11883905 11628479 11298702 11099075 10770690 10549668 9590661 9329992 3659473 3336159 3106182

MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Start 2/1/2008 End 4/4/2008
All Administrations of SOMA 350 MG TAB No Administrations Recorded Warnings Override History for SOMA 350 MG TAB [22961739] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630
001077

Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Fri Feb 1, 2008 0913 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order History Order Date/Time 02/01/08 1307 10/16/07 1736 09/17/07 1803 08/24/07 1248 05/18/07 1823 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/08/06 1636 11/16/06 1902 10/27/06 0936 09/21/06 0905 08/29/06 1221 08/09/06 1629 07/20/06 1229 06/22/06 0802 05/23/06 1218 05/01/06 1426 Provider Information Ordering User Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero, MD
Order ID 22961739 20401029 19830238 19378248 17408551 16234615 15747350 15336224 14957272 14222418 13806607 13399309 12795068 12474894 12188977 11883695 11514417 11099064 10770668
001078

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail EFFEXOR XR 75 MG 24 HR CAP Sig : 1 PO DAILY Route: ORAL Class: Pharmacy
EFFEXOR XR 75 MG 24 HR CAP (Order 23385596) Quantity 30 Refills 0 Start 2/19/2008 End 3/20/2008
All Administrations of EFFEXOR XR 75 MG 24 HR CAP No Administrations Recorded Warnings Override History for EFFEXOR XR 75 MG 24 HR CAP [23385596] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 2/19/2008 1:57 PM Isolation No Isolation Order Details Frequency None Duration None Priority Routine Order Class Pharmacy Electronically Signed By/Authorizing Victor Baquero, MD Department Fol Family Practice
001079
Medication Detail METHADONE 10 MG TAB Sig : Take 2 po every 6 hours (max 10 daily) Route: ORAL All Administrations of METHADONE 10 MG TAB No Administrations Recorded Warnings Override History for METHADONE 10 MG TAB [23437789] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 2/21/2008 9:35 AM Isolation No Isolation Order Details Frequency None Duration None Priority Routine Order Class Normal Electronically Signed By/Authorizing Victor Baquero, MD Department Fol Family Practice Quantity 300 Refills 0 Start 2/21/2008 End 3/12/2008
04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 23437789 22429171 21876329 21267173 20658809 19830274 19493600 18998255 18553324 18102039
16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381
001080
06/29/06 1909 06/15/06 0805
Victor Baquero, MD Victor Baquero, MD
Reordered from Reordered from Authorizing Provider Victor Baquero, MD
11628480 11423903
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
HYDROMORPHONE 4 MG TAB (Order 23437748) Start 2/21/2008 End 3/3/2008
Quantity Refills 0 100 HYDROMORPHONE 4 MG TAB (Discontinued) Sig : take 1 tablet (4 mg) by oral route every 4-6 hours as needed Route: ORAL All Administrations of HYDROMORPHONE 4 MG TAB No Administrations Recorded Warnings Override History for HYDROMORPHONE 4 MG TAB [23437748] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 2/21/2008 9:33 AM Electronically Signed By/Authorizing Victor Baquero, MD On 3/3/08 1818
Priority Routine
Order Class Normal
001081
06/29/06 1909 06/15/06 0805
Victor Baquero, MD Victor Baquero, MD
Reordered from Reordered from Authorizing Provider Victor Baquero, MD
11628480 11423903
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity Refills 1 300 NORCO 10 MG-325 MG TAB (Discontinued) Sig : 2 po q 4 hours. Max 10 per day. Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Class: Pharmacy All Administrations of NORCO 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for NORCO 10 MG-325 MG TAB [23777622] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info

On 4/4/08 1253
This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued Isolation No Isolation Order Details
001082
Frequency None
Duration None
Priority Routine
Order History Order Date/Time 03/05/08 0811 02/01/08 1307 01/09/08 1250 12/10/07 1736 10/16/07 1736 09/18/07 1306 08/01/07 1327 03/29/07 1715 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/16/06 1902 10/27/06 0936 09/18/06 1301 08/29/06 1221 07/20/06 1229 06/29/06 1909 06/06/06 1509 05/23/06 1218 05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235 Provider Information Ordering User Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero, MD
Order ID 23777622 22961591 22349333 21797037 20400950 19897779 18888360 16392919 16234616 15747351 15336225 14957270 14565825 14176753 13806608 13399312 12755804 12474895 11883905 11628479 11298702 11099075 10770690 10549668 9590661 9329992 3659473 3336159 3106182
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
001083
03/05/08 0811 02/01/08 1307 01/09/08 1250 12/10/07 1736 10/16/07 1736 09/18/07 1306 08/01/07 1327 03/29/07 1715 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/16/06 1902 10/27/06 0936 09/18/06 1301 08/29/06 1221 07/20/06 1229 06/29/06 1909 06/06/06 1509 05/23/06 1218 05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero, MD
23777622 22961591 22349333 21797037 20400950 19897779 18888360 16392919 16234616 15747351 15336225 14957270 14565825 14176753 13806608 13399312 12755804 12474895 11883905 11628479 11298702 11099075 10770690 10549668 9590661 9329992 3659473 3336159 3106182
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail EFFEXOR XR 150 MG 24 HR CAP (Discontinued) Sig : 1 po daily Route: ORAL
EFFEXOR XR 150 MG 24 HR CAP (Order 23978593) Quantity 30 Refills 3 Start 3/12/2008 End 4/30/2008
001084
All Administrations of EFFEXOR XR 150 MG 24 HR CAP No Administrations Recorded Warnings Override History for EFFEXOR XR 150 MG 24 HR CAP [23978593] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 3/12/2008 5:20 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued On 4/30/08 1355
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Cherry Mendoza Wed Mar 12, 2008 1543 Isolation No Isolation Order Details Frequency None
Order Class Normal
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
001085
Sig : Take 2 po every 6 hours (max 10 daily) Route: ORAL All Administrations of METHADONE 10 MG TAB No Administrations Recorded Warnings Override History for METHADONE 10 MG TAB [23982000] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 3/12/2008 5:20 PM Electronically Signed By/Authorizing Victor Baquero, MD On 4/4/08 1253 Department Fol Family Practice Reason None
Priority Routine
Order Class Normal
04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 23982000 22429171 21876329 21267173 20658809 19830274 19493600 18998255 18553324 18102039
16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381
001086
Medication
Medication Detail

Start 4/2/2008 End 4/30/2008
All Administrations of NORCO 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for NORCO 10 MG-325 MG TAB [24472171] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 4/4/2008 12:53 PM
Released By CHERRY MENDOZA [955898341] VICTOR H BAQUERO [886764315]
Reason None Reason
Signed and Held / Pended Order History Pending User Date/Time Cherry Mendoza Fri Apr 4, 2008 0820 Cherry Mendoza Wed Apr 2, 2008 1044 Isolation No Isolation Order Details Frequency None
Order ID 24472171
001087
Order History Order Date/Time 04/23/08 1255 04/04/08 1253 03/12/08 1720 01/10/08 1229 12/13/07 1239 11/16/07 1444 10/22/07 1713 09/17/07 1803 08/31/07 0809 08/07/07 1735 07/16/07 1512 06/22/07 1112 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information Ordering User Victor Baquero, MD PCP Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero, MD
Order ID 25043810 24527577 23982000 22429171 21876329 21267173 20658809 19830274 19493600 18998255 18553324 18102039 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
001088
Sig : Take 2 po every 6 hours (max 10 daily) Route: ORAL All Administrations of METHADONE 10 MG TAB No Administrations Recorded Warnings Override History for METHADONE 10 MG TAB [24527577] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Cherry Mendoza Fri Apr 4, 2008 0820 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order Class Normal
Order History Order Date/Time 04/04/08 1253 03/12/08 1720 01/10/08 1229 12/13/07 1239 11/16/07 1444 10/22/07 1713 09/17/07 1803 08/31/07 0809 08/07/07 1735 07/16/07 1512 06/22/07 1112
04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Reordered from Reordered from Reordered from Reordered from
Order ID 24527577 23982000 22429171 21876329 21267173 20658809 19830274 19493600 18998255 18553324 18102039
16827161 16546809 16231762 15816970
001089
02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Start 4/4/2008 End 4/30/2008
001090
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Cherry Mendoza Fri Apr 4, 2008 0820 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order History Order Date/Time 04/04/08 1253 02/01/08 1307 10/16/07 1736 09/17/07 1803 08/24/07 1248 05/18/07 1823 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/08/06 1636 11/16/06 1902 10/27/06 0936 09/21/06 0905 08/29/06 1221 08/09/06 1629 07/20/06 1229 06/22/06 0802 05/23/06 1218 05/01/06 1426 Provider Information Ordering User Victor Baquero, MD PCP Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero, MD
Order ID 24527578 22961739 20401029 19830238 19378248 17408551 16234615 15747350 15336224 14957272 14222418 13806607 13399309 12795068 12474894 12188977 11883695 11514417 11099064 10770668

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
001091
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Quantity 300

Warnings Override History for METHADONE 10 MG TAB [25043810] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 4/23/2008 12:55 PM
Reason None Reason
Signed and Held / Pended Order History Pending User Date/Time Cherry Mendoza Wed Apr 23, 2008 1009 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order Class Normal
001092
Order History Order Date/Time 05/01/08 0807 04/04/08 1253 02/01/08 1307 10/16/07 1736 09/17/07 1803 08/24/07 1248 05/18/07 1823 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/08/06 1636 11/16/06 1902 10/27/06 0936 09/21/06 0905 08/29/06 1221 08/09/06 1629 07/20/06 1229 06/22/06 0802 05/23/06 1218 05/01/06 1426 Provider Information Ordering User Victor Baquero, MD PCP Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 25337230 24527578 22961739 20401029 19830238 19378248 17408551 16234615 15747350 15336224 14957272 14222418 13806607 13399309 12795068 12474894 12188977 11883695 11514417 11099064 10770668
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail METHADONE 10 MG TAB Sig : Take 2 po every 6 hours (max 10 daily) Route: ORAL All Administrations of METHADONE 10 MG TAB No Administrations Recorded
Quantity 75

Warnings Override History for METHADONE 10 MG TAB [25163179] No Warning History Available
001093
Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 4/25/2008 5:07 PM Isolation No Isolation Order Details Frequency None Duration None Priority Routine Order Class Normal Electronically Signed By/Authorizing Victor Baquero, MD Department Fol Family Practice
04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 25163179 25043810 24527577 23982000 22429171 21876329 21267173 20658809 19830274 19493600 18998255 18553324 18102039
16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
001094
09/17/07 1803 08/31/07 0809 08/07/07 1735 07/16/07 1512 06/22/07 1112
04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information Ordering User Victor Baquero, MD
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Reordered from Reordered from Reordered from Reordered from Reordered from
19830274 19493600 18998255 18553324 18102039
16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Start 4/30/2008 End 10/30/2008
Quantity Refills 30 6 FLUOXETINE 40 MG CAP Sig : take 1 capsule (40 mg) by oral route once daily in the morning Route: ORAL Class: Pharmacy
All Administrations of FLUOXETINE 40 MG CAP No Administrations Recorded Warnings Override History for FLUOXETINE 40 MG CAP [25327456] No Warning History Available Pharmacy Selected For Faxed Prescriptions
001095

MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail METHADONE 10 MG TAB (Discontinued) Sig : Take 12 daily (120mg) Route: ORAL Class: Historical All Administrations of METHADONE 10 MG TAB No Administrations Recorded Quantity 300
Warnings Override History for METHADONE 10 MG TAB [25327454] No Warning History Available
001096
Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 4/30/2008 1:59 PM Electronically Signed By/Authorizing Victor Baquero, MD On 6/6/08 1714 Department Fol Family Practice Reason None
Priority Routine
Order History Order Date/Time 04/30/08 1359 04/23/08 1255 04/04/08 1253 03/12/08 1720 01/10/08 1229 12/13/07 1239 11/16/07 1444 10/22/07 1713 09/17/07 1803 08/31/07 0809 08/07/07 1735 07/16/07 1512 06/22/07 1112 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 25327454 25043810 24527577 23982000 22429171 21876329 21267173 20658809 19830274 19493600 18998255 18553324 18102039 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480
001097
06/15/06 0805
Victor Baquero, MD
Reordered from
11423903

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Start 4/30/2008 End 6/24/2008
Quantity Refills 1 100 NORCO 10 MG-325 MG TAB (Discontinued) Sig : 1 po q 4 hrs for pain. Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Class: Pharmacy
All Administrations of NORCO 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for NORCO 10 MG-325 MG TAB [25327455] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 4/30/2008 1:59 PM This Order Has Been Discontinued Order Status By Electronically Signed By/Authorizing Victor Baquero, MD On Department Fol Family Practice Reason
001098
Discontinued
Victor Baquero, MD
6/25/08 1301
None

Order History Order Date/Time 04/30/08 1359 04/04/08 1253 03/05/08 0811 02/01/08 1307 01/09/08 1250 12/10/07 1736 10/16/07 1736 09/18/07 1306 08/01/07 1327 03/29/07 1715 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/16/06 1902 10/27/06 0936 09/18/06 1301 08/29/06 1221 07/20/06 1229 06/29/06 1909 06/06/06 1509 05/23/06 1218 05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235 Provider Information Ordering User Victor Baquero, MD PCP Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 25327455 24472171 23777622 22961591 22349333 21797037 20400950 19897779 18888360 16392919 16234616 15747351 15336225 14957270 14565825 14176753 13806608 13399312 12755804 12474895 11883905 11628479 11298702 11099075 10770690 10549668 9590661 9329992 3659473 3336159 3106182

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
001099
Medication
Medication Detail
Quantity Refills 90 3 SOMA 350 MG TAB (Discontinued) Sig : 1 po tid Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176027 Class: Pharmacy All Administrations of SOMA 350 MG TAB No Administrations Recorded Warnings Override History for SOMA 350 MG TAB [25337230] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 5/1/2008 8:07 AM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Gertrudes Perlas Discontinued Montemayor, MD On 7/22/08 1802 Electronically Signed By/Authorizing Victor Baquero, MD
Reason None
Signed and Held / Pended Order History Pending User Date/Time Cherry Mendoza Wed Apr 30, 2008 1701 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Status Pended
Reason
001100
Medication
Medication Detail METHADONE 10 MG TAB (Discontinued) Sig : Take 12 daily (120mg) Route: ORAL All Administrations of METHADONE 10 MG TAB No Administrations Recorded
Quantity 300

Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Fri Jun 6, 2008 1624 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order Class Normal
Order ID 26682012 25327454 25043810 24527577 23982000 22429171 21876329 21267173 20658809
001101

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity Refills 100 1 NORCO 10 MG-325 MG TAB (Discontinued) Sig : 1 po q 4 hrs for pain. Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Class: Pharmacy All Administrations of NORCO 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for NORCO 10 MG-325 MG TAB [27315388] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 6/25/2008 1:01 PM
Department Fol Internal Medicine
Reason None Reason
Signed and Held / Pended Order History Pending User Date/Time Melanie McLaughlin Tue Jun 24, 2008 1604
001102

Order History Order Date/Time 06/25/08 1301 04/30/08 1359 04/04/08 1253 03/05/08 0811 02/01/08 1307 01/09/08 1250 12/10/07 1736 10/16/07 1736 09/18/07 1306 08/01/07 1327 03/29/07 1715 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/16/06 1902 10/27/06 0936 09/18/06 1301 08/29/06 1221 07/20/06 1229 06/29/06 1909 06/06/06 1509 05/23/06 1218 05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235 Provider Information Ordering User Victor Baquero, MD PCP Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero, MD
Order ID 27315388 25327455 24472171 23777622 22961591 22349333 21797037 20400950 19897779 18888360 16392919 16234616 15747351 15336225 14957270 14565825 14176753 13806608 13399312 12755804 12474895 11883905 11628479 11298702 11099075 10770690 10549668 9590661 9329992 3659473 3336159 3106182
Patient Information Patient Name Amundsen, Mark Unit IMDFOL
MRN 8081369
Sex Male
DOB 9/23/1959
001103
09/17/07 1803 08/24/07 1248 05/18/07 1823 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/08/06 1636 11/16/06 1902 10/27/06 0936 09/21/06 0905 08/29/06 1221 08/09/06 1629 07/20/06 1229 06/22/06 0802 05/23/06 1218 05/01/06 1426
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Gertrudes Perlas Montemayor, MD
19830238 19378248 17408551 16234615 15747350 15336224 14957272 14222418 13806607 13399309 12795068 12474894 12188977 11883695 11514417 11099064 10770668
Provider Information Ordering User Gertrudes Perlas Montemayor, MD PCP Victor Baquero, MD
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail METHADONE 10 MG TAB (Discontinued) Sig : Take 12 daily (120mg) Route: ORAL All Administrations of METHADONE 10 MG TAB No Administrations Recorded Quantity 390
Warnings Override History for METHADONE 10 MG TAB [27379159] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Electronically Signed
001104
Date and Time 6/27/2008 9:01 AM Released By VICTOR H BAQUERO [886764315] VICTOR H BAQUERO [886764315]
By/Authorizing Victor Baquero, MD
On 8/11/08 1128
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Victor Baquero, MD Thu Jun 26, 2008 0943 Thu Jun 26, 2008 0914 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order Class Normal
Order History Order Date/Time 06/27/08 0901 06/06/08 1714 04/30/08 1359 04/23/08 1255 04/04/08 1253 03/12/08 1720 01/10/08 1229 12/13/07 1239 11/16/07 1444 10/22/07 1713 09/17/07 1803 08/31/07 0809 08/07/07 1735 07/16/07 1512 06/22/07 1112 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 27379159 26682012 25327454 25043810 24527577 23982000 22429171 21876329 21267173 20658809 19830274 19493600 18998255 18553324 18102039 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
001105
Medication
Medication Detail
Quantity Refills 90 0 SOMA 350 MG TAB (Discontinued) Sig : 1 po tid Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176027 Class: Pharmacy All Administrations of SOMA 350 MG TAB No Administrations Recorded Warnings Override History for SOMA 350 MG TAB [28300831] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Electronically Signed By/Authorizing Gertrudes Perlas Montemayor
Released By GERTRUDES P MONTEMAYOR [889077681] This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued On 8/20/08 1223
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Tue Jul 22, 2008 1521 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
User Gertrudes Perlas Montemayor, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 28300831 25337230 24527578 22961739 20401029
001106
03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

Unit RH
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail METHADONE 10 MG TAB Sig : Take 2 po every 6 hours (max 10 daily) Route: ORAL Class: Historical All Administrations of METHADONE 10 MG TAB No Administrations Recorded Quantity 300
Warnings Override History for METHADONE 10 MG TAB [28350732] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 7/23/2008 5:13 PM Electronically Signed By/Authorizing Nancy Jaeger, MD Department Fol Family Practice
001107

Duration None Priority Routine Order Class Historical
Order History Order Date/Time 07/23/08 1713 04/23/08 1255 04/04/08 1253 03/12/08 1720 01/10/08 1229 12/13/07 1239 11/16/07 1444 10/22/07 1713 09/17/07 1803 08/31/07 0809 08/07/07 1735 07/16/07 1512 06/22/07 1112 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information Ordering User Nancy Jaeger, MD PCP Victor Baquero, MD
User Nancy Jaeger, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 28350732 25043810 24527577 23982000 22429171 21876329 21267173 20658809 19830274 19493600 18998255 18553324 18102039
Authorizing Provider Nancy Jaeger, MD
16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
MRN 8081369
Sex Male
DOB 9/23/1959
Visit CSN
001108
Medication
Quantity 390

Duration None
Reason None
Priority Routine
Order Class Normal
Order History Order Date/Time 08/11/08 1128 06/27/08 0901 06/06/08 1714 04/30/08 1359 04/23/08 1255 04/04/08 1253 03/12/08 1720 01/10/08 1229 12/13/07 1239 11/16/07 1444 10/22/07 1713 09/17/07 1803 08/31/07 0809 08/07/07 1735 07/16/07 1512 06/22/07 1112 04/20/07 0919 04/06/07 1644 03/22/07 0813
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 28998118 27379159 26682012 25327454 25043810 24527577 23982000 22429171 21876329 21267173 20658809 19830274 19493600 18998255 18553324 18102039
16827161 16546809 16231762
001109
04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity Refills 100 1 NORCO 10 MG-325 MG TAB (Discontinued) Sig : 1 po q 4 hrs for pain. Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Class: Pharmacy All Administrations of NORCO 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for NORCO 10 MG-325 MG TAB [29295197] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE
001110
Encounter View Encounter Order Info Date and Time 8/20/2008 12:17 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued On 10/17/08 1658
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Tue Aug 19, 2008 1128 Isolation No Isolation Order Details Frequency None
Order History Order Date/Time 08/20/08 1217 06/25/08 1301 04/30/08 1359 04/04/08 1253 03/05/08 0811 02/01/08 1307 01/09/08 1250 12/10/07 1736 10/16/07 1736 09/18/07 1306 08/01/07 1327 03/29/07 1715 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/16/06 1902 10/27/06 0936 09/18/06 1301 08/29/06 1221 07/20/06 1229 06/29/06 1909 06/06/06 1509 05/23/06 1218 05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 29295197 27315388 25327455 24472171 23777622 22961591 22349333 21797037 20400950 19897779 18888360 16392919 16234616 15747351 15336225 14957270 14565825 14176753 13806608 13399312 12755804 12474895 11883905 11628479 11298702 11099075 10770690 10549668 9590661 9329992
001111
09/14/04 0856 08/11/04 1721 07/19/04 1235
Victor Baquero Victor Baquero Victor Baquero
3659473 3336159 3106182

MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Start 8/19/2008 End 9/18/2008
Quantity Refills 90 0 SOMA 350 MG TAB (Discontinued) Sig : 1 po tid Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 242072.last fill - 7/22/08 Class: Pharmacy
On 9/18/08 1408
Reason None
001112
Status Pended
Reason
Order History Order Date/Time 08/20/08 1223 07/22/08 1802 05/01/08 0807 04/04/08 1253 02/01/08 1307 10/16/07 1736 09/17/07 1803 08/24/07 1248 05/18/07 1823 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/08/06 1636 11/16/06 1902 10/27/06 0936 09/21/06 0905 08/29/06 1221 08/09/06 1629 07/20/06 1229 06/22/06 0802 05/23/06 1218 05/01/06 1426 Provider Information Ordering User Victor Baquero, MD PCP Victor Baquero, MD
User Victor Baquero, MD Gertrudes Perlas Montemayor, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 29305593 28300831 25337230 24527578 22961739 20401029 19830238 19378248 17408551 16234615 15747350 15336224 14957272 14222418 13806607 13399309 12795068 12474894 12188977 11883695 11514417 11099064 10770668

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
001113
Order History Order Date/Time 09/18/08 1408 08/20/08 1223 07/22/08 1802 05/01/08 0807 04/04/08 1253 02/01/08 1307 10/16/07 1736 09/17/07 1803 08/24/07 1248 05/18/07 1823 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/08/06 1636 11/16/06 1902 10/27/06 0936 09/21/06 0905 08/29/06 1221 08/09/06 1629 07/20/06 1229 06/22/06 0802 05/23/06 1218 05/01/06 1426 Provider Information Ordering User Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Gertrudes Perlas Montemayor, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 30394549 29305593 28300831 25337230 24527578 22961739 20401029 19830238 19378248 17408551 16234615 15747350 15336224 14957272 14222418 13806607 13399309 12795068 12474894 12188977 11883695 11514417 11099064 10770668
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity

Refills Start End
001114
METHADONE 10 MG TAB (Discontinued) Sig : Take 12 daily (120mg) Route: ORAL All Administrations of METHADONE 10 MG TAB No Administrations Recorded
390
9/9/2008
10/6/2008
Warnings Override History for METHADONE 10 MG TAB [29814812] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 9/5/2008 10:08 AM
Reason None Reason
Signed and Held / Pended Order History Pending User Date/Time Wed Sep 3, 2008 0828 Isolation No Isolation Order Details Frequency None
Order Class Normal
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD
Order ID 29814812 28998118 27379159 26682012 25327454 25043810 24527577 23982000 22429171 21876329 21267173 20658809 19830274 19493600 18998255 18553324 18102039
001115

MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Start 9/18/2008 End 10/17/2008
Quantity Refills 90 0 SOMA 350 MG TAB (Discontinued) Sig : 1 po tid Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 242072.last fill - 7/22/08 Class: Pharmacy
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Thu Sep 18, 2008 1139 Isolation
001116
03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/08/06 1636 11/16/06 1902 10/27/06 0936 09/21/06 0905 08/29/06 1221 08/09/06 1629 07/20/06 1229 06/22/06 0802 05/23/06 1218 05/01/06 1426
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero, MD
16234615 15747350 15336224 14957272 14222418 13806607 13399309 12795068 12474894 12188977 11883695 11514417 11099064 10770668
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Warnings Override History for METHADONE 10 MG TAB [31022473] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 10/6/2008 5:35 PM Electronically Signed By/Authorizing Victor Baquero, MD Department Fol Family Practice
001117
Status Pended
Reason None
Reason
Order Class Normal
Order History Order Date/Time 10/06/08 1735 09/05/08 1008 08/11/08 1128 06/27/08 0901 06/06/08 1714 04/30/08 1359 04/23/08 1255 04/04/08 1253 03/12/08 1720 01/10/08 1229 12/13/07 1239 11/16/07 1444 10/22/07 1713 09/17/07 1803 08/31/07 0809 08/07/07 1735 07/16/07 1512 06/22/07 1112
04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 31022473 29814812 28998118 27379159 26682012 25327454 25043810 24527577 23982000 22429171 21876329 21267173 20658809 19830274 19493600 18998255 18553324 18102039 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
001118
8081369
Male
9/23/1959
Medication
Medication Detail
Quantity Refills 1 100 NORCO 10 MG-325 MG TAB (Discontinued) Sig : 1 po q 4 hrs for pain. Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Class: Pharmacy All Administrations of NORCO 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for NORCO 10 MG-325 MG TAB [31477925] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Fri Oct 17, 2008 1503 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
User
Action
Order ID
001119
10/17/08 1658 08/20/08 1217 06/25/08 1301 04/30/08 1359 04/04/08 1253 03/05/08 0811 02/01/08 1307 01/09/08 1250 12/10/07 1736 10/16/07 1736 09/18/07 1306 08/01/07 1327 03/29/07 1715 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/16/06 1902 10/27/06 0936 09/18/06 1301 08/29/06 1221 07/20/06 1229 06/29/06 1909 06/06/06 1509 05/23/06 1218 05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235 Provider Information Ordering User Victor Baquero, MD PCP Victor Baquero, MD
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero, MD
31477925 29295197 27315388 25327455 24472171 23777622 22961591 22349333 21797037 20400950 19897779 18888360 16392919 16234616 15747351 15336225 14957270 14565825 14176753 13806608 13399312 12755804 12474895 11883905 11628479 11298702 11099075 10770690 10549668 9590661 9329992 3659473 3336159 3106182

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
001120
Quantity Refills 90 0 SOMA 350 MG TAB (Discontinued) Sig : 1 po tid Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 242072.last fill - 7/22/08 Class: Pharmacy All Administrations of SOMA 350 MG TAB No Administrations Recorded Warnings Override History for SOMA 350 MG TAB [31477924] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 10/17/2008 4:58 PM
Start 10/17/2008
End 11/13/2008
Reason None Reason
Signed and Held / Pended Order History Pending User Date/Time Fri Oct 17, 2008 1503 Isolation No Isolation Order Details Frequency None
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Gertrudes Perlas Montemayor, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 31477924 30394549 29305593 28300831
25337230 24527578 22961739 20401029 19830238 19378248 17408551
001121
08/09/06 1629 07/20/06 1229 06/22/06 0802 05/23/06 1218 05/01/06 1426
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
12188977 11883695 11514417 11099064 10770668
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Warnings Override History for METHADONE 10 MG TAB [32060748] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 11/3/2008 8:53 AM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued On 12/1/08 0956
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Mon Nov 3, 2008 0823
001122

Duration None Priority Routine Order Class Normal
Order History Order Date/Time 11/03/08 0853 10/06/08 1735 09/05/08 1008 08/11/08 1128 06/27/08 0901 06/06/08 1714 04/30/08 1359 04/23/08 1255 04/04/08 1253 03/12/08 1720 01/10/08 1229 12/13/07 1239 11/16/07 1444 10/22/07 1713 09/17/07 1803 08/31/07 0809 08/07/07 1735 07/16/07 1512 06/22/07 1112 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information Ordering User Victor Baquero, MD PCP Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 32060748 31022473 29814812 28998118 27379159 26682012 25327454 25043810 24527577 23982000 22429171 21876329 21267173 20658809 19830274 19493600 18998255 18553324 18102039
16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
MRN
Sex
DOB
001123
11/16/07 1444 10/22/07 1713 09/17/07 1803 08/31/07 0809 08/07/07 1735 07/16/07 1512 06/22/07 1112
04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information Ordering User Victor Baquero, MD PCP Victor Baquero, MD
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
21267173 20658809 19830274 19493600 18998255 18553324 18102039
16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity Refills 0 90 SOMA 350 MG TAB (Discontinued) Sig : 1 po tid Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 Class: Pharmacy All Administrations of SOMA 350 MG TAB No Administrations Recorded
001124
Warnings Override History for SOMA 350 MG TAB [32485341] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 11/17/2008 3:38 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued
Signed and Held / Pended Order History Pending User Date/Time Thu Nov 13, 2008 1438 Isolation No Isolation Order Details Frequency None
Order History Order Date/Time 11/17/08 1538 10/17/08 1658 09/18/08 1408 08/20/08 1223 07/22/08 1802 05/01/08 0807 04/04/08 1253 02/01/08 1307 10/16/07 1736 09/17/07 1803 08/24/07 1248 05/18/07 1823 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/08/06 1636 11/16/06 1902 10/27/06 0936 09/21/06 0905 08/29/06 1221
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Gertrudes Perlas Montemayor, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 32485341 31477924 30394549 29305593 28300831
25337230 24527578 22961739 20401029 19830238 19378248 17408551 16234615 15747350 15336224 14957272 14222418 13806607 13399309 12795068 12474894
001125
Unit FAMFOL
Medication
Warnings Override History for METHADONE 10 MG TAB [33114228] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/1/2008 9:56 AM Electronically Signed By/Authorizing Victor Baquero, MD On 12/22/08 1330 Department Relayhealth Reason None
Priority Routine
Order Class Normal
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 33114228 32060748 31022473 29814812 28998118 27379159 26682012 25327454 25043810 24527577 23982000 22429171 21876329
001126
08/07/07 1735 07/16/07 1512 06/22/07 1112 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
18998255 18553324 18102039 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity Refills 100 1 NORCO 10 MG-325 MG TAB Sig : 1 po q 4 hrs for pain. Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Class: Pharmacy All Administrations of NORCO 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for NORCO 10 MG-325 MG TAB [33600804] No Warning History Available Pharmacy Selected For Faxed Prescriptions
001127
Date and Time 12/12/2008 12:31 PM
Released By VICTOR H BAQUERO [886764315] Signed and Held / Pended Order History Pending User Date/Time Aneeka Dibble, MA Fri Dec 12, 2008 1155 Isolation No Isolation Order Details Frequency None Duration None Priority Routine Order Class Pharmacy
Order History Order Date/Time 12/12/08 1231 10/17/08 1658 08/20/08 1217 06/25/08 1301 04/30/08 1359 04/04/08 1253 03/05/08 0811 02/01/08 1307 01/09/08 1250 12/10/07 1736 10/16/07 1736 09/18/07 1306 08/01/07 1327 03/29/07 1715 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/16/06 1902 10/27/06 0936 09/18/06 1301 08/29/06 1221 07/20/06 1229 06/29/06 1909 06/06/06 1509 05/23/06 1218 05/01/06 1427
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 33600804 31477925 29295197 27315388 25327455 24472171 23777622 22961591 22349333 21797037 20400950 19897779 18888360 16392919 16234616 15747351 15336225 14957270 14565825 14176753 13806608 13399312 12755804 12474895 11883905 11628479 11298702 11099075 10770690
001128
04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235
Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
10549668 9590661 9329992 3659473 3336159 3106182

MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Start 12/12/2008 End 2/23/2009
Quantity Refills 100 1 SOMA 350 MG TAB (Discontinued) Sig : 1 po tid Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 Class: Pharmacy
001129
On 2/23/09 1744
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Aneeka Dibble, MA Fri Dec 12, 2008 1155 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order History Order Date/Time 12/12/08 1231 11/17/08 1538 10/17/08 1658 09/18/08 1408 08/20/08 1223 07/22/08 1802 05/01/08 0807 04/04/08 1253 02/01/08 1307 10/16/07 1736 09/17/07 1803 08/24/07 1248 05/18/07 1823 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/08/06 1636 11/16/06 1902 10/27/06 0936 09/21/06 0905 08/29/06 1221 08/09/06 1629 07/20/06 1229 06/22/06 0802 05/23/06 1218 05/01/06 1426 Provider Information Ordering User Victor Baquero, MD PCP Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Gertrudes Perlas Montemayor, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 33600806 32485341 31477924 30394549 29305593 28300831 25337230 24527578 22961739 20401029 19830238 19378248 17408551 16234615 15747350 15336224 14957272 14222418 13806607 13399309 12795068 12474894 12188977 11883695 11514417 11099064 10770668
MRN 8081369
Sex Male
DOB 9/23/1959
001130
06/27/08 0901 06/06/08 1714 04/30/08 1359 04/23/08 1255 04/04/08 1253 03/12/08 1720 01/10/08 1229 12/13/07 1239 11/16/07 1444 10/22/07 1713 09/17/07 1803 08/31/07 0809 08/07/07 1735 07/16/07 1512 06/22/07 1112 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
27379159 26682012 25327454 25043810 24527577 23982000 22429171 21876329 21267173 20658809 19830274 19493600 18998255 18553324 18102039 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
Provider Information Ordering User Gertrudes Perlas Montemayor, MD PCP Victor Baquero, MD
Authorizing Provider Gertrudes Perlas Montemayor, MD

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
001131
Sig : Take 12 daily (120mg) Route: ORAL All Administrations of METHADONE 10 MG TAB No Administrations Recorded Warnings Override History for METHADONE 10 MG TAB [33955136] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/22/2008 1:30 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Gertrudes Perlas Discontinued Montemayor, MD
On 1/20/09 1025 Reason None
Signed and Held / Pended Order History Pending User Date/Time Mon Dec 22, 2008 0815 Isolation No Isolation Order Details Frequency None
Status Pended
Reason
Order Class Normal
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 33955136 33114228 32060748 31022473 29814812 28998118 27379159 26682012 25327454 25043810 24527577 23982000 22429171 21876329 21267173 20658809 19830274 19493600
001132
Medication
Medication Detail METHADONE 10 MG TAB (Discontinued) Sig : Take 12 daily (120mg) Route: ORAL Class: Handwritten Rx All Administrations of METHADONE 10 MG TAB No Administrations Recorded
Quantity 390

Warnings Override History for METHADONE 10 MG TAB [34942551] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 1/20/2009 10:25 AM Electronically Signed By/Authorizing Gertrudes Perlas Montemayor Department Fol Family Practice
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Tue Jan 20, 2009 0857 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Order Class Handwritten Rx
User Gertrudes Perlas Montemayor, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 34942551 33955136 33114228 32060748 31022473 29814812 28998118
001133

MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Start 2/13/2009 End 4/27/2009
Quantity Refills 100 1 NORCO 10 MG-325 MG TAB (Discontinued) Sig : 1 po q 4 hrs for pain. Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Class: Pharmacy
All Administrations of NORCO 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for NORCO 10 MG-325 MG TAB [35954313] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Fri Feb 13, 2009 1359 Isolation
001134
Order History Order Date/Time 02/13/09 1739 08/20/08 1217 06/25/08 1301 04/30/08 1359 04/04/08 1253 03/05/08 0811 02/01/08 1307 01/09/08 1250 12/10/07 1736 10/16/07 1736 09/18/07 1306 08/01/07 1327 03/29/07 1715 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/16/06 1902 10/27/06 0936 09/18/06 1301 08/29/06 1221 07/20/06 1229 06/29/06 1909 06/06/06 1509 05/23/06 1218 05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235 Provider Information Ordering User Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero, MD
Order ID 35954313 29295197 27315388 25327455 24472171 23777622 22961591 22349333 21797037 20400950 19897779 18888360 16392919 16234616 15747351 15336225 14957270 14565825 14176753 13806608 13399312 12755804 12474895 11883905 11628479 11298702 11099075 10770690 10549668 9590661 9329992 3659473 3336159 3106182
MRN 8081369
Sex Male
DOB 9/23/1959
001135
11/16/06 1902 10/27/06 0936 09/21/06 0905 08/29/06 1221 08/09/06 1629 07/20/06 1229 06/22/06 0802 05/23/06 1218 05/01/06 1426
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
13806607 13399309 12795068 12474894 12188977 11883695 11514417 11099064 10770668

MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Quantity 390

Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued On 3/16/09 1008 Reason None
001136
Signed and Held / Pended Order History Pending User Date/Time Wed Feb 11, 2009 1206 Isolation No Isolation Order Details Frequency None Duration None Priority Routine
Status Pended
Reason
Order Class Normal
Order History Order Date/Time 02/13/09 0901 01/20/09 1025 12/22/08 1330 12/01/08 0956 11/03/08 0853 10/06/08 1735 09/05/08 1008 08/11/08 1128 06/27/08 0901 06/06/08 1714 04/30/08 1359 04/23/08 1255 04/04/08 1253 03/12/08 1720 01/10/08 1229 12/13/07 1239 11/16/07 1444 10/22/07 1713 09/17/07 1803 08/31/07 0809 08/07/07 1735 07/16/07 1512 06/22/07 1112 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information
User Victor Baquero, MD Gertrudes Perlas Montemayor, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 35855444 34942551 33955136 33114228 32060748 31022473 29814812 28998118 27379159 26682012 25327454 25043810 24527577 23982000 22429171 21876329 21267173 20658809 19830274 19493600 18998255 18553324 18102039 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
001137
01/10/08 1229 12/13/07 1239 11/16/07 1444 10/22/07 1713 09/17/07 1803 08/31/07 0809 08/07/07 1735 07/16/07 1512 06/22/07 1112 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
22429171 21876329 21267173 20658809 19830274 19493600 18998255 18553324 18102039 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity Refills 100 1 SOMA 350 MG TAB (Discontinued) Sig : 1 po tid Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 Class: Pharmacy All Administrations of SOMA 350 MG TAB
001138
No Administrations Recorded Warnings Override History for SOMA 350 MG TAB [36315899] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 2/23/2009 5:44 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued On 4/27/09 1230
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Mon Feb 23, 2009 1629 Isolation No Isolation Order Details Frequency None
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Gertrudes Perlas Montemayor, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 36315899 33600806 32485341 31477924 30394549 29305593 28300831
25337230 24527578 22961739 20401029 19830238 19378248 17408551 16234615 15747350 15336224 14957272 14222418
001139
METHADONE 10 MG TAB (Discontinued) Sig : Take 12 daily (120mg) Route: ORAL All Administrations of METHADONE 10 MG TAB No Administrations Recorded
390
3/12/2009
4/9/2009
This Order Has Been Discontinued Order Status By Martina Discontinued Dobrovodska Randolph, MD
On 4/9/09 1151
Reason None
Signed and Held / Pended Order History Pending User Date/Time Thu Mar 12, 2009 1230 Isolation No Isolation Order Details Frequency None
Status Pended
Reason
Order Class Normal
User Victor Baquero, MD Victor Baquero, MD Gertrudes Perlas Montemayor, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 37025430 35855444 34942551
33955136 33114228 32060748 31022473 29814812 28998118 27379159 26682012 25327454 25043810 24527577 23982000
001140
Medication
Medication Detail METHADONE 10 MG TAB (Discontinued) Sig : Take 12 daily (120mg) Route: ORAL Class: Handwritten Rx All Administrations of METHADONE 10 MG TAB No Administrations Recorded Quantity 390
Released By MARTINA RANDOLPH [846511566]
Electronically Signed By/Authorizing Martina Dobrovodska Randolph
Reason None Reason
Signed and Held / Pended Order History Pending User Date/Time Thu Apr 9, 2009 1135 Isolation No Isolation Order Details Frequency None
User Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Gertrudes Perlas Montemayor, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 38152050
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
37025430 35855444 34942551 33955136 33114228 32060748 31022473 29814812
001141
08/11/08 1128 06/27/08 0901 06/06/08 1714 04/30/08 1359 04/23/08 1255 04/04/08 1253 03/12/08 1720 01/10/08 1229 12/13/07 1239 11/16/07 1444 10/22/07 1713 09/17/07 1803 08/31/07 0809 08/07/07 1735 07/16/07 1512 06/22/07 1112
04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
28998118 27379159 26682012 25327454 25043810 24527577 23982000 22429171 21876329 21267173 20658809 19830274 19493600 18998255 18553324 18102039
Authorizing Provider Martina Dobrovodska Randolph, MD
16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
Provider Information Ordering User Martina Dobrovodska Randolph, MD PCP Victor Baquero, MD
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail Quantity
METHADONE 10 MG TAB (Order 37025430) Refills Start End
001142
10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
13301080 12961787 12648793 12308313 11994381 11628480 11423903

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity Refills 1 100 NORCO 10 MG-325 MG TAB (Discontinued) Sig : 1 po q 4 hrs for pain. Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Class: Pharmacy All Administrations of NORCO 10 MG-325 MG TAB No Administrations Recorded Warnings Override History for NORCO 10 MG-325 MG TAB [38866134] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 4/27/2009 12:30 PM Released By ANEEKA DIBBLE [824564777] Electronically Signed By/Authorizing Victor Baquero, MD
001143
VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Henrique Discontinued Baquero, MD On 6/3/11 1236 Reason None
Signed and Held / Pended Order History Pending User Date/Time Aneeka Dibble, MA Mon Apr 27, 2009 1215 Aneeka Dibble, MA Mon Apr 27, 2009 1151 Isolation No Isolation Order Details Frequency None
Reason
Order History Order Date/Time 04/27/09 1230 02/13/09 1739 08/20/08 1217 06/25/08 1301 04/30/08 1359 04/04/08 1253 03/05/08 0811 02/01/08 1307 01/09/08 1250 12/10/07 1736 10/16/07 1736 09/18/07 1306 08/01/07 1327 03/29/07 1715 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/16/06 1902 10/27/06 0936 09/18/06 1301 08/29/06 1221 07/20/06 1229 06/29/06 1909 06/06/06 1509 05/23/06 1218 05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 38866134 35954313 29295197 27315388 25327455 24472171 23777622 22961591 22349333 21797037 20400950 19897779 18888360 16392919 16234616 15747351 15336225 14957270 14565825 14176753 13806608 13399312 12755804 12474895 11883905 11628479 11298702 11099075 10770690 10549668 9590661 9329992 3659473 3336159 3106182
001144

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity Refills 100 1 SOMA 350 MG TAB (Discontinued) Sig : 1 po tid Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 Class: Pharmacy All Administrations of SOMA 350 MG TAB No Administrations Recorded Warnings Override History for SOMA 350 MG TAB [38867452] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 4/27/2009 12:30 PM
Reason None Reason
Signed and Held / Pended Order History Pending User Date/Time Aneeka Dibble, MA Mon Apr 27, 2009 1215
001145

Order History Order Date/Time 04/27/09 1230 02/23/09 1744 12/12/08 1231 11/17/08 1538 10/17/08 1658 09/18/08 1408 08/20/08 1223 07/22/08 1802 05/01/08 0807 04/04/08 1253 02/01/08 1307 10/16/07 1736 09/17/07 1803 08/24/07 1248 05/18/07 1823 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/08/06 1636 11/16/06 1902 10/27/06 0936 09/21/06 0905 08/29/06 1221 08/09/06 1629 07/20/06 1229 06/22/06 0802 05/23/06 1218 05/01/06 1426 Provider Information Ordering User Victor Baquero, MD PCP Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Gertrudes Perlas Montemayor, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 38867452 36315899 33600806 32485341 31477924 30394549 29305593 28300831
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
25337230 24527578 22961739 20401029 19830238 19378248 17408551 16234615 15747350 15336224 14957272 14222418 13806607 13399309 12795068 12474894 12188977 11883695 11514417 11099064 10770668
MRN 8081369
Sex Male
DOB 9/23/1959
Visit CSN
001146
Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 5/28/2009 8:11 AM Isolation No Isolation Order Details Frequency THREE TIMES DAILY Duration None Priority Routine Order Class Pharmacy Electronically Signed By/Authorizing Victor Baquero, MD Department Fol Family Practice

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Warnings Override History for METHADONE 10 MG TAB [39316280] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter
001147
Order Info Date and Time 5/7/2009 3:12 PM Electronically Signed By/Authorizing Victor Baquero, MD On 6/2/09 1316 Department Fol Family Practice Reason None
Priority Routine
Order Class Normal
Order History Order Date/Time 05/07/09 1512 04/09/09 1151 03/16/09 1008 02/13/09 0901 01/20/09 1025 12/22/08 1330 12/01/08 0956 11/03/08 0853 10/06/08 1735 09/05/08 1008 08/11/08 1128 06/27/08 0901 06/06/08 1714 04/30/08 1359 04/23/08 1255 04/04/08 1253 03/12/08 1720 01/10/08 1229 12/13/07 1239 11/16/07 1444 10/22/07 1713 09/17/07 1803 08/31/07 0809 08/07/07 1735 07/16/07 1512 06/22/07 1112 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334
User Victor Baquero, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Gertrudes Perlas Montemayor, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 39316280 38152050 37025430 35855444 34942551 33955136 33114228 32060748 31022473 29814812 28998118 27379159 26682012 25327454 25043810 24527577 23982000 22429171 21876329 21267173 20658809 19830274 19493600 18998255 18553324 18102039 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358
001148
10/22/07 1713 09/17/07 1803 08/31/07 0809 08/07/07 1735 07/16/07 1512 06/22/07 1112 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
20658809 19830274 19493600 18998255 18553324 18102039 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Metronidazole (FLAGYL) 500 mg PO Tablet (Order 40137996) Refills 0 Start 5/28/2009 End 6/11/2009
Quantity 42 Metronidazole (FLAGYL) 500 mg PO Tablet Sig : Take 1 Tab by mouth 3 times daily. No alcohol Route: ORAL Class: Pharmacy All Administrations of Metronidazole (FLAGYL) 500 mg PO Tablet No Administrations Recorded
Warnings Override History for Metronidazole (FLAGYL) 500 mg PO Tablet [40137996] No Warning History Available
001149
11/17/08 1538 10/17/08 1658 09/18/08 1408 08/20/08 1223 07/22/08 1802
05/01/08 0807 04/04/08 1253 02/01/08 1307 10/16/07 1736 09/17/07 1803 08/24/07 1248 05/18/07 1823 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/08/06 1636 11/16/06 1902 10/27/06 0936 09/21/06 0905 08/29/06 1221 08/09/06 1629 07/20/06 1229 06/22/06 0802 05/23/06 1218 05/01/06 1426 Provider Information Ordering User Victor Baquero, MD PCP Victor Baquero, MD
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Gertrudes Perlas Montemayor, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
32485341 31477924 30394549 29305593 28300831
25337230 24527578 22961739 20401029 19830238 19378248 17408551 16234615 15747350 15336224 14957272 14222418 13806607 13399309 12795068 12474894 12188977 11883695 11514417 11099064 10770668
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail Methadone (DOLOPHINE) 10 mg PO Tablet (Discontinued) Sig : Take 13 Tabs by mouth every day. Route: ORAL
Methadone (DOLOPHINE) 10 mg PO Tablet (Order 40335571) Quantity 390 Refills 0 Start 6/2/2009 End 6/26/2009
All Administrations of Methadone (DOLOPHINE) 10 mg PO Tablet No Administrations
001150
Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg PO Tablet [40335571] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 6/2/2009 1:16 PM
Reason None Reason
Signed and Held / Pended Order History Pending User Date/Time Tue Jun 2, 2009 1037 Isolation No Isolation Order Details Frequency DAILY (OUTPATIENT) Duration None Priority Routine
Order Class Normal
12/22/08 1330 12/01/08 0956 11/03/08 0853 10/06/08 1735 09/05/08 1008 08/11/08 1128 06/27/08 0901 06/06/08 1714 04/30/08 1359 04/23/08 1255 04/04/08 1253 03/12/08 1720 01/10/08 1229 12/13/07 1239 11/16/07 1444
User Victor Baquero, MD Victor Baquero, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Gertrudes Perlas Montemayor, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 40335571 39316280 38152050 37025430 35855444 34942551

33955136 33114228 32060748 31022473 29814812 28998118 27379159 26682012 25327454 25043810 24527577 23982000 22429171 21876329 21267173
001151
Medication
Medication Detail
Carisoprodol (SOMA) 350 mg PO Tablet (Order 41205076)

Start 6/23/2009 End 8/26/2009
Quantity Refills 100 1 Carisoprodol (SOMA) 350 mg PO Tablet (Discontinued) Sig : Take 1 Tab by mouth 3 times daily. Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 Class: Pharmacy
All Administrations of Carisoprodol (SOMA) 350 mg PO Tablet No Administrations Recorded Warnings Override History for Carisoprodol (SOMA) 350 mg PO Tablet [41205076] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Tue Jun 23, 2009 1121 Isolation No Isolation Order Details Frequency THREE TIMES DAILY Duration None Priority Routine
Order ID 41205076 38867452 36315899 33600806
001152
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
All Administrations of Methadone (DOLOPHINE) 10 mg PO Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg PO Tablet [41358443] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 6/26/2009 3:00 PM Electronically Signed By/Authorizing Victor Baquero, MD On 7/24/09 1445 Department Relayhealth Reason None
This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued Isolation No Isolation Order Details Frequency DAILY (OUTPATIENT) Duration None
Priority Routine
Order Class Normal
03/16/09 1008
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD

Reordered from
Order ID 41358443 40335571 39316280 38152050

37025430
001153
02/13/09 0901 01/20/09 1025
12/22/08 1330 12/01/08 0956 11/03/08 0853 10/06/08 1735 09/05/08 1008 08/11/08 1128 06/27/08 0901 06/06/08 1714 04/30/08 1359 04/23/08 1255 04/04/08 1253 03/12/08 1720 01/10/08 1229 12/13/07 1239 11/16/07 1444 10/22/07 1713 09/17/07 1803 08/31/07 0809 08/07/07 1735 07/16/07 1512 06/22/07 1112 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information Ordering User Victor Baquero, MD
Victor Baquero, MD Gertrudes Perlas Montemayor, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Reordered from Reordered from
35855444 34942551
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
33955136 33114228 32060748 31022473 29814812 28998118 27379159 26682012 25327454 25043810 24527577 23982000 22429171 21876329 21267173 20658809 19830274 19493600 18998255 18553324 18102039 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
MRN 8081369
Sex Male
DOB 9/23/1959
001154

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
All Administrations of Methadone (DOLOPHINE) 10 mg PO Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg PO Tablet [42415608] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Thu Jul 23, 2009 1415 Isolation No Isolation Order Details Frequency DAILY (OUTPATIENT) Duration None Priority Routine
Order Class Normal
001155
Order History Order Date/Time 07/24/09 1445 06/26/09 1500 06/02/09 1316 05/07/09 1512 04/09/09 1151 03/16/09 1008 02/13/09 0901 01/20/09 1025 12/22/08 1330 12/01/08 0956 11/03/08 0853 10/06/08 1735 09/05/08 1008 08/11/08 1128 06/27/08 0901 06/06/08 1714 04/30/08 1359 04/23/08 1255 04/04/08 1253 03/12/08 1720 01/10/08 1229 12/13/07 1239 11/16/07 1444 10/22/07 1713 09/17/07 1803 08/31/07 0809 08/07/07 1735 07/16/07 1512 06/22/07 1112 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information Ordering User Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Gertrudes Perlas Montemayor, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 42415608 41358443 40335571 39316280 38152050 37025430 35855444 34942551 33955136 33114228 32060748 31022473 29814812 28998118 27379159 26682012 25327454 25043810 24527577 23982000 22429171 21876329 21267173 20658809 19830274 19493600 18998255 18553324 18102039 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
001156
8081369
Male
9/23/1959
Account # 078438665081
Medication
Medication Detail
Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet (Order 42607372)

Start 7/28/2009 End 9/28/2009
Quantity Refills 100 1 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet (Discontinued) Sig : Take 1 Tab by mouth every 4 hours if needed for pain. Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176026 PRN Reason(s): pain Class: Pharmacy
All Administrations of Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet No Administrations Recorded Warnings Override History for Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet [42607372] Overridden by Victor Baquero, MD on 07/28/09 1652 Drug-Allergy (Active and Inactive Ingredients) 1. MORPHINE [Level: Level 3] Full Warnings History Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 7/28/2009 4:52 PM
001157
On 9/29/09 1258
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Tue Jul 28, 2009 1521 Isolation No Isolation Order Details Frequency EVERY 4 HOURS IF NEEDED
Duration 31 days Priority Routine
Order History Order Date/Time 07/28/09 1652 02/13/09 1739 08/20/08 1217 06/25/08 1301 04/30/08 1359 04/04/08 1253 03/05/08 0811 02/01/08 1307 01/09/08 1250 12/10/07 1736 10/16/07 1736 09/18/07 1306 08/01/07 1327 03/29/07 1715 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/16/06 1902 10/27/06 0936 09/18/06 1301 08/29/06 1221 07/20/06 1229 06/29/06 1909 06/06/06 1509 05/23/06 1218 05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235 Provider Information Ordering User Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero, MD
Order ID 42607372 35954313 29295197 27315388 25327455 24472171 23777622 22961591 22349333 21797037 20400950 19897779 18888360 16392919 16234616 15747351 15336225 14957270 14565825 14176753 13806608 13399312 12755804 12474895 11883905 11628479 11298702 11099075 10770690 10549668 9590661 9329992 3659473 3336159 3106182
001158
Victor Baquero, MD
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
All Administrations of Methadone (DOLOPHINE) 10 mg PO Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg PO Tablet [43512111] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued Isolation No Isolation Order Details Frequency DAILY (OUTPATIENT)
Duration None
Reason None
Priority Routine
Order Class Normal
Order ID 43512111 42415608 41358443
001159
06/02/09 1316 05/07/09 1512 04/09/09 1151 03/16/09 1008 02/13/09 0901 01/20/09 1025 12/22/08 1330 12/01/08 0956 11/03/08 0853 10/06/08 1735 09/05/08 1008 08/11/08 1128 06/27/08 0901 06/06/08 1714 04/30/08 1359 04/23/08 1255 04/04/08 1253 03/12/08 1720 01/10/08 1229 12/13/07 1239 11/16/07 1444 10/22/07 1713 09/17/07 1803 08/31/07 0809 08/07/07 1735 07/16/07 1512 06/22/07 1112 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
Victor Baquero, MD Victor Baquero, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Gertrudes Perlas Montemayor, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
40335571 39316280 38152050 37025430 35855444 34942551 33955136 33114228 32060748 31022473 29814812 28998118 27379159 26682012 25327454 25043810 24527577 23982000 22429171 21876329 21267173 20658809 19830274 19493600 18998255 18553324 18102039 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
MRN
Sex
DOB
001160
10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
13301080 12961787 12648793 12308313 11994381 11628480 11423903

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Carisoprodol (SOMA) 350 mg PO Tablet (Order 43768948) Start 8/26/2009 End 11/2/2009
Quantity Refills 1 100 Carisoprodol (SOMA) 350 mg PO Tablet (Discontinued) Sig : Take 1 Tab by mouth 3 times daily. Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 Class: Pharmacy All Administrations of Carisoprodol (SOMA) 350 mg PO Tablet No Administrations Recorded
Warnings Override History for Carisoprodol (SOMA) 350 mg PO Tablet [43768948] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 8/27/2009 1:16 PM Released By Electronically Signed By/Authorizing Victor Baquero, MD Department Fol Family Practice
001161
VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Henrique Discontinued Baquero, MD On 11/2/09 1219 Reason None
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Wed Aug 26, 2009 1427 Isolation No Isolation Order Details Frequency THREE TIMES DAILY Duration None Priority Routine
Status Pended
Reason
05/01/08 0807 04/04/08 1253 02/01/08 1307 10/16/07 1736 09/17/07 1803 08/24/07 1248 05/18/07 1823 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/08/06 1636 11/16/06 1902 10/27/06 0936 09/21/06 0905 08/29/06 1221 08/09/06 1629 07/20/06 1229 06/22/06 0802 05/23/06 1218 05/01/06 1426
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Gertrudes Perlas Montemayor, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 43768948 41205076 38867452 36315899 33600806 32485341 31477924 30394549 29305593 28300831
25337230 24527578 22961739 20401029 19830238 19378248 17408551 16234615 15747350 15336224 14957272 14222418 13806607 13399309 12795068 12474894 12188977 11883695 11514417 11099064 10770668
Provider Information Ordering User Victor Baquero, MD PCP
001162
05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235
Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
10770690 10549668 9590661 9329992 3659473 3336159 3106182

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
All Administrations of Methadone (DOLOPHINE) 10 mg PO Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg PO Tablet [44543839] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 9/15/2009 1:56 PM
On 10/9/09 1635
Reason None
001163
Signed and Held / Pended Order History Pending User Date/Time Tue Sep 15, 2009 1149 Isolation No Isolation Order Details Frequency DAILY (OUTPATIENT) Duration None Priority Routine
Status Pended
Reason
Order Class Normal
03/16/09 1008 02/13/09 0901 01/20/09 1025 12/22/08 1330 12/01/08 0956 11/03/08 0853 10/06/08 1735 09/05/08 1008 08/11/08 1128 06/27/08 0901 06/06/08 1714 04/30/08 1359 04/23/08 1255 04/04/08 1253 03/12/08 1720 01/10/08 1229 12/13/07 1239 11/16/07 1444 10/22/07 1713 09/17/07 1803 08/31/07 0809 08/07/07 1735 07/16/07 1512 06/22/07 1112 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Gertrudes Perlas Montemayor, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 44543839 43512111 42415608 41358443 40335571 39316280 38152050

37025430 35855444 34942551 33955136 33114228 32060748 31022473 29814812 28998118 27379159 26682012 25327454 25043810 24527577 23982000 22429171 21876329 21267173 20658809 19830274 19493600 18998255 18553324 18102039 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358
001164
09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
12648793 12308313 11994381 11628480 11423903
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet (Order 45096621) Start 9/28/2009 End 11/2/2009
Quantity Refills 1 100 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet (Discontinued) Sig : Take 1 Tab by mouth every 4 hours if needed for pain. Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176026 PRN Reason(s): pain Class: Pharmacy
All Administrations of Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet No Administrations Recorded Warnings Override History for Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet [45096621] Overridden by Victor Baquero, MD on 09/29/09 1258 Drug-Allergy (Active and Inactive Ingredients) 1. MORPHINE [Level: Level 3]
Full Warnings History
Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter
001165
View Encounter Order Info Date and Time 9/29/2009 12:58 PM

This Order Has Been Discontinued Order Status By Victor Henrique Discontinued Baquero, MD
On 11/2/09 1219
Reason None
Signed and Held / Pended Order History Pending User Date/Time Mon Sep 28, 2009 1726 Isolation No Isolation Order Details Frequency EVERY 4 HOURS IF NEEDED
Status Pended
Reason
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 45096621 42607372 35954313 29295197 27315388 25327455 24472171 23777622 22961591 22349333 21797037 20400950 19897779 18888360 16392919 16234616 15747351 15336225 14957270 14565825 14176753 13806608 13399312 12755804 12474895 11883905 11628479 11298702 11099075
001166
06/06/06 1509 05/23/06 1218 05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
11298702 11099075 10770690 10549668 9590661 9329992 3659473 3336159 3106182
Provider Information Ordering User Victor Henrique Baquero, MD

PCP Victor Henrique Baquero, MD
Authorizing Provider Victor Henrique Baquero, MD
Patient Information Patient Name Amundsen, Mark Unit PEDFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Methadone (DOLOPHINE) 10 mg PO Tablet (Order 45578181)

Quantity 390 Refills 0 Start 10/9/2009 End 11/5/2009

On 11/6/09 1450
001167
Isolation No Isolation Order Details Frequency DAILY (OUTPATIENT)

Order History Order Date/Time 10/09/09 1635 09/15/09 1356 08/20/09 0823 07/24/09 1445 06/26/09 1500 06/02/09 1316 05/07/09 1512 04/09/09 1151 03/16/09 1008 02/13/09 0901 01/20/09 1025 12/22/08 1330 12/01/08 0956 11/03/08 0853 10/06/08 1735 09/05/08 1008 08/11/08 1128 06/27/08 0901 06/06/08 1714 04/30/08 1359 04/23/08 1255 04/04/08 1253 03/12/08 1720 01/10/08 1229 12/13/07 1239 11/16/07 1444 10/22/07 1713 09/17/07 1803 08/31/07 0809 08/07/07 1735 07/16/07 1512 06/22/07 1112 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Gertrudes Perlas Montemayor, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 45578181 44543839 43512111 42415608 41358443 40335571 39316280 38152050
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
37025430 35855444 34942551 33955136 33114228 32060748 31022473 29814812 28998118 27379159 26682012 25327454 25043810 24527577 23982000 22429171 21876329 21267173 20658809 19830274 19493600 18998255 18553324 18102039 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787
001168
12/13/07 1239 11/16/07 1444 10/22/07 1713 09/17/07 1803 08/31/07 0809 08/07/07 1735 07/16/07 1512 06/22/07 1112
04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information Ordering User Victor Henrique Baquero, MD
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
21876329 21267173 20658809 19830274 19493600 18998255 18553324 18102039
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Henrique Baquero, MD
16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Start 11/2/2009 End 12/2/2009
Quantity Refills 100 Tab 1 Carisoprodol (SOMA) 350 mg PO Tablet Sig : Take 1 Tab by mouth every 8 hours if needed for muscle spasm. Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 PRN Reason(s): muscle spasm Class: Pharmacy
All Administrations of Carisoprodol (SOMA) 350 mg PO Tablet
001169
No Administrations Recorded Warnings Override History for Carisoprodol (SOMA) 350 mg PO Tablet [46494426] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 11/2/2009 12:19 PM Released By VICTOR H BAQUERO [886764315] Signed and Held / Pended Order History Pending User Date/Time Mon Nov 2, 2009 1009 Isolation No Isolation Order Details Frequency EVERY 8 HOURS IF NEEDED Duration None Priority Routine Order Class Pharmacy
Department Fol Pediatrics
05/01/08 0807 04/04/08 1253 02/01/08 1307 10/16/07 1736 09/17/07 1803 08/24/07 1248 05/18/07 1823 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253
User Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Gertrudes Perlas Montemayor, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 46494426 43768948 41205076 38867452 36315899 33600806 32485341 31477924 30394549 29305593 28300831
25337230 24527578 22961739 20401029 19830238 19378248 17408551 16234615 15747350 15336224 14957272
001170
12/08/06 1636 11/16/06 1902 10/27/06 0936 09/21/06 0905 08/29/06 1221 08/09/06 1629 07/20/06 1229 06/22/06 0802 05/23/06 1218 05/01/06 1426
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
14222418 13806607 13399309 12795068 12474894 12188977 11883695 11514417 11099064 10770668
Provider Information Ordering User Victor Henrique Baquero, MD PCP Victor Henrique Baquero, MD

Unit PEDFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Start 11/2/2009 End 12/2/2009
Quantity Refills 100 Tab 1 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet Sig : Take 1 Tab by mouth every 4 hours if needed for pain. Route: ORAL Comment: This is a REFILL AUTHORIZATION for prescription number 176026 PRN Reason(s): pain Class: Pharmacy
All Administrations of Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet No Administrations Recorded Warnings Override History for Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet [46494307] Overridden by Victor Henrique Baquero, MD on 11/02/09 1219 Drug-Allergy (Active and Inactive Ingredients) 1. MORPHINE [Level: Level 3]
Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630
001171

Department Fol Pediatrics
Released By CORY O'DELL [778869065] VICTOR H BAQUERO [886764315] Signed and Held / Pended Order History Pending User Date/Time Mon Nov 2, 2009 1009 Mon Nov 2, 2009 1008 Isolation No Isolation Order Details Frequency EVERY 4 HOURS IF NEEDED
Duration None Priority Routine Order Class Pharmacy Status Pended Pended Reason
User Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 46494307 45096621 42607372 35954313 29295197 27315388 25327455 24472171 23777622 22961591 22349333 21797037 20400950 19897779 18888360 16392919 16234616 15747351 15336225 14957270 14565825 14176753 13806608 13399312 12755804 12474895 11883905 11628479
001172
08/31/07 0809 08/07/07 1735 07/16/07 1512 06/22/07 1112
04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information Ordering User Victor Henrique Baquero, MD PCP Victor Henrique Baquero, MD
Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
19493600 18998255 18553324 18102039
16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Methadone (DOLOPHINE) 10 mg PO Tablet (Order 46641416) Quantity 390 Tab Refills 0 Start 11/5/2009 End 12/2/2009
All Administrations of Methadone (DOLOPHINE) 10 mg PO Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg PO Tablet [46641416] No Warning History Available Allergies FENTANYL; MORPHINE
001173
Encounter View Encounter Order Info Date and Time 11/6/2009 2:50 PM Released By VICTOR H BAQUERO [886764315] VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Henrique Discontinued Baquero, MD On 12/2/09 1354 Reason None Electronically Signed By/Authorizing Victor Baquero, MD Department Fol Family Practice
Signed and Held / Pended Order History Pending User Date/Time Victor Henrique Baquero, MD Thu Nov 5, 2009 1435 Clare Jennings, MA Thu Nov 5, 2009 0759 Isolation No Isolation Order Details Frequency DAILY (OUTPATIENT) Duration None Priority Routine
Reason
Order Class Normal
Order History Order Date/Time 11/06/09 1450 10/09/09 1635 09/15/09 1356 08/20/09 0823 07/24/09 1445 06/26/09 1500 06/02/09 1316 05/07/09 1512 04/09/09 1151 03/16/09 1008 02/13/09 0901 01/20/09 1025 12/22/08 1330 12/01/08 0956 11/03/08 0853 10/06/08 1735 09/05/08 1008 08/11/08 1128 06/27/08 0901 06/06/08 1714 04/30/08 1359 04/23/08 1255 04/04/08 1253 03/12/08 1720 01/10/08 1229
User Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Gertrudes Perlas Montemayor, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 46641416 45578181 44543839 43512111 42415608 41358443 40335571 39316280 38152050 37025430 35855444 34942551 33955136 33114228 32060748 31022473 29814812 28998118 27379159 26682012 25327454 25043810 24527577 23982000 22429171
001174
Acknowledgement Info For At Placing Order 12/15/09 1549 D/C Order 12/15/09 1842 Patient Information Patient Name Amundsen, Mark Unit D14O
MRN 8081369
Acknowledged By Patricia L Bailey, RN Patricia L Bailey, RN

Sex Male
Acknowledged On 12/15/09 1553 12/15/09 1850

DOB 9/23/1959
Room 14787
Bed 147871
Medication
All Administrations of Methadone (DOLOPHINE) 10 mg PO Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg PO Tablet [47648844] No Warning History Available Medication Notes
Jennifer Mello, PHRMTECH 12/21/2009 8:54 AM Note pt now takes a divided dose 40mg in the am, 40mg at 4pm and 50mg at 10pm
Order Audit Trail: Methadone (DOLOPHINE) 10 mg PO Tablet [47648844] 12/16/09 1039 - Modified by Jennifer Mello, PHRMTECH Name: Methadone (DOLOPHINE) 10 mg PO Medication: METHADONE 10 MG TABLET Tablet [5425] Dose: 130 mg Route: ORAL Frequency: DAILY For: -(OUTPATIENT) Instructions: -Indications of Use: -Dispense Quantity: 390 Refills: 0 Dispense as Written: No tablets Sig: Take 13 Tabs by mouth every day. Order Comments: --
001175
Edited Sig: -Translated Sig: -Written Date: 12/2/2009 Expiration Date: -Start Date: 12/2/2009 End Date: 12/23/2009 Providers Authorized by: Victor Baquero, MD Prescribed by: -Pharmacy: -Pharmacy Comments: -12/02/09 1354 - Original Entry by Victor Henrique Baquero, MD Name: Methadone (DOLOPHINE) 10 mg PO Medication: METHADONE 10 MG TABLET Tablet [5425] For: -Dose: 130 mg Route: ORAL Frequency: DAILY (OUTPATIENT) Instructions: -Indications of Use: -Dispense Quantity: 390 Refills: 0 Dispense as Written: No tablets Sig: Take 13 Tabs by mouth every day. Order Comments: -Edited Sig: -Translated Sig: -Written Date: 12/2/2009 Expiration Date: -End Date: 12/23/2009 Start Date: 12/2/2009 Providers Authorized by: Victor Baquero, MD Prescribed by: -Pharmacy: -Pharmacy Comments: --
Dispense History Audit Trail Date Type 12/02/09 Ordered
Pharmacy --
Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report. Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter
001176

On 12/28/09 1210
Reason None
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Wed Dec 2, 2009 0824 Isolation No Isolation Order Details Frequency DAILY (OUTPATIENT)
Status Pended
Reason
Order Class Normal
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Gertrudes Perlas Montemayor, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 47648844 46641416 45578181 44543839 43512111 42415608 41358443 40335571 39316280 38152050
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
37025430 35855444 34942551 33955136 33114228 32060748 31022473 29814812 28998118 27379159 26682012 25327454 25043810 24527577 23982000 22429171 21876329 21267173 20658809 19830274
001177
Ordering Provider TAMURIAN, ROBERT MICHAEL [10884] Acknowledgement Info For At Placing Order 12/16/09 0741 Verbal Order Info
Action Ordering Order Mode Transcribed Communicator Smiley Hom, PharmD MRN 8081369
Pager 916-762-3059 Acknowledged By Mary Tran, RN Responsible Provider Acknowledged On 12/16/09 0744
Signed By Signature Not Required DOB 9/23/1959
Signed On
Patient Information Patient Name Amundsen, Mark Unit D14O
Sex Male
Room 14787
Bed 147871
Medication
Medication Detail Cefazolin (KEFZOL, ANCEF) 1 g Route: IV Admin Dose: 1 g Admin Instructions: IV: Infuse over 30 minutes Class: Inpatient Normal Last Admin Time: 12/16/09 1310 Number of Doses: 3 Dose 1g
Cefazolin (KEFZOL, ANCEF) 1 g (Order 48191915) Frequency EVERY 8 HOURS NOW Start 12/15/2009 1700 End 12/16/2009 1310
All Administrations of Cefazolin (KEFZOL, ANCEF) 1 g Action Recorded User(s) Time Time Dose/Rate Mary Tran, RN 12/16/09 12/16/09 1 g 1310 1320 Beverly Harrelson, 12/16/09 12/16/09 1 g RN 0500 0606 Beverly Harrelson, 12/15/09 12/15/09 1 g RN 2100 2238
Route IV IV IV
Site
Comment
Action Reason Given Given Given
Warnings Override History for Cefazolin (KEFZOL, ANCEF) 1 g [48191915] No Warning History Available
001178
Order Audit Trail: Cefazolin (KEFZOL, ANCEF) 1 g [48191915] Order Details After Change #1 - Rx Verify Name: Cefazolin (KEFZOL, ANCEF) 1 g Start time: 12/15/09 1700
Frequency: EVERY 8 HOURS NOW Total # of doses: 3 Priority: -Infusion Site: -Rate: -Duration: -Volume: -Ordered dose: 1 g Admin dose: 1 g Route: IV Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION [1573] PRN comments: -PRN reasons: -Indications of use: -Indications comments: -Order comments: -Admin instructions: IV: Infuse over 30 minutes Phase of care: -Order Questions: Hospital acquired infection? (>48 hours in No house/SNF patient) If documented infection, enter pathogen: (no response given) Prophylactic / Empiric Therapy / SURGICAL PROPHYLAXIS (MUST ENTER STOP DATE, Documented Infection ENTER PROCEDURE IN COMMENTS) Site of presumed or documented SKIN infection: Initial Order Details Name: Cefazolin (KEFZOL, ANCEF) 1 g
Ryan Cello, RPH 12/15/09 1919 End time: 12/16/09 1659 First dose: --
Jonathan G Eastman, MD 12/15/09 1550 Start time: 12/15/09 1700 End time: 12/16/09 1659 Total # of doses: 3 First dose: -Frequency: EVERY 8 HOURS NOW Priority: -Infusion Site: -Rate: -Duration: -Volume: -Ordered dose: 1 g Admin dose: 1 g Route: IV Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION [1573] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: IV: Infuse over 30 minutes Phase of care: -Order Questions: Hospital acquired infection? (>48 hours in No house/SNF patient) If documented infection, enter pathogen: (no response given) Prophylactic / Empiric Therapy / SURGICAL PROPHYLAXIS (MUST ENTER STOP DATE, Documented Infection ENTER PROCEDURE IN COMMENTS) Site of presumed or documented SKIN infection:
Changes to the order are displayed in red. Note that there may be changes made to the order that are not
001179
shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Electronically Signed By/Authorizing Jonathan G Eastman, MD
Released By PATRICIA L BAILEY [254588866] Signed and Held / Pended Order History Pending User Date/Time Jonathan G Eastman, MD Tue Dec 15, 2009 1540 Order Questions Question Hospital acquired infection? (>48 hours in house/SNF patient) Prophylactic / Empiric Therapy / Documented Infection Answer No SURGICAL PROPHYLAXIS (MUST ENTER STOP DATE, ENTER PROCEDURE IN COMMENTS) SKIN
Status Signed & Held Reason
Comment
Site of presumed or documented infection: Isolation No Isolation Order Details Frequency EVERY 8 HOURS NOW Duration 3 occurrences
Priority None
Order Class Inpatient Normal
Order History Order Date/Time 12/15/09 1550 12/15/09 0722 Provider Information Ordering User Jonathan G Eastman, MD Attending Provider(s) Robert Michael Tamurian, MD
User Jonathan G Eastman, MD Jonathan G Eastman, MD

Ordering Provider Jonathan G Eastman, MD
Action Current Order Modified from
Order ID 48191915 48147853
Authorizing Provider Jonathan G Eastman, MD
Admitting Provider Robert Michael Tamurian, MD
Billing Provider Jonathan G Eastman, MD
Ordering Provider EASTMAN, JONATHAN G [09983] Acknowledgement Info For At
Pager 916-762-7648 Acknowledged By Acknowledged On
001180
Placing Order
12/15/09 1550 MRN 8081369
Patricia L Bailey, RN Sex Male
12/15/09 1553 DOB 9/23/1959 Bed 147871
Room 14787
Account # 010016806878
Medication
Medication Detail Diazepam (VALIUM) 5 mg Dose 5 mg
Diazepam (VALIUM) 5 mg (Order 48195448) Frequency ONE TIME ONLY Start 12/15/2009 1800 End 12/15/2009 1644
Route: IV Admin Dose: 1 mL = 5 mg of 5 mg/mL Volume: 2 mL Admin Instructions: IV: IV push (undiluted) at 5 mg/min MAX rate Class: Inpatient Normal Last Admin Time: 12/15/09 1644 Number of Doses: 1 All Administrations of Diazepam (VALIUM) 5 mg Action Recorded User(s) Time Time Dose/Rate Route Patricia L Bailey, RN 12/15/09 12/15/09 5 mg IV 1644 1645
Site
Comment
Action Reason Given
Warnings Override History for Diazepam (VALIUM) 5 mg [48195448] No Warning History Available Order Audit Trail: Diazepam (VALIUM) 5 mg [48195448] Order Details After Change #1 - Rx Verify Ryan Cello, RPH 12/15/09 1920 Name: Diazepam (VALIUM) 5 mg Start time: 12/15/09 1800 End time: -Frequency: ONE TIME ONLY Total # of doses: 1 First dose: -Priority: -Infusion Site: -Rate: -Duration: -Volume: 2 mL Ordered dose: 5 mg Admin dose: 5 mg Route: IV Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: DIAZEPAM 5 MG/ML SYRINGE [69505]
001181
PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: IV: IV push (undiluted) at 5 mg/min MAX rate Phase of care: -Order Questions: Initial Order Details John Ted Speicher, MD 12/15/09 1635 Name: Diazepam (VALIUM) 5 mg Start time: 12/15/09 1800 End time: -Frequency: ONE TIME ONLY Total # of doses: 1 First dose: -Priority: -Infusion Site: -Rate: -Duration: -Volume: -Admin dose: 5 mg Route: IV Ordered dose: 5 mg Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: DIAZEPAM 5 MG/ML SYRINGE [69505] PRN comments: -PRN reasons: -Indications of use: -Indications comments: -Order comments: -Admin instructions: IV: IV push (undiluted) at 5 mg/min MAX rate Phase of care: -Order Questions: Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/15/2009 4:35 PM Isolation No Isolation Order Details Frequency ONE TIME ONLY Duration 1 occurrence Priority None Order Class Inpatient Normal
Electronically Signed By John Ted Speicher, MD Authorizing Department Robert Michael Tamurian D14 Orthopedics/Trauma
Provider Information Ordering User John Ted Speicher, MD

Attending Provider(s) Robert Michael Tamurian, MD
Ordering Provider John Ted Speicher, MD

Authorizing Provider Robert Michael Tamurian, MD

Ordering Provider SPEICHER, JOHN TED [10876] Acknowledgement Info For At
001182
Placing Order
12/15/09 1635 MRN 8081369
Jodi Vergara, RN Sex Male
12/15/09 1725 DOB 9/23/1959 Bed 147871
Room 14787
Account # 010016806878
Medication
Medication Detail Diazepam (VALIUM) 5 mg Dose 5 mg
Diazepam (VALIUM) 5 mg (Order 48198304) Frequency ONE TIME ONLY Start 12/15/2009 1900 End 12/15/2009 1900
Route: IV Admin Dose: 1 mL = 5 mg of 5 mg/mL Volume: 2 mL Admin Instructions: IV: IV push (undiluted) at 5 mg/min MAX rate Class: Inpatient Normal Last Admin Time: 12/15/09 1900 Number of Doses: 1 All Administrations of Diazepam (VALIUM) 5 mg Action Recorded User(s) Time Time Dose/Rate Route Patricia L Bailey, RN 12/15/09 12/15/09 5 mg IV 1900 1803
Site
Comment L hip muscle spasms
Action Reason Given
Warnings Override History for Diazepam (VALIUM) 5 mg [48198304] No Warning History Available Order Audit Trail: Diazepam (VALIUM) 5 mg [48198304] Order Details After Change #1 - Rx Verify Ryan Cello, RPH 12/15/09 1920 Name: Diazepam (VALIUM) 5 mg Start time: 12/15/09 1900 End time: -Frequency: ONE TIME ONLY Total # of doses: 1 First dose: -Priority: -Infusion Site: -Rate: -Duration: -Volume: 2 mL Ordered dose: 5 mg Admin dose: 5 mg Route: IV Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: DIAZEPAM 5 MG/ML SYRINGE [69505]
001183
PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: IV: IV push (undiluted) at 5 mg/min MAX rate Phase of care: -Order Questions: Initial Order Details John Ted Speicher, MD 12/15/09 1739 Name: Diazepam (VALIUM) 5 mg Start time: 12/15/09 1900 End time: -Frequency: ONE TIME ONLY Total # of doses: 1 First dose: -Priority: -Infusion Site: -Rate: -Duration: -Volume: -Admin dose: 5 mg Route: IV Ordered dose: 5 mg Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: DIAZEPAM 5 MG/ML SYRINGE [69505] PRN comments: -PRN reasons: -Indications of use: -Indications comments: -Order comments: -Admin instructions: IV: IV push (undiluted) at 5 mg/min MAX rate Phase of care: -Order Questions: Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/15/2009 5:39 PM Isolation No Isolation Order Details Frequency ONE TIME ONLY Duration 1 occurrence Priority None Order Class Inpatient Normal
Electronically Signed By John Ted Speicher, MD Authorizing Department Robert Michael Tamurian D14 Orthopedics/Trauma
Provider Information Ordering User John Ted Speicher, MD

Ordering Provider John Ted Speicher, MD


Ordering Provider SPEICHER, JOHN TED [10876] Acknowledgement Info For At
001184
Placing Order
12/15/09 1739 MRN 8081369
Patricia L Bailey, RN Sex Male
12/15/09 1755 DOB 9/23/1959 Bed 147871
Room 14787
Account # 010016806878
Medication
Medication Detail Mixtures Vancomycin (VANCOCIN) . Route: IV Admin Dose: 1,000 mg Volume: 200 mL Duration: 60 Minutes Class: Inpatient Normal Last Admin Time: 12/15/09 1000 Number of Doses: 1 Dose Additives Components Vancomycin 500 mg 1,000 mg Base Components Iso-Osmotic Dextrose 200 mL Dose 1,000 mg
Vancomycin (VANCOCIN) . (Order 48147854) Frequency Start ONCALL 12/15/2009 TO OR 0722 End 12/15/2009 1000
Frequency Rate (none) (none)
(none)
(none)
All Administrations of Vancomycin (VANCOCIN) . Action Recorded User(s) Time Time Dose/Rate Route Attila Bertalan, RN 12/15/09 12/15/09 1,000 mg IV 1000 1021
Site
Comment
Action Reason Given
Warnings Override History for Vancomycin (VANCOCIN) . [48147854] No Warning History Available Order Audit Trail: Vancomycin (VANCOCIN) . [48147854] Order Details After Change #1 - Rx Verify Name: Vancomycin (VANCOCIN) . Start time: 12/15/09 0722 Frequency: ONCALL TO OR Total # of doses: 1 Priority: -Rate: -Ordered dose: 1,000 mg Dispense from: CIVA/CUDA Dispense code: IV Piggyback Barcode Ryan Cello, RPH 12/15/09 1921 End time: -First dose: As Scheduled Volume: 200 mL Route: IV
Infusion Site: -Duration: 60 Minutes Admin dose: 1,000 mg First doses from: 8RX_UCDMC PRN par level # of doses: --
001185
Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? Yes Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: VANCOMYCIN 500 MG IV SOLUTION [9220], ISO-OSMOTIC DEXTROSE [2000080] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: -Phase of care: -Order Questions: Hospital acquired infection? (>48 hours in No house/SNF patient) Prophylactic / Empiric Therapy / SURGICAL PROPHYLAXIS (MUST ENTER STOP DATE, Documented Infection ENTER PROCEDURE IN COMMENTS) Site of presumed or documented SKIN infection: Initial Order Details Name: Vancomycin (VANCOCIN) . Frequency: ONCALL TO OR Jonathan G Eastman, MD 12/15/09 0722 Start time: 12/15/09 0722 End time: -Total # of doses: 1 First dose: As Scheduled Priority: -Infusion Site: -Rate: -Duration: 60 Minutes Volume: 550 mL Ordered dose: 1,000 mg Admin dose: 1,000 mg Route: IV Dispense from: CIVA/CUDA First doses from: 8RX_UCDMC Dispense code: IV Piggyback Barcode PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: VANCOMYCIN 500 MG IV SOLUTION [9220], D5W 100ML [2000004], ISO-OSMOTIC DEXTROSE [2000080], D5W 250ML CARRIER [2000002] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: -Phase of care: -Order Questions: Hospital acquired infection? (>48 hours in No house/SNF patient) Prophylactic / Empiric Therapy / SURGICAL PROPHYLAXIS (MUST ENTER STOP DATE, Documented Infection ENTER PROCEDURE IN COMMENTS) Site of presumed or documented SKIN infection:
Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/14/2009 4:49 PM Electronically Signed By/Authorizing Jonathan G Eastman, MD Department D14 Orthopedics/Trauma
001186
Released By GITA VAID [847342698]
Signed and Held / Pended Order History Pending User Date/Time Jonathan G Eastman, MD Mon Dec 14, 2009 1649 Order Questions Question Hospital acquired infection? (>48 hours in house/SNF patient) Prophylactic / Empiric Therapy / Documented Infection Answer No SURGICAL PROPHYLAXIS (MUST ENTER STOP DATE, ENTER PROCEDURE IN COMMENTS) SKIN
Status Signed & Held
Reason Hold for Admit
Comment
Site of presumed or documented infection: Isolation No Isolation Order Details Frequency ONCALL TO OR Duration 1 occurrence
Priority None
Provider Information Ordering User Jonathan G Eastman, MD



Ordering Provider EASTMAN, JONATHAN G [09983] Acknowledgement Info For At Placing Order 12/15/09 0722 Patient Information Patient Name Amundsen, Mark
Unit D14O
Pager 916-762-7648 Acknowledged By Gita Vaid, RN Acknowledged On 12/15/09 0723 DOB 9/23/1959
Bed 147871
MRN 8081369
Room 14787
Sex Male
Account # 010016806878 Account Information Acct Number 010016806878 Visit CSN CSN Number:
001187
28141367
Medication
Medication Detail Mixtures Vancomycin (VANCOCIN) .
Dose 1,000 mg
Vancomycin (VANCOCIN) . (Order 48191959)

Frequency Start EVERY 12/15/2009 12 1700 HOURS NOW End 12/16/2009 1800
Route: IV Admin Dose: 1,000 mg Volume: 200 mL Duration: 60 Minutes Admin Instructions: Give 12 hours after dose given in OR Class: Inpatient Normal Last Admin Time: 12/16/09 1800 Number of Doses: 2 Dose Additives Components Vancomycin 500 mg 1,000 mg Base Components Iso-Osmotic Dextrose 200 mL
(none)
(none)
All Administrations of Vancomycin (VANCOCIN) . Action Recorded User(s) Time Time Dose/Rate Route Site Kristine Palaspas, 12/16/09 12/16/09 1,000 mg IV RN 1800 2049 Beverly Harrelson, RN Jodi Vergara, RN 12/16/09 0600 12/16/09 0030 12/16/09 0607 12/15/09 1742 1,000 mg 1,000 mg IV IV
Comment given by Mary Tran.
Action Reason Reported (see comment) Given
Canceled Entry
Warnings Override History for Vancomycin (VANCOCIN) . [48191959] No Warning History Available Order Audit Trail: Vancomycin (VANCOCIN) . [48191959] Order Details After Change #1 - Rx Verify Name: Vancomycin (VANCOCIN) . Start time: 12/15/09 1700 Ryan Cello, RPH 12/15/09 1920 End time: 12/16/09 1659 First dose: --
Frequency: EVERY 12 HOURS NOW Total # of doses: 2 Priority: -Infusion Site: -Rate: -Duration: 60 Minutes Volume: 200 mL Ordered dose: 1,000 mg Admin dose: 1,000 mg Route: IV Dispense from: CIVA/CUDA First doses from: 8RX_UCDMC Dispense code: IV Piggyback Barcode PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: VANCOMYCIN 500 MG IV SOLUTION [9220], ISO-OSMOTIC DEXTROSE [2000080] PRN reasons: -PRN comments: -Indications of use: -Indications comments: --
001188
Order comments: -Admin instructions: Give 12 hours after dose given in OR Phase of care: -Order Questions: Prophylactic / Empiric Therapy / SURGICAL PROPHYLAXIS (ORDER WILL STOP AFTER 24 Documented Infection HRS, ENTER PROCEDURE IN COMMENTS), s/p hip/knee replacement Initial Order Details Name: Vancomycin (VANCOCIN) . Jonathan G Eastman, MD 12/15/09 1550 Start time: 12/15/09 1700 End time: 12/16/09 1659 Frequency: EVERY 12 HOURS NOW Total # of doses: 2 First dose: -Priority: -Infusion Site: -Rate: -Duration: 60 Minutes Volume: 550 mL Ordered dose: 1,000 mg Admin dose: 1,000 mg Route: IV Dispense from: CIVA/CUDA First doses from: 8RX_UCDMC Dispense code: IV Piggyback Barcode PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: VANCOMYCIN 500 MG IV SOLUTION [9220], D5W 100ML [2000004], ISO-OSMOTIC DEXTROSE [2000080], D5W 250ML CARRIER [2000002] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: Give 12 hours after dose given in OR Phase of care: -Order Questions: Prophylactic / Empiric Therapy / SURGICAL PROPHYLAXIS (ORDER WILL STOP AFTER 24 Documented Infection HRS, ENTER PROCEDURE IN COMMENTS), s/p hip/knee replacement
Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Released By PATRICIA L BAILEY [254588866] Signed and Held / Pended Order History Pending User Date/Time Jonathan G Eastman, MD Tue Dec 15, 2009 1540 Order Questions Question Prophylactic / Empiric Therapy / Documented Infection Answer SURGICAL PROPHYLAXIS (ORDER WILL STOP AFTER 24 HRS, ENTER
Comment s/p hip/knee replacement
001189
PROCEDURE IN COMMENTS) Isolation No Isolation Order Details Frequency EVERY 12 HOURS NOW
Duration 2 occurrences Priority None Order Class Inpatient Normal
Provider Information Ordering User Jonathan G Eastman, MD Attending Provider(s) Robert Michael Tamurian, MD
Ordering Provider EASTMAN, JONATHAN G [09983] Acknowledgement Info For At Placing Order 12/15/09 1550 Patient Information Patient Name Amundsen, Mark Unit D14O
MRN 8081369
Pager 916-762-7648 Acknowledged By Patricia L Bailey, RN

Sex Male
Acknowledged On 12/15/09 1552

DOB 9/23/1959
Room 14787
Bed 147871
Medication
Medication Detail Bisacodyl (DULCOLAX) Suppository 10 mg
Bisacodyl (DULCOLAX) Suppository 10 mg (Order 48191939) Dose 10 mg Frequency EVERY 12 HOURS IF NEEDED Start 12/15/2009 1550 End 12/18/2009 1834
Route: RECTALLY Admin Dose: 1 suppository (1 10 mg suppository) PRN Reason(s): constipation PRN Comment: (no results from Magnesium Hydroxide) Class: Inpatient Normal All Administrations of Bisacodyl (DULCOLAX) Suppository 10 mg No Administrations Recorded
001190
Warnings Override History for Bisacodyl (DULCOLAX) Suppository 10 mg [48191939] No Warning History Available Order Audit Trail: Bisacodyl (DULCOLAX) Suppository 10 mg [48191939] Order Details After Change #1 - Rx Verify Ryan Cello, RPH 12/15/09 1921 Name: Bisacodyl (DULCOLAX) Start time: 12/15/09 1550 End time: -Suppository 10 mg Frequency: EVERY 12 HOURS IF Total # of doses: -First dose: -NEEDED Priority: -Infusion Site: -Rate: -Duration: -Volume: -Admin dose: 10 mg Route: Ordered dose: 10 mg RECTALLY Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: BISACODYL 10 MG RECTAL SUPPOSITORY [1175] PRN reasons: constipation PRN comments: (no results from Magnesium Hydroxide) Indications of use: -Indications comments: -Order comments: -Admin instructions: -Phase of care: -Order Questions: Initial Order Details Name: Bisacodyl (DULCOLAX) Suppository 10 mg Frequency: EVERY 12 HOURS IF NEEDED Priority: -Rate: -Ordered dose: 10 mg Jonathan G Eastman, MD 12/15/09 1550 Start time: 12/15/09 1550 End time: -Total # of doses: -Infusion Site: -Duration: -Admin dose: 10 mg First dose: --
Volume: -Route: RECTALLY
Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: BISACODYL 10 MG RECTAL SUPPOSITORY [1175] PRN reasons: constipation PRN comments: (no results from Magnesium Hydroxide) Indications of use: -Indications comments: -Order comments: -Admin instructions: -Phase of care: -Order Questions: Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter
001191

Released By PATRICIA L BAILEY [254588866]
This Order Has Been Discontinued Order Status By On Incoming 12/18/09 1834 Discontinued Scheduling Interface Signed and Held / Pended Order History Pending User Date/Time Jonathan G Eastman, MD Tue Dec 15, 2009 1540 Isolation No Isolation Order Details Frequency EVERY 12 HOURS IF NEEDED
Duration None Priority None
Reason None
Reason
Unit D14O
Pager 916-762-7648 Acknowledged By Patricia L Bailey, RN Acknowledged On 12/15/09 1551 DOB 9/23/1959
Bed 147871
MRN 8081369
Room 14787
Sex Male
Medication
Carisoprodol (SOMA) Tablet 350 mg (Order 48191969)
001192
Medication Detail Carisoprodol (SOMA) Tablet 350 mg Route: ORAL Admin Dose: 1 tablet (1 350 mg tablet) PRN Reason(s): muscle spasm Class: Inpatient Normal Last Admin Time: 12/16/09 0746 All Administrations of Carisoprodol (SOMA) Tablet 350 mg Action Recorded User(s) Time Time Dose/Rate Route Mary Tran, RN 12/16/09 12/16/09 350 mg ORAL 0746 0750 Beverly Harrelson, 12/15/09 12/15/09 350 mg ORAL RN 2222 2239 Dose 350 mg Frequency EVERY 8 HOURS IF NEEDED Start 12/15/2009 1550 End 12/18/2009 1834
Site
Comment
Action Reason Given Given
Warnings Override History for Carisoprodol (SOMA) Tablet 350 mg [48191969] No Warning History Available Order Audit Trail: Carisoprodol (SOMA) Tablet 350 mg [48191969] Order Details After Change #1 - Rx Verify Ryan Cello, RPH 12/15/09 1921 Name: Carisoprodol (SOMA) Tablet 350 Start time: 12/15/09 1550 End time: -mg Total # of doses: -First dose: -Frequency: EVERY 8 HOURS IF NEEDED Priority: -Infusion Site: -Rate: -Duration: -Volume: -Ordered dose: 350 mg Admin dose: 350 mg Route: ORAL Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: CARISOPRODOL 350 MG TABLET [1520] PRN comments: -PRN reasons: muscle spasm Indications of use: -Indications comments: -Order comments: -Admin instructions: -Phase of care: -Order Questions: Initial Order Details Name: Carisoprodol (SOMA) Tablet 350 mg Frequency: EVERY 8 HOURS IF NEEDED Priority: -Rate: -Ordered dose: 350 mg Dispense from: D14O-4_PYXIS Dispense code: UD Grouper Patient supplied med? No Do not dispense? No Dispense only once? No Jonathan G Eastman, MD 12/15/09 1550 Start time: 12/15/09 1550 End time: -Total # of doses: -Infusion Site: -Duration: -Admin dose: 350 mg First doses from: D14O-4_PYXIS PRN par level # of doses: -Patient supplied # of doses: 0 Do not dispense # of doses: 0 Triggered fill list? No First dose: --
Volume: -Route: ORAL
001193
Self administered? No Individual ingredients? No Components: CARISOPRODOL 350 MG TABLET [1520] PRN reasons: muscle spasm PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: -Phase of care: -Order Questions: Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/15/2009 3:40 PM Released By PATRICIA L BAILEY [254588866] This Order Has Been Discontinued Order Status By On Incoming 12/18/09 1834 Discontinued Scheduling Interface Signed and Held / Pended Order History Pending User Date/Time Jonathan G Eastman, MD Tue Dec 15, 2009 1540 Isolation No Isolation Order Details Frequency EVERY 8 HOURS IF NEEDED Duration None Priority None Order Class Inpatient Normal Reason None Electronically Signed By/Authorizing Jonathan G Eastman, MD Department D14 Orthopedics/Trauma
Reason
User Jonathan G Eastman, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Gertrudes Perlas Montemayor, MD Victor Baquero, MD Victor Baquero, MD
Order ID 48191969 46494426 43768948 41205076 38867452 36315899 33600806 32485341 31477924 30394549 29305593 28300831 25337230 24527578
001194
02/01/08 1307 10/16/07 1736 09/17/07 1803 08/24/07 1248 05/18/07 1823 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/08/06 1636 11/16/06 1902 10/27/06 0936 09/21/06 0905 08/29/06 1221 08/09/06 1629 07/20/06 1229 06/22/06 0802 05/23/06 1218 05/01/06 1426
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
22961739 20401029 19830238 19378248 17408551 16234615 15747350 15336224 14957272 14222418 13806607 13399309 12795068 12474894 12188977 11883695 11514417 11099064 10770668
Ordering Provider Jonathan G Eastman, MD Admitting Provider Robert Michael Tamurian, MD
Authorizing Provider Jonathan G Eastman, MD Billing Provider Jonathan G Eastman, MD
Ordering Provider EASTMAN, JONATHAN G [09983]
Acknowledgement Info For At Placing Order 12/15/09 1550 Patient Information Patient Name Amundsen, Mark Unit D14O
MRN 8081369
Sex Male
Room 14787
Bed 147871
Medication
Medication Detail Cefazolin (KEFZOL, ANCEF) 1 g Dose 1g
Cefazolin (KEFZOL, ANCEF) 1 g (Order 48147853) Frequency ONCALL TO Start 12/15/2009 End 12/15/2009
001195
OR Route: IV Admin Dose: 1 g Admin Instructions: IV: Infuse over 30 minutes Reason for Discontinue: Discontinued Class: Inpatient Normal Number of Doses: 1 All Administrations of Cefazolin (KEFZOL, ANCEF) 1 g No Administrations Recorded Warnings Override History for Cefazolin (KEFZOL, ANCEF) 1 g [48147853] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/14/2009 4:49 PM Released By GITA VAID [847342698] This Order Has Been Discontinued Order Status By Jonathan G Discontinued Eastman, MD
0722
1550
On 12/15/09 1550
Reason Discontinued
Signed and Held / Pended Order History Pending User Date/Time Jonathan G Eastman, MD Mon Dec 14, 2009 1649 Order Questions Question Hospital acquired infection? (>48 hours in house/SNF patient) Prophylactic / Empiric Therapy / Documented Infection Answer No SURGICAL PROPHYLAXIS (MUST ENTER STOP DATE, ENTER PROCEDURE IN COMMENTS) SKIN
Reason Hold for Admit
Comment
Site of presumed or documented infection: Isolation No Isolation Order Details Frequency

Duration
Priority
Order Class
001196
ONCALL TO OR
1 occurrence
None
Inpatient Normal
Authorizing Provider Jonathan G Eastman, MD PCP Victor Henrique Baquero, MD
Pager 916-762-7648 Acknowledged By Gita Vaid, RN Patricia L Bailey, RN Acknowledged On 12/15/09 0723 12/15/09 1553
Acknowledgement Info For At Placing Order 12/15/09 0722 D/C Order 12/15/09 1550 Patient Information Patient Name Amundsen, Mark
Unit D14O
MRN 8081369
Room 14787
Sex Male
DOB 9/23/1959
Bed 147871
Medication
Medication Detail
D5 / 0.45% NaCl 1,000 mL with Potassium Chloride 20 mEq (Order 48191934)

Dose (none) Frequency Start CONTINUOUS 12/15/2009 INFUSION 1700 End 12/18/2009 0841
D5 / 0.45% NaCl 1,000 mL with Potassium Chloride 20 mEq Route: IV Rate: 100 mL/hr Volume: 1,000 mL Admin Instructions: Saline lock when taking po well
Reason for Discontinue: Discontinued Class: Inpatient Normal Last Admin Time: 12/15/09 1915 (Currently Running) All Administrations of D5 / 0.45% NaCl 1,000 mL with Potassium Chloride 20 mEq Recorded Action Time Time Dose/Rate Route Site Comment User(s) Beverly Harrelson, 12/15/09 12/15/09 100 mL/hr IV 1915 2237 RN Patricia L Bailey, 12/15/09 12/15/09 100 mL/hr IV RN 1605 1605
Action Reason Assumed care New bag/syringe
001197
Warnings Override History for D5 / 0.45% NaCl 1,000 mL with Potassium Chloride 20 mEq [48191934] No Warning History Available Order Audit Trail: D5 / 0.45% NaCl 1,000 mL with Potassium Chloride 20 mEq [48191934] Order Details After Change #1 - Rx Verify Ryan Cello, RPH 12/15/09 1919 Name: D5 / 0.45% NaCl 1,000 mL with Start time: 12/15/09 1700 End time: -Potassium Chloride 20 mEq Frequency: CONTINUOUS INFUSION Total # of doses: -First dose: -Priority: -Infusion Site: -Rate: 100 mL/hr Duration: -Volume: 1,000 mL Admin dose: -Route: IV Ordered dose: -Dispense from: FLOOR_STOCK_IV First doses from: FLOOR_STOCK_IV Dispense code: No Label PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: D5 / 0.45% NACL W KCL 20 MEQ/L IV SOLUTION [16039] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: Saline lock when taking po well Phase of care: -Order Questions: Initial Order Details Jonathan G Eastman, MD 12/15/09 1550 Name: D5 / 0.45% NaCl 1,000 mL with Start time: 12/15/09 1700 End time: -Potassium Chloride 20 mEq Frequency: CONTINUOUS INFUSION Total # of doses: -First dose: -Priority: -Infusion Site: -Rate: 100 mL/hr Duration: -Volume: -Admin dose: -Route: IV Ordered dose: -Dispense from: FLOOR_STOCK_IV First doses from: FLOOR_STOCK_IV Dispense code: IV Premade PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: D5 / 0.45% NACL W KCL 20 MEQ/L IV SOLUTION [16039] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: Saline lock when taking po well Phase of care: -Order Questions: Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Electronically Signed
001198
Date and Time 12/15/2009 3:40 PM Released By PATRICIA L BAILEY [254588866] This Order Has Been Discontinued Order Status By Jonathan G Discontinued Eastman, MD
By/Authorizing Jonathan G Eastman, MD
On 12/18/09 0841
Reason Discontinued
Signed and Held / Pended Order History Pending User Date/Time Jonathan G Eastman, MD Tue Dec 15, 2009 1540 Isolation No Isolation Order Details Frequency Duration CONTINUOUS INFUSION None Priority None
Reason



Ordering Provider EASTMAN, JONATHAN G [09983] Acknowledgement Info For At Placing Order 12/15/09 1550 D/C Order 12/18/09 0841 Patient Information Patient Name Amundsen, Mark Unit D14O
MRN 8081369
Pager 916-762-7648 Acknowledged By Patricia L Bailey, RN Bryan Owens

Sex Male
Acknowledged On 12/15/09 1551 12/18/09 0847

DOB 9/23/1959
Room 14787
Bed 147871
Medication
Medication Detail
DiphenhydrAMINE (BENADRYL) 25-50 mg (Order 48191941)
001199
DiphenhydrAMINE (BENADRYL) 25-50 mg
Dose 25-50 mg
Frequency EVERY 6 HOURS IF NEEDED
Start 12/15/2009 1550
End 12/18/2009 1834
Route: IV Admin Dose: 0.5-1 mL = 25-50 mg of 50 mg/mL Volume: 1 mL Admin Instructions: May give PO/IV PRN Reason(s): itching Class: Inpatient Normal Last Admin Time: 12/18/09 0326 All Administrations of DiphenhydrAMINE (BENADRYL) 25-50 mg Action Recorded User(s) Time Time Dose/Rate Route Site Kristine Palaspas, 12/18/09 12/18/09 50 mg IV RN 0326 0330
Comment
Action Reason Given
Warnings Override History for DiphenhydrAMINE (BENADRYL) 25-50 mg [48191941] No Warning History Available Order Audit Trail: DiphenhydrAMINE (BENADRYL) 25-50 mg [48191941] Order Details After Change #1 - Rx Verify Ryan Cello, RPH 12/15/09 1919 Name: DiphenhydrAMINE (BENADRYL) Start time: 12/15/09 1550 End time: -25-50 mg Total # of doses: -First dose: -Frequency: EVERY 6 HOURS IF NEEDED Priority: -Infusion Site: -Rate: -Duration: -Volume: 1 mL Ordered dose: 25-50 mg Admin dose: 25-50 mg Route: IV First doses from: D14O-4_PYXIS Dispense from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: DIPHENHYDRAMINE 50 MG/ML INJECTION [2706] PRN reasons: itching PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: May give PO/IV Phase of care: -Order Questions: Initial Order Details Name: DiphenhydrAMINE (BENADRYL) 25-50 mg Frequency: EVERY 6 HOURS IF NEEDED Priority: -Rate: -Ordered dose: 25-50 mg Dispense from: D14O-4_PYXIS Dispense code: UD Grouper Patient supplied med? No Do not dispense? No Jonathan G Eastman, MD 12/15/09 1550 Start time: 12/15/09 1550 End time: -Total # of doses: -Infusion Site: -Duration: -Admin dose: 25-50 mg First doses from: D14O-4_PYXIS PRN par level # of doses: -Patient supplied # of doses: 0 Do not dispense # of doses: 0 First dose: --
Volume: -Route: IV
001200
Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: DIPHENHYDRAMINE 50 MG/ML INJECTION [2706] PRN reasons: itching PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: May give PO/IV Phase of care: -Order Questions: Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/15/2009 3:40 PM Released By PATRICIA L BAILEY [254588866] This Order Has Been Discontinued Order Status By On Incoming 12/18/09 1834 Discontinued Scheduling Interface Signed and Held / Pended Order History Pending User Date/Time Jonathan G Eastman, MD Tue Dec 15, 2009 1540 Isolation No Isolation Order Details Frequency EVERY 6 HOURS IF NEEDED Duration None Priority None Order Class Inpatient Normal Reason None Electronically Signed By/Authorizing Jonathan G Eastman, MD Department D14 Orthopedics/Trauma
Reason



Ordering Provider EASTMAN, JONATHAN G [09983] Acknowledgement Info For At Placing Order 12/15/09 1550 Patient Information
Pager 916-762-7648 Acknowledged By Patricia L Bailey, RN Acknowledged On 12/15/09 1551
001201

Unit D14O
MRN 8081369
Room 14787
Sex Male
DOB 9/23/1959
Bed 147871
Medication
Medication Detail Docusate (COLACE) Capsule 100 mg
Docusate (COLACE) Capsule 100 mg (Order 48191936)

Dose 100 mg Frequency TWO TIMES DAILY Start 12/15/2009 2100 End 12/18/2009 1834
Route: ORAL Admin Dose: 1 capsule (1 100 mg capsule) Admin Instructions: Hold for loose stool Class: Inpatient Normal Last Admin Time: 12/18/09 0825 All Administrations of Docusate (COLACE) Capsule 100 mg Recorded Action Time Time Dose/Rate Route User(s) Bryan Owens 12/18/09 12/18/09 100 mg ORAL 0825 0827 Kristine Palaspas, 12/17/09 12/17/09 100 mg ORAL RN 2126 2126 ORAL Bryan Owens 12/17/09 12/17/09 100 mg 0830 0851 Kristine Palaspas, 12/16/09 12/16/09 100 mg ORAL RN 2100 2214 Mary Tran, RN 12/16/09 12/16/09 100 mg ORAL 0917 0917 Beverly Harrelson, 12/15/09 12/15/09 100 mg ORAL RN 2100 2238
Site
Comment
Action Reason Given Given Given Given Given Given
Warnings Override History for Docusate (COLACE) Capsule 100 mg [48191936] No Warning History Available Order Audit Trail: Docusate (COLACE) Capsule 100 mg [48191936] Order Details After Change #1 - Rx Verify Name: Docusate (COLACE) Capsule Start time: 12/15/09 2100 100 mg Frequency: TWO TIMES DAILY Total # of doses: -Priority: -Rate: -Ordered dose: 100 mg Infusion Site: -Duration: -Admin dose: 100 mg Ryan Cello, RPH 12/15/09 1919 End time: -First dose: As Scheduled Volume: -Route: ORAL
001202
Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: DOCUSATE SODIUM 100 MG CAPSULE [2241] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: Hold for loose stool Phase of care: -Order Questions: Initial Order Details Name: Docusate (COLACE) Capsule 100 mg Frequency: TWO TIMES DAILY Jonathan G Eastman, MD 12/15/09 1550 Start time: 12/15/09 2100 End time: -Total # of doses: -First dose: As Scheduled Volume: -Route: ORAL
Priority: -Infusion Site: -Rate: -Duration: -Ordered dose: 100 mg Admin dose: 100 mg Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: DOCUSATE SODIUM 100 MG CAPSULE [2241] PRN comments: -PRN reasons: -Indications of use: -Indications comments: -Order comments: -Admin instructions: Hold for loose stool Phase of care: -Order Questions:
Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/15/2009 3:40 PM Released By PATRICIA L BAILEY [254588866] This Order Has Been Discontinued Order Status By On Incoming 12/18/09 1834 Discontinued Scheduling Interface Signed and Held / Pended Order History Pending User Date/Time Jonathan G Eastman, MD Tue Dec 15, 2009 1540 Reason None Electronically Signed By/Authorizing Jonathan G Eastman, MD Department D14 Orthopedics/Trauma
Reason
001203
Isolation No Isolation Order Details Frequency TWO TIMES DAILY

Duration None Priority None Order Class Inpatient Normal
Unit D14O
Bed 147871
MRN 8081369
Room 14787
Sex Male
Medication
Medication Detail Fentanyl (SUBLIMAZE) 50 mcg
Dose 50 mcg
Fentanyl (SUBLIMAZE) 50 mcg (Order 48187933)

Frequency EVERY 5 MINUTES IF NEEDED Start 12/15/2009 1549 End 12/15/2009 1842
Route: IV Admin Dose: 1 mL = 50 mcg of 100 mcg/2 mL Admin Instructions: ANESTHESIA POST-OP: Administer in PACU; MAXIMUM dose of 250 mcg in PAR; **2nd line PRN pain** PRN Reason(s): pain Reason for Discontinue: Discontinued
001204
Class: Inpatient Normal Last Admin Time: 12/15/09 1735 All Administrations of Fentanyl (SUBLIMAZE) 50 mcg Action Recorded User(s) Time Time Dose/Rate Route Jodi Vergara, RN 12/15/09 12/15/09 50 mcg IV 1739 1735 Jodi Vergara, RN 12/15/09 12/15/09 50 mcg IV 1725 1728
Site
Comment
Warnings Override History for Fentanyl (SUBLIMAZE) 50 mcg [48187933] Overridden by Patricia L Bailey, RN on 12/15/09 1549 Drug-Allergy (Active and Inactive Ingredients) 1. FENTANYL [Level: Level 2]
Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/15/2009 2:40 PM
Electronically Signed By/Authorizing Sampaguita Tafoya, MD
This Order Has Been Discontinued Order Status By Eva K Boyd, MD Discontinued
On 12/15/09 1842
Reason Discontinued Status Signed & Held Reason
Signed and Held / Pended Order History Pending User Date/Time Sampaguita Tafoya, MD Tue Dec 15, 2009 1440 Isolation No Isolation Order Details Frequency EVERY 5 MINUTES IF NEEDED Duration 24 hours Priority None
Provider Information Ordering User Sampaguita Tafoya, MD Attending Provider(s) Robert Michael Tamurian, MD
Ordering Provider Sampaguita Tafoya, MD Admitting Provider Robert Michael Tamurian, MD
Authorizing Provider Sampaguita Tafoya, MD PCP Victor Henrique Baquero, MD
Ordering Provider TAFOYA, SAMPAGUITA [10767] Acknowledgement Info
Pager 916-762-4929
001205
For Placing Order D/C Order
At 12/15/09 1549 12/15/09 1842 MRN 8081369
Acknowledged By Patricia L Bailey, RN Patricia L Bailey, RN Sex Male
Acknowledged On 12/15/09 1553 12/15/09 1850 DOB 9/23/1959 Bed 147871
Room 14787
Account # 010016806878
Medication
Medication Detail
Ferrous Sulfate (FERATAB) Tablet 300 mg (Order 48191942) Dose 300 mg Frequency Start THREE 12/15/2009 TIMES DAILY 1700 End 12/18/2009 1834
Ferrous Sulfate (FERATAB) Tablet 300 mg
Route: ORAL Admin Dose: 1 tablet (1 300 mg tablet) Admin Instructions: Administer 2 hours before or 4 hours after antacids * 300 mg considered equivalent to 325 mg Class: Inpatient Normal Last Admin Time: 12/18/09 0825 All Administrations of Ferrous Sulfate (FERATAB) Tablet 300 mg Action Recorded User(s) Time Time Dose/Rate Route Site Bryan Owens 12/18/09 12/18/09 300 mg ORAL 0825 0827 Kristine Palaspas, 12/17/09 12/17/09 300 mg ORAL RN 2126 2126 Bryan Owens 12/17/09 12/17/09 300 mg ORAL 1400 1357 Bryan Owens 12/17/09 12/17/09 300 mg ORAL 0830 0851 Kristine Palaspas, 12/16/09 12/16/09 300 mg ORAL RN 2100 2214 ORAL Mary Tran, RN 12/16/09 12/16/09 300 mg 1407 1407 Mary Tran, RN 12/16/09 12/16/09 300 mg ORAL 0917 0917 Beverly Harrelson, 12/15/09 12/15/09 300 mg ORAL RN 2100 2238 Jodi Vergara, RN 12/15/09 12/15/09 300 mg ORAL 1700 1741
Comment
Action Reason Given
Given Given Given Given Given Given Given Not given PACU
001206
Warnings Override History for Ferrous Sulfate (FERATAB) Tablet 300 mg [48191942] No Warning History Available Order Audit Trail: Ferrous Sulfate (FERATAB) Tablet 300 mg [48191942] Order Details After Change #1 - Rx Verify Name: Ferrous Sulfate (FERATAB) Start time: 12/15/09 1700 Tablet 300 mg Frequency: THREE TIMES DAILY Total # of doses: -Ryan Cello, RPH 12/15/09 1919 End time: -First dose: As Scheduled
Priority: -Infusion Site: -Rate: -Duration: -Volume: -Admin dose: 300 mg Route: ORAL Ordered dose: 300 mg Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: FERROUS SULFATE 300 MG (60 MG IRON) TABLET [44943] PRN reasons: -PRN comments: -Indications comments: -Indications of use: -Order comments: -Admin instructions: Administer 2 hours before or 4 hours after antacids * 300 mg considered equivalent to 325 mg Phase of care: -Order Questions: Initial Order Details Name: Ferrous Sulfate (FERATAB) Tablet 300 mg Frequency: THREE TIMES DAILY Jonathan G Eastman, MD 12/15/09 1550 Start time: 12/15/09 1700 End time: -Total # of doses: -First dose: As Scheduled
Priority: -Infusion Site: -Rate: -Duration: -Volume: -Admin dose: 300 mg Route: ORAL Ordered dose: 300 mg Dispense from: 8RX_UCDMC First doses from: 8RX_UCDMC Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: FERROUS SULFATE 300 MG (60 MG IRON) TABLET [44943] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: Administer 2 hours before or 4 hours after antacids * 300 mg considered equivalent to 325 mg Phase of care: -Order Questions: Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
001207
Released By PATRICIA L BAILEY [254588866] This Order Has Been Discontinued Order Status By On Incoming 12/18/09 1834 Discontinued Scheduling Interface Signed and Held / Pended Order History Pending User Date/Time Jonathan G Eastman, MD Tue Dec 15, 2009 1540 Isolation No Isolation Order Details Frequency THREE TIMES DAILY Duration None Priority None Order Class Inpatient Normal Reason None
Reason
MRN 8081369
Sex Male
Room 14787
Bed 147871
Medication
Medication Detail
Hydromorphone (DILAUDID) 0.4-0.6 mg (Order 48187932)
001208
Hydromorphone (DILAUDID) 0.4-0.6 mg
Dose 0.4-0.6 mg
Frequency EVERY 15 MINUTES IF NEEDED
Start 12/15/2009 1549
End 12/15/2009 1842
Route: IV Admin Dose: 0.4-0.6 mL = 0.4-0.6 mg Admin Instructions: ANESTHESIA POST-OP: Administer in PACU; MAXIMUM dose of 4 mg in PAR; **1st line PRN pain** PRN Reason(s): pain Reason for Discontinue: Discontinued Class: Inpatient Normal Last Admin Time: 12/15/09 1820 All Administrations of Hydromorphone (DILAUDID) 0.4-0.6 mg Action Recorded User(s) Time Time Dose/Rate Route Patricia L Bailey, RN 12/15/09 12/15/09 0.4 mg IV 1820 1841 Jodi Vergara, RN 12/15/09 12/15/09 0.5 mg IV 1750 1750 Patricia L Bailey, RN 12/15/09 12/15/09 0.6 mg IV 1705 1758 Patricia L Bailey, RN 12/15/09 12/15/09 0.6 mg IV 1650 1757 Patricia L Bailey, RN 12/15/09 12/15/09 0.6 mg IV 1635 1644 IV Patricia L Bailey, RN 12/15/09 12/15/09 0.6 mg 1620 1644 Patricia L Bailey, RN 12/15/09 12/15/09 0.6 mg IV 1602 1602 Patricia L Bailey, RN 12/15/09 12/15/09 0.6 mg IV 1545 1602
Site
Comment
Action Reason Given
Given Given Given Given Given Given Given
Warnings Override History for Hydromorphone (DILAUDID) 0.4-0.6 mg [48187932] Overridden by Patricia L Bailey, RN on 12/15/09 1549 Drug-Allergy (Active and Inactive Ingredients) 1. MORPHINE [Level: Level 3]
Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/15/2009 2:40 PM
On 12/15/09 1842
Reason Discontinued
001209
Signed and Held / Pended Order History Pending User Date/Time Sampaguita Tafoya, MD Tue Dec 15, 2009 1440 Isolation No Isolation Order Details Frequency EVERY 15 MINUTES IF NEEDED Duration 24 hours Priority None
Reason
Ordering Provider TAFOYA, SAMPAGUITA [10767]
Pager 916-762-4929 Acknowledged By Patricia L Bailey, RN Patricia L Bailey, RN Acknowledged On 12/15/09 1553 12/15/09 1850
Unit D14O
MRN 8081369
Room 14787
Sex Male
DOB 9/23/1959
Bed 147871
Medication
Medication Detail Hydromorphone (DILAUDID) 0.4-2 mg Route: IV Admin Dose: 0.4-2 mL = 0.4-2 mg Volume: 2 mL Admin Instructions: IV: IV push (undiluted) over 2-3 minutes
Hydromorphone (DILAUDID) 0.4-2 mg (Order 48191960)

Dose 0.4-2 mg Frequency EVERY 1 HOUR IF NEEDED Start 12/15/2009 1550 End 12/16/2009 0634
001210
PRN Reason(s): severe pain, severe pain or unable to tolerate PO meds Class: Inpatient Normal Last Admin Time: 12/16/09 0537 All Administrations of Hydromorphone (DILAUDID) 0.4-2 mg Action Recorded User(s) Time Time Dose/Rate Route Beverly Harrelson, 12/16/09 12/16/09 2 mg IV 0537 0607 RN Elizabeth Abucay, 12/16/09 12/16/09 2 mg IV RN 0438 0458 12/16/09 12/16/09 2 mg IV Beverly Harrelson, RN 0329 0448 Beverly Harrelson, 12/16/09 12/16/09 2 mg IV RN 0200 0212 Beverly Harrelson, 12/16/09 12/16/09 2 mg IV RN 0050 0211 Beverly Harrelson, 12/15/09 12/16/09 2 mg IV RN 2257 0046 Beverly Harrelson, 12/15/09 12/15/09 2 mg IV RN 2146 2239 Beverly Harrelson, 12/15/09 12/15/09 1 mg IV RN 2048 2239 12/15/09 12/15/09 1 mg IV Beverly Harrelson, RN 1939 2239
Site
Comment
Action Reason Given Given Given Given Given Given Given Given Given
Warnings Override History for Hydromorphone (DILAUDID) 0.4-2 mg [48191960] Overridden by Ryan Cello, RPH on 12/15/09 1920 Drug-Allergy (Active and Inactive Ingredients) 1. MORPHINE [Level: Level 3] [Reason: Aware/Will monitor] Full Warnings History Order Audit Trail: Hydromorphone (DILAUDID) 0.4-2 mg [48191960] Order Details After Change #1 - Rx Verify Ryan Cello, RPH 12/15/09 1920 Name: Hydromorphone (DILAUDID) 0.4- Start time: 12/15/09 1550 End time: -2 mg Frequency: EVERY 1 HOUR IF NEEDED Total # of doses: -First dose: -Priority: -Infusion Site: -Rate: -Duration: -Volume: 2 mL Ordered dose: 0.4-2 mg Admin dose: 0.4-2 mg Route: IV Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: HYDROMORPHONE (PF) 1 MG/ML SYRINGE [114436] PRN reasons: severe pain, severe pain PRN comments: -or unable to tolerate PO meds Indications of use: -Indications comments: -Order comments: -Admin instructions: IV: IV push (undiluted) over 2-3 minutes Phase of care: -Order Questions: Initial Order Details Name: Hydromorphone (DILAUDID) 0.4Jonathan G Eastman, MD 12/15/09 1550 Start time: 12/15/09 1550 End time: --
001211
2 mg Frequency: EVERY 1 HOUR IF NEEDED Total # of doses: -Priority: -Infusion Site: -Rate: -Duration: -Ordered dose: 0.4-2 mg Admin dose: 0.4-2 mg Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: HYDROMORPHONE (PF) 1 MG/ML SYRINGE [114436] PRN comments: -PRN reasons: severe pain, severe pain or unable to tolerate PO meds Indications of use: -Indications comments: -Order comments: -Admin instructions: IV: IV push (undiluted) over 2-3 minutes Phase of care: -Order Questions:
First dose: -Volume: -Route: IV
Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/15/2009 3:40 PM This Order Has Been Discontinued Order Status By Jonathan G Discontinued Eastman, MD Electronically Signed By/Authorizing Jonathan G Eastman, MD On 12/16/09 0634 Department D14 Orthopedics/Trauma Reason None
Signed and Held / Pended Order History Pending User Date/Time Jonathan G Eastman, MD Tue Dec 15, 2009 1540 Isolation No Isolation Order Details Frequency EVERY 1 HOUR IF NEEDED Duration None Priority None
Reason
001212
Ordering Provider EASTMAN, JONATHAN G [09983] Acknowledgement Info For At Placing Order 12/15/09 1550 D/C Order 12/16/09 0634 Patient Information Patient Name Amundsen, Mark Unit D14O MRN 8081369 Room 14787
Pager 916-762-7648 Acknowledged By Patricia L Bailey, RN Beverly Harrelson, RN Sex Male Acknowledged On 12/15/09 1552 12/16/09 0639 DOB 9/23/1959 Bed 147871
Account # 010016806878
Medication
Medication Detail
Hydromorphone 0.2 mg/mL (DILAUDID) PCA 50 mL (Order 48191965) Frequency PCA Start 12/15/2009 1700 End 12/18/2009 0841
Dose (none) Hydromorphone 0.2 mg/mL (DILAUDID) PCA 50 mL Route: IV Volume: 50 mL Admin Instructions: Incremental dose: 0.4 mg; Lockout interval: q 10 minutes; Basal rate: None; Basal time frame: N/A - no basal rate; Discontinue all other sedatives unless approved by MD
Reason for Discontinue: Discontinued Class: Inpatient Normal Last Admin Time: 12/18/09 0745 (Stopped on: 12/18/09 0850) All Administrations of Hydromorphone 0.2 mg/mL (DILAUDID) PCA 50 mL Action Recorded User(s) Time Time Dose/Rate Route Site Comment Bryan Owens 12/18/09 12/18/09 0 IV 0850 0848 Bryan Owens 12/18/09 12/18/09 IV 0745 0752 Bryan Owens 12/18/09 12/18/09 IV 0725 0817 Kristine Palaspas, 12/18/09 12/18/09 IV RN 0600 0617 Kristine Palaspas, 12/18/09 12/18/09 IV RN 0400 0530 IV Benny Gabriel, RN 12/18/09 12/18/09 0003 0003
Action Stopped
Reason
New bag/syringe New bag/syringe Med check Med check Med check
001213
12/18/09 0001 12/17/09 2000 12/17/09 1930 12/17/09 1800 Bryan Owens 12/17/09 1505 Bryan Owens 12/17/09 1400 Bryan Owens 12/17/09 1000 Bryan Owens 12/17/09 0840 Bryan Owens 12/17/09 0820 Kristine Palaspas, 12/17/09 RN 0711 Kristine Palaspas, 12/17/09 RN 0655 Kristine Palaspas, 12/17/09 RN 0400 12/17/09 Kristine Palaspas, RN 0310 12/17/09 Kristine Palaspas, RN 0028 12/16/09 Kristine Palaspas, RN 2030 Kristine Palaspas, 12/16/09 RN 2001 Mary Tran, RN 12/16/09 1904 12/16/09 Kristine Palaspas, RN 1900 Mary Tran, RN 12/16/09 1800 Mary Tran, RN 12/16/09 1600 Mary Tran, RN 12/16/09 1200 Mary Tran, RN 12/16/09 0800 Mary Tran, RN 12/16/09 0730 Mary Tran, RN 12/16/09 0715 Victoria Marzan, RN 12/16/09 0642 Beverly Harrelson, 12/16/09 RN 0640 12/16/09 Beverly Harrelson, RN 0607 Laura Heberle 12/15/09 2330 Beverly Harrelson, 12/15/09 RN 2325
Kristine Palaspas, RN Kristine Palaspas, RN Kristine Palaspas, RN Bryan Owens
12/18/09 0052 12/18/09 0052 12/17/09 2128 12/17/09 1808 12/17/09 1507 12/17/09 1402 12/17/09 1359 12/17/09 0852 12/17/09 0852 12/17/09 0711 12/17/09 0655 12/17/09 0655 12/17/09 0312 12/17/09 0029 12/16/09 2037 12/16/09 2310 12/16/09 1904 12/16/09 2037 12/16/09 1816 12/16/09 1605 12/16/09 1213 12/16/09 0900 12/16/09 0750 12/16/09 0721 12/16/09 0642 12/16/09 0653 12/16/09 0607 12/16/09 0444 12/16/09 0002
IV IV IV IV IV IV IV IV IV IV IV IV IV IV IV IV IV IV IV IV IV IV IV IV IV IV IV IV IV
Med check Med check Med check Med check Rate Change Med check Med check New bag/syringe Med check Med check Med check Med check New bag/syringe Med check New bag/syringe Med check Med check Med check New bag/syringe Med check Med check New bag/syringe New bag/syringe Med check Med check Rate Change Med check Med check New bag/syringe
001214
Beverly Harrelson, RN Laura Heberle Beverly Harrelson, RN Vincent Rinaldi, RN Patricia L Bailey, RN
12/15/09 2010 12/15/09 2004 12/15/09 1905 12/15/09 1608 12/15/09 1605
12/15/09 2238 12/15/09 2005 12/15/09 2238 12/15/09 1608 12/15/09 1607
IV IV IV IV IV
Med check New bag/syringe Med check Med check New bag/syringe
Warnings Override History for Hydromorphone 0.2 mg/mL (DILAUDID) PCA 50 mL [48191965] Overridden by Jonathan G Eastman, MD on 12/17/09 1449 Drug-Allergy (Active and Inactive Ingredients) 1. MORPHINE [Level: Level 3] Full Warnings History Order Audit Trail: Hydromorphone 0.2 mg/mL (DILAUDID) PCA 50 mL [48191965] Order Details After Change #3 - Order Modified Jonathan G Eastman, MD 12/17/09 1449 Authorizing Provider: Jonathan G Eastman, MD Verifying User: Diana Hao, RPH 12/17/09 1450 Name: Hydromorphone 0.2 mg/mL Start time: 12/15/09 1700 End time: -(DILAUDID) PCA 50 mL Frequency: PCA Total # of doses: -First dose: -Priority: -Infusion Site: -Rate: -Duration: -Volume: 50 mL Ordered dose: -Admin dose: -Route: IV Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: HYDROMORPHONE 10 MG/50 ML (0.2 MG/ML) IN 0.9 % NACL IV PCA SYRINGE [81631] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: Incremental dose: 0.4 mg; Lockout interval: q 10 minutes; Basal rate: None; Basal time frame: N/A - no basal rate; Discontinue all other sedatives unless approved by MD Phase of care: -Order Questions: Basal rate warning assessed for this No patient? Patient screening: 0-1 risk factors Order Details After Change #2 - Order Modified
Jonathan G Eastman, MD 12/16/09 0634 Authorizing Provider: Jonathan G Eastman, MD Verifying User: Laurel L Grefsheim, RPH 12/16/09 0641 Start time: 12/15/09 1700 End time: --
Name: Hydromorphone 0.2 mg/mL (DILAUDID) PCA 50 mL
001215
Frequency: PCA Total # of doses: -First dose: -Priority: -Infusion Site: -Rate: -Duration: -Volume: 50 mL Ordered dose: -Admin dose: -Route: IV Dispense from: 8RX_UCDMC First doses from: -Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: HYDROMORPHONE 10 MG/50 ML (0.2 MG/ML) IN 0.9 % NACL IV PCA SYRINGE [81631] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: Incremental dose: 0.6 mg; Lockout interval: q 6 minutes; Basal rate: None; Basal time frame: N/A - no basal rate; Discontinue all other sedatives unless approved by MD Phase of care: -Order Questions: Basal rate warning assessed for this No patient? Patient screening: 0-1 risk factors Order Details After Change #1 - Rx Verify Ryan Cello, RPH 12/15/09 1920 Name: Hydromorphone 0.2 mg/mL Start time: 12/15/09 1700 End time: -(DILAUDID) PCA 50 mL Frequency: PCA Total # of doses: -First dose: -Priority: -Infusion Site: -Rate: -Duration: -Volume: 50 mL Ordered dose: -Admin dose: -Route: IV First doses from: D14O-4_PYXIS Dispense from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: HYDROMORPHONE 10 MG/50 ML (0.2 MG/ML) IN 0.9 % NACL IV PCA SYRINGE [81631] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: Incremental dose: 0.4 mg; Lockout interval: q 6 minutes; Basal rate: None; Basal time frame: N/A - no basal rate; Discontinue all other sedatives unless approved by MD Phase of care: -Order Questions: Basal rate warning assessed for this No patient? Patient screening: 0-1 risk factors Initial Order Details Name: Hydromorphone 0.2 mg/mL (DILAUDID) PCA 50 mL Jonathan G Eastman, MD 12/15/09 1550 Start time: 12/15/09 1700 End time: --
001216
Frequency: PCA Total # of doses: -First dose: -Priority: -Infusion Site: -Rate: -Duration: -Volume: -Ordered dose: -Admin dose: -Route: IV Dispense from: 8RX_UCDMC First doses from: 8RX_UCDMC Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: HYDROMORPHONE 10 MG/50 ML (0.2 MG/ML) IN 0.9 % NACL IV PCA SYRINGE [81631] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: Incremental dose: 0.4 mg; Lockout interval: q 6 minutes; Basal rate: None; Basal time frame: N/A - no basal rate; Discontinue all other sedatives unless approved by MD Phase of care: -Order Questions: Basal rate warning assessed for this No patient? Patient screening: 0-1 risk factors Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Released By PATRICIA L BAILEY [254588866] This Order Has Been Discontinued Order Status By Jonathan G Discontinued Eastman, MD On 12/18/09 0841 Reason Discontinued
Signed and Held / Pended Order History Pending User Date/Time Jonathan G Eastman, MD Tue Dec 15, 2009 1540 Order Questions Question Basal rate warning assessed for this patient? Patient screening: Isolation No Isolation Order Details Answer No 0-1 risk factors
Reason
Comment
001217
Frequency PCA
Duration None
Priority None



Ordering Provider EASTMAN, JONATHAN G [09983] Acknowledgement Info For At Placing Order 12/15/09 1550 Modifying 12/16/09 0634 Order Modifying 12/17/09 1449 Order D/C Order 12/18/09 0841 Patient Information Patient Name Amundsen, Mark Unit D14O MRN 8081369 Room 14787
Pager 916-762-7648 Acknowledged By Patricia L Bailey, RN Beverly Harrelson, RN Bryan Owens Bryan Owens Sex Male Acknowledged On 12/15/09 1553 12/16/09 0639 12/17/09 1503 12/18/09 0847 DOB 9/23/1959 Bed 147871
Account # 010016806878
Medication
Medication Detail Lactated Ringers Dose (none)
Lactated Ringers (Order 48187931) Frequency Start CONTINUOUS 12/15/2009 INFUSION 1700 End 12/15/2009 1842
Route: IV Rate: 100 mL/hr Admin Instructions: ANESTHESIA POST-OP: Administer in PACU Reason for Discontinue: Discontinued Class: Inpatient Normal Last Admin Time: 12/15/09 1700 (Currently Running) All Administrations of Lactated Ringers Action Recorded
001218
User(s) Patricia L Bailey, RN
Time 12/15/09 1700
Time 12/15/09 1608
Dose/Rate Route 100 mL/hr IV
Site
Comment
Action Reason Med check
Warnings Override History for Lactated Ringers [48187931] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Released By PATRICIA L BAILEY [254588866] This Order Has Been Discontinued Order Status By Eva K Boyd, MD Discontinued On 12/15/09 1842 Reason Discontinued
Signed and Held / Pended Order History Pending User Date/Time Sampaguita Tafoya, MD Tue Dec 15, 2009 1440 Isolation No Isolation Order Details Frequency Duration CONTINUOUS INFUSION 24 hours Priority None
Unit D14O
MRN 8081369
Room 14787
Sex Male
DOB 9/23/1959
Bed 147871
Account #
001219
010016806878 Account Information Acct Number 010016806878 Visit CSN CSN Number: 28141367
Medication
Medication Detail
Magnesium Hydroxide (MILK OF MAGNESIA) Liquid 30 mL (Order 48191937)

Dose 30 mL Frequency EVERY 12 HOURS IF NEEDED Start 12/15/2009 1550 End 12/18/2009 1834
Magnesium Hydroxide (MILK OF MAGNESIA) Liquid 30 mL Route: ORAL Admin Dose: 30 mL Volume: 30 mL PRN Reason(s): constipation Class: Inpatient Normal
All Administrations of Magnesium Hydroxide (MILK OF MAGNESIA) Liquid 30 mL No Administrations Recorded Warnings Override History for Magnesium Hydroxide (MILK OF MAGNESIA) Liquid 30 mL [48191937] No Warning History Available Order Audit Trail: Magnesium Hydroxide (MILK OF MAGNESIA) Liquid 30 mL [48191937] Order Details After Change #1 - Rx Verify Ryan Cello, RPH 12/15/09 1921 Name: Magnesium Hydroxide (MILK OF Start time: 12/15/09 1550 End time: -MAGNESIA) Liquid 30 mL Total # of doses: -First dose: -Frequency: EVERY 12 HOURS IF NEEDED Priority: -Infusion Site: -Rate: -Duration: -Volume: 30 mL Ordered dose: 30 mL Admin dose: 30 mL Route: ORAL Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP [45405] PRN reasons: constipation PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: -Phase of care: -Order Questions: Initial Order Details Name: Magnesium Hydroxide (MILK OF MAGNESIA) Liquid 30 mL Frequency: EVERY 12 HOURS IF NEEDED Priority: -Rate: -Jonathan G Eastman, MD 12/15/09 1550 Start time: 12/15/09 1550 End time: -Total # of doses: -Infusion Site: -Duration: -First dose: --
Volume: --
001220
Ordered dose: 30 mL Admin dose: 30 mL Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Barcode PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP [45405] PRN reasons: constipation PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: -Phase of care: -Order Questions:
Route: ORAL
Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/15/2009 3:40 PM Released By PATRICIA L BAILEY [254588866] This Order Has Been Discontinued Order Status By On Incoming 12/18/09 1834 Discontinued Scheduling Interface Signed and Held / Pended Order History Pending User Date/Time Jonathan G Eastman, MD Tue Dec 15, 2009 1540 Isolation No Isolation Order Details Frequency EVERY 12 HOURS IF NEEDED Duration None Priority None Order Class Inpatient Normal Reason None Electronically Signed By/Authorizing Jonathan G Eastman, MD Department D14 Orthopedics/Trauma
Reason



Ordering Provider EASTMAN, JONATHAN G [09983] Acknowledgement Info
Pager 916-762-7648
001221
For Placing Order
At 12/15/09 1550 MRN 8081369
Acknowledged By Patricia L Bailey, RN Sex Male
Acknowledged On 12/15/09 1551 DOB 9/23/1959

Bed 147871

Unit D14O
Room 14787
Medication
Medication Detail Meperidine (DEMEROL) 12.5 mg
Meperidine (DEMEROL) 12.5 mg (Order 48187934)

Dose 12.5 mg Frequency PRN Start 12/15/2009 1549 End 12/15/2009 1842
Route: IV Admin Dose: 0.25 mL = 12.5 mg of 50 mg/mL Admin Instructions: ANESTHESIA POST-OP: Administer in PACU; May repeat one time after 5 min PRN Reason(s): shivering Reason for Discontinue: Discontinued Class: Inpatient Normal Last Admin Time: 12/15/09 1555 All Administrations of Meperidine (DEMEROL) 12.5 mg Action Recorded User(s) Time Time Dose/Rate Route Patricia L Bailey, RN 12/15/09 12/15/09 12.5 mg IV 1555 1601
Site
Comment
Action Reason Given
Warnings Override History for Meperidine (DEMEROL) 12.5 mg [48187934] Overridden by Patricia L Bailey, RN on 12/15/09 1549 Drug-Allergy (Active and Inactive Ingredients) 1. FENTANYL [Level: Level 3]
Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time Electronically Signed By/Authorizing Department
001222
12/15/2009 2:40 PM Released By PATRICIA L BAILEY [254588866]
Sampaguita Tafoya, MD
D14 Orthopedics/Trauma
On 12/15/09 1842
Reason Discontinued
Signed and Held / Pended Order History Pending User Date/Time Sampaguita Tafoya, MD Tue Dec 15, 2009 1440 Isolation No Isolation Order Details Frequency PRN
Duration 24 hours Priority None
Ordering Provider Sampaguita Tafoya, MD
Authorizing Provider Sampaguita Tafoya, MD
Ordering Provider TAFOYA, SAMPAGUITA [10767] Acknowledgement Info For At Placing Order 12/15/09 1549 D/C Order 12/15/09 1842 Patient Information Patient Name Amundsen, Mark Unit D14O MRN 8081369 Room 14787
Pager 916-762-4929 Acknowledged By Patricia L Bailey, RN Patricia L Bailey, RN Sex Male Acknowledged On 12/15/09 1553 12/15/09 1850 DOB 9/23/1959 Bed 147871
Account # 010016806878
Medication
Medication Detail
Methadone (DOLOPHINE) Injection 100 mg (Order 48181438) Frequency ONE TIME ONLY Start 12/15/2009 1400 End 12/15/2009 1550
Dose Methadone (DOLOPHINE) Injection 100 mg 100 mg
001223
Route: IV Admin Dose: 10 mL = 100 mg of 10 mg/mL Volume: 10 mL Admin Instructions: IV: IV push (undiluted) at max 20 mg/min Class: Inpatient Normal Last Admin Time: 12/15/09 1400 Number of Doses: 1 All Administrations of Methadone (DOLOPHINE) Injection 100 mg Action Recorded User(s) Time Time Dose/Rate Route Site Patricia L Bailey, RN 12/15/09 12/15/09 100 mg IV 1400 1649
Comment OR report
Action Reason Reported (see comment)
Warnings Override History for Methadone (DOLOPHINE) Injection 100 mg [48181438] Overridden by Aaron Roberts, RPH on 12/15/09 1239 Dose 1. METHADONE 10 MG/ML INJECTION: EXCEEDS RECOMMENDED MAXIMUM SINGLE DOSE BY 234% (70 MG) [Reason: Tolerated before] Full Warnings History Order Audit Trail: Methadone (DOLOPHINE) Injection 100 mg [48181438] Order Details After Change #1 - Rx Verify Aaron Roberts, RPH 12/15/09 1239 Name: Methadone (DOLOPHINE) Start time: 12/15/09 1400 End time: -Injection 100 mg Frequency: ONE TIME ONLY Total # of doses: 1 First dose: -Priority: -Infusion Site: -Rate: -Duration: -Volume: 10 mL Ordered dose: 100 mg Admin dose: 100 mg Route: IV First doses from: 2RX_UCDMC Dispense from: 2RX_UCDMC Dispense code: IV Piggyback Barcode PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: METHADONE 10 MG/ML INJECTION [40169] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: IV: IV push (undiluted) at max 20 mg/min Phase of care: -Order Questions: Primary Service Attending Physician has approved use of Does use meet BLACK BOX WARNING restrictions? Methadone in accordance with UCDHS Methadone Therapy Inititation and Monitoring Guidance Initial Order Details Name: Methadone (DOLOPHINE) Injection 100 mg Frequency: ONE TIME ONLY Priority: -Rate: -Ordered dose: 100 mg Dispense from: 8RX_UCDMC Start time: 12/15/09 1400 Aaron Roberts, RPH 12/15/09 1239 End time: -First dose: -Volume: -Route: IV
Total # of doses: 1 Infusion Site: -Duration: -Admin dose: 100 mg First doses from: 8RX_UCDMC
001224
Dispense code: IV Piggyback Barcode PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: METHADONE 10 MG/ML INJECTION [40169] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: IV: IV push (undiluted) at max 20 mg/min Phase of care: -Order Questions: Does use meet BLACK BOX WARNING Primary Service Attending Physician has approved use of restrictions? Methadone in accordance with UCDHS Methadone Therapy Inititation and Monitoring Guidance Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/15/2009 12:39 PM
Electronically Signed By Aaron Roberts Authorizing Phat Giang, MD Department D14 Orthopedics/Trauma
This Order Has Been Discontinued Discontinued Mode Order Status Verbal with Read Discontinued Back Authorizing Provider Jonathan G Eastman, MD
By Jonathan G Eastman, MD Ordering Provider Jonathan G Eastman, MD
On 12/15/09 1550
Reason None
Order Questions Question Does use meet BLACK BOX WARNING restrictions?
Answer Comment Primary Service Attending Physician has approved use of Methadone in accordance with UCDHS Methadone Therapy Inititation and Monitoring Guidance
Isolation No Isolation Order Details Frequency ONE TIME ONLY Duration 1 occurrence Priority None Order Class Inpatient Normal
Provider Information Ordering User
Ordering Provider
001225
Aaron Roberts, RPH Attending Provider(s) Robert Michael Tamurian, MD
Phat Giang, MD Admitting Provider Robert Michael Tamurian, MD
Phat Giang, MD PCP Victor Henrique Baquero, MD Billing Provider Phat Giang, MD
Ordering Provider GIANG, PHAT [10063]
Acknowledgement Info For At Placing Order 12/15/09 1239 D/C Order 12/15/09 1550 Verbal Order Info
Action Ordering Order Mode Verbal with Read Back
Communicator Aaron Roberts, RPH MRN 8081369
Responsible Provider
Signed By Phat Giang, MD
Signed On 12/17/09 0725
Sex Male
DOB 9/23/1959
Room 14787
Bed 147871
Medication
Medication Detail Naloxone (NARCAN) 0.1 mg Dose 0.1 mg
Naloxone (NARCAN) 0.1 mg (Order 48191949) Frequency PRN Start 12/15/2009 1550 End 12/18/2009 1834
Route: IV Admin Dose: 0.25 mL = 0.1 mg of 0.4 mg/mL Volume: 1 mL Admin Instructions: May repeat every 1 minute up to 0.4 mg PRN Comment: (Respiratory Rate less than 8/min OR Sedation Score = 3 or 4) Class: Inpatient Normal Number of Doses: 4 All Administrations of Naloxone (NARCAN) 0.1 mg No Administrations Recorded Warnings Override History for Naloxone (NARCAN) 0.1 mg [48191949]
001226
No Warning History Available Order Audit Trail: Naloxone (NARCAN) 0.1 mg [48191949] Order Details After Change #1 - Rx Verify Ryan Cello, RPH 12/15/09 1919 Name: Naloxone (NARCAN) 0.1 mg Start time: 12/15/09 1550 End time: -Total # of doses: 4 First dose: -Frequency: PRN Priority: -Infusion Site: -Rate: -Duration: -Volume: 1 mL Ordered dose: 0.1 mg Admin dose: 0.1 mg Route: IV Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: NALOXONE 0.4 MG/ML INJECTION [5874] PRN comments: (Respiratory Rate less than 8/min OR PRN reasons: -Sedation Score = 3 or 4) Indications of use: -Indications comments: -Order comments: -Admin instructions: May repeat every 1 minute up to 0.4 mg Phase of care: -Order Questions: Initial Order Details Jonathan G Eastman, MD 12/15/09 1550 Name: Naloxone (NARCAN) 0.1 mg Start time: 12/15/09 1550 End time: -Frequency: PRN Total # of doses: 4 First dose: -Priority: -Infusion Site: -Rate: -Duration: -Volume: -Ordered dose: 0.1 mg Admin dose: 0.1 mg Route: IV Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: NALOXONE 0.4 MG/ML INJECTION [5874] PRN comments: (Respiratory Rate less than 8/min OR PRN reasons: -Sedation Score = 3 or 4) Indications of use: -Indications comments: -Order comments: -Admin instructions: May repeat every 1 minute up to 0.4 mg Phase of care: -Order Questions: Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Released By
001227
PATRICIA L BAILEY [254588866] This Order Has Been Discontinued Order Status By On Incoming 12/18/09 1834 Discontinued Scheduling Interface Signed and Held / Pended Order History Pending User Date/Time Jonathan G Eastman, MD Tue Dec 15, 2009 1540 Isolation No Isolation Order Details Frequency PRN Duration 4 occurrences Priority None Order Class Inpatient Normal Reason None
Reason
MRN 8081369
Sex Male
Room 14787
Bed 147871
Medication
Medication Detail Ondansetron (ZOFRAN) 4 mg Route: IV Admin Dose: 2 mL = 4 mg of 2 mg/mL Admin Instructions: Dose 4 mg
Ondansetron (ZOFRAN) 4 mg (Order 48187929) Frequency PRN Start 12/15/2009 1549 End 12/15/2009 1842
001228
ANESTHESIA POST-OP: Administer in PACU PRN Reason(s): nausea/vomiting Reason for Discontinue: Discontinued Class: Inpatient Normal Number of Doses: 1 All Administrations of Ondansetron (ZOFRAN) 4 mg No Administrations Recorded Warnings Override History for Ondansetron (ZOFRAN) 4 mg [48187929] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/15/2009 2:40 PM Released By PATRICIA L BAILEY [254588866] This Order Has Been Discontinued Order Status By Eva K Boyd, MD Discontinued On 12/15/09 1842 Reason Discontinued
Signed and Held / Pended Order History Pending User Date/Time Sampaguita Tafoya, MD Tue Dec 15, 2009 1440 Isolation No Isolation Order Details Frequency PRN
Duration 1 occurrence Priority None
Ordering Provider TAFOYA, SAMPAGUITA [10767] Acknowledgement Info For At Placing Order 12/15/09 1549 D/C Order 12/15/09 1842 Patient Information Patient Name Amundsen, Mark MRN 8081369
Pager 916-762-4929 Acknowledged By Patricia L Bailey, RN Patricia L Bailey, RN Sex Male Acknowledged On 12/15/09 1553 12/15/09 1850 DOB 9/23/1959
001229
Unit D14O
Room 14787
Bed 147871
Account # 010016806878
Medication
Medication Detail Ondansetron (ZOFRAN) 4 mg Dose 4 mg
Ondansetron (ZOFRAN) 4 mg (Order 48191940) Frequency EVERY 12 HOURS IF NEEDED Start 12/15/2009 1550 End 12/18/2009 1834
Route: IV Admin Dose: 2 mL = 4 mg of 2 mg/mL Volume: 2 mL Admin Instructions: IV: IV push (undiluted) over 30 seconds to 2 minutes PRN Reason(s): nausea/vomiting Class: Inpatient Normal All Administrations of Ondansetron (ZOFRAN) 4 mg No Administrations Recorded Warnings Override History for Ondansetron (ZOFRAN) 4 mg [48191940] No Warning History Available Order Audit Trail: Ondansetron (ZOFRAN) 4 mg [48191940] Order Details After Change #1 - Rx Verify Ryan Cello, RPH 12/15/09 1919 Name: Ondansetron (ZOFRAN) 4 mg Start time: 12/15/09 1550 End time: -Frequency: EVERY 12 HOURS IF Total # of doses: -First dose: -NEEDED Priority: -Infusion Site: -Rate: -Duration: -Volume: 2 mL Ordered dose: 4 mg Admin dose: 4 mg Route: IV Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION [112220] PRN reasons: nausea/vomiting PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: IV: IV push (undiluted) over 30 seconds to 2 minutes Phase of care: -Order Questions:
001230
Initial Order Details Jonathan G Eastman, MD 12/15/09 1550 Name: Ondansetron (ZOFRAN) 4 mg Start time: 12/15/09 1550 End time: -Frequency: EVERY 12 HOURS IF Total # of doses: -First dose: -NEEDED Priority: -Infusion Site: -Rate: -Duration: -Volume: -Ordered dose: 4 mg Admin dose: 4 mg Route: IV Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION [112220] PRN comments: -PRN reasons: nausea/vomiting Indications of use: -Indications comments: -Order comments: -Admin instructions: IV: IV push (undiluted) over 30 seconds to 2 minutes Phase of care: -Order Questions: Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Released By PATRICIA L BAILEY [254588866] This Order Has Been Discontinued Order Status By On Incoming 12/18/09 1834 Discontinued Scheduling Interface Signed and Held / Pended Order History Pending User Date/Time Jonathan G Eastman, MD Tue Dec 15, 2009 1540 Isolation No Isolation Order Details Frequency EVERY 12 HOURS IF NEEDED Duration None Priority None Order Class Inpatient Normal Reason None
Reason
Provider Information Ordering User Jonathan G Eastman, MD Attending Provider(s)
Ordering Provider Jonathan G Eastman, MD Admitting Provider
Authorizing Provider Jonathan G Eastman, MD PCP
001231
Victor Henrique Baquero, MD
Unit D14O
Bed 147871
MRN 8081369
Room 14787
Sex Male
Medication
Medication Detail
Oxycodone 5 mg/Acetaminophen 325 mg (PERCOCET) Tablet 1-2 Tab (Order 48191961)

Dose 1-2 tablet Frequency EVERY 4 HOURS IF NEEDED Start 12/15/2009 1550 End 12/16/2009 0634
Oxycodone 5 mg/Acetaminophen 325 mg (PERCOCET) Tablet 1-2 Tab
Route: ORAL Admin Dose: 1-2 tablet Admin Instructions: Do not exceed 4000 mg TOTAL acetaminophen per 24 hours. PRN Reason(s): pain, mild to moderate pain Class: Inpatient Normal Last Admin Time: 12/16/09 0528 All Administrations of Oxycodone 5 mg/Acetaminophen 325 mg (PERCOCET) Tablet 1-2 Tab Action Recorded User(s) Time Time Dose/Rate Route Site Comment Action Reason Beverly Harrelson, 12/16/09 12/16/09 2 tablet ORAL Given RN 0528 0607 Beverly Harrelson, 12/15/09 12/16/09 2 tablet ORAL Given RN 2256 0046 Patricia L Bailey, RN 12/15/09 12/15/09 2 tablet ORAL Given 1842 1842 Warnings Override History for Oxycodone 5 mg/Acetaminophen 325 mg (PERCOCET) Tablet 1-2 Tab [48191961] Overridden by Ryan Cello, RPH on 12/15/09 1920 Drug-Allergy (Active and Inactive Ingredients) 1. MORPHINE [Level: Level 3] [Reason: Aware/Will monitor]
001232
Full Warnings History Order Audit Trail: Oxycodone 5 mg/Acetaminophen 325 mg (PERCOCET) Tablet 1-2 Tab [48191961] Order Details After Change #1 - Rx Verify Ryan Cello, RPH 12/15/09 1920 End time: -Name: Oxycodone 5 mg/Acetaminophen Start time: 12/15/09 1550 325 mg (PERCOCET) Tablet 1-2 Tab Frequency: EVERY 4 HOURS IF Total # of doses: -First dose: -NEEDED Priority: -Infusion Site: -Rate: -Duration: -Volume: -Admin dose: 1-2 tablet Route: ORAL Ordered dose: 1-2 tablet Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET [6496] PRN comments: -PRN reasons: pain, mild to moderate pain Indications of use: -Indications comments: -Order comments: -Admin instructions: Do not exceed 4000 mg TOTAL acetaminophen per 24 hours. Phase of care: -Order Questions: Initial Order Details Jonathan G Eastman, MD 12/15/09 1550 Name: Oxycodone 5 mg/Acetaminophen Start time: 12/15/09 1550 End time: -325 mg (PERCOCET) Tablet 1-2 Tab Total # of doses: -First dose: -Frequency: EVERY 4 HOURS IF NEEDED Priority: -Infusion Site: -Rate: -Duration: -Volume: -Admin dose: 1-2 tablet Route: ORAL Ordered dose: 1-2 tablet Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET [6496] PRN reasons: pain, mild to moderate PRN comments: -pain Indications of use: -Indications comments: -Order comments: -Admin instructions: Do not exceed 4000 mg TOTAL acetaminophen per 24 hours. Phase of care: -Order Questions: Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
001233

On 12/16/09 0634
Department D14 Orthopedics/Trauma Reason None
This Order Has Been Discontinued Order Status By Jonathan G Discontinued Eastman, MD
Signed and Held / Pended Order History Pending User Date/Time Jonathan G Eastman, MD Tue Dec 15, 2009 1540 Isolation No Isolation Order Details Frequency EVERY 4 HOURS IF NEEDED
Reason
Pager 916-762-7648 Acknowledged By Patricia L Bailey, RN Beverly Harrelson, RN Sex Male Acknowledged On 12/15/09 1552 12/16/09 0639 DOB 9/23/1959 Bed 147871
Account # 010016806878
Medication
Medication Detail
Promethazine (PHENERGAN) 12.5 mg (Order 48187930) Dose Frequency Start End
001234
Promethazine (PHENERGAN) 12.5 mg
12.5 mg
12/15/2009 1549
12/15/2009 1842
Route: IV Admin Dose: 0.5 mL = 12.5 mg of 25 mg/mL Admin Instructions: ANESTHESIA POST-OP: Administer in PACU May repeat one time after 20 min PRN Reason(s): nausea/vomiting PRN Comment: (use if Ondansetron not effective) Reason for Discontinue: Discontinued Class: Inpatient Normal All Administrations of Promethazine (PHENERGAN) 12.5 mg No Administrations Recorded Warnings Override History for Promethazine (PHENERGAN) 12.5 mg [48187930] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/15/2009 2:40 PM Released By PATRICIA L BAILEY [254588866] This Order Has Been Discontinued Order Status By Eva K Boyd, MD Discontinued On 12/15/09 1842 Reason Discontinued
Signed and Held / Pended Order History Pending User Date/Time Sampaguita Tafoya, MD Tue Dec 15, 2009 1440 Isolation No Isolation Order Details Frequency EVERY 4 HOURS IF NEEDED Duration 24 hours Priority None
Provider Information Ordering User Sampaguita Tafoya, MD



Pager 916-762-4929
001235
Amundsen, Mark Unit D14O
8081369 Room 14787
Male
9/23/1959 Bed 147871
Account # 010016806878
Medication
Medication Detail Mixtures Vancomycin (VANCOCIN) . (Modified) Route: IV Admin Dose: 1,000 mg Volume: 200 mL Duration: 60 Minutes Class: Inpatient Normal Last Admin Time: 12/16/09 1811 Number of Doses: 1 Dose Additives Components Vancomycin 500 mg 1,000 mg Base Components Iso-Osmotic Dextrose 200 mL Dose 1,000 mg
Vancomycin (VANCOCIN) . (Order 48247242) Frequency Start ONE 12/16/2009 TIME 1800 ONLY End 12/16/2009 1811
(none)
(none)
All Administrations of Vancomycin (VANCOCIN) . Action Recorded User(s) Time Time Dose/Rate Route Mary Tran, RN 12/16/09 12/16/09 1,000 mg IV 1811 1812
Site
Comment
Action Reason Given
Warnings Override History for Vancomycin (VANCOCIN) . [48247242] No Warning History Available Order Audit Trail: Vancomycin (VANCOCIN) . [48247242] Order Details After Change #1 - Rx Verify Minhdai Nguyen, PharmD 12/16/09 1746 Name: Vancomycin (VANCOCIN) . Start time: 12/16/09 1800 End time: -Frequency: ONE TIME ONLY Total # of doses: 1 First dose: -Priority: -Infusion Site: -Rate: -Duration: 60 Minutes Volume: 200 mL Ordered dose: 1,000 mg Admin dose: 1,000 mg Route: IV First doses from: 8RX_UCDMC Dispense from: CIVA/CUDA Dispense code: IV Piggyback Barcode PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No
001236
Self administered? No Individual ingredients? No Components: VANCOMYCIN 500 MG IV SOLUTION [9220], ISO-OSMOTIC DEXTROSE [2000080] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: -Phase of care: -Order Questions: Hospital acquired infection? (>48 hours in Yes house/SNF patient) Prophylactic / Empiric Therapy / SURGICAL PROPHYLAXIS (MUST ENTER STOP DATE, Documented Infection ENTER PROCEDURE IN COMMENTS) Site of presumed or documented N/A-PROPHYLACTIC ANTIBIOTIC infection: Initial Order Details Minhdai Nguyen, PharmD 12/16/09 1746 Name: Vancomycin (VANCOCIN) . Start time: 12/16/09 1900 End time: -Total # of doses: 1 First dose: -Frequency: ONE TIME ONLY Priority: -Infusion Site: -Rate: -Duration: 60 Minutes Volume: 200 mL Ordered dose: 1,000 mg Admin dose: 1,000 mg Route: IV Dispense from: CIVA/CUDA First doses from: 8RX_UCDMC Dispense code: IV Piggyback Barcode PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: VANCOMYCIN 500 MG IV SOLUTION [9220], ISO-OSMOTIC DEXTROSE [2000080] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: -Phase of care: -Order Questions: Hospital acquired infection? (>48 hours in Yes house/SNF patient) Prophylactic / Empiric Therapy / SURGICAL PROPHYLAXIS (MUST ENTER STOP DATE, Documented Infection ENTER PROCEDURE IN COMMENTS) Site of presumed or documented N/A-PROPHYLACTIC ANTIBIOTIC infection: Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/16/2009 5:46 PM Electronically Signed By Minhdai Nguyen Authorizing Jonathan G Eastman, MD Comment Department D14 Orthopedics/Trauma
Order Questions Question Hospital acquired infection? (>48 hours in house/SNF patient) Prophylactic / Empiric Therapy /
Answer Yes SURGICAL
001237
Documented Infection
Site of presumed or documented infection: Isolation No Isolation Order Details Frequency ONE TIME ONLY
Duration 1 occurrence
PROPHYLAXIS (MUST ENTER STOP DATE, ENTER PROCEDURE IN COMMENTS) N/APROPHYLACTIC ANTIBIOTIC
Priority None
Provider Information Ordering User Minhdai Nguyen, PhrmRes Attending Provider(s) Robert Michael Tamurian, MD
Ordering Provider Minhdai Nguyen, PhrmRes
Ordering Provider NGUYEN, MINHDAI [128022] Acknowledgement Info For At Placing Order 12/16/09 1746 Patient Information Patient Name Amundsen, Mark
Unit D14O
Pager 916-762-3545 Acknowledged By Mary Tran, RN MRN 8081369

Room 14787

Bed 147871
Sex Male
Medication
Medication Detail Diazepam (VALIUM) Tablet 5-10 mg Route: ORAL
Diazepam (VALIUM) Tablet 5-10 mg (Order 48207269)

Dose 5-10 mg Frequency EVERY 6 HOURS IF NEEDED Start 12/16/2009 0122 End 12/18/2009 1834
001238
Admin Dose: 1-2 tablet (1-2 5 mg tablet) PRN Reason(s): muscle spasm Class: Inpatient Normal Last Admin Time: 12/17/09 0132 All Administrations of Diazepam (VALIUM) Tablet 5-10 mg Action Recorded User(s) Time Time Dose/Rate Route Kristine Palaspas, 12/17/09 12/17/09 10 mg ORAL 0132 0134 RN Beverly Harrelson, 12/16/09 12/16/09 10 mg ORAL RN 0151 0211
Site
Comment
Warnings Override History for Diazepam (VALIUM) Tablet 5-10 mg [48207269] No Warning History Available Order Audit Trail: Diazepam (VALIUM) Tablet 5-10 mg [48207269] Order Details After Change #1 - Rx Verify Diana Hao, RPH 12/16/09 0123 Name: Diazepam (VALIUM) Tablet 5-10 Start time: 12/16/09 0122 End time: -mg Total # of doses: -First dose: -Frequency: EVERY 6 HOURS IF NEEDED Priority: -Infusion Site: -Rate: -Duration: -Volume: -Ordered dose: 5-10 mg Admin dose: 5-10 mg Route: ORAL Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: DIAZEPAM 5 MG TABLET [2597] PRN comments: -PRN reasons: muscle spasm Indications of use: -Indications comments: -Order comments: -Admin instructions: -Phase of care: -Order Questions: Initial Order Details Lance K Mitsunaga, MD 12/16/09 0122 Name: Diazepam (VALIUM) Tablet 5-10 Start time: 12/16/09 0122 End time: -mg Frequency: EVERY 6 HOURS IF Total # of doses: -First dose: -NEEDED Priority: -Infusion Site: -Rate: -Duration: -Volume: -Ordered dose: 5-10 mg Admin dose: 5-10 mg Route: ORAL Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: DIAZEPAM 5 MG TABLET [2597] PRN comments: -PRN reasons: muscle spasm Indications of use: -Indications comments: -Order comments: -Admin instructions: --
001239
Phase of care: -Order Questions: Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/16/2009 1:22 AM Electronically Signed By Lance K Mitsunaga Authorizing Department Robert Michael Tamurian D14 Orthopedics/Trauma
Reason None
This Order Has Been Discontinued Order Status By On Incoming 12/18/09 1834 Discontinued Scheduling Interface Isolation No Isolation Order Details Frequency EVERY 6 HOURS IF NEEDED Duration None Priority None
Provider Information Ordering User Lance K Mitsunaga, MD Attending Provider(s) Robert Michael Tamurian, MD
Ordering Provider Lance K Mitsunaga, MD Admitting Provider Robert Michael Tamurian, MD
Authorizing Provider Robert Michael Tamurian, MD Billing Provider Robert Michael Tamurian, MD
Ordering Provider MITSUNAGA, LANCE K [10751]
Pager 916-762-4063 Acknowledged By Beverly Harrelson, RN MRN 8081369 Sex Male Acknowledged On 12/16/09 0129 DOB 9/23/1959
Room 14787
Bed 147871
001240
28141367
Medication
Medication Detail Fluoxetine (PROZAC) Capsule 40 mg Route: ORAL Admin Dose: 2 capsule (2 20 mg capsule) Class: Inpatient Normal Last Admin Time: 12/18/09 0825
Fluoxetine (PROZAC) Capsule 40 mg (Order 48232171)

Dose 40 mg Frequency DAILY MORNING Start 12/16/2009 1500 End 12/18/2009 1834
All Administrations of Fluoxetine (PROZAC) Capsule 40 mg Recorded Action Time Time Dose/Rate Route User(s) Bryan Owens 12/18/09 12/18/09 40 mg ORAL 0825 0827 Bryan Owens 12/17/09 12/17/09 40 mg ORAL 0830 0851 Mary Tran, RN 12/16/09 12/16/09 40 mg ORAL 1407 1407
Site
Comment
Action Reason Given Given Given
Warnings Override History for Fluoxetine (PROZAC) Capsule 40 mg [48232171] No Warning History Available Order Audit Trail: Fluoxetine (PROZAC) Capsule 40 mg [48232171] Order Details After Change #1 - Rx Verify Name: Fluoxetine (PROZAC) Capsule 40 Start time: 12/16/09 1500 mg Frequency: DAILY MORNING Total # of doses: -San Hua, RPH 12/16/09 1320 End time: -First dose: As Scheduled Volume: -Route: ORAL
Priority: -Infusion Site: -Rate: -Duration: -Admin dose: 40 mg Ordered dose: 40 mg Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: FLUOXETINE 20 MG CAPSULE [10941] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: -Phase of care: -Order Questions: Initial Order Details Name: Fluoxetine (PROZAC) Capsule 40 Start time: 12/16/09 1500 mg Frequency: DAILY MORNING Total # of doses: -Priority: -Rate: -Ordered dose: 40 mg Dispense from: D14O-4_PYXIS Dispense code: UD Grouper
San Hua, RPH 12/16/09 1320 End time: -First dose: As Scheduled Volume: -Route: ORAL
Infusion Site: -Duration: -Admin dose: 40 mg First doses from: D14O-4_PYXIS PRN par level # of doses: --
001241
Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: FLUOXETINE 20 MG CAPSULE [10941] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: -Phase of care: -Order Questions: Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/16/2009 1:20 PM
Electronically Signed By San Hua Authorizing Department Robert Michael Tamurian D14 Orthopedics/Trauma Reason None
This Order Has Been Discontinued Order Status By On Incoming 12/18/09 1834 Discontinued Scheduling Interface Isolation No Isolation Order Details Frequency DAILY MORNING Duration None Priority None
Provider Information Ordering User San Hua, RPH



Billing Provider Robert Michael Tamurian, MD
Ordering Provider EASTMAN, JONATHAN G [09983] Acknowledgement Info For At Placing Order 12/16/09 1320 Verbal Order Info Action Ordering Patient Information Patient Name Order Mode Verbal with Read Back Communicator San Hua, RPH
Pager 916-762-7648 Acknowledged By Mary Tran, RN Responsible Provider Acknowledged On 12/16/09 1332
Signed By Jonathan G Eastman, MD DOB
Signed On 12/16/09 1328
MRN
Sex
001242
Amundsen, Mark Unit D14O
8081369 Room 14787
Male
9/23/1959 Bed 147871
Account # 010016806878
Medication
Hydromorphone (DILAUDID) 0.4-3 mg (Order 48210454) Dose 0.4-3 mg Frequency EVERY 1 HOUR IF NEEDED Start 12/16/2009 0633 End 12/17/2009 0529
PRN Reason(s): severe pain, severe pain or unable to tolerate PO meds Class: Inpatient Normal Last Admin Time: 12/17/09 0409 All Administrations of Hydromorphone (DILAUDID) 0.4-3 mg Action Recorded User(s) Time Time Dose/Rate Route Kristine Palaspas, 12/17/09 12/17/09 2 mg IV RN 0409 0412 Kristine Palaspas, 12/17/09 12/17/09 2 mg IV RN 0200 0207 Kristine Palaspas, 12/16/09 12/16/09 2 mg IV RN 1951 1959 Beverly Harrelson, 12/16/09 12/16/09 2 mg IV RN 0647 0652 Beverly Harrelson, 12/16/09 12/16/09 1 mg IV RN 0646 0652
Site
Comment
Action Reason Given
Given Given Given Given
Warnings Override History for Hydromorphone (DILAUDID) 0.4-3 mg [48210454] Overridden by Laurel L Grefsheim, RPH on 12/16/09 0642 Drug-Allergy (Active and Inactive Ingredients) 1. MORPHINE [Level: Level 3] [Reason: Tolerated before] Dose 1. HYDROMORPHONE (PF) 1 MG/ML SYRINGE: EXCEEDS RECOMMENDED MAXIMUM DAILY DOSE BY 50% (24 MG); EXCEEDS FREQUENCY BY 16 DOSES/DAY [Reason: Tolerated before]
Order Audit Trail: Hydromorphone (DILAUDID) 0.4-3 mg [48210454] Order Details After Change #1 - Rx Verify Laurel L Grefsheim, RPH 12/16/09 0642
001243
Name: Hydromorphone (DILAUDID) 0.4- Start time: 12/16/09 0633 3 mg Frequency: EVERY 1 HOUR IF NEEDED Total # of doses: -Priority: -Infusion Site: -Rate: -Duration: -Ordered dose: 0.4-3 mg Admin dose: 0.4-3 mg Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: HYDROMORPHONE (PF) 1 MG/ML SYRINGE [114436] PRN comments: -PRN reasons: severe pain, severe pain or unable to tolerate PO meds Indications of use: -Indications comments: -Order comments: -Admin instructions: IV: IV push (undiluted) over 2-3 minutes Phase of care: -Order Questions:
End time: -First dose: -Volume: 3 mL Route: IV
Initial Order Details Jonathan G Eastman, MD 12/16/09 0634 Name: Hydromorphone (DILAUDID) 0.4- Start time: 12/16/09 0633 End time: -3 mg Frequency: EVERY 1 HOUR IF NEEDED Total # of doses: -First dose: -Infusion Site: -Priority: -Rate: -Duration: -Volume: -Ordered dose: 0.4-3 mg Admin dose: 0.4-3 mg Route: IV Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: HYDROMORPHONE (PF) 1 MG/ML SYRINGE [114436] PRN comments: -PRN reasons: severe pain, severe pain or unable to tolerate PO meds Indications of use: -Indications comments: -Order comments: -Admin instructions: IV: IV push (undiluted) over 2-3 minutes Phase of care: -Order Questions: Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/16/2009 6:34 AM This Order Has Been Discontinued Order Status By Jonathan G Discontinued Electronically Signed By/Authorizing Jonathan G Eastman, MD On 12/17/09 0529 Department D14 Orthopedics/Trauma Reason None
001244
Eastman, MD Isolation No Isolation Order Details Frequency EVERY 1 HOUR IF NEEDED

Order History Order Date/Time 12/16/09 0634 12/15/09 1550 Provider Information Ordering User Jonathan G Eastman, MD
Order ID 48210454 48191960


Ordering Provider EASTMAN, JONATHAN G [09983] Acknowledgement Info For At Placing Order 12/16/09 0634 D/C Order 12/17/09 0529 Patient Information Patient Name Amundsen, Mark Unit D14O
MRN 8081369
Pager 916-762-7648 Acknowledged By Beverly Harrelson, RN Kristine Palaspas, RN

Sex Male
Acknowledged On 12/16/09 0639 12/17/09 0539

DOB 9/23/1959
Room 14787
Bed 147871
Medication
Medication Detail Methadone (DOLOPHINE) Tablet 130 mg Route: ORAL Admin Dose: 13 tablet (13 10 mg tablet) Admin Instructions: Hold for RR< 10 or Sedation Score>1/4
Methadone (DOLOPHINE) Tablet 130 mg (Order 48191970) Dose 130 mg Frequency DAILY MORNING Start 12/16/2009 0900 End 12/17/2009 1449
001245
Class: Inpatient Normal Last Admin Time: 12/17/09 0830 All Administrations of Methadone (DOLOPHINE) Tablet 130 mg Action Recorded User(s) Time Time Dose/Rate Route Bryan Owens 12/17/09 12/17/09 130 mg ORAL 0851 0830 Mary Tran, RN 12/16/09 12/16/09 130 mg ORAL 0917 0917
Site
Comment
Warnings Override History for Methadone (DOLOPHINE) Tablet 130 mg [48191970] Overridden by Ryan Cello, RPH on 12/15/09 1921 Dose 1. METHADONE 10 MG TAB: EXCEEDS RECOMMENDED MAXIMUM DAILY DOSE BY 9% (10 MG); EXCEEDS RECOMMENDED MAXIMUM SINGLE DOSE BY 334% (100 MG) [Reason: Tolerated before]
Order Audit Trail: Methadone (DOLOPHINE) Tablet 130 mg [48191970] Order Details After Change #1 - Rx Verify Name: Methadone (DOLOPHINE) Tablet Start time: 12/16/09 0900 130 mg Frequency: DAILY MORNING Total # of doses: --
Ryan Cello, RPH 12/15/09 1921 End time: -First dose: As Scheduled
Priority: -Infusion Site: -Rate: -Duration: -Volume: -Ordered dose: 130 mg Admin dose: 130 mg Route: ORAL Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: METHADONE 10 MG TABLET [5425] PRN comments: -PRN reasons: -Indications of use: -Indications comments: -Order comments: -Admin instructions: Hold for RR< 10 or Sedation Score>1/4 Phase of care: -Order Questions: Does use meet BLACK BOX WARNING NO-ENTER INDICATION IN COMMENTS restrictions? Initial Order Details Name: Methadone (DOLOPHINE) Tablet 130 mg Frequency: DAILY MORNING Priority: -Rate: -Ordered dose: 130 mg Dispense from: D14O-4_PYXIS Dispense code: UD Grouper Patient supplied med? No Do not dispense? No Dispense only once? No Jonathan G Eastman, MD 12/15/09 1550 Start time: 12/16/09 0900 End time: -Total # of doses: -Infusion Site: -Duration: -Admin dose: 130 mg First doses from: D14O-4_PYXIS PRN par level # of doses: -Patient supplied # of doses: 0 Do not dispense # of doses: 0 Triggered fill list? No First dose: As Scheduled Volume: -Route: ORAL
001246
Self administered? No Individual ingredients? No Components: METHADONE 10 MG TABLET [5425] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: -Phase of care: -Order Questions: Does use meet BLACK BOX WARNING NO-ENTER INDICATION IN COMMENTS restrictions? Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Electronically Signed By/Authorizing Jonathan G Eastman, MD On 12/17/09 1449
This Order Has Been Discontinued Order Status By Jonathan G Discontinued Eastman, MD
Reason None
Signed and Held / Pended Order History Pending User Date/Time Jonathan G Eastman, MD Tue Dec 15, 2009 1540 Order Questions Question Does use meet BLACK BOX WARNING restrictions? Isolation No Isolation Order Details Frequency DAILY MORNING Duration None Priority None Answer NO-ENTER INDICATION IN COMMENTS
Reason
Comment
User Jonathan G Eastman, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Martina Dobrovodska
Order ID 48191970 47648844 46641416 45578181 44543839 43512111 42415608 41358443 40335571 39316280 38152050
001247
03/16/09 1008 02/13/09 0901 01/20/09 1025 12/22/08 1330 12/01/08 0956 11/03/08 0853 10/06/08 1735 09/05/08 1008 08/11/08 1128 06/27/08 0901 06/06/08 1714 04/30/08 1359 04/23/08 1255 04/04/08 1253 03/12/08 1720 01/10/08 1229 12/13/07 1239 11/16/07 1444 10/22/07 1713 09/17/07 1803 08/31/07 0809 08/07/07 1735 07/16/07 1512 06/22/07 1112 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information Ordering User Jonathan G Eastman, MD Attending Provider(s) Robert Michael Tamurian, MD
Randolph, MD Victor Baquero, MD Victor Baquero, MD Gertrudes Perlas Montemayor, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Ordering Provider Jonathan G Eastman, MD
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
37025430 35855444 34942551 33955136 33114228 32060748 31022473 29814812 28998118 27379159 26682012 25327454 25043810 24527577 23982000 22429171 21876329 21267173 20658809 19830274 19493600 18998255 18553324 18102039 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
Pager 916-762-7648
001248
For Placing Order D/C Order
At 12/15/09 1550 12/17/09 1449
Acknowledged By Patricia L Bailey, RN Bryan Owens
Acknowledged On 12/15/09 1553 12/17/09 1503

Unit D14O
MRN 8081369
Room 14787
Sex Male
DOB 9/23/1959
Bed 147871
Medication
Medication Detail
Oxycodone 5 mg/Acetaminophen 325 mg (PERCOCET) Tablet 1-2 Tab (Order 48210453)

Dose 1-2 tablet Frequency EVERY 4 HOURS NOW Start 12/16/2009 0928 End 12/17/2009 1449
Oxycodone 5 mg/Acetaminophen 325 mg (PERCOCET) Tablet 1-2 Tab
Route: ORAL Admin Dose: 1-2 tablet Admin Instructions: Do not exceed 4000 mg TOTAL acetaminophen per 24 hours. Reason for Discontinue: Discontinued Class: Inpatient Normal Last Admin Time: 12/17/09 1400 All Administrations of Oxycodone 5 mg/Acetaminophen 325 mg (PERCOCET) Tablet 1-2 Tab Action Recorded User(s) Time Time Dose/Rate Route Site Comment Action Reason Bryan Owens 12/17/09 12/17/09 2 tablet ORAL Given 1400 1358 Bryan Owens 12/17/09 12/17/09 2 tablet ORAL Given 0955 0956 Kristine Palaspas, 12/17/09 12/17/09 2 tablet ORAL Given RN 0600 0640 Kristine Palaspas, 12/17/09 12/17/09 2 tablet ORAL Given RN 0159 0159 Kristine Palaspas, 12/16/09 12/16/09 2 tablet ORAL Given RN 2200 2214 Mary Tran, RN 12/16/09 12/16/09 0 tablet ORAL pt drowsy and Returned 1800 1812 reports pain at to Pyxis tolerable level. will reassess Mary Tran, RN 12/16/09 12/16/09 2 tablet ORAL Given 1407 1407 Mary Tran, RN 12/16/09 12/16/09 2 tablet ORAL Given 1005 1005
001249
Warnings Override History for Oxycodone 5 mg/Acetaminophen 325 mg (PERCOCET) Tablet 1-2 Tab [48210453] Overridden by Laurel L Grefsheim, RPH on 12/16/09 0642 Drug-Allergy (Active and Inactive Ingredients) 1. MORPHINE [Level: Level 3] [Reason: Tolerated before]
Order Audit Trail: Oxycodone 5 mg/Acetaminophen 325 mg (PERCOCET) Tablet 1-2 Tab [48210453] Order Details After Change #1 - Rx Verify Laurel L Grefsheim, RPH 12/16/09 0642 Name: Oxycodone 5 mg/Acetaminophen Start time: 12/16/09 0928 End time: -325 mg (PERCOCET) Tablet 1-2 Tab Frequency: EVERY 4 HOURS NOW Total # of doses: -First dose: -Priority: -Infusion Site: -Rate: -Duration: -Volume: -Ordered dose: 1-2 tablet Admin dose: 1-2 tablet Route: ORAL Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET [6496] PRN comments: -PRN reasons: -Indications of use: -Indications comments: -Order comments: -Admin instructions: Do not exceed 4000 mg TOTAL acetaminophen per 24 hours. Phase of care: -Order Questions: Initial Order Details Jonathan G Eastman, MD 12/16/09 0634 Name: Oxycodone 5 mg/Acetaminophen Start time: 12/16/09 0928 End time: -325 mg (PERCOCET) Tablet 1-2 Tab Frequency: EVERY 4 HOURS NOW Total # of doses: -First dose: -Priority: -Infusion Site: -Rate: -Duration: -Volume: -Ordered dose: 1-2 tablet Admin dose: 1-2 tablet Route: ORAL Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET [6496] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: Do not exceed 4000 mg TOTAL acetaminophen per 24 hours. Phase of care: -Order Questions: Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter
001250
View Encounter Order Info Date and Time 12/16/2009 6:34 AM This Order Has Been Discontinued Order Status By Jonathan G Discontinued Eastman, MD Isolation No Isolation Order Details Frequency EVERY 4 HOURS NOW Duration None Priority None Order Class Inpatient Normal Electronically Signed By/Authorizing Jonathan G Eastman, MD On 12/17/09 1449 Department D14 Orthopedics/Trauma Reason Discontinued
Order History Order Date/Time 12/16/09 0634 12/15/09 1550 Provider Information Ordering User Jonathan G Eastman, MD Attending Provider(s) Robert Michael Tamurian, MD

Order ID 48210453 48191961
Pager 916-762-7648 Acknowledged By Beverly Harrelson, RN Bryan Owens Sex Male Acknowledged On 12/16/09 0639 12/17/09 1502 DOB 9/23/1959 Bed 147871
Account # 010016806878
Medication
Study Drug - Fondaparinux (IRB 200816251) Syringe 2.5 mg (Order 48212107)
001251
Medication Detail Dose Frequency 2.5 mg DAILY Study Drug - Fondaparinux (IRB MORNING 200816251) Syringe 2.5 mg Route: SUBCUTANEOUS Admin Dose: 0.5 mL = 2.5 mg of 2.5 mg/0.5 mL Comment: Question: call Jose Bosque 4-6291 or 762-5821 Fill from pyxis Admin Instructions: Begin 12-24 hours after surgery for 10 days. Do not give the drug IM. Please complete questionnaire if you are new to this study. When patient discharges, please remove all medication from pyxis and give to patient. Class: Inpatient Normal Last Admin Time: 12/18/09 0825 Number of Doses: 10 All Administrations of Study Drug - Fondaparinux (IRB 200816251) Syringe 2.5 mg Action Recorded User(s) Time Time Dose/Rate Route Site Comment Bryan Owens 12/18/09 12/18/09 2.5 mg SUBCUTANEOUS Right 0825 0827 upper arm Bryan Owens 12/17/09 12/17/09 2.5 mg SUBCUTANEOUS Right 0830 0851 upper arm Mary Tran, RN 12/16/09 12/16/09 2.5 mg SUBCUTANEOUS Left 0900 0917 upper arm Start 12/16/2009 0900 End 12/18/2009 1834
Action Reason Given
Given Given
Warnings Override History for Study Drug - Fondaparinux (IRB 200816251) Syringe 2.5 mg [48212107] No Warning History Available Order Audit Trail: Study Drug - Fondaparinux (IRB 200816251) Syringe 2.5 mg [48212107] Order Details After Change #1 - Rx Verify Smiley Hom, PharmD 12/16/09 0742 Name: Study Drug - Fondaparinux (IRB Start time: 12/16/09 0900 End time: 12/26/09 0859 200816251) Syringe 2.5 mg Frequency: DAILY MORNING Total # of doses: 10 First dose: As Scheduled Priority: -Infusion Site: -Rate: -Duration: -Volume: -Ordered dose: 2.5 mg Admin dose: 2.5 mg Route: SUBCUTANEOUS Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: STUDY DRUG - FONDAPARINUX 2.5 MG/0.5 ML SYRINGE - ARIXTRA TOTAL JOINT ARTHROPLASTY (200816251) [3000529] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: Question: call Jose Bosque 4-6291 or 762-5821 Fill from pyxis Admin instructions: Begin 12-24 hours after surgery for 10 days. Do not give the drug IM. Please complete questionnaire if you are new to this study. When patient discharges, please remove all medication from pyxis and give to patient. Phase of care: -Order Questions:
001252
Initial Order Details Name: Study Drug - Fondaparinux (IRB 200816251) Syringe 2.5 mg Frequency: DAILY MORNING
Smiley Hom, PharmD 12/16/09 0741 Start time: 12/16/09 0900 End time: 12/26/09 0859 Total # of doses: 10 First dose: As Scheduled Priority: -Infusion Site: -Rate: -Duration: -Volume: -Ordered dose: 2.5 mg Admin dose: 2.5 mg Route: SUBCUTANEOUS Dispense from: 8RX_UCDMC First doses from: 8RX_UCDMC Dispense code: UD PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: STUDY DRUG - FONDAPARINUX 2.5 MG/0.5 ML SYRINGE - ARIXTRA TOTAL JOINT ARTHROPLASTY (200816251) [3000529] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: Question: call Jose Bosque 4-6291 or 762-5821 Fill from pyxis Admin instructions: Begin 12-24 hours after surgery for 10 days. Do not give the drug IM. Please complete questionnaire if you are new to this study. When patient discharges, please remove all medication from pyxis and give to patient. Phase of care: -Order Questions:
Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/16/2009 7:41 AM Electronically Signed By Smiley Hom Authorizing Department Robert Michael Tamurian D14 Orthopedics/Trauma Reason None
This Order Has Been Discontinued Order Status By On Incoming 12/18/09 1834 Discontinued Scheduling Interface Isolation No Isolation Order Details Frequency DAILY MORNING Duration 10 days Priority None
Provider Information Ordering User Smiley Hom, PharmD Attending Provider(s) Robert Michael Tamurian, MD
Ordering Provider Robert Michael Tamurian, MD Admitting Provider Robert Michael Tamurian, MD
Authorizing Provider Robert Michael Tamurian, MD Billing Provider Robert Michael Tamurian, MD
001253
Jonathan G Eastman, MD Attending Provider(s) Robert Michael Tamurian, MD
Jonathan G Eastman, MD Admitting Provider Robert Michael Tamurian, MD
Jonathan G Eastman, MD Billing Provider Jonathan G Eastman, MD
Pager 916-762-7648 Acknowledged By Bryan Owens Acknowledged On 12/17/09 1503 DOB 9/23/1959
MRN 8081369
Sex Male
Room 14787
Bed 147871
Medication
Hydromorphone (DILAUDID) 0.4-2 mg (Order 48259129) Dose 0.4-2 mg Frequency EVERY 1 HOUR IF NEEDED Start 12/17/2009 0528 End 12/18/2009 1834
PRN Reason(s): severe pain, severe pain or unable to tolerate PO meds Class: Inpatient Normal All Administrations of Hydromorphone (DILAUDID) 0.4-2 mg No Administrations Recorded Warnings Override History for Hydromorphone (DILAUDID) 0.4-2 mg [48259129] Overridden by Evan Reed, RPH on 12/17/09 0532 Drug-Allergy (Active and Inactive Ingredients) 1. MORPHINE [Level: Level 3] [Reason: Tolerated before] Full Warnings History Order Audit Trail: Hydromorphone (DILAUDID) 0.4-2 mg [48259129]
001254
Order Details After Change #1 - Rx Verify Evan Reed, RPH 12/17/09 0532 Name: Hydromorphone (DILAUDID) 0.4- Start time: 12/17/09 0528 End time: -2 mg Frequency: EVERY 1 HOUR IF NEEDED Total # of doses: -First dose: -Priority: -Infusion Site: -Rate: -Duration: -Volume: 2 mL Ordered dose: 0.4-2 mg Admin dose: 0.4-2 mg Route: IV Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: HYDROMORPHONE (PF) 1 MG/ML SYRINGE [114436] PRN comments: -PRN reasons: severe pain, severe pain or unable to tolerate PO meds Indications of use: -Indications comments: -Order comments: -Admin instructions: IV: IV push (undiluted) over 2-3 minutes Phase of care: -Order Questions: Initial Order Details Jonathan G Eastman, MD 12/17/09 0529 Name: Hydromorphone (DILAUDID) 0.4- Start time: 12/17/09 0528 End time: -2 mg Frequency: EVERY 1 HOUR IF NEEDED Total # of doses: -First dose: -Priority: -Infusion Site: -Rate: -Duration: -Volume: -Ordered dose: 0.4-2 mg Admin dose: 0.4-2 mg Route: IV Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: HYDROMORPHONE (PF) 1 MG/ML SYRINGE [114436] PRN comments: -PRN reasons: severe pain, severe pain or unable to tolerate PO meds Indications of use: -Indications comments: -Order comments: -Admin instructions: IV: IV push (undiluted) over 2-3 minutes Phase of care: -Order Questions: Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Electronically Signed By/Authorizing Jonathan G Eastman, MD On
Reason
001255
Discontinued
Incoming 12/18/09 1834 Scheduling Interface
None
Isolation No Isolation Order Details Frequency EVERY 1 HOUR IF NEEDED

Order History Order Date/Time 12/17/09 0529 12/16/09 0634 12/15/09 1550 Provider Information Ordering User Jonathan G Eastman, MD Attending Provider(s) Robert Michael Tamurian, MD
User Jonathan G Eastman, MD Jonathan G Eastman, MD Jonathan G Eastman, MD
Action Current Order Modified from Modified from
Order ID 48259129 48210454 48191960
Pager 916-762-7648 Acknowledged By Kristine Palaspas, RN Acknowledged On 12/17/09 0539 DOB 9/23/1959
MRN 8081369
Sex Male
Room 14787
Bed 147871
Medication
Medication Detail Methadone (DOLOPHINE) Tablet 40 mg Route: ORAL Admin Dose: 4 tablet (4 10 mg tablet) Class: Inpatient Normal
Methadone (DOLOPHINE) Tablet 40 mg (Order 48286377) Dose 40 mg Frequency DAILY AT 1700 Start 12/17/2009 1600 End 12/18/2009 1834
001256
Last Admin Time: 12/17/09 1700 All Administrations of Methadone (DOLOPHINE) Tablet 40 mg Action Recorded User(s) Time Time Dose/Rate Route Bryan Owens 12/17/09 12/17/09 40 mg ORAL 1702 1700
Site
Comment
Action Reason Given
Warnings Override History for Methadone (DOLOPHINE) Tablet 40 mg [48286377] Overridden by Grace Parng, RPH on 12/18/09 0900 Duplicate Medication Order 1. METHADONE HCL,PO, NON-PRN ORDER Methadone (DOLOPHINE) Tablet 40 mg Other Orders: Methadone (DOLOPHINE) Tablet 50 mg Full Warnings History Order Override History User Override Time Jonathan G 12/17/09 1449 Eastman, MD Previous Schedule 1700 Adjusted Schedule 1600 Override Reason
Order Audit Trail: Methadone (DOLOPHINE) Tablet 40 mg [48286377] Order Details After Change #1 - Rx Verify Name: Methadone (DOLOPHINE) Tablet Start time: 12/17/09 1600 40 mg Frequency: DAILY AT 1700 Total # of doses: --
Diana Hao, RPH 12/17/09 1456 End time: -First dose: As Scheduled
Priority: -Infusion Site: -Rate: -Duration: -Volume: -Admin dose: 40 mg Route: ORAL Ordered dose: 40 mg Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: METHADONE 10 MG TABLET [5425] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: -Phase of care: -Order Questions: Does use meet BLACK BOX WARNING NO-ENTER INDICATION IN COMMENTS restrictions? Initial Order Details Name: Methadone (DOLOPHINE) Tablet 40 mg Frequency: DAILY AT 1700 Priority: -Rate: -Ordered dose: 40 mg Dispense from: D14O-4_PYXIS Jonathan G Eastman, MD 12/17/09 1449 Start time: 12/17/09 1600 End time: -Total # of doses: -Infusion Site: -Duration: -Admin dose: 40 mg First doses from: D14O-4_PYXIS First dose: As Scheduled Volume: -Route: ORAL
001257
Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: METHADONE 10 MG TABLET [5425] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: -Phase of care: -Order Questions: Does use meet BLACK BOX WARNING NO-ENTER INDICATION IN COMMENTS restrictions? Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/17/2009 2:49 PM Electronically Signed By/Authorizing Jonathan G Eastman, MD Department D14 Orthopedics/Trauma Reason None
This Order Has Been Discontinued Order Status By On Incoming 12/18/09 1834 Discontinued Scheduling Interface Order Questions Question Does use meet BLACK BOX WARNING restrictions? Isolation No Isolation Order Details Frequency DAILY AT 1700
Answer NO-ENTER INDICATION IN COMMENTS
Comment
Pager 916-762-7648
001258
For Placing Order
At 12/17/09 1449 MRN 8081369
Acknowledged By Bryan Owens Sex Male

Bed 147871

Unit D14O
Room 14787
Medication
Medication Detail Methadone (DOLOPHINE) Tablet 50 mg Route: ORAL Admin Dose: 5 tablet (5 10 mg tablet) Class: Inpatient Normal Last Admin Time: 12/17/09 2126
Methadone (DOLOPHINE) Tablet 50 mg (Order 48286378)

Dose 50 mg Frequency DAILY AT 2100 Start 12/17/2009 2200 End 12/18/2009 1834
All Administrations of Methadone (DOLOPHINE) Tablet 50 mg Action Recorded User(s) Time Time Dose/Rate Route Kristine Palaspas, 12/17/09 12/17/09 50 mg ORAL RN 2126 2127
Site
Comment
Action Reason Given
Warnings Override History for Methadone (DOLOPHINE) Tablet 50 mg [48286378] Overridden by Grace Parng, RPH on 12/18/09 0900 Duplicate Medication Order 1. METHADONE HCL,PO, NON-PRN ORDER Methadone (DOLOPHINE) Tablet 40 mg Other Orders: Methadone (DOLOPHINE) Tablet 40 mg
Order Override History User Override Time Jonathan G 12/17/09 1449 Eastman, MD
Previous Schedule 2100
Adjusted Schedule 2200
Override Reason
Order Audit Trail: Methadone (DOLOPHINE) Tablet 50 mg [48286378] Order Details After Change #1 - Rx Verify Name: Methadone (DOLOPHINE) Tablet Start time: 12/17/09 2200 50 mg Frequency: DAILY AT 2100 Total # of doses: --
Diana Hao, RPH 12/17/09 1456 End time: -First dose: As
001259
Scheduled Priority: -Infusion Site: -Rate: -Duration: -Volume: -Ordered dose: 50 mg Admin dose: 50 mg Route: ORAL Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: METHADONE 10 MG TABLET [5425] PRN comments: -PRN reasons: -Indications of use: -Indications comments: -Order comments: -Admin instructions: -Phase of care: -Order Questions: Does use meet BLACK BOX WARNING NO-ENTER INDICATION IN COMMENTS restrictions? Initial Order Details Name: Methadone (DOLOPHINE) Tablet 50 mg Frequency: DAILY AT 2100 Jonathan G Eastman, MD 12/17/09 1449 Start time: 12/17/09 2200 End time: -Total # of doses: -First dose: As Scheduled
Priority: -Infusion Site: -Rate: -Duration: -Volume: -Ordered dose: 50 mg Admin dose: 50 mg Route: ORAL Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: METHADONE 10 MG TABLET [5425] PRN comments: -PRN reasons: -Indications of use: -Indications comments: -Order comments: -Admin instructions: -Phase of care: -Order Questions: Does use meet BLACK BOX WARNING NO-ENTER INDICATION IN COMMENTS restrictions? Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/17/2009 2:49 PM This Order Has Been Discontinued Order Status By Electronically Signed By/Authorizing Jonathan G Eastman, MD On Department D14 Orthopedics/Trauma Reason
001260
Discontinued
Incoming 12/18/09 1834 Scheduling Interface Answer NO-ENTER INDICATION IN COMMENTS
None
Order Questions Question Does use meet BLACK BOX WARNING restrictions? Isolation No Isolation Order Details Frequency DAILY AT 2100
Duration None
Comment
Priority None
Ordering Provider EASTMAN, JONATHAN G [09983] Acknowledgement Info For At Placing Order 12/17/09 1449 Patient Information Patient Name Amundsen, Mark Unit D14O
MRN 8081369
Pager 916-762-7648 Acknowledged By Bryan Owens

Sex Male

DOB 9/23/1959
Room 14787
Bed 147871
Medication
Medication Detail Oxycodone (OXYCONTIN) SR Tablet 20 mg Route: ORAL Admin Dose: 1 tablet (1 20 mg tablet)
Oxycodone (OXYCONTIN) SR Tablet 20 mg (Order 48286379) Dose 20 mg Frequency EVERY 3 HOURS IF NEEDED Start 12/17/2009 1449 End 12/17/2009 1455
001261
Comment: q 3 hrs prn breakthrough pain and 60 minutes prior to PT Admin Instructions: Do not crush or chew. PRN Comment: pain. see below Reason for Discontinue: Duplicate Order Class: Inpatient Normal All Administrations of Oxycodone (OXYCONTIN) SR Tablet 20 mg No Administrations Recorded Warnings Override History for Oxycodone (OXYCONTIN) SR Tablet 20 mg [48286379] Overridden by Diana Hao, RPH on 12/17/09 1455 Duplicate Medication Order 1. OXYCODONE HCL,PO, PRN ORDER Oxycodone (ROXICODONE) Tablet 20 mg Other Orders: Oxycodone (ROXICODONE) Tablet 20 mg Full Warnings History Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Electronically Signed By/Authorizing Jonathan G Eastman, MD On 12/17/09 1455
This Order Has Been Discontinued Order Status By Diana Hao, RPH Discontinued Isolation No Isolation Order Details Frequency EVERY 3 HOURS IF NEEDED
Duration None
Reason Duplicate Order
Priority None
Ordering Provider EASTMAN, JONATHAN G [09983] Acknowledgement Info For At Placing Order 12/17/09 1449 D/C Order 12/17/09 1455
Pager 916-762-7648 Acknowledged By Bryan Owens Bryan Owens Acknowledged On 12/17/09 1502 12/17/09 1502
001262
MRN 8081369 Room 14787
Sex Male
DOB 9/23/1959 Bed 147871
Account # 010016806878
Medication
Medication Detail Oxycodone (ROXICODONE) Tablet 20 mg
Oxycodone (ROXICODONE) Tablet 20 mg (Order 48286772) Dose 20 mg Frequency EVERY 3 HOURS IF NEEDED Start 12/17/2009 1454 End 12/18/2009 1834
Route: ORAL Admin Dose: 4 tablet (4 5 mg tablet) Admin Instructions: q 3 hrs prn breakthrough pain and 60 minutes prior to PT PRN Reason(s): breakthrough pain Class: Inpatient Normal Last Admin Time: 12/18/09 1303 All Administrations of Oxycodone (ROXICODONE) Tablet 20 mg Action Recorded User(s) Time Time Dose/Rate Route Ioan Cristian Coman, 12/18/09 12/18/09 20 mg ORAL RN 1303 1305 Bryan Owens 12/18/09 12/18/09 20 mg ORAL 0745 0752 Bryan Owens 12/17/09 12/17/09 20 mg ORAL 1800 1805
Site
Comment
Action Reason Given
Given Given
Warnings Override History for Oxycodone (ROXICODONE) Tablet 20 mg [48286772] Overridden by Diana Hao, RPH on 12/17/09 1456 Duplicate Medication Order 1. OXYCODONE HCL,PO, PRN ORDER Oxycodone (ROXICODONE) Tablet 20 mg Other Orders:
Order Audit Trail: Oxycodone (ROXICODONE) Tablet 20 mg [48286772] Order Details After Change #1 - Rx Verify Name: Oxycodone (ROXICODONE) Start time: 12/17/09 1454 Tablet 20 mg Frequency: EVERY 3 HOURS IF Total # of doses: --
Diana Hao, RPH 12/17/09 1456 End time: -First dose: --
001263
NEEDED Priority: -Infusion Site: -Rate: -Duration: -Ordered dose: 20 mg Admin dose: 20 mg Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: OXYCODONE 5 MG TABLET [11705] PRN comments: -PRN reasons: breakthrough pain Indications of use: -Indications comments: -Order comments: -Admin instructions: q 3 hrs prn breakthrough pain and 60 minutes prior to PT Phase of care: -Order Questions:
Initial Order Details Diana Hao, RPH 12/17/09 1455 Name: Oxycodone (ROXICODONE) Start time: 12/17/09 1454 End time: -Tablet 20 mg Frequency: EVERY 3 HOURS IF Total # of doses: -First dose: -NEEDED Priority: -Infusion Site: -Rate: -Duration: -Volume: -Ordered dose: 20 mg Admin dose: 20 mg Route: ORAL Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: OXYCODONE 5 MG TABLET [11705] PRN comments: -PRN reasons: breakthrough pain Indications of use: -Indications comments: -Order comments: -Admin instructions: q 3 hrs prn breakthrough pain and 60 minutes prior to PT Phase of care: -Order Questions: Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/17/2009 2:55 PM
Electronically Signed By Diana Hao Authorizing George M Watson Department D14 Orthopedics/Trauma
This Order Has Been Discontinued Order Status By On Incoming 12/18/09 1834 Discontinued Scheduling Interface Isolation No Isolation
Reason None
001264
Order Details Frequency EVERY 3 HOURS IF NEEDED
Duration None
Priority None
Provider Information Ordering User Diana Hao, RPH Attending Provider(s) Robert Michael Tamurian, MD
Ordering Provider George M Watson, MD Admitting Provider Robert Michael Tamurian, MD
Authorizing Provider George M Watson, MD Billing Provider George M Watson, MD
Ordering Provider WATSON, GEORGE M [09973]
Pager 916-762-6842 Acknowledged By Bryan Owens Acknowledged On 12/17/09 1501
Acknowledgement Info For At Placing Order 12/17/09 1455 Verbal Order Info Action Ordering Patient Information Patient Name Amundsen, Mark Unit D14O Order Mode Verbal with Read Back
Responsible Communicator Provider Diana Hao, RPH
Signed By Jonathan G Eastman, MD DOB 9/23/1959 Bed 147871
Signed On 12/22/09 0856
MRN 8081369 Room 14787
Sex Male
Account # 010016806878
Medication
Medication Detail Oxycodone (ROXICODONE) Tablet 20 mg
Oxycodone (ROXICODONE) Tablet 20 mg (Order 48286773) Dose 20 mg Frequency PRN Start 12/17/2009 1454 End 12/18/2009 1834
Route: ORAL Admin Dose: 4 tablet (4 5 mg tablet) Admin Instructions: q 3 hrs prn breakthrough pain and 60 minutes prior to PT PRN Comment: for 60 minutes prior to PT Class: Inpatient Normal Last Admin Time: 12/18/09 0835
001265
All Administrations of Oxycodone (ROXICODONE) Tablet 20 mg Action Recorded User(s) Time Time Dose/Rate Route Bryan Owens 12/18/09 12/18/09 20 mg ORAL 0838 0835
Site
Comment
Action Reason Given
Warnings Override History for Oxycodone (ROXICODONE) Tablet 20 mg [48286773] Overridden by Diana Hao, RPH on 12/17/09 1456 Drug-Allergy (Active and Inactive Ingredients) 1. MORPHINE [Level: Level 3] Dose 1. OXYCODONE 5 MG TAB: EXCEEDS RECOMMENDED MAXIMUM SINGLE DOSE BY 34% (5 MG) Duplicate Medication Order 1. OXYCODONE HCL,PO, PRN ORDER Oxycodone (ROXICODONE) Tablet 20 mg Other Orders: Full Warnings History Order Audit Trail: Oxycodone (ROXICODONE) Tablet 20 mg [48286773] Order Details After Change #1 - Rx Verify Diana Hao, RPH 12/17/09 1456 Name: Oxycodone (ROXICODONE) Start time: 12/17/09 1454 End time: -Tablet 20 mg Frequency: PRN Total # of doses: -First dose: -Infusion Site: -Priority: -Rate: -Duration: -Volume: -Ordered dose: 20 mg Admin dose: 20 mg Route: ORAL Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: OXYCODONE 5 MG TABLET [11705] PRN comments: for 60 minutes prior to PT PRN reasons: -Indications of use: -Indications comments: -Order comments: -Admin instructions: q 3 hrs prn breakthrough pain and 60 minutes prior to PT Phase of care: -Order Questions: Initial Order Details Diana Hao, RPH 12/17/09 1455 Start time: 12/17/09 1454 End time: -Name: Oxycodone (ROXICODONE) Tablet 20 mg Frequency: PRN Total # of doses: -First dose: -Priority: -Infusion Site: -Rate: -Duration: -Volume: -Ordered dose: 20 mg Admin dose: 20 mg Route: ORAL Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: OXYCODONE 5 MG TABLET [11705] PRN comments: for 60 minutes prior to PT PRN reasons: --
001266
Indications of use: -Indications comments: -Order comments: -Admin instructions: q 3 hrs prn breakthrough pain and 60 minutes prior to PT Phase of care: -Order Questions: Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/17/2009 2:55 PM
Electronically Signed By Diana Hao Authorizing George M Watson Department D14 Orthopedics/Trauma Reason None
This Order Has Been Discontinued Order Status By On Incoming 12/18/09 1834 Discontinued Scheduling Interface Isolation No Isolation Order Details Frequency PRN Duration None Priority None
Provider Information Ordering User Diana Hao, RPH

Ordering Provider George M Watson, MD

Authorizing Provider George M Watson, MD

Billing Provider George M Watson, MD
Ordering Provider WATSON, GEORGE M [09973] Acknowledgement Info For At Placing Order 12/17/09 1455 Verbal Order Info Action Ordering Patient Information Patient Name Amundsen, Mark
Unit D14O
Pager 916-762-6842 Acknowledged By Bryan Owens Responsible Communicator Provider Diana Hao, RPH Acknowledged On 12/17/09 1501
Order Mode Verbal with Read Back
Signed By Jonathan G Eastman, MD DOB 9/23/1959

Bed 147871
Signed On 12/22/09 0856
MRN 8081369
Room 14787
Sex Male
001267
Medication
Medication Detail Sennosides (SENOKOT) Tablet 2 Tab Route: ORAL Admin Dose: 2 tablet Class: Inpatient Normal Last Admin Time: 12/17/09 2127
Sennosides (SENOKOT) Tablet 2 Tab (Order 48259130) Dose 2 tablet Frequency DAILY AT BEDTIME Start 12/17/2009 2100 End 12/18/2009 1834
All Administrations of Sennosides (SENOKOT) Tablet 2 Tab Action Recorded User(s) Time Time Dose/Rate Route Kristine Palaspas, 12/17/09 12/17/09 2 tablet ORAL RN 2127 2127
Site
Comment
Action Reason Given
Warnings Override History for Sennosides (SENOKOT) Tablet 2 Tab [48259130] No Warning History Available Order Audit Trail: Sennosides (SENOKOT) Tablet 2 Tab [48259130] Order Details After Change #1 - Rx Verify Name: Sennosides (SENOKOT) Tablet 2 Start time: 12/17/09 2100 Tab Frequency: DAILY AT BEDTIME Total # of doses: -Evan Reed, RPH 12/17/09 0532 End time: -First dose: As Scheduled Volume: -Route: ORAL
Priority: -Infusion Site: -Rate: -Duration: -Ordered dose: 2 tablet Admin dose: 2 tablet Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: SENNOSIDES 8.6 MG TABLET [14544] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: -Phase of care: -Order Questions:
Initial Order Details Jonathan G Eastman, MD 12/17/09 0529 Name: Sennosides (SENOKOT) Tablet 2 Start time: 12/17/09 2100 End time: -Tab Frequency: DAILY AT BEDTIME Total # of doses: -First dose: As Scheduled Priority: -Infusion Site: --
001268
Rate: -Duration: -Ordered dose: 2 tablet Admin dose: 2 tablet Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: SENNOSIDES 8.6 MG TABLET [14544] PRN reasons: -PRN comments: -Indications comments: -Indications of use: -Order comments: -Admin instructions: -Phase of care: -Order Questions:
Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/17/2009 5:29 AM Electronically Signed By/Authorizing Jonathan G Eastman, MD Department D14 Orthopedics/Trauma Reason None
This Order Has Been Discontinued Order Status By On Incoming 12/18/09 1834 Discontinued Scheduling Interface Isolation No Isolation Order Details Frequency DAILY AT BEDTIME
Ordering Provider EASTMAN, JONATHAN G [09983] Acknowledgement Info For At Placing Order 12/17/09 0529 Patient Information Patient Name MRN
Pager 916-762-7648 Acknowledged By Kristine Palaspas, RN Sex DOB Acknowledged On 12/17/09 0539
001269
Attending Provider(s) Ru Ya Cai, MD Jia Wang, MD Murali Adusumalli, MD
Admitting Provider Joanna Baginski, MD
Ordering Provider CAI, RU YA [09041] Acknowledgement Info For At Placing Order 12/19/09 2319 Patient Information Patient Name Amundsen, Mark Unit T4EM MRN 8081369 Room 4661
Pager 916-762-5896 Acknowledged By Encarnacion Arenas, RN Sex Male Acknowledged On 12/19/09 2333 DOB 9/23/1959 Bed 466102
Account # 050017321477
Medication
Medication Detail Methadone (DOLOPHINE) Tablet 40 mg Route: ORAL Admin Dose: 4 tablet (4 10 mg tablet) Class: Inpatient Normal Last Admin Time: 12/18/09 0850 Number of Doses: 1
Methadone (DOLOPHINE) Tablet 40 mg (Order 48310526) Dose 40 mg Frequency ONE TIME ONLY Start 12/18/2009 0900 End 12/18/2009 0850
All Administrations of Methadone (DOLOPHINE) Tablet 40 mg Action Recorded User(s) Time Time Dose/Rate Route Bryan Owens 12/18/09 12/18/09 40 mg ORAL 0850 0854
Site
Comment
Action Reason Given
Warnings Override History for Methadone (DOLOPHINE) Tablet 40 mg [48310526] Overridden by Grace Parng, RPH on 12/18/09 0900 Dose 1. METHADONE 10 MG TAB: EXCEEDS RECOMMENDED MAXIMUM SINGLE DOSE BY 34% (10 MG) Duplicate Medication Order 1. METHADONE HCL,PO, NON-PRN ORDER Methadone (DOLOPHINE) Tablet 40 mg Other Orders: Methadone (DOLOPHINE) Tablet 50 mg
001270
Order Audit Trail: Methadone (DOLOPHINE) Tablet 40 mg [48310526] Order Details After Change #1 - Rx Verify Grace Parng, RPH 12/18/09 0900 Name: Methadone (DOLOPHINE) Tablet Start time: 12/18/09 0900 End time: -40 mg Frequency: ONE TIME ONLY Total # of doses: 1 First dose: -Priority: -Infusion Site: -Rate: -Duration: -Volume: -Admin dose: 40 mg Route: ORAL Ordered dose: 40 mg Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: METHADONE 10 MG TABLET [5425] PRN reasons: -PRN comments: -Indications comments: -Indications of use: -Order comments: -Admin instructions: -Phase of care: -Order Questions: Does use meet BLACK BOX WARNING Primary Service Attending Physician has approved use of restrictions? Methadone in accordance with UCDHS Methadone Therapy Inititation and Monitoring Guidance Initial Order Details Jonathan G Eastman, MD 12/18/09 0841 Name: Methadone (DOLOPHINE) Tablet Start time: 12/18/09 0900 End time: -40 mg Frequency: ONE TIME ONLY Total # of doses: 1 First dose: -Infusion Site: -Priority: -Rate: -Duration: -Volume: -Ordered dose: 40 mg Admin dose: 40 mg Route: ORAL Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: METHADONE 10 MG TABLET [5425] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: -Phase of care: -Order Questions: Does use meet BLACK BOX WARNING Primary Service Attending Physician has approved use of restrictions? Methadone in accordance with UCDHS Methadone Therapy Inititation and Monitoring Guidance Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE
001271
Encounter View Encounter Order Info Date and Time 12/18/2009 8:41 AM Electronically Signed By/Authorizing Jonathan G Eastman, MD Department D14 Orthopedics/Trauma
Order Questions Question Does use meet BLACK BOX WARNING restrictions?
Answer Comment Primary Service Attending Physician has approved use of Methadone in accordance with UCDHS Methadone Therapy Inititation and Monitoring Guidance
Isolation No Isolation Order Details Frequency ONE TIME ONLY Duration 1 occurrence Priority None Order Class Inpatient Normal
Pager 916-762-7648 Acknowledged By Bryan Owens Acknowledged On 12/18/09 0847
Acknowledgement Info For At Placing Order 12/18/09 0841 Patient Information Patient Name Amundsen, Mark Unit D14O MRN 8081369
Sex Male
DOB 9/23/1959 Bed 147871
Room 14787
Account # 010016806878
Account Information Acct Number 010016806878 Visit CSN CSN Number:
001272
28141367
Medication
Medication Detail Methadone (DOLOPHINE) Tablet 40 mg Route: ORAL Admin Dose: 4 tablet (4 10 mg tablet) Admin Instructions: Hold for RR< 10 or Sedation Score>1/4 Class: Inpatient Normal

Dose 40 mg Frequency DAILY MORNING Start 12/18/2009 0900 End 12/18/2009 1834
All Administrations of Methadone (DOLOPHINE) Tablet 40 mg No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) Tablet 40 mg [48286376] Overridden by Diana Hao, RPH on 12/17/09 1456 Duplicate Medication Order 1. METHADONE HCL,PO, NON-PRN ORDER Methadone (DOLOPHINE) Tablet 50 mg Other Orders: Methadone (DOLOPHINE) Tablet 40 mg
Order Override History User Override Time Jonathan G 12/17/09 1449 Eastman, MD
Previous Schedule 0900
Adjusted Schedule 0800
Override Reason
Order Audit Trail: Methadone (DOLOPHINE) Tablet 40 mg [48286376] Order Details After Change #1 - Rx Verify Diana Hao, RPH 12/17/09 1456 Name: Methadone (DOLOPHINE) Tablet Start time: 12/18/09 0900 End time: -40 mg Frequency: DAILY MORNING Total # of doses: -First dose: -Priority: -Infusion Site: -Rate: -Duration: -Volume: -Ordered dose: 40 mg Admin dose: 40 mg Route: ORAL Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: METHADONE 10 MG TABLET [5425] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: Hold for RR< 10 or Sedation Score>1/4 Phase of care: -Order Questions: Does use meet BLACK BOX WARNING NO-ENTER INDICATION IN COMMENTS restrictions?
001273
Initial Order Details Jonathan G Eastman, MD 12/17/09 1449 Name: Methadone (DOLOPHINE) Tablet Start time: 12/18/09 0900 End time: -40 mg Frequency: DAILY MORNING Total # of doses: -First dose: -Priority: -Infusion Site: -Rate: -Duration: -Volume: -Ordered dose: 40 mg Admin dose: 40 mg Route: ORAL Dispense from: D14O-4_PYXIS First doses from: D14O-4_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: METHADONE 10 MG TABLET [5425] PRN comments: -PRN reasons: -Indications of use: -Indications comments: -Order comments: -Admin instructions: Hold for RR< 10 or Sedation Score>1/4 Phase of care: -Order Questions: Does use meet BLACK BOX WARNING NO-ENTER INDICATION IN COMMENTS restrictions? Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Department D14 Orthopedics/Trauma Reason None
This Order Has Been Discontinued Order Status By On Incoming 12/18/09 1834 Discontinued Scheduling Interface Order Questions Question Does use meet BLACK BOX WARNING restrictions? Isolation No Isolation Order Details Frequency DAILY MORNING
Duration None Priority None Answer NO-ENTER INDICATION IN COMMENTS
Comment
Order History Order Date/Time 12/17/09 1449 12/15/09 1550
Order ID 48286376 48191970
001274
12/02/09 1354 11/06/09 1450 10/09/09 1635 09/15/09 1356 08/20/09 0823 07/24/09 1445 06/26/09 1500 06/02/09 1316 05/07/09 1512 04/09/09 1151
03/16/09 1008 02/13/09 0901 01/20/09 1025 12/22/08 1330 12/01/08 0956 11/03/08 0853 10/06/08 1735 09/05/08 1008 08/11/08 1128 06/27/08 0901 06/06/08 1714 04/30/08 1359 04/23/08 1255 04/04/08 1253 03/12/08 1720 01/10/08 1229 12/13/07 1239 11/16/07 1444 10/22/07 1713 09/17/07 1803 08/31/07 0809 08/07/07 1735 07/16/07 1512 06/22/07 1112 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information Ordering User
Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Gertrudes Perlas Montemayor, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Ordering Provider
47648844 46641416 45578181 44543839 43512111 42415608 41358443 40335571 39316280 38152050
37025430 35855444 34942551 33955136 33114228 32060748 31022473 29814812 28998118 27379159 26682012 25327454 25043810 24527577 23982000 22429171 21876329 21267173 20658809 19830274 19493600 18998255 18553324 18102039 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
001275
Ordering Provider CAI, RU YA [09041] Acknowledgement Info For At Placing Order 12/19/09 2319 Patient Information Patient Name Amundsen, Mark
Unit T4EM
Pager 916-762-5896 Acknowledged By Encarnacion Arenas, RN MRN 8081369

Room 4661

Bed 466102
Sex Male
Medication
Medication Detail
Acetaminophen (TYLENOL) Tablet 650 mg (Order 48367778)

Dose 650 mg Frequency EVERY 4 HOURS IF NEEDED Start 12/19/2009 2315 End 12/21/2009 2333
Acetaminophen (TYLENOL) Tablet 650 mg
Route: ORAL Admin Dose: 2 tablet (2 325 mg tablet) Admin Instructions: Do not exceed 4000 mg TOTAL acetaminophen per 24 hours. PRN Reason(s): headache, temp greater than 38, mild pain Class: Inpatient Normal Last Admin Time: 12/20/09 0350 All Administrations of Acetaminophen (TYLENOL) Tablet 650 mg Action Recorded User(s) Time Time Dose/Rate Route Site Encarnacion Arenas, 12/20/09 12/20/09 650 mg ORAL RN 0350 0409
Comment pre-med prior to blood transfusion per MD
Action Reason Given
Warnings Override History for Acetaminophen (TYLENOL) Tablet 650 mg [48367778] No Warning History Available Order Audit Trail: Acetaminophen (TYLENOL) Tablet 650 mg [48367778] Order Details After Change #1 - Rx Verify Joseph P Gee, RPH 12/19/09 2333 Start time: 12/19/09 2315 End time: -Name: Acetaminophen (TYLENOL) Tablet 650 mg Frequency: EVERY 4 HOURS IF Total # of doses: -First dose: -NEEDED Priority: -Infusion Site: --
001276
Rate: -Duration: -Ordered dose: 650 mg Admin dose: 650 mg Dispense from: T4LEFT_PYXIS First doses from: T4LEFT_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: ACETAMINOPHEN 325 MG TABLET [112] PRN comments: -PRN reasons: headache, temp greater than 38, mild pain Indications of use: -Indications comments: -Order comments: -Admin instructions: Do not exceed 4000 mg TOTAL acetaminophen per 24 hours. Phase of care: -Order Questions:
Initial Order Details Ru Ya Cai, MD 12/19/09 2319 Name: Acetaminophen (TYLENOL) Start time: 12/19/09 2315 End time: -Tablet 650 mg Frequency: EVERY 4 HOURS IF Total # of doses: -First dose: -NEEDED Priority: -Infusion Site: -Rate: -Duration: -Volume: -Ordered dose: 650 mg Admin dose: 650 mg Route: ORAL Dispense from: T4LEFT_PYXIS First doses from: T4LEFT_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: ACETAMINOPHEN 325 MG TABLET [112] PRN comments: -PRN reasons: headache, temp greater than 38, mild pain Indications of use: -Indications comments: -Order comments: -Admin instructions: Do not exceed 4000 mg TOTAL acetaminophen per 24 hours. Phase of care: -Order Questions: Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/19/2009 11:19 PM Electronically Signed By/Authorizing Ru Ya Cai, MD Department T4 Ent/Internal Medicine Reason None
This Order Has Been Discontinued Order Status By On Incoming 12/21/09 2333 Discontinued Scheduling Interface Isolation
001277
No Isolation Order Details Frequency EVERY 4 HOURS IF NEEDED Duration None Priority None Order Class Inpatient Normal
Provider Information Ordering User Ru Ya Cai, MD Attending Provider(s) Ru Ya Cai, MD Jia Wang, MD Murali Adusumalli, MD
Ordering Provider Ru Ya Cai, MD Admitting Provider Joanna Baginski, MD
Authorizing Provider Ru Ya Cai, MD PCP Victor Henrique Baquero, MD Billing Provider Ru Ya Cai, MD
Ordering Provider CAI, RU YA [09041] Acknowledgement Info For At Placing Order 12/19/09 2319 Patient Information Patient Name Amundsen, Mark Unit T4EM MRN 8081369 Room 4661
Pager 916-762-5896 Acknowledged By Encarnacion Arenas, RN Sex Male Acknowledged On 12/19/09 2331 DOB 9/23/1959 Bed 466102
Account # 050017321477
Medication
Medication Detail Bisacodyl (DULCOLAX) Suppository 10 mg
Bisacodyl (DULCOLAX) Suppository 10 mg (Order 48367777) Dose 10 mg Frequency EVERY 24 HOURS IF NEEDED Start 12/19/2009 2315 End 12/21/2009 2333
Route: RECTALLY Admin Dose: 1 suppository (1 10 mg suppository) PRN Reason(s): constipation Class: Inpatient Normal All Administrations of Bisacodyl (DULCOLAX) Suppository 10 mg No Administrations Recorded Warnings Override History for Bisacodyl (DULCOLAX) Suppository 10 mg [48367777]
001278
No Warning History Available Order Audit Trail: Bisacodyl (DULCOLAX) Suppository 10 mg [48367777] Order Details After Change #1 - Rx Verify Evan Reed, RPH 12/19/09 2356 Start time: 12/19/09 2315 End time: -Name: Bisacodyl (DULCOLAX) Suppository 10 mg Frequency: EVERY 24 HOURS IF Total # of doses: -First dose: -NEEDED Priority: -Infusion Site: -Rate: -Duration: -Volume: -Admin dose: 10 mg Route: Ordered dose: 10 mg RECTALLY First doses from: T4LEFT_PYXIS Dispense from: T4LEFT_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: BISACODYL 10 MG RECTAL SUPPOSITORY [1175] PRN reasons: constipation PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: -Phase of care: -Order Questions: Initial Order Details Name: Bisacodyl (DULCOLAX) Suppository 10 mg Frequency: EVERY 24 HOURS IF NEEDED Priority: -Rate: -Ordered dose: 10 mg Start time: 12/19/09 2315 Total # of doses: -Infusion Site: -Duration: -Admin dose: 10 mg Ru Ya Cai, MD 12/19/09 2319 End time: -First dose: --
Volume: -Route: RECTALLY
First doses from: T4LEFT_PYXIS Dispense from: T4LEFT_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: BISACODYL 10 MG RECTAL SUPPOSITORY [1175] PRN reasons: constipation PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: -Phase of care: -Order Questions: Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Electronically Signed
001279
Date and Time 12/19/2009 11:19 PM
By/Authorizing Ru Ya Cai, MD
Department T4 Ent/Internal Medicine Reason None
This Order Has Been Discontinued Order Status By On Incoming 12/21/09 2333 Discontinued Scheduling Interface Isolation No Isolation Order Details Frequency EVERY 24 HOURS IF NEEDED
Ordering Provider Ru Ya Cai, MD
Authorizing Provider Ru Ya Cai, MD
Ordering Provider CAI, RU YA [09041]
Pager 916-762-5896 Acknowledged By Encarnacion Arenas, RN MRN 8081369 Sex Male Acknowledged On 12/19/09 2331 DOB 9/23/1959
Acknowledgement Info For At Placing Order 12/19/09 2319 Patient Information Patient Name Amundsen, Mark Unit T4EM
Room 4661
Bed 466102
Medication
Medication Detail
DiphenhydrAMINE (BENADRYL) Capsule 25 mg (Order 48367779) Frequency PREMED Start 12/19/2009 2315 End 12/21/2009 2333
Dose 25 mg DiphenhydrAMINE (BENADRYL) Capsule 25 mg Route: ORAL Admin Dose: 1 capsule (1 25 mg capsule)
001280
Admin Instructions: May give PO/NG
Class: Inpatient Normal Last Admin Time: 12/20/09 0350 All Administrations of DiphenhydrAMINE (BENADRYL) Capsule 25 mg Action Recorded User(s) Time Time Dose/Rate Route Site Encarnacion Arenas, 12/20/09 12/20/09 25 mg ORAL RN 0350 0408
Comment
Action Reason Given
Warnings Override History for DiphenhydrAMINE (BENADRYL) Capsule 25 mg [48367779] No Warning History Available Order Audit Trail: DiphenhydrAMINE (BENADRYL) Capsule 25 mg [48367779] Order Details After Change #1 - Rx Verify Joseph P Gee, RPH 12/19/09 2333 End time: -Name: DiphenhydrAMINE (BENADRYL) Start time: 12/19/09 2315 Capsule 25 mg Frequency: PREMED Total # of doses: -First dose: As Scheduled Priority: -Infusion Site: -Rate: -Duration: -Volume: -Ordered dose: 25 mg Admin dose: 25 mg Route: ORAL Dispense from: T4LEFT_PYXIS First doses from: T4LEFT_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: DIPHENHYDRAMINE 25 MG CAPSULE [2707] PRN reasons: -PRN comments: -Indications comments: -Indications of use: -Order comments: -Admin instructions: May give PO/NG Phase of care: -Order Questions: Initial Order Details Name: DiphenhydrAMINE (BENADRYL) Capsule 25 mg Frequency: PREMED Start time: 12/19/09 2315 Total # of doses: -Ru Ya Cai, MD 12/19/09 2319 End time: -First dose: As Scheduled Volume: -Route: ORAL
Priority: -Infusion Site: -Rate: -Duration: -Ordered dose: 25 mg Admin dose: 25 mg Dispense from: T4LEFT_PYXIS First doses from: T4LEFT_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: DIPHENHYDRAMINE 25 MG CAPSULE [2707] PRN comments: -PRN reasons: -Indications of use: -Indications comments: -Order comments: -Admin instructions: May give PO/NG Phase of care: --
001281
Order Questions: Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Date and Time 12/19/2009 11:19 PM
Electronically Signed By/Authorizing Ru Ya Cai, MD
This Order Has Been Discontinued Order Status By On Incoming 12/21/09 2333 Discontinued Scheduling Interface Isolation No Isolation Order Details Frequency PREMED Duration None Priority None
Provider Information Ordering User Ru Ya Cai, MD

Attending Provider(s) Ru Ya Cai, MD


PCP Victor Henrique Baquero, MD Billing Provider Ru Ya Cai, MD
Jia Wang, MD Murali Adusumalli, MD
Unit T4EM

Room 4661

Bed 466102
Sex Male
001282
Medication
Medication Detail
DiphenhydrAMINE (BENADRYL) Capsule 25-50 mg (Order 48368166) Dose 25-50 mg Frequency EVERY 6 HOURS IF NEEDED Start 12/19/2009 2343 End 12/21/2009 2333
DiphenhydrAMINE (BENADRYL) Capsule 25-50 mg
Route: ORAL Admin Dose: 1-2 capsule (1-2 25 mg capsule) PRN Reason(s): itching Class: Inpatient Normal All Administrations of DiphenhydrAMINE (BENADRYL) Capsule 25-50 mg No Administrations Recorded Warnings Override History for DiphenhydrAMINE (BENADRYL) Capsule 25-50 mg [48368166] No Warning History Available Order Audit Trail: DiphenhydrAMINE (BENADRYL) Capsule 25-50 mg [48368166] Order Details After Change #1 - Rx Verify Evan Reed, RPH 12/19/09 2356 Name: DiphenhydrAMINE (BENADRYL) Start time: 12/19/09 2343 End time: -Capsule 25-50 mg Total # of doses: -First dose: -Frequency: EVERY 6 HOURS IF NEEDED Priority: -Infusion Site: -Rate: -Duration: -Volume: -Ordered dose: 25-50 mg Admin dose: 25-50 mg Route: ORAL Dispense from: T4LEFT_PYXIS First doses from: T4LEFT_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: DIPHENHYDRAMINE 25 MG CAPSULE [2707] PRN comments: -PRN reasons: itching Indications of use: -Indications comments: -Order comments: -Admin instructions: -Phase of care: -Order Questions: Initial Order Details Name: DiphenhydrAMINE (BENADRYL) Capsule 25-50 mg Frequency: EVERY 6 HOURS IF NEEDED Priority: -Rate: -Ordered dose: 25-50 mg Dispense from: T4LEFT_PYXIS Dispense code: UD Grouper Patient supplied med? No Do not dispense? No Dispense only once? No Self administered? No Start time: 12/19/09 2343 Total # of doses: -Infusion Site: -Duration: -Admin dose: 25-50 mg First doses from: T4LEFT_PYXIS PRN par level # of doses: -Patient supplied # of doses: 0 Do not dispense # of doses: 0 Triggered fill list? No Individual ingredients? No Ru Ya Cai, MD 12/19/09 2343 End time: -First dose: --
001283
Components: DIPHENHYDRAMINE 25 MG CAPSULE [2707] PRN reasons: itching PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: -Phase of care: -Order Questions: Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/19/2009 11:43 PM Electronically Signed By/Authorizing Ru Ya Cai, MD Department T4 Ent/Internal Medicine Reason None
This Order Has Been Discontinued Order Status By On Incoming 12/21/09 2333 Discontinued Scheduling Interface Isolation No Isolation Order Details Frequency EVERY 6 HOURS IF NEEDED
Acknowledgement Info For At Placing Order 12/19/09 2343 Patient Information Patient Name Amundsen, Mark Unit T4EM
Room 4661
Bed 466102
Account #
001284
050017321477 Account Information Acct Number 050017321477 Visit CSN CSN Number: 29359774
Medication
Medication Detail
Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) Tablet 1 Tab (Order 48367757)

Dose 1 tablet Frequency EVERY 4 HOURS IF NEEDED Start 12/19/2009 2259 End 12/21/2009 2333
Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) Tablet 1 Tab
Route: ORAL Admin Dose: 1 tablet Admin Instructions: Do not exceed 4000 mg TOTAL acetaminophen per 24 hours. PRN Reason(s): mild to moderate pain Class: Inpatient Normal All Administrations of Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) Tablet 1 Tab No Administrations Recorded Warnings Override History for Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) Tablet 1 Tab [48367757] Overridden by Joseph P Gee, RPH on 12/19/09 2333 Drug-Allergy (Active and Inactive Ingredients) 1. MORPHINE [Level: Level 3]
Order Audit Trail: Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) Tablet 1 Tab [48367757] Order Details After Change #1 - Rx Verify Joseph P Gee, RPH 12/19/09 2333 Name: Hydrocodone 10 Start time: 12/19/09 2259 End time: -mg/Acetaminophen 325 mg (NORCO) Tablet 1 Tab Total # of doses: -First dose: -Frequency: EVERY 4 HOURS IF NEEDED Priority: -Infusion Site: -Rate: -Duration: -Volume: -Ordered dose: 1 tablet Admin dose: 1 tablet Route: ORAL Dispense from: T4LEFT_PYXIS First doses from: T4LEFT_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET [30179] PRN reasons: mild to moderate pain PRN comments: -Indications comments: -Indications of use: -Order comments: -Admin instructions: Do not exceed 4000 mg TOTAL acetaminophen per 24 hours. Phase of care: --
001285
Order Questions: Initial Order Details Ru Ya Cai, MD 12/19/09 2319 Name: Hydrocodone 10 Start time: 12/19/09 2259 End time: -mg/Acetaminophen 325 mg (NORCO) Tablet 1 Tab Total # of doses: -First dose: -Frequency: EVERY 4 HOURS IF NEEDED Priority: -Infusion Site: -Rate: -Duration: -Volume: -Ordered dose: 1 tablet Admin dose: 1 tablet Route: ORAL First doses from: T4LEFT_PYXIS Dispense from: T4LEFT_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET [30179] PRN reasons: mild to moderate pain PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: Do not exceed 4000 mg TOTAL acetaminophen per 24 hours. Phase of care: -Order Questions: Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Date and Time 12/19/2009 11:19 PM
This Order Has Been Discontinued Order Status By On Incoming 12/21/09 2333 Discontinued Scheduling Interface Isolation No Isolation Order Details Frequency EVERY 4 HOURS IF NEEDED Duration None Priority None
Order History Order Date/Time 12/19/09 2319 12/16/09 1039 Provider Information Ordering User Ru Ya Cai, MD
User Ru Ya Cai, MD Jennifer Mello, PHRMTECH Ordering Provider Ru Ya Cai, MD
Order ID 48367757 48222914
001286
Patient Information Patient Name Amundsen, Mark Unit T4EM
MRN 8081369 Room 4661
Sex Male
DOB 9/23/1959 Bed 466102
Account # 050017321477
Medication
Medication Detail
Study Drug - Fondaparinux (IRB 200816251) Syringe 2.5 mg (Order 48376818) Start 12/20/2009 1500 End 12/20/2009 2100
Dose Frequency 2.5 mg ONE TIME Study Drug - Fondaparinux (IRB ONLY 200816251) Syringe 2.5 mg Route: SUBCUTANEOUS Admin Dose: 0.5 mL = 2.5 mg of 2.5 mg/0.5 mL Admin Instructions: Begin 12-24 hours after surgery for 10 days. Do not give the drug IM. Please complete questionnaire if you are new to this study. Class: Inpatient Normal Last Admin Time: 12/20/09 2100 Number of Doses: 1
All Administrations of Study Drug - Fondaparinux (IRB 200816251) Syringe 2.5 mg Recorded Action Time Time Dose/Rate Route Site Comment Action Reason User(s) Darcey Arnold, 12/20/09 12/21/09 2.5 mg SUBCUTANEOUS Right Given RN 2100 0012 upper arm Warnings Override History for Study Drug - Fondaparinux (IRB 200816251) Syringe 2.5 mg [48376818] No Warning History Available Order Audit Trail: Study Drug - Fondaparinux (IRB 200816251) Syringe 2.5 mg [48376818] Order Details After Change #1 - Rx Verify William E Dager, RPH 12/20/09 1250 Name: Study Drug - Fondaparinux (IRB Start time: 12/20/09 1500 End time: -200816251) Syringe 2.5 mg Frequency: ONE TIME ONLY Total # of doses: 1 First dose: -Priority: -Infusion Site: -Rate: -Duration: -Volume: -Ordered dose: 2.5 mg Admin dose: 2.5 mg Route: SUBCUTANEOUS Dispense from: 8RX_UCDMC First doses from: 8RX_UCDMC Dispense code: UD PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No
001287
Components: STUDY DRUG - FONDAPARINUX 2.5 MG/0.5 ML SYRINGE - ARIXTRA TOTAL JOINT ARTHROPLASTY (200816251) [3000529] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: Begin 12-24 hours after surgery for 10 days. Do not give the drug IM. Please complete questionnaire if you are new to this study. Phase of care: -Order Questions: Initial Order Details Name: Study Drug - Fondaparinux (IRB 200816251) Syringe 2.5 mg Frequency: ONE TIME ONLY Priority: -Rate: -Ordered dose: 2.5 mg William E Dager, RPH 12/20/09 1250 Start time: 12/20/09 1500 End time: -Total # of doses: 1 Infusion Site: -Duration: -Admin dose: 2.5 mg First dose: -Volume: -Route: SUBCUTANEOUS
Dispense from: 8RX_UCDMC First doses from: 8RX_UCDMC Dispense code: UD PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: STUDY DRUG - FONDAPARINUX 2.5 MG/0.5 ML SYRINGE - ARIXTRA TOTAL JOINT ARTHROPLASTY (200816251) [3000529] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: Begin 12-24 hours after surgery for 10 days. Do not give the drug IM. Please complete questionnaire if you are new to this study. Phase of care: -Order Questions: Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/20/2009 12:50 PM Isolation No Isolation Order Details Frequency ONE TIME ONLY Duration 1 occurrence Priority None Order Class Inpatient Normal Electronically Signed By William E Dager Authorizing Jia Wang Department T4 Ent/Internal Medicine
Provider Information Ordering User William E Dager, RPH

Ordering Provider Jia Wang, MD

Authorizing Provider Jia Wang, MD

PCP Victor Henrique Baquero, Billing Provider Jia Wang, MD
001288
MD
Ordering Provider WANG, JIA [09895]
Pager 916-762-9629 Acknowledged By Christena R Schob, RN Acknowledged On 12/20/09 1322
Acknowledgement Info For At Placing Order 12/20/09 1250 Verbal Order Info Action Ordering Patient Information Patient Name Amundsen, Mark Unit T4EM Order Mode Verbal with Read Back
Communicator William E Dager, RPH MRN 8081369 Room 4661
Signed By Jia Wang, MD
Signed On 12/20/09 2007
Sex Male
DOB 9/23/1959 Bed 466102
Account # 050017321477
Medication
Medication Detail Carisoprodol (SOMA) Tablet 700 mg Route: ORAL Admin Dose: 2 tablet (2 350 mg tablet) Class: Inpatient Normal Last Admin Time: 12/20/09 2100
Carisoprodol (SOMA) Tablet 700 mg (Order 48367755) Dose 700 mg Frequency DAILY AT BEDTIME Start 12/20/2009 0000 End 12/21/2009 2333
All Administrations of Carisoprodol (SOMA) Tablet 700 mg Action Recorded User(s) Time Time Dose/Rate Route Darcey Arnold, RN 12/20/09 12/21/09 700 mg ORAL 2100 0009 Encarnacion Arenas, 12/20/09 12/20/09 700 mg ORAL RN 0200 0206
Site
Comment
Action Reason Given
Given
Warnings Override History for Carisoprodol (SOMA) Tablet 700 mg [48367755] Overridden by Joseph P Gee, RPH on 12/19/09 2334 Dose 1. CARISOPRODOL 350 MG TAB: BELOW RECOMMENDED MINIMUM DAILY DOSE BY 7% (50 MG); EXCEEDS RECOMMENDED MAXIMUM SINGLE DOSE BY 100% (350 MG); BELOW FREQUENCY
001289
Order Audit Trail: Carisoprodol (SOMA) Tablet 700 mg [48367755] Order Details After Change #1 - Rx Verify Joseph P Gee, RPH 12/19/09 2334 Name: Carisoprodol (SOMA) Tablet 700 Start time: 12/20/09 0000 End time: -mg Frequency: DAILY AT BEDTIME Total # of doses: -First dose: As Scheduled Priority: -Infusion Site: -Rate: -Duration: -Volume: -Admin dose: 700 mg Route: ORAL Ordered dose: 700 mg Dispense from: T4LEFT_PYXIS First doses from: T4LEFT_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: CARISOPRODOL 350 MG TABLET [1520] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: -Phase of care: -Order Questions: Initial Order Details Name: Carisoprodol (SOMA) Tablet 700 mg Frequency: DAILY AT BEDTIME Start time: 12/20/09 0000 Total # of doses: -Ru Ya Cai, MD 12/19/09 2319 End time: -First dose: As Scheduled Volume: -Route: ORAL
Priority: -Infusion Site: -Rate: -Duration: -Admin dose: 700 mg Ordered dose: 700 mg Dispense from: T4LEFT_PYXIS First doses from: T4LEFT_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: CARISOPRODOL 350 MG TABLET [1520] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: -Phase of care: -Order Questions:
Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Electronically Signed
001290
Date and Time 12/19/2009 11:19 PM
By/Authorizing Ru Ya Cai, MD
Order History Order Date/Time 12/19/09 2319 12/16/09 1039 Provider Information Ordering User Ru Ya Cai, MD
User Ru Ya Cai, MD Jennifer Mello, PHRMTECH
Order ID 48367755 48222915


Unit T4EM

Room 4661

Bed 466102
Sex Male
Medication
Medication Detail
Docusate (COLACE) Capsule 100 mg (Order 48367775)

Dose Frequency Start End
001291
Docusate (COLACE) Capsule 100 mg
100 mg
TWO TIMES DAILY
12/20/2009 0100
12/21/2009 2333
Route: ORAL Admin Dose: 1 capsule (1 100 mg capsule) Admin Instructions: Hold for loose stool Class: Inpatient Normal Last Admin Time: 12/21/09 0845 All Administrations of Docusate (COLACE) Capsule 100 mg Action Recorded User(s) Time Time Dose/Rate Route Christena R Schob, 12/21/09 12/21/09 100 mg ORAL 0845 0926 RN Darcey Arnold, RN 12/20/09 12/21/09 100 mg ORAL 2100 0009 Christena R Schob, 12/20/09 12/20/09 100 mg ORAL RN 0905 1544 Encarnacion Arenas, 12/20/09 12/20/09 100 mg ORAL RN 0200 0206
Site
Comment
Action Reason Given Given Given Given
Warnings Override History for Docusate (COLACE) Capsule 100 mg [48367775] No Warning History Available Order Audit Trail: Docusate (COLACE) Capsule 100 mg [48367775] Order Details After Change #1 - Rx Verify Joseph P Gee, RPH 12/19/09 2333 Name: Docusate (COLACE) Capsule Start time: 12/20/09 0100 End time: -100 mg Frequency: TWO TIMES DAILY Total # of doses: -First dose: As Scheduled Priority: -Infusion Site: -Rate: -Duration: -Volume: -Admin dose: 100 mg Route: ORAL Ordered dose: 100 mg Dispense from: T4LEFT_PYXIS First doses from: T4LEFT_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: DOCUSATE SODIUM 100 MG CAPSULE [2241] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: Hold for loose stool Phase of care: -Order Questions: Initial Order Details Name: Docusate (COLACE) Capsule 100 mg Frequency: TWO TIMES DAILY Priority: -Rate: -Ordered dose: 100 mg Dispense from: T4LEFT_PYXIS Dispense code: UD Grouper Start time: 12/20/09 0100 Total # of doses: -Infusion Site: -Duration: -Admin dose: 100 mg First doses from: T4LEFT_PYXIS PRN par level # of doses: -Ru Ya Cai, MD 12/19/09 2319 End time: -First dose: As Scheduled Volume: -Route: ORAL
001292
Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: DOCUSATE SODIUM 100 MG CAPSULE [2241] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: Hold for loose stool Phase of care: -Order Questions: Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/19/2009 11:19 PM Electronically Signed By/Authorizing Ru Ya Cai, MD Department T4 Ent/Internal Medicine Reason None
This Order Has Been Discontinued Order Status By On Incoming 12/21/09 2333 Discontinued Scheduling Interface Isolation No Isolation Order Details Frequency TWO TIMES DAILY
Provider Information Ordering User Ru Ya Cai, MD Attending Provider(s) Ru Ya Cai, MD

Billing Provider Ru Ya Cai, MD
Acknowledgement Info For At Placing Order 12/19/09 2319 Patient Information Patient Name Amundsen, Mark Unit
Room
Bed
001293
T4EM
4661
466102
Medication
Medication Detail
Ferrous Sulfate (FERATAB) Tablet 300 mg (Order 48368167) Dose 300 mg Frequency Start THREE 12/20/2009 TIMES DAILY 0900 End 12/21/2009 2333
Ferrous Sulfate (FERATAB) Tablet 300 mg
Route: ORAL Admin Dose: 1 tablet (1 300 mg tablet) Admin Instructions: Administer 2 hours before or 4 hours after antacids * 300 mg considered equivalent to 325 mg Class: Inpatient Normal Last Admin Time: 12/21/09 1630 All Administrations of Ferrous Sulfate (FERATAB) Tablet 300 mg Action Recorded User(s) Time Time Dose/Rate Route Site 12/21/09 12/21/09 300 mg ORAL Christena R Schob, 1630 1646 RN Christena R Schob, 12/21/09 12/21/09 300 mg ORAL RN 0845 0926 ORAL Darcey Arnold, RN 12/20/09 12/21/09 300 mg 2100 0009 Christena R Schob, 12/20/09 12/20/09 300 mg ORAL RN 1610 1623 Christena R Schob, 12/20/09 12/20/09 300 mg ORAL RN 0905 1544
Comment
Action Reason Given Given Given Given Given
Warnings Override History for Ferrous Sulfate (FERATAB) Tablet 300 mg [48368167] No Warning History Available Order Audit Trail: Ferrous Sulfate (FERATAB) Tablet 300 mg [48368167] Order Details After Change #1 - Rx Verify Name: Ferrous Sulfate (FERATAB) Start time: 12/20/09 0900 Tablet 300 mg Frequency: THREE TIMES DAILY Total # of doses: -Priority: -Rate: -Ordered dose: 300 mg Dispense from: T4LEFT_PYXIS Dispense code: UD Grouper Patient supplied med? No Do not dispense? No Dispense only once? No Evan Reed, RPH 12/19/09 2356 End time: -First dose: As Scheduled Volume: -Route: ORAL
Infusion Site: -Duration: -Admin dose: 300 mg First doses from: T4LEFT_PYXIS PRN par level # of doses: -Patient supplied # of doses: 0 Do not dispense # of doses: 0 Triggered fill list? No
001294
Self administered? No Individual ingredients? No Components: FERROUS SULFATE 300 MG (60 MG IRON) TABLET [44943] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: Administer 2 hours before or 4 hours after antacids * 300 mg considered equivalent to 325 mg Phase of care: -Order Questions: Initial Order Details Name: Ferrous Sulfate (FERATAB) Tablet 300 mg Frequency: THREE TIMES DAILY Start time: 12/20/09 0900 Total # of doses: -Ru Ya Cai, MD 12/19/09 2343 End time: -First dose: As Scheduled
Priority: -Infusion Site: -Rate: -Duration: -Volume: -Admin dose: 300 mg Route: ORAL Ordered dose: 300 mg Dispense from: 8RX_UCDMC First doses from: 8RX_UCDMC Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: FERROUS SULFATE 300 MG (60 MG IRON) TABLET [44943] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: Administer 2 hours before or 4 hours after antacids * 300 mg considered equivalent to 325 mg Phase of care: -Order Questions: Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/19/2009 11:43 PM Electronically Signed By/Authorizing Ru Ya Cai, MD Department T4 Ent/Internal Medicine Reason None
This Order Has Been Discontinued Order Status By On Incoming 12/21/09 2333 Discontinued Scheduling Interface Isolation No Isolation Order Details Frequency THREE TIMES DAILY
001295
Ordering User Ru Ya Cai, MD



Unit T4EM

Room 4661

Bed 466102
Sex Male
Medication
Medication Detail Fluoxetine (PROZAC) 40 mg
Dose 1 capsule
Fluoxetine (PROZAC) 40 mg (Order 48367756)

Frequency DAILY MORNING Start 12/20/2009 0900 End 12/20/2009 0710
Route: ORAL Admin Dose: 1 capsule (1 40 mg capsule) Reason for Discontinue: Pharmacy product adjustment Non-formulary Exception Code: Taking this medication prior to admission Class: Inpatient Normal All Administrations of Fluoxetine (PROZAC) 40 mg No Administrations Recorded Warnings Override History for Fluoxetine (PROZAC) 40 mg [48367756] No Warning History Available Order Audit Trail: Fluoxetine (PROZAC) 40 mg [48367756] Order Details After Change #1 - Rx Verify Joseph P Gee, RPH 12/19/09 2334 Name: Fluoxetine (PROZAC) 40 mg Start time: 12/20/09 0900 End time: -Frequency: DAILY MORNING Total # of doses: -First dose: As Scheduled Priority: -Infusion Site: --
001296
Rate: -Duration: -Ordered dose: 1 capsule Admin dose: 40 mg Dispense from: 8RX_UCDMC First doses from: 8RX_UCDMC Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: FLUOXETINE 40 MG CAPSULE [22553] PRN reasons: -PRN comments: -Indications comments: -Indications of use: -Order comments: -Admin instructions: -Phase of care: -Order Questions: Initial Order Details Name: Fluoxetine (PROZAC) 40 mg Frequency: DAILY MORNING Start time: 12/20/09 0900 Total # of doses: --
Ru Ya Cai, MD 12/19/09 2319 End time: -First dose: As Scheduled Volume: -Route: ORAL
Priority: -Infusion Site: -Rate: -Duration: -Ordered dose: 1 capsule Admin dose: 40 mg Dispense from: 8RX_UCDMC First doses from: 8RX_UCDMC Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: FLUOXETINE 40 MG CAPSULE [22553] PRN reasons: -PRN comments: -Indications comments: -Indications of use: -Order comments: -Admin instructions: -Phase of care: -Order Questions:
Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/19/2009 11:19 PM Electronically Signed By/Authorizing Ru Ya Cai, MD On 12/20/09 0710 Department T4 Ent/Internal Medicine Reason Pharmacy product adjustment
This Order Has Been Discontinued Order Status By Joseph P Gee, RPH Discontinued Isolation No Isolation Order Details
001297
Frequency DAILY MORNING
Duration None
Priority None
Order History Order Date/Time 12/19/09 2319 12/16/09 1039 Provider Information Ordering User Ru Ya Cai, MD Attending Provider(s) Ru Ya Cai, MD Jia Wang, MD Murali Adusumalli, MD
User Ru Ya Cai, MD Jennifer Mello, PHRMTECH Ordering Provider Ru Ya Cai, MD Admitting Provider Joanna Baginski, MD
Order ID 48367756 48222913
Ordering Provider CAI, RU YA [09041] Acknowledgement Info For At Placing Order 12/19/09 2319 D/C Order 12/20/09 0710 Patient Information Patient Name Amundsen, Mark Unit T4EM
MRN 8081369
Pager 916-762-5896 Acknowledged By Encarnacion Arenas, RN Christena R Schob, RN

Sex Male
Acknowledged On 12/19/09 2333 12/20/09 0925

DOB 9/23/1959
Room 4661
Bed 466102
Medication
Medication Detail Fluoxetine (PROZAC) Capsule 40 mg
Fluoxetine (PROZAC) Capsule 40 mg (Order 48372558) Dose 40 mg Frequency DAILY MORNING Start 12/20/2009 0900 End 12/21/2009 2333
Route: ORAL Admin Dose: 2 capsule (2 20 mg capsule) Non-formulary Exception Code: Taking this medication prior to admission Class: Inpatient Normal Last Admin Time: 12/21/09 0845 All Administrations of Fluoxetine (PROZAC) Capsule 40 mg Action Recorded
001298
User(s) Christena R Schob, RN Christena R Schob, RN
Time 12/21/09 0845 12/20/09 0905
Time 12/21/09 0926 12/20/09 1544
Dose/Rate Route 40 mg ORAL 40 mg ORAL
Site
Comment
Warnings Override History for Fluoxetine (PROZAC) Capsule 40 mg [48372558] No Warning History Available Order Audit Trail: Fluoxetine (PROZAC) Capsule 40 mg [48372558] Order Details After Change #1 - Rx Verify Joseph P Gee, RPH 12/20/09 0711 Name: Fluoxetine (PROZAC) Capsule 40 Start time: 12/20/09 0900 End time: -mg Frequency: DAILY MORNING Total # of doses: -First dose: As Scheduled Priority: -Infusion Site: -Rate: -Duration: -Volume: -Ordered dose: 40 mg Admin dose: 40 mg Route: ORAL Dispense from: T4LEFT_PYXIS First doses from: T4LEFT_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: FLUOXETINE 20 MG CAPSULE [10941] PRN comments: -PRN reasons: -Indications of use: -Indications comments: -Order comments: -Admin instructions: -Phase of care: -Order Questions: Initial Order Details Joseph P Gee, RPH 12/20/09 0711 Name: Fluoxetine (PROZAC) Capsule 40 Start time: 12/20/09 0900 End time: -mg Frequency: DAILY MORNING Total # of doses: -First dose: As Scheduled Priority: -Infusion Site: -Rate: -Duration: -Volume: -Ordered dose: 40 mg Admin dose: 40 mg Route: ORAL Dispense from: T4LEFT_PYXIS First doses from: T4LEFT_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: FLUOXETINE 20 MG CAPSULE [10941] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: -Phase of care: -Order Questions: Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE
001299
Encounter View Encounter Order Info Date and Time 12/20/2009 7:11 AM
Electronically Signed By Joseph P Gee Authorizing Ru Ya Cai, MD Department T4 Ent/Internal Medicine Reason None
This Order Has Been Discontinued Order Status By On Incoming 12/21/09 2333 Discontinued Scheduling Interface Isolation No Isolation Order Details Frequency DAILY MORNING Duration None Priority None
Order History Order Date/Time 12/20/09 0711 12/19/09 2319 12/16/09 1039 Provider Information Ordering User Joseph P Gee, RPH Attending Provider(s) Ru Ya Cai, MD
User Joseph P Gee, RPH Ru Ya Cai, MD Jennifer Mello, PHRMTECH
Order ID 48372558 48367756 48222913
Pager 916-762-5896
Acknowledgement Info For At Placing Order 12/20/09 0711 Verbal Order Info Action Ordering Patient Information Patient Name Amundsen, Mark
Unit T4EM
Acknowledged By Christena R Schob, RN Responsible Provider
Order Mode Transcribed
Communicator Joseph P Gee, RPH MRN 8081369

Room 4661
Signed By Signature Not Required DOB 9/23/1959

Bed 466102
Signed On
Sex Male
Account # 050017321477
001300
Medication
Medication Detail Fondaparinux (ARIXTRA) 2.5 mg
Dose 2.5 mg
Fondaparinux (ARIXTRA) 2.5 mg (Order 48368173)

Frequency EVERY 24 HOURS Start 12/20/2009 0900 End 12/20/2009 0002
Route: SUBCUTANEOUS Admin Dose: 0.5 mL = 2.5 mg of 2.5 mg/0.5 mL Comment: Patient s/p hip surgery, on arixtra trial Class: Inpatient Normal Number of Doses: 6 All Administrations of Fondaparinux (ARIXTRA) 2.5 mg No Administrations Recorded Warnings Override History for Fondaparinux (ARIXTRA) 2.5 mg [48368173] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/19/2009 11:46 PM This Order Has Been Discontinued Order Status By Ru Ya Cai, MD Discontinued Order Questions Question Does use meet restrictions? Electronically Signed By/Authorizing Ru Ya Cai, MD On 12/20/09 0002 Answer NO-ENTER INDICATION IN COMMENTS Department T4 Ent/Internal Medicine Reason None Comment
Isolation No Isolation Order Details Frequency EVERY 24 HOURS Duration 6 occurrences Priority None Order Class Inpatient Normal
Authorizing Provider Ru Ya Cai, MD PCP Victor Henrique Baquero, MD
001301
Pager 916-762-5896
Acknowledgement Info For At D/C Order 12/20/09 0002 Placing Order 12/19/09 2346 Patient Information Patient Name Amundsen, Mark Unit T4EM
MRN 8081369
Acknowledged By Encarnacion Arenas, RN Encarnacion Arenas, RN

Sex Male
Acknowledged On 12/20/09 0008 12/20/09 0008

DOB 9/23/1959
Room 4661
Bed 466102
Medication
Medication Detail Fondaparinux (ARIXTRA) 2.5 mg Dose 2.5 mg
Fondaparinux (ARIXTRA) 2.5 mg (Order 48368658) Frequency EVERY 24 HOURS Start 12/20/2009 0900 End 12/20/2009 0855
Route: SUBCUTANEOUS Admin Dose: 0.5 mL = 2.5 mg of 2.5 mg/0.5 mL Comment: Patient s/p hip surgery, on arixtra trial OK to use study supply Reason for Discontinue: Entered in error Class: Inpatient Normal Number of Doses: 6 All Administrations of Fondaparinux (ARIXTRA) 2.5 mg No Administrations Recorded Warnings Override History for Fondaparinux (ARIXTRA) 2.5 mg [48368658] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/20/2009 12:02 AM Electronically Signed By/Authorizing Ru Ya Cai, MD Department T4 Ent/Internal Medicine
001302
This Order Has Been Discontinued Order Status By William E Dager, Discontinued RPH Order Questions Question Does use meet restrictions?
On 12/20/09 0855
Reason Entered in error
Comment
Isolation No Isolation Order Details Frequency EVERY 24 HOURS Duration 6 occurrences Priority None Order Class Inpatient Normal
Order History Order Date/Time 12/20/09 0002 12/19/09 2346 Provider Information Ordering User Ru Ya Cai, MD Attending Provider(s) Ru Ya Cai, MD Jia Wang, MD Murali Adusumalli, MD
User Ru Ya Cai, MD Ru Ya Cai, MD

Order ID 48368658 48368173
Pager 916-762-5896 Acknowledged By Encarnacion Arenas, RN Christena R Schob, RN Acknowledged On 12/20/09 0008 12/20/09 0925
Unit T4EM
MRN 8081369
Room 4661
Sex Male
DOB 9/23/1959
Bed 466102
001303
Medication
Medication Detail Fondaparinux (ARIXTRA) 2.5 mg
Dose 2.5 mg
Fondaparinux (ARIXTRA) 2.5 mg (Order 48375069)

Frequency EVERY 24 HOURS Start 12/20/2009 1200 End 12/20/2009 1246
Route: SUBCUTANEOUS Admin Dose: 0.5 mL = 2.5 mg of 2.5 mg/0.5 mL Reason for Discontinue: Discontinued Class: Inpatient Normal All Administrations of Fondaparinux (ARIXTRA) 2.5 mg Action Recorded User(s) Time Time Dose/Rate Route Site Comment Action Reason Christena R 12/20/09 12/20/09 2.5 mg SUBCUTANEOUS study Not Other 1200 1547 drug pt to given (see Schob, RN take own comment) but has none here new orders to follow Warnings Override History for Fondaparinux (ARIXTRA) 2.5 mg [48375069] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/20/2009 10:51 AM This Order Has Been Discontinued Discontinued Order Status Mode Verbal with Read Discontinued Back Authorizing Provider Jia Wang, MD Order Questions Question Does use meet restrictions? Electronically Signed By/Authorizing Jia Wang Department T4 Ent/Internal Medicine
By William E Dager, RPH
On 12/20/09 1246
Reason Discontinued
Ordering Provider Jia Wang, MD Answer Comment ANTICOAGULATION SERVICE APPROVAL BY: (ENTER NAME IN COMMENTS)
Communicator William E Dager, RPH
Isolation No Isolation Order Details Frequency EVERY 24 HOURS

001304
Provider Information Ordering User Jia Wang, MD Attending Provider(s) Ru Ya Cai, MD Jia Wang, MD Murali Adusumalli, MD
Ordering Provider Jia Wang, MD Admitting Provider Joanna Baginski, MD
Authorizing Provider Jia Wang, MD PCP Victor Henrique Baquero, MD
Ordering Provider WANG, JIA [09895] Acknowledgement Info For At Placing Order 12/20/09 1051 D/C Order 12/20/09 1246 Verbal Order Info Action Discontinuing Patient Information Patient Name Amundsen, Mark Unit T4EM Order Mode Verbal with Read Back Communicator William E Dager, RPH MRN 8081369 Room 4661
Pager 916-762-9629 Acknowledged By Christena R Schob, RN Christena R Schob, RN Responsible Provider Acknowledged On 12/20/09 1105 12/20/09 1322
Signed By Jia Wang, MD
Signed On 12/20/09 2007
Sex Male
DOB 9/23/1959 Bed 466102
Account # 050017321477
Medication
Medication Detail Methadone (DOLOPHINE) Tablet 130 mg Route: ORAL Admin Dose: 13 tablet (13 10 mg tablet) Comment: Patient home medication. Class: Inpatient Normal
Methadone (DOLOPHINE) Tablet 130 mg (Order 48367758) Dose 130 mg Frequency DAILY MORNING Start 12/20/2009 0900 End 12/20/2009 0000
All Administrations of Methadone (DOLOPHINE) Tablet 130 mg No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) Tablet 130 mg [48367758] Overridden by Evan Reed, RPH on 12/19/09 2356 Dose 1. METHADONE 10 MG TAB: EXCEEDS RECOMMENDED MAXIMUM DAILY DOSE BY 9% (10 MG);
001305
EXCEEDS RECOMMENDED MAXIMUM SINGLE DOSE BY 334% (100 MG) [Reason: Tolerated before]
Order Audit Trail: Methadone (DOLOPHINE) Tablet 130 mg [48367758] Order Details After Change #1 - Rx Verify Name: Methadone (DOLOPHINE) Tablet Start time: 12/20/09 0900 130 mg Frequency: DAILY MORNING Total # of doses: --
Evan Reed, RPH 12/19/09 2356 End time: -First dose: As Scheduled
Priority: -Infusion Site: -Rate: -Duration: -Volume: -Admin dose: 130 mg Route: ORAL Ordered dose: 130 mg Dispense from: T4LEFT_PYXIS First doses from: T4LEFT_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: METHADONE 10 MG TABLET [5425] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: Patient home medication. Admin instructions: -Phase of care: -Order Questions: Does use meet BLACK BOX WARNING NO-ENTER INDICATION IN COMMENTS restrictions? Initial Order Details Name: Methadone (DOLOPHINE) Tablet 130 mg Frequency: DAILY MORNING Start time: 12/20/09 0900 Total # of doses: -Ru Ya Cai, MD 12/19/09 2319 End time: -First dose: As Scheduled
Priority: -Infusion Site: -Rate: -Duration: -Volume: -Ordered dose: 130 mg Admin dose: 130 mg Route: ORAL Dispense from: T4LEFT_PYXIS First doses from: T4LEFT_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: METHADONE 10 MG TABLET [5425] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: Patient home medication. Admin instructions: -Phase of care: -Order Questions: Does use meet BLACK BOX WARNING NO-ENTER INDICATION IN COMMENTS restrictions? Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE
001306
Encounter View Encounter Order Info Date and Time 12/19/2009 11:19 PM This Order Has Been Discontinued Order Status By Ru Ya Cai, MD Discontinued Order Questions Question Does use meet BLACK BOX WARNING restrictions? Isolation No Isolation Order Details Frequency DAILY MORNING Duration None Priority None Order Class Inpatient Normal Electronically Signed By/Authorizing Ru Ya Cai, MD On 12/20/09 0000 Answer NO-ENTER INDICATION IN COMMENTS Department T4 Ent/Internal Medicine Reason None Comment
User Ru Ya Cai, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Gertrudes Perlas Montemayor, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 48367758 47648844 46641416 45578181 44543839 43512111 42415608 41358443 40335571 39316280 38152050 37025430 35855444 34942551 33955136 33114228 32060748 31022473 29814812 28998118 27379159 26682012 25327454 25043810 24527577 23982000 22429171 21876329
001307
11/16/07 1444 10/22/07 1713 09/17/07 1803 08/31/07 0809 08/07/07 1735 07/16/07 1512 06/22/07 1112
04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information Ordering User Ru Ya Cai, MD Attending Provider(s) Ru Ya Cai, MD Jia Wang, MD Murali Adusumalli, MD
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Ordering Provider Ru Ya Cai, MD
21267173 20658809 19830274 19493600 18998255 18553324 18102039
16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
Pager 916-762-5896 Acknowledged By Encarnacion Arenas, RN Encarnacion Arenas, RN Acknowledged On 12/19/09 2333 12/20/09 0008
Unit T4EM
MRN 8081369
Room 4661
Sex Male
DOB 9/23/1959
Bed 466102
001308
Medication
Medication Detail Methadone (DOLOPHINE) Tablet 40 mg Route: ORAL Admin Dose: 4 tablet (4 10 mg tablet) Comment: Patient home medication. Class: Inpatient Normal Last Admin Time: 12/21/09 1630
Methadone (DOLOPHINE) Tablet 40 mg (Order 48368375) Dose 40 mg Frequency TWO TIMES DAILY Start 12/20/2009 0100 End 12/21/2009 2333
All Administrations of Methadone (DOLOPHINE) Tablet 40 mg Action Recorded User(s) Time Time Dose/Rate Route Christena R Schob, 12/21/09 12/21/09 40 mg ORAL RN 1630 1646 Christena R Schob, 12/21/09 12/21/09 40 mg ORAL RN 0845 0926 12/20/09 12/20/09 40 mg ORAL Christena R Schob, RN 1610 1624 12/20/09 12/20/09 40 mg ORAL Christena R Schob, RN 0905 1544
Site
Comment
Action Reason Given Given Given Given
Warnings Override History for Methadone (DOLOPHINE) Tablet 40 mg [48368375] Overridden by Evan Reed, RPH on 12/20/09 0002 Duplicate Medication Order 1. METHADONE HCL,PO, NON-PRN ORDER Methadone (DOLOPHINE) Tablet 50 mg Other Orders: Full Warnings History Order Override History User Override Time Ru Ya Cai, MD 12/20/09 0000 Previous Schedule 0900 2100 Adjusted Schedule 0800 1600 Override Reason
Order Audit Trail: Methadone (DOLOPHINE) Tablet 40 mg [48368375] Order Details After Change #1 - Rx Verify Name: Methadone (DOLOPHINE) Tablet Start time: 12/20/09 0100 40 mg Frequency: TWO TIMES DAILY Total # of doses: --
Evan Reed, RPH 12/20/09 0002 End time: -First dose: As Scheduled Volume: -Route: ORAL
Priority: -Infusion Site: -Rate: -Duration: -Ordered dose: 40 mg Admin dose: 40 mg Dispense from: T4LEFT_PYXIS First doses from: T4LEFT_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: METHADONE 10 MG TABLET [5425]
001309
PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: Patient home medication. Admin instructions: -Phase of care: -Order Questions: Does use meet BLACK BOX WARNING NO-ENTER INDICATION IN COMMENTS restrictions? Initial Order Details Name: Methadone (DOLOPHINE) Tablet 40 mg Frequency: TWO TIMES DAILY Start time: 12/20/09 0100 Total # of doses: -Ru Ya Cai, MD 12/20/09 0000 End time: -First dose: As Scheduled
Priority: -Infusion Site: -Rate: -Duration: -Volume: -Ordered dose: 40 mg Admin dose: 40 mg Route: ORAL Dispense from: T4LEFT_PYXIS First doses from: T4LEFT_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: METHADONE 10 MG TABLET [5425] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: Patient home medication. Admin instructions: -Phase of care: -Order Questions: Does use meet BLACK BOX WARNING NO-ENTER INDICATION IN COMMENTS restrictions? Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Date and Time 12/20/2009 12:00 AM
This Order Has Been Discontinued Order Status By On Incoming 12/21/09 2333 Discontinued Scheduling Interface Order Questions Question Does use meet BLACK BOX WARNING restrictions? Isolation No Isolation
Comment
001310
Order Details Frequency TWO TIMES DAILY
Duration None
Priority None
Order History Order Date/Time 12/20/09 0000 12/19/09 2319 12/02/09 1354 11/06/09 1450 10/09/09 1635 09/15/09 1356 08/20/09 0823 07/24/09 1445 06/26/09 1500 06/02/09 1316 05/07/09 1512 04/09/09 1151 03/16/09 1008 02/13/09 0901 01/20/09 1025 12/22/08 1330 12/01/08 0956 11/03/08 0853 10/06/08 1735 09/05/08 1008 08/11/08 1128 06/27/08 0901 06/06/08 1714 04/30/08 1359 04/23/08 1255 04/04/08 1253 03/12/08 1720 01/10/08 1229 12/13/07 1239 11/16/07 1444 10/22/07 1713 09/17/07 1803 08/31/07 0809 08/07/07 1735 07/16/07 1512 06/22/07 1112 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822
User Ru Ya Cai, MD Ru Ya Cai, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Gertrudes Perlas Montemayor, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Modified from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 48368375 48367758 47648844 46641416 45578181 44543839 43512111 42415608 41358443 40335571 39316280 38152050 37025430 35855444 34942551 33955136 33114228 32060748 31022473 29814812 28998118 27379159 26682012 25327454 25043810 24527577 23982000 22429171 21876329 21267173 20658809 19830274 19493600 18998255 18553324 18102039 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080
001311
10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
12961787 12648793 12308313 11994381 11628480 11423903
Provider Information Ordering User Ru Ya Cai, MD



Unit T4EM

Room 4661

Bed 466102
Sex Male
Medication
Medication Detail Methadone (DOLOPHINE) Tablet 50 mg Route: ORAL Admin Dose: 5 tablet (5 10 mg tablet) Class: Inpatient Normal Last Admin Time: 12/20/09 2130 Include Now: Yes

Dose 50 mg Frequency DAILY AT BEDTIME Start 12/20/2009 0200 End 12/21/2009 2333
All Administrations of Methadone (DOLOPHINE) Tablet 50 mg Action Recorded User(s) Time Time Dose/Rate Route Darcey Arnold, RN 12/20/09 12/21/09 50 mg ORAL 2130 0011
Site
Comment
Action Reason Given
001312
Encarnacion Arenas, RN
12/20/09 0200
12/20/09 0206
50 mg
ORAL
Given
Warnings Override History for Methadone (DOLOPHINE) Tablet 50 mg [48368376] Overridden by Evan Reed, RPH on 12/20/09 0002 Dose 1. METHADONE 10 MG TAB: EXCEEDS RECOMMENDED MAXIMUM SINGLE DOSE BY 67% (20 MG) Duplicate Medication Order 1. METHADONE HCL,PO, NON-PRN ORDER Methadone (DOLOPHINE) Tablet 40 mg Other Orders: Full Warnings History Order Override History User Override Time Ru Ya Cai, MD 12/20/09 0000
Previous Schedule 2100 Adjusted Schedule 2200 Override Reason
Order Audit Trail: Methadone (DOLOPHINE) Tablet 50 mg [48368376] Order Details After Change #1 - Rx Verify Name: Methadone (DOLOPHINE) Tablet Start time: 12/20/09 0200 50 mg Frequency: DAILY AT BEDTIME Total # of doses: --
Evan Reed, RPH 12/20/09 0002 End time: -First dose: Include Now
Priority: -Infusion Site: -Rate: -Duration: -Volume: -Admin dose: 50 mg Route: ORAL Ordered dose: 50 mg Dispense from: T4LEFT_PYXIS First doses from: T4LEFT_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: METHADONE 10 MG TABLET [5425] PRN comments: -PRN reasons: -Indications of use: -Indications comments: -Order comments: -Admin instructions: -Phase of care: -Order Questions: Does use meet BLACK BOX WARNING NO-ENTER INDICATION IN COMMENTS restrictions? Initial Order Details Name: Methadone (DOLOPHINE) Tablet 50 mg Frequency: DAILY AT BEDTIME Priority: -Rate: -Ordered dose: 50 mg Dispense from: T4LEFT_PYXIS Dispense code: UD Grouper Patient supplied med? No Do not dispense? No Dispense only once? No Start time: 12/20/09 0200 Total # of doses: -Infusion Site: -Duration: -Admin dose: 50 mg First doses from: T4LEFT_PYXIS PRN par level # of doses: -Patient supplied # of doses: 0 Do not dispense # of doses: 0 Triggered fill list? No Ru Ya Cai, MD 12/20/09 0000 End time: -First dose: Include Now Volume: -Route: ORAL
001313
Self administered? No Individual ingredients? No Components: METHADONE 10 MG TABLET [5425] PRN reasons: -PRN comments: -Indications of use: -Indications comments: -Order comments: -Admin instructions: -Phase of care: -Order Questions: Does use meet BLACK BOX WARNING NO-ENTER INDICATION IN COMMENTS restrictions? Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Date and Time 12/20/2009 12:00 AM
This Order Has Been Discontinued Order Status By On Incoming 12/21/09 2333 Discontinued Scheduling Interface Order Questions Question Does use meet BLACK BOX WARNING restrictions? Isolation No Isolation Order Details Frequency DAILY AT BEDTIME
Duration None Priority None Answer NO-ENTER INDICATION IN COMMENTS
Reason None
Comment

Pager 916-762-5896 Acknowledged By Encarnacion Arenas, RN Acknowledged On 12/20/09 0008
Acknowledgement Info For At Placing Order 12/20/09 0000
001314
MRN 8081369 Room 4661
Sex Male
DOB 9/23/1959 Bed 466102
Account # 050017321477
Medication
Medication Detail Sennosides (SENOKOT) Tablet 2 Tab Route: ORAL Admin Dose: 2 tablet Class: Inpatient Normal Last Admin Time: 12/20/09 2100
Sennosides (SENOKOT) Tablet 2 Tab (Order 48367776) Dose 2 tablet Frequency DAILY AT BEDTIME Start 12/20/2009 2100 End 12/21/2009 2333
All Administrations of Sennosides (SENOKOT) Tablet 2 Tab Action Recorded User(s) Time Time Dose/Rate Route Darcey Arnold, RN 12/20/09 12/21/09 2 tablet ORAL 2100 0011
Site
Comment
Action Reason Given
Warnings Override History for Sennosides (SENOKOT) Tablet 2 Tab [48367776] No Warning History Available Order Audit Trail: Sennosides (SENOKOT) Tablet 2 Tab [48367776] Order Details After Change #1 - Rx Verify Name: Sennosides (SENOKOT) Tablet 2 Start time: 12/20/09 2100 Tab Frequency: DAILY AT BEDTIME Total # of doses: -Evan Reed, RPH 12/19/09 2356 End time: -First dose: As Scheduled Volume: -Route: ORAL
Priority: -Infusion Site: -Rate: -Duration: -Ordered dose: 2 tablet Admin dose: 2 tablet Dispense from: T4LEFT_PYXIS First doses from: T4LEFT_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: SENNOSIDES 8.6 MG TABLET [14544] PRN comments: -PRN reasons: -Indications of use: -Indications comments: -Order comments: -Admin instructions: -Phase of care: --
001315
Order Questions: Initial Order Details Name: Sennosides (SENOKOT) Tablet 2 Start time: 12/20/09 2100 Tab Frequency: DAILY AT BEDTIME Total # of doses: -Ru Ya Cai, MD 12/19/09 2319 End time: -First dose: As Scheduled Volume: -Route: ORAL
Priority: -Infusion Site: -Rate: -Duration: -Ordered dose: 2 tablet Admin dose: 2 tablet Dispense from: T4LEFT_PYXIS First doses from: T4LEFT_PYXIS Dispense code: UD Grouper PRN par level # of doses: -Patient supplied med? No Patient supplied # of doses: 0 Do not dispense? No Do not dispense # of doses: 0 Dispense only once? No Triggered fill list? No Self administered? No Individual ingredients? No Components: SENNOSIDES 8.6 MG TABLET [14544] PRN comments: -PRN reasons: -Indications of use: -Indications comments: -Order comments: -Admin instructions: -Phase of care: -Order Questions:
Changes to the order are displayed in red. Note that there may be changes made to the order that are not shown in this report, such as changes to details about ingredients. Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Date and Time 12/19/2009 11:19 PM
001316
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Oxycodone 20 mg PO Tab (Order 48396632) Refills Start 12/21/2009 End 2/4/2010
Quantity Oxycodone 20 mg PO Tab (Discontinued) Sig : Take 1 Tab by mouth every 3 hours if needed. For pain. Route: ORAL Class: Historical All Administrations of Oxycodone 20 mg PO Tab No Administrations Recorded
Warnings Override History for Oxycodone 20 mg PO Tab [48396632] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/21/2009 9:11 AM Electronically Signed By Jennifer Mello Authorizing Patient Reported Department T4 Ent/Internal Medicine Reason None
This Order Has Been Discontinued Order Status By Victor Henrique Discontinued Baquero, MD Isolation No Isolation Order Details Frequency EVERY 3 HOURS IF NEEDED
Duration None
On 2/4/10 0905
Priority Routine
Provider Information Ordering User Jennifer Mello, PHRMTECH Attending Provider(s) Ru Ya Cai, MD Jia Wang, MD Murali Adusumalli, MD
Authorizing Provider Patient Reported
001317
FAMFOL
Medication

Quantity 390 Tab Refills 0 Start 12/23/2009 End 1/20/2010
Date and Time 12/28/2009 12:10 PM
Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Henrique Discontinued Baquero, MD On 1/20/10 1311 Reason None
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Wed Dec 23, 2009 1405 Isolation No Isolation Order Details Frequency DAILY (OUTPATIENT) Duration None Priority Routine
Status Pended
Reason
Order Class Normal
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 48504727 47648844 46641416 45578181 44543839 43512111
001318
07/24/09 1445 06/26/09 1500 06/02/09 1316 05/07/09 1512 04/09/09 1151
03/16/09 1008 02/13/09 0901 01/20/09 1025 12/22/08 1330 12/01/08 0956 11/03/08 0853 10/06/08 1735 09/05/08 1008 08/11/08 1128 06/27/08 0901 06/06/08 1714 04/30/08 1359 04/23/08 1255 04/04/08 1253 03/12/08 1720 01/10/08 1229 12/13/07 1239 11/16/07 1444 10/22/07 1713 09/17/07 1803 08/31/07 0809 08/07/07 1735 07/16/07 1512 06/22/07 1112 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information Ordering User Victor Henrique Baquero, MD
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Gertrudes Perlas Montemayor, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
42415608 41358443 40335571 39316280 38152050
37025430 35855444 34942551 33955136 33114228 32060748 31022473 29814812 28998118 27379159 26682012 25327454 25043810 24527577 23982000 22429171 21876329 21267173 20658809 19830274 19493600 18998255 18553324 18102039 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
001319
08/07/07 1735 07/16/07 1512 06/22/07 1112 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
18998255 18553324 18102039 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Start 1/8/2010 End 6/4/2010
Quantity Refills 100 Tab 0 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet (Discontinued) Sig : Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. Route: ORAL PRN Reason(s): pain Class: Pharmacy
All Administrations of Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet No Administrations Recorded
001320
Warnings Override History for Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet [49038497] Overridden by Victor Henrique Baquero, MD on 01/08/10 1506 Drug-Allergy (Active and Inactive Ingredients) 1. MORPHINE [Level: Level 3]
Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 1/8/2010 3:06 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Henrique Discontinued Baquero, MD On 6/4/10 1404 Reason None Electronically Signed By/Authorizing Victor Baquero, MD Department Fol Family Practice
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Fri Jan 8, 2010 1448 Isolation No Isolation Order Details Frequency Duration EVERY 4 TO 6 HOURS IF None NEEDED Priority Routine
Status Pended
Reason
Order History Order Date/Time 01/08/10 1506 12/16/09 1039 Provider Information Ordering User Victor Henrique Baquero, MD PCP Victor Henrique Baquero, MD
User Victor Henrique Baquero, MD Jennifer Mello, PHRMTECH
Order ID 49038497 48222914

Unit
MRN 8081369
Sex Male
DOB 9/23/1959
001321
03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Jeffrey Alan Applebaum, MD
16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
Provider Information Ordering User Jeffrey Alan Applebaum, MD PCP Victor Henrique Baquero, MD
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
All Administrations of Methadone (DOLOPHINE) 10 mg PO Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg PO Tablet [49468547] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 1/20/2010 1:11 PM Electronically Signed By/Authorizing Victor Baquero, MD Department Fol Family Practice
001322
Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Jeffrey Alan Discontinued Applebaum, MD On 2/19/10 1457 Reason None
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Wed Jan 20, 2010 0930 Isolation No Isolation Order Details Frequency DAILY (OUTPATIENT) Duration None Priority Routine
Status Pended
Reason
Order Class Normal
Order History Order Date/Time 01/20/10 1311 12/28/09 1210 12/02/09 1354 11/06/09 1450 10/09/09 1635 09/15/09 1356 08/20/09 0823 07/24/09 1445 06/26/09 1500 06/02/09 1316 05/07/09 1512 04/09/09 1151 03/16/09 1008 02/13/09 0901 01/20/09 1025 12/22/08 1330 12/01/08 0956 11/03/08 0853 10/06/08 1735 09/05/08 1008 08/11/08 1128 06/27/08 0901 06/06/08 1714 04/30/08 1359 04/23/08 1255 04/04/08 1253 03/12/08 1720 01/10/08 1229 12/13/07 1239 11/16/07 1444 10/22/07 1713 09/17/07 1803 08/31/07 0809
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Gertrudes Perlas Montemayor, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 49468547 48504727 47648844 46641416 45578181 44543839 43512111 42415608 41358443 40335571 39316280 38152050 37025430 35855444 34942551 33955136 33114228 32060748 31022473 29814812 28998118 27379159 26682012 25327454 25043810 24527577 23982000 22429171 21876329 21267173 20658809 19830274 19493600
001323
02/24/10 1725 05/31/07 2000 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information Ordering User Victor Henrique Baquero, MD
Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Quantity 60 Tab Methadone (DOLOPHINE) 10 mg PO Tablet Sig : Take by mouth. Maximum of 2 tablets up to 4 times a day Route: ORAL Class: Handwritten Rx
All Administrations of Methadone (DOLOPHINE) 10 mg PO Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg PO Tablet [50718484] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter
001324
Order Info Date and Time 2/19/2010 2:57 PM Isolation No Isolation Order Details Frequency None Duration None Priority Routine Order Class Handwritten Rx Electronically Signed By/Authorizing Jeffrey Alan Applebaum Department Fol Family Practice
03/16/09 1008 02/13/09 0901 01/20/09 1025 12/22/08 1330 12/01/08 0956 11/03/08 0853 10/06/08 1735 09/05/08 1008 08/11/08 1128 06/27/08 0901 06/06/08 1714 04/30/08 1359 04/23/08 1255 04/04/08 1253 03/12/08 1720 01/10/08 1229 12/13/07 1239 11/16/07 1444 10/22/07 1713 09/17/07 1803 08/31/07 0809 08/07/07 1735 07/16/07 1512 06/22/07 1112 04/20/07 0919 04/06/07 1644
User Jeffrey Alan Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD Gertrudes Perlas Montemayor, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Kurt J Slapnik, MD Martina Dobrovodska Randolph, MD Victor Baquero, MD Victor Baquero, MD
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 50718484 49468547 48504727 47648844 46641416 45578181 44543839 43512111 42415608 41358443 40335571 39316280 38152050
37025430 35855444 34942551 33955136 33114228 32060748 31022473 29814812 28998118 27379159 26682012 25327454 25043810 24527577 23982000 22429171 21876329 21267173 20658809 19830274 19493600 18998255 18553324 18102039 16827161 16546809
001325

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Methadone (DOLOPHINE) 10 mg PO Tablet (Discontinued) Sig : Take 2 Tabs by mouth every 6 hours. Route: ORAL

On 3/18/10 1752
This Order Has Been Discontinued Order Status By Victor Henrique Discontinued Baquero, MD Isolation No Isolation Order Details Frequency EVERY 6 HOURS Duration None
Priority Routine
Order Class Normal
User
Action
Order ID
001326

Order History Order Date/Time 04/14/10 1344 03/18/10 1752 02/24/10 1725 05/31/07 2000 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information Ordering User Victor Henrique Baquero, MD PCP Victor Henrique Baquero, MD
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

001327
All Administrations of Methadone (DOLOPHINE) 10 mg PO Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg PO Tablet [51770975] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 3/18/2010 5:52 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Henrique Discontinued Baquero, MD On 4/14/10 1344 Reason None Electronically Signed By/Authorizing Victor Baquero, MD Department Fol Family Practice
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Wed Mar 17, 2010 1528 Isolation No Isolation Order Details Frequency EVERY 6 HOURS Duration None Priority Routine
Status Pended
Reason
Order Class Normal
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
001328
07/26/06 1703 06/29/06 1909 06/15/06 0805
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
11994381 11628480 11423903

MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Wed Apr 14, 2010 1322
Status Pended
Reason
001329
Isolation No Isolation Order Details Frequency EVERY 6 HOURS Duration None Priority Routine Order Class Normal
Order History Order Date/Time 05/24/10 1406 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information Ordering User Victor Henrique Baquero, MD PCP Victor Henrique Baquero, MD
User Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 54508623 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

Unit RH
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
001330
Transmission Method Printed All Administrations of Methadone (DOLOPHINE) 10 mg PO Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg PO Tablet [53986715] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 5/12/2010 8:53 AM
This Order Has Been Discontinued Order Status By Jeffrey Alan Discontinued Applebaum, MD
On 6/7/10 1345
Reason None
Signed and Held / Pended Order History Pending User Date/Time Tue May 11, 2010 1459 Isolation No Isolation Order Details Frequency EVERY 6 HOURS
Status Pended
Reason
Order Class Normal
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313
001331
VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Gertrudes Perlas Discontinued Montemayor, MD On 7/12/10 1745 Reason None
Signed and Held / Pended Order History Pending User Date/Time Stephanie L Esparza, LVN Fri Jun 4, 2010 1223 Isolation No Isolation Order Details Frequency Duration EVERY 4 TO 6 HOURS IF None NEEDED Priority Routine
Status Pended
Reason
Order History Order Date/Time 06/04/10 1404 01/08/10 1506 12/16/09 1039 Provider Information Ordering User Victor Henrique Baquero, MD
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jennifer Mello, PHRMTECH
Order ID 54938948 49038497 48222914
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Methadone (DOLOPHINE) 10 mg PO Tablet Sig : Take 2 Tabs by mouth every 6 hours. Route: ORAL Transmission Method Printed
All Administrations of Methadone (DOLOPHINE) 10 mg PO Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg PO Tablet [54508623]
001332
Medication
Medication Detail

Quantity 100 Tab Carisoprodol (SOMA) 350 mg PO Tablet (Discontinued) Sig : Take 2 Tabs by mouth every day at bedtime. Route: ORAL Class: Pharmacy
Transmission Method E-Prescribed All Administrations of Carisoprodol (SOMA) 350 mg PO Tablet No Administrations Recorded Warnings Override History for Carisoprodol (SOMA) 350 mg PO Tablet [54938947] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 6/4/2010 2:04 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Henrique Discontinued Baquero, MD On 9/22/10 1712 Reason None Electronically Signed By/Authorizing Victor Baquero, MD Department Fol Family Practice
Signed and Held / Pended Order History Pending User Date/Time Stephanie L Esparza, LVN Fri Jun 4, 2010 1223 Isolation No Isolation Order Details Frequency DAILY AT BEDTIME Duration None Priority Routine
Status Pended
Reason
Order History Order Date/Time 06/04/10 1404 12/16/09 1039 Provider Information Ordering User Victor Henrique Baquero, MD
Order ID 54938947 48222915
001333

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Start 6/4/2010 End 7/12/2010
Quantity Refills 100 Tab 0 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet (Discontinued) Sig : Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. Route: ORAL PRN Reason(s): pain Class: Pharmacy
Transmission Method Faxed All Administrations of Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet No Administrations Recorded Warnings Override History for Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet [54938948] Overridden by Victor Henrique Baquero, MD on 06/04/10 1404 Drug-Allergy (Active and Inactive Ingredients) 1. MORPHINE [Level: Level 3] Full Warnings History Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Released By
001334
10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
12961787 12648793 12308313 11994381 11628480 11423903

MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Methadone (DOLOPHINE) 10 mg PO Tablet (Discontinued) Sig : Take 2 Tabs by mouth every 6 hours. Route: ORAL Transmission Method Printed
All Administrations of Methadone (DOLOPHINE) 10 mg PO Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg PO Tablet [55012451] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 6/7/2010 1:45 PM Released By JEFFREY APPLEBAUM [307513234] This Order Has Been Discontinued Order Status By On Reason Electronically Signed By/Authorizing Jeffrey Alan Applebaum Department Fol Family Practice
001335
Discontinued
7/1/10 1259
None
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Mon Jun 7, 2010 0936 Isolation No Isolation Order Details Frequency EVERY 6 HOURS Duration None Priority Routine
Status Pended
Reason
Order Class Normal
Order History Order Date/Time 06/07/10 1345 05/12/10 0853 04/14/10 1344 03/18/10 1752 02/24/10 1725 05/31/07 2000 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information Ordering User Jeffrey Alan Applebaum, MD PCP Victor Henrique Baquero, MD
User Jeffrey Alan Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 55012451 53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
Authorizing Provider Jeffrey Alan Applebaum, MD

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
001336
Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 7/12/2010 9:40 AM This Order Has Been Discontinued Order Status By Victor Henrique Discontinued Baquero, MD Isolation No Isolation Order Details Frequency DAILY MORNING Duration None Priority Routine Order Class Pharmacy Electronically Signed By/Authorizing Jeffrey Alan Applebaum On 11/16/10 1734 Department Fol Family Practice Reason None

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Methadone (DOLOPHINE) 10 mg PO Tablet (Discontinued) Sig : Take 2 Tabs by mouth every 6 hours.
001337
Route: ORAL Transmission Method Printed All Administrations of Methadone (DOLOPHINE) 10 mg PO Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg PO Tablet [55986133] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 7/1/2010 12:59 PM
On 7/28/10 1715
Reason None
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Thu Jul 1, 2010 0742 Isolation No Isolation Order Details Frequency EVERY 6 HOURS Duration None Priority Routine
Status Pended
Reason
Order Class Normal
User Victor Henrique Baquero, MD Jeffrey Alan Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 55986133 55012451 53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080
001338
Frequency EVERY 6 HOURS
Duration None
Priority Routine
Order Class Normal
Order History Order Date/Time 07/28/10 1715 07/01/10 1259 06/07/10 1345 05/12/10 0853 04/14/10 1344 03/18/10 1752 02/24/10 1725 05/31/07 2000 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information Ordering User Victor Henrique Baquero, MD PCP Victor Henrique Baquero, MD
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jeffrey Alan Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 57021280 55986133 55012451 53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule (Order 56372692) Start 7/12/2010 End 5/24/2012
Quantity Refills 8 Cap 1 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig : Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for
001339
next 2 months. Then lab follow up 4 weeks later. Route: ORAL Class: Pharmacy Transmission Method E-Prescribed All Administrations of Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule No Administrations Recorded Warnings Override History for Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule [56372692] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 7/12/2010 9:38 AM Isolation No Isolation Order Details Frequency None
Electronically Signed By/Authorizing Jeffrey Alan Applebaum

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Account # 078548433073
001340
Medication
Medication Detail
Fenofibrate (TRICOR) 145 mg PO Tablet (Order 56372986)

Quantity 30 Tab Fenofibrate (TRICOR) 145 mg PO Tablet Sig : Take 1 Tab by mouth every morning after a meal. Route: ORAL Class: Pharmacy
Transmission Method E-Prescribed All Administrations of Fenofibrate (TRICOR) 145 mg PO Tablet No Administrations Recorded Warnings Override History for Fenofibrate (TRICOR) 145 mg PO Tablet [56372986] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 7/12/2010 9:40 AM Isolation No Isolation Order Details Frequency DAILY MORNING AFTER MEAL
MRN 8081369
Sex Male
DOB 9/23/1959
Account # 078548433073
Account Information
001341
Acct Number 078548433073 Visit CSN CSN Number: 31971257
Medication
Medication Detail
Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet (Order 56399863) Start 7/12/2010 End 8/13/2010
Quantity Refills 0 100 Tab Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet (Discontinued) Sig : Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. Route: ORAL PRN Reason(s): pain Class: Pharmacy Transmission Method Faxed
All Administrations of Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet No Administrations Recorded Warnings Override History for Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet [56399863] Overridden by Gertrudes Perlas Montemayor, MD on 07/12/10 1745 Drug-Allergy (Active and Inactive Ingredients) 1. MORPHINE [Level: Level 3] [Reason: Tolerated before] Full Warnings History Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 7/12/2010 5:45 PM Electronically Signed By/Authorizing Gertrudes Perlas Montemayor Department Fol Family Practice
Released By GERTRUDES P MONTEMAYOR [889077681]
On 8/13/10 1023
Reason None
Signed and Held / Pended Order History Pending User Date/Time Mon Jul 12, 2010 1636
Status Pended
Reason
001342
Isolation No Isolation Order Details Frequency Duration EVERY 4 TO 6 HOURS IF None NEEDED
Priority Routine Order Class Pharmacy
User Gertrudes Perlas Montemayor, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jennifer Mello, PHRMTECH
Order ID 56399863
54938948 49038497 48222914
Provider Information Ordering User Gertrudes Perlas Montemayor, MD PCP Victor Henrique Baquero, MD
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg PO Tablet (Order 56372911) Quantity 30 Tab Refills 3 Start 7/12/2010 End 11/16/2010
Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg PO Tablet (Discontinued) Sig : Take 1 Tab by mouth every morning. Route: ORAL Class: Pharmacy Transmission Method E-Prescribed
All Administrations of Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg PO Tablet No Administrations Recorded Warnings Override History for Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg PO Tablet [56372911] No Warning History Available
001343

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail Methadone (DOLOPHINE) 10 mg Tablet (Discontinued) Sig : Take 2 Tabs by mouth every 6 hours. Route: ORAL
Transmission Method Printed
Methadone (DOLOPHINE) 10 mg Tablet (Order 57021280) Quantity 200 Tab Refills 0 Start 7/27/2010 End 8/24/2010
All Administrations of Methadone (DOLOPHINE) 10 mg Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [57021280] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 7/28/2010 5:15 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Henrique Discontinued Baquero, MD On 8/24/10 1344 Reason None Electronically Signed By/Authorizing Victor Baquero, MD Department Fol Family Practice
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Tue Jul 27, 2010 1653 Isolation No Isolation Order Details
Status Pended
Reason
001344
07/28/10 1715 07/01/10 1259 06/07/10 1345 05/12/10 0853 04/14/10 1344 03/18/10 1752 02/24/10 1725 05/31/07 2000 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jeffrey Alan Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
57021280 55986133 55012451 53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet (Order 57685505) Start 8/13/2010 End 9/22/2010
Quantity Refills 100 Tab 0 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet (Discontinued) Sig : Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. Route: ORAL PRN Reason(s): pain Class: Pharmacy
001345
Transmission Method Faxed All Administrations of Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet No Administrations Recorded Warnings Override History for Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet [57685505] Overridden by Victor Henrique Baquero, MD on 08/13/10 1023 Drug-Allergy (Active and Inactive Ingredients) 1. MORPHINE [Level: Level 3] Full Warnings History Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Fri Aug 13, 2010 1016 Isolation No Isolation Order Details Frequency Duration EVERY 4 TO 6 HOURS IF None NEEDED Priority Routine
Status Pended
Reason
Order History Order Date/Time 08/13/10 1023 07/12/10 1745 06/04/10 1404 01/08/10 1506 12/16/09 1039 Provider Information Ordering User Victor Henrique Baquero, MD
User Victor Henrique Baquero, MD Gertrudes Perlas Montemayor, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jennifer Mello, PHRMTECH
Order ID 57685505 56399863 54938948 49038497 48222914
001346
8081369
Male
9/23/1959
Medication
Medication Detail Methadone (DOLOPHINE) 10 mg Tablet (Discontinued) Sig : Take 2 Tabs by mouth every 6 hours. Route: ORAL Transmission Method Printed
All Administrations of Methadone (DOLOPHINE) 10 mg Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [58110191] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 8/24/2010 1:44 PM
On 9/20/10 1005
Reason None
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Tue Aug 24, 2010 1222 Isolation No Isolation Order Details Frequency EVERY 6 HOURS Duration None Priority Routine
Status Pended
Reason
Order Class Normal
User Victor Henrique Baquero, MD
Order ID 58110191
001347
Order History Order Date/Time 09/22/10 1712 08/13/10 1023 07/12/10 1745 06/04/10 1404 01/08/10 1506 12/16/09 1039 Provider Information Ordering User Victor Henrique Baquero, MD
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Gertrudes Perlas Montemayor, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jennifer Mello, PHRMTECH
Order ID 59244090 57685505 56399863 54938948 49038497 48222914
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Methadone (DOLOPHINE) 10 mg Tablet (Order 59123182)

All Administrations of Methadone (DOLOPHINE) 10 mg Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [59123182] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 9/20/2010 10:05 AM Electronically Signed By/Authorizing Victor Baquero, MD Department Fol Family Practice
001348
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Mon Sep 20, 2010 0827 Isolation No Isolation Order Details Frequency EVERY 6 HOURS Duration None Priority Routine
Status Pended
Reason
Order Class Normal
Order History Order Date/Time 09/20/10 1005 08/24/10 1344 07/28/10 1715 07/01/10 1259 06/07/10 1345 05/12/10 0853 04/14/10 1344 03/18/10 1752 02/24/10 1725 05/31/07 2000 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information Ordering User Victor Henrique Baquero, MD
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jeffrey Alan Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 59123182 58110191 57021280 55986133 55012451 53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
MRN
Sex
DOB
001349
Baquero, MD Isolation No Isolation Order Details Frequency DAILY (OUTPATIENT)

Order ID 59326735 48222913
MRN 8081369
Sex Male
DOB 9/23/1959
Account # 078548433099 Visit CSN CSN Number: 32973389
Medication
Medication Detail
Carisoprodol (SOMA) 350 mg Tablet (Order 59244089) Refills 1 Start 9/22/2010 End 2/1/2011
Quantity 100 Tab Carisoprodol (SOMA) 350 mg Tablet (Discontinued) Sig : Take 2 Tabs by mouth every day at bedtime. Route: ORAL Class: Pharmacy
Transmission Method E-Prescribed
All Administrations of Carisoprodol (SOMA) 350 mg Tablet No Administrations Recorded Warnings Override History for Carisoprodol (SOMA) 350 mg Tablet [59244089] Overridden by Victor Henrique Baquero, MD on 09/22/10 1712 Dose 1. CARISOPRODOL, 700 MG, ORAL, DAILY AT BEDTIME DAILY DOSE 700 MG. UNDERDOSE (MIN. 750 MG); SINGLE DOSE 700 MG. OVERDOSE (MAX. 350 MG); FREQUE
001350
Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 9/22/2010 5:12 PM
This Order Has Been Discontinued Order Status By Xiao Cai, MD Discontinued
Reason None Reason
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Wed Sep 22, 2010 1411 Isolation No Isolation Order Details Frequency DAILY AT BEDTIME
Order History Order Date/Time 09/22/10 1712 06/04/10 1404 12/16/09 1039 Provider Information Ordering User Victor Henrique Baquero, MD
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jennifer Mello, PHRMTECH
Order ID 59244089 54938947 48222915
MRN 8081369
Sex Male
DOB 9/23/1959
001351
Medication
Medication Detail
Quantity Refills 100 Tab 0 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet (Discontinued) Sig : Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. Route: ORAL PRN Reason(s): pain Class: Pharmacy Transmission Method Faxed
All Administrations of Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet No Administrations Recorded Warnings Override History for Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet [59244090] Overridden by Victor Henrique Baquero, MD on 09/22/10 1712 Drug-Allergy (Active and Inactive Ingredients) 1. MORPHINE [Level: Level 3] Full Warnings History Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 9/22/2010 5:12 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Henrique Discontinued Baquero, MD On 10/20/10 1649 Reason None Electronically Signed By/Authorizing Victor Baquero, MD Department Fol Family Practice
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Wed Sep 22, 2010 1411 Isolation No Isolation Order Details Frequency Duration EVERY 4 TO 6 HOURS IF None NEEDED Priority Routine
Status Pended
Reason
001352
08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
12308313 11994381 11628480 11423903

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail Fluoxetine (PROZAC) 40 mg capsule (Discontinued) Sig : Take 1 Cap by mouth every day. Route: ORAL Class: Pharmacy
Fluoxetine (PROZAC) 40 mg capsule (Order 59326735) Quantity 30 Cap Refills 6 Start 9/24/2010 End 10/18/2010
All Administrations of Fluoxetine (PROZAC) 40 mg capsule No Administrations Recorded Warnings Override History for Fluoxetine (PROZAC) 40 mg capsule [59326735] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 9/24/2010 9:54 AM This Order Has Been Discontinued Order Status By Victor Henrique Discontinued Electronically Signed By/Authorizing Victor Baquero, MD On 10/18/10 1457 Department Fol Family Practice Reason None
001353
Baquero, MD Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Wed Oct 20, 2010 1342 Isolation No Isolation Order Details Frequency Duration EVERY 4 TO 6 HOURS IF None NEEDED Priority Routine Order Class Pharmacy
06/04/10 1404 01/08/10 1506 12/16/09 1039
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Gertrudes Perlas Montemayor, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jennifer Mello, PHRMTECH

Order ID 60411336 59244090 57685505 56399863

54938948 49038497 48222914

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail Methadone (DOLOPHINE) 10 mg Tablet (Discontinued) Sig : Take 2 Tabs by mouth every 6 hours. Route: ORAL
All Administrations of Methadone (DOLOPHINE) 10 mg Tablet No Administrations Recorded
001354
Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [60292329] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 10/18/2010 12:18 PM
This Order Has Been Discontinued Order Status By Martina Discontinued Dobrovodska Randolph, MD
On 11/12/10 1110
Reason None
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Mon Oct 18, 2010 0900 Isolation No Isolation Order Details Frequency EVERY 6 HOURS
Status Pended
Reason
Order Class Normal
Order History Order Date/Time 10/18/10 1218 09/20/10 1005 08/24/10 1344 07/28/10 1715 07/01/10 1259 06/07/10 1345 05/12/10 0853 04/14/10 1344 03/18/10 1752 02/24/10 1725 05/31/07 2000 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jeffrey Alan Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 60292329 59123182 58110191 57021280 55986133 55012451 53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793
001355
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Levothyroxine (LEVOXYL) 50 mcg Tablet (Order 60398539) Start 10/20/2010 End 1/18/2011
Quantity Refills 30 Tab 3 Levothyroxine (LEVOXYL) 50 mcg Tablet Sig : Take 1 Tab by mouth every day. take on an empty stomach Route: ORAL Class: Pharmacy Transmission Method E-Prescribed All Administrations of Levothyroxine (LEVOXYL) 50 mcg Tablet No Administrations Recorded
Warnings Override History for Levothyroxine (LEVOXYL) 50 mcg Tablet [60398539] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 10/20/2010 10:05 AM Isolation No Isolation Order Details Frequency DAILY (OUTPATIENT) Duration None Priority Routine Order Class Pharmacy Electronically Signed By/Authorizing Victor Baquero, MD Department Fol Family Practice
001356
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Transmission Method Faxed
All Administrations of Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet No Administrations Recorded Warnings Override History for Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet [60411336] Overridden by Victor Henrique Baquero, MD on 10/20/10 1649 Drug-Allergy (Active and Inactive Ingredients) 1. MORPHINE [Level: Level 3] Full Warnings History Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 10/20/2010 4:49 PM
This Order Has Been Discontinued Order Status By Victor Henrique Discontinued
On 11/16/10 1734
Reason None
001357
Order Date/Time 11/16/10 1734 10/20/10 1649 09/22/10 1712 08/13/10 1023 07/12/10 1745
06/04/10 1404 01/08/10 1506 12/16/09 1039
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Gertrudes Perlas Montemayor, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jennifer Mello, PHRMTECH
Order ID 61496775 60411336 59244090 57685505 56399863

54938948 49038497 48222914

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail Methadone (DOLOPHINE) 10 mg Tablet (Discontinued) Sig : Take 2 Tabs by mouth every 6 hours. Route: ORAL Class: Handwritten Rx Transmission Method Handwritten
All Administrations of Methadone (DOLOPHINE) 10 mg Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [61320752] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 11/12/2010 11:10 AM Electronically Signed By/Authorizing Martina Dobrovodska Randolph Department Fol Family Practice
001358
Released By MARTINA RANDOLPH [846511566] This Order Has Been Discontinued Order Status By Victor Henrique Discontinued Baquero, MD On 12/7/10 1358 Reason None
Signed and Held / Pended Order History Pending User Date/Time Stephanie L Esparza, LVN Fri Nov 12, 2010 0855 Isolation No Isolation Order Details Frequency EVERY 6 HOURS Duration None Priority Routine
Status Pended
Reason
User Martina Dobrovodska Randolph, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jeffrey Alan Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 61320752 60292329 59123182 58110191 57021280 55986133 55012451 53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
Provider Information Ordering User Martina Dobrovodska Randolph, MD PCP Victor Henrique Baquero, MD
Authorizing Provider Martina Dobrovodska Randolph, MD
001359
06/07/10 1345 05/12/10 0853 04/14/10 1344 03/18/10 1752 02/24/10 1725 05/31/07 2000 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
Jeffrey Alan Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
55012451 53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet (Order 61496776)

Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig : Take 1 Tab by mouth every morning. Route: ORAL Class: Pharmacy Transmission Method E-Prescribed
All Administrations of Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet No Administrations
001360
Recorded Warnings Override History for Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet [61496776] No Warning History Available Pharmacy Selected For Faxed Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 11/16/2010 5:34 PM Released By VICTOR H BAQUERO [886764315] Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Tue Nov 16, 2010 1607 Isolation No Isolation Order Details Frequency DAILY MORNING
Duration None Priority Routine Order Class Pharmacy Status Pended Reason
User Victor Henrique Baquero, MD Jeffrey Alan Applebaum, MD
Order ID 61496776 56372911
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet (Order 61496775)
001361
Medication Detail Quantity Refills 0 100 Tab Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet (Discontinued) Sig : Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. Route: ORAL PRN Reason(s): pain Class: Pharmacy
Start 11/16/2010
End 12/28/2010
All Administrations of Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet No Administrations Recorded Warnings Override History for Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet [61496775] Overridden by Victor Henrique Baquero, MD on 11/16/10 1734 Drug-Allergy (Active and Inactive Ingredients) 1. MORPHINE [Level: Level 3]
Pharmacy Selected For Faxed Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 11/16/2010 5:34 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Henrique Discontinued Baquero, MD On 12/28/10 1112 Reason None Electronically Signed By/Authorizing Victor Baquero, MD Department Fol Family Practice
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Tue Nov 16, 2010 1607 Isolation No Isolation Order Details Frequency Duration EVERY 4 TO 6 HOURS IF None NEEDED Priority Routine
Status Pended
Reason
Order History
001362
34456482
Medication

All Administrations of Methadone (DOLOPHINE) 10 mg Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [62262627] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/7/2010 1:58 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Henrique Discontinued Baquero, MD
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Tue Dec 7, 2010 0746 Isolation No Isolation Order Details Frequency EVERY 6 HOURS
Status Pended
Reason
Order Class Normal
Order History Order Date/Time 12/07/10 1358 11/12/10 1110

10/18/10 1218 09/20/10 1005 08/24/10 1344 07/28/10 1715 07/01/10 1259
User Victor Henrique Baquero, MD Martina Dobrovodska Randolph, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD
Order ID 62262627 61320752 60292329 59123182 58110191 57021280 55986133
001363
08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
12308313 11994381 11628480 11423903

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Start 12/28/2010 End 1/21/2011
Transmission Method Faxed All Administrations of Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet No Administrations Recorded Warnings Override History for Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet [63044766] Overridden by Victor Henrique Baquero, MD on 12/28/10 1112 Drug-Allergy (Active and Inactive Ingredients) 1. MORPHINE [Level: Level 3] Full Warnings History Pharmacy Selected For Faxed Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter
001364

Released By ANDREA A TINSEY [412156705] VICTOR H BAQUERO [886764315]
On 1/21/11 1110
Reason None
Signed and Held / Pended Order History Pending User Date/Time Tue Dec 28, 2010 0956 Michele Melendez Tue Dec 28, 2010 0953 Isolation No Isolation Order Details Frequency Duration EVERY 4 TO 6 HOURS IF None NEEDED Priority Routine
Reason
Order History Order Date/Time 12/28/10 1112 11/16/10 1734 10/20/10 1649 09/22/10 1712 08/13/10 1023 07/12/10 1745 06/04/10 1404 01/08/10 1506 12/16/09 1039 Provider Information Ordering User Victor Henrique Baquero, MD PCP Victor Henrique Baquero, MD
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Gertrudes Perlas Montemayor, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jennifer Mello, PHRMTECH
Order ID 63044766 61496775 60411336 59244090 57685505 56399863 54938948 49038497 48222914
MRN 8081369
Sex Male
DOB 9/23/1959
Visit CSN CSN Number:
001365
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Fri Jan 21, 2011 0953 Isolation No Isolation Order Details Frequency Duration EVERY 4 TO 6 HOURS IF None NEEDED Priority Routine
Status Pended
Reason
06/04/10 1404 01/08/10 1506 12/16/09 1039
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Gertrudes Perlas Montemayor, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jennifer Mello, PHRMTECH
Order ID 63993357 63044766 61496775 60411336 59244090 57685505 56399863

54938948 49038497 48222914

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
001366
All Administrations of Methadone (DOLOPHINE) 10 mg Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [63101198] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/29/2010 1:09 PM This Order Has Been Discontinued Order Status By Victor Henrique Discontinued Baquero, MD Isolation No Isolation Order Details Frequency EVERY 6 HOURS
Duration None Priority Routine Order Class Handwritten Rx
10/18/10 1218 09/20/10 1005 08/24/10 1344 07/28/10 1715 07/01/10 1259 06/07/10 1345 05/12/10 0853 04/14/10 1344 03/18/10 1752 02/24/10 1725 05/31/07 2000 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Martina Dobrovodska Randolph, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jeffrey Alan Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 63101198 62262627 61320752 60292329 59123182 58110191 57021280 55986133 55012451 53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793
001367

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Start 1/21/2011 End 2/16/2011
Quantity Refills 0 100 Tab Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet (Discontinued) Sig : Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. Route: ORAL PRN Reason(s): pain Class: Pharmacy
Transmission Method Faxed All Administrations of Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet No Administrations Recorded Warnings Override History for Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet [63993357] Overridden by Victor Henrique Baquero, MD on 01/21/11 1110 Drug-Allergy (Active and Inactive Ingredients) 1. MORPHINE [Level: Level 3] Full Warnings History Pharmacy Selected For Faxed Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
001368
Ordering User Xiao Cai, MD

Authorizing Provider Barton Lahn Wise, MD
Patient Information Patient Name Amundsen, Mark Unit RHEACC
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail Methadone (DOLOPHINE) 10 mg Tablet (Discontinued) Sig : Take 2 Tabs by mouth every 6 hours. Route: ORAL Class: Handwritten Rx
Transmission Method Handwritten
All Administrations of Methadone (DOLOPHINE) 10 mg Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [64086132] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Henrique Discontinued On 2/18/11 1345 Reason None
001369
Baquero, MD Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Mon Jan 24, 2011 0950 Isolation No Isolation Order Details Frequency EVERY 6 HOURS Duration None Priority Routine Order Class Handwritten Rx
10/18/10 1218 09/20/10 1005 08/24/10 1344 07/28/10 1715 07/01/10 1259 06/07/10 1345 05/12/10 0853 04/14/10 1344 03/18/10 1752 02/24/10 1725 05/31/07 2000 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Martina Dobrovodska Randolph, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jeffrey Alan Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD

Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 64086132 63101198 62262627 61320752

60292329 59123182 58110191 57021280 55986133 55012451 53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
Patient Information
001370
Medication
Medication Detail
Quantity 100 Tab Carisoprodol (SOMA) 350 mg Tablet (Discontinued) Sig : Take 2 Tabs by mouth every day at bedtime. Route: ORAL Class: Historical All Administrations of Carisoprodol (SOMA) 350 mg Tablet No Administrations Recorded
Warnings Override History for Carisoprodol (SOMA) 350 mg Tablet [64435382] Overridden by Xiao Cai, MD on 02/01/11 1002 Dose 1. CARISOPRODOL, 700 MG, ORAL, DAILY AT BEDTIME DAILY DOSE 700 MG. UNDERDOSE (MIN. 750 MG); SINGLE DOSE 700 MG. OVERDOSE (MAX. 350 MG); FREQUE [Reason: Aware/Will monitor] Full Warnings History Pharmacy Selected For Faxed Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 2/1/2011 10:02 AM Electronically Signed By Xiao Cai, MD Authorizing Barton Lahn Wise, MD Department Rheumatology Acc
This Order Has Been Discontinued Order Status By Victor Henrique Discontinued Baquero, MD Isolation No Isolation Order Details Frequency DAILY AT BEDTIME Duration None
On 4/29/11 0906
Reason None
Priority Routine
Order History Order Date/Time 02/01/11 1002 09/22/10 1712 06/04/10 1404 12/16/09 1039 Provider Information
User Xiao Cai, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jennifer Mello, PHRMTECH
Order ID 64435382 59244089 54938947 48222915
001371
05/12/10 0853 04/14/10 1344 03/18/10 1752 02/24/10 1725 05/31/07 2000 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail Carisoprodol (SOMA) 350 mg Tablet Sig : Take 1 Tab by mouth 3 times daily. Route: ORAL Class: Pharmacy Transmission Method E-Prescribed
Carisoprodol (SOMA) 350 mg Tablet (Order 65083667)

All Administrations of Carisoprodol (SOMA) 350 mg Tablet No Administrations Recorded Warnings Override History for Carisoprodol (SOMA) 350 mg Tablet [65083667] No Warning History Available
001372
Pharmacy Selected For Faxed Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 2/16/2011 3:36 PM
Signed and Held / Pended Order History Pending User Date/Time Michele Melendez Wed Feb 16, 2011 1414 Isolation No Isolation Order Details Frequency THREE TIMES DAILY
Status Pended
Reason
05/01/08 0807 04/04/08 1253 02/01/08 1307 10/16/07 1736 09/17/07 1803 08/24/07 1248 05/18/07 1823 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/08/06 1636 11/16/06 1902 10/27/06 0936 09/21/06 0905 08/29/06 1221 08/09/06 1629 07/20/06 1229
User Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Gertrudes Perlas Montemayor, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 65083667 38867452 36315899 33600806 32485341 31477924 30394549 29305593 28300831 25337230 24527578 22961739 20401029 19830238 19378248 17408551 16234615 15747350 15336224 14957272 14222418 13806607 13399309 12795068 12474894 12188977 11883695
001373
06/22/06 0802 05/23/06 1218 05/01/06 1426
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
11514417 11099064 10770668

MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity Refills 100 Tab 0 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet (Discontinued) Sig : Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. Route: ORAL PRN Reason(s): pain Class: Pharmacy Transmission Method Faxed
All Administrations of Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet No Administrations Recorded Warnings Override History for Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet [65083452] Overridden by Victor Henrique Baquero, MD on 02/16/11 1536 Drug-Allergy (Active and Inactive Ingredients) 1. MORPHINE [Level: Level 3] Full Warnings History Pharmacy Selected For Faxed Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter
001374

Released By MICHELE MELENDEZ [497746297] VICTOR H BAQUERO [886764315]
On 3/18/11 1255
Reason None
Signed and Held / Pended Order History Pending User Date/Time Michele Melendez Wed Feb 16, 2011 1414 Michele Melendez Wed Feb 16, 2011 1410 Isolation No Isolation Order Details Frequency Duration EVERY 4 TO 6 HOURS IF None NEEDED Priority Routine
Reason
Order History Order Date/Time 02/16/11 1536 01/21/11 1110 12/28/10 1112 11/16/10 1734 10/20/10 1649 09/22/10 1712 08/13/10 1023 07/12/10 1745
06/04/10 1404 01/08/10 1506 12/16/09 1039
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Gertrudes Perlas Montemayor, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jennifer Mello, PHRMTECH
Order ID 65083452 63993357 63044766 61496775 60411336 59244090 57685505 56399863

54938948 49038497 48222914

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Visit CSN
001375
Medication

All Administrations of Methadone (DOLOPHINE) 10 mg Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [65177606] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 2/18/2011 1:45 PM This Order Has Been Discontinued Order Status By Victor Henrique Discontinued Baquero, MD Isolation No Isolation Order Details Frequency EVERY 6 HOURS Duration None Priority Routine Order Class Normal Electronically Signed By/Authorizing Victor Baquero, MD On 3/14/11 1223 Department Fol Family Practice Reason None
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Martina Dobrovodska Randolph, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jeffrey Alan Applebaum, MD
Order ID 65177606 64086132 63101198 62262627 61320752 60292329 59123182 58110191 57021280 55986133 55012451
001376

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
All Administrations of Methadone (DOLOPHINE) 10 mg Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [66118725] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 3/14/2011 12:23 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Henrique Discontinued Baquero, MD On 4/11/11 1247 Reason None Electronically Signed By/Authorizing Victor Baquero, MD Department Fol Family Practice
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Mon Mar 14, 2011 0815 Isolation No Isolation Order Details
Status Pended
Reason
001377
Frequency EVERY 6 HOURS
Duration None
Priority Routine
Order History Order Date/Time 03/14/11 1223 02/18/11 1345 01/24/11 1027 12/29/10 1309 12/07/10 1358 11/12/10 1110 10/18/10 1218 09/20/10 1005 08/24/10 1344 07/28/10 1715 07/01/10 1259 06/07/10 1345 05/12/10 0853 04/14/10 1344 03/18/10 1752 02/24/10 1725 05/31/07 2000 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information Ordering User Victor Henrique Baquero, MD PCP Victor Henrique Baquero, MD
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Martina Dobrovodska Randolph, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jeffrey Alan Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 66118725 65177606 64086132 63101198 62262627 61320752 60292329 59123182 58110191 57021280 55986133 55012451 53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
MRN 8081369
Sex Male
DOB 9/23/1959
001378
04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Start 3/18/2011 End 4/29/2011
Transmission Method Faxed All Administrations of Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet No Administrations Recorded Warnings Override History for Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet [66326322]
001379
Overridden by Victor Henrique Baquero, MD on 03/18/11 1255 Drug-Allergy (Active and Inactive Ingredients) 1. MORPHINE [Level: Level 3]
Pharmacy Selected For Faxed Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 3/18/2011 12:55 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Henrique Discontinued Baquero, MD
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Fri Mar 18, 2011 0825 Isolation No Isolation Order Details Frequency Duration EVERY 4 TO 6 HOURS IF None NEEDED
Priority Routine
Status Pended
Reason
Order History Order Date/Time 03/18/11 1255 02/16/11 1536 01/21/11 1110 12/28/10 1112 11/16/10 1734 10/20/10 1649 09/22/10 1712 08/13/10 1023 07/12/10 1745 06/04/10 1404 01/08/10 1506 12/16/09 1039 Provider Information Ordering User Victor Henrique Baquero, MD
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Gertrudes Perlas Montemayor, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jennifer Mello, PHRMTECH
Order ID 66326322 65083452 63993357 63044766 61496775 60411336 59244090 57685505 56399863
54938948 49038497 48222914
001380
On 8/16/11 1012
Reason None
Signed and Held / Pended Order History Pending User Date/Time Fri Apr 29, 2011 0830 Isolation No Isolation Order Details Frequency DAILY AT BEDTIME Duration None Priority Routine
Status Pended
Reason
Order History Order Date/Time 04/29/11 0906 02/01/11 1002 09/22/10 1712 06/04/10 1404 12/16/09 1039 Provider Information Ordering User Victor Henrique Baquero, MD PCP Victor Henrique Baquero, MD
User Victor Henrique Baquero, MD Xiao Cai, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jennifer Mello, PHRMTECH
Order ID 68056455 64435382 59244089 54938947 48222915

Unit SRGFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail Methadone (DOLOPHINE) 10 mg Tablet (Discontinued) Sig : Take 2 Tabs by mouth every 6 hours. Route: ORAL Class: Handwritten Rx
All Administrations of Methadone (DOLOPHINE) 10 mg Tablet No Administrations
001381
Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [67144337] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 4/11/2011 12:47 PM
Released By VICTOR H BAQUERO [886764315] VICTOR H BAQUERO [886764315] VICTOR H BAQUERO [886764315]
On 5/4/11 1133
Reason None
Signed and Held / Pended Order History Pending User Date/Time Victor Henrique Baquero, MD Mon Apr 11, 2011 1247 Victor Henrique Baquero, MD Mon Apr 11, 2011 1247 Clare Jennings, MA Thu Apr 7, 2011 0812 Isolation No Isolation Order Details Frequency EVERY 6 HOURS Duration None Priority Routine
Status Pended Pended Pended
Reason
10/18/10 1218 09/20/10 1005 08/24/10 1344 07/28/10 1715 07/01/10 1259 06/07/10 1345 05/12/10 0853 04/14/10 1344 03/18/10 1752 02/24/10 1725 05/31/07 2000
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Martina Dobrovodska Randolph, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jeffrey Alan Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD
Order ID 67144337 66118725 65177606 64086132 63101198 62262627 61320752

60292329 59123182 58110191 57021280 55986133 55012451 53986715 52885589 51770975 50915951 17662191
001382
06/07/10 1345 05/12/10 0853 04/14/10 1344 03/18/10 1752 02/24/10 1725 05/31/07 2000 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
55012451 53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Start 4/29/2011 End 5/30/2011
Quantity Refills 100 Tab 0 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet Sig : Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. Route: ORAL PRN Reason(s): pain Class: Pharmacy
001383
All Administrations of Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet No Administrations Recorded Warnings Override History for Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet [68080256] Overridden by Victor Henrique Baquero, MD on 04/29/11 1707 Drug-Allergy (Active and Inactive Ingredients) 1. MORPHINE [Level: Level 3] Full Warnings History Pharmacy Selected For Faxed Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Fri Apr 29, 2011 1509 Isolation No Isolation Order Details Frequency Duration EVERY 4 TO 6 HOURS IF None NEEDED Priority Routine
Status Pended
Reason
Order History Order Date/Time 04/29/11 1707 03/18/11 1255 02/16/11 1536 01/21/11 1110 12/28/10 1112 11/16/10 1734 10/20/10 1649 09/22/10 1712 08/13/10 1023 07/12/10 1745 06/04/10 1404 01/08/10 1506 12/16/09 1039 Provider Information
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Gertrudes Perlas Montemayor, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jennifer Mello, PHRMTECH
Order ID 68080256 66326322 65083452 63993357 63044766 61496775 60411336 59244090 57685505 56399863 54938948 49038497 48222914
001384
Ordering User Victor Henrique Baquero, MD
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity 100 Tab Carisoprodol (SOMA) 350 mg Tablet (Discontinued) Sig : Take 2 Tabs by mouth every day at bedtime. Route: ORAL Class: Pharmacy Transmission Method E-Prescribed All Administrations of Carisoprodol (SOMA) 350 mg Tablet No Administrations Recorded
Warnings Override History for Carisoprodol (SOMA) 350 mg Tablet [68056455] Overridden by Victor Henrique Baquero, MD on 04/29/11 0906 Dose 1. CARISOPRODOL, 700 MG, ORAL, DAILY AT BEDTIME DAILY DOSE 700 MG. UNDERDOSE (MIN. 750 MG); SINGLE DOSE 700 MG. OVERDOSE (MAX. 350 MG); FREQUE Full Warnings History Pharmacy Selected For Faxed Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Department Fol General Surgery
001385
01/24/11 1027 12/29/10 1309 12/07/10 1358 11/12/10 1110
10/18/10 1218 09/20/10 1005 08/24/10 1344 07/28/10 1715 07/01/10 1259 06/07/10 1345 05/12/10 0853 04/14/10 1344 03/18/10 1752 02/24/10 1725 05/31/07 2000 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information Ordering User Victor Henrique Baquero, MD PCP Victor Henrique Baquero, MD
Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Martina Dobrovodska Randolph, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jeffrey Alan Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
64086132 63101198 62262627 61320752
60292329 59123182 58110191 57021280 55986133 55012451 53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail Methadone (DOLOPHINE) 10 mg
001386
Tablet (Discontinued) Sig : Take 2 Tabs by mouth every 6 hours. Route: ORAL Class: Handwritten Rx Transmission Method Handwritten All Administrations of Methadone (DOLOPHINE) 10 mg Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [68240659] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Wed May 4, 2011 0853 Isolation No Isolation Order Details Frequency EVERY 6 HOURS Duration None Priority Routine
Status Pended
Reason
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Martina Dobrovodska Randolph, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD
Order ID 68240659 67144337 66118725 65177606 64086132 63101198 62262627 61320752 60292329 59123182 58110191 57021280 55986133
001387
Medication

On 6/20/11 0905
Reason None
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Thu May 26, 2011 1423 Isolation No Isolation Order Details Frequency EVERY 6 HOURS
Status Pended
Reason
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD
Order ID 69195206 68240659 67144337 66118725 65177606
001388
Medication
Medication Detail
Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet (Order 69486857) Refills 1 Start 6/3/2011 End 8/16/2011
Quantity 100 Tab Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet (Discontinued) Sig : Take 1 Tab by mouth every 4 to 6 hours if needed. Route: ORAL Class: Pharmacy
All Administrations of Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet No Administrations Recorded Warnings Override History for Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet [69486857] Overridden by Victor Henrique Baquero, MD on 06/03/11 1236 Drug-Allergy (Active and Inactive Ingredients) 1. MORPHINE [Level: Level 3]
Pharmacy Selected For Faxed Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 6/3/2011 12:36 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Henrique Discontinued Baquero, MD On 8/16/11 1012 Reason None Electronically Signed By/Authorizing Victor Baquero, MD Department Fol Family Practice
Signed and Held / Pended Order History Pending User Date/Time Stephanie L Esparza, LVN Fri Jun 3, 2011 0902 Isolation No Isolation Order Details Frequency Duration EVERY 4 TO 6 HOURS IF None Priority Routine
Status Pended
Reason
001389
NEEDED
Order History Order Date/Time 06/03/11 1236 04/27/09 1230 02/13/09 1739 08/20/08 1217 06/25/08 1301 04/30/08 1359 04/04/08 1253 03/05/08 0811 02/01/08 1307 01/09/08 1250 12/10/07 1736 10/16/07 1736 09/18/07 1306 08/01/07 1327 03/29/07 1715 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/16/06 1902 10/27/06 0936 09/18/06 1301 08/29/06 1221 07/20/06 1229 06/29/06 1909 06/06/06 1509 05/23/06 1218 05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235 Provider Information Ordering User Victor Henrique Baquero, MD
User Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 69486857 38866134 35954313 29295197 27315388 25327455 24472171 23777622 22961591 22349333 21797037 20400950 19897779 18888360 16392919 16234616 15747351 15336225 14957270 14565825 14176753 13806608 13399312 12755804 12474895 11883905 11628479 11298702 11099075 10770690 10549668 9590661 9329992 3659473 3336159 3106182
MRN 8081369
Sex Male
DOB 9/23/1959
001390
8081369
Male
9/23/1959
Medication
All Administrations of Methadone (DOLOPHINE) 10 mg Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [70166205] No Warning History Available Pharmacy Selected For Faxed Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 6/20/2011 9:05 AM This Order Has Been Discontinued Order Status By Victor Henrique Discontinued Baquero, MD Isolation No Isolation Order Details Frequency EVERY 6 HOURS Duration None Priority Routine Order Class Handwritten Rx Electronically Signed By/Authorizing Victor Baquero, MD On 7/13/11 1231 Department Fol Family Practice Reason None
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD
Order ID 70166205 69195206 68240659
001391
04/11/11 1247 03/14/11 1223 02/18/11 1345 01/24/11 1027 12/29/10 1309 12/07/10 1358 11/12/10 1110
Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Martina Dobrovodska Randolph, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jeffrey Alan Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
67144337 66118725 65177606 64086132 63101198 62262627 61320752
60292329 59123182 58110191 57021280 55986133 55012451 53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
001392

MRN 8081369
Sex Male
DOB 9/23/1959
Medication

On 8/9/11 1450
Reason None
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Wed Jul 13, 2011 0825 Isolation No Isolation
Status Pended
Reason
001393
Order Details Frequency EVERY 6 HOURS
Duration None
Priority Routine
Order Class Normal
Order History Order Date/Time 07/13/11 1231 06/20/11 0905 05/26/11 1502 05/04/11 1133 04/11/11 1247 03/14/11 1223 02/18/11 1345 01/24/11 1027 12/29/10 1309 12/07/10 1358 11/12/10 1110 10/18/10 1218 09/20/10 1005 08/24/10 1344 07/28/10 1715 07/01/10 1259 06/07/10 1345 05/12/10 0853 04/14/10 1344 03/18/10 1752 02/24/10 1725 05/31/07 2000 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information Ordering User Victor Henrique Baquero, MD PCP Victor Henrique Baquero, MD
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Martina Dobrovodska Randolph, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jeffrey Alan Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 71096422 70166205 69195206 68240659 67144337 66118725 65177606 64086132 63101198 62262627 61320752 60292329 59123182 58110191 57021280 55986133 55012451 53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
MRN
Sex
DOB
001394
MRN 8081369
Sex Male
DOB 9/23/1959
Account # 078661756086
Medication
Medication Detail
Methadone (DOLOPHINE) 10 mg Tablet (Order 72185529) Refills 0 Start 8/9/2011 End 9/2/2011
Quantity 7 Tab Methadone (DOLOPHINE) 10 mg Tablet (Discontinued) Sig : Take 2 Tabs by mouth every 6 hours. 9 daily. Route: ORAL Class: Handwritten Rx
All Administrations of Methadone (DOLOPHINE) 10 mg Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [72185529] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 8/9/2011 2:50 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Henrique Discontinued On 9/2/11 1128 Reason None Electronically Signed By/Authorizing Victor Baquero, MD Department Fol Family Practice
001395
Baquero, MD Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Tue Aug 9, 2011 0758 Isolation No Isolation Order Details Frequency EVERY 6 HOURS Duration None Priority Routine Order Class Handwritten Rx
Order History Order Date/Time 08/09/11 1450 07/13/11 1231 06/20/11 0905 05/26/11 1502 05/04/11 1133 04/11/11 1247 03/14/11 1223 02/18/11 1345 01/24/11 1027 12/29/10 1309 12/07/10 1358 11/12/10 1110 10/18/10 1218 09/20/10 1005 08/24/10 1344 07/28/10 1715 07/01/10 1259 06/07/10 1345 05/12/10 0853 04/14/10 1344 03/18/10 1752 02/24/10 1725 05/31/07 2000 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Martina Dobrovodska Randolph, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jeffrey Alan Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 72185529 71096422 70166205 69195206 68240659 67144337 66118725 65177606 64086132 63101198 62262627 61320752 60292329 59123182 58110191 57021280 55986133 55012451 53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
001396
05/12/10 0853 04/14/10 1344 03/18/10 1752 02/24/10 1725 05/31/07 2000 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Quantity 100 Tab Carisoprodol (SOMA) 350 mg Tablet (Discontinued) Sig : Take 2 Tabs by mouth every day at bedtime. Route: ORAL Class: Pharmacy
Transmission Method E-Prescribed All Administrations of Carisoprodol (SOMA) 350 mg Tablet No Administrations Recorded Warnings Override History for Carisoprodol (SOMA) 350 mg Tablet [72477362]
001397
Overridden by Victor Henrique Baquero, MD on 08/16/11 1012 Dose 1. CARISOPRODOL, 700 MG, ORAL, DAILY AT BEDTIME DAILY DOSE 700 MG. UNDERDOSE (MIN. 750 MG); SINGLE DOSE 700 MG. OVERDOSE (MAX. 350 MG); FREQUE
Pharmacy Selected For Faxed Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 8/16/2011 10:12 AM Electronically Signed By/Authorizing Victor Baquero, MD On 2/21/12 1725 Department Fol Family Practice Reason None
This Order Has Been Discontinued Order Status By Jeffrey A Discontinued Applebaum, MD Isolation No Isolation Order Details Frequency DAILY AT BEDTIME
Duration None
Priority Routine
Order History Order Date/Time 08/16/11 1012 04/29/11 0906 02/01/11 1002 09/22/10 1712 06/04/10 1404 12/16/09 1039 Provider Information Ordering User Victor Henrique Baquero, MD PCP Victor Henrique Baquero, MD
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Xiao Cai, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jennifer Mello, PHRMTECH
Order ID 72477362 68056455 64435382 59244089 54938947 48222915

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
001398
Medication
Medication Detail
Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet (Order 72477361) Refills 1 Start 8/16/2011 End 10/26/2011
Quantity 100 Tab Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet (Discontinued) Sig : Take 1 Tab by mouth every 4 to 6 hours if needed. Route: ORAL Class: Pharmacy Transmission Method Faxed
All Administrations of Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet No Administrations Recorded Warnings Override History for Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet [72477361] Overridden by Victor Henrique Baquero, MD on 08/16/11 1012 Drug-Allergy (Active and Inactive Ingredients) 1. MORPHINE [Level: Level 3] Full Warnings History Pharmacy Selected For Faxed Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 8/16/2011 10:12 AM This Order Has Been Discontinued Order Status By Victor Henrique Discontinued Baquero, MD Isolation No Isolation Order Details Frequency Duration EVERY 4 TO 6 HOURS IF None Priority Routine Order Class Pharmacy Electronically Signed By/Authorizing Victor Baquero, MD On 10/26/11 1221 Department Fol Family Practice Reason None
001399
NEEDED
Order History Order Date/Time 08/16/11 1012 06/03/11 1236 04/27/09 1230 02/13/09 1739 08/20/08 1217 06/25/08 1301 04/30/08 1359 04/04/08 1253 03/05/08 0811 02/01/08 1307 01/09/08 1250 12/10/07 1736 10/16/07 1736 09/18/07 1306 08/01/07 1327 03/29/07 1715 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/16/06 1902 10/27/06 0936 09/18/06 1301 08/29/06 1221 07/20/06 1229 06/29/06 1909 06/06/06 1509 05/23/06 1218 05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235 Provider Information Ordering User Victor Henrique Baquero, MD PCP Victor Henrique Baquero, MD
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 72477361 69486857 38866134 35954313 29295197 27315388 25327455 24472171 23777622 22961591 22349333 21797037 20400950 19897779 18888360 16392919 16234616 15747351 15336225 14957270 14565825 14176753 13806608 13399312 12755804 12474895 11883905 11628479 11298702 11099075 10770690 10549668 9590661 9329992 3659473 3336159 3106182
MRN 8081369
Sex Male
DOB 9/23/1959
001400
Medication
Medication Detail
Levothyroxine (SYNTHROID) 75 mcg Tablet (Order 72477286) Start 8/16/2011 End 11/4/2011
Quantity Refills 30 Tab 11 Levothyroxine (SYNTHROID) 75 mcg Tablet (Discontinued) Sig : Take 1 Tab by mouth every morning before a meal. take on an empty stomach Route: ORAL Class: Pharmacy
All Administrations of Levothyroxine (SYNTHROID) 75 mcg Tablet No Administrations Recorded Warnings Override History for Levothyroxine (SYNTHROID) 75 mcg Tablet [72477286] No Warning History Available Pharmacy Selected For Faxed Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 8/16/2011 10:11 AM This Order Has Been Discontinued Order Status By Victor Henrique Discontinued Baquero, MD Isolation No Isolation Order Details Frequency DAILY MORNING BEFORE MEAL Duration None Priority Routine Order Class Pharmacy Electronically Signed By/Authorizing Victor Baquero, MD On 11/4/11 1642 Department Fol Family Practice Reason None
001401
09/20/10 1005 08/24/10 1344 07/28/10 1715 07/01/10 1259 06/07/10 1345 05/12/10 0853 04/14/10 1344 03/18/10 1752 02/24/10 1725 05/31/07 2000 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jeffrey Alan Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
59123182 58110191 57021280 55986133 55012451 53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity 240 Tab Methadone (DOLOPHINE) 10 mg Tablet (Discontinued) Sig : Take 2 Tabs by mouth every 6 hours. 9 daily. Route: ORAL Class: Handwritten Rx Transmission Method Handwritten
001402
All Administrations of Methadone (DOLOPHINE) 10 mg Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [73199917] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 9/2/2011 11:28 AM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Henrique Discontinued Baquero, MD On 9/29/11 1744 Reason None Electronically Signed By/Authorizing Victor Baquero, MD Department Fol Family Practice
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Fri Sep 2, 2011 0852 Isolation No Isolation Order Details Frequency EVERY 6 HOURS Duration None Priority Routine
Status Pended
Reason
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Martina Dobrovodska Randolph, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jeffrey Alan Applebaum, MD
Order ID 73199917 72185529 71096422 70166205 69195206 68240659 67144337 66118725 65177606 64086132 63101198 62262627 61320752 60292329 59123182 58110191 57021280 55986133 55012451
001403
Class: Pharmacy Transmission Method E-Prescribed All Administrations of Trimethoprim 160 mg/Sulfamethoxazole 800 mg (BACTRIM DS) 800-160 mg Tablet No Administrations Recorded Warnings Override History for Trimethoprim 160 mg/Sulfamethoxazole 800 mg (BACTRIM DS) 800-160 mg Tablet [74770322] No Warning History Available Pharmacy Selected For Faxed Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 10/10/2011 12:08 PM Isolation No Isolation Order Details Frequency TWO TIMES DAILY Duration 10 days Priority Routine Order Class Pharmacy Electronically Signed By/Authorizing Victor Baquero, MD Department Fol Family Practice

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity 270 Tab Methadone (DOLOPHINE) 10 mg Tablet (Discontinued) Sig : Take 2 Tabs by mouth every 6 hours. 9 daily.
001404
Route: ORAL Class: Handwritten Rx Transmission Method Handwritten All Administrations of Methadone (DOLOPHINE) 10 mg Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [74316584] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 9/29/2011 5:44 PM
On 10/25/11 1656
Reason None
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Thu Sep 29, 2011 0844 Isolation No Isolation Order Details Frequency EVERY 6 HOURS Duration 30 days Priority Routine
Status Pended
Reason
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Martina Dobrovodska Randolph, MD Victor Henrique Baquero, MD
Order ID 74316584 73199917 72185529 71096422 70166205 69195206 68240659 67144337 66118725 65177606 64086132 63101198 62262627 61320752 60292329
001405
Randolph, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jeffrey Alan Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
60292329 59123182 58110191 57021280 55986133 55012451 53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Trimethoprim 160 mg/Sulfamethoxazole 800 mg (BACTRIM DS) 800-160 mg Tablet (Order 74770322)
Trimethoprim 160 mg/Sulfamethoxazole 800 mg (BACTRIM DS) 800-160 mg Tablet Sig : Take 1 Tab by mouth 2 times daily. Route: ORAL
001406
04/30/08 1359 04/04/08 1253 03/05/08 0811 02/01/08 1307 01/09/08 1250 12/10/07 1736 10/16/07 1736 09/18/07 1306 08/01/07 1327 03/29/07 1715 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/16/06 1902 10/27/06 0936 09/18/06 1301 08/29/06 1221 07/20/06 1229 06/29/06 1909 06/06/06 1509 05/23/06 1218 05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
25327455 24472171 23777622 22961591 22349333 21797037 20400950 19897779 18888360 16392919 16234616 15747351 15336225 14957270 14565825 14176753 13806608 13399312 12755804 12474895 11883905 11628479 11298702 11099075 10770690 10549668 9590661 9329992 3659473 3336159 3106182

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail Methadone (DOLOPHINE) 10 mg Tablet (Discontinued)
001407
Sig : Take 2 Tabs by mouth every 6 hours. 9 daily. Route: ORAL Class: Handwritten Rx Transmission Method Handwritten All Administrations of Methadone (DOLOPHINE) 10 mg Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [75400929] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
On 11/4/11 1612
Reason None
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Tue Oct 25, 2011 0901 Isolation No Isolation Order Details Frequency EVERY 6 HOURS Duration 30 days Priority Routine
Status Pended
Reason
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Martina Dobrovodska
Order ID 75400929 74316584 73199917 72185529 71096422 70166205 69195206 68240659 67144337 66118725 65177606 64086132 63101198 62262627 61320752
001408
11/12/10 1110 10/18/10 1218 09/20/10 1005 08/24/10 1344 07/28/10 1715 07/01/10 1259 06/07/10 1345 05/12/10 0853 04/14/10 1344 03/18/10 1752 02/24/10 1725 05/31/07 2000 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information Ordering User Victor Henrique Baquero, MD PCP Victor Henrique Baquero, MD
Martina Dobrovodska Randolph, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jeffrey Alan Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
61320752 60292329 59123182 58110191 57021280 55986133 55012451 53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Quantity 100 Tab Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet (Discontinued) Sig : Take 1 Tab by mouth every 4 to 6 hours if needed.
001409
Route: ORAL Class: Pharmacy Transmission Method Faxed All Administrations of Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet No Administrations Recorded Warnings Override History for Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet [75462118] Overridden by Victor Henrique Baquero, MD on 10/26/11 1221 Drug-Allergy (Active and Inactive Ingredients) 1. MORPHINE [Level: Level 3]
Pharmacy Selected For Faxed Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 10/26/2011 12:21 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued On 1/25/12 1237
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Wed Oct 26, 2011 1126 Isolation No Isolation Order Details Frequency Duration EVERY 4 TO 6 HOURS IF 30 days NEEDED Priority Routine
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 75462118 72477361 69486857 38866134 35954313 29295197 27315388
001410
Transmission Method E-Prescribed All Administrations of PredniSONE (DELTASONE) 20 mg Tablet No Administrations Recorded Warnings Override History for PredniSONE (DELTASONE) 20 mg Tablet [76052068] No Warning History Available Pharmacy Selected For Faxed Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 11/9/2011 1:24 PM Isolation No Isolation Order Details Frequency None
Duration 13 days Priority Routine Order Class Pharmacy

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Levothyroxine (SYNTHROID) 75 mcg Tablet (Order 75872967) Start 11/4/2011 End 11/3/2012
Quantity Refills 30 Tab 11 Levothyroxine (SYNTHROID) 75 mcg Tablet Sig : Take 1 Tab by mouth every morning before a meal. take on an empty stomach Route: ORAL Class: Pharmacy
001411
All Administrations of Levothyroxine (SYNTHROID) 75 mcg Tablet No Administrations Recorded Warnings Override History for Levothyroxine (SYNTHROID) 75 mcg Tablet [75872967] No Warning History Available Pharmacy Selected For Faxed Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 11/4/2011 4:42 PM Isolation No Isolation Order Details Frequency DAILY MORNING BEFORE MEAL Duration 365 days Priority Routine Order Class Pharmacy Electronically Signed By/Authorizing Victor Baquero, MD Department Fol Family Practice
Order History Order Date/Time 11/04/11 1642 08/16/11 1011 Provider Information Ordering User Victor Henrique Baquero, MD PCP Victor Henrique Baquero, MD
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD
Order ID 75872967 72477286
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
001412
Methadone (DOLOPHINE) 10 mg Tablet (Discontinued) Sig : Take 3 Tabs by mouth every 8 hours. 9 daily. Route: ORAL Class: Historical All Administrations of Methadone (DOLOPHINE) 10 mg Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [75840636] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 11/4/2011 4:12 PM
On 11/16/11 1315
Reason None
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Fri Nov 4, 2011 0837 Isolation No Isolation Order Details Frequency EVERY 8 HOURS
Status Pended
Reason
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD
Order ID 75840636 75400929 74316584 73199917 72185529 71096422 70166205 69195206 68240659 67144337 66118725 65177606 64086132 63101198 62262627
001413
Randolph, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jeffrey Alan Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
60292329 59123182 58110191 57021280 55986133 55012451 53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
PredniSONE (DELTASONE) 20 mg Tablet (Order 76052068) Start 11/9/2011 End 11/22/2011
Quantity Refills 20 tablet 0 PredniSONE (DELTASONE) 20 mg Tablet Sig : Take by mouth. Take 3 pills every morning for 3 days then 2 for 3 days then 1 for 3 days then 1/2 for 4 days. Route: ORAL Class: Pharmacy
001414
61320752 60292329 59123182 58110191 57021280 55986133 55012451 53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity 270 tablet Methadone (DOLOPHINE) 10 mg Tablet (Discontinued) Sig : Take 3 tablets by mouth every 8 hours. 9 daily. Route: ORAL
001415
Class: Handwritten Rx Transmission Method Handwritten All Administrations of Methadone (DOLOPHINE) 10 mg Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [76248383] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 11/16/2011 1:15 PM
On 12/8/11 1222
Reason None
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Tue Nov 15, 2011 0814 Isolation No Isolation Order Details Frequency EVERY 8 HOURS Duration 30 days Priority Routine
Status Pended
Reason
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Martina Dobrovodska
Order ID 76248383 75840636 75400929 74316584 73199917 72185529 71096422 70166205 69195206 68240659 67144337 66118725 65177606 64086132 63101198 62262627 61320752
001416
61320752 60292329 59123182 58110191 57021280 55986133 55012451 53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity 270 tablet Methadone (DOLOPHINE) 10 mg Tablet (Discontinued) Sig : Take 3 tablets by mouth every 8 hours. 9 daily. Route: ORAL
001417
Class: Handwritten Rx Transmission Method Handwritten All Administrations of Methadone (DOLOPHINE) 10 mg Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [77203602] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/8/2011 12:22 PM
On 1/3/12 0838
Reason None
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Thu Dec 8, 2011 0741 Isolation No Isolation Order Details Frequency EVERY 8 HOURS Duration 30 days Priority Routine
Status Pended
Reason
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD
Order ID 77203602 76248383 75840636 75400929 74316584 73199917 72185529 71096422 70166205 69195206 68240659 67144337 66118725 65177606 64086132 63101198 62262627
001418
Quantity 270 tablet Methadone (DOLOPHINE) 10 mg Tablet (Discontinued) Sig : Take 3 tablets by mouth every 8 hours. 9 daily. Route: ORAL Class: Handwritten Rx Transmission Method Handwritten All Administrations of Methadone (DOLOPHINE) 10 mg Tablet No Administrations Recorded
Refills 0
Start 1/3/2012
End 1/25/2012
Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [78135698] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 1/3/2012 8:38 AM Electronically Signed By/Authorizing Victor Baquero, MD On 1/25/12 1727 Department Fol Family Practice Reason None
This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued Isolation No Isolation Order Details Frequency EVERY 8 HOURS
Duration 30 days
Priority Routine
User Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD
Order ID 78135698 77203602 76248383 75840636 75400929 74316584 73199917 72185529 71096422 70166205 69195206 68240659 67144337 66118725 65177606 64086132 63101198 62262627
001419
Quantity 100 tablet Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet Sig : Take 1 tablet by mouth every 4 to 6 hours if needed. Route: ORAL Class: Pharmacy Transmission Method Faxed
Refills 1
Start 1/25/2012
End 2/24/2012
All Administrations of Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet No Administrations Recorded Warnings Override History for Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet [79074138] Overridden by Victor Baquero, MD on 01/25/12 1237 Drug-Allergy (Active and Inactive Ingredients) 1. MORPHINE [Level: Level 3] Full Warnings History Pharmacy Selected For Faxed Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 1/25/2012 12:37 PM
Signed and Held / Pended Order History Pending User Date/Time Yelena Tsvirinko Wed Jan 25, 2012 1108 Isolation No Isolation Order Details Frequency Duration EVERY 4 TO 6 HOURS IF 30 days NEEDED
Priority Routine
Status Pended
Reason
User Victor Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 79074138 75462118 72477361 69486857 38866134 35954313 29295197
001420
06/25/08 1301 04/30/08 1359 04/04/08 1253 03/05/08 0811 02/01/08 1307 01/09/08 1250 12/10/07 1736 10/16/07 1736 09/18/07 1306 08/01/07 1327 03/29/07 1715 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/16/06 1902 10/27/06 0936 09/18/06 1301 08/29/06 1221 07/20/06 1229 06/29/06 1909 06/06/06 1509 05/23/06 1218 05/01/06 1427 04/18/06 1716 02/06/06 1705 01/19/06 0938 09/14/04 0856 08/11/04 1721 07/19/04 1235
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero Victor Baquero Victor Baquero Victor Baquero Victor Baquero
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero, MD
27315388 25327455 24472171 23777622 22961591 22349333 21797037 20400950 19897779 18888360 16392919 16234616 15747351 15336225 14957270 14565825 14176753 13806608 13399312 12755804 12474895 11883905 11628479 11298702 11099075 10770690 10549668 9590661 9329992 3659473 3336159 3106182
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Methadone (DOLOPHINE) 10 mg Tablet (Order 79064819) Quantity 270 tablet Refills 0 Start 1/25/2012 End 2/17/2012
001421
Tablet (Discontinued) Sig : Take 3 tablets by mouth every 8 hours. 9 daily. Route: ORAL Class: Handwritten Rx Transmission Method Handwritten All Administrations of Methadone (DOLOPHINE) 10 mg Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [79064819] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Yelena Tsvirinko Wed Jan 25, 2012 0854 Isolation No Isolation Order Details Frequency EVERY 8 HOURS Duration 30 days Priority Routine
User Victor Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD
Order ID 79064819 78135698 77203602 76248383 75840636 75400929 74316584 73199917 72185529 71096422 70166205 69195206 68240659 67144337
001422
03/14/11 1223 02/18/11 1345 01/24/11 1027 12/29/10 1309 12/07/10 1358 11/12/10 1110 10/18/10 1218 09/20/10 1005 08/24/10 1344 07/28/10 1715 07/01/10 1259 06/07/10 1345 05/12/10 0853 04/14/10 1344 03/18/10 1752 02/24/10 1725 05/31/07 2000 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Martina Dobrovodska Randolph, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jeffrey Alan Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
66118725 65177606 64086132 63101198 62262627 61320752 60292329 59123182 58110191 57021280 55986133 55012451 53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
001423
08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
12308313 11994381 11628480 11423903

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity 60 tablet Carisoprodol (SOMA) 350 mg Tablet (Discontinued) Sig : Take 2 tablets by mouth every day at bedtime. Route: ORAL Class: Pharmacy
All Administrations of Carisoprodol (SOMA) 350 mg Tablet No Administrations Recorded Warnings Override History for Carisoprodol (SOMA) 350 mg Tablet [80231533] Overridden by Jeffrey A Applebaum, MD on 02/21/12 1725 Dose 1. CARISOPRODOL, 700 MG, ORAL, DAILY AT BEDTIME DAILY DOSE 700 MG. UNDERDOSE (MIN. 750 MG); SINGLE DOSE 700 MG. OVERDOSE (MAX. 350 MG); FREQUE
Pharmacy Selected For Faxed Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter
001424

Released By JEFFREY APPLEBAUM [307513234]
Department Fol Endocrine
Reason None Reason
Signed and Held / Pended Order History Pending User Date/Time Tue Feb 21, 2012 1505 Isolation No Isolation Order Details Frequency DAILY AT BEDTIME Duration 92 days Priority Routine
Order History Order Date/Time 02/21/12 1725 08/16/11 1012 04/29/11 0906 02/01/11 1002 09/22/10 1712 06/04/10 1404 12/16/09 1039 Provider Information Ordering User Jeffrey A Applebaum, MD PCP Victor Baquero, MD
User Jeffrey A Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Xiao Cai, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jennifer Mello, PHRMTECH
Order ID 80231533 72477362 68056455 64435382 59244089 54938947 48222915
Authorizing Provider Jeffrey A Applebaum, MD

Unit ENDFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity 270 tablet Methadone (DOLOPHINE) 10 mg Tablet (Discontinued) Sig : Take 3 tablets by mouth every 8 hours. 9 daily.
001425
Route: ORAL Class: Handwritten Rx Transmission Method Handwritten All Administrations of Methadone (DOLOPHINE) 10 mg Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [80085627] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 2/17/2012 2:25 PM
On 3/14/12 0815
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Fri Feb 17, 2012 0919 Isolation No Isolation Order Details Frequency EVERY 8 HOURS Duration 30 days Priority Routine
Order History Order Date/Time 02/17/12 1425 01/25/12 1727 01/03/12 0838 12/08/11 1222 11/16/11 1315 11/04/11 1612 10/25/11 1656 09/29/11 1744 09/02/11 1128 08/09/11 1450 07/13/11 1231 06/20/11 0905 05/26/11 1502 05/04/11 1133 04/11/11 1247 03/14/11 1223
User Victor Baquero, MD Victor Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD
Order ID 80085627 79064819 78135698 77203602 76248383 75840636 75400929 74316584 73199917 72185529 71096422 70166205 69195206 68240659 67144337 66118725
001426
02/18/11 1345 01/24/11 1027 12/29/10 1309 12/07/10 1358 11/12/10 1110
10/18/10 1218 09/20/10 1005 08/24/10 1344 07/28/10 1715 07/01/10 1259 06/07/10 1345 05/12/10 0853 04/14/10 1344 03/18/10 1752 02/24/10 1725 05/31/07 2000 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805 Provider Information Ordering User Victor Baquero, MD PCP Victor Baquero, MD
Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Martina Dobrovodska Randolph, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jeffrey Alan Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
65177606 64086132 63101198 62262627 61320752
60292329 59123182 58110191 57021280 55986133 55012451 53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
001427
Ordering User Gertrudes Perlas Montemayor, MD

MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Quantity 270 tablet Methadone (DOLOPHINE) 10 mg Tablet (Discontinued) Sig : Take 3 tablets by mouth every 8 hours. 9 daily. Route: ORAL Class: Handwritten Rx
Transmission Method Handwritten All Administrations of Methadone (DOLOPHINE) 10 mg Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [81188770] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 3/14/2012 8:15 AM
Released By VICTOR H BAQUERO [886764315] VICTOR H BAQUERO [886764315]
Reason None Reason
Signed and Held / Pended Order History Pending User Date/Time Victor Baquero, MD Wed Mar 14, 2012 0815 Clare Jennings, MA Wed Mar 14, 2012 0748
001428

Duration 30 days Priority Routine Order Class Handwritten Rx
Order History Order Date/Time 03/14/12 0815 02/17/12 1425 01/25/12 1727 01/03/12 0838 12/08/11 1222 11/16/11 1315 11/04/11 1612 10/25/11 1656 09/29/11 1744 09/02/11 1128 08/09/11 1450 07/13/11 1231 06/20/11 0905 05/26/11 1502 05/04/11 1133 04/11/11 1247 03/14/11 1223 02/18/11 1345 01/24/11 1027 12/29/10 1309 12/07/10 1358 11/12/10 1110 10/18/10 1218 09/20/10 1005 08/24/10 1344 07/28/10 1715 07/01/10 1259 06/07/10 1345 05/12/10 0853 04/14/10 1344 03/18/10 1752 02/24/10 1725 05/31/07 2000 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Martina Dobrovodska Randolph, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jeffrey Alan Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Order ID 81188770 80085627 79064819 78135698 77203602 76248383 75840636 75400929 74316584 73199917 72185529 71096422 70166205 69195206 68240659 67144337 66118725 65177606 64086132 63101198 62262627 61320752
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
60292329 59123182 58110191 57021280 55986133 55012451 53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793
001429
Medication
Medication Detail
Quantity Refills 100 tablet 0 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet (Discontinued) Sig : Take 1 tablet by mouth every 4 to 6 hours if needed for pain. Route: ORAL PRN Reason(s): pain Class: Pharmacy
All Administrations of Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet No Administrations Recorded Warnings Override History for Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet [82144325] Overridden by Gertrudes Perlas Montemayor, MD on 04/05/12 1711 Drug-Allergy (Active and Inactive Ingredients) 1. MORPHINE [Level: Level 3] [Reason: Tolerated before]
Pharmacy Selected For Faxed Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 4/5/2012 5:11 PM Electronically Signed By/Authorizing Gertrudes Perlas Montemayor Department Fol Family Practice
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Kimberly Anderson, MA Thu Apr 5, 2012 1703 Isolation No Isolation Order Details Frequency Duration EVERY 4 TO 6 HOURS IF 30 days NEEDED
Priority Routine
001430
01/24/11 1027 12/29/10 1309 12/07/10 1358 11/12/10 1110
64086132 63101198 62262627 61320752
60292329 59123182 58110191 57021280 55986133 55012451 53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Methadone (DOLOPHINE) 10 mg Tablet (Order 82303773) Quantity 270 tablet Refills 0 Start 4/10/2012 End 5/3/2012
001431
Tablet (Discontinued) Sig : Take 3 tablets by mouth every 8 hours. 9 daily. Route: ORAL Class: Handwritten Rx Transmission Method Handwritten All Administrations of Methadone (DOLOPHINE) 10 mg Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [82303773] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Yelena Tsvirinko Tue Apr 10, 2012 0809 Isolation No Isolation Order Details Frequency EVERY 8 HOURS Duration 30 days Priority Routine
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD
Order ID 82303773 81188770 80085627 79064819 78135698 77203602 76248383 75840636 75400929 74316584 73199917 72185529 71096422 70166205
001432
05/26/11 1502 05/04/11 1133 04/11/11 1247 03/14/11 1223 02/18/11 1345 01/24/11 1027 12/29/10 1309 12/07/10 1358 11/12/10 1110 10/18/10 1218 09/20/10 1005 08/24/10 1344 07/28/10 1715 07/01/10 1259 06/07/10 1345 05/12/10 0853 04/14/10 1344 03/18/10 1752 02/24/10 1725 05/31/07 2000 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Martina Dobrovodska Randolph, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jeffrey Alan Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
69195206 68240659 67144337 66118725 65177606 64086132 63101198 62262627 61320752 60292329 59123182 58110191 57021280 55986133 55012451 53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

MRN 8081369
Sex Male
DOB 9/23/1959
001433
10/18/10 1218 09/20/10 1005 08/24/10 1344 07/28/10 1715 07/01/10 1259 06/07/10 1345 05/12/10 0853 04/14/10 1344 03/18/10 1752 02/24/10 1725 05/31/07 2000 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jeffrey Alan Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
60292329 59123182 58110191 57021280 55986133 55012451 53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Transmission Method
001434
Handwritten All Administrations of Methadone (DOLOPHINE) 10 mg Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [83301037] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 5/3/2012 12:27 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued On 5/30/12 0932
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Thu May 3, 2012 1021 Isolation No Isolation Order Details Frequency EVERY 8 HOURS
Order History Order Date/Time 05/03/12 1227 04/11/12 1315 03/14/12 0815 02/17/12 1425 01/25/12 1727 01/03/12 0838 12/08/11 1222 11/16/11 1315 11/04/11 1612 10/25/11 1656 09/29/11 1744 09/02/11 1128 08/09/11 1450 07/13/11 1231 06/20/11 0905 05/26/11 1502 05/04/11 1133 04/11/11 1247 03/14/11 1223 02/18/11 1345
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 83301037 82303773 81188770 80085627 79064819 78135698 77203602 76248383 75840636 75400929 74316584 73199917 72185529 71096422 70166205 69195206 68240659 67144337 66118725 65177606
001435
Victor Baquero, MD PCP Victor Baquero, MD
Victor Baquero, MD

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Start 5/29/2012 End 7/19/2012
Quantity Refills 100 tablet 0 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet (Discontinued) Sig : Take 1 tablet by mouth every 4 to 6 hours if needed for pain. Route: ORAL PRN Reason(s): pain Class: Pharmacy
Transmission Method Faxed All Administrations of Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet No Administrations Recorded Warnings Override History for Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet [84402408] Overridden by Victor Baquero, MD on 05/29/12 1658 Drug-Allergy (Active and Inactive Ingredients) 1. MORPHINE [Level: Level 3] Full Warnings History Pharmacy Selected For Faxed Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
001436
On 7/19/12 1259
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Aneeka Dibble Tue May 29, 2012 1534 Isolation No Isolation Order Details Frequency Duration EVERY 4 TO 6 HOURS IF 30 days NEEDED Priority Routine
User Action Victor Baquero, MD Current Order Gertrudes Perlas Montemayor, Reordered from MD Authorizing Provider Victor Baquero, MD
Order ID 84402408 82144325

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
All Administrations of Methadone (DOLOPHINE) 10 mg Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [84390696]
001437
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Tue May 29, 2012 1241 Isolation No Isolation Order Details Frequency EVERY 8 HOURS Duration 30 days Priority Routine
Order History Order Date/Time 05/30/12 0932 05/03/12 1227 04/11/12 1315 03/14/12 0815 02/17/12 1425 01/25/12 1727 01/03/12 0838 12/08/11 1222 11/16/11 1315 11/04/11 1612 10/25/11 1656 09/29/11 1744 09/02/11 1128 08/09/11 1450 07/13/11 1231 06/20/11 0905 05/26/11 1502 05/04/11 1133 04/11/11 1247 03/14/11 1223 02/18/11 1345 01/24/11 1027 12/29/10 1309 12/07/10 1358 11/12/10 1110
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Martina Dobrovodska Randolph, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 84390696 83301037 82303773 81188770 80085627 79064819 78135698 77203602 76248383 75840636 75400929 74316584 73199917 72185529 71096422 70166205 69195206 68240659 67144337 66118725 65177606 64086132 63101198 62262627 61320752
001438
10/18/10 1218 09/20/10 1005 08/24/10 1344 07/28/10 1715 07/01/10 1259 06/07/10 1345 05/12/10 0853 04/14/10 1344 03/18/10 1752 02/24/10 1725 05/31/07 2000 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jeffrey Alan Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
60292329 59123182 58110191 57021280 55986133 55012451 53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Transmission Method
001439
Faxed All Administrations of Carisoprodol (SOMA) 350 mg Tablet No Administrations Recorded Warnings Override History for Carisoprodol (SOMA) 350 mg Tablet [84434696] Overridden by Victor Baquero, MD on 05/30/12 0939 Dose 1. CARISOPRODOL, 700 MG, ORAL, DAILY AT BEDTIME DAILY DOSE 700 MG. UNDERDOSE (MIN. 750 MG); SINGLE DOSE 700 MG. OVERDOSE (MAX. 350 MG); FREQUE Full Warnings History Pharmacy Selected For Faxed Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 5/30/2012 9:39 AM
Reason None Reason
Signed and Held / Pended Order History Pending User Date/Time Yelena Tsvirinko Wed May 30, 2012 0933 Isolation No Isolation Order Details Frequency DAILY AT BEDTIME
Order History Order Date/Time 05/30/12 0939 02/21/12 1725 08/16/11 1012 04/29/11 0906 02/01/11 1002 09/22/10 1712 06/04/10 1404 12/16/09 1039 Provider Information Ordering User
User Victor Baquero, MD Jeffrey A Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Xiao Cai, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jennifer Mello, PHRMTECH
Order ID 84434696 80231533 72477362 68056455 64435382 59244089 54938947 48222915
001440
03/18/10 1752 02/24/10 1725 05/31/07 2000 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
All Administrations of Methadone (DOLOPHINE) 10 mg Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [85510852] No Warning History Available
001441

Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Mon Jun 25, 2012 0901 Isolation No Isolation Order Details Frequency EVERY 8 HOURS Duration 30 days Priority Routine
Order History Order Date/Time 06/25/12 0915 05/30/12 0932 05/03/12 1227 04/11/12 1315 03/14/12 0815 02/17/12 1425 01/25/12 1727 01/03/12 0838 12/08/11 1222 11/16/11 1315 11/04/11 1612 10/25/11 1656 09/29/11 1744 09/02/11 1128 08/09/11 1450 07/13/11 1231 06/20/11 0905 05/26/11 1502 05/04/11 1133 04/11/11 1247 03/14/11 1223 02/18/11 1345 01/24/11 1027 12/29/10 1309 12/07/10 1358 11/12/10 1110
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Martina Dobrovodska Randolph, MD
Order ID 85510852 84390696 83301037 82303773 81188770 80085627 79064819 78135698 77203602 76248383 75840636 75400929 74316584 73199917 72185529 71096422 70166205 69195206 68240659 67144337 66118725 65177606 64086132 63101198 62262627 61320752
001442
Isolation No Isolation Order Details Frequency Duration EVERY 4 TO 6 HOURS IF 30 days NEEDED
Priority Routine Order Class Pharmacy
User Victor Baquero, MD Victor Baquero, MD Gertrudes Perlas Montemayor, MD
Order ID 86521187 84402408 82144325

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO 10) 10-325 mg per tablet (Order 86429215)
Start 7/17/2012 End 8/16/2012
Quantity Refills 100 tablet 0 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO 10) 10-325 mg per tablet Sig : Take 1 tablet by mouth every 4 to 6 hours if needed for pain. Route: ORAL PRN Reason(s): pain Class: Pharmacy
Transmission Method Faxed All Administrations of Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO 10) 10-325 mg per tablet No Administrations Recorded Warnings Override History for Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO 10) 10-325 mg per tablet [86429215] Overridden by Victor Baquero, MD on 07/19/12 1302 Drug-Allergy (Active and Inactive Ingredients) 1. MORPHINE [Level: Level 3]
001443
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Tue Jul 17, 2012 1329 Isolation No Isolation Order Details Frequency Duration EVERY 4 TO 6 HOURS IF 30 days NEEDED
Priority Routine
Status Pended
Reason
User Victor Baquero, MD Victor Baquero, MD Gertrudes Perlas Montemayor, MD
Order ID 86429215 84402408 82144325

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
001444
Medication Detail Quantity 60 tablet Carisoprodol (SOMA) 350 mg Tablet (Discontinued) Sig : Take 2 tablets by mouth every day at bedtime. Route: ORAL Class: Pharmacy
Refills 0
Start 7/17/2012
End 8/22/2012
All Administrations of Carisoprodol (SOMA) 350 mg Tablet No Administrations Recorded Warnings Override History for Carisoprodol (SOMA) 350 mg Tablet [86429213] Overridden by Victor Baquero, MD on 07/19/12 1302 Dose 1. CARISOPRODOL, 700 MG, ORAL, DAILY AT BEDTIME DAILY DOSE 700 MG. UNDERDOSE (MIN. 750 MG); SINGLE DOSE 700 MG. OVERDOSE (MAX. 350 MG); FREQUE Full Warnings History Pharmacy Selected For Faxed Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 7/19/2012 1:02 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued On 8/22/12 1428
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Tue Jul 17, 2012 1329 Isolation No Isolation Order Details Frequency DAILY AT BEDTIME Duration 92 days Priority Routine
Order ID 86429213
001445
05/30/12 0939 02/21/12 1725 08/16/11 1012 04/29/11 0906 02/01/11 1002 09/22/10 1712 06/04/10 1404 12/16/09 1039
Victor Baquero, MD Jeffrey A Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Xiao Cai, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jennifer Mello, PHRMTECH
84434696 80231533 72477362 68056455 64435382 59244089 54938947 48222915
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [86429214] No Warning History Available Pharmacy Selected For Faxed Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 7/19/2012 1:02 PM Electronically Signed By/Authorizing Victor Baquero, MD Department Fol Family Practice
001446
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Tue Jul 17, 2012 1329 Isolation No Isolation Order Details Frequency EVERY 8 HOURS
Order History Order Date/Time 07/19/12 1302 06/25/12 0915 05/30/12 0932 05/03/12 1227 04/11/12 1315 03/14/12 0815 02/17/12 1425 01/25/12 1727 01/03/12 0838 12/08/11 1222 11/16/11 1315 11/04/11 1612 10/25/11 1656 09/29/11 1744 09/02/11 1128 08/09/11 1450 07/13/11 1231 06/20/11 0905 05/26/11 1502 05/04/11 1133 04/11/11 1247 03/14/11 1223 02/18/11 1345 01/24/11 1027 12/29/10 1309 12/07/10 1358 11/12/10 1110
10/18/10 1218 09/20/10 1005 08/24/10 1344 07/28/10 1715 07/01/10 1259 06/07/10 1345 05/12/10 0853 04/14/10 1344
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Martina Dobrovodska Randolph, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jeffrey Alan Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD
Order ID 86429214 85510852 84390696 83301037 82303773 81188770 80085627 79064819 78135698 77203602 76248383 75840636 75400929 74316584 73199917 72185529 71096422 70166205 69195206 68240659 67144337 66118725 65177606 64086132 63101198 62262627 61320752 60292329 59123182 58110191 57021280 55986133 55012451 53986715 52885589
001447
05/31/07 2000 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Authorizing Provider Victor Baquero, MD
17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity 60 tablet Carisoprodol (SOMA) 350 mg Tablet (Discontinued) Sig : Take 2 tablets by mouth every day at bedtime. Route: ORAL Class: Pharmacy Transmission Method Faxed All Administrations of Carisoprodol (SOMA) 350 mg Tablet No Administrations Recorded
Warnings Override History for Carisoprodol (SOMA) 350 mg Tablet [86521186] Overridden by Victor Baquero, MD on 07/19/12 1259 Dose 1. CARISOPRODOL, 700 MG, ORAL, DAILY AT BEDTIME DAILY DOSE 700 MG. UNDERDOSE (MIN. 750 MG);
001448
SINGLE DOSE 700 MG. OVERDOSE (MAX. 350 MG); FREQUE

Pharmacy Selected For Faxed Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 7/19/2012 12:59 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Thu Jul 19, 2012 1110 Isolation No Isolation Order Details Frequency DAILY AT BEDTIME
Order History Order Date/Time 07/19/12 1259 05/30/12 0939 02/21/12 1725 08/16/11 1012 04/29/11 0906 02/01/11 1002 09/22/10 1712 06/04/10 1404 12/16/09 1039 Provider Information Ordering User Victor Baquero, MD PCP Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Jeffrey A Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Xiao Cai, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jennifer Mello, PHRMTECH
Order ID 86521186 84434696 80231533 72477362 68056455 64435382 59244089 54938947 48222915
MRN 8081369
Sex Male
DOB 9/23/1959
001449
Unit FAMFOL
Medication
Medication Detail
Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO 10) 10-325 mg per tablet (Order 86521187) Start 7/19/2012 End 8/22/2012
Quantity Refills 100 tablet 0 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO 10) 10-325 mg per tablet (Discontinued) Sig : Take 1 tablet by mouth every 4 to 6 hours if needed for pain. Route: ORAL PRN Reason(s): pain Class: Pharmacy Transmission Method Faxed
All Administrations of Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO 10) 10-325 mg per tablet No Administrations Recorded Warnings Override History for Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO 10) 10-325 mg per tablet [86521187] Overridden by Victor Baquero, MD on 07/19/12 1259 Drug-Allergy (Active and Inactive Ingredients) 1. MORPHINE [Level: Level 3] Full Warnings History Pharmacy Selected For Faxed Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 7/19/2012 12:59 PM
Reason None Reason
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Thu Jul 19, 2012 1110
001450
Order Details Frequency Duration EVERY 4 TO 6 HOURS IF 30 days NEEDED
Priority Routine
Order History Order Date/Time 08/22/12 1428 07/19/12 1259 05/29/12 1658 04/05/12 1711 Provider Information Ordering User Victor Baquero, MD PCP Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Gertrudes Perlas Montemayor, MD
Order ID 87956441 86521187 84402408 82144325

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [87378729] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
001451

On 9/6/12 1336
Duration 30 days
Priority Routine
Order History Order Date/Time 08/08/12 1712 07/19/12 1302 06/25/12 0915 05/30/12 0932 05/03/12 1227 04/11/12 1315 03/14/12 0815 02/17/12 1425 01/25/12 1727 01/03/12 0838 12/08/11 1222 11/16/11 1315 11/04/11 1612 10/25/11 1656 09/29/11 1744 09/02/11 1128 08/09/11 1450 07/13/11 1231 06/20/11 0905 05/26/11 1502 05/04/11 1133 04/11/11 1247 03/14/11 1223 02/18/11 1345 01/24/11 1027 12/29/10 1309 12/07/10 1358 11/12/10 1110 10/18/10 1218 09/20/10 1005 08/24/10 1344 07/28/10 1715 07/01/10 1259 06/07/10 1345 05/12/10 0853 04/14/10 1344 03/18/10 1752 02/24/10 1725
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Martina Dobrovodska Randolph, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jeffrey Alan Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD
Order ID 87378729 86429214 85510852 84390696 83301037 82303773 81188770 80085627 79064819 78135698 77203602 76248383 75840636 75400929 74316584 73199917 72185529 71096422 70166205 69195206 68240659 67144337 66118725 65177606 64086132 63101198 62262627 61320752
60292329 59123182 58110191 57021280 55986133 55012451 53986715 52885589 51770975 50915951
001452
03/18/10 1752 02/24/10 1725 05/31/07 2000 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity 60 tablet Carisoprodol (SOMA) 350 mg Tablet Sig : Take 2 tablets by mouth every day at bedtime. Route: ORAL Class: Pharmacy
All Administrations of Carisoprodol (SOMA) 350 mg Tablet No Administrations Recorded Warnings Override History for Carisoprodol (SOMA) 350 mg Tablet [87956440] Overridden by Victor Baquero, MD on 08/22/12 1428 Dose 1. CARISOPRODOL, 700 MG, ORAL, DAILY AT BEDTIME
001453
DAILY DOSE 700 MG. UNDERDOSE (MIN. 750 MG); SINGLE DOSE 700 MG. OVERDOSE (MAX. 350 MG); FREQUE
Pharmacy Selected For Faxed Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 8/22/2012 2:28 PM Released By VICTOR H BAQUERO [886764315] Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Wed Aug 22, 2012 0947 Isolation No Isolation Order Details Frequency DAILY AT BEDTIME Duration 92 days Priority Routine Order Class Pharmacy
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Jeffrey A Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Xiao Cai, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jennifer Mello, PHRMTECH
Order ID 87956440 86429213 84434696 80231533 72477362 68056455 64435382 59244089 54938947 48222915
MRN 8081369
Sex Male
DOB 9/23/1959
001454
FAMFOL
Medication
Medication Detail
Quantity Refills 0 100 tablet Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO 10) 10-325 mg per tablet (Discontinued) Sig : Take 1 tablet by mouth every 4 to 6 hours if needed for pain. Route: ORAL PRN Reason(s): pain Class: Pharmacy
All Administrations of Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO 10) 10-325 mg per tablet No Administrations Recorded Warnings Override History for Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO 10) 10-325 mg per tablet [87956441] Overridden by Victor Baquero, MD on 08/22/12 1428 Drug-Allergy (Active and Inactive Ingredients) 1. MORPHINE [Level: Level 3]
Pharmacy Selected For Faxed Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 8/22/2012 2:28 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued On 9/24/12 1708
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Wed Aug 22, 2012 0947 Isolation No Isolation
001455
Order Details Frequency Duration EVERY 4 TO 6 HOURS IF 30 days NEEDED
Priority Routine
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Gertrudes Perlas Montemayor, MD
Order ID 89369281 87956441 86521187 84402408 82144325
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
All Administrations of Methadone (DOLOPHINE) 10 mg Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [88603185] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter
001456
Order Info Date and Time 9/6/2012 1:36 PM Electronically Signed By/Authorizing Victor Baquero, MD On 9/28/12 1311 Department Fol Family Practice Reason None
This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued Isolation No Isolation Order Details Frequency EVERY 8 HOURS Duration 30 days
Priority Routine
10/18/10 1218 09/20/10 1005 08/24/10 1344 07/28/10 1715 07/01/10 1259 06/07/10 1345 05/12/10 0853 04/14/10 1344
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Martina Dobrovodska Randolph, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jeffrey Alan Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD
Order ID 88603185 87378729 86429214 85510852 84390696 83301037 82303773 81188770 80085627 79064819 78135698 77203602 76248383 75840636 75400929 74316584 73199917 72185529 71096422 70166205 69195206 68240659 67144337 66118725 65177606 64086132 63101198 62262627 61320752
60292329 59123182 58110191 57021280 55986133 55012451 53986715 52885589
001457
02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail

Transmission Method Faxed All Administrations of Carisoprodol (SOMA) 350 mg Tablet No Administrations Recorded Warnings Override History for Carisoprodol (SOMA) 350 mg Tablet [89369321] Overridden by Victor Baquero, MD on 09/24/12 1708 Dose 1. CARISOPRODOL, 700 MG, ORAL, DAILY AT BEDTIME DAILY DOSE 700 MG. UNDERDOSE (MIN. 750 MG); SINGLE DOSE 700 MG. OVERDOSE (MAX. 350 MG); FREQUE Full Warnings History
001458
Reason None Reason
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Mon Sep 24, 2012 1541 Isolation No Isolation Order Details Frequency DAILY AT BEDTIME Duration 92 days Priority Routine
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Jeffrey A Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Xiao Cai, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jennifer Mello, PHRMTECH
Order ID 89369321 86521186 84434696 80231533 72477362 68056455 64435382 59244089 54938947 48222915

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
001459
Medication
Medication Detail
Quantity Refills 100 tablet 0 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO 10) 10-325 mg per tablet (Discontinued) Sig : Take 1 tablet by mouth every 4 to 6 hours if needed for pain. Route: ORAL PRN Reason(s): pain Class: Pharmacy
Pharmacy Selected For Faxed Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 9/24/2012 5:08 PM Released By CLARE JENNINGS [250243482] VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued On 10/22/12 1029
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Mon Sep 24, 2012 1541 Clare Jennings, MA Mon Sep 24, 2012 1540 Isolation No Isolation
001460

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [89563223] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 9/28/2012 1:11 PM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued On 10/23/12 0900
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Fri Sep 28, 2012 1106
001461

Duration 30 days Priority Routine Order Class Handwritten Rx
10/18/10 1218 09/20/10 1005 08/24/10 1344 07/28/10 1715 07/01/10 1259 06/07/10 1345 05/12/10 0853 04/14/10 1344 03/18/10 1752 02/24/10 1725 05/31/07 2000 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Martina Dobrovodska Randolph, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jeffrey Alan Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 89563223 88603185 87378729 86429214 85510852 84390696 83301037 82303773 81188770 80085627 79064819 78135698 77203602 76248383 75840636 75400929 74316584 73199917 72185529 71096422 70166205 69195206 68240659 67144337 66118725 65177606 64086132 63101198 62262627 61320752 60292329 59123182 58110191 57021280 55986133 55012451 53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970
001462

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity 60 tablet Carisoprodol (SOMA) 350 mg Tablet (Discontinued) Sig : Take 2 tablets by mouth every day at bedtime. Route: ORAL Class: Pharmacy Transmission Method Faxed All Administrations of Carisoprodol (SOMA) 350 mg Tablet No Administrations Recorded
Warnings Override History for Carisoprodol (SOMA) 350 mg Tablet [90529704] Overridden by Victor Baquero, MD on 10/22/12 1029 Dose 1. CARISOPRODOL, 700 MG, ORAL, DAILY AT BEDTIME DAILY DOSE 700 MG. UNDERDOSE (MIN. 750 MG); SINGLE DOSE 700 MG. OVERDOSE (MAX. 350 MG); FREQUE
Pharmacy Selected For Faxed Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 10/22/2012 10:29 AM Released By VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Electronically Signed By/Authorizing Victor Baquero, MD Department Fol Family Practice
001463
Reason None Reason
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Mon Oct 22, 2012 0923 Isolation No Isolation Order Details Frequency DAILY AT BEDTIME
Order History Order Date/Time 10/22/12 1029 09/24/12 1708 07/19/12 1259 05/30/12 0939 02/21/12 1725 08/16/11 1012 04/29/11 0906 02/01/11 1002 09/22/10 1712 06/04/10 1404 12/16/09 1039 Provider Information Ordering User Victor Baquero, MD
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Jeffrey A Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Xiao Cai, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jennifer Mello, PHRMTECH
Order ID 90529704 89369321 86521186 84434696 80231533 72477362 68056455 64435382 59244089 54938947 48222915
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity Refills 100 tablet 0 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO 10) 10-325 mg per tablet (Discontinued) Sig : Take 1 tablet by mouth every 4 to 6 hours if needed for pain. Route: ORAL PRN Reason(s): pain
001464
Class: Pharmacy Transmission Method Faxed All Administrations of Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO 10) 10-325 mg per tablet No Administrations Recorded Warnings Override History for Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO 10) 10-325 mg per tablet [90529654] Overridden by Victor Baquero, MD on 10/22/12 1029 Drug-Allergy (Active and Inactive Ingredients) 1. MORPHINE [Level: Level 3] Full Warnings History Pharmacy Selected For Faxed Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 10/22/2012 10:29 AM Released By CLARE JENNINGS [250243482] VICTOR H BAQUERO [886764315] This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued On 11/19/12 1707
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Mon Oct 22, 2012 0923 Clare Jennings, MA Mon Oct 22, 2012 0922 Isolation No Isolation Order Details Frequency Duration EVERY 4 TO 6 HOURS IF 30 days NEEDED Priority Routine
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Gertrudes Perlas Montemayor, MD
Order ID 90529654 89369281 87956441 86521187 84402408 82144325
001465
Medication
Medication Detail
Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [90579828] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Status Pended
Reason None
Reason
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Tue Oct 23, 2012 0858 Isolation No Isolation Order Details Frequency EVERY 8 HOURS Duration 30 days Priority Routine
Order ID 90579828 89563223 88603185 87378729 86429214 85510852 84390696
001466
05/03/12 1227 04/11/12 1315 03/14/12 0815 02/17/12 1425 01/25/12 1727 01/03/12 0838 12/08/11 1222 11/16/11 1315 11/04/11 1612 10/25/11 1656 09/29/11 1744 09/02/11 1128 08/09/11 1450 07/13/11 1231 06/20/11 0905 05/26/11 1502 05/04/11 1133 04/11/11 1247 03/14/11 1223 02/18/11 1345 01/24/11 1027 12/29/10 1309 12/07/10 1358 11/12/10 1110 10/18/10 1218 09/20/10 1005 08/24/10 1344 07/28/10 1715 07/01/10 1259 06/07/10 1345 05/12/10 0853 04/14/10 1344 03/18/10 1752 02/24/10 1725 05/31/07 2000 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Martina Dobrovodska Randolph, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jeffrey Alan Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
83301037 82303773 81188770 80085627 79064819 78135698 77203602 76248383 75840636 75400929 74316584 73199917 72185529 71096422 70166205 69195206 68240659 67144337 66118725 65177606 64086132 63101198 62262627 61320752 60292329 59123182 58110191 57021280 55986133 55012451 53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
001467
44788233
Medication
Medication Detail

Quantity 60 tablet Carisoprodol (SOMA) 350 mg Tablet Sig : Take 2 tablets by mouth every day at bedtime. Route: ORAL Class: Pharmacy
Transmission Method Faxed All Administrations of Carisoprodol (SOMA) 350 mg Tablet No Administrations Recorded Warnings Override History for Carisoprodol (SOMA) 350 mg Tablet [91733000] Overridden by Victor Baquero, MD on 11/19/12 1707 Dose 1. CARISOPRODOL, 700 MG, ORAL, DAILY AT BEDTIME DAILY DOSE 700 MG. UNDERDOSE (MIN. 750 MG); SINGLE DOSE 700 MG. OVERDOSE (MAX. 350 MG); FREQUE Full Warnings History Pharmacy Selected For Faxed Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 11/19/2012 5:07 PM
Released By CLARE JENNINGS [250243482] VICTOR H BAQUERO [886764315]
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Mon Nov 19, 2012 1639 Clare Jennings, MA Mon Nov 19, 2012 1638 Isolation No Isolation Order Details Frequency DAILY AT BEDTIME Duration 92 days Priority Routine
Reason
Order ID 91733000
001468
10/22/12 1029 09/24/12 1708 07/19/12 1259 05/30/12 0939 02/21/12 1725 08/16/11 1012 04/29/11 0906 02/01/11 1002 09/22/10 1712 06/04/10 1404 12/16/09 1039
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Jeffrey A Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Xiao Cai, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jennifer Mello, PHRMTECH
90529704 89369321 86521186 84434696 80231533 72477362 68056455 64435382 59244089 54938947 48222915
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
Quantity Refills 100 tablet 0 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO 10) 10-325 mg per tablet (Discontinued) Sig : Take 1 tablet by mouth every 4 to 6 hours if needed for pain. Route: ORAL PRN Reason(s): pain Class: Pharmacy
All Administrations of Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO 10) 10-325 mg per tablet No Administrations Recorded Warnings Override History for Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO 10) 10-325 mg per tablet [91733077] Overridden by Victor Baquero, MD on 11/19/12 1707 Drug-Allergy (Active and Inactive Ingredients) 1. MORPHINE [Level: Level 3] Full Warnings History
001469
Reason None Reason
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Mon Nov 19, 2012 1639 Isolation No Isolation Order Details Frequency Duration EVERY 4 TO 6 HOURS IF 30 days NEEDED Priority Routine
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Gertrudes Perlas Montemayor, MD
Order ID 91733077 90529654 89369281 87956441 86521187 84402408 82144325

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Visit CSN
001470
06/07/10 1345 05/12/10 0853 04/14/10 1344 03/18/10 1752 02/24/10 1725 05/31/07 2000 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
55012451 53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
All Administrations of Methadone (DOLOPHINE) 10 mg Tablet No Administrations Recorded
001471
Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [91789212] No Warning History Available Pharmacy Selected For Faxed Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 11/20/2012 6:28 PM Electronically Signed By/Authorizing Victor Baquero, MD On 12/14/12 1258 Department Fol Family Practice Reason None
This Order Has Been Discontinued Order Status By Victor Baquero, MD Discontinued Isolation No Isolation Order Details Frequency EVERY 8 HOURS Duration 30 days
Priority Routine
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD
Order ID 91789212 90579828 89563223 88603185 87378729 86429214 85510852 84390696 83301037 82303773 81188770 80085627 79064819 78135698 77203602 76248383 75840636 75400929 74316584 73199917 72185529 71096422 70166205 69195206 68240659 67144337 66118725 65177606
001472
01/24/11 1027 12/29/10 1309 12/07/10 1358 11/12/10 1110
64086132 63101198 62262627 61320752
60292329 59123182 58110191 57021280 55986133 55012451 53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
001473
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Gertrudes Perlas Montemayor, MD
Order ID 93060993 91733077 90529654 89369281 87956441 86521187 84402408 82144325
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail
All Administrations of Methadone (DOLOPHINE) 10 mg Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [92773649] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
001474
Date and Time 12/14/2012 12:58 PM

On 1/3/13 1322
Duration 30 days
Priority Routine
Order History Order Date/Time 12/14/12 1258 11/20/12 1828 10/23/12 0900 09/28/12 1311 09/06/12 1336 08/08/12 1712 07/19/12 1302 06/25/12 0915 05/30/12 0932 05/03/12 1227 04/11/12 1315 03/14/12 0815 02/17/12 1425 01/25/12 1727 01/03/12 0838 12/08/11 1222 11/16/11 1315 11/04/11 1612 10/25/11 1656 09/29/11 1744 09/02/11 1128 08/09/11 1450 07/13/11 1231 06/20/11 0905 05/26/11 1502 05/04/11 1133 04/11/11 1247 03/14/11 1223 02/18/11 1345 01/24/11 1027 12/29/10 1309 12/07/10 1358 11/12/10 1110
10/18/10 1218 09/20/10 1005 08/24/10 1344 07/28/10 1715 07/01/10 1259
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Martina Dobrovodska Randolph, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 92773649 91789212 90579828 89563223 88603185 87378729 86429214 85510852 84390696 83301037 82303773 81188770 80085627 79064819 78135698 77203602 76248383 75840636 75400929 74316584 73199917 72185529 71096422 70166205 69195206 68240659 67144337 66118725 65177606 64086132 63101198 62262627 61320752 60292329 59123182 58110191 57021280 55986133
001475

Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Medication
Medication Detail Carisoprodol (SOMA) 350 mg Tablet Sig : Take 1 tablet by mouth 3 times daily. Route: ORAL Class: Pharmacy Transmission Method Faxed
Carisoprodol (SOMA) 350 mg Tablet (Order 93061176) Quantity 100 tablet Refills 1 Start 12/21/2012 End 1/20/2013
All Administrations of Carisoprodol (SOMA) 350 mg Tablet No Administrations Recorded Warnings Override History for Carisoprodol (SOMA) 350 mg Tablet [93061176] No Warning History Available Pharmacy Selected For Faxed Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info
Date and Time 12/21/2012 12:08 PM
Released By VICTOR H BAQUERO [886764315] VICTOR H BAQUERO [886764315] Signed and Held / Pended Order History Pending User Date/Time Victor Baquero, MD Fri Dec 21, 2012 1207 Maria Mason, MA Fri Dec 21, 2012 1015
Status Pended Pended Reason
001476
Isolation No Isolation Order Details Frequency THREE TIMES DAILY

Duration 30 days Priority Routine Order Class Pharmacy
05/01/08 0807 04/04/08 1253 02/01/08 1307 10/16/07 1736 09/17/07 1803 08/24/07 1248 05/18/07 1823 03/22/07 1012 03/02/07 0817 02/06/07 1743 01/18/07 1253 12/08/06 1636 11/16/06 1902 10/27/06 0936 09/21/06 0905 08/29/06 1221 08/09/06 1629 07/20/06 1229 06/22/06 0802 05/23/06 1218 05/01/06 1426
User Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Gertrudes Perlas Montemayor, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
Action Current Order Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from Reordered from
Order ID 93061176 38867452 36315899 33600806 32485341 31477924 30394549 29305593 28300831 25337230 24527578 22961739 20401029 19830238 19378248 17408551 16234615 15747350 15336224 14957272 14222418 13806607 13399309 12795068 12474894 12188977 11883695 11514417 11099064 10770668

MRN 8081369
Sex Male
DOB 9/23/1959
001477
Medication
Medication Detail
Quantity Refills 100 tablet 0 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO 10) 10-325 mg per tablet Sig : Take 1 tablet by mouth every 4 to 6 hours if needed for pain. Route: ORAL PRN Reason(s): pain
Pharmacy Selected For Faxed Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 12/21/2012 12:08 PM Released By MARIA MASON [806444964] VICTOR H BAQUERO [886764315] VICTOR H BAQUERO [886764315] Signed and Held / Pended Order History Pending User Date/Time Victor Baquero, MD Fri Dec 21, 2012 1207 Maria Mason, MA Fri Dec 21, 2012 1015 Maria Mason, MA Fri Dec 21, 2012 1013 Isolation No Isolation Order Details Frequency Duration EVERY 4 TO 6 HOURS IF 30 days NEEDED
Priority Routine Order Class Normal Status Pended Pended Pended Reason
001478
Medication
Medication Detail

Transmission Method Handwritten All Administrations of Methadone (DOLOPHINE) 10 mg Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [93425436] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 1/3/2013 1:22 PM
Reason None Reason
Signed and Held / Pended Order History Pending User Date/Time Clare Jennings, MA Wed Jan 2, 2013 1510 Isolation No Isolation Order Details Frequency EVERY 8 HOURS
Order ID 93425436 92773649 91789212 90579828 89563223 88603185
001479
08/08/12 1712 07/19/12 1302 06/25/12 0915 05/30/12 0932 05/03/12 1227 04/11/12 1315 03/14/12 0815 02/17/12 1425 01/25/12 1727 01/03/12 0838 12/08/11 1222 11/16/11 1315 11/04/11 1612 10/25/11 1656 09/29/11 1744 09/02/11 1128 08/09/11 1450 07/13/11 1231 06/20/11 0905 05/26/11 1502 05/04/11 1133 04/11/11 1247 03/14/11 1223 02/18/11 1345 01/24/11 1027 12/29/10 1309 12/07/10 1358 11/12/10 1110
10/18/10 1218 09/20/10 1005 08/24/10 1344 07/28/10 1715 07/01/10 1259 06/07/10 1345 05/12/10 0853 04/14/10 1344 03/18/10 1752 02/24/10 1725 05/31/07 2000 04/20/07 0919 04/06/07 1644 03/22/07 0813 03/02/07 0820 02/06/07 1736 01/18/07 1253 12/28/06 0803 12/06/06 1654 11/14/06 1334 10/23/06 0822 10/02/06 1038 09/11/06 0843 08/17/06 1255 07/26/06 1703 06/29/06 1909 06/15/06 0805
Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Martina Dobrovodska Randolph, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Jeffrey Alan Applebaum, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD
87378729 86429214 85510852 84390696 83301037 82303773 81188770 80085627 79064819 78135698 77203602 76248383 75840636 75400929 74316584 73199917 72185529 71096422 70166205 69195206 68240659 67144337 66118725 65177606 64086132 63101198 62262627 61320752
60292329 59123182 58110191 57021280 55986133 55012451 53986715 52885589 51770975 50915951 17662191 16827161 16546809 16231762 15816970 15343963 14957271 14565826 14176752 13748358 13301080 12961787 12648793 12308313 11994381 11628480 11423903
001480
Medication
Medication Detail Methadone (DOLOPHINE) 10 mg Tablet Sig : Take 3 tablets by mouth every 8 hours. Route: ORAL Transmission Method Printed

Quantity 18 tablet Refills 0 Start 1/5/2013 End 1/7/2013
All Administrations of Methadone (DOLOPHINE) 10 mg Tablet No Administrations Recorded Warnings Override History for Methadone (DOLOPHINE) 10 mg Tablet [93562191] No Warning History Available Allergies FENTANYL; MORPHINE Encounter View Encounter Order Info Date and Time 1/5/2013 6:44 PM Isolation No Isolation Order Details Frequency EVERY 8 HOURS Duration 2 days Priority Routine Order Class Normal Electronically Signed By/Authorizing Kelly P Owen Department Emergency - Pavilion
Provider Information Ordering User Kelly P Owen, MD Attending Provider(s) Kelly P Owen, MD
Ordering Provider Kelly P Owen, MD
Authorizing Provider Kelly P Owen, MD
Ordering Provider OWEN, KELLY P [09926]
Patient Information Patient Name Amundsen, Mark Unit EDPAV
Room ED CHAIRS1-8
Bed F-CH4
001481
MRN:
8081369,
Patient
Last,
First:
AMUNDSEN.
MARK
02/20/2013
01,15,13
PM
Page 1 of,
I'
NURSES NOTES
n:l .
D.",
-rime
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/
lead
~e-IPR
EC10PIc:s
orutor Tech. FtN. Date
m.
ythm
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j?R
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onitor Tech.
t:ctopJcs
Date
Ome
Hhythm
f Lead
/
~
Rate
C1oPIs
QRS
Monitor Tl3cn . N.
001482
~DI~l (ENTER
. U<DAVISMC
, " .'
,UCD
DEPA~T!NTL R~\"mI
.
~SEP--fC9-20n2-
~jjfD)o(Qja(Q)(tfif" '
uq::
1
.REPO
RT
, NAME: AMUNDSEN,MARK PT LOCATION: MR#: 8081369, DOB: REQUESTING PHYSICIA1J':" VICTOR HENRIQUE BAQUERO MD EXAM DATE:'
,"
Day.~UYJ.5;gic~I.,Cen,t2r 2315 SLOcKLOIl'Bivd. S~cramento CA 9581'7 (916)7~4-0655 " (patient scheduling')
I,
UCDMGFO i3~Sep-.59 13-Sep-02
LUMBARSPINE: The, lumbar vertebral column appears normally , 'spaces are well', preserved': A minor Schmorl' LS'" Sacroiliac'joints 'are, well preserved, IMPRESSION: ' IN THE
, I
a li qried . ',The s :.i'ntr,usion is
disc seen
at
NO, SIGNIFICJ\NT RADIOGRAPHIC ABNORMALITY IDENTIFIED LUMBAR "SPINE FOR THE ,PATIENT,' S CHRONOLOGICALAGE. Dictated By: Russell ExamJs) Reviewed By And 'Firidirigs,Gonfirmed,By: 'Russel'l 'Report ,Signed By:' -RusseLL RM/sc'
><.'
"
A,
McFa Ll. , M,D,
A.' McFall; M.D: A. McF'a.l Lj- M,D ..
810-091302
, T:
"P':
18-Sep-2002, , 16-Sep-02 ,IS :,58, D: 16~Sep-02 15:23

"
'
----':ReSuIIs
Chart'needed
01<
,~ResullS as expected'
'
,
=N~, ' ,"

.
~~ OODISC~edresu~fs";fhparent, , ~,,::. """" needed"
caflJ~ntofr"UI:/
'tJ'~
<
t1d~!'?y/
' ' ,
'
<.
1)0'-0~ '
':
~,
18-Sep-2002
I '
, ,I
-,----------------------
,'
001483
'
MEDICAL (ENTER
UCOflV'SMC
UCD
DEPARTMENT
OF RADIOLOGY
.RADIOLOGY
REPORT
NAME: AMUNDSEN,MARK MR#: 8081369 REQUESTING PHYSICIAN: VICTOR HENRIQUE BAQUERO
UC Davis Medical Center 2315 Stockton Blvd, Sacramento CA 95817 (916)734-0655 (patient scheduling) PT LOCATION: UCDMGFO DOB: 23-Sep-59 MD EXAM DATE: 20-Dec-02
MRI LUMBOSACRAL INDICATION:
SPINE:
Left-sided TECHNIQUE:
L5 radiculopathy,
MRI of the lumbosacral spine performed with sagittal nonenhanced T1 and T2-weighted sequences, FINDINGS:
and axial
The L1-2 and 2-3 levels are unremarkable, At L3-4 the disk is unremarkable but there are degenerative changes of the facets bilaterally, moderate degree. At L4-5, the disk is unremarkable but there are degenerative changes of moderate degree involving the facets. There is no evidence of compression of either of the L5 roots within the wide neural foramina or within the spinal canal. At ,L5 -S1 there is an annular tear involving the pors t.e'r i or and 'left side of the annulus, without disk protru'sioh. The S1'roots are. unremarkable. 'Again, the L5 roots are unremarkable. No evidence of a lateral herniated disk to account for. symptoms. IMPRESSION: OTHER THAN THE ANNULAR TEAR INVOLVING THE L5-S1 DISK TO THE LEFT OF' THE MIDLINE, AND THE DEGENERATIVE CHANAGES OF' THE FACETS, NO ABNORMALITY IS SEEN. , Dictated By: Richard Exam(s) Reviewed By And Findings Confirmed By: Richard Report Signed By: Richard REL/kg 80-122002 P: 23-Dec-2002 T: 21-Dec-02 10:50 D: 21-Dec-02 10:43 E. Latchaw, E. Latchaw, E. Latchaw, M.D. M.D. M.D.
Medical Records
001484
----------------RBCBMID---
MEDICR~i~':;;lMC
UCD
,.
DEPARTMENT
<DF RADIOLOGY
V<T: \)s.\is Medical Center 1 , l~~{l5 Stockton Blvd.
I
[f1JJ@U@g@~rlf' REPORT
NAME: AMUND:::EN, MARK MR#: 8081369 REQUESTING PHYSICIAN: VICTOR HENRIQUE BAQUERO BILATERAL CLINICAL HIPSjAP HISTORY: PELVIS:
DEC
CA 95817 (916)734-0655 I (patient scheduling) PT LOCAT[ON: UCDMGFO DOB: I 23-Sep-59 MD EXAM DATE: 01-Dec-03
MeOlCaJ R~entD
Left hip pain. FINDINGS: AP film of the pelvis and frog lateral view of each hip demonstrate similar sclerosis and minimal joint space narrowing bi l..LaL-~ra.L.l.Y There is sljghtly more spurring at the left femoral neck than the right. The bony pelvis is grossly intact.
l ... I l I
IMPRESSION: 1. MILD BILATERAL c OSTEOARTHRITIS OF THE HIPS. K. Ontell, K. Ontell, K. Ontell, M.D. M.D. M.D.
Dicta ed By: Francesca Exam(s) Reviewed y And Findings Conf' med By: Francesca Report igned By: Francesca FKojmbh 910-120103
P: 04-Dec-2003 T: 03-Dec-03 08:22 D: 02-Dec-03 13:28
o OKtoliJe
04-Dec-2003
001485
None
None
Routine
Normal
Schedule Information
Release Date/Time None Schedule Date/Time
Ordered By GARY J COLLINS [08983] Admitting Provider Ordering Provider COLLINS, GARY J [08983] Authorized By GARY J COLLINS [08983] PCP Victor Baquero, MD Pager

Collection Date 3/5/2004
Patient Information
Patient Name Amundsen, Mark MRN 8081369 Sex Male DOB 9/23/1959
Unit UCDPMC
Parent Child Order Details

Order ID 1867712
Imaging Results
Entry Date 12/4/2003
HIP BIL, 2 VW EA + PELVIS PCN (Accession 910A-120103) (Order 1065124) PACS Images Show images for HIP BIL, 2 VW EA + PELVIS PCN
Component Results TRANSCRIPTIONS: Exam: PCN HIP BIL, 2 VW EA + PELVIS Clinical data: LT HIP PAIN Report: BILATERAL HIPS/AP PELVIS: CLINICAL HISTORY: Left hip pain. FINDINGS: AP film of the pelvis and frog lateral view of each hip demonstrate similar sclerosis and minimal joint space narrowing bilaterally. There is slightly more spurring at the left femoral neck than the right. The bony pelvis is grossly intact. Impression:
001486
1.
MILD BILATERAL OSTEOARTHRITIS OF THE HIPS.
signed: Francesca K. Ontell, M.D. Result History HIP BIL, 2 VW EA + PELVIS PCN (Order#1065124) on 12/4/03 - Order Result History Report. MyChart Status: This result is currently not released to MyChart. Radiology Result Information Result Date and Time 12/4/2003 1:40 PM Order Providers Authorizing Provider (08139) Victor Baquero Status Final result Encounter Provider (08139) Victor Baquero

Unit IMFFOL
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Order
Allergies
FENTANYL; MORPHINE
HIP BIL, 2 VW EA + PELVIS PCN (Accession 910A-120103) (Order 1065124)
Order Information
Date and Time 12/1/2003 3:35 PM Authorizing Victor Baquero, MD Department Fol Fam Prac/Int Med
Isolation
No Isolation
Order Details
Frequency None Duration None Priority Routine Order Class Normal
Ordered By VICTOR BAQUERO [08139] Admitting Provider Ordering Provider BAQUERO, VICTOR [08139] Authorized By VICTOR BAQUERO [08139] PCP Victor Baquero, MD Pager 916-762-2086

001487
Patient Information
Patient Name Amundsen, Mark Unit IMFFOL MRN 8081369 Sex Male DOB 9/23/1959

Order ID 1065124
001488
4/11/2005 8:55 PM
Rad Results Interface
Yoav Hahn
Ent Physicians
Isolation
No Isolation
Order Details
Frequency None Duration None Priority Routine Order Class Internal Referral
Ordered By YOAV HAHN [08555] Authorized By YOAV HAHN [08555]
Admitting Provider
Ordering Provider HAHN, YOAV [08555]

Pager

Patient Information
Patient Name Amundsen, Mark Unit ENTCL5 MRN 8081369 Sex Male DOB 9/23/1959

Order ID 5808386
Imaging Results
Entry Date 3/8/2004 Component Results TRANSCRIPTIONS: Exam: MR LSPINE
MR LSPINE (Accession 252A-030504) (Order 1867712) PACS Images Show images for MR LSPINE
72148
Clinical data: H/O MULTI LEVEL LUMBAR DDD .PT PROGRESION OF LT. S1 RADICULAR SX & DEVELOPING RT.SIDE SX' EVAL L5 S1 DISC TO R/O HNP/STENOSIS,ALSO DIFFICULTY W/ INC. DIFF.W/VOMITING. Report: MRI LUMBAR SPINE: CLINICAL HISTORY: Back pain with radiculopathy.
001489
TECHNIQUE: Proton T1, T2-weighted, and fat suppressed fast spin-echo sagittal and proton transaxial images were obtained through the lumbosacral spine. FINDINGS: No paraspinal masses are evident. No significant disc protrusion or disc bulge is seen. No foraminal or osseous spinal stenosis is evident. No paraspinal abnormalities are detected. Impression: UNREMARKABLE MRI OF THE LUMBOSACRAL SPINE FOR AGE. signed: Arthur B. Dublin, M.D. Result History MR LSPINE (Order#1867712) on 3/8/04 - Order Result History Report. MyChart Status: This result is currently not released to MyChart. Radiology Result Information Result Date and Time 3/8/2004 9:31 AM Order Providers Authorizing Provider (08983) Gary J Collins
Status Final result
Encounter Provider (08983) Gary J Collins
Patient Information Patient Name Amundsen, Mark Unit UCDPMC
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Order
Allergies
FENTANYL; MORPHINE
MR LSPINE (Accession 252A-030504) (Order 1867712)
Order Information
Date and Time 3/4/2004 3:32 PM Authorizing Gary J Collins Department Pain Clinic Acc
Isolation
No Isolation
Order Details
Frequency Duration Priority Order Class
001490
Order Information
Date and Time 2/13/2006 12:08 PM Electronically Signed By Rad Results Interface Authorizing H. David Moehring Department Fol Internal Medicine
Web Links
Radiology Locations Ordering Physician Rad. Contact Info.
Isolation
No Isolation
Order Details
Frequency None Duration None Priority Routine Order Class UCD RAD
Ordered By H. DAVID MOEHRING [02627] Admitting Provider Ordering Provider MOEHRING, H. DAVID [02627] Authorized By H. DAVID MOEHRING [02627] PCP Victor Baquero, MD Pager 916-762-5822

Patient Information
Unit IMDFOL
MRN 8081369
Sex Male
DOB 9/23/1959

Order ID 9686877
Imaging Results
Entry Date 4/15/2005 Component Results TRANSCRIPTIONS: Exam: CT SINUS LTD Clinical data: R RETRO-ORBITAL PAIN Report: CT SINUS: INDICATION:
CT SINUS LTD (Accession 99A-041305) (Order 5808386) PACS Images Show images for CT SINUS LTD
70486
001491
Patient with right retro orbital pain. FINDINGS: Contiguous 2.5 mm transcoronal image obtained of the face show no abnormal mass or abnormal lesion identified in the right retro orbital region. The left retro orbital region is also normal. There is a retention cyst versus polyp seen in the left maxillary sinus. The nasal septum is slightly deviated toward the left. Osseous structures appear normal. If symptoms persist, MRI may be helpful in further evaluation. Impression: 1. NO ABNORMAL LESION IDENTIFIED IN THE RIGHT RETROORBITAL FOSSA. 2. SMALL LEFT MAXILLARY SINUS RETENTION CYST VERSUS POLYP.
Dr. Dublin present for discussion and review of the case.
dictated: Huan N. Pham, M.D. cosigned: Arthur B. Dublin, M.D. Result History CT SINUS LTD (Order#5808386) on 4/15/05 - Order Result History Report. MyChart Status: This result is currently not released to MyChart. Radiology Result Information Result Date and Time 4/15/2005 7:51 AM Order Providers Authorizing Provider (08555) Yoav Hahn Status Final result Encounter Provider (08555) Yoav Hahn

Unit ENTCL5
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Order
Allergies
FENTANYL; MORPHINE
CT SINUS LTD (Accession 99A-041305) (Order 5808386)
Order Information
Date and Time Electronically Signed By Authorizing Department
001492
Entry Date 2/15/2006 Component Results TRANSCRIPTIONS: EXAM DATE: 02/13/2006 PELVIS: No comparison. HISTORY: Low back pain and groin pain. There is mild superior joint narrowing with associated subchondral sclerosis and osteophyte formation bilaterally, consistent with osteoarthritis. Findings are worse on the left than the right. Sacroiliac joints appear unremarkable. IMPRESSION: 1. BILATERAL OSTEOARTHRITIS.
PACS Images Show images for PELVIS 1 OR 2 VIEWS
EE:jj(rad017) ACC#: 000000324515 02/14/2006 08:26
D: 02/14/2006 01:22 PM T: PM C#: 1625633
signed: Eva Escobedo, M.D. Result History PELVIS 1 OR 2 VIEWS (Order#9686789) on 2/15/06 - Order Result History Report. MyChart Status: This result is currently not released to MyChart. Radiology Result Information Result Date and Time 2/15/2006 4:54 PM Order Providers Authorizing Provider (02627) H. David Moehring
Status Final result
Encounter Provider (02627) H. David Moehring
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
001493
Unit IMDFOL
Order
Allergies
FENTANYL; MORPHINE
PELVIS 1 OR 2 VIEWS (Accession 324515) (Order 9686789)
Order Information
Date and Time 2/13/2006 12:05 PM Electronically Signed By Rad Results Interface Authorizing H. David Moehring Department Fol Internal Medicine
Web Links
Isolation
No Isolation
Order Details
Ordered By H. DAVID MOEHRING [02627] Admitting Provider Ordering Provider MOEHRING, H. DAVID [02627] Authorized By H. DAVID MOEHRING [02627] PCP Victor Baquero, MD Pager 916-762-5822

Patient Information
Patient Name Amundsen, Mark Unit IMDFOL MRN 8081369 Sex Male DOB 9/23/1959

Order ID 9686789
Imaging Results
Entry Date 2/15/2006 Component Results TRANSCRIPTIONS: EXAM DATE: 02/13/2006
L-SPINE 2 OR 3 VIEWS (Accession 324527) (Order 9686877) PACS Images Show images for L-SPINE 2 OR 3 VIEWS
001494
LUMBAR SPINE: Two views from 02/13/06, no comparison. HISTORY: Low back pain. Alignment is normal. Disc interspaces are preserved. There is mild osteophyte formation throughout the lumbar spine. Facet joints are unremarkable. Sacroiliac joints appear normal.
IMPRESSION: 1. MILD DEGENERATIVE CHANGES.
EE:hh(rad012) ACC#: 000000324527 02/14/2006 08:25
D: 02/14/2006 01:21 PM T: PM C#: 1625631
signed: Eva Escobedo, M.D. Result History L-SPINE 2 OR 3 VIEWS (Order#9686877) on 2/15/06 - Order Result History Report. MyChart Status: This result is currently not released to MyChart. Radiology Result Information Result Date and Time 2/15/2006 4:54 PM Order Providers Authorizing Provider (02627) H. David Moehring Status Final result
Encounter Provider (02627) H. David Moehring
Patient Information Patient Name Amundsen, Mark Unit IMDFOL
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Order
Allergies
FENTANYL; MORPHINE
L-SPINE 2 OR 3 VIEWS (Accession 324527) (Order 9686877)
001495
Ordered By JASON M MILLER [09773] Admitting Provider Ordering Provider MILLER, JASON M [09773] Authorized By JASON M MILLER [09773] PCP Victor Baquero, MD Pager

Patient Information
Patient Name Amundsen, Mark Unit UCDPMC MRN 8081369 Sex Male DOB 9/23/1959

Order ID 10952742
Imaging Results
Entry Date 4/27/2006 Component Results TRANSCRIPTIONS: EXAM DATE: 04/21/2006 MRI PELVIS: CLINICAL HISTORY: Chronic left hip pain. TECHNIQUE:
MR PELVIS (Accession 345854) (Order 10630675) PACS Images Show images for MR PELVIS
Using a 1.5-Tesla magnet, the following MRI images were obtained through the pelvis: coronal STIR, coronal T1, sagittal proton density fat-saturated, axial T2 fat-saturated, axial T1. FINDINGS: There are advanced osteoarthritic changes of the left hip including joint space narrowing, a collar of osteophyte formation around the femoral head, and lateral acetabular bone spurring. There is a small left hip effusion, as well as a multiloculated ganglion cyst along the inferomedial aspect of the hip. There is no evidence of avascular necrosis.
001496
The right hip demonstrates a small effusion, likely physiologic. The bony pelvis is unremarkable. IMPRESSION: 1. ADVANCED OSTEOARTHRITIS OF THE LEFT HIP.
2. GANGLION CYST ALONG THE INFEROMEDIAL ASPECT OF THE LEFT HIP. DR. HUNTER REVIEWED THE EXAM.
LM:lw(rad931) ACC#: 000000345854 04/24/2006 07:06
D: 04/24/2006 12:57 PM T: PM C#: 1790188
signed: Linda Miles, M.D. cosigned: John C. Hunter, M.D. Result History MR PELVIS WITHOUT CONTRAST (Order#10630675) on 4/27/06 - Order Result History Report. MyChart Status: This result is currently not released to MyChart. Radiology Result Information Result Date and Time 4/27/2006 4:09 PM Order Providers Authorizing Provider (08139) Victor Baquero, MD Status Final result Encounter Provider (08139) Victor Baquero, MD
Reviewed by List BAQUERO, VICTOR H on Thu Apr 27, 2006 7:15 PM GROVES, SHERI L on Mon May 1, 2006 3:11 PM Patient Information Patient Name Amundsen, Mark Unit FAMFOL
MRN 8081369 Sex M DOB 9/23/1959 (53yr) Home Phone 916-509-0158
Result Notes Notes recorded by Sheri L Groves on 05/01/2006 at 3:11 PM Patient was seen in office. ------
001497
Notes recorded by Sheri L Groves on 05/01/2006 at 9:18 AM A message was left on 5/1/06 at 918am, for pt to call back. -----Notes recorded by Victor H Baquero on 04/27/2006 at 7:15 PM Please notify MRI results: 1. ADVANCED OSTEOARTHRITIS OF THE LEFT HIP. 2. GANGLION CYST OF THE LEFT HIP. He should follow up with ortho for further management of hip pain.
Order
Allergies
FENTANYL; MORPHINE
MR PELVIS (Accession 345854) (Order 10630675) - Reflex for Order 9843190
Order Information
Date and Time 3/10/2006 3:22 PM Electronically Signed By Rad Results Interface Authorizing Victor Baquero, MD Department Fol Family Practice
Associated Diagnoses
Enthesopathy of hip region [726.5] - Primary
Web Links
Radiology Locations Ordering Physician Rad. Contact Info. MR Hours of Operation MRI REVO PACEMAKER OP.pdf MRI REVO PACEMAKER IP
Isolation
No Isolation
Order Details
Ordered By Authorized By VICTOR BAQUERO [08139]
Admitting Provider

Done by List
Done By BAQUERO, VICTOR H GROVES, SHERI L Done On Thu Apr 27, 2006 1915 Mon May 1, 2006 1511
001498
Patient Information
Patient Name Amundsen, Mark Unit FAMFOL MRN 8081369 Sex Male DOB 9/23/1959
Account # 078080963024
Account Information
Acct Number 078080963024

Order ID 10630675
Imaging Results
MR LOWER EXTREMITY JOINT WITH / WITHOUT CONTRAST (Accession 345854) (Order 9843190)
On 4/20/06 1723 Reason Cancelled via RIS
This Order Has Been Canceled Order Status By Rad Results Canceled Interface Entry Date
Result History MR LOWER EXTREMITY JOINT WITH / WITHOUT CONTRAST (Order#9843190) on - Order Result History Report. MyChart Status: This result is automatically blocked from release to MyChart. Radiology Result Information Order Providers Authorizing Provider (08139) Victor Baquero, MD Encounter Provider (08139) Victor Baquero, MD
Reviewed by List BAQUERO, VICTOR H on Thu Apr 20, 2006 5:25 PM Patient Information Patient Name Amundsen, Mark
Unit FAMFOL
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Order
Allergies
FENTANYL; MORPHINE
MR LOWER EXTREMITY JOINT WITH / WITHOUT CONTRAST (Accession 345854) (Order 9843190)
Order Information
Date and Time 2/24/2006 8:20 AM Electronically Signed By/Authorizing Victor Baquero, MD Department Fol Family Practice
001499
This Order Has Been Canceled

Order Status Canceled By Rad Results Interface On 4/20/06 1723 Reason Cancelled via RIS
Order Questions
Question Pager? Pacemaker? Answer 916-762-2086 No Comment
Comments
Signs/Symptoms: Chronic left hip pain.
Web Links
Isolation
No Isolation
Order Details
Release Date/Time None Schedule Date/Time 2/24/2006
Ordered By Admitting Provider Authorized By VICTOR BAQUERO [08139] PCP Victor Baquero, MD

Done by List
Done By BAQUERO, VICTOR H Done On Thu Apr 20, 2006 1725
Patient Information
Account # 078080963024
Account Information

Order ID 9843190
Imaging Results
001500
Frequency None
Duration None
Priority Routine
Order Class UCD RAD

Done by List
Done By BAQUERO, VICTOR H Done On Sun Feb 22, 2009 0944
Patient Information
Account # 078438665024
Account Information

Order ID 36121436
Imaging Results
Entry Date 4/25/2007 Component Results TRANSCRIPTIONS:
C-SPINE 2 OR 3 VIEWS (Accession 981898) (Order 16830147) PACS Images Show images for C-SPINE 2 OR 3 VIEWS
EXAM DATE: 04/20/2007
HISTORY: Pain. CERVICAL SPINE:

AP and lateral views of the cervical spine are viewed without
001501
comparison studies. There are seven normally developed cervical vertebrae in anatomic alignment. Mild disc space narrowing is noted mainly in the lower cervical spine accompanied by mild arthropathy of the Luschka's and facet joints. The soft tissues are normal. IMPRESSION: MILD DEGENERATIVE CHANGES AS ABOVE.
AG:kc(rad007) ACC#: 000000981898 04/25/2007 03:43
D: 04/25/2007 07:56 AM T: PM C#: 2688910
signed: Adam Greenspan, M.D. Result History C-SPINE 2 OR 3 VIEWS (Order#16830147) on 4/25/07 - Order Result History Report. MyChart Status: This result is currently not released to MyChart. Radiology Result Information Result Date and Time 4/25/2007 4:24 PM Order Providers Authorizing Provider (08139) Victor Baquero, MD
Status Final result Encounter Provider (08139) Victor Baquero, MD
Reviewed by List BAQUERO, VICTOR H on Wed Apr 25, 2007 6:11 PM TAYLOR, ERNESTINE on Thu Apr 26, 2007 7:59 AM Patient Information Patient Name Amundsen, Mark
Unit FAMFOL
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Result Notes Notes recorded by Ernestine Taylor on 04/26/2007 at 7:57 AM Letter mailed out today. -----Notes recorded by Victor H Baquero on 04/25/2007 at 6:11 PM
001502
Mark Amundsen 2017 Tarbolton Cir Folsom, CA 95630. Dear Mark, Your recent xray shows wear and tear changes - no acute findings. See report below. VICTOR BAQUERO, M.D.
Order
Allergies
FENTANYL; MORPHINE
C-SPINE 2 OR 3 VIEWS (Accession 981898) (Order 16830147)
Order Information
Date and Time 4/20/2007 10:42 AM Electronically Signed By Rad Results Interface Authorizing Victor Baquero, MD Department Fol Family Practice
Brachial neuritis or radiculitis NOS [723.4]
Web Links
Isolation
No Isolation
Order Details

Done by List
Done By BAQUERO, VICTOR H TAYLOR, ERNESTINE Done On Wed Apr 25, 2007 1811 Thu Apr 26, 2007 0759
Patient Information
Patient Name MRN Sex DOB
001503
8081369
Male
9/23/1959
Account # 078199740040
Account Information

Order ID 16830147
Order
Allergies
FENTANYL; MORPHINE
C-SPINE COMPLETE (Order 16827304)
Order Information

Order Questions
Question Pager? Return to clinic? Answer 916-762-2086 No Comment
Comments
Diagnosis
Web Links
Isolation
No Isolation
Order Details
Done by List
Done By BAQUERO, VICTOR H Done On Fri Apr 20, 2007 1220
Patient Information
001504
Unit FAMFOL
Account # 078199740040
Account Information

Order ID 16827304
Imaging Results
MR PELVIS (Accession 477249) (Order 11087736) On 6/5/06 1510 Reason Duplicate Order
Result History MR PELVIS WITHOUT CONTRAST (Order#11087736) on Order Result History Report. MyChart Status: This result is automatically blocked from release to MyChart. Radiology Result Information Order Providers Authorizing Provider (09773) Jason M Miller, MD Encounter Provider (09773) Jason M Miller, MD
Patient Information Patient Name Amundsen, Mark Unit UCDPMC
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Order
Allergies
FENTANYL; MORPHINE
MR PELVIS (Accession 477249) (Order 11087736)
Order Information
Date and Time 5/22/2006 4:41 PM Electronically Signed By Rad Results Interface Authorizing Jason M Miller Department Pain Clinic Acc

Order Status Canceled By Rad Results Interface On 6/5/06 1510 Reason Duplicate Order
Web Links
Radiology Locations Ordering Physician Rad. Contact Info. MR Hours of Operation
001505
MRI REVO PACEMAKER OP.pdf MRI REVO PACEMAKER IP
Isolation
No Isolation
Order Details
Ordered By JASON M MILLER [09773] Authorized By JASON M MILLER [09773]
Admitting Provider
Ordering Provider MILLER, JASON M [09773]

Pager

Patient Information
Patient Name Amundsen, Mark Unit UCDPMC MRN 8081369 Sex Male DOB 9/23/1959

Order ID 11087736
Imaging Results
MR LOWER EXTREMITY (Accession 410695) (Order 10475285) On 5/12/06 1632 Reason Cancelled via RIS
Result History MR LOWER EXTREMITY WITHOUT CONTRAST (Order#10475285) on - Order Result History Report. MyChart Status: This result is automatically blocked from release to MyChart. Radiology Result Information Order Providers Authorizing Provider (09773) Jason M Miller, MD
Encounter Provider (09773) Jason M Miller, MD
Patient Information
001506

Unit UCDPMC
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Order
Allergies
FENTANYL; MORPHINE
MR LOWER EXTREMITY (Accession 410695) (Order 10475285)
Order Information
Date and Time 4/10/2006 9:39 AM Electronically Signed By Rad Results Interface Authorizing Jason M Miller Department Pain Clinic Acc

Web Links
Isolation
No Isolation
Order Details
Ordered By JASON M MILLER [09773] Admitting Provider Ordering Provider MILLER, JASON M [09773] Authorized By JASON M MILLER [09773] PCP Victor Baquero, MD Pager

Patient Information
Unit UCDPMC

Order ID 10475285
001507
Imaging Results
MR PELVIS (Accession 410695) (Order 10952742)

On 5/16/06 0711 Reason Patient did not keep appointment
Result History MR PELVIS WITHOUT CONTRAST (Order#10952742) on Order Result History Report. MyChart Status: This result is automatically blocked from release to MyChart. Radiology Result Information Order Providers Authorizing Provider (09773) Jason M Miller, MD Encounter Provider (09773) Jason M Miller, MD

Unit UCDPMC
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Order
Allergies
FENTANYL; MORPHINE
MR PELVIS (Accession 410695) (Order 10952742) - Reflex for Order 10475285
Order Information
Date and Time 4/10/2006 9:39 AM Electronically Signed By Rad Results Interface Authorizing Jason M Miller Department Pain Clinic Acc

Order Status Canceled By Rad Results Interface On 5/16/06 0711 Reason Patient did not keep appointment
Web Links
Isolation
No Isolation
Order Details
001508
Imaging Results
ABDOMEN 1 VIEW (Accession 1935050) (Order 36121436) PACS Images Show images for ABDOMEN 1 VIEW
EXAM DATE: 02/18/2009
SUPINE FRONTAL VIEW OF ABDOMEN: Comparison: Not available.
CLINICAL INDICATION: Abdominal pain. FINDINGS: There is a nonobstructive bowel gas pattern. No abnormal masses or calcifications are identified. There is bilateral osteoarthritis of the hips, left worse than right. IMPRESSION: 1. NONOBSTRUCTIVE BOWEL GAS PATTERN.
DR. KATZBERG WAS PRESENT FOR THE EVALUATION OF THIS STUDY.
PY:so(rad024) ACC#: 000001935050 02/20/2009 10:23
D: 02/19/2009 11:23 AM T: AM C#: 4271131
Exam reviewed by and findings confirmed by me, the attending physician signed: Philip Yen, M.D. cosigned: Richard Katzberg, M.D. Result History ABDOMEN 1 VIEW (Order#36121436) on 2/21/09 - Order Result History Report. MyChart Status: This result is currently not released to MyChart.
001509
Radiology Result Information Result Date and Time 2/21/2009 4:04 PM Order Providers Authorizing Provider (08139) Victor Baquero, MD
Status Final result Encounter Provider (08139) Victor Baquero, MD
Reviewed by List BAQUERO, VICTOR H on Sun Feb 22, 2009 9:44 AM Patient Information Patient Name Amundsen, Mark Unit FAMFOL MRN 8081369 Sex M DOB 9/23/1959 (53yr) Home Phone 916-509-0158
Result Notes Notes recorded by Victor H Baquero on 02/22/2009 at 9:44 AM Reviewed in office -----Notes recorded by Victor H Baquero on 02/20/2009 at 12:34 PM As expected.
Order
Allergies
FENTANYL; MORPHINE
ABDOMEN 1 VIEW (Accession 1935050) (Order 36121436)
Order Information
Date and Time 2/18/2009 4:41 PM Electronically Signed By/Authorizing Victor Baquero, MD Department Fol Family Practice
Abdominal pain, other specified site [789.09] - Primary
Order Questions
Comments
Signs/symptoms: abdomen pain Suspected dx: constipation, 4 days. Relevant surg: None Comments:
Web Links
Isolation
No Isolation
Order Details
001510
Done by List
Done By TAMURIAN, ROBERT Done On Wed Jan 6, 2010 1247
Patient Information
Unit ORTHO
MRN 8081369
Sex Male
DOB 9/23/1959

Order ID 47978712
Imaging Results
Entry Date 9/29/2009 Component Results TRANSCRIPTIONS: Addendum Begins
HIPS BILATERAL WITH PELVIS (Accession 2163936) (Order 43417405) PACS Images Show images for HIPS BILATERAL WITH PELVIS
EXAM DATE: 08/20/2009
ADDENDUM PELVIS ADDENDUM: Prior study from 02/13/06 was obtained. Compared to this study, there has been progression of osteoarthritis, particularly involving the left hip which shows increase in narrowing, subchondral sclerosis, osteophyte formation, and subchondral cyst formation.
EE:sh(usa135) ACC#: 000002163936 09/28/2009 04:31
D: 09/28/2009 01:17 PM T: PM C#: 4703263
Addendum Ends
EXAM DATE: 08/20/2009
001511
CLINICAL HISTORY: Advanced osteoarthritis of the left hip. Ganglion cyst in inferomedial aspect of the left hip. FINDINGS:
Two views of bilateral hips were obtained with comparison from 4/21/2006.
The spine and SI joints are unremarkable. There is decreased joint space sclerosis and osteophytes in the right hip joint consistent with moderate osteoarthritis. There is decreased joint space sclerosis, osteophytes and subchondral cyst in the left hip joint consistent with severe osteoarthritis. This is unchanged compared with prior. The soft tissues are unremarkable. IMPRESSION: 1. 2. MODERATE OA OF THE RIGHT HIP. SEVERE OA OF THE LEFT HIP.
This study was reviewed with Dr. Mak. DD:so(rad040) ACC#: 000002163936 08/20/2009 01:13
D: 08/20/2009 11:14 AM T: PM C#: 4641089
Electronically signed by: Eva Escobedo, M.D. Result History HIPS BILATERAL WITH PELVIS (Order#43417405) on 9/29/09 - Order Result History Report. MyChart Status: This result is currently not released to MyChart. Radiology Result Information Result Date and Time 9/29/2009 8:46 AM Order Providers Authorizing Provider (10884) Robert Michael Tamurian, MD Status Edited Encounter Provider (10884) Robert Michael Tamurian, MD
Reviewed by List
001512
TAMURIAN, ROBERT on Tue Sep 29, 2009 1:59 PM Patient Information Patient Name Amundsen, Mark Unit ORTHO MRN 8081369 Sex M DOB 9/23/1959 (53yr) Home Phone 916-509-0158
Order
Allergies
FENTANYL; MORPHINE
HIPS BILATERAL WITH PELVIS (Accession 2163936) (Order 43417405)
Order Information
Date and Time 8/18/2009 9:26 AM Electronically Signed By Rosemary Brixie Authorizing Robert Michael Tamurian Department Ortho Clinic Acc
ADVANCED OSTEOARTHRITIS OF THE LEFT HIP [726.5] - Primary
Order Questions
Question Pager? Return to clinic? Answer 3059 No Comment
Comments
AP Pelvis/ Lauenstein bilateral hips Advanced OA left hip. Ganglion cyst inferiomedial aspect of left hip
Web Links
Isolation
No Isolation
Order Details
Ordered By Admitting Provider Authorized By ROBERT MICHAEL TAMURIAN [10884] PCP Victor Baquero, MD
Cosign Info
Action Ordering Responsible Provider Robert Michael Tamurian, MD Signed By Robert Michael Tamurian, MD Signed On 08/24/09 1305
Cosign Order Info


Collection Date and Time
001513
8/20/2009 0856
Done by List
Done By TAMURIAN, ROBERT Done On Tue Sep 29, 2009 1359
Patient Information
Unit ORTHO

Order ID 43417405
Imaging Results
L-SPINE 2 OR 3 VIEWS (Accession 2163937) (Order 43417406) PACS Images Show images for L-SPINE 2 OR 3 VIEWS
EXAM DATE: 08/20/2009
THREE VIEWS LUMBAR SPINE: INDICATIONS: Advanced OA left hip. Gangrene cyst inferomedial aspect of left hip. COMPARISON: L-spine radiograph report 02/13/06. bilateral hips 08/20/09. FINDINGS: Five non rib-bearing lumbar vertebral bodies show normal height and alignment without evidence of acute fracture, subluxation, or lytic/blastic lesion. Anterior osteophyte formation involves nearly all levels. Additionally, there is mild loss of disc height and end plate sclerosis at L5-S1. Apparent lucency in the expected location of the L5 pars interarticularis is incompletely evaluate without oblique views. There is no associated L5 anterolisthesis. The
Two views
001514
sacroiliac joints are unremarkable. The bowel gas pattern is nonobstructive. A nonspecific round calcification projecting just right of the T12 vertebral body is nonspecific.
IMPRESSION: 1. MILD DEGENERATIVE CHANGES OF THE LUMBAR SPINE WITHOUT DEFINITE ACUTE BONY ABNORMALITY. 2. APPARENT LUCENCY IN THE EXPECTED LOCATION OF THE L5 PARS INTERARTICULARIS IS INCOMPLETELY EVALUATED. IF THERE IS SUFFICIENT CLINICAL CONCERN FOR SPONDYLOLYSIS, FURTHER EVALUATION COULD BE OBTAINED WITH OBLIQUE VIEWS.
BDW:cw(rad035) ACC#: 000002163937 08/20/2009 11:14
D: 08/20/2009 09:57 AM T: AM C#: 4640807
Electronically signed by: Brant D Wommack, M.D. Result History L-SPINE 2 OR 3 VIEWS (Order#43417406) on 8/21/09 - Order Result History Report. MyChart Status: This result is currently not released to MyChart. Radiology Result Information Result Date and Time 8/21/2009 9:48 AM Order Providers Authorizing Provider (10884) Robert Michael Tamurian, MD Status Final result Encounter Provider (10884) Robert Michael Tamurian, MD
Reviewed by List TAMURIAN, ROBERT on Tue Sep 29, 2009 1:59 PM Patient Information Patient Name Amundsen, Mark Unit ORTHO MRN 8081369 Sex M DOB 9/23/1959 (53yr) Home Phone 916-509-0158
001515
Order
Allergies
FENTANYL; MORPHINE
L-SPINE 2 OR 3 VIEWS (Accession 2163937) (Order 43417406)
Order Information
Order Questions
Question Pager? Return to clinic? Answer 3059 No Comment
Comments
LS spine views Physical findings (must include Laterality/location including dermatome or Cranial Nerve distribution): Advanced OA left hip. Ganglion cyst inferiomedial aspect of left hip
Web Links
Isolation
No Isolation
Order Details
Cosign Info
Cosign Order Info


Done by List
Done By TAMURIAN, ROBERT Done On Tue Sep 29, 2009 1359
Patient Information
001516
Unit ORTHO

Order ID 43417406
Order
Allergies
FENTANYL; MORPHINE
PELVIS 1 OR 2 VIEWS (Order 43417404)
Order Information

Order Status Canceled By Scotty Kyzer On 9/2/11 1315 Reason Database Cleanup
Order Questions
Question Pager? Return to clinic? Answer 3059 Yes Comment
Comments
Signs/Symptoms: Advanced OA left hip. Suspected dx: Arthritis Duration: > 6 months Comments: Ganglion cyst inferiomedial aspect of left hip
Web Links
Isolation
No Isolation
Order Details
Cosign Info
Cosign Order Info

Patient Information
001517
MRN 8081369
Sex Male
DOB 9/23/1959
Unit ORTHO

Order ID 43417404
Order
Allergies
FENTANYL; MORPHINE
HIP 2+ VIEWS, LEFT + HIP 2+ VIEWS, RIGHT (Order 42845691)
Order Information

Order Status Canceled By Scotty Kyzer On 9/1/11 1231 Reason Database Cleanup
Order Questions
Comments
Signs/Symptoms: chroinc osteo arthritis of hips.
Web Links
Isolation
No Isolation
Order Details
Patient Information

Order ID 42845691
001518
Isolation
No Isolation
Order Details
Frequency ONCE Duration 1 occurrence Priority Routine Order Class Inpatient Normal
Acknowledgement Info
For Placing Order At 12/15/09 1550 Acknowledged By Patricia L Bailey, RN Acknowledged On 12/15/09 1553
Release Date/Time 12/15/2009 1550 Schedule Date/Time 12/15/2009 1600
Ordered By JONATHAN G EASTMAN [09983] Admitting Provider Robert Michael Tamurian, MD Ordering Provider EASTMAN, JONATHAN G [09983] Authorized By JONATHAN G EASTMAN [09983] PCP Victor Baquero, MD Pager 916-762-7648 Date/Time Tue Dec 15, 2009 1540 Status Signed & Held Reason Released By PATRICIA L BAILEY [254588866]
Signed and Held / Pended Order History

Pending User Jonathan G Eastman, MD

Done by List
Done By EASTMAN, JONATHAN Done On Thu Dec 17, 2009 1512
Patient Information
Patient Name Amundsen, Mark Unit D14O MRN 8081369 Room 14787 Sex Male DOB 9/23/1959 Bed 147871
Account # 010016806878
Account Information

Parent Order ID 48191967 Child Order ID 48192769
Imaging Results
CHEST 2 VIEWS (Accession 2299565) (Order 47978712) PACS Images Show images for CHEST 2 VIEWS
001519
EXAM DATE: 12/14/2009
DUAL-ENERGY DIGITAL SUBTRACTION CHEST, TWO VIEWS CLINICAL HISTORY: Pending total hip arthroplasty. FINDINGS: Heart size and pulmonary vascularity are normal. The aorta is minimally unfolded but normal in caliber. No infiltrates or effusions are demonstrated. Bony structures with degenerative changes in the thoracic spine and at the right acromioclavicular joint. The left side is not included. IMPRESSION: NO EVIDENCE OF ACTIVE DISEASE IN THE CHEST.
FKO:ls(rad049) ACC#: 000002299565 12/15/2009 07:22
D: 12/14/2009 04:38 PM T: AM C#: 4826221
Electronically signed by: Francesca Ontell, M.D. Result History CHEST 2 VIEWS (Order#47978712) on 12/15/09 - Order Result History Report. MyChart Status: This result is currently not released to MyChart. Radiology Result Information Result Date and Time 12/15/2009 8:14 AM Order Providers Authorizing Provider (10884) Robert Michael Tamurian, MD Status Final result
Encounter Provider (10884) Robert Michael Tamurian, MD
Reviewed by List TAMURIAN, ROBERT on Wed Jan 6, 2010 12:47 PM Patient Information
001520

Unit ORTHO
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Order
Allergies
FENTANYL; MORPHINE
CHEST 2 VIEWS (Accession 2299565) (Order 47978712)
Order Information
Order Questions
Comments
Signs/Symptoms: Pending THA Suspected dx/hx/surg: r/o lung disease Comments:
Web Links
Isolation
No Isolation
Order Details
Ordered By
Admitting Provider
Authorized By ROBERT MICHAEL TAMURIAN [10884]

Cosign Info
Cosign Order Info


001521
Unit ORTHO
Account # 038541463022
Account Information

Order ID 50338725
Imaging Results
PELVIS 1 OR 2 VIEWS (Accession 2305743) (Order 48192769) PACS Images Show images for PELVIS 1 OR 2 VIEWS
EXAM DATE: 12/16/2009
PELVIS: Comparison: 2/13/06 CLINICAL HISTORY: Post left total hip arthroplasty. FINDINGS: In the interval, placement of noncemented total left hip arthroplasty. The very distal tip of the femoral component is not included on the imaging field of view. Soft tissue gas as well as overlying skin staples reflecting recent postoperative status. Mild narrowing of right hip joint space compatible with osteoarthritis. Bony prominence at the femoral head-neck junction suggesting predisposition to impingement.
Minimal degenerative spurring symphysis pubis. SI joints unremarkable. Lower lumbar spine unremarkable.
IMPRESSION: 1. TOTAL LEFT HIP ARTHROPLASTY.
001522
2.
RIGHT HIP JOINT OSTEOARTHRITIS, MILD.
WM:so(rad040) ACC#: 000002305743 12/16/2009 01:20
D: 12/16/2009 11:33 AM T: PM C#: 4829394
Electronically signed by: Walter Mak, M.D. Result History PELVIS 1 OR 2 VIEWS (Order#48192769) on 12/17/09 - Order Result History Report. MyChart Status: This result is currently not released to MyChart. Radiology Result Information Result Date and Time 12/17/2009 3:07 PM Order Providers Authorizing Provider (09983) Jonathan G Eastman, MD Status Final result Encounter Provider None
Reviewed by List EASTMAN, JONATHAN on Wed Dec 16, 2009 1:55 PM EASTMAN, JONATHAN on Thu Dec 17, 2009 3:11 PM EASTMAN, JONATHAN on Thu Dec 17, 2009 3:12 PM Patient Information Patient Name Amundsen, Mark Unit D14O
Room 14787
Order
Allergies
FENTANYL; MORPHINE
Order Information
Date and Time 12/15/2009 3:40 PM Electronically Signed By/Authorizing Jonathan G Eastman, MD Department D14 Orthopedics/Trauma
Order Questions
Question Portable? Answer No Comment
Comments
Signs/Symptoms or Diagnosis: s/p L THA Special Instructions: Please do in PACU
Web Links
001523
No Isolation
Order Details
Cosign Info
Cosign Order Info

Action Ordering Pending User Melinda Ehlers, LVN Melinda Ehlers, LVN Responsible Provider Robert Michael Tamurian, MD Date/Time Mon Jun 21, 2010 0909 Mon Jun 21, 2010 0909 Signed By Robert Michael Tamurian, MD Status Pended Pended Signed On 06/25/10 0947 Reason

Patient Information
Unit ORTHO
Account # 038541463063
Account Information

Order ID 55574719
Imaging Results
HIP 2+ VIEWS, LEFT + AP PELVIS (Accession 2367896) (Order 50338725) PACS Images Show images for HIP 2+ VIEWS, LEFT + AP PELVIS
EXAM DATE: 02/22/2010
001524
PELVIS AND LEFT HIP COMPARISON: 12/18/09. Left hip arthroplasty.
CLINICAL HISTORY: FINDINGS:
Noncemented total left hip arthroplasty, unchanged in alignment. No evidence of complication. Moderate osteoarthritis of right hip, unchanged. Mild irregularities, symphysis pubis. IMPRESSION: TOTAL LEFT ARTHROPLASTY WITHOUT EVIDENCE OF COMPLICATION. WM:sh(usa135) ACC#: 000002367896 02/22/2010 07:33
D: 02/22/2010 03:23 PM T: PM C#: 4927184
Electronically signed by: Walter Mak, M.D. Result History HIP 2+ VIEWS, LEFT + AP PELVIS (Order#50338725) on 2/22/10 - Order Result History Report. MyChart Status: This result is currently not released to MyChart. Radiology Result Information Result Date and Time 2/22/2010 8:51 PM Order Providers Authorizing Provider (10884) Robert Michael Tamurian, MD Status Final result Encounter Provider (10884) Robert Michael Tamurian, MD
Reviewed by List TAMURIAN, ROBERT on Mon Mar 1, 2010 9:16 AM Patient Information Patient Name Amundsen, Mark Unit ORTHO
Order
Allergies
FENTANYL; MORPHINE
HIP 2+ VIEWS, LEFT + AP PELVIS (Accession 2367896) (Order 50338725)
Order Information
001525
Electronically Signed By Rosemary Brixie
Authorizing Robert Michael Tamurian
Order Questions
Comments
Signs/Symptoms: eval s/p Lt total hip arthroplasty Suspected dx: same as above Duration: 2 wks to 6 months Comments:
Web Links
Isolation
No Isolation
Order Details
Cosign Info
Cosign Order Info

Action Ordering Pending User Melinda Ehlers Responsible Provider Robert Michael Tamurian, MD Date/Time Wed Feb 10, 2010 0945 Signed By Robert Michael Tamurian, MD Status Pended Signed On 02/12/10 0611 Reason

Done by List
Done By TAMURIAN, ROBERT Done On Mon Mar 1, 2010 0916
Patient Information
001526
ANDREW KIM OH [10912] Admitting Provider PCP Victor Baquero, MD

Done by List
Done By OH, ANDREW Done On Sun May 1, 2011 1527
Patient Information
Unit NEUCAR
MRN 8081369
Sex Male
DOB 9/23/1959
Account # 078661756037
Account Information

Order ID 66574346
Imaging Results
HIP 2+ VIEWS, LEFT + AP PELVIS (Accession 2523459) (Order 55593818) PACS Images Show images for HIP 2+ VIEWS, LEFT + AP PELVIS
EXAM DATE: 06/21/2010
LEFT HIP, THREE VIEWS: CLINICAL HISTORY: Status post hip arthroplasty. TECHNIQUE: AP view of the pelvis, along with AP and frogleg lateral views of the left hip are obtained and compared to prior study of 2/20/2010. FINDINGS:
No interval change in position or alignment of the left hip status post total knee arthroplasty. No evidence of hardware complication.
001527
There is moderate osteoarthritis of the right hip with prominence of the femoral head-neck junction which can predispose to impingement. Incidental note of degenerative changes of the lumbar spine. IMPRESSION: 1. STATUS POST LEFT TOTAL HIP ARTHROPLASTY, UNCHANGED IN ALIGNMENT. NO EVIDENCE OF HARDWARE COMPLICATION. 2. MODERATE OSTEOARTHRITIS OF THE RIGHT HIP.
This study was reviewed with Dr. Mak.
JT:cg(rad039) ACC#: 000002523459 06/22/2010 01:40
D: 06/22/2010 10:32 AM T: PM C#: 5112467
Exam reviewed by and findings confirmed by me, the attending physician Electronically signed by: Jimmy Ton, M.D. Electronically co-signed by: Walter Mak, M.D. Result History HIP 2+ VIEWS, LEFT + AP PELVIS (Order#55593818) on 6/22/10 - Order Result History Report. MyChart Status: This result is currently not released to MyChart. Radiology Result Information Result Date and Time 6/22/2010 2:15 PM Order Providers Authorizing Provider (10884) Robert Michael Tamurian, MD Status Final result Encounter Provider (10884) Robert Michael Tamurian, MD
Reviewed by List TAMURIAN, ROBERT on Fri Jun 25, 2010 9:51 AM Patient Information Patient Name Amundsen, Mark Unit ORTHO MRN 8081369 Sex M DOB 9/23/1959 (53yr) Home Phone 916-509-0158
001528
Order
Allergies
FENTANYL; MORPHINE
HIP 2+ VIEWS, LEFT + AP PELVIS (Accession 2523459) (Order 55593818) - Reflex for Order 55574719
Order Information
Date and Time 6/21/2010 2:04 PM Electronically Signed By Rad Results Interface Authorizing Robert Michael Tamurian Department Ortho Clinic Acc
Aftercare following joint replacement [V54.81]
Web Links
Isolation
No Isolation
Order Details

Done by List
Done By TAMURIAN, ROBERT Done On Fri Jun 25, 2010 0951
Patient Information
Patient Name Amundsen, Mark Unit ORTHO MRN 8081369 Sex Male DOB 9/23/1959
Account # 038541463063
Account Information

Order ID 55593818
Imaging Results
HIP 2+ VIEWS, RIGHT + AP PELVIS (Accession 2523459) (Order 55574719)
001529
Order Status Canceled
By Rad Results Interface Cancelled via RIS Interface
On 6/21/10 1412
Reason Cancelled
Entry Date Result History HIP 2+ VIEWS, RIGHT + AP PELVIS (Order#55574719) on Order Result History Report. MyChart Status: This result is automatically blocked from release to MyChart. Radiology Result Information Order Providers Authorizing Provider (10884) Robert Michael Tamurian, MD Encounter Provider (10884) Robert Michael Tamurian, MD
Patient Information Patient Name Amundsen, Mark Unit ORTHO
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Order
Allergies
FENTANYL; MORPHINE
HIP 2+ VIEWS, RIGHT + AP PELVIS (Accession 2523459) (Order 55574719)
Order Information
Date and Time 6/21/2010 10:03 AM Electronically Signed By Cynthia L Anderson Authorizing Robert Michael Tamurian Department Ortho Clinic Acc

Order Status By Rad Results Interface Canceled Cancelled via RIS Interface On 6/21/10 1412 Reason Cancelled
Order Questions
Comments
Standing AP Pelvis/ AP/Lat right hip Xray to include entire prosthesis Signs/Symptoms: s/p right total hip arthroplasty Suspected dx: Arthritis Duration: 2 wks to 6 months Comments:
Web Links
Isolation
001530
Ordering Physician Rad. Contact Info.
Isolation
No Isolation
Order Details
Ordered By
Admitting Provider
Authorized By VICTOR BAQUERO [08139]

Patient Information

Order ID 69057091
Imaging Results
Entry Date 4/28/2011 Component Results TRANSCRIPTIONS: EXAM DATE:
FLUOROSCOPY UNDER 60 MINUTES WITH RADIOLOGIST (Accession 2862152) (Order 66574346) PACS Images Show images for FLUOROSCOPY UNDER 60 MINUTES WITH RADIOLOGIST
4/28/2011
PROCEDURE: FLUOROSCOPY UNDER 60 MINUTES WITH RADIOLOGIST. LUMBAR PUNCTURE WITH COLLECTION OF CSF FOR ANALYSIS. COMPARISON: No prior
INDICATION: Demyelinating neuropathy. Needs CSF analysis for possible CIDP (chronic inflammatory demyelinating polyradiculoneuropathy).
TECHNIQUE: Fluoroscopic guided lumbar puncture was performed. OPERATORS: Dr. Carbognin and Dr. Bobinski CONSENT: The risks and benefits of the procedure were explained to the patient and written informed consent was obtained.
001531
PROCEDURE: The patient was brought back to the fluoroscopy suite and placed in the prone position. A procedural pause was performed prior to the procedure and the patient's identity was confirmed by name and date of birth. The overlying soft tissues were sterilely prepped and draped in the usual fashion. The L4-5 disk space was localized using fluoroscopic guidance. Approximately 5 mL of local 1% lidocaine was administered for anesthesia. A 22-gauge spinal needle was advanced into the thecal sac. Approximately 12 mL of clear appearing CSF was removed and sent to laboratory for analysis. The stylet was replaced and the spinal needle removed. Hemostasis was quickly achieved. No immediate complication. FINDINGS: A total of 12 mL of clear CSF was removed. Total fluoroscopy time: 0 minutes and 6 seconds IMPRESSION: 1. SUCCESSFUL FLUOROSCOPIC GUIDED LUMBAR PUNCTURE AT THE L4-5 LEVEL. NO IMMEDIATE COMPLICATION. DR. BOBINSKI WAS PRESENT FOR KEY PORTIONS OF THE PROCEDURE INCLUDING INSERTION OF THE SPINAL NEEDLE INTO THE THECAL SAC.
Preliminary Report Created By: Susan Carbognin, M.D. on 4/28/2011 4:39 PM Final Report Created By: Matthew Bobinski, M.D. on 4/28/2011 5:45 PM Exam reviewed by and findings confirmed by me, the attending physician Electronically signed by: Susan Carbognin, M.D. Electronically co-signed by: Matthew Bobinski, M.D.
Result History FLUOROSCOPY UNDER 60 MINUTES WITH RADIOLOGIST (Order#66574346) on 4/28/11 - Order Result History Report. MyChart Status: This result is currently not released to MyChart. Radiology Exam Information Exam Scheduled Date Exam Scheduled Time 4/28/2011 13:00 Exam Completed Date 4/28/2011 Exam Completed Time 14:53
001532
Radiology Result Information Result Date and Time 4/28/2011 5:46 PM Order Providers Authorizing Provider (10912) Andrew Kim Oh, MD
Status Final result Encounter Provider (10912) Andrew Kim Oh, MD
Reviewed by List OH, ANDREW on Sun May 1, 2011 3:27 PM Patient Information Patient Name Amundsen, Mark Unit NEUCAR MRN 8081369 Sex M DOB 9/23/1959 (53yr) Home Phone 916-509-0158
Order
Allergies
FENTANYL; MORPHINE
FLUOROSCOPY UNDER 60 MINUTES WITH RADIOLOGIST (Accession 2862152) (Order 66574346)
Order Information
Date and Time 3/24/2011 8:48 AM Electronically Signed By/Authorizing Andrew Kim Oh, MD Department Carm Neurology
Polyneuropathy [356.9] - Primary
Order Questions
Question Pager? Answer 9169043090 Comment
Comments
Signs/symptoms: Demyelinating neuropathy. Needs CSF analysis for possible CIDP (chronic inflammatory demyelinating polyradiculoneuropathy). Please do LP under fluoroscopy. He has had a difficult time with lumbar spine epidural steroid injections in the past with procedural nausea. Suspected dx: Rule out CIDP. Size/location: LP under fluoro.
Web Links
Isolation
No Isolation
Order Details
Ordered By Authorized By
001533
Imaging Results
Entry Date 6/17/2011 Component Results TRANSCRIPTIONS: EXAM DATE: 6/17/2011
HIPS BILATERAL WITH PELVIS (Accession 2939884) (Order 70096790) PACS Images Show images for HIPS BILATERAL WITH PELVIS
INDICATION: Signs/Symptoms: bilateral hip pain. History of total hip on left. Comments:
TECHNIQUE: AP pelvis, AP left hip, bilateral frog leg views. COMPARISON: 6/21/10 FINDINGS: Left total hip arthroplasty. The femoral and acetabular components are well seated and articulate normal fashion. No interval change. Osseous metaplasia right acetabular rim. Small collar osteophytes right femoral head. Mild joint space narrowing. Bony prominence and lateral head neck junction. Mild interval progression.
IMPRESSION: STABLE LEFT TOTAL HIP ARTHROPLASTY. OSTEOARTHRITIC DEGENERATIVE CHANGES RIGHT HIP WITH MILD INTERVAL PROGRESSION.
Final Report Created By: Tad Laird on 6/17/2011 3:58 PM Electronically signed by: Tad Laird, M.D.
Result History HIPS BILATERAL WITH PELVIS (Order#70096790) on 6/17/11 - Order Result History Report. MyChart Status: This result is currently not released to MyChart. Radiology Exam Information Exam Scheduled Date Exam Scheduled Time 6/17/2011 14:40 Radiology Result Information Result Date and Time 6/17/2011 3:58 PM Order Providers Authorizing Provider (08139) Victor Henrique Baquero, MD Status Final result Encounter Provider (08139) Victor Henrique Baquero, MD Exam Completed Date 6/17/2011 Exam Completed Time 14:54
001534
Reviewed by List TRAUTH, JAMES on Fri Jun 17, 2011 5:21 PM RHODEWALT, TERI L on Mon Jun 20, 2011 7:56 AM Patient Information Patient Name Amundsen, Mark Unit FAMFOL
Result Notes Notes Recorded by Teri L Rhodewalt on 6/20/2011 at 7:56 AM Result letter sent to patient -----Notes Recorded by James William Trauth, MD on 6/17/2011 at 5:21 PM
Mark Amundsen 2017 Tarbolton Cir Folsom CA 95630
Dear Mark Amundsen I have reviewed your recent x-ray readout from the radiologist which shows: STABLE LEFT TOTAL HIP ARTHROPLASTY. OSTEOARTHRITIC DEGENERATIVE CHANGES RIGHT HIP WITH MILD INTERVAL PROGRESSION. Follow up with Dr Baquero if you have any questions. Sincerely, James W Trauth, MD
Order
Allergies
FENTANYL; MORPHINE
HIPS BILATERAL WITH PELVIS (Accession 2939884) (Order 70096790) - Reflex for Order 69057091
Order Information
Date and Time 6/17/2011 2:33 PM Electronically Signed By Rad Results Interface Authorizing Victor Baquero, MD Department Fol Family Practice
Enthesopathy of hip region [726.5] - Primary
Web Links
Radiology Locations
001535
Ordering Physician Rad. Contact Info.
Isolation
No Isolation
Order Details
Ordered By
Admitting Provider


Done by List
Done By TRAUTH, JAMES RHODEWALT, TERI L Done On Fri Jun 17, 2011 1721 Mon Jun 20, 2011 0756
Patient Information

Order ID 70096790
Order
Allergies
FENTANYL; MORPHINE
HIP 2+ VIEWS, LEFT + HIP 2+ VIEWS, RIGHT (Accession 2939884) (Order 69057091)
Order Information

Order Status Canceled By Rad Results Interface On 6/17/11 1433 Reason Order Changed by Radiology
Order Questions
Comments
Signs/Symptoms: bilateral hip pain. History of total hip on left. Comments:
Web Links
Radiology Locations
001536
MRN:
8081369,
Patient
Last,
First:
AMUNDSEN,
MARK
AMUNDSEN
"ARK
UR 8081389
G1-NQ,-HlD 09/23/1958 M
1~:JJ:42
PM
IJllrk Mil ~
ImD"lIrt~
opcrator:
Rate
cJ
tR
QRSD OT
o'te
61 187 98 4I4 417
,Norllal
a~i',
PR,
rllt.t
,hrllllll
Rfquelled 0,; fllqu",ro
001537
02/20/2013 MEN: 80B1369, Patient Last, First:
01,15,13
PM
page
~v~DSEN, MARK
AMUNDSEN I\ARK
MR 8081369
Ra t c 56 RegUlar rhythm,
IO:OC:3S
AM
mark Ihl e
.muDduD
o e r et o r :
ul1dclcrllllntd DriJill, rile 51 .. P Ilis not
PR
QRSD Q1 QTt
190
98 439 431
Rtljuell~d
by:
b.'1u r c
001538
3/3/2011 1:43 PM
Ucd Registration
35451714
Appointment
Sex Male

DOB 9/23/1959
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Center None
Office Visit
Provider Ricardo A Maselli, MD

Department Emg Neurology Out/Inpt
Referring Provider Andrew Kim Oh, MD
001539
Plan UCD/B/S HMO
Financial Class P
Plan Number B72
Plan Phone 916-734-0739
Diagnoses Chronic inflammatory demyelinating polyneuropathy Primary
357.81
Medications
Medications at Start of Encounter Disp Refills Start End 30 Tab 1 2/16/2011 3/18/2011 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Pharmacy 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet 30 Tab Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 100 Tab 1 2/1/2011 5/4/2011 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical 0 2/16/2011 3/19/2011 Hydrocodone 10 mg/Acetaminophen 325 100 Tab mg (NORCO) 10-325 mg Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 240 Tab 0 2/18/2011 3/20/2011 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Medication Review History Med Rev Hx Medication Administration Report for Amundsen, Mark All administrations No administration data available
Immunizations
Immunizations as of 3/2/2011 Never Reviewed
001540
Name Date 11/2/2010 Cyanocobalamin inj clinic Site: Left deltoid Given By: Clare Jennings, MA
Dose VIS Date 1,000mcg NA
Route Intramuscular
Visit Summary
Vitals Recorded in This Encounter No data found. Medications Given (Excluding those documented in Imm/Injections Activity) No data found. Procedure Notes Author David P Chesak, MD Status Signed Last Editor David P Chesak, MD Updated 3/3/2011 4:04 PM Created 3/3/2011 4:04 PM
Assoc. Orders EMG/NCS; EMG/NCS
Procedures EMG/NCS
University of California, Davis Department of Neurology EMG Laboratory
Referring Physician:
Oh
CLINICAL INFORMATION: This is a 51-year-old right-handed male with history of advanced bilateral hip osteoarthritis s/p total hip replacement on the left in 12/2009 who is referred for weakness. Six months ago he was in his usual state of health when he awoke one day with sudden onset of notable bilateral symmetric weakness in the proximal leg muscles and mild weakness in the proximal arm muscles. The weakness in the legs has remained relatively constant but the weakness in the arms has resolved. For the past 9 months, he has also complained of numbness and tingling in the medial plantar surface of the right foot, rarely in the left foot. PHYSICAL EXAMINATION: Sensory Light touch, pinprick, and temperature are intact; however, there is an area of decreased pinprick sensation along the calf region of the right lower extremity. Vibration is moderately reduced at the great toes bilaterally, worse on the right. Proprioception is intact. Motor Strength is 5/5 throughout except for 5-/5 at the bilateral knee flexors. Reflexes 1+ brachioradialis, absent triceps, and trace biceps on both sides. Patellar reflexes are trace on both sides, ankle reflexes are absent on the right and trace on the left. Motor Nerve Conduction:
Nerve and Site Latenc y Amplitud e Segment
Latency Differenc e
Distance
Conductio n Velocity
Tibial.R Ankle Popliteal fossa
5.5 ms 20.4
4.5 mV 2.1 mV
Abductor hallucisAnkle Ankle-Popliteal fossa
5.5 ms 14.9 ms
80 mm 456 mm
m/s 31 m/s
001541
ms Peroneal.R Fibula (head) Popliteal fossa
4.2 ms 6.6 ms
5.2 mV 5.4 mV
Tibialis anterior-fibula (head) fibula (head)Popliteal fossa
4.2 ms 2.4 ms
106 mm 140 mm
m/s 58 m/s
Median.R Wrist Elbow Ulnar.R Wrist Below elbow Above elbow
3.8 ms 9.0 ms
13.5 mV 13.1 mV
Abductor pollicis brevis-Wrist Wrist-Elbow
3.8 ms 5.2 ms
80 mm 258 mm
m/s 50 m/s
3.0 ms 7.2 ms 9.9 ms
9.7 mV 8.8 mV 8.5 mV
Abductor digiti minimi (manus)-Wrist Wrist-Below elbow Below elbow-Above elbow
3.0 ms 4.2 ms 2.7 ms
80 mm 205 mm 120 mm
m/s 49 m/s 44 m/s
Tibial.L Ankle
5.6 ms 20.2 ms
4.9 mV 3.7 mV
Popliteal fossa
5.6 ms 14.6 ms
80 mm 450 mm
m/s 31 m/s
Peroneal.L Ankle Fibula (head) Popliteal fossa
6.1 ms 16.4 ms 20.7 ms
2.7 mV 2.7 mV 3.1 mV
Extensor digitorum brevis-Ankle Ankle-Fibula (head) Fibula (head)Popliteal fossa
6.1 ms 10.3 ms 4.3 ms
80 mm 308 mm 154 mm
m/s 30 m/s 36 m/s
Median.L Wrist
Elbow
3.8 ms
8.9 ms
11.8 mV
11.3 mV
3.8 ms
5.1 ms
80 mm
267 mm
m/s
52 m/s
F-Wave Studies
Nerve Tibial.R Median.R Ulnar.R Tibial.L Median.L M-Latency 5.1 3.5 3.1 5.5 3.5 F-Latency 66.6 32.3 33.9 51.5 31.1
Sensory Nerve Conduction:

Nerve and Site
Peak Latenc y
Amplitu de
Segment
Latency Differen ce
Distan ce
Sural.R Lower leg Median.R Wrist
NR
NR
Ankle-Lower leg
ms
mm
m/s
3.4 ms
18 uV
Digit II (index finger)Wrist
2.9 ms
140 mm
48 m/s
001542
Ulnar.R Wrist
3.7 ms
7 uV
Digit V (little finger)Wrist
2.7 ms
140 mm
51 m/s
Sural.L Lower leg
5.1 ms
3 uV
Ankle-Lower leg
4.1 ms
140 mm
34 m/s
Needle EMG Examination:

Insertio Spontaneous Volitional MUAPs Max Volitional Activity nal Activity Config RecruitmAmplitu Pattern Activatio InsertionFibs + Fasc Duratio Amplitu Poly al n de ent de Wave n/Effort Max. Normal NoneNone NoneIncreas Normal None Normal Normal Normal Full ed Max. Normal NoneNone None Normal Normal None Normal Normal Normal Full
Normal None Rare NoneIncreas Normal Few ed Normal NoneNone None Normal Normal None Normal NoneNone None Normal Normal None Normal NoneNone None Normal Normal None Normal NoneNone None Normal Normal None Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal
Muscle Vastus medialis.L Vastus medialis.R Tibialis anterior.L Tibialis anterior.R Gastrocnemius (Medial head).L Gastrocnemius (Medial head).R Extensor hallucis longus.L Peroneus longus.L Deltoid.L
Full Full Full Full Full
Max. Max. Max. Max. Max.
Normal NoneNone None Normal Normal None Normal NoneNone None Normal Normal None
Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal
Full Full Full Full
Max. Max. Max. Max.
1st dorsal Normal NoneNone None Normal Normal None interosseous.L Biceps femoris Normal NoneNone None Normal Normal None (short head).R
ELECTRODIAGNOSTIC FINDINGS: 1. 2. 3. 4. 5. 6.
Motor nerve conduction studies of the right peroneal, bilateral median, and right ulnar nerves were normal. Motor nerve conduction studies of the bilateral tibial and left peroneal nerves showed normal distal latencies and compound muscle action potential amplitudes but mildly slowed conduction velocities bilaterally. F-wave latencies of the left median and left tibial nerves were normal while F-wave latencies of the right median and right ulnar nerves were mildly prolonged and F-wave latency of the right tibial nerve was moderately prolonged. Sensory nerve conduction study of the right sural nerve showed no response while study of the left sural nerve showed severely reduced sensory nerve action potential amplitude and mildly reduced conduction velocity. Sensory nerve conduction study of the right median and right ulnar nerves were normal. Needle EMG examination of selected proximal and distal muscles of the left upper and bilateral lower extremities was normal except for rare positive sharp waves seen a the left tibialis anterior.
CLINICAL IMPRESSION: Abnormal study. There is evidence of segmental demyelination in the bilateral lower extremities consistent with a predominantly demyelinating polyneuropathy affecting the bilateral lower extremities. There is no evidence of myopathy.
David Chesak, M.D. (Fellow) Nandini Bakshi, M.D. (Attending)
Electronically signed by David P Chesak, MD at 3/3/2011 4:04 PM Author Ricardo A Maselli, Status Signed Last Editor Ricardo A Maselli, Updated 3/4/2011 10:15 PM Created 3/4/2011 10:15 PM
001543
MD Assoc. Orders None
MD
I have personally reviewed the record and the fellow's interpretation, and I agree with the findings.
Electronically signed by Ricardo A Maselli, MD at 3/4/2011 10:15 PM All Flowsheet Templates (all recorded) None

Problem List
Noted Resolved
10/22/2010 1/19/2006 5/26/2006 4/30/2008

See lab

Class: Acute High arch 7/12/2010 2/17/2011

Weakness Encounter Closed By Closed By MASELLI, RICARDO A
Appointment
001544
Doctor Staff
Victor Baquero, MD

Collection Date and Time 11/18/2010 1425 Interfaced Collector PCN.KD
Screening for other and unspecified endocrine, nutritional, metabolic, and immunity disorders [V77.99]
Patient Information
Patient Name Amundsen, Mark Unit UCDREG MRN 8081369 Sex Male DOB 9/23/1959
Account # 078548433115
Account Information
Order Details
Future Order Information

Expected By 11/17/10 (Approximate) Expires 11/17/11
Lab Results
Collection Information Collection Date and Time 10/3/2003 0920
COMPREHENSIVE CHEMISTRY PANEL (Order 583288)

Received Date and Time 10/3/2003 1040
Entry Date
10/3/2003 Component Results Component SODIUM POTASSIUM CHLORIDE CARBON DIOXIDE TOTAL UREA NITROGEN, BLOOD (BUN) CREATININE BLOOD GLUCOSE CALCIUM PROTEIN ALBUMIN ALKALINE PHOSPHATASE (ALP) ASPARTATE TRANSAMINASE (AST) BILIRUBIN TOTAL MyChart Status: Value 140 3.6 104 28 17 0.8 71 9.1 6.5 3.8 58 19 0.7 Flag Reference Range 135 - 145 mEq/L 3.3 - 5.0 mEq/L 95 - 110 mEq/L 24 - 32 mEq/L 8 - 22 mg/dL 0.5 - 1.3 mg/dL 70 - 110 mg/dL 8.6 - 10.5 mg/dL 6.3 - 8.3 g/dL 3.4 - 4.8 g/dL 35 - 115 U/L 15 - 43 U/L 0.3 - 1.3 mg/dL Status Final Final Final Final Final Final Final Final Final Final Final Final Final
001545
This result is currently released to MyChart. Related Tests LIPID PANEL (Order#583289) on 10/3/03 Other IDs Lab Specimen # 1003:CI00578R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Lab Information Lab UC DAVIS MED CTR 2315 Stockton Blvd Sacramento CA 95817 Phone Number 916-734-0500 Lab NPI 1710918545
Order
Allergies
FENTANYL; MORPHINE
Lab Director Ralph Green, MD
COMPREHENSIVE CHEMISTRY PANEL (Order 583288)
Order Information
Date and Time 10/3/2003 9:20 AM Authorizing Victor Baquero, MD Department Fol Fam Prac/Int Med
Isolation
No Isolation
Order Details

Collection Date and Time 10/3/2003 0920 Interfaced Collector SW
001546
Patient Information
Account # 078548433115
Account Information
Order Details

Lab Results
LIPID PANEL (Order 583289)
Entry Date
10/3/2003
Component Results Component Value FASTING YES CHOLESTEROL 236 Comment: Desirable adult value < 200 mg/dL 49 HDL CHOLESTEROL LDL CHOLESTEROL 156 CALCULATION TOTAL 4.8 CHOLESTEROL:HDL RATIO TRIGLYCERIDE 153 MyChart Status:
This result is currently released to MyChart.
Flag
Reference Range
0 - 200 mg/dL
Status Final Final
H H
>= 35 mg/dL < 130 mg/dL < 4.0
Final Final Final
35 - 160 mg/dL
Final
Related Tests COMPREHENSIVE CHEMISTRY PANEL (Order#583288) on 10/3/03 Other IDs Reflex Order # 583288 Lab Specimen # 1003:CI00578R

Unit
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
001547
IMFFOL
Lab Information Lab UC DAVIS MED CTR 2315 Stockton Blvd Sacramento CA 95817
Phone Number 916-734-0500
Lab NPI 1710918545

Order
Allergies
FENTANYL; MORPHINE
Order Information
Isolation
No Isolation
Order Details
Frequency None Duration None Priority Routine Order Class None

Patient Information
Order Details
Order ID 583289
Lab Results
Collection Information
LIPID PANEL WITH DLDL REFLEX (Order 75750551)
001548
Entry Date
10/3/2003
Component Results Component Value Flag Reference Range PSA SCREEN 0.9 0 - 4.0 ng/mL Comment: The PSA test in conjunction with DRE is intended for use as an aid in the detection of prostate cancer in men 50 years and older. This test is also further indicated as an aid in the management of patients with prostate cancer. MyChart Status:
Status Final
Related Tests TSH (SENSITIVE) (Order#581771) on 10/3/03 Other IDs Lab Specimen # 1003:SC00193R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Lab NPI 1710918545

Order
Allergies
FENTANYL; MORPHINE
PSA SCREEN (Order 581770)
Order Information
Isolation
No Isolation
Order Details
001549
Frequency None
Duration None
Priority Routine
Order Class Normal

Patient Information
Unit IMFFOL
Order Details
Order ID 581770
Lab Results
Description NOT REQUIRED
RED BLOOD CELLS (Order 48367803) Received Date and Time 12/20/2009 0303 Source BLOOD
Entry Date
12/27/2009
Results
UNIT CROSSMATCH/TRANSFUSION - Scan on 12/27/2009 5:53 AM UNIT CROSSMATCH/TRANSFUSION - Scan on 12/27/2009 5:53 AM
Result History
RED BLOOD CELLS (Order#48367803) on 12/27/09 - Order Result History Report MyChart Status: This result is currently released to MyChart. Other IDs Lab Specimen # 1220:BB00012R
001550
MRN 8081369
Sex M
DOB 9/23/1959 (53yr) Room 4661
Home Phone 916-509-0158
Lab Information Lab

Order
Allergies
FENTANYL; MORPHINE
RED BLOOD CELLS (Order 48367803)
Order Information
Date and Time 12/19/2009 11:19 PM Electronically Signed By/Authorizing Ru Ya Cai, MD Department T4 Ent/Internal Medicine
Order Questions
Question Units required (1-10): Clinical Indications: Irradiated: CMV Negative: Washed: Frozen deglycerolized: Collection Date: Collection Time: Collected By: Answer 2 Hemoglobin < 8 g/dl No No No No 12/20/2009 12:20 AM ARENAS, ENCARNACION Comment
Comments
Nursing Transfusion Instructions: Give 2 unit(s), begin transfusion Now. pre-med with tylenol 650mg po x1 and benadryl 25mg po x1
Process Instructions
A Type and Screen specimen, less than 3 days old, is required for a Red Blood Cell crossmatch.*** NOTE: The ANTIBODY SCREEN result is displayed below.*** Crossmatched units will be held for 72 hours only. If transfusion is not imminent or inevitable, please order a Type & Screen instead. See EMR "READY" status for product availability
Isolation
No Isolation
Order Details
Ordered By RU YA CAI [09041]
Admitting Provider
Authorized By RU YA CAI [09041]

PCP
Released By RU YA CAI [036929149]
001551
60332328
Lab Results
TSH (SENSITIVE) (Order 581771) Received Date and Time 10/3/2003 1040
Entry Date
10/3/2003 Component Results Component THYROID STIMULATING HORMONE MyChart Status:
Value 1.87
Flag
Reference Range 0.35 - 5.5 mcIU/mL
Status Final
Related Tests PSA SCREEN (Order#581770) on 10/3/03 Other IDs Reflex Order # 581770 Lab Specimen # 1003:SC00193R

Unit IMFFOL
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Lab Information Lab UC DAVIS MED CTR 2315 Stockton Blvd Sacramento CA 95817 Phone Number 916-734-0500
Lab NPI 1710918545 Order
Allergies
FENTANYL; MORPHINE
TSH (SENSITIVE) (Order 581771)
Order Information
Isolation
No Isolation
Order Details
Frequency None Duration None Priority Routine Order Class None
001552
Fatigue [780.79]
Patient Information
Unit UCDREG
MRN 8081369
Sex Male
DOB 9/23/1959
Account # 078548433024
Account Information
Order Details

Lab Results
URINALYSIS-COMPLETE (Order 582705)

Entry Date
10/3/2003
Component Results Component COLLECTION COLOR CLARITY SP GRAVITY pH URINE OCCULT BLOOD URINE BILIRUBIN URINE KETONES GLUCOSE URINE PROTEIN URINE UROBILINOGEN NITRITE URINE LEUK. ESTERASE MICROSCOPIC MyChart Status:
Value Clean Catch Yellow Clear 1.029 5.0 Negative Negative Negative Negative Negative 0.2 Negative Negative NOT INDICATED
Flag
Reference Range None/Yellow Clr/Sl Turb 1.002 - 1.030 4.8 - 7.8 Negative Negative Negative mg/dL Negative mg/dL Neg/Trace mg/dL 0.2 - 1.0 EU/dL Negative Negative Negative
Status Final Final Final Final Final Final Final Final Final Final Final Final Final Final
This result is currently released to MyChart. Other IDs Lab Specimen # 1003:UA00100R
Patient Information
001553

Unit IMFFOL
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Allergies
FENTANYL; MORPHINE
Order Information
Isolation
No Isolation
Order Details

Patient Information
Order Details
Order ID
001554
Order Details
Frequency None Duration None Priority Routine Order Class UCD LAB
Release Date/Time 2/4/2010 0924 Schedule Date/Time 2/4/2010
Ordered By Admitting Provider Doctor Staff Authorized By VICTOR BAQUERO [08139] PCP Victor Baquero, MD Released By BARBARA BLANKENCHIP [006147847]

Collection Date and Time 2/4/2010 0923 Interfaced Collector S.BB1
Fatigue [780.79]
Patient Information
Account # 078548433024
Account Information
Order Details

Lab Results
TESTOSTERONE,BIOAVAILABLE (Order 598954)
Entry Date
10/6/2003 Component Results Component Value Flag Reference Range TESTOSTERONE,TOTAL 192 L 350 - 890 ng/dL Comment: INTERPRETATION: Testosterone Serum concentrations of testosterone in both sexes during the first week of life average about 25 ng/dL. In male Status Corrected
001555
infants, values increase sharply in the second week to a maximum (mean about 175 ng/dL) at about two months, which lasts until about six months of age. In female infants, values decrease in the first week and remain low throughout early childhood. Levels increase during puberty to adult values, and are related to pubertal stage rather than chronological age. Tanner Stage or Age (yrs) ------------I (7 mos-9 yrs) II (10-13) III (14-15) IV,V (16-19) 20-39 yrs 40-59 yrs 60 and over Serum Testosterone (ng/dL) Male Female ------------- -----------Less than 30 Less than 10 Less than 150 Less than 30 100 - 320 Less than 35 200 - 970 15 - 40 400 - 1080 15 - 70 350 - 890 4 - 70 350 - 720 4 - 60
To convert to nmol/L, multiply ng/dL by 0.0347. 13 - 71 nmol/L SEX HORMONE BINDING 19 GLOBULIN ALBUMIN,SERUM 4.4 3.5 - 5.0 g/dL TESTOSTERONE,BIO 119.6 L 130.5 - 681.7 ng/dL AVAILABLE Comment: TEST INFORMATION: Testosterone, Bioavailable The concentration of Bioavailable Testosterone is derived from a mathematical expression based on constants for the binding of Testosterone to Sex Hormone Binding Globulin and Albumin. TESTOSTERONE,FREE 43.8 L 47.0 - 244.0 pg/mL Comment: TEST INFORMATION: Testosterone, Free To convert to pmol/L, multiply pg/mL by 3.47. The concentration of Free Testosterone is derived from a mathematical expression based on constants for the binding of Testosterone to Sex Hormone Binding Globulin. TESTOSTERONE, % 2.3 1.6 - 2.9 % FREE Comment: Test Performed By: ARUP Laboratories 500 Chipeta Way Salt Lake City, Utah .
Final Final Corrected
Corrected
Final
84108-1221
Result History
TESTOSTERONE,BIOAVAILABLE (Order#598954) on 10/6/03 - Order Result History Report MyChart Status: This result is currently released to MyChart. Other IDs Lab Specimen # 1003:S00025R
001556
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Lab Information Lab ARUP LABORATORIES 500 Chipeta Way Salt Lake City UT 84108-1221 Phone Number 800-242-2787 Lab NPI 1982694931
Order
Allergies
FENTANYL; MORPHINE
Order Information
Isolation
No Isolation
Order Details

Patient Information
Unit IMFFOL
001557
Account # 038541463121
Account Information
Order Details

Lab Results
BLOOD COUNT (Order 40064944)
Entry Date
5/26/2009 Component Results Component WHITE BLOOD CELL COUNT RED CELL COUNT HEMOGLOBIN HEMATOCRIT MCV MCH MCHC RDW MPV PLATELET COUNT
Value 15.9 Flag H Reference Range 4.5-11.0 K/MM3 Status Final
4.91 14.8 44.2 90.0 30.1 33.5 14.2 8.7 261
4.5-5.9 M/MM3 13.5-17.5 GM/DL 41-53 % 80-100 UM3 27-33 PG 32-36 % 0-14.7 UNITS 6.8-10.0 UM3 130-400 K/MM3
Final Final Final Final Final Final Final Final Final
Result History
BLOOD COUNT (Order#40064944) on 5/26/09 - Order Result History Report MyChart Status: This result is currently released to MyChart. Related Tests SED RATE WESTERGREN (Order#40064946) on 5/26/09 Other IDs Lab Specimen # 0526:H01176R
Patient Information Patient Name Amundsen, Mark Unit UCDREG
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
001558
Result Notes Notes recorded by Victor H Baquero on 05/30/2009 at 6:12 PM Patient notified of results. Positive C. Diff. Treated. -----Notes recorded by Victor H Baquero on 05/29/2009 at 2:59 PM Notified of results. Started antibiotics. Feels mildly better. -----Notes recorded by Cory O'Dell on 05/28/2009 at 12:44 PM LEFT MESSAGE FOR PT TO RETURN CALL. -----Notes recorded by Victor H Baquero on 05/26/2009 at 8:44 PM Please call with results. Labs show low grade infection but otherwise within normal limits. . Please turn in stool cultures. Follow up if not better. Lab Information Lab UC DAVIS MED CTR 2315 Stockton Blvd Sacramento CA 95817 Phone Number 916-734-0500
Allergies
FENTANYL; MORPHINE
Order Information
Result Notes
Notes recorded by Victor H Baquero on 05/30/2009 at 6:12 PM Patient notified of results. Positive C. Diff. Treated. -----Notes recorded by Victor H Baquero on 05/29/2009 at 2:59 PM Notified of results. Started antibiotics. Feels mildly better. -----Notes recorded by Cory O'Dell on 05/28/2009 at 12:44 PM LEFT MESSAGE FOR PT TO RETURN CALL. -----Notes recorded by Victor H Baquero on 05/26/2009 at 8:44 PM Please call with results. Labs show low grade infection but otherwise within normal limits. . Please turn in stool cultures. Follow up if not better.
Isolation
No Isolation
Order Details
001559
Ordered By Admitting Provider Doctor Staff Authorized By VICTOR BAQUERO [08139] PCP Victor Baquero, MD Released By JOANNE SAIZ [259598266]

Collection Date and Time 5/26/2009 1547 Interfaced Collector S.JS2
Diarrhea [787.91] Colitis [558.9]
Patient Information
Unit UCDREG
Account # 078438665057
Account Information
Order Details

Order
Allergies
FENTANYL; MORPHINE
Order Information

Order Status Canceled By Victor Baquero, MD On 4/30/08 1345 Reason None
Isolation
No Isolation
Order Details
001560

Fatigue [780.79]
Patient Information
Account # 078548433024
Account Information
Order Details

Lab Results
COMPREHENSIVE METABOLIC PANEL (Order 40064945)
Entry Date
5/26/2009
Component Results Component SODIUM POTASSIUM CHLORIDE CARBON DIOXIDE TOTAL UREA NITROGEN, BLOOD (BUN) CREATININE BLOOD E-GFR, AFRICAN AMERICAN Comment: mL/min/1.73 square E-GFR, NON-AFRICAN AMERICAN
Value 137 3.4 101 27
Flag
Reference Range 135-145 mEq/L 3.3-5.0 mEq/L 95-110 mEq/L 24-32 mEq/L
Status Final Final Final Final
8 1.04 >60
8-22 mg/dL 0.44-1.27 mg/dL >60 SEE NOTE
Final Final Final
meters >60
>60 SEE NOTE
Final
001561
Comment: mL/min/1.73 square meters Note: The estimated GFR result assumes a steady-state and is most accurate for GFRs <60 mL/min/1.73 square meters. The eGFR is not reliable in certain groups, including severely ill patients. Also, patients >59 years of age can have a mildly reduced GFR due to aging. The MDRD equations used to estimate GFR have been validated only in Caucasian and African-Americans 18 - 70 years of age. The equations have not been validated in other population groups, including pregnant women, transplant recipients, medically unstable patients including those with acute renal failure, or in persons with extremes of body size, muscle mass, or nutritional status. Application of the MDRD calculation in these cases may lead to errors in GFR estimation. GLUCOSE 107 70-110 mg/dL CALCIUM 9.2 8.6-10.5 mg/dL PROTEIN 6.5 6.3-8.3 g/dL ALBUMIN 3.3 L 3.4-4.8 g/dL 93 35-115 U/L ALKALINE PHOSPHATASE (ALP) ASPARTATE 19 15-43 U/L TRANSAMINASE (AST) BILIRUBIN TOTAL 0.4 0.3-1.3 mg/dL ALANINE TRANSFERASE 17 6-63 U/L (ALT)
Final Final Final Final Final Final Final Final
Result History
COMPREHENSIVE METABOLIC PANEL (Order#40064945) on 5/26/09 - Order Result History Report MyChart Status: This result is currently released to MyChart. Other IDs Lab Specimen # 0526:CI01444R

Unit UCDREG
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Result Notes Notes recorded by Victor H Baquero on 05/30/2009 at 6:12 PM Patient notified of results. Positive C. Diff. Treated. -----Notes recorded by Victor H Baquero on 05/29/2009 at 2:59 PM Notified of results. Started antibiotics. Feels mildly better. -----Notes recorded by Cory O'Dell on 05/28/2009 at 12:44 PM LEFT MESSAGE FOR PT TO RETURN CALL.
001562
-----Notes recorded by Victor H Baquero on 05/26/2009 at 8:44 PM Please call with results. Labs show low grade infection but otherwise within normal limits. . Please turn in stool cultures. Follow up if not better. Lab Information Lab UC DAVIS MED CTR 2315 Stockton Blvd Sacramento CA 95817
Lab NPI 1710918545

Order
Allergies
FENTANYL; MORPHINE
Order Information
Result Notes
Isolation
No Isolation
Order Details
001563

Collection Date and Time 5/26/2009 1547 Interfaced Collector S.JS2
Patient Information
Account # 078438665057
Account Information
Order Details

Order
Allergies
FENTANYL; MORPHINE
Order Information

Isolation
No Isolation
Order Details

001564
Order Details

Lab Results
SED RATE WESTERGREN (Order 40064946)
Entry Date
5/26/2009 Component Results Component SED RATE WESTERGREN Value 32 Flag H Reference Range 0-15 Status Final
Result History
SED RATE WESTERGREN (Order#40064946) on 5/26/09 - Order Result History Report MyChart Status: This result is currently released to MyChart. Related Tests BLOOD COUNT (Order#40064944) on 5/26/09 Other IDs Lab Specimen # 0526:H01176R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Result Notes Notes recorded by Victor H Baquero on 05/30/2009 at 6:12 PM Patient notified of results. Positive C. Diff. Treated. -----Notes recorded by Victor H Baquero on 05/29/2009 at 2:59 PM Notified of results. Started antibiotics. Feels mildly better. -----Notes recorded by Cory O'Dell on 05/28/2009 at 12:44 PM LEFT MESSAGE FOR PT TO RETURN CALL. ------
001565
Notes recorded by Victor H Baquero on 05/26/2009 at 8:44 PM Please call with results. Labs show low grade infection but otherwise within normal limits. . Please turn in stool cultures. Follow up if not better. Lab Information Lab UC DAVIS MED CTR 2315 Stockton Blvd Sacramento CA 95817 Phone Number 916-734-0500 Lab NPI 1710918545
Order
Allergies
FENTANYL; MORPHINE SED RATE WESTERGREN (Order 40064946)
Order Information
Result Notes
Isolation
No Isolation
Order Details
001566
Interfaced Collector S.JS2
Patient Information
Account # 078438665057
Account Information
Order Details

Expected By 5/26/09 (Approximate) Expires 5/27/10 SED RATE WESTERGREN (Order 15494559)
Order
Allergies
FENTANYL; MORPHINE
Order Information

Isolation
No Isolation
Order Details

001567
Order Details
Lab Results
C DIFFICILE TOXIN A & B EIA (Order 40125849) Received Date and Time 5/27/2009 2119 Source STOOL
Entry Date
5/27/2009
Component Results
C DIFFICILE TOXIN A & B EIA: C DIFFICILE TOXIN A & B EIA Final
CLOSTRIDIUM DIFFICILE TOXIN DETECTED DATE/TIME: 05/27/09 2216 BY: CANTRELL,STEPHANIE C DIFFICILE TOXIN A & B EIA: CLOSTRIDIUM DIFFICILE TOXIN
Result Narrative
WATERY
Result History
C DIFFICILE TOXIN A & B EIA (Order#40125849) on 5/27/09 - Order Result History Report Other IDs
Lab Specimen # 09:V0004310R
MyChart Status: This result is currently released to MyChart. Microbiology Report Microbiology Reviewed by List BAQUERO, VICTOR H on Sat May 30, 2009 1812 Patient Information Patient Name Amundsen, Mark Unit UCDREG
Result Notes Notes recorded by Victor H Baquero on 05/30/2009 at 6:12 PM
001568
Patient notified of results. Positive C. Diff. Treated. -----Notes recorded by Victor H Baquero on 05/29/2009 at 2:59 PM Notified of results. Started antibiotics. Feels mildly better. Lab Information Lab UCDMC SPECIALTY TESTING CENTER 3740 Business Drive Sacramento CA 95820-2164
Lab Director Ralph Green, M.D.
Lab NPI 1710918545

Order
Allergies
FENTANYL; MORPHINE C DIFFICILE TOXIN A & B EIA (Order 40125849)
Order Information
Result Narrative:
WATERY
Order Questions
Question Specimen Type: Answer STOOL Comment
Submit 2-4 grams of stool in a sterile container. If not delivered immediately, REFRIGERATE AND DELIVER ON ICE within 48 hours of collection. Testing is not performed on hard, formed specimens.
Result Notes
Notes recorded by Victor H Baquero on 05/30/2009 at 6:12 PM Patient notified of results. Positive C. Diff. Treated. -----Notes recorded by Victor H Baquero on 05/29/2009 at 2:59 PM Notified of results. Started antibiotics. Feels mildly better.
Isolation
No Isolation
Order Details
Ordered By Admitting Provider Doctor Staff Authorized By VICTOR BAQUERO [08139] PCP Victor Baquero, MD Released By YYESHA CHA [397296906]
001569
No Isolation
Order Details
Ordered By Admitting Provider Doctor Staff Authorized By ANDREW KIM OH [10912] PCP Victor Baquero, MD Released By MATTHEW MANTHEI [551506892]

Collection Date and Time 3/24/2011 0905 Interfaced Collector S.MM/A
Polyneuropathy [356.9]
Patient Information
Account # 078661756037
Account Information
Order Details

Lab Results
CRYPTOSPORIDIUM/GIARDIA FA (Order 40125852)

Received Date and Time 5/27/2009 2120 Source STOOL
Entry Date
5/29/2009
Component Results
CRYPTOSPORIDIUM/GIARDIA FA: CRYPTOSPORIDIUM/GIARDIA FA
Final
NO CRYPTOSPORIDIUM OOCYSTS OR GIARDIA LAMBLIA CYSTS SEEN
001570
This immunofluorescence procedure tests for the presence of both Cryptosporidium species oocysts and Giardia lamblia cysts.
Result Narrative
PARA PAK
Result History
CRYPTOSPORIDIUM/GIARDIA FA (Order#40125852) on 5/29/09 - Order Result History Report
Other IDs Lab Specimen # 09:P0000971R
MyChart Status: This result is currently released to MyChart. Microbiology Report Microbiology Reviewed by List BAQUERO, VICTOR H on Sat May 30, 2009 1812 Patient Information Patient Name Amundsen, Mark Unit UCDREG MRN 8081369 Sex M DOB 9/23/1959 (53yr) Home Phone 916-509-0158
Result Notes Notes recorded by Victor H Baquero on 05/30/2009 at 6:12 PM Patient notified of results. Positive C. Diff. Treated. -----Notes recorded by Victor H Baquero on 05/29/2009 at 2:59 PM Notified of results. Started antibiotics. Feels mildly better. Lab Information Lab UCDMC SPECIALTY TESTING CENTER 3740 Business Drive Sacramento CA 95820-2164 Phone Number 916-734-0500 Lab NPI 1710918545
Order
Allergies
FENTANYL; MORPHINE
Lab Director Ralph Green, M.D.
CRYPTOSPORIDIUM/GIARDIA FA (Order 40125852)
Order Information
Date and Time Electronically Signed By/Authorizing Department
001571
5/26/2009 3:26 PM
Victor Baquero, MD
Fol Family Practice
Result Narrative:
PARA PAK
Order Questions
Collect in ova and parasite preservative vials.
Result Notes
Isolation
No Isolation
Order Details

Specimen STOOL Collection Date and Time 5/27/2009 0800
Patient Information
Unit UCDREG
MRN 8081369
Sex Male
DOB 9/23/1959
Account # 078438665057
Account Information
Order Details
001572
Parent Order ID 40063722
Child Order ID 40125852

Order
Allergies
FENTANYL; MORPHINE
CULTURE CSF (INCLUDES GS), BACTI (Order 68126271)
Order Information

Order Status By Lab Results Interface Canceled Auto-cancelled after 3 days. On 5/5/11 0003 Reason Cancelled
Result Narrative:
Auto-cancelled after 3 days.
Order Questions
Question Specimen Type: Answer CSF, LUMBAR PUNCTURE Comment
Submit as much fluid as possible in a sterile container. At least 0.5mL fluid is required per test request. Prioritize testing if necessary.
In comments, indicate specimen source for CSF shunt specimens.
Isolation
No Isolation
Order Details
Frequency None Duration None Priority STAT Order Class UCD LAB
Ordered By
Admitting Provider Doctor Staff
Authorized By ANDREW KIM OH [10912]

Released By PATRICIA CONNOLLY [312125479]

Specimen CSF, LUMBAR PUNCTURE Collection Date and Time 5/1/2011 1552
Patient Information
Account #
001573
Lab Results
CULTURE GASTROINTESTINAL, BACTI (Order 40125850)

Received Date and Time 5/27/2009 2119 Source STOOL
Entry Date
5/30/2009
Component Results
CULTURE STOOL: CULTURE STOOL Final
NO SALMONELLA, SHIGELLA OR CAMPYLOBACTER ISOLATED
Result Narrative
ENT
Result History
CULTURE GASTROINTESTINAL, BACTI (Order#40125850) on 5/30/09 - Order Result History Report Other IDs Lab Specimen # 09:B0031125R
MyChart Status: This result is currently released to MyChart. Microbiology Report Microbiology Reviewed by List BAQUERO, VICTOR H on Sat May 30, 2009 1812 Patient Information Patient Name Amundsen, Mark
Unit UCDREG
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Result Notes Notes recorded by Victor H Baquero on 05/30/2009 at 6:12 PM Patient notified of results. Positive C. Diff. Treated. -----Notes recorded by Victor H Baquero on 05/29/2009 at 2:59 PM Notified of results. Started antibiotics. Feels mildly better. Lab Information Lab UCDMC SPECIALTY TESTING CENTER 3740 Business Drive Lab Director Ralph Green, M.D.
001574
Sacramento CA 95820-2164

Allergies
FENTANYL; MORPHINE
CULTURE GASTROINTESTINAL, BACTI (Order 40125850)
Order Information
Result Narrative:
ENT
Order Questions
"Collect stool specimens using enteric transport medium (Cary-Blair) and submit within 72 hours of collection. Rectal swabs must be submitted within 24 hours and have fecal material visible. Routine culture includes Salmonella, Shigella, Campylobacter, Aeromonas, Plesiomonas, E. coli O157 and Shiga-toxin. Note any other suspected organisms in the comments section. "
Result Notes
Isolation
No Isolation
Order Details

001575

Pending User Jonathan G Eastman, MD Date/Time Tue Dec 15, 2009 1540 Status Signed & Held Reason
Patient Information
Account # 010016806878
Account Information
Order Details
Order ID 48191944
Lab Results
BASIC METABOLIC PANEL (Order 48135732) Received Date and Time 12/14/2009 1336
Entry Date
12/14/2009 Component Results Component SODIUM POTASSIUM CHLORIDE CARBON DIOXIDE TOTAL UREA NITROGEN, BLOOD (BUN) CREATININE BLOOD E-GFR, AFRICAN AMERICAN Comment: mL/min/1.73 square E-GFR, NON-AFRICAN AMERICAN Comment: mL/min/1.73 square Value 139 3.9 103 28 13 1.01 >60 Flag Reference Range 135 - 145 mEq/L 3.3 - 5.0 mEq/L 95 - 110 mEq/L 24 - 32 mEq/L 8 - 22 mg/dL 0.44 - 1.27 mg/dL >60 SEE NOTE Status Final Final Final Final Final Final Final
meters >60
>60 SEE NOTE
Final
meters
Note: The estimated GFR result assumes a steady-state and is most accurate for GFRs <60 mL/min/1.73 square meters. The eGFR is not reliable in certain groups, including severely ill patients. Also, patients >59 years of age can have a mildly reduced GFR due to aging. The MDRD equations used to estimate GFR have been validated only in Caucasian and African-Americans 18 - 70 years of age. The equations have not been validated in other population groups, including pregnant women, transplant recipients, medically unstable patients including those with acute renal failure, or in persons with extremes of body size, muscle mass, or
001576
nutritional status. Application of the MDRD calculation in these cases may lead to errors in GFR estimation. GLUCOSE 88 70 - 110 mg/dL CALCIUM 9.2 8.6 - 10.5 mg/dL
Final Final
Result History
BASIC METABOLIC PANEL (Order#48135732) on 12/14/09 - Order Result History Report MyChart Status: This result is currently released to MyChart. Other IDs Lab Specimen # 1214:CI01292R

Unit UCDREG
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Lab Information Lab UCDMC LAB Phone Number
Order
Allergies
FENTANYL; MORPHINE
BASIC METABOLIC PANEL (Order 48135732)
Order Information
Isolation
No Isolation
Order Details
Ordered By Admitting Provider Doctor Staff Authorized By ROBERT MICHAEL TAMURIAN [10884] PCP Victor Baquero, MD Released By MICHAEL PAULAR [982641136]
Cosign Info
Action Responsible Provider Signed By Signed On
001577
D14O
14787
147871
Account # 010016806878

Isolation
No Isolation
Account Information
Order Details
Lab Results
Entry Date
12/14/2009 Component Results Component WHITE BLOOD CELL COUNT RED CELL COUNT HEMOGLOBIN HEMATOCRIT MCV MCH MCHC RDW MPV PLATELET COUNT Value 7.9 3.91 12.2 35.4 90.5 31.2 34.5 13.3 8.2 208 Flag Reference Range 4.5 - 11.0 K/MM3 4.5 - 5.9 M/MM3 13.5 - 17.5 GM/DL 41 - 53 % 80 - 100 UM3 27 - 33 PG 32 - 36 % 0 - 14.7 UNITS 6.8 - 10.0 UM3 130 - 400 K/MM3 Status Final Final Final Final Final Final Final Final Final Final
L L L
Result History
BLOOD COUNT (Order#48135731) on 12/14/09 - Order Result History Report
MyChart Status:
Other IDs Lab Specimen # 1214:H00965R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
001578
Unit UCDREG
Lab Information Lab UCDMC LAB

Phone Number
Order
Allergies
FENTANYL; MORPHINE
Order Information
Isolation
No Isolation
Order Details
Cosign Info
Cosign Order Info


Collection Date and Time 12/14/2009 1336 Interfaced Collector ACCLAB
ADVANCED OSTEOARTHRITIS OF THE LEFT HIP [726.5]
Patient Information
001579
Order Questions
Question Anticoagulants: Answer Unknown Comment
Isolation
No Isolation
Order Details

Ordered By
Admitting Provider
Authorized By ARTHUR BROOKS DUBLIN [00230]

Polyneuropathy [356.9] - Primary Preop testing [V72.84]
Patient Information
Patient Name Amundsen, Mark Unit VASCLN MRN 8081369 Sex Male DOB 9/23/1959
Order Details
Order ID 66746139
Lab Results
Collection Information Collection Date and Time 12/14/2009 1336 Received Date and Time 12/14/2009 1336
INR (Order 48135733)
Entry Date
12/14/2009
Component Results Component INR
Value 0.94
Flag
Reference Range 0.75 - 1.19
Status Final
Result History
INR (Order#48135733) on 12/14/09 - Order Result History Report
MyChart Status: This result is currently released to MyChart.
001580
Other IDs Lab Specimen # 1214:CG00343R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158

Phone Number
Order
Allergies
FENTANYL; MORPHINE
Order Information
Order Questions
Isolation
No Isolation
Order Details
Ordered By Authorized By ROBERT MICHAEL TAMURIAN [10884] Released By MICHAEL PAULAR [982641136]
Cosign Info
Cosign Order Info


001581
Patient Information
Unit UCDREG
Account # 038541463121
Account Information
Order Details

Order
Allergies
FENTANYL; MORPHINE
LAB MISCELLANEOUS PROCEDURE (Order 61646567)
Order Information
Order Questions
Question Pager? Procedure Name: Answer 916-762-2086 Cobalt level - urine Comment
This order is ONLY for procedures not in the lab procedure database. The request will be evaluated and processed by the laboratory per protocol. If outside protocol, the clinician will be notified.
Isolation
No Isolation
Order Details
Ordered By Authorized By VICTOR BAQUERO [08139] Released By KELLY DELEON [012355806]
001582
Cosign Info
Cosign Order Info


Specimen BLOOD Collection Date and Time 12/14/2009 1336 Interfaced Collector ACCLAB
Patient Information
Unit UCDREG
MRN 8081369
Sex Male
DOB 9/23/1959
Account # 038541463121
Account Information
Order Details

Lab Results
URINALYSIS AND CULTURE IF IND (Order 48135734)

Received Date and Time 12/14/2009 1336 Source URINE
Entry Date
12/14/2009
Component Results Component COLLECTION COLOR CLARITY SPECIFIC GRAVITY
Value Clean Catch Yellow Clear 1.023
Flag
Reference Range None/Yellow Clr/Sl Turb 1.002 - 1.030
001583
pH URINE OCCULT BLOOD URINE BILIRUBIN URINE KETONES GLUCOSE URINE PROTEIN URINE UROBILINOGEN. NITRITE URINE LEUK. ESTERASE MICROSCOPIC URINE CULTURE
6.0 Negative Negative Negative Negative Negative Negative Negative Negative Not Indicated Not Indicated
4.8 - 7.8 Negative mg/dL Negative Negative mg/dL Negative mg/dL Neg/Trace mg/dL Neg-2.0 mg/dL Negative Negative
Final Final Final Final Final Final Final Final Final Final Final
Result History
URINALYSIS AND CULTURE IF IND (Order#48135734) on 12/14/09 - Order Result History Report MyChart Status: This result is currently released to MyChart. Other IDs Lab Specimen # 1214:UA00156R

Unit UCDREG
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Order
Allergies
FENTANYL; MORPHINE
URINALYSIS AND CULTURE IF IND (Order 48135734)
Order Information
Order Questions
Question Collection Method: Answer CLEAN CATCH Comment
Isolation
No Isolation
Order Details
001584
Release Date/Time 12/14/2009 1337
Schedule Date/Time 12/14/2009
Cosign Info
Cosign Order Info


Specimen URINE Collection Date and Time 12/14/2009 1336 Interfaced Collector ACCLAB
Patient Information
Account # 038541463121
Account Information
Order Details

Order
Allergies
FENTANYL; MORPHINE
URINALYSIS-CHEM ONLY (Order 15494564)
Order Information

Order Questions
Isolation
001585

Ordered By
Admitting Provider

Patient Information
Unit FAMFOL
Account # 078199740024
Account Information
Order Details
Order ID 15494558
Lab Results
BLOOD TYPE VERIFICATION (Order 48187588)

Entry Date
12/15/2009
Component Results
PATIENT BLOOD TYPE: B NEGATIVE
Result History
BLOOD TYPE VERIFICATION (Order#48187588) on 12/15/09 - Order Result History Report
MyChart Status:
Other IDs Lab Specimen # 1215:BB00101S
001586
MRN 8081369
Sex M
DOB 9/23/1959 (53yr) Room 14787
Home Phone 916-509-0158

Phone Number
Order
Allergies
FENTANYL; MORPHINE
BLOOD TYPE VERIFICATION (Order 48187588)
Order Information
Date and Time 12/15/2009 2:36 PM Electronically Signed By Lab Results Interface Authorizing Phat Giang, MD Department D14 Orthopedics/Trauma
Specimen must be collected by a phlebotomist/RN who independently identifies the patient and is not the original collector of the Type and Screen specimen. It must be collected at a different time and transported in its own s pecimen bag.
Isolation
No Isolation
Order Details
Frequency ONCE Duration 1 occurrence Priority STAT Order Class UCD LAB
Ordered By Admitting Provider Robert Michael Tamurian, MD Authorized By PHAT GIANG [10063] PCP Victor Baquero, MD

Collection Date and Time 12/15/2009 1430 Interfaced Collector TAFOYA
Patient Information
Unit D14O
MRN 8081369
Room 14787
Sex Male
DOB 9/23/1959
Bed 147871
Account # 010016806878
Account Information
001587
Ordering
12/10/09 1351
Cosign Order Info


Patient Information
Account # 038541463121
Account Information
Order Details

Lab Results
BLD GAS VENOUS (Order 48186917)
Entry Date
12/15/2009
Component Results Component PO2, VEN O2 SAT, VEN PCO2, VEN pH, VEN HCO3, VEN BASE EXCESS, VEN
Value 73.2 94.1 45.8 7.32 22.2 -2.6
Flag H
Reference Range 30 - 55 mmHG 70 - 100 % 35 - 50 mmHG 7.3 - 7.4 20 - 28 mEq/L -2 - 2 mmol/L
Status Final Final Final Final Final Final
Result History
BLD GAS VENOUS (Order#48186917) on 12/15/09 - Order Result History Report MyChart Status: This result is currently not released to MyChart. Related Tests
001588
ELECTROLYTES, WHOLE BLOOD (OR) (Order#48186913) on 12/15/09 Other IDs Reflex Order # 48186913 Lab Specimen # 1215:BG00258S
MRN 8081369
Sex M
DOB 9/23/1959 (53yr) Room 14787
Home Phone 916-509-0158

Phone Number
Order
Allergies
FENTANYL; MORPHINE
BLD GAS VENOUS (Order 48186917)
Order Information
Order Date and Time 12/15/2009 1424 Electronically Signed By LAB RESULTS INTERFACE Title
Ordering User Lab Results Interface Attending Provider(s) Robert Michael Tamurian, MD Authorizing Provider Phat Giang, MD Admitting Provider Robert Michael Tamurian, MD PCP Victor Henrique Baquero, MD
Order Details
Collected by:______________________________ Date/Time:_________________________________ Patient Temp:_________________________________ Hemoglobin:_________________________________ FIO2:_________________________________ Sample Type:________________________________
Patient Information
Patient Name Amundsen, Mark Unit MRN 8081369 Room Sex Male DOB 9/23/1959 Bed
001589
Placing Order D/C Order
12/15/09 1550 12/15/09 1915
Patricia L Bailey, RN Beverly Harrelson, RN
12/15/09 1551 12/15/09 1933
Verbal Order Info

Action Discontinuing Order Mode Change in Location Communicator Cynthia Smith, MA Responsible Provider Signed By Signature Not Required
Signed On

Pending User Jonathan G Eastman, MD Date/Time Tue Dec 15, 2009 1540

Specimen NASAL SWAB
Patient Information
Account # 010016806878
Account Information
Order Details
Lab Results
ELECTROLYTES, WHOLE BLOOD (OR) (Order 48186913)
Entry Date
12/15/2009 Component Results Component SODIUM, WHOLE BLOOD POTASSIUM, WHOLE BLOOD CHLORIDE, WHOLE BLOOD CALCIUM ION WHOLE BLOOD GLUCOSE (OR), WHOLE BLOOD LACTIC ACID (OR), WHOLE BLOOD HEMOGLOBIN WHOLE BLOOD HEMATOCRIT (OR) WHOLE BLOOD Value 138.1 3.3 112 1.18 112 0.9 10.8 33.3 L L H Flag Reference Range 137 - 147 mmol/L 3.3 - 4.8 mmol/L 95 - 110 mmol/L 1.17 - 1.31 mmol/L 70 - 110 mg/dL 0.3 - 2.2 mmol/L 14 - 18 g/dL 37 - 47 % Status Final Final Final Final Final Final Final Final
001590
Result History
ELECTROLYTES, WHOLE BLOOD (OR) (Order#48186913) on 12/15/09 - Order Result History Report MyChart Status: This result is currently not released to MyChart. Related Tests BLD GAS VENOUS (Order#48186917) on 12/15/09 Other IDs Lab Specimen # 1215:BG00258S
MRN 8081369
Sex M
DOB 9/23/1959 (53yr) Room 14787
Home Phone 916-509-0158

Phone Number
Order
Allergies
FENTANYL; MORPHINE
ELECTROLYTES, WHOLE BLOOD (OR) (Order 48186913)
Order Information
Order Date and Time 12/15/2009 1424 Electronically Signed By LAB RESULTS INTERFACE Title
Ordering User Lab Results Interface Attending Provider(s) Robert Michael Tamurian, MD Authorizing Provider Phat Giang, MD Admitting Provider Robert Michael Tamurian, MD PCP Victor Henrique Baquero, MD
Order Details
Collected by:______________________________
Date/Time:_________________________________ Patient Temp:_________________________________
001591
Entry Date
12/16/2009
Component Results Component SODIUM POTASSIUM CHLORIDE CARBON DIOXIDE TOTAL UREA NITROGEN, BLOOD (BUN) CREATININE BLOOD E-GFR, AFRICAN AMERICAN Comment: mL/min/1.73 square E-GFR, NON-AFRICAN AMERICAN Comment: mL/min/1.73 square
Value 135 3.9 103 27
Flag
Reference Range 135 - 145 mEq/L 3.3 - 5.0 mEq/L 95 - 110 mEq/L 24 - 32 mEq/L
5 0.93 >60
8 - 22 mg/dL 0.44 - 1.27 mg/dL >60 SEE NOTE
Final Final Final
meters >60
>60 SEE NOTE
Final
meters
Note: The estimated GFR result assumes a steady-state and is most accurate for GFRs <60 mL/min/1.73 square meters. The eGFR is not reliable in certain groups, including severely ill patients. Also, patients >59 years of age can have a mildly reduced GFR due to aging. The MDRD equations used to estimate GFR have been validated only in Caucasian and African-Americans 18 - 70 years of age. The equations have not been validated in other population groups, including pregnant women, transplant recipients, medically unstable patients including those with acute renal failure, or in persons with extremes of body size, muscle mass, or nutritional status. Application of the MDRD calculation in these cases may lead to errors in GFR estimation. GLUCOSE 129 H 70 - 110 mg/dL CALCIUM 8.0 L 8.6 - 10.5 mg/dL
Final Final
Result History
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
001592
Unit D14O
Room 14787

Phone Number
Order
Allergies
FENTANYL; MORPHINE
Order Information
Date and Time 12/15/2009 7:15 PM Electronically Signed By Cynthia Smith Authorizing Robert Michael Tamurian Department D14 Orthopedics/Trauma
Isolation
No Isolation
Order Details
Frequency EVERY MORNING Duration 3 occurrences Priority Routine Order Class Inpatient Normal
Ordered By ROBERT MICHAEL TAMURIAN [10884] Admitting Provider Robert Michael Tamurian, MD Ordering Provider TAMURIAN, ROBERT MICHAEL [10884] Authorized By ROBERT MICHAEL TAMURIAN [10884] PCP Victor Baquero, MD Pager 916-762-3059 Released By CYNTHIA SMITH [510378490]
For Placing Order At 12/15/09 1915 Acknowledged By Beverly Harrelson, RN Acknowledged On 12/15/09 1933
Verbal Order Info

Action Ordering Order Mode Change in Location Communicator Cynthia Smith, MA
Signed By Signature Not Required
Signed On

Collection Date and Time 12/16/2009 0530 Interfaced Collector VM
Order History
Order Date/Time 12/15/09 1915 12/15/09 1550 User Cynthia Smith, MA Jonathan G Eastman, MD Action Current Order Modified from Order ID 48200843 48191944
Patient Information
001593
Unit D14O
Room 14787
Bed 147871
Account # 010016806878
Account Information
Order Details
Order
Allergies
FENTANYL; MORPHINE
Order Information

Order Status Canceled Discontinued Mode Change in Location By Cynthia Smith, MA Ordering Provider Robert Michael Tamurian, MD On 12/15/09 1915 Communicator Cynthia Smith, MA Reason Order Modified
Isolation
No Isolation
Order Details
Standing Order Information

Remaining Occurrences 3/3 Interval EVERY MORNING
Release Date/Time None Schedule Date/Time 12/16/2009 0500
Ordered By JONATHAN G EASTMAN [09983] Admitting Provider Robert Michael Tamurian, MD Authorized By JONATHAN G EASTMAN [09983] PCP Victor Baquero, MD
Pager 916-762-7648
For Placing Order D/C Order At 12/15/09 1550 12/15/09 1915 Acknowledged By Patricia L Bailey, RN Beverly Harrelson, RN Responsible Provider Acknowledged On 12/15/09 1551 12/15/09 1933
Verbal Order Info

Action Discontinuing Order Mode Change in Location Communicator Cynthia Smith, MA Signed By Signature Not Required Signed On
001594
12/17/2009 0007
12/17/2009 0500
Verbal Order Info

Signed On

Collection Date and Time 12/17/2009 0615 Interfaced Collector SM
Order History
Patient Information
Unit D14O
MRN 8081369
Room 14787
Sex Male
DOB 9/23/1959
Bed 147871
Account # 010016806878
Account Information
Order Details
Lab Results
CBC AUTO + REFLEX MANUAL DIFF (Order 48206156)
Entry Date
12/16/2009 Component Results Component WHITE BLOOD CELL COUNT RED CELL COUNT HEMOGLOBIN Value 6.3 3.03 9.5 Flag Reference Range 4.5 - 11.0 K/MM3 4.5 - 5.9 M/MM3 13.5 - 17.5 GM/DL Status Final Final Final
L L
001595
HEMATOCRIT MCV MCH MCHC RDW MPV PLATELET COUNT NEUTROPHILS % AUTO LYMPHOCYTES % AUTO MONOCYTES % AUTO EOSINOPHIL % AUTO BASOPHILS % AUTO NEUTROPHIL ABS AUTO LYMPHOCYTE ABS AUTO MONOCYTES ABS AUTO EOSINOPHIL ABS AUTO BASOPHILS ABS AUTO
27.6 91.1 31.5 34.6 13.4 8.3 154 72.2 19.8 7.7 0.1 0.2 4.50 1.2 0.5 0 0
41 - 53 % 80 - 100 UM3 27 - 33 PG 32 - 36 % 0 - 14.7 UNITS 6.8 - 10.0 UM3 130 - 400 K/MM3 % % % % % 1.80 - 7.70 K/MM3 1.0 - 4.8 K/MM3 0.1 - 0.8 K/MM3 0 - 0.5 K/MM3 0 - 0.2 K/MM3
Final Final Final Final Final Final Final Final Final Final Final Final Final Final Final Final Final
Result History
CBC AUTO + REFLEX MANUAL DIFF (Order#48206156) on 12/16/09 - Order Result History Report MyChart Status: This result is currently released to MyChart. Other IDs Lab Specimen # 1216:H00236R

Unit D14O
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)

Room 14787
Home Phone 916-509-0158
Order
Allergies
FENTANYL; MORPHINE
Order Information
Isolation
No Isolation
Order Details
001596
Frequency EVERY MORNING
Duration 3 occurrences
Priority Routine
Verbal Order Info

Signed On

Collection Date and Time 12/16/2009 0530 Interfaced Collector VM
Order History
Patient Information
Account # 010016806878
Account Information
Order Details
Order
Allergies
FENTANYL; MORPHINE
Order Information

Order Status Discontinued Mode By On Reason
001597
Canceled
Change in Location
Cynthia Smith, MA
Ordering Provider Robert Michael Tamurian, MD
12/15/09 1915
Communicator Cynthia Smith, MA
Order Modified
Isolation
No Isolation
Order Details
Standing Order Information

Remaining Occurrences 3/3 Interval EVERY MORNING
Ordered By JONATHAN G EASTMAN [09983]
Authorized By JONATHAN G EASTMAN [09983]

Pager 916-762-7648
For Placing Order D/C Order At 12/15/09 1550 12/15/09 1915 Acknowledged By Patricia L Bailey, RN Beverly Harrelson, RN Acknowledged On 12/15/09 1553 12/15/09 1933
Verbal Order Info

Action Discontinuing Order Mode Change in Location Communicator Cynthia Smith, MA
Signed By Signature Not Required Status Signed & Held Reason
Signed On

Pending User Jonathan G Eastman, MD Date/Time Tue Dec 15, 2009 1540
Patient Information
Account # 010016806878
Account Information
Order Details
Order ID 48191968
Order
Allergies
FENTANYL; MORPHINE
CELIAC REFLEXIVE PANEL (Order 15494567)
Order Information
001598
Verbal Order Info

Signed On

Order History
Patient Information
Unit D14O
Room 14787
Bed 147871
Account # 010016806878
Account Information
Order Details
Lab Results
Entry Date
12/17/2009
Component Results Component SODIUM POTASSIUM CHLORIDE CARBON DIOXIDE TOTAL
Value 135 4.2 100 29
Flag
Reference Range 135 - 145 mEq/L 3.3 - 5.0 mEq/L 95 - 110 mEq/L 24 - 32 mEq/L
001599
UREA NITROGEN, BLOOD (BUN) CREATININE BLOOD E-GFR, AFRICAN AMERICAN Comment: mL/min/1.73 square E-GFR, NON-AFRICAN AMERICAN Comment: mL/min/1.73 square
9 0.96 >60
Final Final Final
meters >60
>60 SEE NOTE
Final
meters
Note: The estimated GFR result assumes a steady-state and is most accurate for GFRs <60 mL/min/1.73 square meters. The eGFR is not reliable in certain groups, including severely ill patients. Also, patients >59 years of age can have a mildly reduced GFR due to aging. The MDRD equations used to estimate GFR have been validated only in Caucasian and African-Americans 18 - 70 years of age. The equations have not been validated in other population groups, including pregnant women, transplant recipients, medically unstable patients including those with acute renal failure, or in persons with extremes of body size, muscle mass, or nutritional status. Application of the MDRD calculation in these cases may lead to errors in GFR estimation. GLUCOSE 119 H 70 - 110 mg/dL CALCIUM 8.0 L 8.6 - 10.5 mg/dL
Final Final
Result History

Unit D14O
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)

Room 14787
Home Phone 916-509-0158
Order
Allergies
FENTANYL; MORPHINE
001600
Order Information
Isolation
No Isolation
Order Details
Verbal Order Info

Signed On

Order History
Patient Information
Unit D14O
MRN 8081369
Room 14787
Sex Male
DOB 9/23/1959
Bed 147871
Account # 010016806878
Account Information
Order Details
Lab Results
001601
Ordering Provider TAMURIAN, ROBERT MICHAEL [10884]
Pager 916-762-3059
Verbal Order Info

Signed On

Collection Date and Time 12/18/2009 0715 Interfaced Collector S.SM
Order History
Patient Information
Account # 010016806878
Account Information
Order Details
Lab Results
Entry Date
12/17/2009 Component Results Component WHITE BLOOD CELL COUNT RED CELL COUNT HEMOGLOBIN HEMATOCRIT MCV MCH MCHC RDW Value 7.4 2.51 7.8 22.8 91.0 31.0 34.1 13.7 Flag Reference Range 4.5 - 11.0 K/MM3 4.5 - 5.9 M/MM3 13.5 - 17.5 GM/DL 41 - 53 % 80 - 100 UM3 27 - 33 PG 32 - 36 % 0 - 14.7 UNITS Status Final Final Final Final Final Final Final Final
L L L
001602
MPV PLATELET COUNT NEUTROPHILS % AUTO LYMPHOCYTES % AUTO MONOCYTES % AUTO EOSINOPHIL % AUTO BASOPHILS % AUTO NEUTROPHIL ABS AUTO LYMPHOCYTE ABS AUTO MONOCYTES ABS AUTO EOSINOPHIL ABS AUTO BASOPHILS ABS AUTO
8.6 134 62.2 27.2 8.5 1.9 0.2 4.60 2.0 0.6 0.1 0
6.8 - 10.0 UM3 130 - 400 K/MM3 % % % % % 1.80 - 7.70 K/MM3 1.0 - 4.8 K/MM3 0.1 - 0.8 K/MM3 0 - 0.5 K/MM3 0 - 0.2 K/MM3
Final Final Final Final Final Final Final Final Final Final Final Final
Result History
CBC AUTO + REFLEX MANUAL DIFF (Order#48255730) on 12/17/09 - Order Result History Report
MyChart Status:
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Room 14787
Order
Allergies
FENTANYL; MORPHINE
Order Information
Isolation
No Isolation
Order Details
Release Date/Time Schedule Date/Time
001603
Patient Information
Account # 078438665057
Account Information
Order Details

Lab Results
Description SPECIMEN 1
CULTURE SURVEILLANCE, MRSA (Order 48200855) Received Date and Time 12/16/2009 0759 Source NASAL SWAB
Entry Date
12/17/2009
Component Results
CULTURE SURVEILLANCE, MRSA: CULTURE SURVEILLANCE, MRSA NO MRSA ISOLATED
Final
Result History
CULTURE SURVEILLANCE, MRSA (Order#48200855) on 12/17/09 - Order Result History Report Other IDs Lab Specimen # 09:E0019928R
MyChart Status: This result is currently released to MyChart. Microbiology Report Microbiology Patient Information Patient Name Amundsen, Mark Unit
Room
001604
D14O
14787
Order
Allergies
FENTANYL; MORPHINE
CULTURE SURVEILLANCE, MRSA (Order 48200855)
Order Information
Order Questions
Question Specimen Type: Answer NASAL SWAB Comment
This procedure is intended for Infection Control Surveillance only.
Isolation
No Isolation
Order Details
Verbal Order Info

Signed On

Specimen NASAL SWAB Collection Date and Time 12/15/2009 2330 Interfaced Collector HARRELSON, BEVERLY
EMR Collector: HARRELSON, BEVERLY [170498026]
001605
Joanna Baginski, MD Ordering Provider CAI, RU YA [09041]
Victor Baquero, MD Pager 916-762-5896
For Placing Order At 12/19/09 2319 Acknowledged By Encarnacion Arenas, RN Acknowledged On 12/19/09 2331

Specimen BLOOD Collection Date and Time 12/20/2009 0020 Interfaced Collector ARENAS, ENCARNACION
EMR Collector: ARENAS, ENCARNACION [828421230]
Patient Information
Patient Name Amundsen, Mark Unit T4EM MRN 8081369 Room 4661 Sex Male DOB 9/23/1959 Bed 466102
Account # 050017321477
Account Information
Order Details
Lab Results

Entry Date
12/17/2009
Component Results
RED BLOOD CELLS: UNIT #: BLD TYPE: PRODUCT: STATUS: ISSUE DATE/TIME: VOL: W035809242918 B NEG PACKED CELL NOT AVAILABLE 300 Compatible? W035809245034 B NEG PACKED CELL NOT AVAILABLE 300 Compatible?
UNIT #: BLD TYPE: PRODUCT: STATUS: ISSUE DATE/TIME: VOL:
Result History
001606
RED BLOOD CELLS (Order#48186894) on 12/17/09 - Order Result History Report
MyChart Status:
This result is automatically blocked from release to MyChart.
Related Tests TYPE AND SCREEN (Order#48135735) on 12/14/09 Other IDs Reflex Order # 48135735 Lab Specimen # 1214:BB00114R

Unit UCDREG
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Order
Allergies
FENTANYL; MORPHINE
Order Information
Date and Time 12/15/2009 2:24 PM Electronically Signed By Lab Results Interface Authorizing Robert Michael Tamurian Department Ucd Registration
A Type and Screen specimen, less than 3 days old, is required for a Red Blood Cell crossmatch.*** NOTE: The ANTIBODY SCREEN result is displayed below.*** Crossmatched units will be held for 72 hours only. If transfusion is not imminent or inevitable, please order a Type & Screen instead.
See EMR "READY" status for product availability
Isolation
No Isolation
Order Details
Ordered By Admitting Provider Doctor Staff Authorized By ROBERT MICHAEL TAMURIAN [10884] PCP Victor Baquero, MD
001607

Patient Information
Account # 038541463121
Account Information
Order Details
Order ID 48186894
Order
Allergies
FENTANYL; MORPHINE
RHEUMATOID FACTOR (Order 15494561)
Order Information

Isolation
No Isolation
Order Details

Enthesopathy of hip region [726.5]
Patient Information
001608
Order History
Patient Information
Account # 010016806878
Account Information
Order Details
Order
Allergies
FENTANYL; MORPHINE
CULTURE SURVEILLANCE, MRSA (Order 48192755)
Order Information

Order Status Canceled By Cynthia Smith, MA On 12/15/09 1915 Reason None
Order Questions
Question Specimen Type: Answer NASAL SWAB Comment
This procedure is intended for Infection Control Surveillance only.
Isolation
No Isolation
Order Details
Ordered By JONATHAN G EASTMAN [09983] Admitting Provider Robert Michael Tamurian, MD Ordering Provider EASTMAN, JONATHAN G [09983] Authorized By JONATHAN G EASTMAN [09983] PCP Victor Baquero, MD Pager 916-762-7648 Released By PATRICIA L BAILEY [254588866]
For At Acknowledged By Acknowledged On
001609
Ordered By RU YA CAI [09041] Admitting Provider Joanna Baginski, MD Ordering Provider CAI, RU YA [09041] Authorized By RU YA CAI [09041] PCP Victor Baquero, MD Pager 916-762-5896 Released By RU YA CAI [036929149]

Specimen BLOOD Collection Date and Time 12/20/2009 0020 Interfaced Collector E.ARENAS
EMR Collector: ARENAS, ENCARNACION [828421230]
Patient Information
Unit T4EM
MRN 8081369
Room 4661
Sex Male
DOB 9/23/1959
Bed 466102
Account # 050017321477
Account Information
Order Details
Lab Results
TYPE AND SCREEN (Order 48135735) Received Date and Time 12/14/2009 1537 Source BLOOD
Entry Date
12/17/2009
Component Results
PATIENT BLOOD TYPE: B NEGATIVE ANTIBODY SCREEN (ORTHO GEL): NEGATIVE
Result Narrative
Crossmatched units will be released at approximately 2200 hrs on 12/17/09.
001610
BLOOD TYPE AND ANTIBODY SCREEN ONLY CROSSMATCH HAS NOT BEEN PERFORMED. SPECIMEN WILL BE VALID FOR CROSSMATCH UP TO 3 DAYS FROM COLLECTION.
Result History
TYPE AND SCREEN (Order#48135735) on 12/17/09 - Order Result History Report MyChart Status: This result is currently released to MyChart. Related Tests RED BLOOD CELLS (Order#48186894) on 12/15/09 Other IDs Lab Specimen # 1214:BB00114R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158

Phone Number
Order
Allergies
FENTANYL; MORPHINE
TYPE AND SCREEN (Order 48135735)
Order Information
Result Narrative:
Crossmatched units will be released at approximately 2200 hrs on 12/17/09. BLOOD TYPE AND ANTIBODY SCREEN ONLY CROSSMATCH HAS NOT BEEN PERFORMED. SPECIMEN WILL BE VALID FOR CROSSMATCH UP TO 3 DAYS FROM COLLECTION.
A Type and Screen includes the Blood Type and the Antibody Screen. A crossmatch is NOT INCLUDED. If transfusion is required, the patient's specimen can be used for up to 3 days from the collection date.
Isolation
No Isolation
Order Details
001611
Ordered By RU YA CAI [09041]
Authorized By RU YA CAI [09041]
Released By RU YA CAI [036929149]


Pager 916-762-5896
Patient Information
Account # 050017321477
Account Information
Order Details
Lab Results
Entry Date
meters >60
>60 SEE NOTE
Final
meters
Note: The estimated GFR result assumes a steady-state and is most accurate for GFRs <60 mL/min/1.73 square meters. The eGFR is not reliable in certain groups, including
001612
severely ill patients. Also, patients >59 years of age can have a mildly reduced GFR due to aging. The MDRD equations used to estimate GFR have been validated only in Caucasian and African-Americans 18 - 70 years of age. The equations have not been validated in other population groups, including pregnant women, transplant recipients, medically unstable patients including those with acute renal failure, or in persons with extremes of body size, muscle mass, or nutritional status. Application of the MDRD calculation in these cases may lead to errors in GFR estimation. GLUCOSE 128 H 70 - 110 mg/dL CALCIUM 8.2 L 8.6 - 10.5 mg/dL
Final Final
Result History

Unit D14O
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)

Room 14787
Home Phone 916-509-0158
Order
Allergies
FENTANYL; MORPHINE
Order Information
Isolation
No Isolation
Order Details
001613
Patient Information
Unit T4EM
MRN 8081369
Room 4661
Sex Male
DOB 9/23/1959
Bed 466102
Account # 050017321477
Account Information
Order Details
Lab Results
Entry Date
12/18/2009 Component Results Component WHITE BLOOD CELL COUNT RED CELL COUNT HEMOGLOBIN HEMATOCRIT MCV MCH MCHC RDW MPV PLATELET COUNT NEUTROPHILS % AUTO LYMPHOCYTES % AUTO MONOCYTES % AUTO Value 7.8 2.29 7.1 20.9 91.2 31.0 34.0 13.0 8.6 147 64.7 26.0 6.0 Flag Reference Range 4.5 - 11.0 K/MM3 4.5 - 5.9 M/MM3 13.5 - 17.5 GM/DL 41 - 53 % 80 - 100 UM3 27 - 33 PG 32 - 36 % 0 - 14.7 UNITS 6.8 - 10.0 UM3 130 - 400 K/MM3 % % % Status Final Final Final Final Final Final Final Final Final Final Final Final Final
L L L
001614
EOSINOPHIL % AUTO BASOPHILS % AUTO NEUTROPHIL ABS AUTO LYMPHOCYTE ABS AUTO MONOCYTES ABS AUTO EOSINOPHIL ABS AUTO BASOPHILS ABS AUTO
3.1 0.2 5.00 2.0 0.5 0.2 0
% % 1.80 - 7.70 K/MM3 1.0 - 4.8 K/MM3 0.1 - 0.8 K/MM3 0 - 0.5 K/MM3 0 - 0.2 K/MM3
Final Final Final Final Final Final Final
Result History
CBC AUTO + REFLEX MANUAL DIFF (Order#48301982) on 12/18/09 - Order Result History Report MyChart Status:
MRN 8081369
Sex M
DOB 9/23/1959 (53yr) Room 14787
Home Phone 916-509-0158

Phone Number
Order
Allergies
FENTANYL; MORPHINE
Order Information
Isolation
No Isolation
Order Details
Ordered By ROBERT MICHAEL TAMURIAN [10884] Authorized By ROBERT MICHAEL TAMURIAN [10884] Released By CYNTHIA SMITH [510378490]
001615

Collection Date and Time 12/21/2009 0550 Interfaced Collector S.RW
Patient Information
Account # 050017321477
Account Information
Order Details
Lab Results
Entry Date
meters >60
>60 SEE NOTE
Final
meters
Note: The estimated GFR result assumes a steady-state and is most accurate for GFRs <60 mL/min/1.73 square meters. The eGFR is not reliable in certain groups, including severely ill patients. Also, patients >59 years of age can have a mildly reduced GFR due to aging. The MDRD equations
001616
used to estimate GFR have been validated only in Caucasian and African-Americans 18 - 70 years of age. The equations have not been validated in other population groups, including pregnant women, transplant recipients, medically unstable patients including those with acute renal failure, or in persons with extremes of body size, muscle mass, or nutritional status. Application of the MDRD calculation in these cases may lead to errors in GFR estimation. GLUCOSE 92 70 - 110 mg/dL CALCIUM 8.2 L 8.6 - 10.5 mg/dL
Final Final
Result History
MRN 8081369
Sex M
DOB 9/23/1959 (53yr) Room 4661
Home Phone 916-509-0158

Phone Number
Order
Allergies
FENTANYL; MORPHINE
Order Information
Isolation
No Isolation
Order Details
001617

Collection Date and Time 12/20/2009 0020 Interfaced Collector EA
Patient Information
Unit T4EM
MRN 8081369
Room 4661
Sex Male
DOB 9/23/1959
Bed 466102
Account # 050017321477
Account Information
Order Details
Order
Allergies
FENTANYL; MORPHINE
Order Information

Result Narrative:
Isolation
No Isolation
Order Details
001618
Order Details

Collection Date and Time 12/21/2009 0550 Interfaced Collector S.RW
Patient Information
Account # 050017321477
Account Information
Order Details
Lab Results
Entry Date
12/20/2009 Component Results Component WHITE BLOOD CELL COUNT RED CELL COUNT HEMOGLOBIN HEMATOCRIT MCV
Value 5.6 Flag Reference Range 4.5 - 11.0 K/MM3 Status Final
2.11 6.7 19.1 90.6
L L L
4.5 - 5.9 M/MM3 13.5 - 17.5 GM/DL 41 - 53 % 80 - 100 UM3
Final Final Final Final
001619
MCH MCHC RDW MPV PLATELET COUNT NEUTROPHILS % AUTO LYMPHOCYTES % AUTO MONOCYTES % AUTO EOSINOPHIL % AUTO BASOPHILS % AUTO NEUTROPHIL ABS AUTO LYMPHOCYTE ABS AUTO MONOCYTES ABS AUTO EOSINOPHIL ABS AUTO BASOPHILS ABS AUTO
31.7 35.0 13.5 8.1 207 52.6 33.6 7.9 5.7 0.2 3.00 1.9 0.4 0.3 0
27 - 33 PG 32 - 36 % 0 - 14.7 UNITS 6.8 - 10.0 UM3 130 - 400 K/MM3 % % % % % 1.80 - 7.70 K/MM3 1.0 - 4.8 K/MM3 0.1 - 0.8 K/MM3 0 - 0.5 K/MM3 0 - 0.2 K/MM3
Final Final Final Final Final Final Final Final Final Final Final Final Final Final Final
Result History
MyChart Status:
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Room 4661
Order
Allergies
FENTANYL; MORPHINE
Order Information
Isolation
No Isolation
Order Details
001620

Collection Date and Time 12/20/2009 0020 Interfaced Collector EA
Patient Information
Account # 050017321477
Account Information
Order Details
Order
Allergies
FENTANYL; MORPHINE
Order Information

Result Narrative:
Isolation
No Isolation
Order Details
001621
Doctor Staff
Victor Baquero, MD

Collection Date and Time 11/19/2010 1545 Interfaced Collector PCN.KD
Patient Information
Account # 078548433115
Account Information
Order Details

Lab Results
HEMATOCRIT (Order 48373106)
Entry Date
12/20/2009
Component Results Component HEMATOCRIT
Value 24.9
Flag L
Reference Range 41 - 53 %
Status Final
Result History
HEMATOCRIT (Order#48373106) on 12/20/09 - Order Result History Report
MyChart Status: This result is currently released to MyChart. Related Tests HEMOGLOBIN (Order#48373107) on 12/20/09 Other IDs Lab Specimen # 1220:H00365R
MRN
Sex
DOB
Home Phone
001622
Amundsen, Mark Unit T4EM
8081369
9/23/1959 (53yr) Room 4661
916-509-0158

Phone Number
Order
Allergies
FENTANYL; MORPHINE
HEMATOCRIT (Order 48373106)
Order Information
Date and Time 12/20/2009 8:08 AM Electronically Signed By/Authorizing Jia Wang Department T4 Ent/Internal Medicine
Isolation
No Isolation
Order Details
Ordered By JIA WANG [09895] Admitting Provider Joanna Baginski, MD Ordering Provider WANG, JIA [09895] Authorized By JIA WANG [09895] PCP Victor Baquero, MD Pager 916-762-9629 Released By JIA WANG [738383587]
For Placing Order At 12/20/09 0808 Acknowledged By Christena R Schob, RN Acknowledged On 12/20/09 0926

Collection Date and Time 12/20/2009 1505 Interfaced Collector CRS
Patient Information
Account # 050017321477
Account Information
001623
Isolation
No Isolation
Order Details
Frequency ONCE Duration 1 occurrence Priority STAT Order Class Inpatient Normal
Ordered By MURALI ADUSUMALLI [10970]
Authorized By MURALI ADUSUMALLI [10970]

Released By MURALI ADUSUMALLI [462915133]
Ordering Provider ADUSUMALLI, MURALI [10970]
Pager 916-762-6366
For Placing Order At 12/21/09 1239 Acknowledged By Christena R Schob, RN Acknowledged On 12/21/09 1332

Patient Information
Account # 050017321477
Account Information
Order Details
Lab Results
HEMOGLOBIN (Order 48373107)
Entry Date
12/20/2009 Component Results Component HEMOGLOBIN Value 8.5 Flag L Reference Range 13.5 - 17.5 GM/DL Status Final
001624
Result History
HEMOGLOBIN (Order#48373107) on 12/20/09 - Order Result History Report MyChart Status: This result is currently released to MyChart. Related Tests HEMATOCRIT (Order#48373106) on 12/20/09 Other IDs Lab Specimen # 1220:H00365R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr) Room 4661
Home Phone 916-509-0158

Phone Number
Order
Allergies
FENTANYL; MORPHINE
Order Information
Date and Time 12/20/2009 8:08 AM Electronically Signed By/Authorizing Jia Wang Department T4 Ent/Internal Medicine
Isolation
No Isolation
Order Details
Ordered By JIA WANG [09895]
Admitting Provider Joanna Baginski, MD Ordering Provider WANG, JIA [09895]
Authorized By JIA WANG [09895]

PCP Victor Baquero, MD Pager 916-762-9629
Released By JIA WANG [738383587]
001625

Admitting Provider
Patient Information
Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Account # 078199740024
Account Information
Order Details
Order ID 15494565
Lab Results
TYPE AND SCREEN (Order 48367802) Received Date and Time 12/20/2009 0154 Source BLOOD
Entry Date
12/20/2009
Component Results
PATIENT BLOOD TYPE: B NEGATIVE ANTIBODY SCREEN (ORTHO GEL): NEGATIVE
Result Narrative
Sufficient specimen available to add units until: 12/23 Crossmatched units are released approx 2200 hrs. on above date.
001626
Result History
TYPE AND SCREEN (Order#48367802) on 12/20/09 - Order Result History Report MyChart Status: This result is currently released to MyChart. Other IDs Lab Specimen # 1220:BB00001R

Unit T4EM
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)

Room 4661
Home Phone 916-509-0158
Order
Allergies
FENTANYL; MORPHINE
TYPE AND SCREEN (Order 48367802)
Order Information
Result Narrative:
Sufficient specimen available to add units until: 12/23 Crossmatched units are released approx 2200 hrs. on above date.
Order Questions
Question Collection Date: Collection Time: Collected By: Answer 12/20/2009 12:20 AM ARENAS, ENCARNACION Comment
A Type and Screen includes the Blood Type and the Antibody Screen. A crossmatch is NOT INCLUDED. If transfusion is required, the patient's specimen can be used for up to 3 days from the collection date.
Isolation
No Isolation
Order Details
001627
Amundsen, Mark Unit UCDREG
8081369
Male
9/23/1959
Account # 078661756110
Account Information
Order Details

Lab Results
Entry Date
meters >60
>60 SEE NOTE
Final
meters
Note: The estimated GFR result assumes a steady-state and is most accurate for GFRs <60 mL/min/1.73 square meters. The eGFR is not reliable in certain groups, including severely ill patients. Also, patients >59 years of age can have a mildly reduced GFR due to aging. The MDRD equations used to estimate GFR have been validated only in Caucasian and African-Americans 18 - 70 years of age. The equations have not been validated in other population groups, including pregnant women, transplant recipients, medically unstable patients including those with acute renal failure, or in persons with extremes of body size, muscle mass, or nutritional status. Application of the MDRD calculation in
001628
these cases may lead to errors in GFR estimation. GLUCOSE 106 70 - 110 mg/dL CALCIUM 8.1 L 8.6 - 10.5 mg/dL
Final Final
Result History
BASIC METABOLIC PANEL (Order#48386835) on 12/21/09 - Order Result History Report
MyChart Status: This result is currently released to MyChart. Other IDs Lab Specimen # 1221:CI00294R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Room 4661
Order
Allergies
FENTANYL; MORPHINE
Order Information
Isolation
No Isolation
Order Details
001629
No Isolation
Order Details

Fatigue [780.79]
Patient Information
Account # 078548433024
Account Information
Order Details

Lab Results
Entry Date
12/21/2009
Component Results Component WHITE BLOOD CELL COUNT RED CELL COUNT
Value 5.7
Flag
Reference Range 4.5 - 11.0 K/MM3
Status Final
2.60
4.5 - 5.9 M/MM3
Final
001630
HEMOGLOBIN HEMATOCRIT MCV MCH MCHC RDW MPV PLATELET COUNT NEUTROPHILS % AUTO LYMPHOCYTES % AUTO MONOCYTES % AUTO EOSINOPHIL % AUTO BASOPHILS % AUTO NEUTROPHIL ABS AUTO LYMPHOCYTE ABS AUTO MONOCYTES ABS AUTO EOSINOPHIL ABS AUTO BASOPHILS ABS AUTO
8.0 23.6 90.7 30.8 33.9 14.0 7.8 232 49.9 33.7 10.2 5.8 0.4 2.80 1.9 0.6 0.3 0
L L
13.5 - 17.5 GM/DL 41 - 53 % 80 - 100 UM3 27 - 33 PG 32 - 36 % 0 - 14.7 UNITS 6.8 - 10.0 UM3 130 - 400 K/MM3 % % % % % 1.80 - 7.70 K/MM3 1.0 - 4.8 K/MM3 0.1 - 0.8 K/MM3 0 - 0.5 K/MM3 0 - 0.2 K/MM3
Final Final Final Final Final Final Final Final Final Final Final Final Final Final Final Final Final Final
Result History
MyChart Status:
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Room 4661
Order
Allergies
FENTANYL; MORPHINE
Order Information
Isolation
No Isolation
001631
Order Details
Lab Results
Entry Date
12/21/2009 Component Results Component HEMOGLOBIN Value 8.6 Flag L Reference Range 13.5 - 17.5 GM/DL Status Final
Result History
HEMOGLOBIN (Order#48411209) on 12/21/09 - Order Result History Report MyChart Status: This result is currently released to MyChart. Other IDs Lab Specimen # 1221:H00825S
MRN 8081369
Sex M
DOB 9/23/1959 (53yr) Room 4661
Home Phone 916-509-0158
Order
Allergies
FENTANYL; MORPHINE
Order Information
Date and Time 12/21/2009 12:39 PM Electronically Signed By/Authorizing Murali Adusumalli, MD Department T4 Ent/Internal Medicine
001632
10/18/10 (Approximate)
10/18/11
Lab Results
Entry Date
2/4/2010 Component Results Component WHITE BLOOD CELL COUNT RED CELL COUNT HEMOGLOBIN HEMATOCRIT MCV MCH MCHC RDW MPV PLATELET COUNT NEUTROPHILS % AUTO LYMPHOCYTES % AUTO MONOCYTES % AUTO EOSINOPHIL % AUTO BASOPHILS % AUTO NEUTROPHIL ABS AUTO LYMPHOCYTE ABS AUTO MONOCYTES ABS AUTO EOSINOPHIL ABS AUTO BASOPHILS ABS AUTO Value 7.2 4.40 13.5 38.9 88.5 30.6 34.6 14.3 9.1 201 38.4 51.1 5.4 4.7 0.4 2.80 3.7 0.4 0.3 0 Flag Reference Range 4.5 - 11.0 K/MM3 4.5 - 5.9 M/MM3 13.5 - 17.5 GM/DL 41 - 53 % 80 - 100 UM3 27 - 33 PG 32 - 36 % 0 - 14.7 UNITS 6.8 - 10.0 UM3 130 - 400 K/MM3 % % % % % 1.80 - 7.70 K/MM3 1.0 - 4.8 K/MM3 0.1 - 0.8 K/MM3 0 - 0.5 K/MM3 0 - 0.2 K/MM3 Status Final Final Final Final Final Final Final Final Final Final Final Final Final Final Final Final Final Final Final Final
L L
Result History
MyChart Status: This result is currently released to MyChart. Last viewed in MyChart: 10/22/2010 8:26 PM By: Mark Amundsen Other IDs Lab Specimen # 0204:H00587R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
001633
UCDREG
Result Notes Notes recorded by Victor H Baquero on 02/08/2010 at 6:30 PM As expected, your Vitamin D levels are low (normal levels range between 50 and 70). Vitamin D is obtained from the sun and is necessary for overall health. Low levels of vitamin D cause fatigue, diffuse (not pinpointed to one location) bone pain, especially in the hips, muscle weakness and increased risk of fractures. I recommend you take 1000mg of calcium and 5000iu-10,000 of vitamin D daily. In Folsom you can purchase it at Elliott's Natural Foods. Your testosterone levels are also very low. We discussed one way to raise them is to go off the methadone gradually. If you want to go back on Androgel let me know. Your cholesterol levels are borderline. I recommend focusing on diet and exercise along with weight loss in an effort to improve the cholesterol profile. I also recommend rechecking cholesterol levels in 6 months. Your fasting glucose level is elevated (ideally the fasting glucose should be in the 80-90 range). When the glucose goes above 100 it is considered pre-diabetes. The best way to lower the glucose is to lose weight through diet and regular aerobic exercise. I would like to recheck this again in 6 months.
Otherwise all other labs are within normal limits.
Lab Director Lydia P. Howell, M.D.
Lab NPI 1710918545

Order
Allergies
FENTANYL; MORPHINE
Order Information
Result Notes
Notes recorded by Victor H Baquero on 02/08/2010 at 6:30 PM As expected, your Vitamin D levels are low (normal levels range between 50 and 70). Vitamin D is obtained from the sun and is necessary for overall health. Low levels of vitamin D cause fatigue, diffuse (not pinpointed to one location) bone pain, especially in the hips, muscle weakness and increased risk of fractures. I recommend you take 1000mg of calcium and 5000iu-10,000 of vitamin D daily. In Folsom you can purchase it at Elliott's Natural Foods. Your testosterone levels are also very low. We discussed one way to raise them is to go off the methadone gradually. If you want to go back on Androgel let me know. Your cholesterol levels are borderline. I recommend focusing on diet and exercise along with weight loss in an effort to improve the cholesterol profile. I also recommend rechecking cholesterol levels in 6 months. Your fasting glucose level is elevated (ideally the fasting glucose should be in the 80-90 range). When the glucose goes above 100 it is considered pre-diabetes. The best way to lower the glucose is to lose weight through diet and regular aerobic exercise. I would like to recheck this again in 6 months. Otherwise all other labs are within normal limits.
Isolation
001634
Pending User Victor Henrique Baquero, MD
Date/Time Mon Oct 18, 2010 1452
Status Pended
Reason

Other malaise and fatigue [780.79]
Patient Information
Account # 078548433107
Account Information
Order Details

Lab Results
COMPREHENSIVE METABOLIC PANEL (Order 50091516) Received Date and Time 2/4/2010 0923
Entry Date
2/4/2010 Component Results Component SODIUM POTASSIUM CHLORIDE CARBON DIOXIDE TOTAL UREA NITROGEN, BLOOD (BUN) CREATININE BLOOD E-GFR, AFRICAN AMERICAN Comment: mL/min/1.73 square E-GFR, NON-AFRICAN AMERICAN Comment: mL/min/1.73 square Note:
Value 139 3.8 104 29 Flag Reference Range 135 - 145 mEq/L 3.3 - 5.0 mEq/L 95 - 110 mEq/L 24 - 32 mEq/L Status Final Final Final Final
9 0.92 >60
Final Final Final
meters >60
>60 SEE NOTE
Final
meters
The estimated GFR result assumes a steady-state and
001635
is most accurate for GFRs <60 mL/min/1.73 square meters. The eGFR is not reliable in certain groups, including severely ill patients. Also, patients >59 years of age can have a mildly reduced GFR due to aging. The MDRD equations used to estimate GFR have been validated only in Caucasian and African-Americans 18 - 70 years of age. The equations have not been validated in other population groups, including pregnant women, transplant recipients, medically unstable patients including those with acute renal failure, or in persons with extremes of body size, muscle mass, or nutritional status. Application of the MDRD calculation in these cases may lead to errors in GFR estimation. GLUCOSE 99 70 - 110 mg/dL CALCIUM 9.2 8.6 - 10.5 mg/dL PROTEIN 6.9 6.3 - 8.3 g/dL ALBUMIN 3.9 3.4 - 4.8 g/dL ALKALINE 107 35 - 115 U/L PHOSPHATASE (ALP) ASPARTATE 22 15 - 43 U/L TRANSAMINASE (AST) BILIRUBIN TOTAL 0.4 0.3 - 1.3 mg/dL ALANINE TRANSFERASE 24 6 - 63 U/L (ALT)
Result History
COMPREHENSIVE METABOLIC PANEL (Order#50091516) on 2/4/10 - Order Result History Report MyChart Status: This result is currently released to MyChart. Last viewed in MyChart: 10/22/2010 8:24 PM By: Mark Amundsen Related Tests LIPID PANEL WITH DLDL REFLEX (Order#50091517) on 2/4/10 Other IDs Lab Specimen # 0204:CI00812R

Unit UCDREG
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Result Notes Notes recorded by Victor H Baquero on 02/08/2010 at 6:30 PM As expected, your Vitamin D levels are low (normal levels range between 50 and 70). Vitamin D is obtained from the sun and is necessary for overall health. Low levels of vitamin D cause fatigue, diffuse (not pinpointed to one location) bone pain, especially in the hips, muscle weakness and increased risk of fractures. I recommend you take 1000mg of calcium and 5000iu-10,000 of vitamin D daily. In Folsom you can purchase it at Elliott's Natural Foods.
001636
Your testosterone levels are also very low. We discussed one way to raise them is to go off the methadone gradually. If you want to go back on Androgel let me know. Your cholesterol levels are borderline. I recommend focusing on diet and exercise along with weight loss in an effort to improve the cholesterol profile. I also recommend rechecking cholesterol levels in 6 months. Your fasting glucose level is elevated (ideally the fasting glucose should be in the 80-90 range). When the glucose goes above 100 it is considered pre-diabetes. The best way to lower the glucose is to lose weight through diet and regular aerobic exercise. I would like to recheck this again in 6 months. Otherwise all other labs are within normal limits. Lab Information
Lab UC DAVIS MED CTR 2315 Stockton Blvd Sacramento CA 95817 Lab Director Lydia P. Howell, M.D.

Allergies
FENTANYL; MORPHINE
Order Information
Result Notes
Notes recorded by Victor H Baquero on 02/08/2010 at 6:30 PM As expected, your Vitamin D levels are low (normal levels range between 50 and 70). Vitamin D is obtained from the sun and is necessary for overall health. Low levels of vitamin D cause fatigue, diffuse (not pinpointed to one location) bone pain, especially in the hips, muscle weakness and increased risk of fractures. I recommend you take 1000mg of calcium and 5000iu-10,000 of vitamin D daily. In Folsom you can purchase it at Elliott's Natural Foods. Your testosterone levels are also very low. We discussed one way to raise them is to go off the methadone gradually. If you want to go back on Androgel let me know. Your cholesterol levels are borderline. I recommend focusing on diet and exercise along with weight loss in an effort to improve the cholesterol profile. I also recommend rechecking cholesterol levels in 6 months. Your fasting glucose level is elevated (ideally the fasting glucose should be in the 80-90 range). When the glucose goes above 100 it is considered pre-diabetes. The best way to lower the glucose is to lose weight through diet and regular aerobic exercise. I would like to recheck this again in 6 months.
Isolation
No Isolation
Order Details
001637
Hemoglobin:_________________________________ FIO2:_________________________________ Sample Type:________________________________
Patient Information
Account # 010016806878

Isolation
No Isolation
Account Information
Order Details
Lab Results
FERRITIN (Order 50091523)

Entry Date
2/4/2010 Component Results Component FERRITIN Value 134 Flag Reference Range 22 - 322 ng/mL Status Final
Result History
FERRITIN (Order#50091523) on 2/4/10 - Order Result History Report MyChart Status: This result is currently released to MyChart. Related Tests PSA SCREEN (Order#50091518) on 2/4/10 TSH WITH FREE T4 REFLEX (Order#50091519) on 2/4/10 VITAMIN D, 25 HYDROXY (Order#50091521) on 2/4/10 Other IDs Lab Specimen # 0204:SC00176R
MRN
Sex
DOB
Home Phone
001638
8081369
9/23/1959 (53yr)
916-509-0158
Result Notes Notes recorded by Victor H Baquero on 02/08/2010 at 6:30 PM As expected, your Vitamin D levels are low (normal levels range between 50 and 70). Vitamin D is obtained from the sun and is necessary for overall health. Low levels of vitamin D cause fatigue, diffuse (not pinpointed to one location) bone pain, especially in the hips, muscle weakness and increased risk of fractures. I recommend you take 1000mg of calcium and 5000iu-10,000 of vitamin D daily. In Folsom you can purchase it at Elliott's Natural Foods. Your testosterone levels are also very low. We discussed one way to raise them is to go off the methadone gradually. If you want to go back on Androgel let me know. Your cholesterol levels are borderline. I recommend focusing on diet and exercise along with weight loss in an effort to improve the cholesterol profile. I also recommend rechecking cholesterol levels in 6 months. Your fasting glucose level is elevated (ideally the fasting glucose should be in the 80-90 range). When the glucose goes above 100 it is considered pre-diabetes. The best way to lower the glucose is to lose weight through diet and regular aerobic exercise. I would like to recheck this again in 6 months. Otherwise all other labs are within normal limits. Lab Information Lab UCDMC SPECIALTY TESTING CENTER 3740 Business Drive Sacramento CA 95820-2164 Phone Number 916-734-0500 Lab NPI 1710918545
Order
Allergies
FENTANYL; MORPHINE
FERRITIN (Order 50091523)
Order Information
Result Notes
001639

Patient Information
Account # 078548433115
Account Information
Order Details

Lab Results
Entry Date
2/4/2010
Component Results Component Value FASTING YES CHOLESTEROL 226 Comment: Desirable adult value < 200 mg/dL HDL CHOLESTEROL 23 LDL CHOLESTEROL 128 CALCULATION TOTAL 9.8 CHOLESTEROL:HDL RATIO TRIGLYCERIDE 373 NON-HDL CHOLESTEROL 203 Comment: Desirable: <160 mg/dl
Flag
Reference Range
0 - 200 mg/dL
Status Final Final
>= 35 mg/dL < 130 mg/dL < 4.0
Final Final Final
H H
35 - 160 mg/dL 0 - 160 mg/dl
Final Final
001640
Result History
LIPID PANEL WITH DLDL REFLEX (Order#50091517) on 2/4/10 - Order Result History Report MyChart Status: This result is currently released to MyChart. Last viewed in MyChart: 10/22/2010 8:27 PM By: Mark Amundsen Related Tests COMPREHENSIVE METABOLIC PANEL (Order#50091516) on 2/4/10 Other IDs Lab Specimen # 0204:CI00812R

Unit UCDREG
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Result Notes Notes recorded by Victor H Baquero on 02/08/2010 at 6:30 PM As expected, your Vitamin D levels are low (normal levels range between 50 and 70). Vitamin D is obtained from the sun and is necessary for overall health. Low levels of vitamin D cause fatigue, diffuse (not pinpointed to one location) bone pain, especially in the hips, muscle weakness and increased risk of fractures. I recommend you take 1000mg of calcium and 5000iu-10,000 of vitamin D daily. In Folsom you can purchase it at Elliott's Natural Foods. Your testosterone levels are also very low. We discussed one way to raise them is to go off the methadone gradually. If you want to go back on Androgel let me know. Your cholesterol levels are borderline. I recommend focusing on diet and exercise along with weight loss in an effort to improve the cholesterol profile. I also recommend rechecking cholesterol levels in 6 months. Your fasting glucose level is elevated (ideally the fasting glucose should be in the 80-90 range). When the glucose goes above 100 it is considered pre-diabetes. The best way to lower the glucose is to lose weight through diet and regular aerobic exercise. I would like to recheck this again in 6 months. Otherwise all other labs are within normal limits. Lab Information
Lab UC DAVIS MED CTR 2315 Stockton Blvd Sacramento CA 95817 Lab Director Lydia P. Howell, M.D.

Lab NPI 1710918545
001641
Order
Allergies
FENTANYL; MORPHINE
Order Information
Order Questions
Question Fasting (Y/N): Answer Yes Comment
Result Notes
Isolation
No Isolation
Order Details

Fatigue [780.79]
Patient Information
Unit UCDREG
001642
Account # 078548433024
Account Information
Order Details

Order
Allergies
FENTANYL; MORPHINE
Order Information

Order Questions
Isolation
No Isolation
Order Details

Patient Information
001643

Routine general medical examination at a health care facility [V70.0]
Patient Information
Account # 078872030115
Account Information
Order Details

Lab Results

Entry Date
2/4/2010 Component Results Component Value Flag Reference Range PSA SCREEN 0.4 0 - 4.0 ng/mL Comment: Result obtained by the Siemens Advia Centaur PSA chemiluminometric immunoassay method. Values obtained with different assay methods cannot be used interchangeably. The PSA test in conjunction with DRE is intended for use as an aid in the detection of prostate cancer in men 50 years and older. This test is also further indicated as an aid in the management of patients with prostate cancer. Status Final
Result History
PSA SCREEN (Order#50091518) on 2/4/10 - Order Result History Report MyChart Status:
001644
This result is currently released to MyChart. Last viewed in MyChart: 10/22/2010 8:24 PM By: Mark Amundsen Related Tests TSH WITH FREE T4 REFLEX (Order#50091519) on 2/4/10 VITAMIN D, 25 HYDROXY (Order#50091521) on 2/4/10 FERRITIN (Order#50091523) on 2/4/10 Other IDs Lab Specimen # 0204:SC00176R

Unit UCDREG
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Lab UCDMC SPECIALTY TESTING CENTER 3740 Business Drive Sacramento CA 95820-2164 Lab Director Lydia P. Howell, M.D.

Allergies
FENTANYL; MORPHINE
001645
Order Information
Result Notes
Isolation
No Isolation
Order Details

Fatigue [780.79] Screening for other and unspecified endocrine, nutritional, metabolic, and immunity disorders [V77.99]
Patient Information
Unit UCDREG
MRN 8081369
Sex Male
DOB 9/23/1959
Account # 078548433024
Account Information
001646
Order Details

Order
Allergies
FENTANYL; MORPHINE
Order Information

Isolation
No Isolation
Order Details

Ordered By
Admitting Provider

Patient Information
Unit FAMFOL
Account # 078199740024
Account Information
Order Details
Order ID 15494566
Lab Results
001647
Patient Information
Unit UCDREG
MRN 8081369
Sex Male
DOB 9/23/1959
Account # 078548433107
Account Information
Order Details

Lab Results
TSH WITH FREE T4 REFLEX (Order 50091519)

Entry Date
2/4/2010
Component Results Component THYROID STIMULATING HORMONE
Value 3.55
Flag
Status Final
Result History
TSH WITH FREE T4 REFLEX (Order#50091519) on 2/4/10 - Order Result History Report MyChart Status: This result is currently released to MyChart. Related Tests PSA SCREEN (Order#50091518) on 2/4/10 VITAMIN D, 25 HYDROXY (Order#50091521) on 2/4/10 FERRITIN (Order#50091523) on 2/4/10 Other IDs Lab Specimen # 0204:SC00176R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
001648
Lab Information Lab UCDMC SPECIALTY TESTING CENTER 3740 Business Drive Sacramento CA 95820-2164
Lab NPI 1710918545

Order
Allergies
FENTANYL; MORPHINE TSH WITH FREE T4 REFLEX (Order 50091519)
Order Information
Result Notes
Notes recorded by Victor H Baquero on 02/08/2010 at 6:30 PM As expected, your Vitamin D levels are low (normal levels range between 50 and 70). Vitamin D is obtained from the sun and is necessary for overall health. Low levels of vitamin D cause fatigue, diffuse (not pinpointed to one location) bone pain, especially in the hips, muscle weakness and increased risk of fractures. I recommend you take 1000mg of calcium and 5000iu-10,000 of vitamin D daily. In Folsom you can purchase it at Elliott's Natural Foods. Your testosterone levels are also very low. We discussed one way to raise them is to go off the methadone gradually. If you want to go back on Androgel let me know. Your cholesterol levels are borderline. I recommend focusing on diet and exercise along with weight loss in an effort to improve the cholesterol profile. I also recommend rechecking cholesterol levels in 6 months. Your fasting glucose level is elevated (ideally the fasting glucose should be in the 80-90 range). When the glucose goes above 100 it is considered pre-diabetes. The best way to lower the glucose is to lose weight through diet and regular aerobic exercise. I would like to recheck this again in 6 months. Otherwise all other labs are within normal limits.
Isolation
No Isolation
001649
Order Details

Fatigue [780.79]
Patient Information
Account # 078548433024
Account Information
Order Details

Order
Allergies
FENTANYL; MORPHINE
Order Information

Isolation
No Isolation
Order Details
001650
No Isolation
Order Details


Specimen URINE
Patient Information
Account # 078199740024
Account Information
Order Details
Order ID 15494564
Lab Results
Source URINE
Entry Date
2/4/2010 Component Results Component COLLECTION COLOR CLARITY Value Clean Catch Yellow Clear Flag Reference Range None/Yellow Clr/Sl Turb Status Final Final Final
001651
SPECIFIC GRAVITY pH URINE OCCULT BLOOD URINE BILIRUBIN URINE KETONES GLUCOSE URINE PROTEIN URINE SULFOSAL UROBILINOGEN. NITRITE URINE LEUK. ESTERASE MICROSCOPIC WBC RBC MUCOUS/LPF HYALINE CASTS
1.020 6.0 Negative Negative Negative Negative Trace Negative 2.0 Negative TRACE INDICATED 3 4 MANY 2
Abnl
1.002 - 1.030 4.8 - 7.8 Negative mg/dL Negative Negative mg/dL Negative mg/dL Neg/Trace mg/dL Negative Neg-2.0 mg/dL Negative Negative 0 - 3 /HPF 0 - 6 /HPF Neg/Few /LPF 0 - 3 /LPF
Abnl
Final Final Final Final Final Final Final Final Final Final Final Final Final Final Final Final
Result History
URINALYSIS-COMPLETE (Order#50091520) on 2/4/10 - Order Result History Report MyChart Status: This result is currently released to MyChart. Other IDs Lab Specimen # 0204:UA00085R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
001652
Lab UC DAVIS MED CTR 2315 Stockton Blvd Sacramento CA 95817 Phone Number 916-734-0500 Lab NPI 1710918545
Order
Allergies
FENTANYL; MORPHINE
Order Information
Order Questions
Result Notes
Isolation
No Isolation
Order Details

Specimen URINE Collection Date and Time 2/4/2010 0923 Interfaced Collector S.BB1
001653
Account # 078548433107
Account Information
Order Details

Lab Results
VITAMIN D, 25 HYDROXY (Order 50091521)
Entry Date
2/4/2010 Component Results Component Value Flag VITAMIN D, 25 12.6 L HYDROXY Comment: Vitamin D Status ng/mL ************************************* Deficiency < 10 Insufficiency 10-29 Sufficiency 30-100 Toxicity > 100 Reference Range 30.0 - 100.0 ng/mL Status Final
Recent studies have suggested the above classification. This assay quantitatively measures 25-OH Vitamin D which includes the metabolites 25-hydroxy Vitamin D2 and 25-hydroxy Vitamin D3.
Result History
VITAMIN D, 25 HYDROXY (Order#50091521) on 2/4/10 - Order Result History Report
MyChart Status: This result is currently released to MyChart. Related Tests PSA SCREEN (Order#50091518) on 2/4/10 TSH WITH FREE T4 REFLEX (Order#50091519) on 2/4/10 FERRITIN (Order#50091523) on 2/4/10 Other IDs Lab Specimen # 0204:SC00176R
Patient Information
001654
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Unit UCDREG
Lab NPI 1710918545

Order
Allergies
FENTANYL; MORPHINE
Order Information
Result Notes
Notes recorded by Victor H Baquero on 02/08/2010 at 6:30 PM As expected, your Vitamin D levels are low (normal levels range between 50 and 70). Vitamin D is obtained from the sun and is necessary for overall health. Low levels of vitamin D cause fatigue, diffuse (not pinpointed to one location) bone pain, especially in the hips, muscle weakness and increased risk of fractures. I recommend you take 1000mg of calcium and 5000iu-10,000 of vitamin D daily. In Folsom you can purchase it at Elliott's Natural Foods. Your testosterone levels are also very low. We discussed one way to raise them is to go off the methadone gradually. If you want to go back on Androgel let me know. Your cholesterol levels are borderline. I recommend focusing on diet and exercise along with weight loss in an effort to improve the cholesterol profile. I also recommend rechecking cholesterol levels in 6 months. Your fasting glucose level is elevated (ideally the fasting glucose should be in the 80-90 range). When the glucose goes above 100 it is considered pre-diabetes. The best way to lower the glucose is to lose weight through diet and regular aerobic exercise. I would like to
001655
recheck this again in 6 months.

Isolation
No Isolation
Order Details

Fatigue [780.79]
Patient Information
Account # 078548433024
Account Information
Order Details

001656
Order Information

Order Status Canceled By System Maintenance On 2/5/12 1803 Reason Database Cleanup
Isolation
No Isolation
Order Details

Weakness [780.79] - Primary
Patient Information
Account # 078548433115
Account Information
Order Details
Order ID 60917267
Lab Results
Entry Date
2/6/2010 Component Results
001657
Flag Reference Range Component Value TESTOSTERONE,TOTAL 106 L 300 - 890 ng/dL Comment: Test Information: Testosterone, Adult Male To convert to nmol/L, multiply ng/dL by 0.0347. 11 - 80 nmol/L SEX HORMONE BINDING 51 GLOBULIN TESTOSTERONE,BIO 38 L 131 - 682 ng/dL AVAILABLE Comment: REFERENCE INTERVAL: Testosterone, Bioavailable Tanner Stage IV 40 - 485 ng/dL Tanner Stage V 124 - 596 ng/dL The concentrations of free and bioavailable testosterone are derived from mathematical expressions based on constants for the binding of testosterone to albumin and/or sex hormone binding globulin. TESTOSTERONE,FREE 14 L 47 - 244 pg/mL Comment: REFERENCE INTERVAL: Testosterone, Free Tanner Stage IV Tanner Stage V 35 - 169 pg/mL 41 - 239 pg/mL
Status Final
Final Final
Final
To convert to pmol/L, multiply pg/mL by 3.47. The concentration of Free Testosterone is derived from a mathematical expression based on the constant for the binding of testosterone to sex hormone binding globulin. TESTOSTERONE, % 1.3 L 1.6 - 2.9 % FREE Comment: Test Performed By: ARUP Laboratories 500 Chipeta Way Salt Lake City, Utah
Final
84108-1221 .
Result History
TESTOSTERONE,BIOAVAILABLE (Order#50091522) on 2/6/10 - Order Result History Report MyChart Status: This result is currently released to MyChart. Other IDs Lab Specimen # 0204:S00042R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
001658
Lab Information Lab ARUP LABORATORIES 500 Chipeta Way Salt Lake City UT 84108-1221
Lab Director Edward R Ashwood, M.D.
Lab NPI 1982694931

Order
Allergies
FENTANYL; MORPHINE TESTOSTERONE,BIOAVAILABLE (Order 50091522)
Order Information
Result Notes
Isolation
No Isolation
001659
Isolation
No Isolation
Order Details
Ordered By
Authorized By ARTHUR BROOKS DUBLIN [00230]

Released By BARBARA BLANKENCHIP [006147847]

Polyneuropathy [356.9] Preop testing [V72.84]
Patient Information
Account # 078661756110
Account Information
Order Details

Lab Results

Entry Date
10/18/2010 Component Results Component WHITE BLOOD CELL Value 8.3 Flag Reference Range 4.5 - 11.0 K/MM3 Status Final
001660
COUNT RED CELL COUNT HEMOGLOBIN HEMATOCRIT MCV MCH MCHC RDW MPV PLATELET COUNT NEUTROPHILS % AUTO LYMPHOCYTES % AUTO MONOCYTES % AUTO EOSINOPHIL % AUTO BASOPHILS % AUTO NEUTROPHIL ABS AUTO LYMPHOCYTE ABS AUTO MONOCYTES ABS AUTO EOSINOPHIL ABS AUTO BASOPHILS ABS AUTO
4.56 14.5 41.9 91.8 31.9 34.7 14.0 9.1 195 62.9 30.6 4.6 1.7 0.2 5.20 2.50 0.40 0.10 0
4.5 - 5.9 M/MM3 13.5 - 17.5 GM/DL 41 - 53 % 80 - 100 UM3 27 - 33 PG 32 - 36 % 0 - 14.7 UNITS 6.8 - 10.0 UM3 130 - 400 K/MM3 % % % % % 1.80 - 7.70 K/MM3 1.0 - 4.8 K/MM3 0.1 - 0.8 K/MM3 0 - 0.5 K/MM3 0 - 0.2 K/MM3
Final Final Final Final Final Final Final Final Final Final Final Final Final Final Final Final Final Final Final
Result History
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Result Notes Notes Recorded by Victor Henrique Baquero, MD on 10/19/2010 at 12:52 PM See tel encounter. Lab Information Lab UC DAVIS MED CTR 2315 Stockton Blvd Sacramento CA 95817
Phone Number
001661
916-734-0500 Lab NPI 1710918545

Order
Allergies
FENTANYL; MORPHINE
Order Information
Result Notes
Notes Recorded by Victor Henrique Baquero, MD on 10/19/2010 at 12:52 PM See tel encounter.
Isolation
No Isolation
Order Details

Patient Information
Account # 078548433107
Account Information
Order Details

Expected By Expires
001662
Order Information
Isolation
No Isolation
Order Details

Routine general medical examination at a health care facility [V70.0] Weight loss [783.21]
Patient Information
Account # 078872030115
Account Information
Order Details

Lab Results
COMPREHENSIVE METABOLIC PANEL (Order 60318987) Received Date and Time 10/18/2010 1529
Entry Date
10/18/2010
001663
Component Results Component SODIUM POTASSIUM CHLORIDE CARBON DIOXIDE TOTAL UREA NITROGEN, BLOOD (BUN) CREATININE BLOOD E-GFR, AFRICAN AMERICAN Comment: mL/min/1.73 square E-GFR, NON-AFRICAN AMERICAN Comment: mL/min/1.73 square
Value 137 3.8 103 24 9 0.86 >60
Flag
Reference Range 135 - 145 mEq/L 3.3 - 5.0 mEq/L 95 - 110 mEq/L 24 - 32 mEq/L 8 - 22 mg/dL 0.44 - 1.27 mg/dL >60 SEE NOTE
Status Final Final Final Final Final Final Final
meters >60
>60 SEE NOTE
Final
meters
Note: The estimated GFR result assumes a steady-state and is most accurate for GFRs <60 mL/min/1.73 square meters. The eGFR is not reliable in certain groups, including severely ill patients. Also, patients >59 years of age can have a mildly reduced GFR due to aging. The MDRD equations used to estimate GFR have been validated only in Caucasian and African-Americans 18 - 70 years of age. The equations have not been validated in other population groups, including pregnant women, transplant recipients, medically unstable patients including those with acute renal failure, or in persons with extremes of body size, muscle mass, or nutritional status. Application of the MDRD calculation in these cases may lead to errors in GFR estimation. GLUCOSE 92 70 - 110 mg/dL CALCIUM 9.2 8.6 - 10.5 mg/dL PROTEIN 6.8 6.3 - 8.3 g/dL ALBUMIN 4.1 3.4 - 4.8 g/dL ALKALINE 87 35 - 115 U/L PHOSPHATASE (ALP) 25 15 - 43 U/L ASPARTATE TRANSAMINASE (AST) BILIRUBIN TOTAL 0.3 0.3 - 1.3 mg/dL ALANINE TRANSFERASE 24 6 - 63 U/L (ALT)
Result History
COMPREHENSIVE METABOLIC PANEL (Order#60318987) on 10/18/10 - Order Result History Report
MyChart Status:
Last viewed in MyChart: 10/22/2010 8:33 PM By: Mark Amundsen Related Tests CREATINE KINASE (Order#60318991) on 10/18/10
001664
Other IDs Lab Specimen # 1018:CI01288R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Result Notes Notes Recorded by Victor Henrique Baquero, MD on 10/19/2010 at 12:52 PM See tel encounter. Lab Information Lab UC DAVIS MED CTR 2315 Stockton Blvd Sacramento CA 95817 Phone Number 916-734-0500 Lab NPI 1710918545
Order
Allergies
FENTANYL; MORPHINE
Order Information
Result Notes
Isolation
No Isolation
Order Details
001665
65114097
65115070

Lab Results
CREATINE KINASE (Order 60318991) Received Date and Time 10/18/2010 1529
Entry Date
10/18/2010
Component Results Component CREATINE KINASE
Value 40
Flag
Reference Range 0 - 250 U/L
Status Final
Result History
CREATINE KINASE (Order#60318991) on 10/18/10 - Order Result History Report
MyChart Status:
Last viewed in MyChart: 10/22/2010 8:33 PM By: Mark Amundsen Related Tests COMPREHENSIVE METABOLIC PANEL (Order#60318987) on 10/18/10 Other IDs Lab Specimen # 1018:CI01288R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Result Notes Notes Recorded by Victor Henrique Baquero, MD on 10/19/2010 at 12:52 PM See tel encounter. Lab Information Lab UC DAVIS MED CTR 2315 Stockton Blvd Sacramento CA 95817
001666
Lab NPI 1710918545

Order
Allergies
FENTANYL; MORPHINE
CREATINE KINASE (Order 60318991)
Order Information
Result Notes
Isolation
No Isolation
Order Details

Patient Information
Account # 078548433107
Account Information
Order Details

001667

Lab Results
THYROXINE, FREE (FREE T4) (Order 60332328) Received Date and Time 10/18/2010 1529
Entry Date
10/18/2010 Component Results Component Value Flag Reference Range THYROXINE, FREE 0.87 0.60 - 1.20 ng/dL (FREE T4) Comment: Effective Oct 10, 2010 the Clinical Laboratory will begin reporting results from a Beckman Coulter Synchron DxI800 that uses a different methodology. Comparison studies have been performed with the previous platform. Please direct any questions or concerns to the Chemistry laboratory supervisor at phone # 734-2109, or pager # 762-0018. Status Final
Result History
THYROXINE, FREE (FREE T4) (Order#60332328) on 10/18/10 - Order Result History Report
MyChart Status:
Last viewed in MyChart: 10/22/2010 8:40 PM By: Mark Amundsen Related Tests TSH WITH FREE T4 REFLEX (Order#60318989) on 10/18/10 Other IDs Reflex Order # 60318989
Lab Specimen # 1018:SC00731R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Result Notes Notes Recorded by Victor Henrique Baquero, MD on 10/19/2010 at 12:52 PM See tel encounter. Lab Information
001668
Lab UC DAVIS MED CTR 2315 Stockton Blvd Sacramento CA 95817

Allergies
FENTANYL; MORPHINE
THYROXINE, FREE (FREE T4) (Order 60332328)
Order Information
Date and Time 10/18/2010 9:11 PM Electronically Signed By Lab Results Interface Authorizing Victor Baquero, MD Department Ucd Registration
Result Notes
Isolation
No Isolation
Order Details
Ordered By


Patient Information
Account # 078548433107
Account Information
Order Details
Order ID
001669
Hypothyroid [244.9] - Primary
Patient Information
Order Details
Order ID 75872998
Lab Results
Entry Date
10/18/2010 Component Results Component Value Flag Reference Range THYROID STIMULATING 3.42 H 0.35 - 3.30 mcIU/ml HORMONE Comment: Effective Oct 10, 2010 the Clinical Laboratory will begin reporting results from a Beckman Coulter Synchron DxI800 that uses a different methodology. Comparison studies have been performed with the previous platform. Please direct any questions or concerns to the Chemistry laboratory supervisor at phone # 734-2109, or pager # 762-0018. Status Final
Result History
TSH WITH FREE T4 REFLEX (Order#60318989) on 10/18/10 - Order Result History Report
MyChart Status: This result is currently released to MyChart. Last viewed in MyChart: 10/22/2010 8:40 PM By: Mark Amundsen Related Tests THYROXINE, FREE (FREE T4) (Order#60332328) on 10/18/10 Other IDs Lab Specimen # 1018:SC00731R
MRN
Sex
DOB
Home Phone
001670
8081369
9/23/1959 (53yr)
916-509-0158
Result Notes Notes Recorded by Victor Henrique Baquero, MD on 10/19/2010 at 12:52 PM See tel encounter. Lab Information Lab UC DAVIS MED CTR 2315 Stockton Blvd Sacramento CA 95817 Phone Number 916-734-0500 Lab NPI 1710918545
Order
Allergies
FENTANYL; MORPHINE
Order Information
Result Notes
Isolation
No Isolation
Order Details
Ordered By Admitting Provider Doctor Staff Authorized By VICTOR BAQUERO [08139] PCP Victor Baquero, MD Date/Time Mon Oct 18, 2010 1452 Status Pended Reason Released By BARBARA BLANKENCHIP [006147847]


001671

Lab Results
Entry Date
10/18/2010
Component Results Component Value Flag 16.3 L VITAMIN D, 25 HYDROXY Comment: Vitamin D Status ng/mL ************************************* Deficiency < 10 Insufficiency 10-29 Sufficiency 30-100 Toxicity > 100
Reference Range 30.0 - 100.0 ng/mL
Status Final
Result History
VITAMIN D, 25 HYDROXY (Order#60318988) on 10/18/10 - Order Result History Report MyChart Status: This result is currently released to MyChart. Last viewed in MyChart: 10/22/2010 8:33 PM By: Mark Amundsen Other IDs Lab Specimen # 1018:SC00730R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Result Notes Notes Recorded by Victor Henrique Baquero, MD on 10/19/2010 at 12:52 PM See tel encounter.
001672
Lab Information Lab UCDMC SPECIALTY TESTING CENTER 3740 Business Drive Sacramento CA 95820-2164 Phone Number 916-734-0500 Lab NPI 1710918545
Order
Allergies
FENTANYL; MORPHINE
Order Information
Result Notes
Isolation
No Isolation
Order Details
Ordered By Admitting Provider Doctor Staff Authorized By VICTOR BAQUERO [08139] PCP Victor Baquero, MD Date/Time Mon Oct 18, 2010 1452 Status Pended Reason Released By BARBARA BLANKENCHIP [006147847]


Patient Information
001673
Isolation
No Isolation
Order Details

Fatigue [780.79]
Patient Information
Account # 078548433024
Account Information
Order Details

Lab Results
Collection Information Collection Date and Time 11/2/2010 1337 Received Date and Time 11/2/2010 1337
FOLATE (Order 60921095)
Entry Date
11/2/2010
Component Results Component FOLATE
Value 14.7
Flag
Reference Range >=5.4 ng/mL
Status Final
001674
Result History
FOLATE (Order#60921095) on 11/2/10 - Order Result History Report MyChart Status: This result is currently released to MyChart. Last viewed in MyChart: 11/5/2010 3:35 PM By: Mark Amundsen Related Tests VITAMIN B12 (Order#60921094) on 11/2/10 Other IDs Lab Specimen # 1102:SC00649R

Unit UCDREG
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Patient Result Comments Entered by Victor Baquero, MD at 11/5/2010 2:01 PM Read by Mark Amundsen at 11/5/2010 3:35 PM Mark, I got all the labs back. Other than the low vitamin D (cont replacement until the level is closer to 50), the only other abnormality is that your cholesterol is high. I am thinking that your symptoms are possibly due to medications. Consider decreasing the dose of methadone gradually - I how pain may increase but I can't help but think that the long term use of methadone may be causing some of your symptoms. All organ systems are within normal limits. I'm away this week on vacation but come see me after the 16th if you are not feeling better. Lab Information Lab UCDMC SPECIALTY TESTING CENTER 3740 Business Drive Sacramento CA 95820-2164
Lab NPI 1710918545

Order
Allergies
FENTANYL; MORPHINE
FOLATE (Order 60921095)
Order Information
Isolation
001675
Order Details
Order ID 66574451
Lab Results
GLUCOSE FASTING BLOOD (Order 60921091)

Entry Date
11/2/2010 Component Results Component GLUCOSE FASTING BLOOD Value 94 Flag Reference Range 70 - 110 mg/dL Status Final
Result History
GLUCOSE FASTING BLOOD (Order#60921091) on 11/2/10 - Order Result History Report
MyChart Status: This result is currently released to MyChart. Last viewed in MyChart: 11/5/2010 3:35 PM By: Mark Amundsen Other IDs Lab Specimen # 1102:LG00028R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Patient Result Comments Entered by Victor Baquero, MD at 11/5/2010 2:01 PM Read by Mark Amundsen at 11/5/2010 3:35 PM Mark, I got all the labs back. Other than the low vitamin D (cont replacement until the level is closer to 50), the only other abnormality is that your cholesterol is high. I am thinking that your symptoms are possibly due to medications. Consider decreasing the dose of methadone gradually - I how pain may increase but I can't help but think that the long term use of methadone may be causing some of your symptoms. All organ systems are within normal limits. I'm away this week on vacation but come see me after the 16th if you are not feeling better. Lab Information Lab UC DAVIS MED CTR 2315 Stockton Blvd
001676
Sacramento CA 95817

Allergies
FENTANYL; MORPHINE
GLUCOSE FASTING BLOOD (Order 60921091)
Order Information
Date and Time 2/8/2010 6:30 PM Electronically Signed By/Authorizing Victor Baquero, MD Department Ucd Registration
Isolation
No Isolation
Order Details

Patient Information
Unit UCDREG
MRN 8081369
Sex Male
DOB 9/23/1959
Account # 078548433115
Account Information
Order Details

001677
Weakness [780.79]
Patient Information
Unit UCDREG
MRN 8081369
Sex Male
DOB 9/23/1959
Account # 078661756110
Account Information
Order Details

Lab Results
HEPATIC FUNCTION PANEL (Order 60921093)

Entry Date
11/2/2010
Component Results Component PROTEIN ALBUMIN ALKALINE PHOSPHATASE (ALP) ASPARTATE TRANSAMINASE (AST) BILIRUBIN TOTAL ALANINE TRANSFERASE (ALT) BILIRUBIN DIRECT
Value 7.2 4.1 79 23 0.3 23 < 0.1
Flag
Reference Range 6.3 - 8.3 g/dL 3.4 - 4.8 g/dL 35 - 115 U/L 15 - 43 U/L 0.3 - 1.3 mg/dL 6 - 63 U/L 0.0 - 0.2 mg/dL
Result History
HEPATIC FUNCTION PANEL (Order#60921093) on 11/2/10 - Order Result History Report
MyChart Status:
This result is currently not released to MyChart.
Related Tests LIPID PANEL WITH DLDL REFLEX (Order#60921090) on 11/2/10 Other IDs Lab Specimen # 1102:CI01013R
001678
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Order
Allergies
FENTANYL; MORPHINE
Order Information
Date and Time 7/12/2010 9:41 AM Electronically Signed By/Authorizing Jeffrey Alan Applebaum Department Fol Family Practice
Isolation
No Isolation
Order Details
Ordered By Admitting Provider Doctor Staff Authorized By JEFFREY ALAN APPLEBAUM [06402] PCP Victor Baquero, MD Released By BARBARA BLANKENCHIP [006147847]

Hypertension [401.9]
Patient Information
001679
UCDREG
Account # 078661756110
Account Information
Order Details

Lab Results
Entry Date
11/2/2010
Component Results Component Value FASTING YES CHOLESTEROL 254 Comment: Desirable adult value < 200 mg/dL HDL CHOLESTEROL 31 150 LDL CHOLESTEROL CALCULATION TOTAL 8.2 CHOLESTEROL:HDL RATIO TRIGLYCERIDE 364 NON-HDL CHOLESTEROL 223 Comment: Desirable: <160 mg/dl
Flag
Reference Range
0 - 200 mg/dL
Status Final Final
L H H
>= 35 mg/dL < 130 mg/dL < 4.0
Final Final Final
H H
35 - 160 mg/dL 0 - 160 mg/dl
Final Final
Result History
LIPID PANEL WITH DLDL REFLEX (Order#60921090) on 11/2/10 - Order Result History Report
MyChart Status:
Last viewed in MyChart: 11/5/2010 3:35 PM By: Mark Amundsen Related Tests HEPATIC FUNCTION PANEL (Order#60921093) on 11/2/10 Other IDs
001680
Lab Specimen # 1102:CI01013R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Patient Result Comments Entered by Victor Baquero, MD at 11/5/2010 2:01 PM Read by Mark Amundsen at 11/5/2010 3:35 PM Mark, I got all the labs back. Other than the low vitamin D (cont replacement until the level is closer to 50), the only other abnormality is that your cholesterol is high. I am thinking that your symptoms are possibly due to medications. Consider decreasing the dose of methadone gradually - I how pain may increase but I can't help but think that the long term use of methadone may be causing some of your symptoms. All organ systems are within normal limits. I'm away this week on vacation but come see me after the 16th if you are not feeling better. Lab Information Lab UC DAVIS MED CTR 2315 Stockton Blvd Sacramento CA 95817 Phone Number 916-734-0500 Lab NPI 1710918545
Order
Allergies
FENTANYL; MORPHINE
Order Information
Order Questions
Isolation
No Isolation
Order Details
001681
Unit FAMFOL
Account # 078199740024
Account Information
Order Details
Order ID 15494561
Lab Results
SED RATE WESTERGREN (Order 60921096) Received Date and Time 11/2/2010 1337
Entry Date
11/2/2010
Component Results Component SED RATE WESTERGREN
Value 8
Flag
Reference Range 0 - 20
Status Final
Result History
SED RATE WESTERGREN (Order#60921096) on 11/2/10 - Order Result History Report
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Patient Result Comments Entered by Victor Baquero, MD at 11/5/2010 2:01 PM Read by Mark Amundsen at 11/5/2010 3:34 PM Mark, I got all the labs back. Other than the low vitamin D (cont replacement until the level is closer to 50), the only other abnormality is that your cholesterol is high. I am thinking that your symptoms are possibly due to medications. Consider decreasing the dose of
001682
methadone gradually - I how pain may increase but I can't help but think that the long term use of methadone may be causing some of your symptoms. All organ systems are within normal limits. I'm away this week on vacation but come see me after the 16th if you are not feeling better. Lab Information Lab UC DAVIS MED CTR 2315 Stockton Blvd Sacramento CA 95817
Lab NPI 1710918545

Order
Allergies
FENTANYL; MORPHINE
SED RATE WESTERGREN (Order 60921096)
Order Information
Isolation
No Isolation
Order Details

Weakness [780.79]
Patient Information
Account # 078548433115
Account Information
001683
2/17/2011 9:04 AM
Andrew Kim Oh, MD
Carm Neurology
Isolation
No Isolation
Order Details
Ordered By Authorized By ANDREW KIM OH [10912] Released By MATTHEW MANTHEI [551506892]

Weakness [780.79]
Patient Information
Account # 078661756029
Account Information
Order Details

Lab Results
ANTI-NUCLEAR AB (ANA) (Order 60921097) Received Date and Time 11/2/2010 1337
Entry Date
11/3/2010 Component Results Component ANA SCREEN Value Neg Flag Reference Range Negative Status Final
001684
Result History
ANTI-NUCLEAR AB (ANA) (Order#60921097) on 11/3/10 - Order Result History Report MyChart Status: This result is currently released to MyChart. Last viewed in MyChart: 11/5/2010 3:34 PM By: Mark Amundsen Other IDs Lab Specimen # 1102:I00064R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Patient Result Comments Entered by Victor Baquero, MD at 11/5/2010 2:01 PM Read by Mark Amundsen at 11/5/2010 3:34 PM Mark, I got all the labs back. Other than the low vitamin D (cont replacement until the level is closer to 50), the only other abnormality is that your cholesterol is high. I am thinking that your symptoms are possibly due to medications. Consider decreasing the dose of methadone gradually - I how pain may increase but I can't help but think that the long term use of methadone may be causing some of your symptoms. All organ systems are within normal limits. I'm away this week on vacation but come see me after the 16th if you are not feeling better. Lab Information Lab UCDMC SPECIALTY TESTING CENTER 3740 Business Drive Sacramento CA 95820-2164 Phone Number 916-734-0500 Lab NPI 1710918545
Order
Allergies
FENTANYL; MORPHINE
ANTI-NUCLEAR AB (ANA) (Order 60921097)
Order Information
Isolation
No Isolation
001685
Order Details

Weakness [780.79]
Patient Information
Account # 078548433115
Account Information
Order Details

Order
Allergies
FENTANYL; MORPHINE
ANTI-NUCLEAR AB (ANA) (Order 15494560)
Order Information

Isolation
No Isolation
Order Details
001686
Patient Information
Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Account # 078199740024
Account Information
Order Details
Order ID 15494559
Lab Results
SENDOUT MISC (Order 61646759) Received Date and Time 11/19/2010 1545
Entry Date
Result History
SENDOUT MISC (Order#61646759) on - Order Result History Report
MyChart Status:
This result is automatically blocked from release to MyChart.
Related Tests HEAVY METALS PNL 6,RFLX ARS FR (Order#61646566) on 11/19/10 Other IDs Reflex Order # 61646566 Lab Specimen # 1119:S00112R

Unit UCDREG
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Lab Information Lab

Order
Allergies
FENTANYL; MORPHINE
SENDOUT MISC (Order 61646759)
001687
Order Information

Order Status By Lab Results Interface Canceled ORDERED ON NEW REQ On 11/19/10 2037 Reason Cancelled
Isolation
No Isolation
Order Details
Ordered By Admitting Provider Doctor Staff Authorized By VICTOR BAQUERO [08139] PCP Victor Baquero, MD

Patient Information
Unit UCDREG
MRN 8081369
Sex Male
DOB 9/23/1959
Account # 078548433115
Account Information
Order Details
Order ID 61646759
Lab Results
SENDOUT URINE (Order 61656577) Received Date and Time 11/19/2010 2037
Entry Date
11/28/2010
Component Results
TEST REQUESTED, URINE:
001688
COBALT LEVEL,URINE URINE SAMPLE SENT TO: ARUP RESULT, URINE: Comment: SEE SCANNED ATTACHMENT IN EMR
Result Narrative
TEST: COLBALT SOURCE: 24 HOUR URINE 11/18/10 @ 1150 THRU 11/19/10 @ 1145 T.V.=1050mL
Results
EXT LAB RESULT - Scan on 11/28/2010 12:08 PM
Result History
SENDOUT URINE (Order#61656577) on 11/28/10 - Order Result History Report
MyChart Status: This result is currently released to MyChart. Last viewed in MyChart: 4/22/2011 3:18 AM By: Mark Amundsen Other IDs Lab Specimen # 1119:S00123R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Patient Result Comments Entered by Victor Baquero, MD at 11/28/2010 5:41 PM Read by Mark Amundsen at 4/22/2011 3:18 AM Mark, The cobalt urine test came back abnormal. The normal range is 1.0-2.0. Your level was just slightly elevated at 2.9. FYI. Not sure if this is related to the implants or diet or water, etc. I don't know how you would go about testing your water and your environment other than calling the County Health Department. Lab Information Lab UC DAVIS MED CTR 2315 Stockton Blvd Sacramento CA 95817 Phone Number
001689
No Isolation
Order Details

Patient Information
Account # 078661756037
Account Information
Order Details
Order ID 66574449
Lab Results
CHROMIUM,SERUM (Order 61592091) Received Date and Time 11/18/2010 1425
Entry Date
11/23/2010 Component Results Component CHROMIUM,SERUM Value <1.0 Flag Reference Range <=5.0 ug/L Status Final
Result History
CHROMIUM,SERUM (Order#61592091) on 11/23/10 - Order Result History Report MyChart Status: This result is currently released to MyChart.
001690
Last viewed in MyChart: 4/22/2011 3:16 AM By: Mark Amundsen Other IDs Lab Specimen # 1118:S00086R

Unit UCDREG
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Patient Result Comments Entered by Victor Baquero, MD at 11/24/2010 1:53 PM Read by Mark Amundsen at 4/22/2011 3:16 AM Mark, the heavy metals screen is normal. Lab Information Lab ARUP LABORATORIES 500 Chipeta Way Salt Lake City UT 84108-1221 Phone Number 800-242-2787 Lab NPI 1982694931
Order
Allergies
FENTANYL; MORPHINE
CHROMIUM,SERUM (Order 61592091)
Order Information
Isolation
No Isolation
Order Details
Ordered By Admitting Provider Authorized By VICTOR BAQUERO [08139] PCP Released By KELLY DELEON [012355806]
001691
Lab Results
HEAVY METALS PNL 6,RFLX ARS FR (Order 61646566)

Entry Date
11/24/2010 Component Results Component Value Flag 1050 TOTAL VOLUME TIME OF COLLECTION 24 CADMIUM,URINE 0.8 CADMIUM,URINE (24 0.8 HOUR) CADMIUM PER GRAM OF 0.5 CREATININE ARSENIC,URINE 26.6 Comment: TEST INFORMATION: Arsenic, Urine w/ Reflex Reference Range () mL () hr 0.0 - 2.6 ug/L 0.0 - 3.3 ug/d 0.0 - 3.0 ug/gCR 0.0 - 35.0 ug/L to Fractionated Status Final Final Final Final Final Final
Specific toxic thresholds for arsenic are not well defined. The ACGIH Biological Exposure Index is 35 ug/L for the sum of the inorganic and methylated forms of arsenic. For specimens with a total arsenic concentration between 35-2000 ug/L, fractionation is performed to determine the proportion of organic, inorganic and methylated forms. If low-level chronic poisoning is suspected, the ug/gCRT ratio may be more sensitive than the total arsenic concentration. It may be appropriate to fractionate specimens with a ug/gCRT ratio greater than 30 ug/gCRT despite a total arsenic concentration less than 35 ug/L; the laboratory will perform this on request. The organic forms of arsenic, most commonly arsenobetaine, are considered nontoxic and arise primarily from food. Inorganic forms of arsenic, As(III) and As(V), are most toxic. Methylated forms (MMA and DMA) arise primarily from metabolism of inorganic forms but may also come from dietary sources and are of moderate toxic potential. As this test does not detect all species of arsenic, it is expected that the sum of the organic,inorganic and methylated forms will not equal the total arsenic concentration. ARSENIC,URINE (24 27.9 0.0 - 50.0 ug/d HOUR) ARSENIC PER GRAM OF 16.1 () ug/gCR CREATININE COPPER,URINE 1.6 0.2 - 8.0 ug/dL COPPER,URINE (24 17 3 - 50 ug/d HOUR) Comment: TEST INFORMATION: Copper, Urine ug/day Individuals with symptomatic Wilson disease usually excrete more than 100 ug copper per day. Other conditions associated with elevated urine copper include cholestatic
001692
liver disease, proteinuria, some medications, and contaminated specimens. Although random specimens may contain diagnostic information, a 24-hour collection is a more consistent indicator of urine copper. COPPER PER GRAM OF 9.7 () ug/gCR CREATININE LEAD,URINE 1 0 - 23 ug/L LEAD,URINE (24 1 0 - 31 ug/d HOUR) LEAD PER GRAM OF 0.6 () ug/gCR CREATININE MERCURY,URINE 0 0 - 10 ug/L Comment: TEST INFORMATION: Mercury, Urine - ug/L Urine mercury concentration may correlate better with inorganic mercury exposure than blood concentrations since organic mercury is eliminated primarily in the feces. Urine mercury levels may also be used to monitor chelation therapy. MERCURY,URINE (24 0 0 - 15 ug/d HOUR) MERCURY PER GRAM OF 0.0 <=35.0 ug/gCR CREATININE ZINC,URINE 98 15 - 120 ug/dL ZINC,URINE (24 1029 150 - 1200 ug/d HOUR) ZINC PER GRAM OF 593.9 () ug/gCR CREATININE Comment: TEST INFORMATION: Zinc, Urine Zinc is predominantly eliminated in the feces. Elevated urine zinc may suggest excessive zinc supplementation but should be interpreted with a corresponding serum zinc concentration. CREATININE,UR PER 165 () mg/dL VOLUME CREATININE,UR PER 1732 800 - 2100 mg/d 24HR
Final Final Final Final Final
Final Final Final Final Final
Final Final
Result Narrative
SOURCE: 24 HOUR URINE 11/18/10 @ 1150 THRU 11/19/10 @ 1145 T.V.=1050mL
Result History
HEAVY METALS PNL 6,RFLX ARS FR (Order#61646566) on 11/24/10 - Order Result History Report
MyChart Status:
Last viewed in MyChart: 12/1/2010 6:06 PM By:
001693
Mark Amundsen Other IDs Lab Specimen # 1119:S00112R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Patient Result Comments Entered by Victor Baquero, MD at 11/24/2010 1:53 PM Read by Mark Amundsen at 12/1/2010 6:06 PM Mark, the heavy metals screen is normal. Lab Information Lab ARUP LABORATORIES 500 Chipeta Way Salt Lake City UT 84108-1221
Lab NPI 1982694931

Order
Allergies
FENTANYL; MORPHINE
HEAVY METALS PNL 6,RFLX ARS FR (Order 61646566)
Order Information
Result Narrative:
SOURCE: 24 HOUR URINE 11/18/10 @ 1150 THRU 11/19/10 @ 1145 T.V.=1050mL
Isolation
No Isolation
Order Details
Ordered By Admitting Provider Authorized By VICTOR BAQUERO [08139] PCP Released By KELLY DELEON [012355806]
001694
Account Information
Order Details

Lab Results
CREATINE KINASE (Order 65115070) Received Date and Time 2/17/2011 0918
Entry Date
2/17/2011 Component Results Component CREATINE KINASE Value 45 Flag Reference Range 0 - 250 U/L Status Final
Result History
CREATINE KINASE (Order#65115070) on 2/17/11 - Order Result History Report MyChart Status: This result is currently released to MyChart. Last viewed in MyChart: 10/10/2011 7:49 AM By: Mark Amundsen Other IDs Lab Specimen # 0217:CI00616R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Patient Result Comments Entered by Andrew Kim Oh, MD at 2/22/2011 9:40 AM Read by Mark Amundsen at 10/10/2011 7:49 AM Mr. Amundsen, Your blood test results are normal except for elevated TSH. Elevated TSH may indicate that your thyroid hormone levels are still too low. Talk with your primary care doctor, Dr. Baquero, about this. -Dr. Oh
001695
Lab NPI 1710918545

Order
Allergies
FENTANYL; MORPHINE CREATINE KINASE (Order 65115070)
Order Information
Isolation
No Isolation
Order Details
Ordered By Authorized By ANDREW KIM OH [10912] Released By MATTHEW MANTHEI [551506892]

Weakness [780.79]
Patient Information
Unit UCDREG
Account # 078661756029
Account Information
Order Details
Parent Order ID Child Order ID
001696
Unit UCDREG
Account # 078661756045
Account Information
Order Details

Lab Results
MUSK ANTIBODY (Order 65115069)

Entry Date
Result History
MUSK ANTIBODY (Order#65115069) on - Order Result History Report MyChart Status: This result is automatically blocked from release to MyChart. Related Tests ACETYLCHOLINE RECEPTOR (Order#65115067) on 2/17/11 ACETYLCHOLINE MODULATING AB (Order#65115068) on 2/17/11 ALDOLASE (Order#65115071) on 2/17/11 Other IDs Lab Specimen # 0217:S00032R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Lab Information Lab

Order
Allergies
FENTANYL; MORPHINE
Order Information
001697
Electronically Signed By/Authorizing Andrew Kim Oh, MD

Order Status By Lab Results Interface Canceled ORDERED ON NEW REQ On 2/17/11 1335 Reason Cancelled
Isolation
No Isolation
Order Details

Patient Information
Account # 078661756029
Account Information
Order Details

Lab Results
MUSK ANTIBODY (Order 65131614) Received Date and Time 2/17/2011 1334
Entry Date
3/14/2011
001698
Component Results
MUSK ANTIBODY: SEE NOTE Comment: SEE SCANNED ATTACHMENT IN EMR
Results
EXT LAB RESULT - Scan on 3/14/2011 9:05 AM
Result History
MUSK ANTIBODY (Order#65131614) on 3/14/11 - Order Result History Report MyChart Status: This result is currently not released to MyChart. Other IDs Lab Specimen # 0217:S00084R

Unit NEUCAR
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Lab Information Lab ATHENA DIAGNOSTICS 377 Plantation St. Worcester MA 01605 Phone Number (800)394-4493
Allergies
FENTANYL; MORPHINE
Lab Director Sat Bev Batish, PhD FACMG
Order Information
Date and Time 2/17/2011 1:35 PM Electronically Signed By Lab Results Interface Authorizing Andrew Kim Oh, MD Department Carm Neurology
Isolation
No Isolation
Order Details
Release Date/Time Schedule Date/Time
001699
Lab Results
THYROID STIMULATING HORMONE (Order 65115073)
Entry Date
2/17/2011
Component Results Component Value Flag Reference Range THYROID STIMULATING 4.54 H 0.35 - 3.30 mcIU/mL HORMONE Comment: Effective Oct 10, 2010 the Clinical Laboratory will begin reporting results from a Beckman Coulter Synchron DxI800 that uses a different methodology. Comparison studies have been performed with the previous platform. Please direct any questions or concerns to the Chemistry laboratory supervisor at phone # 734-2109, or pager # 762-0018.
Status Final
Result History
THYROID STIMULATING HORMONE (Order#65115073) on 2/17/11 - Order Result History Report MyChart Status: This result is currently released to MyChart. Last viewed in MyChart: 3/4/2011 7:03 AM By: Mark Amundsen Related Tests THYROXINE, FREE (FREE T4) (Order#65115074) on 2/17/11 Other IDs Lab Specimen # 0217:SC00302R

Unit UCDREG
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Patient Result Comments Entered by Andrew Kim Oh, MD at 2/22/2011 9:40 AM Read by Mark Amundsen at 3/4/2011 7:03 AM Mr. Amundsen, Your blood test results are normal except for elevated TSH. Elevated TSH may indicate that your thyroid hormone levels are still too low. Talk with your primary care doctor, Dr. Baquero, about this.
001700
-Dr. Oh Lab Information Lab UC DAVIS MED CTR 2315 Stockton Blvd Sacramento CA 95817
Lab NPI 1710918545

Order
Allergies
FENTANYL; MORPHINE
Order Information
Isolation
No Isolation
Order Details

Weakness [780.79]
Patient Information
Account # 078661756029
Account Information
001701
2/17/2011 0918
2/17/2011 0918
Entry Date
2/17/2011 Component Results Component Value Flag Reference Range 0.78 0.60 - 1.64 ng/dL THYROXINE, FREE (FREE T4) Comment: Effective Oct 10, 2010 the Clinical Laboratory will begin reporting results from a Beckman Coulter Synchron DxI800 that uses a different methodology. Comparison studies have been performed with the previous platform. Please direct any questions or concerns to the Chemistry laboratory supervisor at phone # 734-2109, or pager # 762-0018. Status Final
Result History
THYROXINE, FREE (FREE T4) (Order#65115074) on 2/17/11 - Order Result History Report MyChart Status:
Last viewed in MyChart: 3/4/2011 7:10 AM By: Mark Amundsen Related Tests THYROID STIMULATING HORMONE (Order#65115073) on 2/17/11 Other IDs Lab Specimen # 0217:SC00302R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
-Dr. Oh
Lab Information
001702
Order
Allergies
FENTANYL; MORPHINE
Order Information
Isolation
No Isolation
Order Details

Weakness [780.79]
Patient Information
Account # 078661756029
Account Information
Order Details
001703
Order Details
Order ID 598954
Lab Results
THYROID PEROXIDASE (TPO) AB (Order 65115072) Received Date and Time 2/17/2011 0918
Entry Date
2/18/2011 Component Results Component THYROID PEROXIDASE (TPO) Ab
Value 22 Flag Reference Range < 35 IU/mL Status Final
Result History
THYROID PEROXIDASE (TPO) AB (Order#65115072) on 2/18/11 - Order Result History Report MyChart Status: This result is currently released to MyChart. Last viewed in MyChart: 10/10/2011 7:50 AM By: Mark Amundsen Other IDs Lab Specimen # 0217:SC00301R

Unit UCDREG
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Patient Result Comments Entered by Andrew Kim Oh, MD at 2/22/2011 9:40 AM Read by Mark Amundsen at 10/10/2011 7:50 AM Mr. Amundsen, Your blood test results are normal except for elevated TSH. Elevated TSH may indicate that your thyroid hormone levels are still too low. Talk with your primary care doctor, Dr. Baquero, about this. -Dr. Oh Lab Information Lab UCDMC SPECIALTY TESTING CENTER 3740 Business Drive
001704
Sacramento CA 95820-2164

Allergies
FENTANYL; MORPHINE
THYROID PEROXIDASE (TPO) AB (Order 65115072)
Order Information
Isolation
No Isolation
Order Details

Weakness [780.79]
Patient Information
Unit UCDREG
MRN 8081369
Sex Male
DOB 9/23/1959
Account # 078661756029
Account Information
Order Details

001705
Entry Date
2/20/2011 Component Results Component Value 1.5 LEAD, BLOOD Comment: VENOUS COLLECTION Blood Lead Levels (BLL) in Adults Blood Lead ---------<10 mcg/dL 10-24 mcg/dL Comment * --------No action needed Identify and minimize lead exposure. Remove from exposure if pregnant. Remove from exposure if symptomatic. Monitor blood lead and zinc protoporphyrin. Medical evaluation required by OSHA if BLL >= 40 mcg/dL. Remove from work with lead. Immediate medical evaluation indicated. Chelation not indicated unless significant symptoms due to lead poisoning. Flag Reference Range 0 - 9.9 mcg/dL Status Final
25-49 mcg/dL
50-79 mcg/dL
>= 80 mcg/dL
Remove from work with lead. Immediate medical evaluation indicated. Chelation may be indicated if symptomatic. Seek consultation. ----------------------------------------------------------*California Dept. of Health services, Childhood Lead Prevention Branch and Occupational Lead Poisoning Prevention Program. Revised 11/02. (510) 622-4332 Refer to OSHA and/or industrial standards.
Result History
LEAD, BLOOD (Order#65115075) on 2/20/11 - Order Result History Report
MyChart Status: This result is currently released to MyChart. Last viewed in MyChart: 3/4/2011 7:02 AM By: Mark Amundsen Other IDs Lab Specimen # 0217:TX00061R
001706
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
-Dr. Oh
Lab NPI 1710918545

Order
Allergies
FENTANYL; MORPHINE
LEAD, BLOOD (Order 65115075)
Order Information
For Capillary (fingerstick) Lead collections: One 0.5 mL lavender Microtainer, mixed well is required. The proper lead capillary collection technique should be followed to minimize extraneous lead contamination of the specime n.
Isolation
No Isolation
Order Details
001707

Weakness [780.79]
Patient Information
Unit UCDREG
Account # 078661756029
Account Information
Order Details

Order
Allergies
FENTANYL; MORPHINE
Order Information
Date and Time 7/12/2010 9:41 AM Electronically Signed By/Authorizing Jeffrey Alan Applebaum Department Fol Family Practice
Order Questions
Isolation
No Isolation
Order Details
Ordered By Admitting Provider Doctor Staff Authorized By JEFFREY ALAN APPLEBAUM [06402] PCP Victor Baquero, MD Released By BARBARA BLANKENCHIP [006147847]
Hypertension [401.9]
001708
Order
Allergies
FENTANYL; MORPHINE
ALBUMIN (Order 60921099)
Order Information
Isolation
No Isolation
Order Details
Ordered By Authorized By VICTOR BAQUERO [08139] Released By BARBARA BLANKENCHIP [006147847]
Weakness [780.79]
Patient Information
Account # 078548433115
Account Information
Order Details

Lab Results
ALDOLASE (Order 65115071) Received Date and Time 2/17/2011 0918
Entry Date
2/21/2011
Component Results Component
Value
Flag
Reference Range
Status
001709
ALDOLASE
5.7
1.5 - 8.1 U/L
Final
Result History
ALDOLASE (Order#65115071) on 2/21/11 - Order Result History Report MyChart Status:
Last viewed in MyChart: 10/10/2011 7:50 AM By: Mark Amundsen Related Tests ACETYLCHOLINE RECEPTOR (Order#65115067) on 2/17/11 ACETYLCHOLINE MODULATING AB (Order#65115068) on 2/17/11 MUSK ANTIBODY (Order#65115069) on 2/17/11 Other IDs Lab Specimen # 0217:S00032R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Patient Result Comments Entered by Andrew Kim Oh, MD at 2/22/2011 9:40 AM Read by Mark Amundsen at 10/10/2011 7:50 AM Mr. Amundsen, Your blood test results are normal except for elevated TSH. Elevated TSH may indicate that your thyroid hormone levels are still too low. Talk with your primary care doctor, Dr. Baquero, about this. -Dr. Oh Lab Information Lab ARUP LABORATORIES 500 Chipeta Way Salt Lake City UT 84108-1221 Phone Number 800-242-2787
Allergies
FENTANYL; MORPHINE
ALDOLASE (Order 65115071)
Order Information
Date and Time Electronically Signed By/Authorizing Department
001710
Account # 078548433115
Account Information
Order Details

Lab Results
HEPATITIS C AB SCREEN (Order 66575308)

Entry Date
3/24/2011
Component Results Component HEPATITIS C Ab SCREEN
Value NR
Flag
Reference Range NonReac/NR
Status Final
Result History
HEPATITIS C AB SCREEN (Order#66575308) on 3/24/11 - Order Result History Report MyChart Status: This result is currently released to MyChart. Last viewed in MyChart: 10/10/2011 7:49 AM By: Mark Amundsen Other IDs Lab Specimen # 0324:SC00277R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Phone Number
001711
916-734-0500 Lab NPI 1710918545

Order
Allergies
FENTANYL; MORPHINE
HEPATITIS C AB SCREEN (Order 66575308)
Order Information
Isolation
No Isolation
Order Details

Patient Information
Account # 078661756037
Account Information
Order Details

Lab Results
HOMOCYSTEINE (Order 91767030)
001712
Lab Results
CRYOGLOBULIN (Order 66575307)

Entry Date
3/27/2011 Component Results Component CRYOGLOBULIN Value 0 Flag Reference Range 0 - 1 % Status Final
Result History
CRYOGLOBULIN (Order#66575307) on 3/27/11 - Order Result History Report MyChart Status:
Last viewed in MyChart: 11/21/2012 11:54 PM By: Mark Amundsen Other IDs Lab Specimen # 0324:CG00159R

Unit UCDREG
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Allergies
FENTANYL; MORPHINE
CRYOGLOBULIN (Order 66575307)
Order Information
Isolation
001713
Associated Diagnoses Diarrhea [787.91] Colitis [558.9] Priority and Order Details Priority Class Routine Back Office
Lab Results
PROTEIN CSF (Order 68032996) Received Date and Time 4/28/2011 1457
Entry Date
4/28/2011
Component Results Component PROTEIN CSF
Value 44
Flag
Reference Range 15 - 45 mg/dL
Status Final
Result History
PROTEIN CSF (Order#68032996) on 4/28/11 - Order Result History Report
MyChart Status: This result is currently not released to MyChart. Related Tests GLUCOSE CSF (Order#68032995) on 4/28/11 Other IDs Reflex Order # 68032995 Lab Specimen # 0428:SF00007S

Unit NEUCAR
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
PROTEIN CSF (Order 68032996)
001714
Allergies
FENTANYL; MORPHINE
Order Information
Isolation
No Isolation
Order Details
Ordered By Authorized By ANDREW KIM OH [10912]
Admitting Provider

Collection Date and Time 4/28/2011 1445 Interfaced Collector 11275
Patient Information
Order Details
Order ID 68032996
Order
Allergies
FENTANYL; MORPHINE
PROTEIN CSF (Order 66574450)
Order Information

Order Status Canceled By Victor Henrique Baquero, MD On 10/27/11 1316 Reason None
Isolation
No Isolation
Order Details
001715
No Isolation
Order Details

Weakness [780.79]
Patient Information
Account # 078548433115
Account Information
Order Details

Lab Results
GLUCOSE CSF (Order 68032995)

Entry Date
4/28/2011
Component Results Component GLUCOSE CSF
Value 55
Flag
Reference Range 45 - 80 mg/dL
Status Final
Result History
GLUCOSE CSF (Order#68032995) on 4/28/11 - Order Result History Report
001716
MyChart Status: This result is currently not released to MyChart. Related Tests PROTEIN CSF (Order#68032996) on 4/28/11 Other IDs Lab Specimen # 0428:SF00007S
Patient Information Patient Name Amundsen, Mark Unit NEUCAR
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Lab NPI 1710918545

Order
Allergies
FENTANYL; MORPHINE
Order Information
Isolation
No Isolation
Order Details
Admitting Provider

001717
Patient Information
Order Details
Order ID 68032995
Order
Allergies
FENTANYL; MORPHINE
Order Information

Isolation
No Isolation
Order Details

Patient Information
Account # 078661756037
Account Information
001718
Account # 078199740024
Account Information
Order Details
Order ID 15494563
Lab Results
LYME(B.BURGDORFERI) AB, CSF (Order 68032994) Received Date and Time 4/28/2011 1457
Entry Date
4/29/2011
Component Results Component Value Flag Reference Range B.BURGDORFERI 0.07 <=0.99 LIV ABS,TOTAL (CSF) Comment: REFERENCE INTERVAL: Borrelia burgdorferi Total Antibodies, by ELISA (CSF) 0.99 LIV or less: ......... Negative - Antibody to Borrelia burgdorferi not detected. 1.00 - 1.20 LIV ........... Equivocal - Repeat testing in 10-14 days may be helpful. 1.21 LIV or greater: ...... Positive - Probable presence of antibody to Borrelia burgdorferi detected. The detection of antibodies to Borrelia burgdorferi in CSF may indicate central nervous system infection. However, consideration must be given to possible contamination by blood or transfer of serum antibodies across the blood-brain barrier. Current CDC recommendations for the serologic diagnosis of Lyme disease are to screen with a polyvalent ELISA test and confirm equivocal and positive results with Western Blot. Both IgM and IgG Western Blots should be performed on samples less than 4 weeks after appearance of erythema migrans. Only IgG Western Blot should be performed on samples greater than 4 weeks after the disease onset. IgM Western Blot in the chronic stage is not recommended and does not aid in the diagnosis of neuroborreliosis or chronic Lyme disease. Please submit requests for appropriate Western Blot testing within 10 days. The manufacturer has not determined the efficacy of this test when performed on CSF specimens. The performance characteristics of this test were determined by ARUP Laboratories.
Status Final
Result History
001719
LYME(B.BURGDORFERI) AB, CSF (Order#68032994) on 4/29/11 - Order Result History Report MyChart Status:
Other IDs Lab Specimen # 0428:S00102R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Lab Information Lab ARUP LABORATORIES 500 Chipeta Way Salt Lake City UT 84108-1221 Phone Number 800-242-2787 Lab NPI 1982694931
Order
Allergies
FENTANYL; MORPHINE
LYME(B.BURGDORFERI) AB, CSF (Order 68032994)
Order Information
Isolation
No Isolation
Order Details

001720
Patient Information
Order Details
Order ID 68032994
Order
Allergies
FENTANYL; MORPHINE
LYME(B.BURGDORFERI) AB, CSF (Order 66574452)
Order Information

Isolation
No Isolation
Order Details

Patient Information
Account # 078661756037
Account Information
001721
078661756037
Account Information
Order Details

Lab Results

Received Date and Time 4/28/2011 1700 Source CSF, LUMBAR PUNCTURE
Entry Date
5/1/2011
Component Results
GRAM STAIN: GRAM STAIN
Final
GRAM STAIN CULTURE CSF, ABBREV: CULTURE CSF, ABBREV
1+ WHITE BLOOD CELLS NO ORGANISMS SEEN Final
NO GROWTH AFTER 3 DAYS
Result History
CULTURE CSF (INCLUDES GS), BACTI (Order#68126522) on 5/1/11 - Order Result History Report
Other IDs Lab Specimen # 11:B0023992S
MyChart Status: This result is currently not released to MyChart. Microbiology Report Microbiology Reviewed by List CARBOGNIN, SUSAN on Mon May 2, 2011 0832 CARBOGNIN, SUSAN on Mon May 2, 2011 0832 OH, ANDREW on Mon May 9, 2011 1133 CARBOGNIN, SUSAN on Mon Jun 4, 2012 0749 Patient Information Patient Name Amundsen, Mark MRN 8081369 Sex M DOB 9/23/1959 (53yr) Home Phone 916-509-0158
001722
Unit NEUCAR
Lab Information Lab UCDMC SPECIALTY TESTING CENTER 3740 Business Drive Sacramento CA 95820-2164 Phone Number 916-734-0500 Lab NPI 1710918545
Order
Allergies
FENTANYL; MORPHINE
Order Information
Submit as much fluid as possible in a sterile container. At least 0.5mL fluid is required per test request. Prioritize testing if necessary. In comments, indicate specimen source for CSF shunt specimens.
Isolation
No Isolation
Order Details
Ordered By
Admitting Provider


Specimen CSF, LUMBAR PUNCTURE Collection Date and Time 4/28/2011 1430
Patient Information
Order Details
Order ID 68126522
001723

Isolation
No Isolation
Order Details

Dyspepsia and other specified disorders of function of stomach [536.8]
Patient Information
Account # 078199740024
Account Information
Order Details
Order ID 15494567
Lab Results
CELL COUNT, CSF (Order 68032993)
Entry Date
5/3/2011 Component Results Component Value Flag Reference Range Status
001724
APPEARANCE CSF #3 CLEAR/COLORLESS CSF VOLUME 14.0 0 - 50 CC Comment: SPLIT WITH CHEM, IMMUNO,MICRO AND SENDOUTS. CSF XANTHOCHROMIA ABSENT CSF #3 RED CELL 1 H 0 - 0 /MM3 COUNT 3 0 - 5 /MM3 CSF #3 WHITE CELL COUNT CSF LYMPHOCYTES% 59 40 - 80 % CSF HISTIOCYTES% 38 % CSF MACROPHAGES% 3 % CSF # OF WBC 100 # IDENTIFIED INTERPRETATION, See Comment FLUID CYTOPATH Comment: A cytospin slide is reviewed. Concur with differential. No overt foreign cells or organisms seen. FACULTY PI 06322 ATTESTATION, FLUID Comment: I have personally reviewed the Laboratory test results and this is my assessment of them. Electronically signed by: Ralph Green, MD PI# 06322 Pathology Faculty 05/03/11 1554
Final Final
Final
Result History
CELL COUNT, CSF (Order#68032993) on 5/3/11 - Order Result History Report MyChart Status: This result is currently not released to MyChart. Other IDs Lab Specimen # 0428:H00852S
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Lab Information Lab UC DAVIS MED CTR 2315 Stockton Blvd Sacramento CA 95817 Phone Number
001725
916-734-0500 Lab NPI 1710918545

Order
Allergies
FENTANYL; MORPHINE
Order Information
Isolation
No Isolation
Order Details

Patient Information
Unit NEUCAR
MRN 8081369
Sex Male
DOB 9/23/1959
Order Details
Order ID 68032993
Order
Allergies
FENTANYL; MORPHINE
Order Information

Isolation
001726
Ordered By Admitting Provider Doctor Staff Authorized By ANDREW KIM OH [10912] PCP Victor Baquero, MD Released By BARBARA BLANKENCHIP [006147847]

Patient Information
Account # 078661756110
Account Information
Order Details

Lab Results
SYPHILIS TEST CSF (VDRL) (Order 68033292) Received Date and Time 4/28/2011 1457
Entry Date
5/6/2011 Component Results Component VDRL SCREEN Value NR Flag Reference Range NonReac/NR Status Final
Result History
SYPHILIS TEST CSF (VDRL) (Order#68033292) on 5/6/11 - Order Result History Report MyChart Status: This result is currently not released to MyChart. Other IDs Lab Specimen # 0428:I00105S
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
001727
Unit NEUCAR
Lab Information Lab UCDMC SPECIALTY TESTING CENTER 3740 Business Drive Sacramento CA 95820-2164 Phone Number 916-734-0500
Allergies
FENTANYL; MORPHINE
SYPHILIS TEST CSF (VDRL) (Order 68033292)
Order Information
Isolation
No Isolation
Order Details
Ordered By
Admitting Provider


Patient Information
Order Details
Order ID 68033292
Order
Allergies
FENTANYL; MORPHINE
TESTOSTERONE,BIOAVAIL MALE>17 (Order 60917267)
001728
01:15:13
PM
Page 1 of,
AMUNDSEN IWIK
MR 8081369 0912311969 M
_.SP&CIMEN INro~'l'ION
PATIBNT
AKQNDSBN, MARK
DOB: 09/23/1959 AGE: 51 GENDER: M FASTING: N
IV:
IN1'OIU'IATtON
R13PORT STA'lVS
PINAL
J
999999
--
-----1314.2
13: 43-
ORDB1l.ING l'RYBICIAtl'
llAQUBRO, VICTOR
Cl.l1:NT lNrolUU.'l."IOtl:
SPECIMEN:
GZS5?0758
REOOISITION; COLLBCTED: RBPORTIID: 05/05/11 05/05/11 05/11/11
PaoNE: 916-983 2599

w
601142B v:rCTOR aAQUERO, MD 251 TllllN PIKE DR
FOLSOM, CA
95630
RECEIVED:
916-985-9300
08:34 O1.1t of Range
Teet Name
COBALT. SERUM/PLASMA
Lob meg/I,
COBALT
NOllE DETECTED
Analysis by lnductively
Spectrometry Reporting (ICP/MS) 1.0 Limit:
CoupleQ plasma/Mass
Reference range: Less than 0.5 meg/L. Not for clinical diagnostic purpoees. Not for clinical purposes in New York State.
PatroRKlKG
1CM
;t.A8OUroay
nOl
IDOItDTI.ON
Willow QrQve, PA 19090
lIlMSLab
wellll'lo Rd,
Laborat~ry Oirector~ Robert A. ~1ddl.berg, PH.D.
Phone, 215-657-0900
AMUNDSEN,MARK
- GZ55707SB
Page 1 - End of Report
001729
Order Details
Order ID 66574452
Lab Results
MULTIPLE SCLEROSIS PANEL (Order 68029621)

Entry Date
5/18/2011 Component Results Component Value Flag Reference Range IMMUNOGLOBULIN G,SERUM 1020 768 - 1632 mg/dL IMMUNOGLOBULIN G, CSF 3.1 0.0 - 6.0 mg/dL ALBUMIN,SERUM (NEPH) 4360 3500 - 5200 mg/dL ALBUMIN,CSF 31 0 - 35 mg/dL ALBUMIN INDEX 7.1 0.0 - 9.0 ratio CSF IgG SYNTHESIS RATE <0.0 <=8.0 mg/d IGG INDEX 0.43 0.28 - 0.66 ratio CSF IgG/ALBUMIN RATIO 0.10 0.09 - 0.25 ratio CSF OLIGOCLONAL BANDS Negative Negative INTERPRETATION/SPECIAL See Note () Comment: Isoelectric focusing/immunofixation reveals no oligoclonal bands in either the CSF or the serum. This is considered to be a negative result for oligoclonal bands. Approximately 5 percent of patients with clinically definitive multiple sclerosis will have a negative result. Status Final Final Final Final Final Final Final Final Final Final
Result History
MULTIPLE SCLEROSIS PANEL (Order#68029621) on 5/18/11 - Order Result History Report
MyChart Status: This result is currently released to MyChart. Last viewed in MyChart: 10/10/2011 7:52 AM By: Mark Amundsen Other IDs
001730
Lab Specimen # 0428:S00090R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Lab Information Lab ARUP LABORATORIES 500 Chipeta Way Salt Lake City UT 84108-1221
Lab NPI 1982694931

Order
Allergies
FENTANYL; MORPHINE
MULTIPLE SCLEROSIS PANEL (Order 68029621)
Order Information
Isolation
No Isolation
Order Details
Ordered By Admitting Provider Doctor Staff Authorized By ANDREW KIM OH [10912] PCP Victor Baquero, MD Released By LANY LEUNG [369730874]

Patient Information
001731
Order Details

Patient Information
Account # 078872030115
Account Information
Order Details

Lab Results
Entry Date
11/2/2011 Component Results Component WHITE BLOOD CELL COUNT RED CELL COUNT Value 7.4 4.22 Flag Reference Range 4.5 - 11.0 K/MM3 4.5 - 5.9 M/MM3 Status Final Final
001732
HEMOGLOBIN HEMATOCRIT MCV MCH MCHC RDW MPV PLATELET COUNT NEUTROPHILS % AUTO LYMPHOCYTES % AUTO MONOCYTES % AUTO EOSINOPHIL % AUTO BASOPHILS % AUTO NEUTROPHIL ABS AUTO LYMPHOCYTE ABS AUTO MONOCYTES ABS AUTO EOSINOPHIL ABS AUTO BASOPHILS ABS AUTO
13.1 38.3 90.8 31.1 34.3 13.7 9.4 170 43.4 47.1 5.1 4.1 0.3 3.20 3.5 0.4 0.3 0
L L
13.5 - 17.5 GM/DL 41 - 53 % 80 - 100 UM3 27 - 33 PG 32 - 36 % 0 - 14.7 UNITS 6.8 - 10.0 UM3 130 - 400 K/MM3 % % % % % 1.80 - 7.70 K/MM3 1.0 - 4.8 K/MM3 0.1 - 0.8 K/MM3 0 - 0.5 K/MM3 0 - 0.2 K/MM3
Final Final Final Final Final Final Final Final Final Final Final Final Final Final Final Final Final Final
Result History
MyChart Status:
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Lab NPI 1710918545

Order
Allergies
FENTANYL; MORPHINE
Order Information
Date and Time 3/29/2011 10:26 AM Electronically Signed By Margaret Korzewski Authorizing Arthur Brooks Dublin, MD Department Vascular Center Clinic
001733

Admitting Provider
Patient Information
Unit FAMFOL
MRN 8081369
Sex Male
DOB 9/23/1959
Account # 078199740024
Account Information
Order Details
Order ID 15494560
Lab Results
APTT STUDIES (Order 75750547) Received Date and Time 11/2/2011 1106
Entry Date
11/2/2011
Component Results Component APTT
Value 29.8
Flag
Reference Range 24.1 - 36.7 SECONDS
Status Final
Result History
APTT STUDIES (Order#75750547) on 11/2/11 - Order Result History Report
MyChart Status: This result is currently not released to MyChart. Other IDs Lab Specimen # 1102:CG00224R
001734
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Order
Allergies
FENTANYL; MORPHINE
APTT STUDIES (Order 75750547)
Order Information
Order Questions
Isolation
No Isolation
Order Details
Ordered By Admitting Provider Doctor Staff Authorized By ARTHUR BROOKS DUBLIN [00230] PCP Victor Baquero, MD Released By BARBARA BLANKENCHIP [006147847]

Polyneuropathy [356.9] Preop testing [V72.84]
Patient Information
Patient Name MRN Sex DOB
001735
Patient Information
Account # 078661756110
Account Information
Order Details

Lab Results

Entry Date
11/2/2011 Component Results Component CREATINE KINASE Value 55 Flag Reference Range 0 - 250 U/L Status Final
Result History
CREATINE KINASE (Order#75750543) on 11/2/11 - Order Result History Report MyChart Status: This result is currently not released to MyChart. Related Tests HEPATIC FUNCTION PANEL (Order#75750544) on 11/2/11 LIPID PANEL WITH DLDL REFLEX (Order#75750551) on 11/2/11 LDL CHOLESTEROL (DIRECT) (Order#75771653) on 11/2/11 Other IDs Lab Specimen # 1102:CI00895R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Lab Information
001736
Order
Allergies
FENTANYL; MORPHINE
Order Information
Date and Time 2/1/2011 11:08 AM Electronically Signed By Xiao Cai, MD Authorizing Barton Lahn Wise, MD Department Rheumatology Acc
Isolation
No Isolation
Order Details
Ordered By Admitting Provider Doctor Staff Authorized By BARTON LAHN WISE [11121] PCP Victor Baquero, MD Released By BARBARA BLANKENCHIP [006147847]
Cosign Info
Action Ordering Responsible Provider Barton Lahn Wise, MD Signed By Barton Lahn Wise, MD Signed On 02/01/11 1236
Cosign Order Info


Weakness [780.79]
Patient Information
Unit UCDREG
MRN 8081369
Sex Male
DOB 9/23/1959
Account # 078661756110
001737
For Placing Order
At 12/20/09 0808
Acknowledged By Christena R Schob, RN

Patient Information
Account # 050017321477
Account Information
Order Details
Lab Results

Entry Date
11/2/2011
Component Results Component PROTEIN ALBUMIN ALKALINE PHOSPHATASE (ALP) ASPARTATE TRANSAMINASE (AST) BILIRUBIN TOTAL ALANINE TRANSFERASE (ALT) BILIRUBIN DIRECT
Value 6.8 3.9 75 20 0.5 20 < 0.1
Flag
Reference Range 6.3 - 8.3 g/dL 3.4 - 4.8 g/dL 35 - 115 U/L 15 - 43 U/L 0.3 - 1.3 mg/dL 6 - 63 U/L 0.0 - 0.2 mg/dL
Result History
HEPATIC FUNCTION PANEL (Order#75750544) on 11/2/11 - Order Result History Report
MyChart Status:
Related Tests CREATINE KINASE (Order#75750543) on 11/2/11 LIPID PANEL WITH DLDL REFLEX (Order#75750551) on 11/2/11 LDL CHOLESTEROL (DIRECT) (Order#75771653) on 11/2/11 Other IDs Lab Specimen #
001738
1102:CI00895R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Order
Allergies
FENTANYL; MORPHINE
Order Information
Date and Time 2/1/2011 11:08 AM Electronically Signed By Xiao Cai, MD Authorizing Barton Lahn Wise, MD Department Rheumatology Acc
Isolation
No Isolation
Order Details
Ordered By Admitting Provider Doctor Staff Authorized By BARTON LAHN WISE [11121] PCP Victor Baquero, MD Released By BARBARA BLANKENCHIP [006147847]
Cosign Info
Cosign Order Info


001739
Patient Information
Account # 078548433115
Account Information
Order Details

Lab Results
LDL CHOLESTEROL (DIRECT) (Order 75771653) Received Date and Time 11/2/2011 1106
Entry Date
11/2/2011 Component Results Component LDL CHOLESTEROL (DIRECT)
Value 103 Flag Reference Range <130 mg/dL Status Final
Result History
LDL CHOLESTEROL (DIRECT) (Order#75771653) on 11/2/11 - Order Result History Report MyChart Status: This result is currently not released to MyChart. Related Tests CREATINE KINASE (Order#75750543) on 11/2/11 HEPATIC FUNCTION PANEL (Order#75750544) on 11/2/11 LIPID PANEL WITH DLDL REFLEX (Order#75750551) on 11/2/11 Other IDs Reflex Order # 75750543
Lab Specimen # 1102:CI00895R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
001740
Lab NPI 1710918545

Order
Allergies
FENTANYL; MORPHINE LDL CHOLESTEROL (DIRECT) (Order 75771653)
Order Information
Date and Time 11/2/2011 4:47 PM Electronically Signed By Lab Results Interface Authorizing Barton Lahn Wise, MD Department Ucd Registration
Isolation
No Isolation
Order Details
Ordered By Authorized By BARTON LAHN WISE [11121]

Patient Information
Account # 078661756110
Account Information
Order Details
Order ID 75771653
Lab Results
LEAD, BLOOD (Order 65115075)
001741
Entry Date
11/2/2011
Component Results Component Value Flag Reference Range FASTING YES CHOLESTEROL 220 H 0 - 200 mg/dL Comment: Desirable adult value < 200 mg/dL HDL CHOLESTEROL 36 >= 35 mg/dL LDL CHOLESTEROL Test not < 130 mg/dL CALCULATION performed Comment: Unable to calculate LDL due to elevated triglyceride. TOTAL 6.1 H < 4.0 CHOLESTEROL:HDL RATIO TRIGLYCERIDE 444 H 35 - 160 mg/dL NON-HDL CHOLESTEROL 184 H 0 - 160 mg/dl Comment: Desirable: <160 mg/dl
Status Final Final
Final Final
Final
Final Final
Result History
LIPID PANEL WITH DLDL REFLEX (Order#75750551) on 11/2/11 - Order Result History Report
MyChart Status: This result is currently released to MyChart. Last viewed in MyChart: 11/4/2011 8:04 AM By: Mark Amundsen Related Tests CREATINE KINASE (Order#75750543) on 11/2/11 HEPATIC FUNCTION PANEL (Order#75750544) on 11/2/11 LDL CHOLESTEROL (DIRECT) (Order#75771653) on 11/2/11 Other IDs Lab Specimen # 1102:CI00895R

Unit UCDREG
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Patient Result Comments Entered by Victor Baquero, MD at 11/3/2011 12:16 PM Read by Mark Amundsen at 11/4/2011 8:04 AM
001742
Mark, The thyroid level is still low. Are you taking the levothyroxine every morning by itself? The cholesterol is mildly elevated. Triglycerides in particular. This will improve as the thyroid level returns to normal - target TSH is 0.8. Lab Information Lab UC DAVIS MED CTR 2315 Stockton Blvd Sacramento CA 95817 Phone Number 916-734-0500
Allergies
FENTANYL; MORPHINE
Order Information
Order Questions
Isolation
No Isolation
Order Details

Patient Information
Unit
001743
916-734-0500 Lab NPI 1710918545

Order
Allergies
FENTANYL; MORPHINE
SENDOUT URINE (Order 61656577)
Order Information
Date and Time 11/19/2010 8:38 PM Electronically Signed By Lab Results Interface Authorizing Victor Baquero, MD Department Fol Family Practice
Result Narrative:
TEST: COLBALT SOURCE: 24 HOUR URINE 11/18/10 @ 1150 THRU 11/19/10 @ 1145 T.V.=1050mL
Isolation
No Isolation
Order Details

Patient Information
Order Details
Order ID 61656577
Lab Results

Entry Date
001744
Result Narrative
RELEASED FROM EMR IN ERROR By: BLANKENSHIP,BARBARA Date/time: 11/02/11 1116
Result History
SYPHILIS TEST CSF (VDRL) (Order#75750545) on - Order Result History Report MyChart Status: This result is automatically blocked from release to MyChart. Other IDs Lab Specimen # 1102:I00052R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Lab Information Lab

Order
Allergies
FENTANYL; MORPHINE
Order Information

Order Status By Lab Results Interface Canceled RELEASED FROM EMR IN ERROR On 11/2/11 1116 Reason Cancelled
Result Narrative:
RELEASED FROM EMR IN ERROR By: BLANKENSHIP,BARBARA Date/time: 11/02/11 1116
Isolation
No Isolation
Order Details
001745
Lab Results
Entry Date
11/2/2011
Component Results Component THYROID STIMULATING HORMONE
Value 6.08
Flag H
Status Final
Result History
THYROID STIMULATING HORMONE (Order#75750548) on 11/2/11 - Order Result History Report MyChart Status: This result is currently released to MyChart. Last viewed in MyChart: 11/21/2012 11:49 PM By: Mark Amundsen Related Tests THYROXINE, FREE (FREE T4) (Order#75750550) on 11/2/11 Other IDs Lab Specimen # 1102:SC00535R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Patient Result Comments Entered by Victor Baquero, MD at 11/3/2011 12:16 PM Read by Mark Amundsen at 11/21/2012 11:49 PM Mark, The thyroid level is still low. Are you taking the levothyroxine every morning by itself? The cholesterol is mildly elevated. Triglycerides in particular. This will improve as the thyroid level returns to normal - target TSH is 0.8. Lab Information Lab UC DAVIS MED CTR 2315 Stockton Blvd Sacramento CA 95817
001746

Allergies
FENTANYL; MORPHINE
Order Information
Isolation
No Isolation
Order Details

Hypothyroid [244.9]
Patient Information
Account # 078661756110
Account Information
Order Details

001747
Entry Date
11/2/2011 Component Results Component THYROXINE, FREE (FREE T4) Value 0.68 Flag Reference Range 0.56 - 1.64 ng/dL Status Final
Result History
THYROXINE, FREE (FREE T4) (Order#75750550) on 11/2/11 - Order Result History Report MyChart Status:
Last viewed in MyChart: 11/21/2012 11:54 PM By: Mark Amundsen Related Tests THYROID STIMULATING HORMONE (Order#75750548) on 11/2/11 Other IDs Lab Specimen # 1102:SC00535R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Patient Result Comments Entered by Victor Baquero, MD at 11/3/2011 12:16 PM Read by Mark Amundsen at 11/21/2012 11:54 PM Mark, The thyroid level is still low. Are you taking the levothyroxine every morning by itself? The cholesterol is mildly elevated. Triglycerides in particular. This will improve as the thyroid level returns to normal - target TSH is 0.8. Lab Information Lab UC DAVIS MED CTR 2315 Stockton Blvd Sacramento CA 95817 Phone Number 916-734-0500
001748
Lab NPI 1710918545

Order
Allergies
FENTANYL; MORPHINE
Order Information
Isolation
No Isolation
Order Details

Hypothyroid [244.9]
Patient Information
Account # 078661756110
Account Information
Order Details

Lab Results
Collection Information Collection Date and Time
THYROXINE, FREE (FREE T4) (Order 65115074) Received Date and Time
001749
582705
Lab Results
VITAMIN B12 (Order 75750552) Received Date and Time 11/2/2011 1106
Entry Date
11/2/2011 Component Results Component VITAMIN B12 Value 495 Flag Reference Range 211 - 911 pg/mL Status Final
Result History
VITAMIN B12 (Order#75750552) on 11/2/11 - Order Result History Report MyChart Status: This result is currently released to MyChart. Last viewed in MyChart: 11/4/2011 8:04 AM By: Mark Amundsen Other IDs Lab Specimen # 1102:SC00536R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Patient Result Comments Entered by Victor Baquero, MD at 11/3/2011 12:16 PM Read by Mark Amundsen at 11/4/2011 8:04 AM Mark, The thyroid level is still low. Are you taking the levothyroxine every morning by itself? The cholesterol is mildly elevated. Triglycerides in particular. This will improve as the thyroid level returns to normal - target TSH is 0.8. Lab Information Lab UCDMC SPECIALTY TESTING CENTER 3740 Business Drive Sacramento CA 95820-2164 Phone Number 916-734-0500
Lab NPI
001750
1710918545
Order
Allergies
FENTANYL; MORPHINE
VITAMIN B12 (Order 75750552)
Order Information
Isolation
No Isolation
Order Details

Patient Information
Account # 078661756110
Account Information
Order Details

Lab Results
VITAMIN B12 (Order 60921094) Received Date and Time 11/2/2010 1337
001751
Entry Date
11/2/2010 Component Results Component VITAMIN B12 Value 478 Flag Reference Range 211 - 911 pg/mL Status Final
Result History
VITAMIN B12 (Order#60921094) on 11/2/10 - Order Result History Report MyChart Status: This result is currently released to MyChart. Last viewed in MyChart: 11/5/2010 3:35 PM By: Mark Amundsen Related Tests FOLATE (Order#60921095) on 11/2/10 Other IDs Lab Specimen # 1102:SC00649R

Unit UCDREG
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Patient Result Comments Entered by Victor Baquero, MD at 11/5/2010 2:01 PM Read by Mark Amundsen at 11/5/2010 3:35 PM Mark, I got all the labs back. Other than the low vitamin D (cont replacement until the level is closer to 50), the only other abnormality is that your cholesterol is high. I am thinking that your symptoms are possibly due to medications. Consider decreasing the dose of methadone gradually - I how pain may increase but I can't help but think that the long term use of methadone may be causing some of your symptoms. All organ systems are within normal limits. I'm away this week on vacation but come see me after the 16th if you are not feeling better. Lab Information Lab UCDMC SPECIALTY TESTING CENTER 3740 Business Drive Sacramento CA 95820-2164
Lab NPI 1710918545
001752
Admitting Provider
Patient Information
Unit FAMFOL
Account # 078199740024
Account Information
Order Details
Order ID 15494562
Lab Results
CORTISOL (Order 75750542)

Entry Date
11/3/2011 Component Results Component Value 3.6 CORTISOL Comment: Cortisol Reference Range: ========================= AM = 4.3 - 22.4 mcg/dL PM = 3.1 - 16.7 mcg/dL Flag Reference Range mcg/dL Status Final
Result History
CORTISOL (Order#75750542) on 11/3/11 - Order Result History Report
MyChart Status: This result is currently released to MyChart. Last viewed in MyChart: 11/4/2011 8:05 AM By: Mark Amundsen Other IDs Lab Specimen # 1102:SC00534R
MRN
Sex
DOB
Home Phone
001753
8081369
9/23/1959 (53yr)
916-509-0158
Patient Result Comments Entered by Victor Baquero, MD at 11/3/2011 12:16 PM Read by Mark Amundsen at 11/4/2011 8:05 AM Mark, The thyroid level is still low. Are you taking the levothyroxine every morning by itself? The cholesterol is mildly elevated. Triglycerides in particular. This will improve as the thyroid level returns to normal - target TSH is 0.8. Lab Information Lab UCDMC SPECIALTY TESTING CENTER 3740 Business Drive Sacramento CA 95820-2164 Phone Number 916-734-0500
Allergies
FENTANYL; MORPHINE
CORTISOL (Order 75750542)
Order Information
Isolation
No Isolation
Order Details

Weakness [780.79]
001754
Order
Allergies
FENTANYL; MORPHINE
VITAMIN B12 (Order 60921094)
Order Information
Isolation
No Isolation
Order Details

Weakness [780.79]
Patient Information
Unit UCDREG
Account # 078548433115
Account Information
Order Details

Lab Results
001755
Entry Date
11/3/2010 Component Results Component Value Flag VITAMIN D, 25 25.1 L HYDROXY Comment: ng/mL Vitamin D Status ************************************* Deficiency < 10 Insufficiency 10-29 Sufficiency 30-100 Toxicity > 100 Reference Range 30.0 - 100.0 ng/mL Status Final
Result History
VITAMIN D, 25 HYDROXY (Order#60921089) on 11/3/10 - Order Result History Report
MyChart Status:
Last viewed in MyChart: 11/5/2010 3:34 PM By: Mark Amundsen Other IDs Lab Specimen # 1102:SC00648R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Patient Result Comments Entered by Victor Baquero, MD at 11/5/2010 2:01 PM Read by Mark Amundsen at 11/5/2010 3:34 PM Mark, I got all the labs back. Other than the low vitamin D (cont replacement until the level is closer to 50), the only other abnormality is that your cholesterol is high. I am thinking that your symptoms are possibly due to medications. Consider decreasing the dose of methadone gradually - I how pain may increase but I can't help but think that the long term use of methadone may be causing some of your symptoms. All organ systems are within normal limits. I'm away this week on vacation but come see me after the 16th if you are not feeling better. Lab Information
001756
Lab UCDMC SPECIALTY TESTING CENTER 3740 Business Drive Sacramento CA 95820-2164 Phone Number 916-734-0500 Lab NPI 1710918545
Order
Allergies
FENTANYL; MORPHINE
Order Information
Isolation
No Isolation
Order Details

Patient Information
Account # 078548433115
Account Information
Order Details
001757

Patient Information
Account # 078438665057
Account Information
Order Details

Lab Results
CBC AUTO + REFLEX MANUAL DIFF (Order 91767028) Received Date and Time 11/20/2012 1151
Entry Date
11/20/2012
Component Results Component WHITE BLOOD CELL COUNT RED CELL COUNT HEMOGLOBIN HEMATOCRIT MCV MCH MCHC RDW MPV PLATELET COUNT NEUTROPHILS % AUTO LYMPHOCYTES % AUTO MONOCYTES % AUTO EOSINOPHIL % AUTO BASOPHILS % AUTO NEUTROPHIL ABS AUTO
Value 7.6
Flag
Reference Range 4.5-11.0 K/MM3
Status Final
4.50 14.0 41.0 91.2 31.0 34.0 13.8 9.8 167 45.9 44.7 6.6 2.7 0.1 3.50
4.5-5.9 M/MM3 13.5-17.5 GM/DL 41-53 % 80-100 UM3 27-33 PG 32-36 % 0-14.7 UNITS 6.8-10.0 UM3 130-400 K/MM3 % % % % % 1.80-7.70 K/MM3
Final Final Final Final Final Final Final Final Final Final Final Final Final Final Final
001758
LYMPHOCYTE ABS AUTO MONOCYTES ABS AUTO EOSINOPHIL ABS AUTO BASOPHILS ABS AUTO
3.4 0.5 0.2 0
1.0-4.8 K/MM3 0.1-0.8 K/MM3 0-0.5 K/MM3 0-0.2 K/MM3
Result History
MyChart Status:
Last viewed in MyChart: 11/21/2012 11:52 PM By: Mark Amundsen Other IDs Lab Specimen # 1120:H00734R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Patient Result Comments Entered by Victor Baquero, MD at 11/21/2012 1:24 PM Read by Mark Amundsen at 11/21/2012 11:52 PM Mark, recent labs are normal. The thyroid is actually improved compared to the previous test, and within the normal range. Perhaps slightly low but not like before. All other physiologic markers and tests are normal. Lab Information Lab UC DAVIS MED CTR 2315 Stockton Blvd Sacramento CA 95817
Lab NPI 1710918545

Order
Allergies
FENTANYL; MORPHINE
Order Information
Isolation
No Isolation
001759
Patient Information
Order Details
Order ID 583288
Lab Results
Entry Date
11/20/2012 Component Results Component SODIUM POTASSIUM CHLORIDE CARBON DIOXIDE TOTAL UREA NITROGEN, BLOOD (BUN) CREATININE BLOOD E-GFR, AFRICAN AMERICAN Comment: mL/min/1.73 square E-GFR, NON-AFRICAN AMERICAN Comment: mL/min/1.73 square Value 138 4.2 103 25 11 0.97 >60 Flag Reference Range 135-145 mEq/L 3.3-5.0 mEq/L 95-110 mEq/L 24-32 mEq/L 8-22 mg/dL 0.44-1.27 mg/dL >60 SEE NOTE Status Final Final Final Final Final Final Final
meters >60
>60 SEE NOTE
Final
meters
Note: The estimated GFR result assumes a steady-state and is most accurate for GFRs <60 mL/min/1.73 square meters. The eGFR is not reliable in certain groups, including severely ill patients. Also, patients >59 years of age can have a mildly reduced GFR due to aging. The MDRD equations used to estimate GFR have been validated only in Caucasian and African-Americans 18 - 70 years of age. The equations have not been validated in other population groups, including pregnant women, transplant recipients, medically unstable patients including those with acute renal failure, or in persons with extremes of body size, muscle mass, or nutritional status. Application of the MDRD calculation in these cases may lead to errors in GFR estimation. GLUCOSE 61 L 70-99 mg/dL Comment: The reference interval is based on a fasting patient. CALCIUM 9.1 8.6-10.5 mg/dL
Final
Final
001760
PROTEIN ALBUMIN ALKALINE PHOSPHATASE (ALP) ASPARTATE TRANSAMINASE (AST) BILIRUBIN TOTAL ALANINE TRANSFERASE (ALT)
6.8 4.1 83 18 0.6 13
6.3-8.3 g/dL 3.4-4.8 g/dL 35-115 U/L 15-43 U/L 0.3-1.3 mg/dL 6-63 U/L
Final Final Final Final Final Final
Result History
COMPREHENSIVE METABOLIC PANEL (Order#91767027) on 11/20/12 - Order Result History Report MyChart Status: This result is currently released to MyChart. Last viewed in MyChart: 11/21/2012 11:54 PM By: Mark Amundsen Other IDs Lab Specimen # 1120:CI00931R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Patient Result Comments Entered by Victor Baquero, MD at 11/21/2012 1:24 PM Read by Mark Amundsen at 11/21/2012 11:54 PM Mark, recent labs are normal. The thyroid is actually improved compared to the previous test, and within the normal range. Perhaps slightly low but not like before. All other physiologic markers and tests are normal. Lab Information Lab UC DAVIS MED CTR 2315 Stockton Blvd Sacramento CA 95817 Phone Number 916-734-0500
Allergies
FENTANYL; MORPHINE
001761
Expected By 3/24/11 (Approximate)
Expires 3/23/12
Admitting Provider
Patient Information
Account # 078661756037
Account Information
Order Details
Order ID 66574450
Lab Results
PSA SCREEN (Order 91767029) Received Date and Time 11/20/2012 1151
Entry Date
11/20/2012 Component Results Flag Reference Range Component Value PSA SCREEN 0.6 0-4.0 ng/mL Comment: Result obtained by the Siemens Advia Centaur PSA chemiluminometric immunoassay method. Values obtained with different assay methods cannot be used interchangeably. The PSA test in conjunction with DRE is intended for use as an aid in the detection of prostate cancer in men 50 years and older. This test is also further indicated as an aid in the management of patients with prostate cancer. Status Final
Result History
PSA SCREEN (Order#91767029) on 11/20/12 - Order Result History Report MyChart Status:
001762
This result is currently released to MyChart. Last viewed in MyChart: 11/21/2012 11:53 PM By: Mark Amundsen Other IDs Lab Specimen # 1120:SC00670R

Unit UCDREG
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Patient Result Comments Entered by Victor Baquero, MD at 11/21/2012 1:24 PM Read by Mark Amundsen at 11/21/2012 11:53 PM Mark, recent labs are normal. The thyroid is actually improved compared to the previous test, and within the normal range. Perhaps slightly low but not like before. All other physiologic markers and tests are normal. Lab Information Lab UCDMC SPECIALTY TESTING CENTER 3740 Business Drive Sacramento CA 95820-2164 Phone Number 916-734-0500 Lab NPI 1710918545
Order
Allergies
FENTANYL; MORPHINE
Order Information
Isolation
No Isolation
Order Details
001763
Order Details

Lab Results

Entry Date
11/20/2012
Component Results Component THYROXINE, FREE (FREE T4)
Value 0.91
Flag
Reference Range 0.56-1.64 ng/dL
Status Final
Result History
THYROXINE, FREE (FREE T4) (Order#91787276) on 11/20/12 - Order Result History Report MyChart Status: This result is currently released to MyChart. Last viewed in MyChart: 11/21/2012 11:54 PM By: Mark Amundsen Related Tests TSH WITH FREE T4 REFLEX (Order#91767026) on 11/20/12 Other IDs Reflex Order # 91767026 Lab Specimen # 1120:SC00669R

Unit UCDREG
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Patient Result Comments Entered by Victor Baquero, MD at 11/21/2012 1:24 PM Read by Mark Amundsen at 11/21/2012 11:54 PM Mark, recent labs are normal. The thyroid is actually improved compared to the previous test, and within the normal range. Perhaps slightly low but not like before. All other physiologic markers and tests are normal.
001764
Lab NPI 1710918545

Order
Allergies
FENTANYL; MORPHINE THYROXINE, FREE (FREE T4) (Order 91787276)
Order Information
Isolation
No Isolation
Order Details

Patient Information
Account # 078872030115
Account Information
Order Details
Order ID 91787276
Lab Results
001765

Patient Information
Unit IMFFOL
Order Details
Order ID 581771
Lab Results
Entry Date
11/20/2012 Component Results Component THYROID STIMULATING HORMONE Value 3.41 Flag H Reference Range 0.35-3.30 mcIU/mL Status Final
Result History
TSH WITH FREE T4 REFLEX (Order#91767026) on 11/20/12 - Order Result History Report
MyChart Status:
Last viewed in MyChart: 11/21/2012 11:49 PM By: Mark Amundsen Related Tests THYROXINE, FREE (FREE T4) (Order#91787276) on 11/20/12 Other IDs Lab Specimen #
001766
1120:SC00669R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Patient Result Comments Entered by Victor Baquero, MD at 11/21/2012 1:24 PM Read by Mark Amundsen at 11/21/2012 11:49 PM Mark, recent labs are normal. The thyroid is actually improved compared to the previous test, and within the normal range. Perhaps slightly low but not like before. All other physiologic markers and tests are normal. Lab Information Lab UC DAVIS MED CTR 2315 Stockton Blvd Sacramento CA 95817
Lab NPI 1710918545

Order
Allergies
FENTANYL; MORPHINE
Order Information
Isolation
No Isolation
Order Details

001767
Patient Information
Account # 078872030115
Account Information
Order Details

Order
Allergies
FENTANYL; MORPHINE
Order Information

Order Status Canceled order is expired By Barbara Blankenchip On 11/20/12 1151 Reason Other
Isolation
No Isolation
Order Details

Ordered By
Admitting Provider

001768
Entry Date
11/21/2012
Component Results Component HOMOCYSTEINE
Value 9.6
Flag
Reference Range 5.0-11.7 umol/L
Status Final
Result History
HOMOCYSTEINE (Order#91767030) on 11/21/12 - Order Result History Report
MyChart Status: This result is currently released to MyChart. Last viewed in MyChart: 11/21/2012 11:53 PM By: Mark Amundsen Other IDs Lab Specimen # 1120:TX00076R
MRN 8081369
Sex M
DOB 9/23/1959 (53yr)
Home Phone 916-509-0158
Patient Result Comments Entered by Victor Baquero, MD at 11/21/2012 1:24 PM Read by Mark Amundsen at 11/21/2012 11:53 PM Mark, recent labs are normal. The thyroid is actually improved compared to the previous test, and within the normal range. Perhaps slightly low but not like before. All other physiologic markers and tests are normal. Lab Information Lab UCDMC SPECIALTY TESTING CENTER 3740 Business Drive Sacramento CA 95820-2164
Lab NPI 1710918545

Order
Allergies
FENTANYL; MORPHINE
HOMOCYSTEINE (Order 91767030)
Order Information
001769
Date and Time 11/20/2012 11:12 AM
Isolation
No Isolation
Order Details

Patient Information
Unit UCDREG
Account # 078872030115
Account Information
Order Details

Order
Allergies
FENTANYL; MORPHINE
Order Information

001770
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed >> BEVERLY A BLAGG Tue Jan 3, 2006 3:15 PM He is calling for a refill of norco. He did call his pharmacy for a refill already. He states that the dose is 10325mg and the instructions are: 1 q 4-6 hours. He requests Send to preferred pharmacy. He is calling for a refill of flexeril. He did call his pharmacy for a refill already. He states that the dose is 10mg and the instructions are: 1 bid. He requests Send to preferred pharmacy. pharmacy has faxed several times.
Created by
Approved
Disp Refills Start End 135 0/0 1/3/2006 2/2/2006 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy DAW: No Comment: This is a REFILL AUTHORIZATION for prescription number 1049713 / 1052502. Last filled 11/17/05 Authorizing Provider: Victor Baquero 60 3 1/3/2006 2/24/2006 CYCLOBENZAPRINE 10 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 tablet (10mg) by oral route 2 times per day - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1030339. Authorizing Provider: Victor Baquero

Disp Refills Start 30 6 1/11/2005 FLUOXETINE HCL 40 MG ORAL CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy 60 0 ALEVE 220 MG ORAL TAB Sig - Route: 1 TABLET EVERY 12 HOURS AS NEEDED - ORAL Class: Historical 10 0 AMBIEN 10 MG ORAL TAB Sig - Route: 1 TABLET AT BEDTIME AS NEEDED - ORAL Class: Historical 300.00 3 12/8/2005 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 60 3 9/8/2005 CYCLOBENZAPRINE 10 MG TAB (Discontinued) Sig - Route: take 1 tablet (10mg) by oral route 2 times per day - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1030339. 10 0 7/15/2004 FENTANYL 25 MCG/HR TD PT72 Sig - Route: apply q 3 days. - Transdermal 30 6 1/2/2006 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 0/0 12/12/2005 135 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Discontinued) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1049713 / 1052502. Last filled 11/17/05 90G 1 9/14/2004 KETOCONAZOLE 2 % TOP CREA (Taking) Sig - Route: apply by topical route once daily to the affected area(s) - TOPICAL End 7/10/2005
3/8/2006
1/3/2006
1/3/2006
001771
Group Number 620229011
Plan AETNA PPO
Plan Number A06
Plan Phone 888-632-3862
Center None
Patient Information

Contacts
Telephone Encounter
2/6/2006 2:27 PM Provider Victor Baquero, MD, MD Department Fol Pediatrics
Reason for Call

Other
Call Documentation
SYSTEM Signed >> SHERI L GROVES Tue Feb 7, 2006 1:50 PM Pt was informed 2/7/06 at 150pm. Sheri Groves, MA >> SHERI L GROVES Tue Feb 7, 2006 11:06 AM A message was left on 2/7/06 at 1105am, for pt to call back. >> TRACY D KASIK Tue Feb 7, 2006 10:00 AM Referral was done on 1/20/06. Please have patient call Brian at 985-9372 to schedule appt. >> SHERI L GROVES Tue Feb 7, 2006 9:17 AM tracy has referral been done. >> VICTOR H BAQUERO Mon Feb 6, 2006 5:14 PM Please contact. Ortho referral was done on 1/19. Please give him the phone number to call. 2. May discontinue methadone. I will call in 8 norco per day. He will need a follow up to discuss alternative medications to the methadone. >> SHERI L GROVES Mon Feb 6, 2006 2:33 PM methadone is bothering Patient he is going to fax in information for you. >> BRENDA J FALLON Mon Feb 6, 2006 2:28 PM patient needs to get his norco adjusted and the methadone. please call and advise.
Created by
001772
Acct Number 038112613039 1 Payor AUSHC Patient Insurance ID W142637665 Group Number 620229011
Plan AETNA PPO
Financial Class P
Plan Number A06
Plan Phone 888-632-3862
Center None
Patient Information

Contacts
Telephone Encounter
3/2/2006 3:34 PM
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed >> BEVERLY A BLAGG Thu Mar 2, 2006 3:38 PM He is calling for a refill of norco. He did call his pharmacy for a refill already. He states that the dose is 10325mg and the instructions are: 1-2 q 6 hrs. He requests Send to preferred pharmacy. Prescription sent on 0227-06 was not picked up due to the quantity was #135 and should be #250. Pharmacy faxed over request today.
Created by
Approved
Disp Refills Start End 250 0/0 3/2/2006 3/24/2006 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1043578. Authorizing Provider: Victor Baquero
001773
Disp Refills 300.00 3 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 BACLOFEN 10 MG TAB (Taking) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 0 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 135 0/0 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Discontinued) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1043578. 250 0 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy
Start 2/27/2006
End
1/19/2006
2/18/2006
1/19/2006
2/24/2006
2/27/2006
3/2/2006
2/6/2006
3/8/2006

DOB 9/23/1959
Telephone Encounter
2/27/2006 4:19 PM
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed >> SHERI L GROVES Mon Feb 27, 2006 4:20 PM Encounter initiated.
Created by
Approved
Disp Refills Start End 300.00 3 2/27/2006 2/19/2008 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. Authorizing Provider: Victor Baquero 135 0/0 2/27/2006 3/2/2006 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1043578.
001774
Patient Information

Telephone Encounter
5/23/2006 10:54 AM
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed >> JULIE A WILSON Tue May 23, 2006 10:54 AM Encounter initiated.
Created by
Approved
Disp Refills Start End 90 0 5/23/2006 6/21/2006 SOMA 350 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1 po tid - ORAL Class: Pharmacy Authorizing Provider: Victor Baquero, MD 250 0 5/23/2006 6/6/2006 NORCO 10 MG-325 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Authorizing Provider: Victor Baquero, MD

Disp Refills 300.00 3 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 BACLOFEN 10 MG TAB (Taking/Discontinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 0 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 250 0/0 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Discontinued) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 250 0/0 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 Start 2/27/2006 End
1/19/2006
4/18/2006
1/19/2006
2/24/2006
3/24/2006
5/23/2006
5/23/2006
6/22/2006
001775
60 0 5/1/2006 METHADONE 5 MG TAB Sig - Route: 1 po BID - ORAL 250 0 2/6/2006 NORCO 10 MG-325 MG TAB (Taking/Disco ntinued) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy 0 5/1/2006 250 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy 0 5/1/2006 90 SOMA 350 MG TAB (Discontinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy 20 0 5/1/2006 TORADOL ORAL 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4-6 hours as needed not to exceed 40mg per 24 hours - ORAL Class: Pharmacy
6/1/2006 4/14/2006
5/23/2006
5/23/2006
5/31/2006

DOB 9/23/1959
Contacts
05/18/2006 1:47 PM
Type Phone (Incoming)
Contact Amundsen, Mark (Self)
Phone 916-983-2589 (H)
Telephone Encounter
5/18/2006 1:46 PM
Reason for Call

Results Other Refill Request
Reason For Call History Recorded
Call Documentation
SYSTEM Signed >> BRENDA J FALLON Tue May 23, 2006 11:30 AM Patient notified of medication refill and doctor message. Patient has appointment with pcp on 5/26/06. >> JULIE A WILSON Tue May 23, 2006 11:09 AM Left voicemail for pt to return call.Julie Wilson, MA >> VICTOR H BAQUERO Tue May 23, 2006 9:26 AM Norco refilled. I would recommend he go to pain clinic. They may have other options for pain relief for him. >> BRENDA J FALLON Mon May 22, 2006 4:26 PM Patient would like to get refill on norco and the soma states his back/hip is killing him. Patient has appointment scheduled with pcp on Friday 5/26/06. Patient does not know if he should keep appointment with pmc. Please call when done. >> BRENDA J FALLON Mon May 22, 2006 10:40 AM Patient has pmc appointment on 5/25/06? >> SHERI L GROVES Mon May 22, 2006 9:49 AM Please call Patient with an appointment for this week.
001776
>> VICTOR H BAQUERO Mon May 22, 2006 9:46 AM Please see my message below. I can refill norco or soma. He has tried so much in the past. Perhaps he knows what works better before I write for it . >> CARLA BOSWELL Mon May 22, 2006 8:33 AM Patient called in and needs a refill on norco and soma and he also needs another RX because what he is using is not working. Please advise. >> VICTOR H BAQUERO Fri May 19, 2006 4:02 PM He has a long history of pain medications that he has taken in the past. Is there something that he thinks will work for him. Otherwise follow up in office to discuss medication . >> SHERI L GROVES Fri May 19, 2006 2:18 PM Please advise pain medication is not working, thank you. >> SHERI L GROVES Thu May 18, 2006 2:19 PM Results were given. Pain medication is not working. >> JULIE STEWART Thu May 18, 2006 1:47 PM He is calling for the results of MRI done at UC Davis last month. He would like a phone call back. Patient also would like to discuss medication change.
Created by
Approved
Disp Refills Start End 250 0/0 5/23/2006 4/24/2007 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 Authorizing Provider: Victor Baquero, MD

Disp Refills 90 2 BACLOFEN 10 MG TAB Sig - Route: take 1 tablet oralley 3 times a day as needed - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1056944. 300.00 3 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 BACLOFEN 10 MG TAB (Taking/Discontinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 0 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 250 0/0 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Discontinued) Sig - Route: take 1 tablet by oral route every 4-6 hours as needed for pain, - ORAL Class: Pharmacy Start 4/18/2006 End 5/18/2006
2/27/2006
1/19/2006
4/18/2006
1/19/2006
2/24/2006
3/24/2006
5/23/2006
001777
Reason for Call

Other Prior-authorization
Call Documentation
SYSTEM Signed Addended by: BAQUERO, VICTOR H on: 6/6/2006 3:09:54 PM Modules accepted: Orders, Medications, Level of Service Called and left tmessage to have pt call back and make appt. Will fax Pa letter today to insurance. Andrea A Tinsey, MA >> VICTOR H BAQUERO Wed May 31, 2006 5:02 PM Pa done. Follow up to discuss alternative pain medications in the office. >> HELEN BACA Wed May 31, 2006 2:45 PM PA form under new letter. >> BRENDA J FALLON Wed May 31, 2006 2:01 PM Patient was seen in office on 5/26/06 and perscribed dilaudid(generic). Patient picked up medication on Sunday and started medication. Patient has no relief with medication and wants to know what to do next? Patient wanted to let you know that he didn't have any side effects ( states he is allergic to a lot of stuff. Patient also needs to know what the status of prior authorization on celexia? Please advise.
Created by
Approved
Disp Refills Start End 250 1 6/6/2006 6/29/2006 NORCO 10 MG-325 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Authorizing Provider: Victor Baquero, MD

Disp Refills 60 0 CYMBALTA 30 MG CAP (Taking) Sig - Route: 1 po qam for 1 week then bid thereafter - ORAL Class: Pharmacy 40 0 DILAUDID 2 MG TAB (Taking) Sig - Route: take 1-2 by oral route every 4-6 hours as needed - ORAL 3 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET 300.00 Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 90 2 BACLOFEN 10 MG TAB (Taking/Discontinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 CYMBALTA 60 MG CAP (Taking) Sig - Route: 1 PO DAILY - ORAL 30 6 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1022914. 0 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL Start 5/26/2006 End 6/25/2006
5/26/2006 2/27/2006
6/25/2006
1/19/2006
4/18/2006
5/26/2006 1/19/2006
11/22/2006
2/24/2006
001778
to be appreciated. Thanks for the offer. I will keep it in mind.

Take care.
Links Previous Version Transcription Type Unstructured to Doctor Preliminary

Document Text Mark,
ID RH4595425
Thank you for the positive comments - it's always nice to be appreciated. Thanks for the offer. I will keep it in mind. Take care. Display only: Transcription (RH4595425) on 7/27/2006 7:59 PM
Document history: Transcription (RH4595425) on 7/27/2006 7:59 PM
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Mark, Thanks for the update. I noted the changes in medication. Glad things are going well. Links Previous Version Transcription Type Unstructured to Doctor
Preliminary ID RH4556484 Date and Time 7/21/2006 1:05 PM
Document Text Mark, Thanks for the update. I noted the changes in medication. Glad things are going well.
Display only: Transcription (RH4556484) on 7/21/2006 1:05 PM Document history: Transcription (RH4556484) on 7/21/2006 1:05 PM
Chart Review Routing History
001779
Thanks for the quick response, Dr Baquero - I really appreciate it!! /> Mark Amundsen Links Previous Version Transcription Type Unstructured to Doctor
Document Text Thanks for the quick response, Dr Baquero - I really appreciate it!! /> Mark Amundsen Display only: Transcription (RH4932145) on 9/11/2006 2:31 PM Document history: Transcription (RH4932145) on 9/11/2006 2:31 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Mark, I refilled the methadose. Its ready for pickup. Links Previous Version Transcription Type Unstructured to Doctor Preliminary
Document Text Mark, I refilled the methadose. Its ready for pickup.
ID RH4761783
Display only: Transcription (RH4761783) on 8/17/2006 12:58 PM Document history: Transcription (RH4761783) on 8/17/2006 12:58 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> SHERI L GROVES Wed Aug 9, 2006 2:19 PM Encounter initiated. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Mark, Thank you for the positive comments - it's always nice
001780
Display only: Transcription (RH5166188) on 10/6/2006 5:23 PM Document history: Transcription (RH5166188) on 10/6/2006 5:23 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Please contact. Prescription refilled. He needs to follow up with me to discuss medication prior to next refill. Electronically signed byVictor Baquero, MD on 10/6/2006 4:26 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Patient states that he will be out of meds by Sunday and wants to take care of refills before sunday. Patient is not sure why he is out of medication so soon. Electronically signed byDeborah L Hughes on 10/6/2006 3:20 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Both prescriptions recently called in. Please inquire why the early refill? Electronically signed byVictor Baquero, MD on 10/5/2006 12:48 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Thanks once again, Dr Baquero
Mark Amundsen
Links Previous Version Transcription Type Unstructured to Doctor Preliminary Document Text Thanks once again, Dr Baquero Mark Amundsen Display only: Transcription (RH5104793) on 10/2/2006 2:16 PM Document history: Transcription (RH5104793) on 10/2/2006 2:16 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes
ID RH5104793 Date and Time 10/2/2006 2:16 PM
001781
Vital signs taken, allergies verified, screened for pain, pharmacy varified, cc was taken. Sheri L Groves
Progress Notes Mark, It's ready for pickup. Links Previous Version Transcription Type Unstructured to Doctor
Preliminary
ID RH5303825
Document Text Mark, It's ready for pickup.

Display only: Transcription (RH5303825) on 10/23/2006 8:22 AM
Document history: Transcription (RH5303825) on 10/23/2006 8:22 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Left message Electronically signed byDeborah L Hughes on 10/9/2006 9:08 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Mark, I called them in. I do want to see you in the next few weeks to review the medication usage and symptoms. Links Previous Version Transcription Type Unstructured to Doctor Preliminary Document Text Mark, I called them in. I do want to see you in the next few weeks to review the medication usage and symptoms.
001782
1/19/2006

Patient Information

Contacts
Telephone Encounter
10/5/2006 11:47 AM
Reason for Call

Refill Request
Call Documentation
Deborah L Hughes 10/9/2006 9:08 AM Signed Left message Electronically signed by Deborah L Hughes at 10/9/2006 9:08 AM Victor Baquero, MD, MD 10/6/2006 4:26 PM Signed Please contact. Prescription refilled. He needs to follow up with me to discuss medication prior to next refill. Electronically signed by Victor Baquero, MD at 10/6/2006 4:26 PM Deborah L Hughes 10/6/2006 3:18 PM Signed Patient states that he will be out of meds by Sunday and wants to take care of refills before sunday. Patient is not sure why he is out of medication so soon. Electronically signed by Deborah L Hughes at 10/6/2006 3:20 PM Victor Baquero, MD, MD 10/5/2006 12:48 PM Signed Both prescriptions recently called in. Please inquire why the early refill? Electronically signed by Victor Baquero, MD at 10/5/2006 12:48 PM
Created by
Approved
Disp Refills Start End 250 1 10/5/2006 11/4/2006 NORCO 10 MG-325 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 177788
001783
Authorizing Provider: Victor Baquero, MD 90 0 10/5/2006 11/4/2006 SOMA 350 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: take 1 tabket 3 times a day - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1178084 Authorizing Provider: Victor Baquero, MD

Disp Refills Start End 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 2 1/19/2006 4/18/2006 90 BACLOFEN 10 MG TAB (Taking/Discontinued) Sig - Route: 1 PO TID PRN - ORAL Class: Pharmacy 30 6 7/19/2006 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 180 0 10/2/2006 11/1/2006 METHADONE 10 MG TAB (Taking) Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 1 9/18/2006 10/5/2006 250 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 0 9/20/2006 10/5/2006 SOMA 350 MG TAB (Discontinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027

Orders Chart Cosign

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
001784
Type Unstructured to Doctor Preliminary

Document Text Thanks Dr Baquero!!
ID RH5563195
Display only: Transcription (RH5563195) on 11/16/2006 9:08 PM Document history: Transcription (RH5563195) on 11/16/2006 9:08 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Mark, I wrote out the prescription. you may come by and pick it up. Links Previous Version Transcription Type Unstructured to Doctor Preliminary
Document Text Mark, I wrote out the prescription. you may come by and pick it up.
ID RH5525553
Display only: Transcription (RH5525553) on 11/14/2006 1:34 PM Document history: Transcription (RH5525553) on 11/14/2006 1:34 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Glad you are better. Keep me posted. Links Previous Version Transcription Type Unstructured to Doctor Preliminary Document Text Glad you are better. Keep me posted. Display only: Transcription (RH5403252) on 11/1/2006 11:33 AM Document history: Transcription (RH5403252) on 11/1/2006 11:33 AM ID RH5403252 Date and Time 11/1/2006 11:33 AM
001785
Document Text Thanks Dr BaqueroI will definitely come in - I now have insurance woohoo!! See you in January... Mark Amundsen Display only: Transcription (RH5882490) on 12/28/2006 1:52 PM Document history: Transcription (RH5882490) on 12/28/2006 1:52 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Mark, if you are taking 10 norco per day, I would recommend increasing the methadone - it is intended to take care of the pain - the norco is for break through pain. Make sure you only make changes to the methadone every 3 days. I will refill them, but we should touch basis on the meds in one month to optimize the treatment. />The refill is ready for pickup. Links Previous Version Transcription Type Unstructured to Doctor Preliminary Document Text Mark, if you are taking 10 norco per day, I would recommend increasing the methadone - it is intended to take care of the pain the norco is for break through pain. Make sure you only make changes to the methadone every 3 days. I will refill them, but we should touch basis on the meds in one month to optimize the treatment. />The refill is ready for pickup.
Display only: Transcription (RH5729021) on 12/6/2006 4:53 PM Document history: Transcription (RH5729021) on 12/6/2006 4:53 PM ID RH5729021 Date and Time 12/6/2006 4:53 PM
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Thanks Dr Baquero!! Links Previous Version Transcription
001786
Document history: Transcription (RH6078458) on 1/18/2007 2:32 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi Dr BaqueroIt's time to get my Methadose prescription refilled I have around 2-3 days worth left. I also submitted />a refill for all the others through the pharmacist. I have an appointment to come in for a check on the 14th of February - I'll see you then!
Mark Amundsen
Transcription Type Unstructured to Doctor

Preliminary
ID RH6062564
Document Text Hi Dr BaqueroIt's time to get my Methadose prescription refilled I have around 2-3 days worth left. I also submitted />a refill for all the others through the pharmacist. I have an appointment to come in for a check on the 14th of February - I'll see you then! Mark Amundsen Display only: Transcription (RH6062564) on 1/16/2007 7:27 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Thanks Dr BaqueroI will definitely come in - I now have insurance woohoo!! See you in January... Mark Amundsen Links Previous Version Transcription Type Unstructured to Doctor
Preliminary
ID RH5882490
001787
P.S. The stomach thing I figured out it was the pain in the knee joints downward that was wierd. Maybe from staying in bed so long? Links Previous Version Transcription Type Unstructured to Doctor Preliminary
Document Text Already getting better- I finally started moving around and doing things today, and I feel better. Also, I've been able to eat, so that's good. Not the best way to lose 5 pounds-I don't recommend it... ID RH6140363 Date and Time 1/25/2007 8:15 PM
Mark P.S. The stomach thing I figured out it was the pain in the knee joints downward that was wierd. Maybe from staying in bed so long? Display only: Transcription (RH6140363) on 1/25/2007 8:15 PM Document history: Transcription (RH6140363) on 1/25/2007 8:15 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Thanks Dr BaqueroI'll see ya then! Mark Links Previous Version Transcription Type Unstructured to Doctor
Preliminary
ID RH6078458
Document Text Thanks Dr BaqueroI'll see ya then! Mark

001788
The patient and/or caregiver was educated regarding his medical care. No guarantees were made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit. Electronically signed byVictor Baquero, MD on 2/14/2007 12:46 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Visit Notes GROVES, SHERI L 2/14/2007 8:57 am Vital signs taken, allergies verified, screened for pain, pharmacy varified, cc was taken. Sheri L Groves Electronically signed by GROVES, SHERI L at 2/14/2007 8:57 am Progress Notes Mark, I wrote a prescription and dated it on the 9th. Please be more careful with taking it as directed - I do expect these to last for 1 month. If you feel that the dose you are on is not sufficient, come see me so we can modify it. Links Previous Version Transcription Type Unstructured to Doctor Preliminary
Document Text Mark, I wrote a prescription and dated it on the 9th. Please be more careful with taking it as directed - I do expect these to last
ID RH6239213
for 1 month. If you feel that the dose you are on is not sufficient, come see me so we can modify it. Display only: Transcription (RH6239213) on 2/6/2007 5:35 PM Document history: Transcription (RH6239213) on 2/6/2007 5:35 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Already getting better- I finally started moving around and doing things today, and I feel better. Also, I've been able to eat, so that's good. Not the best way to lose 5 pounds-I don't recommend it... Mark
001789
Yes, I know that it's been faster than the thirty day period, However, last time I was in, I told you I />was taking ten a day of these, which would put the current prescription at 24 days. This month, 10 a day would take me to Sunday, which is exactly when I will run out. I can cut back to the 8 a day no problem, but they don't seem to work as well as they did before. I'll make an appt for next week so we can go over this... Mark Amundsen Display only: Transcription (RH6622955) on 3/23/2007 1:17 AM Document history: Transcription (RH6622955) on 3/23/2007 1:17 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Thanks Dr BaqueroHaven't had the return of the stomach/knees symptoms - hopefully gone for good. I'm hanging on to the blood test form just in case... Mark Links Previous Version Transcription Type Unstructured to Doctor Preliminary Document Text Thanks Dr BaqueroHaven't had the return of the stomach/knees symptoms - hopefully gone for good. I'm hanging on to the blood test form just in case... Mark
Display only: Transcription (RH6443703) on 3/2/2007 8:26 AM Document history: Transcription (RH6443703) on 3/2/2007 8:26 AM
ID RH6443703
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed.
001790
Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Visit Notes GROVES, SHERI L 4/20/2007 8:48 am Vital signs taken, allergies verified, screened for pain, pharmacy varified, cc was taken. Sheri L Groves Electronically signed by GROVES, SHERI L at 4/20/2007 8:48 am Telephone Encounter Patient will pick up prescription Electronically signed byTeri L Rhodewalt on 4/6/2007 4:46 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Triplicate written. Please notify patient. Electronically signed byVictor Baquero, MD on 4/6/2007 4:44 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Patient stating he will be out of methadone tomorrow and needs rx today. Please call as soon as done. Electronically signed byJulie Stewart on 4/6/2007 4:27 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi Dr BaqueroI wanted to write and see about getting a refill on the methadone - you prescribed a 2 week supply about 2 weeks ago - I made an appointment, but the earliest I could get was April 20th. I will run out of Methadone after tomorrow, so i'm hoping I can pick up another refill. The 8 a day are doing almost as good as the ten a day, so I guess you were right after all... See you on the 20th..
Mark Amundsen

Preliminary
ID RH6758078
Document Text Hi Dr BaqueroI wanted to write and see about getting a
001791
refill on the methadone - you prescribed a 2 week supply about 2 weeks ago - I made an appointment, but the earliest I could get was April 20th. I will run out of Methadone after tomorrow, so i'm hoping I can pick up another refill. The 8 a day are doing almost as good as the ten a day, so I guess you were right after all... See you on the 20th.. Mark Amundsen Display only: Transcription (RH6758078) on 4/5/2007 5:20 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Pt states that phar has rx for Fluoxetine and Soma but not the Norco.Can you call it in and let pt know Electronically signed byJasvir K Bhele on 3/29/2007 3:37 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi Dr BAqueroYes, I know that it's been faster than the thirty day period, However, last time I was in, I told you I />was taking ten a day of these, which would put the current prescription at 24 days. This month, 10 a day would take me to Sunday, which is exactly when I will run out. I can cut back to the 8 a day no problem, but they don't seem to work as well as they did before. I'll make an appt for next week so we can go over this...
Mark Amundsen
Links Previous Version Transcription Type Unstructured to Doctor Preliminary Document Text Hi Dr BAqueroID RH6622955 Date and Time 3/23/2007 1:17 AM
001792
Progress Notes Dear patients, Due to an increase in the volume of messages I have been receiving, I have decided to change the way the messages get routed. Until now, most messages came directly to me. From now on they will first go to my assistant who will handle the majority of the messages and send the remainder to me. I still believe this is a valuable communication tool and want to continue using it. I am hopefull this change will help decrease the frequency and volume of messages I receive so that I can continue to provide this service. />Sincerely, Victor Baquero, MD Transcription Type Provider Initiated Preliminary Document Text Dear patients, Due to an increase in the volume of messages I have been receiving, I have decided to change the way the messages get routed. Until now, most messages came directly to me. From now on they will first go to my assistant who will handle the majority of the messages and send the remainder to me. I still believe this is a valuable communication tool and want to continue using it. I am hopefull this change will help decrease the frequency and volume of messages I receive so that I can continue to provide this service. />Sincerely, Victor Baquero, MD
ID RH7166485
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Glad you feel better. I'll pay attention to the refill request. Links Previous Version Transcription Type Unstructured to Doctor Preliminary
Document Text ID RH7155985 Date and Time 5/18/2007 12:59 PM
001793
300 0/0 5/18/2007 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking) Sig - Route: take 1-2 tablet by oral route every 4 hours as needed for pain, may take up to 10 daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 0 2/9/2007 240 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 0 5/4/2007 300 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical 300 0 5/31/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 3/29/2007 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 5/18/2007 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
6/17/2007
2/14/2007 5/31/2007
6/30/2007 4/28/2007
6/17/2007

DOB 9/23/1959
Contacts
Telephone Encounter
5/31/2007 2:17 PM
Provider Victor Baquero, MD, MD Department Fol Internal Medicine
Reason for Call

Refill Request
Call Documentation
Cherry Mendoza 6/1/2007 8:50 AM Signed Refill done. Cherry Mendoza Electronically signed by Cherry Mendoza at 6/1/2007 8:50 AM Charles W Griffin 5/31/2007 2:19 PM Signed He is calling for a refill of methodoen. He did not call his pharmacy for a refill already. He states that the dose is 10mg and the instructions are: as directed . He requests Send to preferred pharmacy. Electronically signed by Charles W Griffin at 5/31/2007 2:19 PM
001794
I am now out of methadone, and could use a refill ASAP. I know things are busy, but I'm hoping you can get to this soon, as the weekend is coming soon. Thanks iin advance for your help...
Mark Amundsen
Transcription Type Unstructured to Office

Preliminary
ID RH7317127
Document Text Hi Dr Baquero and staff I am now out of methadone, and could use a refill ASAP. I know things are busy, but I'm hoping you can get to this soon, as the weekend is coming soon. Thanks iin advance for your help... Mark Amundsen
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi Dr BaqueroI am now out of methadone, and could use a refill ASAP. I know tings are busy, but I'm hoping you can get to this soon, as the weekend is coming soon. Thanks iin advance for your help... Mark Amundsen Transcription Type Unstructured to Doctor Preliminary
Document Text Hi Dr BaqueroID RH7317013 Date and Time 5/31/2007 2:01 PM
I am now out of methadone, and could use a refill ASAP. I know tings are busy, but I'm hoping you can get to this soon, as the weekend is coming soon. Thanks iin advance for your help... Mark Amundsen Display only: Transcription (RH7317013) on 5/31/2007 2:01 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed.
001795
the Celexa seemed to work well for a week or two, it failed soon after that. Since it's been two months, it should be long enough for the Prozac to start working again. I'm keeping my fingers crossed. />Thanks for all the assistance, Dr. BaqueroMark Amundsen Display only: Transcription (RH7606587) on 6/22/2007 10:17 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Thanks again, Dr Baquero!! Mark Amundsen Links Previous Version Transcription Type Unstructured to Doctor Preliminary Document Text Thanks again, Dr Baquero!! Mark Amundsen
ID RH7279850
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Refill done. Cherry Mendoza Electronically signed byCherry Mendoza on 6/1/2007 8:50 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter He is calling for a refill of methodoen. He did not call his pharmacy for a refill already. He states that the dose is 10mg and the instructions are: as directed . He requests Send to preferred pharmacy. Electronically signed byCharles W Griffin on 5/31/2007 2:19 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi Dr Baquero and staff
001796
4/20/2007 8:32 AM
Patient Information

Telephone Encounter
6/22/2007 10:49 AM
Reason for Call

Refill Request
Call Documentation
April Holt 6/22/2007 12:04 PM Addendum Patient notified Rx was waiting up front. Martina Dobrovodska Randolph, MD 6/22/2007 11:49 AM Signed Patient had refill on 6/1. Patient should have enough of Methadone. MARTINA RANDOLPH, M.D.
Electronically signed by Martina Dobrovodska Randolph, MD at 6/22/2007 11:49 AM
Created by
Refused
Disp Refills Start End 300 0 6/22/2007 7/22/2007 METHADONE 10 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Normal DAW: No Reason for Refusal: Patient has requested refill too soon Refused By: Martina Dobrovodska Randolph, MD

Disp Refills Start End 30 2 4/20/2007 6/20/2007 CELEXA 40 MG TAB (Taking) Sig - Route: take 1 tablet (40mg) by oral route once daily - ORAL Class: Pharmacy 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 300 0/0 5/18/2007 6/17/2007 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking) Sig - Route: take 1-2 tablet by oral route every 4 hours as needed for pain, may take up to 10 daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 240 0 2/9/2007 2/14/2007 METHADONE 10 MG TAB (Taking/Discontinued)
001797
Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 300 0 5/4/2007 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical 300 0 5/31/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 6/22/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 3/29/2007 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 250 1 6/13/2007 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 201184. Last date filled 09/23/1959 90 3 5/18/2007 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
5/31/2007
6/30/2007 7/22/2007 4/28/2007
7/13/2007
6/17/2007

DOB 9/23/1959
Telephone Encounter
Reason for Call

Refill Request
Call Documentation
Martina Dobrovodska Randolph, MD 6/22/2007 11:13 AM Signed Methadone prescription written. Given to April. MARTINA RANDOLPH, M.D. Electronically signed by Martina Dobrovodska Randolph, MD at 6/22/2007 11:13 AM Cherry Mendoza 6/22/2007 10:49 AM Signed From: Amundsen,Mark Sent: 06/22/2007 10:17 AM Hi Dr Baquero and staffIt's about refill time for the Methadose prescription again - it's a day or so early, but I know the new procedures take a little longer. Also, I wanted to let you know I have stopped the Celexa, and restarted the Prozac. While the Celexa seemed to work well for a week or two, it failed soon after that. Since it's been two months, it should be long enough for the Prozac to start working again. I'm keeping my fingers crossed. Thanks for all the assistance, Dr. BaqueroMark Amundsen Electronically signed by Cherry Mendoza at 6/22/2007 10:49 AM
Created by
001798
Approved
Disp Refills Start End 300 0 6/22/2007 7/16/2007 METHADONE 10 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Normal Authorizing Provider: Martina Dobrovodska Randolph, MD

Disp Refills Start End 30 2 4/20/2007 6/20/2007 CELEXA 40 MG TAB Sig - Route: take 1 tablet (40mg) by oral route once daily - ORAL Class: Pharmacy 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 300 0/0 5/18/2007 6/17/2007 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB Sig - Route: take 1-2 tablet by oral route every 4 hours as needed for pain, may take up to 10 daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 0 2/9/2007 2/14/2007 240 METHADONE 10 MG TAB (Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 0 5/4/2007 5/31/2007 300 METHADONE 10 MG TAB (Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical 300 0 5/31/2007 6/30/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 3/29/2007 4/28/2007 NORCO 10 MG-325 MG TAB Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 250 1 6/13/2007 7/13/2007 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1-2 po q 6 hours. Max 8 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 201184. Last date filled 09/23/1959 90 3 5/18/2007 6/17/2007 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
RH MD Msg
Patient Information
001799
I am just about out of Norco - I found out last time that Costco had changed the prescription back to 250 per month for June and July. I am hoping you can instruct them to change it back to 10 per day, 300 per month - I asked them if then could fix it, and they said contact your doctor. I am putting in a refill request, but it will probably come in as 250 per month. I'm hoping you can fix that. I talked to the pharmacist, he says the nausea I'm having could be due to the Norco, or could be due to the constipation. I'm eating more fruit, and that seems to be helping, but I still get sick two or three times per month... Mark Amundsen Electronically signed byCherry Mendoza on 8/1/2007 9:43 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter ----- Message # 1 ----From: Amundsen,Mark Sent: 07/15/2007 1:17 PM Hi Dr BaqueroI am currently out of Methadone, due to some stomach issues last week. The stomach issues have mostly subsided, but as a result, I lost a few days worth of Methadone. If you could write a prescription ASAP on Monday, I would really appreciate it. The stomach issues are very similar to the ones I have a few months ago - however, I do not currently have the money to perform the blood tests, so I guess I will have to wait on that- I atill have the form for it, however. Thanks for all your help. Mark Amundsen Electronically signed byCherry Mendoza on 7/18/2007 2:03 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Left message for patient to pick-up prescription Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Please notify Mr. Amundsen his prescription is ready to be picked up at UCDavis in Folsom. Electronically signed byKurt J Slapnik, MD on 7/16/2007 3:12 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Patient is calling for a refill of methadone. Patient did not call their pharmacy for a refill already. Patient requests call to pick up rx. Patient is aware that pcp is not available until July 18. Patient sent Relay Health message yesterday. Patient is completely out of medication and would like a covering physician to help with refill today.
001800
Electronically signed byDeborah L Hughes on 7/16/2007 11:09 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi Dr BaqueroI am currently out of Methadone, due to some stomach issues last week. The stomach issues have mostly subsided, but as a result, I lost a few days worth of Methadone. If you could write a prescription ASAP on Monday, I would really appreciate it. The stomach issues are very similar to the ones I have a few months ago - however, I do not currently have the money to perform the blood tests, so I guess I will have to wait on that- I atill have the form for it, however. Thanks for all your help.
Mark Amundsen

Preliminary
ID RH7850241
Document Text Hi Dr BaqueroI am currently out of Methadone, due to some stomach issues last week. The stomach issues have mostly subsided, but as a result, I lost a few days worth of Methadone. If you could write a prescription ASAP on Monday, I would really appreciate it. The stomach issues are very similar to the ones I have a few months ago - however, I do not currently have the money to perform the blood tests, so I guess I will have to wait on that- I atill have the form for it, however. Thanks for all your help. Mark Amundsen Display only: Transcription (RH7850241) on 7/15/2007 1:17 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Patient notified Rx was waiting up front. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Patient had refill on 6/1. Patient should have enough of Methadone. MARTINA RANDOLPH, M.D. Electronically signed byMartina Dobrovodska Randolph, MD on 6/22/2007 11:49 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed.
001801
Telephone Encounter
7/16/2007 11:07 AM
Reason for Call

Refill Request
Call Documentation
Teri L Rhodewalt 7/16/2007 4:26 PM Addendum Left message for patient to pick-up prescription Kurt J Slapnik, MD, MD 7/16/2007 3:12 PM Signed Please notify Mr. Amundsen his prescription is ready to be picked up at UCDavis in Folsom. Electronically signed by Kurt J Slapnik, MD at 7/16/2007 3:12 PM Deborah L Hughes 7/16/2007 11:09 AM Signed Patient is calling for a refill of methadone. Patient did not call their pharmacy for a refill already. Patient requests call to pick up rx. Patient is aware that pcp is not available until July 18. Patient sent Relay Health message yesterday. Patient is completely out of medication and would like a covering physician to help with refill today. Electronically signed by Deborah L Hughes at 7/16/2007 11:09 AM
Created by
Approved
Disp Refills Start End 300 0 7/16/2007 8/7/2007 METHADONE 10 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical Authorizing Provider: Kurt J Slapnik, MD

Disp Refills Start End 30 2 4/20/2007 6/20/2007 CELEXA 40 MG TAB (Taking) Sig - Route: take 1 tablet (40mg) by oral route once daily - ORAL Class: Pharmacy 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 300 0/0 5/18/2007 6/17/2007 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking) Sig - Route: take 1-2 tablet by oral route every 4 hours as needed for pain, may take up to 10 daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 240 0 2/9/2007 2/14/2007 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 300 0 5/4/2007 5/31/2007 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical 300 0 6/22/2007 7/16/2007 METHADONE 10 MG TAB (Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 3/29/2007 4/28/2007
001802
"Mark, I did send a refill request for 300 of the norco. I agree that nausea nad consipation may be caused by the norco. If it persists come see me for evaluation. Try Miralax or docusate to help with consitpation both are over the counter. " Display only: Transcription (RH8008835) on 8/3/2007 9:16 AM
Document history: Transcription (RH8008835) on 8/3/2007 9:16 AM
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Note transferred to Relay Health. Electronically signed byCherry Mendoza on 8/3/2007 9:17 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Mark, I did send a refill request for 300 of the norco. I agree that nausea nad consipation may be caused by the norco. If it persists come see me for evaluation. Try Miralax or docusate to help with consitpation both are over the counter. Electronically signed byVictor Baquero, MD on 8/3/2007 9:15 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: Amundsen,Mark Sent: 07/31/2007 6:05 PM Hi Dr BaqueroI am just about out of Norco - I found out last time that Costco had changed the prescription back to 250 per month for June and July. I am hoping you can instruct them to change it back to 10 per day, 300 per month - I asked them if then could fix it, and they said contact your doctor. I am putting in a refill request, but it will probably come in as 250 per month. I'm hoping you can fix that. I talked to the pharmacist, he says the nausea I'm having could be due to the Norco, or could be due to the constipation. I'm eating more fruit, and that seems to be helping, but I still get sick two or three times per month... Mark Amundsen Electronically signed byCherry Mendoza on 8/2/2007 3:41 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: Amundsen,Mark Sent: 07/31/2007 6:05 PM Hi Dr Baquero-
001803
Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 300 0 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical 300 0 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical 300 1 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
5/4/2007
5/31/2007
7/16/2007
8/15/2007
8/1/2007
8/31/2007
5/18/2007
6/17/2007
Orders Chart Cosign

Patient Information

Telephone Encounter
8/1/2007 9:41 AM
Call Documentation
Cherry Mendoza 8/1/2007 9:43 AM Signed From: Amundsen,Mark Sent: 07/31/2007 6:05 PM Hi Dr BaqueroI am just about out of Norco - I found out last time that Costco had changed the prescription back to 250 per month for June and July. I am hoping you can instruct them to change it back to 10 per day, 300 per month - I asked them if then could fix it, and they said contact your doctor. I am putting in a refill request, but it will probably come in as 250 per month. I'm hoping you can fix that. I talked to the pharmacist, he says the nausea I'm having could be due to the Norco, or could be due to the constipation. I'm eating more fruit, and that seems to be helping, but I still get sick two or three times per month... Mark Amundsen Electronically signed by Cherry Mendoza at 8/1/2007 9:43 AM
Created by
Approved
001804
Telephone Encounter
Call Documentation
Cherry Mendoza 8/3/2007 9:17 AM Signed Note transferred to Relay Health. Electronically signed by Cherry Mendoza at 8/3/2007 9:17 AM Victor Baquero, MD, MD 8/3/2007 9:15 AM Signed Mark, I did send a refill request for 300 of the norco. I agree that nausea nad consipation may be caused by the norco. If it persists come see me for evaluation. Try Miralax or docusate to help with consitpation both are over the counter. Electronically signed by Victor Baquero, MD at 8/3/2007 9:15 AM Cherry Mendoza 8/2/2007 3:41 PM Signed From: Amundsen,Mark Sent: 07/31/2007 6:05 PM Hi Dr BaqueroI am just about out of Norco - I found out last time that Costco had changed the prescription back to 250 per month for June and July. I am hoping you can instruct them to change it back to 10 per day, 300 per month - I asked them if then could fix it, and they said contact your doctor. I am putting in a refill request, but it will probably come in as 250 per month. I'm hoping you can fix that. I talked to the pharmacist, he says the nausea I'm having could be due to the Norco, or could be due to the constipation. I'm eating more fruit, and that seems to be helping, but I still get sick two or three times per month... Mark Amundsen
Created by

Disp Refills Start End 30 2 4/20/2007 6/20/2007 CELEXA 40 MG TAB (Taking) Sig - Route: take 1 tablet (40mg) by oral route once daily - ORAL Class: Pharmacy 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 300 0/0 5/18/2007 6/17/2007 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking) Sig - Route: take 1-2 tablet by oral route every 4 hours as needed for pain, may take up to 10 daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 240 0 2/9/2007 2/14/2007 METHADONE 10 MG TAB (Taking/Discontinued)
001805
Electronically signed byVictor Baquero, MD on 8/7/2007 5:35 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hello again Mr. Amundsen. You are very welcome. Yes, I am Dr. Baquero's new assistant. I try to get things done the same day or at least the next day. Have a good afternoon!
/>Cherry, MA
Links Previous Version Transcription Type Unstructured to Doctor Preliminary Document Text Hello again Mr. Amundsen. You are very welcome. Yes, I am Dr. Baquero's new assistant. I try to get things done the same day or at least the next day. Have a good afternoon! />Cherry, MA Display only: Transcription (RH8057668) on 8/7/2007 4:15 PM Document history: Transcription (RH8057668) on 8/7/2007 4:15 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes "Mark, I did send a refill request for 300 of the norco. I agree that nausea nad consipation may be caused by the norco. If it persists come see me for evaluation. Try Miralax or docusate to help with consitpation both are over the counter. " Links Previous Version Transcription Type Unstructured to Doctor
Preliminary ID RH8008835 Date and Time 8/3/2007 9:16 AM ID RH8057668 Date and Time 8/7/2007 4:15 PM
Document Text
001806
Progress Notes Hi Dr Baquero and CherryIt's about time for the monthly Methadone refill- not a huge hurry, but I will run out this weekend sometime. Thanks for all your assistance in this matter/>Mark Amundsen Transcription Type Unstructured to Doctor Preliminary
Document Text Hi Dr Baquero and Cherry-
ID RH8280366
It's about time for the monthly Methadone refill- not a huge hurry, but I will run out this weekend sometime. Thanks for all your assistance in this matter/>Mark Amundsen
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Note transferred to Relay Health. Electronically signed byCherry Mendoza on 8/8/2007 8:29 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Good morning, I just want to let you know that your METHADONE 10 MG TAB is ready to be picked up at the front desk. Have a great day! Transcription Type Provider Initiated Preliminary Document Text Good morning, I just want to let you know that your METHADONE 10 MG TAB is ready to be picked up at the front desk. Have a great day!
ID RH8071711
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Triplicate written. Please notify patient.
001807
Noted
Resolved
1/19/2006

Patient Information

Telephone Encounter
8/30/2007 8:23 AM
Reason for Call

Refill Request
Call Documentation
Cherry Mendoza 8/31/2007 10:06 AM Signed Note transferred to Relay Health. Electronically signed by Cherry Mendoza at 8/31/2007 10:06 AM Victor Baquero, MD, MD 8/31/2007 8:09 AM Signed Triplicate written. Please notify patient. Electronically signed by Victor Baquero, MD at 8/31/2007 8:09 AM Cherry Mendoza 8/30/2007 8:23 AM Signed ----- Message # 1 ----From: Amundsen,Mark Sent: 08/29/2007 5:43 PM Hi Dr Baquero and CherryIt's about time for the monthly Methadone refill- not a huge hurry, but I will run out this weekend sometime. Thanks for all your assistance in this matterMark Amundsen Electronically signed by Cherry Mendoza at 8/30/2007 8:23 AM
001808
Created by
Approved

Disp Refills Start End 30 2 4/20/2007 6/20/2007 CELEXA 40 MG TAB (Taking) Sig - Route: take 1 tablet (40mg) by oral route once daily - ORAL Class: Pharmacy 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 300 0/0 5/18/2007 6/17/2007 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking) Sig - Route: take 1-2 tablet by oral route every 4 hours as needed for pain, may take up to 10 daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 0 2/9/2007 2/14/2007 240 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 300 0 5/4/2007 5/31/2007 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical 0 8/7/2007 8/30/2007 300 METHADONE 10 MG TAB (Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 8/1/2007 8/31/2007 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 8/24/2007 9/23/2007 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027

Orders Chart Cosign

RH MD Msg
Visit Information
001809
Patient Information
Contacts
Telephone Encounter
9/18/2007 12:07 PM
Reason for Call

Refill Request
Call Documentation
Cherry Mendoza 9/18/2007 1:52 PM Signed Patient notified via VM. Electronically signed by Cherry Mendoza at 9/18/2007 1:52 PM Victor Baquero, MD, MD 9/18/2007 1:07 PM Signed Prescription called in. Electronically signed by Victor Baquero, MD at 9/18/2007 1:07 PM Orquidia Siu 9/18/2007 12:09 PM Signed He is calling for a refill of NORCO. He did not call his pharmacy for a refill already. He states that the dose is please check and the instructions are: as indicated. He requests a phone call when is ready. He has a Rx for METHADONE ready but he is llergic to it . Please revise the Rx.
Electronically signed by Orquidia Siu at 9/18/2007 12:09 PM
Created by
Approved

Disp Refills Start End 30 2 4/20/2007 6/20/2007 CELEXA 40 MG TAB (Taking) Sig - Route: take 1 tablet (40mg) by oral route once daily - ORAL Class: Pharmacy 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 300 0/0 5/18/2007 6/17/2007 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking) Sig - Route: take 1-2 tablet by oral route every 4 hours as needed for pain, may take up to 10 daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 0 10/27/2006 ALEVE 220 MG TAB (Taking)
001810
4/20/2007 8:32 AM
Ucd Registration
17032099
Patient Information

Contacts
Telephone Encounter
Reason for Call

Refill Request
Call Documentation
Cherry Mendoza 10/25/2007 9:34 AM Addendum Patient notified. Cherry Mendoza 10/17/2007 9:08 AM Addendum Left message for patient to call back. Victor Baquero, MD, MD 10/16/2007 5:38 PM Addendum Prescription called in. I got the request - however according to my records he was not due to receive a refill to later this week. Let him know that I expect the refills to last a full month. If this is not the case he should follow up in the office to discuss medication use. Brenda J Fallon 10/16/2007 3:21 PM Signed Patient is calling to check on status of refills again. Patient states costco has been faxing refill request to our office since 10/10/07. Patient states he even sent a relay health message to make sure request was received. Patient states he needs norco 10mg-325mg, 2 po q 4 hours maximum 10 tablets per day. Patient also needs refill on soma 350 mg tablets, 1 tablet tid. Please notify patient when done. Electronically signed by Brenda J Fallon at 10/16/2007 3:21 PM Deborah L Hughes 10/16/2007 11:53 AM Signed Patient is checking on status of refills for Norco and Soma. Please advise Electronically signed by Deborah L Hughes at 10/16/2007 11:53 AM Orquidia Siu 10/15/2007 3:48 PM Signed Patient calling for refill status of his NORCO and SOMA to Costco. Electronically signed by Orquidia Siu at 10/15/2007 3:48 PM
Created by
Approved
Disp Refills Start End 300 1 10/10/2007 12/10/2007 NORCO 10 MG-325 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Authorizing Provider: Victor Baquero, MD 90 3 10/10/2007 2/1/2008 SOMA 350 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 Authorizing Provider: Victor Baquero, MD

CELEXA 40 MG TAB (Taking) Disp 30 Refills 2 Start 4/20/2007 End 6/20/2007
001811
Sig - Route: take 1 tablet (40mg) by oral route once daily - ORAL Class: Pharmacy 30 6 3/22/2007 10/20/2007 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40mg) by oral route once daily in the morning - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for the faxed request for prescription number 1044954. Last date filled 06/26/2006. 300 0/0 5/18/2007 6/17/2007 HYDROCODONE-ACETAMINOPHEN 10 MG-325 MG TAB (Taking) Sig - Route: take 1-2 tablet by oral route every 4 hours as needed for pain, may take up to 10 daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1058318 0 10/27/2006 ALEVE 220 MG TAB (Taking) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300.00 3 2/27/2006 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET (Taking) Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 2/24/2006 GLUCOSAMINE 1,000 MG TAB (Taking) Class: Historical Route: ORAL 240 0 2/9/2007 2/14/2007 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 8 daily) - ORAL 300 0 5/4/2007 5/31/2007 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical 300 1 9/18/2007 10/10/2007 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 9/14/2007 10/10/2007 SOMA 350 MG TAB (Discontinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
001812

Appointment
Orders
DOB 9/23/1959
Plan UCD/B/S HMO
Financial Class P
Plan Number B72
Plan Phone 916-734-0739
Center None
Patient Information
Telephone Encounter
001813
1/30/2008 9:54 AM
Call Documentation
Cherry Mendoza 1/30/2008 9:54 AM Signed ----- Message # 1 -----
From: Amundsen,Mark Sent: 01/29/2008 11:24 PM Hi Dr Baquero- Sorry for the multiple messages. I also wanted to let you know the Prozac never did work after I started on it again. Things are fairly critical in this area. Is there an alternative I haven't tried? (Preferably low cost). Perhaps I should make an appointment? So far I've been on Prozac 40mg, Celexa, and I think Zoloft. I'm thinking maybe Effexor... Thanks again, Mark Amundsen
Created by

Disp Refills 0 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 3 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET 300.00 Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 GLUCOSAMINE 1,000 MG TAB Class: Historical Route: ORAL 0 300 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Start 10/27/2006 End
2/27/2006
2/24/2006
1/10/2008 1/7/2008
1/30/2008 2/6/2008
Orders Chart Cosign

Patient Information

Telephone Encounter
Call Documentation
Cherry Mendoza 1/30/2008 2:49 PM Signed Note transferred to Relay Health. Patient notified.
001814
Victor Baquero, MD, MD 1/30/2008 12:51 PM Signed Refill will be ready to pick up on Friday. Also request follow up evaluation. I need to see him at least every 6 months while he is on the medications for evaluation.
Cherry Mendoza 1/30/2008 9:54 AM Signed ----- Message # 1 ----From: Amundsen,Mark Sent: 01/29/2008 10:55 PM Hi Dr Baquero and Cherry- I wanted to email you early on a refill, because I think I'll be out of Methadone next Monday. I know it's a few days early, but I've been using more during the bad weather. Also, I've been having increasing problems around both knees and hands. I'm pretty sure it's arthritis, and since I can't do anything for the arthritis on the hips, I'm assuming the same for the knees and hands. Thanks for any info you can provide- Mark Amundsen
Created by
Approved

Disp Refills 0 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 3 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET 300.00 Sig - Route: 2 PACKETS DAILY - Transdermal Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 1023839. 0 GLUCOSAMINE 1,000 MG TAB Class: Historical Route: ORAL 300 0 METHADONE 10 MG TAB (Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Start 10/27/2006 End
2/27/2006
2/24/2006
1/10/2008 1/7/2008
1/30/2008 2/6/2008
Orders Chart Cosign

RH MD Msg
Visit Information Provider Department
Encounter #
001815
Problem List
1/19/2006

Patient Information

Telephone Encounter
2/21/2008 5:43 PM
Call Documentation
Cherry Mendoza 2/21/2008 5:43 PM Signed
----- Message # 2 ----From: Amundsen,Mark

Sent: 02/21/2008 5:19 PM Oops - didn't know about it being triplicate. It better work fantastic to make up for the extra driving. I'll email in two weeks to update on the hydromorphone and the Effexor.
Thanks for all the helpMark Amundsen

Created by

EFFEXOR XR 75 MG 24 HR CAP (Taking) Sig - Route: 1 PO DAILY - ORAL
001816
Class: Pharmacy 300 0 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 0 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 100 0 HYDROMORPHONE 4 MG TAB (Taking) Sig - Route: take 1 tablet (4 mg) by oral route every 4-6 hours as needed - ORAL 0 300 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
2/21/2008 10/27/2006
3/12/2008
2/21/2008 1/10/2008 2/1/2008
3/22/2008 1/30/2008 3/2/2008
2/1/2008
3/2/2008
Orders Chart Cosign

Patient Information

Telephone Encounter
2/21/2008 9:06 AM
Call Documentation
Victor Baquero, MD, MD 2/21/2008 9:35 AM Signed Mark.
THe hydromorphone is also a triplicate. Not as convenient as norco. I wrote 1 month out for you to try it. The methadone is ready as well.
Cherry Mendoza 2/21/2008 9:06 AM Signed ----- Message # 1 ----From: Amundsen,Mark Sent: 02/20/2008 6:31 PM Hi Dr Baquero- I have been doing price comparisons - they seem to have equalized the prices according to how well the meds work and their equivalant dosages - pretty sneaky! I did find a fairly good deal- Costco 8mg hydromorphone 100 ea for $66.00 - which should equal 300 of the 10/325 hydrocodone in usage. However, the price difference wasn't spectacular.($50) It takes a couple of days to get as well. So, I guess maybe I should switch to whatever you feel will work the best - the prices seem to equate. I do ask that whatever is proscribed, the least amount of pills to take is best. Also, I will be out of the Methadone next Monday - I'm hoping to get a refill on those as well by then. I have not picked up the Effexor yet - going to get them all at the same time probably. Thanks for everything- Mark Amundsen
001817
Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 3/5/2008 NORCO 10 MG-325 MG TAB Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 2/1/2008 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
6/30/2007 4/4/2008
3/2/2008
Allergies
Problem List
Noted Resolved
1/19/2006

Patient Information

Telephone Encounter
3/4/2008 1:37 PM
Call Documentation
Victor Baquero, MD, MD 3/5/2008 8:11 AM Signed Will resume norco.

001818
Cherry Mendoza 3/4/2008 1:37 PM Signed ----- Message # 2 ----From: Amundsen,Mark Sent: 03/04/2008 1:33 PM Hi Dr Baquero-
Norco is more affordable - but I thought there was something else you wanted to try before going back to the Norco. If not, I guess Norco would be the best choice,,, Mark Amundsen
Created by
Approved

Disp Refills 30 0 EFFEXOR XR 75 MG 24 HR CAP (Taking) Sig - Route: 1 PO DAILY - ORAL Class: Pharmacy 300 0 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 0 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 0 300 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 1 300 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 Start 2/19/2008 End 3/20/2008
2/21/2008 10/27/2006
3/12/2008
1/10/2008 2/1/2008
1/30/2008 3/5/2008
2/1/2008
3/2/2008

DOB 9/23/1959
Telephone Encounter
3/3/2008 8:51 AM
001819
Call Documentation
Cherry Mendoza 3/4/2008 9:22 AM Signed Note transferred to Relay Health.

Victor Baquero, MD, MD 3/3/2008 6:20 PM Signed Thanks for the update. Find out what is more affordable - vicodin or norco (I would prefer the norco because of the lower tylenol content).
Cherry Mendoza 3/3/2008 8:51 AM Signed ----- Message # 1 ----From: Amundsen,Mark Sent: 03/03/2008 7:56 AM Hi Dr Baquero- I wanted to let you know about the results of the prescription changes we attempted last visit. 1. The switch to Effexor seems to be working well. I am feeling much better in mood and general health. I did experience some initial hyperactivity, which may have been getting used to the pill, or just getting caught up on my projects. It seems to have leveled out nicely now. 2. The Hydromorphone did not work at all, at any dose. The pharmacist supplied 4mg tablets instead of 8mg - I hadn't looked to see what you had prescribed, but it worked out well, as the price of these was half of the 8mg. The only thing Hydromorphone caused was severe allergic itching, all over. It took a while to find out whether it was that or the Effexor. I'd like to give another try at a Hydrocodone substitute - perhaps we could try the other med you suggested (I can't remember what it was). If this doesn't work, than maybe converting some of the Hydrocodone to Methadone is the better way to go. Let me know what you think- Mark Amundsen
Created by

Disp Refills 30 0 EFFEXOR XR 75 MG 24 HR CAP (Taking) Sig - Route: 1 PO DAILY - ORAL Class: Pharmacy 300 0 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 0 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 100 0 HYDROMORPHONE 4 MG TAB (Discontinued) Sig - Route: take 1 tablet (4 mg) by oral route every 4-6 hours as needed - ORAL 300 0 METHADONE 10 MG TAB (Taking/Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 1 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 3 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 Start 2/19/2008 End 3/20/2008
2/21/2008 10/27/2006
3/12/2008
2/21/2008 1/10/2008 2/1/2008
3/3/2008 1/30/2008 3/2/2008
2/1/2008
3/2/2008
Orders
001820
Fentanyl, dilaudid.
1/19/2006

Patient Information

Telephone Encounter
3/5/2008 3:52 PM
Call Documentation

Victor Baquero, MD, MD 3/5/2008 4:26 PM Signed I called in the norco.

Cherry Mendoza 3/5/2008 3:53 PM Signed ----- Message # 1 ----From: Amundsen,Mark Sent: 03/05/2008 3:49 PM Hi Dr Baquero and Cherry- I'm hoping you got my last message about the Norco - I don't have anything left that works, so hopefully Dr Baquero can call in a prescription, either the one he suggested in the office ( I can't remember what that was), or another Norco prescription as recommended. Please call if there is any confusion 916-983-2589 Thanks- Mark Amundsen
Created by

EFFEXOR XR 75 MG 24 HR CAP (Taking) Sig - Route: 1 PO DAILY - ORAL
001821
1/19/2006

Patient Information

Telephone Encounter
4/23/2008 10:08 AM
Reason for Call

Refill Request
Call Documentation


Victor Baquero, MD, MD 4/25/2008 5:07 PM Signed Mark, I'll need to meet with you to discuss the medication. Please schedule with me next week. I'll prescribe enough methadone until you can see me. I sent you a message but the computer crashed thereafter. I presumed you did not get it.
Cherry Mendoza 4/25/2008 10:34 AM Signed ----- Message # 1 ----From: Amundsen,Mark Sent: 04/24/2008 9:03 PM Hi Dr Baquero and Cherry- I just wanted to make sure you received my last message - I will be out of
001822
Methadose on Sunday or Monday. I know it is faster than usual, but the Norco has been ineffective. I was hoping we could do what we discussed last visit - increasing the Methadone, and reducing the Norco, perhaps to 400 Methadone, and a corresponding reduction in Norco. Or another amount as you can suggest. Thanks for your attention in this matter- Mark Amundsen
Cherry Mendoza 4/23/2008 10:08 AM Signed ----- Message # 1 ----From: Amundsen,Mark Sent: 04/23/2008 9:54 AM Hi Dr Baquero- I am going to be out of Methadone and Norco on Monday the 28th. I know it's early, but they haven't been working very well lately. I am hoping that you can increase the number of Methadone to 400 per month, and reduce the number of Norco by an equivalent amount, since the Norco seems to work less well than the Methadone, and I have been throwing up the Norco fairly regularly - and it will save a little money as well. If this amount doesn't work for you, than I leave it to yor judgement as to how to modify the amount. Please let me know if this is okay, or other arrangements should be made. Since both items will have different amounts, new prescriptions for both wil have to be established. Thanks in advance Dr Baquero... Mark Amundsen P.S. I have stopped taking the Effexor XR - it was too up and down, especially if I missed a dose. I'm trying the prozac again - it's been three months since I took it last, so maybe thats enough... Mark Amundsen
Created by
Approved
Disp Refills Start End 300 0 4/23/2008 9/4/2008 METHADONE 10 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Normal Authorizing Provider: Victor Baquero, MD 75 0 4/25/2008 5/2/2008 METHADONE 10 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Normal Authorizing Provider: Victor Baquero, MD
Refused
Disp Refills Start End 300 1 4/23/2008 5/23/2008 NORCO 10 MG-325 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 2 po q 4 hours. Max 10 per day. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Reason for Refusal: Patient has requested refill too soon Refused By: Victor Baquero, MD

Disp Refills 30 0 EFFEXOR XR 75 MG 24 HR CAP (Taking) Sig - Route: 1 PO DAILY - ORAL Class: Pharmacy 300 0 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 0 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical Start 2/19/2008 End 3/20/2008
2/21/2008 10/27/2006
3/12/2008
001823
weekly.
Patient Information

Telephone Encounter
5/14/2008 4:57 PM
Call Documentation

Cherry Mendoza 5/14/2008 4:57 PM Signed ----- Message # 1 ----From: Amundsen,Mark Sent: 05/14/2008 5:57 AM Hi Dr Baquero- I have been using about 13 Methadone per day, which has mostly done the trick. I haven't been missing the Norco at all. However, I will be out of the Methadone on Saturday, so I would like to get a refill before Friday. I'll get refills for the other meds through the pharmacy... Thanks again Mark Amundsen P.S. The Prozac still seems to be working - yaay!!
Created by

Disp Refills 30 6 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40 mg) by oral route once daily in the morning - ORAL Class: Pharmacy 0 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300 0 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 METHADONE 10 MG TAB (Taking) Sig - Route: Take 12 daily (120mg) - ORAL Class: Historical Start 4/30/2008 End 10/30/2008
10/27/2006
4/23/2008 4/30/2008
5/13/2008 5/2/2008
001824
Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027
Allergies
Problem List
1/19/2006

Patient Information

Telephone Encounter
7/23/2008 2:17 PM
Reason for Call

Refill Request
Call Documentation
Mandy Chilson 7/24/2008 9:28 AM Addendum Left message informing patient.
001825
Nancy Jaeger, MD, MD 7/23/2008 5:13 PM Signed Please notify patient of prescription being ready for pick-up. Thanks.
Julie Stewart 7/23/2008 2:44 PM Signed Yes, patient usually takes 4 tabs 3 times a day; 10-12 pills per day of methadone. Please call patient when written and ready for pick up.
Electronically signed by Julie Stewart at 7/23/2008 2:44 PM
Nancy Jaeger, MD, MD 7/23/2008 2:38 PM Signed Please clarify dosing--Methadone should be dosed every 8 hrs for pain control; is he atking 4 tabs TID?
Created by
Approved
Disp Refills Start End 300 0 7/23/2008 7/25/2008 METHADONE 10 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical Authorizing Provider: Nancy Jaeger, MD

Disp Refills 30 6 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40 mg) by oral route once daily in the morning - ORAL Class: Pharmacy 0 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300 0 METHADONE 10 MG TAB (Taking) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 390 0 METHADONE 10 MG TAB (Taking) Sig - Route: Take 12 daily (120mg) - ORAL 100 1 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 0 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176027 Start 4/30/2008 End 10/30/2008
10/27/2006
4/23/2008 6/26/2008 6/24/2008
5/13/2008 6/28/2008 7/24/2008
7/22/2008
10/23/2008
DOB 9/23/1959
Telephone Encounter
7/22/2008 3:20 PM
Reason for Call

Refill Request
001826


Patient Information

Telephone Encounter
9/3/2008 8:27 AM
Reason for Call

Refill Request
copy from RH
Call Documentation
Mandy Chilson 9/9/2008 8:18 AM Signed Notified via Relay Health.

Victor Baquero, MD, MD 9/5/2008 10:09 AM Signed Please notify. Triplicate will be ready on the 9th. As mentioned on the pain contract. Prescriptions are to last the entire month. Any changes to the normal use should be discussed in the office.
Mandy Chilson 9/5/2008 9:54 AM Signed Hi MandyYes, I realize it's a bit early this month - However, let me point out two things. There were 31 days last month, and the refill usually goes day 5 to day 4, so the normal refill this month should be on the 9th, not the 11th. Also, I used more pills than normal this month due to contracting a jaw infection due to dental work. The dentist offered pain pills, but since I am only supposed to get them from 1 doctor, I turned them down. If Dr Baquero would like to check with the dentist, his name is Dr Judd at 916-983-1999 However, I will understand if Dr Baquero wishes to wait until the regular time, but the regular time should be the 9th, not the 11th... Thanks!
001827
Mark Amundsen
Mandy Chilson 9/3/2008 8:28 AM Signed It's about tim for another refill - I'll be out on Saturday or Sunday, so any time before Friday would be great. Thanks for your attention in this - I'll be sure to make an appt in October... Mark Amundsen
Created by
Approved

Disp Refills Start 30 6 4/30/2008 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40 mg) by oral route once daily in the morning - ORAL Class: Pharmacy 300 0 7/23/2008 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL Class: Historical 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 300 0 4/23/2008 METHADONE 10 MG TAB (Discontinued) Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 390 0 8/11/2008 METHADONE 10 MG TAB (Discontinued) Sig - Route: Take 12 daily (120mg) - ORAL 100 1 6/24/2008 NORCO 10 MG-325 MG TAB (Discontinued) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 100 1 8/19/2008 NORCO 10 MG-325 MG TAB Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 0 8/19/2008 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 242072.last fill - 7/22/08 End 10/30/2008
7/25/2008
9/4/2008 9/3/2008 8/19/2008
9/18/2008
11/20/2008
Orders Chart Cosign

RH MD Msg
001828
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills Start End 30 6 4/30/2008 10/30/2008 FLUOXETINE 40 MG CAP Sig - Route: take 1 capsule (40 mg) by oral route once daily in the morning - ORAL Class: Pharmacy 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 240 0 11/14/2006 12/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 6/30/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 300 0 4/23/2008 5/13/2008 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 390 0 9/9/2008 10/7/2008 METHADONE 10 MG TAB Sig - Route: Take 12 daily (120mg) - ORAL 100 1 8/19/2008 9/18/2008 NORCO 10 MG-325 MG TAB Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 90 0 8/19/2008 11/20/2008 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 242072.last fill - 7/22/08
Allergies
Problem List
Noted Resolved
001829
Class: Historical 390 0 10/6/2008 METHADONE 10 MG TAB (Taking) Sig - Route: Take 12 daily (120mg) - ORAL 90 0 9/18/2008 SOMA 350 MG TAB (Discontinued) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 242072.last fill - 7/22/08
11/3/2008 10/17/2008

DOB 9/23/1959
Telephone Encounter
10/6/2008 9:55 AM
Reason for Call

Refill Request
Call Documentation
Teri L Rhodewalt 10/7/2008 10:24 AM Signed Left message for patient to pick up prescription at our front desk
Electronically signed by Teri L Rhodewalt at 10/7/2008 10:24 AM
Teri L Rhodewalt 10/6/2008 9:55 AM Signed From RH

Electronically signed by Teri L Rhodewalt at 10/6/2008 9:55 AM
Created by
Approved

Disp Refills 30 6 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40 mg) by oral route once daily in the morning - ORAL Class: Pharmacy 0 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 390 0 METHADONE 10 MG TAB (Discontinued) Sig - Route: Take 12 daily (120mg) - ORAL 90 0 SOMA 350 MG TAB (Taking) Start 4/30/2008 End 10/30/2008
10/27/2006
9/9/2008 9/18/2008
10/6/2008 10/18/2008
001830
weekly.
Patient Information

Contacts
10/17/2008 2:52 PM
Type Phone (Incoming) Contact Amundsen, Mark (Self) Phone 916-983-2589 (H)
Telephone Encounter
Reason for Call

Refill Request
Call Documentation
Charles W Griffin 10/17/2008 2:55 PM Signed He is calling for a refill of SOMA . He did call his pharmacy for a refill already. He states that the dose is 350mg and the instructions are: as directed . He requests Send to preferred pharmacy.
He is calling for a refill of NORCO. He did call his pharmacy for a refill already. He states that the dose is 10mg and the instructions are: as directed . He requests Send to preferred pharmacy. Patient is out of both these meds and need to get today please let the patient know when ordered
Electronically signed by Charles W Griffin at 10/17/2008 2:55 PM
Created by
Approved
Disp Refills Start End 90 0 10/17/2008 11/13/2008 SOMA 350 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 242072.last fill - 7/22/08 Authorizing Provider: Victor Baquero, MD 100 1 10/17/2008 12/12/2008 NORCO 10 MG-325 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Authorizing Provider: Victor Baquero, MD

Disp Refills 30 6 FLUOXETINE 40 MG CAP (Taking) Sig - Route: take 1 capsule (40 mg) by oral route once daily in the morning - ORAL Class: Pharmacy 0 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Start 4/30/2008 End 10/30/2008
10/27/2006
001831
Patient Information
Telephone Encounter
12/22/2008 8:13 AM
Reason for Call

Refill Request
Call Documentation
Deborah L Hughes 12/22/2008 3:43 PM Signed Left messages at both numbers

Electronically signed by Deborah L Hughes at 12/22/2008 3:43 PM
Mandy Chilson 12/22/2008 8:13 AM Signed will be out of Methadone on Friday or Saturday - however, I will be leaving to go to my brothers house on Wednesday. I am hoping you can write out a prescription before Wednesday so I won't have to come back to town. Please let me know when to come in.... Thanks! Mark Amundsen
Created by
Approved

Disp Refills 100 1 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 0 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 390 0 METHADONE 10 MG TAB (Discontinued) Start 12/12/2008 End 1/11/2009
10/27/2006
12/1/2008
12/22/2008
001832
Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008
Allergies
Problem List
1/19/2006

Patient Information

Telephone Encounter
1/13/2009 8:49 AM
Reason for Call

Other copy from RH
Call Documentation
Mandy Chilson 1/13/2009 12:23 PM Signed Notified via Relay Health.

001833
Victor Baquero, MD, MD 1/13/2009 12:11 PM Addendum The placard is a possibility. I would like to see you to discuss medications, symptoms, etc.
Previous Version Electronically signed by Victor Baquero, MD at 1/13/2009 12:09 PM Electronically signed by Victor Baquero, MD at 1/13/2009 12:11 PM
Mandy Chilson 1/13/2009 8:50 AM Signed Hi Dr Baquero and AmandaI have started a new job, which is really good, except the parking is downtown, and quite a ways away. As my hip is getting worse, I am hoping I would be able to receive a handicapped placard to use until I get the hip replaced. I'd also like to make an appointment for a checkup, but I'd like to wait until after the insurance kicks in to do so. Please let me know whether a placard is a possibility. Thanks for all your helpMark Amundsen
Created by

Disp Refills Start 100 1 12/12/2008 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 390 0 12/22/2008 METHADONE 10 MG TAB (Taking) Sig - Route: Take 12 daily (120mg) - ORAL 100 1 12/12/2008 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 End 1/11/2009
1/19/2009 1/11/2009
Orders Chart Cosign

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
001834
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Disp Refills Start End 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 240 0 11/14/2006 12/14/2006 METHADONE 10 MG TAB Sig - Route: take 1 tablet (10mg) by oral route every 4 hours as directed - ORAL 300 0 5/31/2007 6/30/2007 METHADONE 10 MG TAB Sig - Route: Take 2 po every 6 hours (max 10 daily) - ORAL 390 0 12/22/2008 1/19/2009 METHADONE 10 MG TAB Sig - Route: Take 12 daily (120mg) - ORAL 100 1 12/12/2008 1/11/2009 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008
Allergies
Problem List
1/19/2006

Class: Acute
001835
Patient Information

Telephone Encounter
1/20/2009 8:57 AM
Reason for Call

Refill Request
copy from RH
Call Documentation
Gertrudes Perlas Montemayor, MD 1/20/2009 10:25 AM Signed Prescription done.

Electronically signed by Gertrudes Perlas Montemayor, MD at 1/20/2009 10:25 AM
Mandy Chilson 1/20/2009 8:57 AM Signed Hi Dr Baquero and Amanda- I wanted to let y'all know that I will be needing a refill on Methadone - I will be out of medication on Wednesday. I'm sending this a little early since I will be out of town on Tuesday, and I know y'all are closed on Monday. I will make an appointment after Feb 1st to talk about the handicapped placard - I'll have coverage by then. Thanks- Mark Amundsen
Created by
Approved
Disp Refills Start End 390 0 1/20/2009 2/11/2009 METHADONE 10 MG TAB Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: Take 12 daily (120mg) - ORAL Class: Handwritten Rx Authorizing Provider: Gertrudes Perlas Montemayor, MD

Disp Refills Start 100 1 12/12/2008 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 390 0 12/22/2008 METHADONE 10 MG TAB (Discontinued) Sig - Route: Take 12 daily (120mg) - ORAL 100 1 12/12/2008 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 End 1/11/2009
1/20/2009 1/11/2009
RH MD Msg
Visit Information
001836
Plan UCD/B/S HMO
Financial Class P
Plan Number B72
Plan Phone 916-734-0739
Center None
Center None
Patient Information

Telephone Encounter
2/13/2009 1:59 PM
Reason for Call

Refill Request
Created by
Approved

Disp Refills 100 1 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 0 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical Start 12/12/2008 End 1/11/2009
10/27/2006
001837
390 0 2/17/2009 METHADONE 10 MG TAB (Taking) Sig - Route: Take 12 daily (120mg) - ORAL 100 1 12/12/2008 SOMA 350 MG TAB Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008
3/17/2009 1/11/2009

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Medications
Allergies
Allergies
001838
Try Miralax twice a day. Magnesium citrate - to clear the bowels. Both are over the counter.
Problem List
Noted Resolved
1/19/2006

Class: Acute Encounter Closed By Closed By BAQUERO, VICTOR H
Patient Information
Closed Time 20:25

Contacts
Telephone Encounter
2/18/2009 8:58 AM
Reason for Call

Other
Call Documentation
Jasvir K Bhele 2/18/2009 11:37 AM Signed Pt called back and scheduled with Dr.Baquero for 4:00 pm today
Electronically signed by Jasvir K Bhele at 2/18/2009 11:37 AM
Victor Baquero, MD, MD 2/18/2009 9:29 AM Signed
001839
Request urgent care or evaluation with any available provider. Otherwise ok to schedule with me at 4pm.
Dannel Cameron 2/18/2009 9:03 AM Signed Patient called and states that he has been extremelly nautious, he said that he is belching what ever he eats for at least 11 to 12 hours. He can't go to the bathroom. He thinks everything is shutting down on him. There are no avalible appt left for today. Please call patient.
Electronically signed by Dannel Cameron at 2/18/2009 9:03 AM
Created by

Disp Refills 100 1 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 0 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 390 0 METHADONE 10 MG TAB (Taking) Sig - Route: Take 12 daily (120mg) - ORAL 100 1 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 Start 12/12/2008 End 1/11/2009
10/27/2006
2/17/2009 2/13/2009
3/17/2009 3/15/2009

Orders Chart Cosign

Appointment
Sex Male

DOB 9/23/1959
001840
BRACHIAL NEURITIS NOS ADVANCED OSTEOARTHRITIS OF THE LEFT HIP
1/19/2006

Patient Information

Telephone Encounter
4/9/2009 11:34 AM
Reason for Call

Refill Request
Call Documentation
Martina Dobrovodska Randolph, MD 4/9/2009 11:51 AM Signed Prescription is ready. MARTINA RANDOLPH, M.D.
Electronically signed by Martina Dobrovodska Randolph, MD at 4/9/2009 11:51 AM
Mandy Chilson 4/9/2009 11:35 AM Signed It's about that time again for another Methadone refill. I will be out on next Tuesday, but I'm hoping to pick up the prescription Monday night unless it's done earlier. I have to take off early from work to get there in time. If it's done before then, maybe I could pick it up Monday morning before work... Thanks for all your helpMark Amundsen
Created by
Approved
METHADONE 10 MG TAB
001841
Plan UCD/B/S HMO
Financial Class P
Plan Number B72
Plan Phone 916-734-0739
Center None
Patient Information

Telephone Encounter
5/7/2009 11:35 AM
Reason for Call

Refill Request
copy from rh
Call Documentation

Mandy Chilson 5/7/2009 11:35 AM Signed It's time for another refill on Methadone. Please let me know via email when it is available. Also, I am hoping you can specify that I am taking 13 per day versus 12, as the amount prescribed works out to 30 days at 13 per day. They had me pay for a few extra days cause they said the script was for 32 days. even when it was not... Thanks!
001842
Medication Problem
Call Documentation
Cory O'Dell 5/28/2009 4:18 PM Signed Rx called in and patient notified.

Electronically signed by Cory O'Dell at 5/28/2009 4:18 PM
Brenda J Fallon 5/28/2009 3:44 PM Signed Patient states that pharmacy has not received perscription via fax yet. Please advise when done.
Electronically signed by Brenda J Fallon at 5/28/2009 3:44 PM
Cory O'Dell 5/28/2009 8:29 AM Signed LEFT MESSAGE FOR PT TO RETURN CALL.
Electronically signed by Cory O'Dell at 5/28/2009 8:29 AM
Victor Baquero, MD, MD 5/28/2009 8:11 AM Signed Please notify. Culture is positive for C. Diff - as expected. Called in antibiotics to his pharmacy. Take for 2 weeks. Also take probiotics. Follow up if not better.
Created by
Approved
Disp Refills Start End 42 0 5/28/2009 6/11/2009 Metronidazole (FLAGYL) 500 mg PO Tablet Warning: The medication was pended with free-text dispense values. You will have to enter discrete dispense values to sign the order. Sig - Route: Take 1 Tab by mouth 3 times daily. No alcohol - ORAL Class: Pharmacy Authorizing Provider: Victor Baquero, MD

Disp Refills Start 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 390 0 5/7/2009 METHADONE 10 MG TAB (Taking) Sig - Route: Take 13 daily (130mg) - ORAL 100 1 4/27/2009 NORCO 10 MG-325 MG TAB (Taking) Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 100 1 4/27/2009 SOMA 350 MG TAB (Taking) Sig - Route: 1 po tid - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 End
6/4/2009 5/27/2009
5/27/2009

Orders Chart Cosign

Appointment
Patient Information
001843
Patient Information

Telephone Encounter
6/2/2009 10:37 AM
Reason for Call

Refill Request
Call Documentation

Victor Baquero, MD, MD 6/2/2009 1:19 PM Signed Triplicate written. Please notify patient. Letter written.
Mandy Chilson 6/2/2009 10:37 AM Signed Just wanted to let you know that it's time for a refill on Methadone. Also, I am starting to feel normal again after the C-Diff. The trots stopped Sunday morning, but It took a little longer to get my strength back. I will go back to work tomorrow (Wednesday) or Thursday. Speaking of this, my work asked for another note to finish my absence up - I'm hoping that maybe you could write up a note excusing me the 29th of May through the 3rd of June. Hopefully, I can pick up the note along with the prescription. Thanks for everything, especially for making me better after the C-Diff. I just didn't know how bad going 15 times a day could make you feel... Mark Amundsen
Created by
Approved

Disp Refills 42 0 Metronidazole (FLAGYL) 500 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth 3 times daily. No alcohol - ORAL Class: Pharmacy 0 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Start 5/28/2009 End 6/11/2009
10/27/2006
001844
1/19/2006


Patient Information

Contacts
06/29/2009 1:50 PM Type Phone (Incoming) Contact Amundsen, Mark (Self) Phone 916-337-0490 (W)
Telephone Encounter
6/29/2009 1:50 PM
Reason for Call

Refill Request
Call Documentation
Clare Jennings, MA 6/29/2009 4:34 PM Addendum Patient came in and picked up RX
Clare Jennings, MA 6/29/2009 2:34 PM Signed RX ready for pick up, left message for patient to return call
Erica F Wilson 6/29/2009 1:51 PM Signed Pt would like to know if his Methadone (DOLOPHINE) 10 mg PO Tablet is ready to pick up?
Electronically signed by Erica F Wilson at 6/29/2009 1:51 PM
001845
Patient notified
Electronically signed byLeah Reyes, MOSC on 7/24/2009 2:46 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Triplicate written. Please notify patient.

Electronically signed byVictor Baquero, MD on 7/24/2009 2:45 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi Mandy- Just wanted to check that you got my message about a refill I'm hoping to pick it up today so I won't be out on Monday. Thanks for everything... Mark Amundsen Transcription Type Unstructured to Doctor
Preliminary ID RH17939368 Date and Time 7/24/2009 11:26 AM
Document Text Hi Mandy- Just wanted to check that you got my message about a refill I'm hoping to pick it up today so I won't be out on Monday. Thanks for everything... Mark Amundsen Display only: Transcription (RH17939368) on 7/24/2009 11:26 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Patient will be out Monday

Electronically signed byMandy Chilson on 7/23/2009 2:15 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi Dr Baquero and Mandy- It's time for another refill on Methadone. I'll be out Monday morning, so a refill anytime before then would be great. Thanks for the quick responses!! Mark Amundsen Transcription Type Unstructured to Doctor Preliminary
Document Text Hi Dr Baquero and Mandy- It's time for another refill on Methadone.
ID RH17912948
001846
I'll be out Monday morning, so a refill anytime before then would be great. Thanks for the quick responses!! Mark Amundsen Display only: Transcription (RH17912948) on 7/23/2009 9:18 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed.
001847
HIPS BILATERAL WITH PELVIS (43417405) L-SPINE 2 OR 3 VIEWS (43417406)
8/18/2009 8/18/2009
Encounter Closed By
Closed By BRIXIE, ROSEMARY Closed Date 08182009 Closed Time 09:26
Patient Information

Telephone Encounter
8/3/2009 12:14 PM
Reason for Call

Other copy from RH
Call Documentation

Victor Baquero, MD, MD 8/3/2009 4:58 PM Signed Referral done. Please notify patient. Also he will need xrays done in order for ortho to process the referral. Notify patient. Orders placed in EMR, come in for xrays.
Mandy Chilson 8/3/2009 12:14 PM Signed Hi Dr Baquero and Mandy- The pain in my hip has increased significantly in the last 2 weeks, why I don't know. It's jumped from a static three to a five with spikes of sevens. I've decided it's time to get the hip replaced - I made an appt with Dr Baquero for Aug 20th, but I was hoping to get a referral to the ortho clinic before that time, to get the ball rolling on the replacement.. Please let me know if there is any way to expedite the referral to the ortho clinic... Thanks for your attention in this matterMark Amundsen
Created by

Disp Refills Start 42 0 5/28/2009 Metronidazole (FLAGYL) 500 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth 3 times daily. No alcohol - ORAL Class: Pharmacy 0 10/27/2006 ALEVE 220 MG TAB Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 100 1 6/23/2009 Carisoprodol (SOMA) 350 mg PO Tablet (Taking) Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 100 1 7/28/2009 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet (Taking) End 6/11/2009
7/23/2009
8/27/2009
001848
placed in EMR, come in for xrays. Links Previous Version Transcription Type Unstructured to Doctor
Document Text Referral done. Please notify patient. Also he will need xrays done in order for ortho to process the referral. Notify patient. Orders placed in EMR, come in for xrays.
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Notified via Relay Health.

Electronically signed byMandy Chilson on 8/3/2009 4:59 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Referral done. Please notify patient. Also he will need xrays done in order for ortho to process the referral. Notify patient. Orders placed in EMR, come in for xrays.
Hi Dr Baquero and Mandy- The pain in my hip has increased significantly in the last 2 weeks, why I don't know. It's jumped from a static three to a five with spikes of sevens. I've decided it's time to get the hip replaced - I made an appt with Dr Baquero for Aug 20th, but I was hoping to get a referral to the ortho clinic before that time, to get the ball rolling on the replacement.. Please let me know if there is any way to expedite the referral to the ortho clinic... Thanks for your attention in this matterMark Amundsen
001849
Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Triplicate written. Please notify patient. Also, please pull up chart and obtain DMV placard form - at DMV.org or you may have a copy of the forms in your file drawer. THanks.
Electronically signed byVictor Henrique Baquero, MD on 11/5/2009 2:35 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
From: Amundsen,Mark Sent: 11/04/2009 9:15 PM
Hi Dr Baquero and Teri- It's time for another refill on Methadone. I will be out Saturday or Sunday, so I'm hoping to pick up a prescription on Friday. Also, my Disabled tag expired October 31. I'm hoping to get another one to run from November 1 to April 31, which should cover my recuperation from the hip replacement. If you would like, I can send a copy of the old application via email, or I can bring it in, to use in filling out a new application. Please let me know what I should do to facilitate receiving a new application for a disabled placard, and please let me know when I can pick up a refill... Thanks for all your help... Mark Amundsen
Electronically signed byClare Jennings, MA on 11/5/2009 7:59 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi Dr Baquero and Teri- It's time for another refill on Methadone. I will be out Saturday or Sunday, so I'm hoping to pick up a prescription on Friday. Also, my Disabled tag expired October 31. I'm hoping to get another one to run from November 1 to April 31, which should cover my recuperation from the hip replacement. If you would like, I can send a copy of the old application via email, or I can bring it in, to use in filling out a new application. Please let me know what I should do to facilitate receiving a new application for a disabled placard, and please let me know when I can pick up a refill... Thanks for all your help... Mark Amundsen Transcription Type Unstructured to Doctor Preliminary Document Text Hi Dr Baquero and Teri- It's time for another refill on Methadone. I will be out Saturday or Sunday, so I'm hoping to pick up a prescription on Friday. Also, my Disabled tag expired October 31. I'm hoping to get another one to run from November 1 to April 31, which should cover my recuperation from the hip replacement. If you would like, I can send a copy of the old application via email, or I can bring it in, to use in filling out a new application. Please let me know what I should do to ID RH20442044 Date and Time 11/4/2009 9:15 PM
001850
facilitate receiving a new application for a disabled placard, and please let me know when I can pick up a refill... Thanks for all your help... Mark Amundsen
Pharmacist notified. Andrea A Tinsey,MA

Electronically signed byAndrea A Tinsey on 10/12/2009 9:12 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Ok to fill early.
Electronically signed byVictor Baquero, MD on 10/12/2009 9:02 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Vi pharmacist calling wanting to know if it's ok to fill Methadone 5 days early since patient is leaving to go out of town.Pt is waiting at the phar
Electronically signed byJasvir K Bhele on 10/12/2009 8:28 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Message left that RX was at the front desk

Triplicate written. Please notify patient. Ready on Monday.

Hi Dr Baquero- It's about time for another refill on Methadone - I'll be out next Monday or Tuesday.
001851
Appointment
Sex Male

DOB 9/23/1959
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Center None
Patient Information

Contacts
11/06/2009 10:41 AM
Type Phone (Incoming) Contact AMUNDSEN, MARK (Self) Phone 916-337-0490 (W)
Telephone Encounter
Provider Department
001852
11/5/2009 7:59 AM
Fol Family Practice
Reason for Call

Refill Request
Call Documentation
Stephanie L Esparza, LVN 11/6/2009 1:59 PM Signed Please sign and close chart.
Electronically signed by Stephanie L Esparza, LVN at 11/6/2009 1:59 PM
Erica F Wilson 11/6/2009 10:42 AM Signed Pt notified Triplicate ready.

Electronically signed by Erica F Wilson at 11/6/2009 10:42 AM
Clare Jennings, MA 11/5/2009 3:02 PM Signed Left message for patient to return call. DMV forms are in your in box
Victor Baquero, MD, MD 11/5/2009 2:35 PM Signed Triplicate written. Please notify patient. Also, please pull up chart and obtain DMV placard form - at DMV.org or you may have a copy of the forms in your file drawer. THanks.

Hi Dr Baquero and Teri- It's time for another refill on Methadone. I will be out Saturday or Sunday, so I'm hoping to pick up a prescription on Friday. Also, my Disabled tag expired October 31. I'm hoping to get another one to run from November 1 to April 31, which should cover my recuperation from the hip replacement. If you would like, I can send a copy of the old application via email, or I can bring it in, to use in filling out a new application. Please let me know what I should do to facilitate receiving a new application for a disabled placard, and please let me know when I can pick up a refill... Thanks for all your help... Mark Amundsen
Routing History
11/6/2009 1:59 PM 11/5/2009 2:35 PM 11/5/2009 7:59 AM
From Stephanie L Esparza, LVN Victor Henrique Baquero, MD Clare Jennings, MA
To Victor Henrique Baquero, MD P FOL MA FP Victor Henrique Baquero, MD
Priority Routine Routine Routine
Created by
Approved
Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 13 Tabs by mouth every day. - ORAL Class: Normal Authorizing Provider: Victor Henrique Baquero, MD

Disp Refills 100 Tab 1 Carisoprodol (SOMA) 350 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 8 hours if needed for muscle spasm. - ORAL Start 11/2/2009 End 12/2/2009
001853
communication record creation was suppressed. Progress Notes Hi Dr BaqueroIt's time for another refill on Methadone. I should be out on Thursday, so I'm hoping to pick up a prescription then. Sorry I didn't give more warning, but I got really busy today. Please have someone call or email when the script is ready for pickup... /> Thanks! Mark Amundsen Transcription Type Unstructured to Doctor Preliminary
Document Text Hi Dr Baquero-
ID RH21137708
It's time for another refill on Methadone. I should be out on Thursday, so I'm hoping to pick up a prescription then. Sorry I didn't give more warning, but I got really busy today. Please have someone call or email when the script is ready for pickup... /> Thanks! Mark Amundsen Display only: Transcription (RH21137708) on 12/1/2009 10:25 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Please sign and close chart.

Electronically signed byStephanie L Esparza, LVN on 11/6/2009 1:59 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Pt notified Triplicate ready.

Electronically signed byErica F Wilson on 11/6/2009 10:42 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Left message for patient to return call. DMV forms are in your in box
Electronically signed byClare Jennings, MA on 11/5/2009 3:02 PM Chart Review Routing History
001854
Sex Male
DOB 9/23/1959
Account # 038541463121
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Financial Class P
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Center None
Patient Information

Telephone Encounter
12/2/2009 8:23 AM
Reason for Call

Refill Request
Call Documentation
Clare Jennings, MA 12/2/2009 2:02 PM Signed Left message that RX is ready
001855
Clare Jennings, MA 12/2/2009 8:23 AM Signed From: Amundsen,Mark Sent: 12/01/2009 10:25 PM Hi Dr BaqueroIt's time for another refill on Methadone. I should be out on Thursday, so I'm hoping to pick up a prescription then. Sorry I didn't give more warning, but I got really busy today. Please have someone call or email when the script is ready for pickup... Thanks! Mark Amundsen
Routing History
12/2/2009 2:02 PM 12/2/2009 1:54 PM 12/2/2009 8:24 AM
From Clare Jennings, MA Victor Henrique Baquero, MD Clare Jennings, MA
To Victor Henrique Baquero, MD P FOL MA FP Victor Henrique Baquero, MD
Created by
Approved
Disp Refills 390 Tab 0 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 13 Tabs by mouth every day. - ORAL Class: Normal Notes: >> Jennifer Mello, PHRMTECH 12/21/2009 8:54 AM Note pt now takes a divided dose 40mg in the am, 40mg at 4pm and 50mg at 10pm Authorizing Provider: Victor Henrique Baquero, MD Start 12/2/2009 End 12/23/2009

Disp Refills Start 100 Tab 1 11/2/2009 Carisoprodol (SOMA) 350 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 8 hours if needed for muscle spasm. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 249890. Last date filled 10172008 100 Tab 1 11/2/2009 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 hours if needed for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026 0 10/27/2006 ALEVE 220 MG TAB (Discontinued) Sig - Route: take 1 tablet (220mg) by oral route every 12 hours as needed - ORAL Class: Historical 390 Tab 0 11/5/2009 Methadone (DOLOPHINE) 10 mg PO Tablet (Discontinued) Sig - Route: Take 13 Tabs by mouth every day. - ORAL End 12/2/2009
12/2/2009
12/15/2009
12/2/2009
Orders
001856
Call Documentation
Clare Jennings, MA 12/28/2009 3:43 PM Signed Patient informed

Victor Baquero, MD, MD 12/28/2009 12:11 PM Signed Triplicate written. Please notify patient. Request follow up with me end of January.

Hi Dr Baquero and TeriJust a quick reminder - I need a refill on my Methadone today. I shot an email off last week, but with Christmas and all, I thought I'd send a reminder. The hip replacement is going pretty well - I can't walk without the walker yet, but I'm getting around pretty good with it. The wound seems to be healing nicely, and hopefully I'll gt the staples out on the next visit. Next milestone - skiing in 2011 !! Mark Amundsen P.S. Please call or shoot me an email when the prescription is ready, would you? Thanks!
Clare Jennings, MA 12/23/2009 2:05 PM Signed From: Amundsen,Mark Sent: 12/23/2009 1:53 PM Hi Dr Baquero and TeriIts about time for another refill on Methadone. I know its early , but this is due to the horrible weather we have had, and due to the hip replacement I had on December 15h, 2009!!!!!!! YYEEEAAAHHH!!! They tried to move it back to the end of March, but when I said No way , they offered Dec 15th, and I took it. The surgeon totally underestimated the amount of pain meds the procedure would require, even though we had discussed it extensively before the procedure. Other than that everything was A-OK, I;m getting around quite well with the walker, but Im still spending most of my time in bed. Anyway, if I could get a refill on Thursday the 24th, or Monday the 28th, that would be great, I figured yall would be out on of those weeks anyhow,,, Regards, Mark Amundsen
001857
Routing History
12/28/2009 12:11 PM 12/28/2009 10:23 AM 12/23/2009 2:05 PM
From Victor Henrique Baquero, MD Clare Jennings, MA Clare Jennings, MA
To P FOL MA FP Victor Henrique Baquero, MD Victor Henrique Baquero, MD
Created by
Approved

Disp Refills Start End Carisoprodol (SOMA) 350 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical Diazepam (VALIUM) 5 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 8 hours if needed. - ORAL Class: Historical DiphenhydrAMINE (BENADRYL) 25 mg PO Capsule Sig - Route: Take 1 Cap by mouth every 6 hours if needed. - ORAL Class: Historical Docusate (COLACE) 100 mg PO Capsule Sig - Route: Take 1 Cap by mouth 2 times daily. - ORAL Class: Historical Ferrous Sulfate (FERATAB) 300 mg (60 mg Iron) PO Tablet Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Historical Fluoxetine (PROZAC) 40 mg PO capsule Sig - Route: Take 1 Cap by mouth every day. - ORAL Class: Historical Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 hours if needed. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources or less as directed by your doctor. ** - ORAL Class: Historical 390 Tab 0 12/2/2009 12/23/2009 Methadone (DOLOPHINE) 10 mg PO Tablet (Discontinued) Sig - Route: Take 13 Tabs by mouth every day. - ORAL Number of times this order has been changed since signing: 1 Order Audit Trail 12/21/2009 Oxycodone 20 mg PO Tab Sig - Route: Take 1 Tab by mouth every 3 hours if needed. For pain. - ORAL Class: Historical Pantoprazole (PROTONIX) 40 mg PO Delayed Release Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Historical SENNOSIDES (SENNA PO) Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical Study Drug - Fondaparinux (IRB 200816251) Syringe Sig - Route: Inject 1 Syringe subcutaneously every morning. - SUBCUTANEOUS Class: Historical
Orders
001858
Call Documentation
Clare Jennings, MA 1/20/2010 2:05 PM Signed Left message that Rx is at the front desk
Victor Baquero, MD, MD 1/20/2010 1:11 PM Signed Please contact. Request follow up with me to discuss medications. Triplicate written. Please notify patient.
Clare Jennings, MA 1/20/2010 9:30 AM Signed From: Amundsen,Mark Sent: 01/20/2010 7:37 AM Hi Dr Baquero, Well, it's that time again. I will be out of Methadone on Saturday, so I'm hoping I can pick up a refill script on Friday. The pain from the hip is mostly gone, except for the incision itself., and some lingering sciatica I am still left with some lower back pain, but I'm hoping it will work itself out when everything settles down in my body. Thanks again for everything Mark AMundsen
Routing History
1/20/2010 1:11 PM 1/20/2010 9:30 AM
From Victor Henrique Baquero, MD Clare Jennings, MA To P FOL MA FP Victor Henrique Baquero, MD Priority Routine Routine
Created by
Approved

Disp Carisoprodol (SOMA) 350 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical Diazepam (VALIUM) 5 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 8 hours if needed. - ORAL Class: Historical DiphenhydrAMINE (BENADRYL) 25 mg PO Capsule Sig - Route: Take 1 Cap by mouth every 6 hours if needed. - ORAL Class: Historical Docusate (COLACE) 100 mg PO Capsule Sig - Route: Take 1 Cap by mouth 2 times daily. - ORAL Class: Historical Ferrous Sulfate (FERATAB) 300 mg (60 mg Iron) PO Tablet Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Historical Fluoxetine (PROZAC) 40 mg PO capsule Sig - Route: Take 1 Cap by mouth every day. - ORAL Refills Start End
001859
Problem List
1/19/2006

Class: Acute C. Difficile Diarrhea 5/29/2009 12/19/2009 1/5/2010 Closed Time 08:48

Anemia Orthopedic Aftercare for Joint Replacement Encounter Closed By Closed By TAMURIAN, ROBERT
Patient Information
Telephone Encounter
2/19/2010 1:20 PM
Reason for Call

Refill Request
Call Documentation
Stephanie L Esparza, LVN 2/19/2010 4:49 PM Signed Patient notified.

Electronically signed by Stephanie L Esparza, LVN at 2/19/2010 4:49 PM
Jasvir K Bhele 2/19/2010 3:45 PM Signed Pt given Dr.Applebaum's msg and will p/u rx today
001860
Electronically signed by Jasvir K Bhele at 2/19/2010 3:45 PM
Jeffrey Alan Applebaum, MD 2/19/2010 2:57 PM Signed I am comfortable writing for methadone 10mg at maximum of 2 tablets 4 times a day # 60. Patient can pick up this prescription and then follow up with Victor Baquero,MD for additional medication. Please notify patient. JApplebaum,MD
Electronically signed by Jeffrey Alan Applebaum, MD at 2/19/2010 2:57 PM
Jasvir K Bhele 2/19/2010 1:21 PM Signed Pt calling in to check on RH msg.He needs to p/u med today
Routing History
2/19/2010 2:58 PM
2/19/2010 1:47 PM 2/19/2010 1:21 PM From Jeffrey Alan Applebaum, MD Stephanie L Esparza, LVN Jasvir K Bhele To P FOL MA FP Victor Henrique Baquero, MD Victor Henrique Baquero, MD P FOL MA FP Priority Routine Routine Routine
Created by
Jasvir K Bhele on 2/19/2010 1:20 PM
Approved
Disp 60 Tab Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take by mouth. Maximum of 2 tablets up to 4 times a day - ORAL Class: Handwritten Rx Authorizing Provider: Jeffrey Alan Applebaum, MD Refills 0 Start 2/19/2010 End 3/19/2010

Disp Refills Start End Carisoprodol (SOMA) 350 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical Fluoxetine (PROZAC) 40 mg PO capsule Sig - Route: Take 1 Cap by mouth every day. - ORAL Class: Historical 100 Tab 0 1/8/2010 2/8/2010 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 390 Tab 0 1/20/2010 2/19/2010 Methadone (DOLOPHINE) 10 mg PO Tablet (Discontinued) Sig - Route: Take 13 Tabs by mouth every day. - ORAL
Orders Chart Cosign

Required By Victor Baquero, MD
RH MD Msg
Patient Information
001861
Center None
Patient Information

Contacts
Telephone Encounter
2/24/2010 10:37 AM
Reason for Call

Refill Request
Call Documentation
Clare Jennings, MA 2/25/2010 8:52 AM Signed Left message that RX is at front desk and also for patient to return call
Victor Baquero, MD, MD 2/24/2010 5:27 PM Signed Triplicate written. Please notify patient. Please ask him how many of the methadone he is taking right now. We had talked about tapering down by 5mg-10mg weekly when we last met.
Deborah L Hughes 2/24/2010 4:08 PM Signed Patient is checking on status of refill message from yesterday, patient states Dr Applebaum wrote a prescription for meds on Feb 19 but states this rx lasted for 5 days. Please advise
Electronically signed by Deborah L Hughes at 2/24/2010 4:08 PM

From: Amundsen,Mark
Sent: 02/23/2010 4:55 PM Hi Dr Baquero and TeriI'm due another refill on methadone. I received one last week while y'all were gone, but since the
001862
doctor wasn't my normal doctor, he only gave me a five day supply. I'll be out again on Wednesday (tomorrow), so I could really use a refill by Wednesday at your earliest convenience. Please let me know via email or phone when the script is ready. Thanks for everything... Mark Amundsen
Routing History
2/24/2010 5:27 PM 2/24/2010 4:57 PM 2/24/2010 4:08 PM 2/24/2010 10:37 AM From Victor Henrique Baquero, MD Clare Jennings, MA Deborah L Hughes Clare Jennings, MA To P FOL MA FP Victor Henrique Baquero, MD P FOL MA FP Victor Henrique Baquero, MD Priority Routine Routine Routine Routine
Created by
Approved

Disp Refills Start End 60 Tab 0 2/19/2010 3/19/2010 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take by mouth. Maximum of 2 tablets up to 4 times a day - ORAL Class: Handwritten Rx Carisoprodol (SOMA) 350 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical ERGOCALCIFEROL (VITAMIN D PO) Sig - Route: Take by mouth. - ORAL Class: Historical Fluoxetine (PROZAC) 40 mg PO capsule Sig - Route: Take 1 Cap by mouth every day. - ORAL Class: Historical 100 Tab 0 1/8/2010 2/8/2010 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy
Orders Chart Cosign

RH MD Msg
MRN
Sex
DOB
PATIENTPHONE
001863
1. ADVANCED OSTEOARTHRITIS OF THE LEFT HIP. 2. GANGLION CYST ALONG THE INFEROMEDIAL ASPECT OF THE LEFT HIP. Status post total hip replacement. 12/2009


Patient Information

Telephone Encounter
3/17/2010 3:27 PM
Reason for Call

Refill Request
Call Documentation
Clare Jennings, MA 3/19/2010 9:40 AM Signed Patient informed that RX is at front desk
Clare Jennings, MA 3/17/2010 3:28 PM Signed

Hi Dr BaqueroIt's time for another refill on Methadone, since the last refill was for 3 weeks worth. I will be out on Saturday or Sunday. I have planned on reducing this month's supply to 300 10MG tablets. Please let me know when the refill is ready, either by telephone or email. Thanks in advance..
001864
Mark Amundsen
Routing History
3/18/2010 5:52 PM 3/17/2010 3:28 PM From Victor Henrique Baquero, MD Clare Jennings, MA To P FOL MA FP Victor Henrique Baquero, MD Priority Routine Routine
Created by
Approved

Disp Refills Start End 60 Tab 0 2/19/2010 3/19/2010 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take by mouth. Maximum of 2 tablets up to 4 times a day - ORAL Class: Handwritten Rx Carisoprodol (SOMA) 350 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical ERGOCALCIFEROL (VITAMIN D PO) Sig - Route: Take by mouth. - ORAL Class: Historical Fluoxetine (PROZAC) 40 mg PO capsule Sig - Route: Take 1 Cap by mouth every day. - ORAL Class: Historical 100 Tab 0 1/8/2010 2/8/2010 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 300 Tab 0 2/24/2010 3/17/2010 Methadone (DOLOPHINE) 10 mg PO Tablet (Discontinued) Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL
Orders Chart Cosign

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
001865
1. ADVANCED OSTEOARTHRITIS OF THE LEFT HIP. 2. GANGLION CYST ALONG THE INFEROMEDIAL ASPECT OF THE LEFT HIP. Status post total hip replacement. 12/2009


Patient Information

Telephone Encounter
4/14/2010 1:21 PM
Reason for Call

Refill Request
Call Documentation
Clare Jennings, MA 4/14/2010 2:28 PM Signed Left message that rx is at front desk

Hi Dr Baquero and TeriIt's time for another refill on Methadone. I will be out on Friday, 16 April 2010, so I'm hoping to pick up a new prescription on Friday, since I'm off work that day. Please let me know when the new prescription is ready, either by email or phone. This month, the prescription should be reduced to 250 10mg tablets.
001866
I've been having some issues with pain in the other hip - it usually lasts 1-2 days , then goes away. I might want to keep some Norco on hand for these times...
Routing History
4/14/2010 1:44 PM 4/14/2010 1:22 PM From Victor Henrique Baquero, MD Clare Jennings, MA To P FOL MA FP Victor Henrique Baquero, MD Priority Routine Routine
Created by
Approved

Disp Refills Start End Carisoprodol (SOMA) 350 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical ERGOCALCIFEROL (VITAMIN D PO) Sig - Route: Take by mouth. - ORAL Class: Historical Fluoxetine (PROZAC) 40 mg PO capsule Sig - Route: Take 1 Cap by mouth every day. - ORAL Class: Historical 100 Tab 0 1/8/2010 2/8/2010 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 300 Tab 0 3/17/2010 4/14/2010 Methadone (DOLOPHINE) 10 mg PO Tablet (Discontinued) Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL
Orders Chart Cosign

RH MD Msg
MRN 8081369
Sex Male
DOB 9/23/1959
Phone
E-mail Address
001867
4/17/2013 5:00 PM
None
Patient Email
MRN 8081369 Sex Male

Patient Email Encounter 6/7/2010 9:34 AM

Encounter Messages MyChart message report Message [153089] Mark Amundsen From To Victor Baquero, MD Sent 6/7/2010 9:22 AM For Delivery 6/7/2010 9:22 AM On Subject Visit Follow-up Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr Baquero and TeriBody I'm finally on Mychart, so we can talk on email again. It's time for another refill on Methadone. This time, the refill should be 200 units, versus 250 units. I will be out on Wednesday, so I'm hoping to pick up the refill before then. Please let me know when the refill is ready via email or telephone (916-983-2589). Thanks for all your helpMark Amundsen
Encounter Messages Read Composed From Y 6/7/2010 9:22 Mark AM Amundsen Encounter Documentation
Subject Visit Follow-up Question
Clare Jennings, MA 6/7/2010 2:44 PM Signed Left message that RX is at front desk
Jeffrey Alan Applebaum, MD 6/7/2010 1:46 PM Signed Refilled. Ready for pick up. JApplebaum,MD
Electronically signed by Jeffrey Alan Applebaum, MD at 6/7/2010 1:46 PM
Victor Baquero, MD, MD 6/7/2010 12:50 PM Signed Please have the covering physician write for the methadone prescription. Thanks, VB
001868
From: AMUNDSEN,MARK To: Victor H Baquero Sent: Mon Jun 7, 2010 9:22 AM Subject: Visit Follow-up Question Hi Dr Baquero and TeriI'm finally on Mychart, so we can talk on email again. It's time for another refill on Methadone. This time, the refill should be 200 units, versus 250 units. I will be out on Wednesday, so I'm hoping to pick up the refill before then. Please let me know when the refill is ready via email or telephone (916-983-2589). Thanks for all your helpMark Amundsen
Electronically signed by Clare Jennings, MA at 6/7/2010 9:34 AM Routing History 6/7/2010 1:46 PM 6/7/2010 1:38 PM 6/7/2010 12:50 PM From Jeffrey Alan Applebaum, MD Clare Jennings, MA Victor Henrique Baquero, MD To P FOL MA FP Jeffrey Alan Applebaum, MD P FOL MA FP Priority Routine Routine Routine
Created by Clare Jennings, MA on 6/7/2010 9:34 AM Approved Disp 200 Tab Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Class: Normal Authorizing Provider: Jeffrey Alan Applebaum, MD Refills 0 Start 6/7/2010 End 7/1/2010
Orders
Chart Cosign Required By Victor Baquero, MD
Patient Information
Telephone Encounter
6/4/2010 12:22 PM
Reason for Call

Refill Request
001869
Routing History
6/4/2010 12:23 PM
From Stephanie L Esparza, LVN To Victor Henrique Baquero, MD Priority Routine
Created by
Stephanie L Esparza, LVN on 6/4/2010 12:22 PM
Approved
Disp Refills Start End 100 Tab 1 6/4/2010 9/22/2010 Carisoprodol (SOMA) 350 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Pharmacy Authorizing Provider: Victor Henrique Baquero, MD 100 Tab 0 6/4/2010 7/12/2010 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy Authorizing Provider: Victor Henrique Baquero, MD

Disp Refills Start End 250 Tab 0 5/24/2010 6/15/2010 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL 6/4/2010 Carisoprodol (SOMA) 350 mg PO Tablet (Discontinued) Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical ERGOCALCIFEROL (VITAMIN D PO) Sig - Route: Take by mouth. - ORAL Class: Historical Fluoxetine (PROZAC) 40 mg PO capsule Sig - Route: Take 1 Cap by mouth every day. - ORAL Class: Historical 100 Tab 0 1/8/2010 6/4/2010 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet (Discontinued) Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 250 Tab 0 5/11/2010 6/10/2010 Methadone (DOLOPHINE) 10 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL

DOB 9/23/1959
Telephone Encounter
5/11/2010 2:59 PM
Reason for Call

Refill Request
Call Documentation
Clare Jennings, MA 5/12/2010 9:14 AM Signed Left message that RX is at front desk
001870
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Center None
Patient Email


Encounter Messages MyChart message report Message [169119] Victor Baquero, MD From To Mark Amundsen Sent 7/1/2010 12:59 PM For Delivery 7/1/2010 12:59 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 7/28/2010 3:40 PM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, the refill is ready. Please follow up for evaluation or the right hip. Take care. Body ----- Message ----From: AMUNDSEN,MARK Sent: 6/30/10 05:48 PM To: Victor Henrique Baquero, MD
001871
Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's about time for another refill on Methadone. I will be out on Sunday, so I'm hoping to pick up a refill on Friday. Also, I'm starting to get similar pain of the left hip on the right side - I may need to stay at the current refill level (200 X 10 mg) and come in for a visit. I mentioned it to the Ortho doctor when in there, but he did not seem too worried - he looked at the right hip x rays and found them okay. Possibly need an MRI on right hip? Thanks, Mark Amundsen MyChart message report Message [168527] From Mark Amundsen To Victor Baquero, MD Sent 6/30/2010 5:48 PM For Delivery 6/30/2010 5:48 PM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody It's about time for another refill on Methadone. I will be out on Sunday, so I'm hoping to pick up a refill on Friday. Also, I'm starting to get similar pain of the left hip on the right side - I may need to stay at the current refill level (200 X 10 mg) and come in for a visit. I mentioned it to the Ortho doctor when in there, but he did not seem too worried - he looked at the right hip x rays and found them okay. Possibly need an MRI on right hip? Thanks, Mark Amundsen Encounter Messages Read Composed DEL 7/1/2010 12:59 PM Y 6/30/2010 5:48 PM
From Victor Baquero, MD Mark Amundsen
To Mark Amundsen Victor Baquero, MD
Subject RE: Non-urgent Medical Advice Question Non-urgent Medical Advice Question
Encounter Documentation Clare Jennings, MA 7/1/2010 7:42 AM Signed From: AMUNDSEN,MARK To: Victor H Baquero Sent: Wed Jun 30, 2010 5:48 PM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's about time for another refill on Methadone. I will be out on Sunday, so I'm hoping to pick up a refill on Friday. Also, I'm starting to get similar pain of the left hip on the right side - I may need to stay at the current refill level (200 X 10 mg) and come in for a visit. I mentioned it to the Ortho doctor when in there, but he did not seem too worried - he looked at the right hip x rays and found them okay. Possibly need an MRI on right hip? Thanks, Mark Amundsen Electronically signed by Clare Jennings, MA at 7/1/2010 7:42 AM Routing History 7/1/2010 7:42 AM From Clare Jennings, MA To Victor Henrique Baquero, MD Priority Routine
001872
Selected Appointment 8/10/2010 9:20 AM Provider Flabs Labfol Department Fol Lab
Center None
Patient Email

Patient Email Encounter 7/27/2010 4:53 PM

Encounter Messages MyChart message report From Victor Baquero, MD To Mark Amundsen Sent 7/28/2010 5:15 PM For Delivery 7/28/2010 5:15 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 7/28/2010 11:25 PM MyChart Mark Amundsen By Responsibility Audit Trail
Message [186753]
001873
Message Body
Mark, The prescription is ready to pick up at our front desk. ----- Message ----From: AMUNDSEN,MARK Sent: 7/27/10 04:31 PM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr Baquero and staffIt's time for another refill on Methadone. I am currently staying at 200 10 MG tablets per month until I can come in to get my right hip evaluated. It is still acting up, but intermittantly. I will be out on Friday, so I am hoping I can pick up the prescription before Thursday. Please call or email when the script is complete. Thanks for your attention in this matter... Mark Amundsen
MyChart message report Message [185820] From Mark Amundsen To Victor Baquero, MD Sent 7/27/2010 4:31 PM For Delivery 7/27/2010 4:31 PM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr Baquero and staffBody It's time for another refill on Methadone. I am currently staying at 200 10 MG tablets per month until I can come in to get my right hip evaluated. It is still acting up, but intermittantly. I will be out on Friday, so I am hoping I can pick up the prescription before Thursday. Please call or email when the script is complete. Thanks for your attention in this matter... Mark Amundsen Encounter Messages Read Composed DEL 7/28/2010 5:15 PM Y 7/27/2010 4:31 PM
Encounter Documentation
Brenda J Fallon 7/28/2010 3:48 PM Signed Patient is calling to follow up on medication refill for the following medication methadone 10 mg tablet , take three tablets twice daily. Patient will be out of medication as of this evening. Please advise when ready for pickup. Patient can be reached at 916-708-6423.
Electronically signed by Brenda J Fallon at 7/28/2010 3:48 PM
From: AMUNDSEN,MARK To: Victor H Baquero 001874

Sent: Tue Jul 27, 2010 4:31 PM Subject: Non-urgent Medical Advice Question Hi Dr Baquero and staffIt's time for another refill on Methadone. I am currently staying at 200 10 MG tablets per month until I can come in to get my right hip evaluated. It is still acting up, but intermittantly. I will be out on Friday, so I am hoping I can pick up the prescription before Thursday. Please call or email when the script is complete. Thanks for your attention in this matter... Mark Amundsen
Electronically signed by Clare Jennings, MA at 7/27/2010 4:53 PM Routing History 7/28/2010 3:59 PM 7/28/2010 3:48 PM 7/27/2010 4:53 PM From Clare Jennings, MA Brenda J Fallon Clare Jennings, MA To Victor Henrique Baquero, MD P FOL MA FP Victor Henrique Baquero, MD Priority Routine Routine Routine
Created by Clare Jennings, MA on 7/27/2010 4:53 PM Approved

Disp 200 Tab Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Class: Normal Authorizing Provider: Victor Henrique Baquero, MD Telephone/Refill Encounter
Refills 0
Start 7/27/2010
End 8/24/2010
Telephone Encounter
7/12/2010 4:35 PM
Provider Martina Dobrovodska Randolph, MD Department Fol Family Practice
Reason for Call

Refill Request
Routing History
7/12/2010 4:36 PM From Mandy Chilson To Victor Henrique Baquero, MD Priority Routine
Created by
Mandy Chilson on 7/12/2010 4:35 PM
Approved
Disp Refills Start End 100 Tab 0 7/12/2010 8/13/2010 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10325 mg PO Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of
001875
Appointment
Orders
DOB 9/23/1959
Account # 078548433073 Patient Demographics Address 2025 TARBOLTON CIR FOLSOM CA 95630 Selected Appointment 8/17/2010 8:00 AM Provider Victor Baquero, MD, MD Department Fol Family Practice Phone 916-509-0158 (Home) 916-983-4484 (Work) E-mail Address mamundsen@sbcglobal.net
Center None
Patient Information
Telephone Encounter
8/13/2010 10:15 AM
001876
Reason for Call

Refill Request
Routing History
8/13/2010 10:16 AM
Priority Routine
Created by
Approved

Disp Refills Start End 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 100 Tab 1 6/4/2010 9/4/2010 Carisoprodol (SOMA) 350 mg PO Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Pharmacy Fluoxetine (PROZAC) 40 mg PO capsule Sig - Route: Take 1 Cap by mouth every day. - ORAL Class: Historical 100 Tab 0 7/12/2010 8/13/2010 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg PO Tablet (Discontinued) Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 200 Tab 0 7/27/2010 8/26/2010 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL 30 Tab 3 7/12/2010 7/12/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy

Appointment
Orders
Sex Male
DOB 9/23/1959
Account # 078548433073 Patient Demographics Address 2025 TARBOLTON CIR FOLSOM CA 95630 Phone 916-509-0158 (Home) 916-983-4484 (Work) E-mail Address mamundsen@sbcglobal.net
001877

Disp 200 Tab Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Class: Normal Authorizing Provider: Victor Henrique Baquero, MD Refills 0 Start 9/20/2010 End 10/18/2010
Orders
Chart Cosign Accepted By Victor Henrique Baquero, MD Accepted On 9/20/2010 12:25 PM Mark Amundsen (MRN8081369) Sex Male DOB 9/23/1959
Appointment
Future Appointments Date & Time
Provider
Department
Center
001878
4/17/2013 5:00 PM
None
Patient Email


Encounter Messages MyChart message report From Victor Baquero, MD To Mark Amundsen Sent 8/25/2010 1:45 PM For Delivery 8/25/2010 1:45 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 10/18/2010 8:47 AM MyChart Mark Amundsen By Responsibility Audit Trail Message Great. See you soon. Body ----- Message ----From: AMUNDSEN,MARK Sent: 8/24/10 10:59 PM To: Victor Henrique Baquero, MD Subject: RE: Non-urgent Medical Advice Question Thanks Dr Baquero-
Message [206484]
Somehow the appointment disappeared from my calender. I went out of town on Monday, and didn't get the appointment message until Wednesday, I need to come in about the hip, and also about the foot - it's still been swelling up, even after being on the water pills. Blood pressure doesn't feel good, either. I'll make an appointment tomorrow... Regards, Mark Amundsen ----- Message ----From: Victor Henrique Baquero, MD Sent: 08/24/2010 1:45 PM To: Mark Amundsen Subject: RE: Non-urgent Medical Advice Question Mark, I want to see you at some point in the near future. You had an appointment with me last week but did not show.
001879
I'll refill it, please schedule a follow up with me to discuss medications. The prescription is ready to pick up at our front desk. ----- Message ----From: AMUNDSEN,MARK Sent: 8/24/10 11:29 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's time for another refill on Methadone. I am staying at 200 until re-evaluation. I will be out on Thursday, so I'm hoping to pick up the precription on Wednesday evening. Please let me know via phone or email when it is ready for pickup. Thank you for your attention in this matter... Regards, Mark Amundsen MyChart message report Message [205941] From Mark Amundsen To Victor Baquero, MD Sent 8/24/2010 10:59 PM For Delivery 8/24/2010 10:59 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Thanks Dr BaqueroBody Somehow the appointment disappeared from my calender. I went out of town on Monday, and didn't get the appointment message until Wednesday, I need to come in about the hip, and also about the foot - it's still been swelling up, even after being on the water pills. Blood pressure doesn't feel good, either. I'll make an appointment tomorrow... Regards, Mark Amundsen ----- Message ----From: Victor Henrique Baquero, MD Sent: 08/24/2010 1:45 PM To: Mark Amundsen Subject: RE: Non-urgent Medical Advice Question Mark, I want to see you at some point in the near future. You had an appointment with me last week but did not show. I'll refill it, please schedule a follow up with me to discuss medications. The prescription is ready to pick up at our front desk. ----- Message ----From: AMUNDSEN,MARK
001880
Sent: 8/24/10 11:29 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's time for another refill on Methadone. I am staying at 200 until re-evaluation. I will be out on Thursday, so I'm hoping to pick up the precription on Wednesday evening. Please let me know via phone or email when it is ready for pickup. Thank you for your attention in this matter... Regards, Mark Amundsen MyChart message report Message [205199] From Victor Baquero, MD To Mark Amundsen Sent 8/24/2010 1:45 PM For Delivery 8/24/2010 1:45 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 8/24/2010 10:55 PM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, I want to see you at some point in the near future. Body You had an appointment with me last week but did not show. I'll refill it, please schedule a follow up with me to discuss medications. The prescription is ready to pick up at our front desk. ----- Message ----From: AMUNDSEN,MARK Sent: 8/24/10 11:29 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's time for another refill on Methadone. I am staying at 200 until re-evaluation. I will be out on Thursday, so I'm hoping to pick up the precription on Wednesday evening. Please let me know via phone or email when it is ready for pickup. Thank you for your attention in this matter... Regards, Mark Amundsen MyChart message report From Mark Amundsen To Victor Baquero, MD Sent 8/24/2010 11:29 AM For Delivery 8/24/2010 11:29 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Message [205048]
001881
Responsibility Audit Trail Message Body
Hi Dr BaqueroIt's time for another refill on Methadone. I am staying at 200 until re-evaluation. I will be out on Thursday, so I'm hoping to pick up the precription on Wednesday evening. Please let me know via phone or email when it is ready for pickup. Thank you for your attention in this matter... Regards,
Mark Amundsen
Encounter Messages Read Composed DEL 8/25/2010 1:45 PM Y 8/24/2010 10:59 PM DEL 8/24/2010 1:45 PM Y 8/24/2010 11:29 AM
From Victor Baquero, MD Mark Amundsen Victor Baquero, MD Mark Amundsen
To Mark Amundsen Victor Baquero, MD Mark Amundsen Victor Baquero, MD
Encounter Documentation Clare Jennings, MA 8/24/2010 12:21 PM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Tue Aug 24, 2010 11:29 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's time for another refill on Methadone. I am staying at 200 until re-evaluation. I will be out on Thursday, so I'm hoping to pick up the precription on Wednesday evening. Please let me know via phone or email when it is ready for pickup. Thank you for your attention in this matter... Regards, Mark Amundsen
Routing History 8/25/2010 8:22 AM 8/24/2010 10:59 PM 8/24/2010 1:45 PM 8/24/2010 12:22 PM From Clare Jennings, MA Epic User Victor Henrique Baquero, MD Clare Jennings, MA To Victor Henrique Baquero, MD P FOL MA FP Victor Henrique Baquero, MD Priority Routine Routine Routine Routine
Created by Clare Jennings, MA on 8/24/2010 12:21 PM Approved

001882
Sig - Route: Take 1 Cap by mouth every day. - ORAL Class: Historical 100 Tab 0 8/13/2010 9/22/2010 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet (Discontinued) Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 200 Tab 0 9/20/2010 10/20/2010 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL 30 Tab 3 7/12/2010 7/12/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy

Patient Email
Orders
Patient Information Patient Name Amundsen, Mark MRN 8081369 Sex Male
DOB 9/23/1959
Patient Email Encounter 9/20/2010 8:27 AM Provider Victor Baquero, MD, MD Department Fol Family Practice
Encounter Messages MyChart message report From Victor Baquero, MD To Mark Amundsen Sent 9/20/2010 10:05 AM For Delivery 9/20/2010 10:05 AM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 9/20/2010 10:55 PM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, Body The prescription is ready to pick up at our front desk. ----- Message ----From: AMUNDSEN,MARK Sent: 9/20/10 08:04 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr Baquero-
Message [225790]
It's time for another refill on Methadone. I will be out on Wednesday, so I'm hoping to pick up a script on Tuesday afternoon.
001883
I'vve got an appointment on Friday for the right hip and foot. The foot is still swelling, even after the medication. Regards,
Mark Amundsen
MyChart message report Message [225590] From Mark Amundsen To Victor Baquero, MD Sent 9/20/2010 8:04 AM For Delivery 9/20/2010 8:04 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody It's time for another refill on Methadone. I will be out on Wednesday, so I'm hoping to pick up a script on Tuesday afternoon. I'vve got an appointment on Friday for the right hip and foot. The foot is still swelling, even after the medication. Regards, Mark Amundsen Encounter Messages Read Composed DEL 9/20/2010 10:05 AM Y 9/20/2010 8:04 AM
Encounter Documentation Clare Jennings, MA 9/20/2010 8:27 AM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Mon Sep 20, 2010 8:04 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's time for another refill on Methadone. I will be out on Wednesday, so I'm hoping to pick up a script on Tuesday afternoon. I'vve got an appointment on Friday for the right hip and foot. The foot is still swelling, even after the medication. Regards, Mark Amundsen
Routing History From 9/20/2010 10:05 AM Victor Henrique Baquero, MD 9/20/2010 8:27 AM Clare Jennings, MA To P FOL MA FP Victor Henrique Baquero, MD Priority Routine Routine
001884
ADVANCED OSTEOARTHRITIS OF THE LEFT HIP
1/19/2006

See lab


Patient Email
Encounter Messages MyChart message report From Victor Baquero, MD To Mark Amundsen Sent 10/18/2010 12:18 PM For Delivery 10/18/2010 12:18 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 10/21/2010 11:02 PM MyChart Mark Amundsen By
Message [256186]
001885
Mark, The prescription is ready to pick up at our front desk. Yes, follow up with me if you are not feeling better.
----- Message ----From: AMUNDSEN,MARK Sent: 10/18/10 08:51 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr baqueroIt's time for another refill on the Methadone prescription. I will be out on Wednesday, so I'm hoping I can pick up a script on Tuesday evening. The problem I came in for last week (uncontrollable shaking and fatigue) is still occurring, so I doubt it's a virus. I will be coming in soon for a consultation... Regards,
Mark Amundsen
MyChart message report Message [255879] From Mark Amundsen To Victor Baquero, MD Sent 10/18/2010 8:51 AM For Delivery 10/18/2010 8:51 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr baqueroBody It's time for another refill on the Methadone prescription. I will be out on Wednesday, so I'm hoping I can pick up a script on Tuesday evening. The problem I came in for last week (uncontrollable shaking and fatigue) is still occurring, so I doubt it's a virus. I will be coming in soon for a consultation... Regards, Mark Amundsen Encounter Messages Read Composed Y 10/18/2010 12:18 PM Y 10/18/2010 8:51 AM
Encounter Documentation Clare Jennings, MA 10/18/2010 8:59 AM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD
001886
Orthopedic Aftercare for Joint Replacement Dyslipidemia
1/5/2010 2/1/2010
See lab


Patient Information
Closed Time 13:27

Telephone Encounter
9/22/2010 2:09 PM
Reason for Call

Refill Request
Routing History
Created by
Approved
Disp Refills Start End 100 Tab 1 9/22/2010 2/1/2011 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Pharmacy Authorizing Provider: Victor Henrique Baquero, MD 100 Tab 0 9/22/2010 10/20/2010 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10325 mg Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy Authorizing Provider: Victor Henrique Baquero, MD

Disp Refills Start End 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 100 Tab 1 6/4/2010 9/22/2010 Carisoprodol (SOMA) 350 mg PO Tablet (Discontinued) Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Pharmacy Fluoxetine (PROZAC) 40 mg PO capsule
001887
10/20/2010 1:42 PM
Clare Jennings, MA
Routine
Created by
Approved

Disp Refills Start End 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 3 10/20/2010 1/18/2011 Levothyroxine (LEVOXYL) 50 mcg Tablet Sig - Route: Take 1 Tab by mouth every day. take on an empty stomach - ORAL Class: Pharmacy 100 Tab 1 9/22/2010 12/23/2010 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Pharmacy 100 Tab 0 9/22/2010 10/20/2010 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet (Discontinued) Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 200 Tab 0 10/18/2010 11/17/2010 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL 30 Tab 3 7/12/2010 7/12/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy

DOB 9/23/1959
Contacts
Telephone Encounter
Reason for Call

Other
Call Documentation
Clare Jennings, MA 10/20/2010 10:31 AM Signed Patient informed of doctors message
001888
Victor Baquero, MD, MD 10/20/2010 10:07 AM Signed Prescription called in. Take every morning - before meal. Recheck labs in 6 weeks. Also make sure he is takes his Vitamin D.
Joseph Jernigan 10/20/2010 9:38 AM Signed Pt called in read him info below. Pt is interested in the prescription for the thyroide. Please call when ready. Thanks
Electronically signed by Joseph Jernigan at 10/20/2010 9:38 AM
Clare Jennings, MA 10/19/2010 1:41 PM Signed Left message for patient to return call
Victor Baquero, MD, MD 10/19/2010 12:52 PM Signed Please contact. Let him know labs show 2 things that are off. His vitamin D levels are VERY low. Low levels of vitamin D are associated with fatigue, diffuse bone and joint pain, muscle weakness, increased risk of fractures, heart disease, depression and even many forms of cancer. I recommend he take 5,000iu - 10,000 of vitamin D daily - long term. In Folsom he can purchase the small 5,000iu capsules at Elliott's Natural Foods. His thyroid is also a bit low. This can make him tired and draggy. I can start him on low dose replacement. Take every morning BY ITSELF then eat about 30 minutes later. If he is interested I'll call in a script and I'll want him to check labs in 6 weeks. All other tests are normal. All organ systems are working normally.
Routing History
10/20/2010 10:07 AM 10/20/2010 9:40 AM 10/20/2010 9:38 AM 10/19/2010 12:52 PM From Victor Henrique Baquero, MD Clare Jennings, MA Joseph Jernigan Victor Henrique Baquero, MD To P FOL MA FP Victor Henrique Baquero, MD P FOL MA FP P FOL MA FP Priority Routine Routine Routine Routine
Created by
Victor Henrique Baquero, MD on 10/19/2010 12:49 PM
Approved
Disp Refills 30 Tab 3 Levothyroxine (LEVOXYL) 50 mcg Tablet Sig - Route: Take 1 Tab by mouth every day. take on an empty stomach - ORAL Class: Pharmacy Authorizing Provider: Victor Henrique Baquero, MD Start 10/20/2010 End 1/18/2011

Disp Refills Start End 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL
001889
Class: Pharmacy 100 Tab 1 9/22/2010 12/23/2010 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Pharmacy 100 Tab 0 9/22/2010 10/23/2010 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 200 Tab 0 10/18/2010 11/17/2010 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL 30 Tab 3 7/12/2010 7/12/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy

Orders Chart Cosign

Appointment
Sex Male

DOB 9/23/1959
Account # 078548433107 Patient Demographics Address 2025 TARBOLTON CIR FOLSOM CA 95630 Selected Appointment 10/18/2010 3:27 PM Provider Flabs Labfol Department Fol Lab Phone 916-509-0158 (Home) 916-983-4484 (Work) E-mail Address mamundsen@sbcglobal.net
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
001890
Thanks in advanceMark Amundsen

Routing History 10/25/2010 9:09 AM

Created by Clare Jennings, MA on 10/25/2010 9:09 AM
Orders
Patient Email
Encounter Messages MyChart message report From Victor Baquero, MD To Mark Amundsen Sent 10/22/2010 8:20 AM For Delivery 10/22/2010 8:20 AM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 10/22/2010 8:25 PM MyChart Mark Amundsen By Responsibility Audit Trail Message All labs released. Body Take care. ----- Message ----From: AMUNDSEN,MARK Sent: 10/21/10 11:06 PM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr. Baquero and staff-
Message [260351]
I was wondering if someone could forward me the results of the blood test I took on 1019-2010? I'd like to find out how bad the Vitamin D and Thyroid hormone levels were...
001891
Thanks in advanceMark R. Amundsen
MyChart message report Message [260203] From Mark Amundsen To Victor Baquero, MD Sent 10/21/2010 11:06 PM For Delivery 10/21/2010 11:06 PM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr. Baquero and staffBody I was wondering if someone could forward me the results of the blood test I took on 1019-2010? I'd like to find out how bad the Vitamin D and Thyroid hormone levels were... Thanks in advanceMark R. Amundsen Encounter Messages Read Composed Y 10/22/2010 8:20 AM Y 10/21/2010 11:06 PM
Encounter Documentation Clare Jennings, MA 10/22/2010 8:07 AM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Thu Oct 21, 2010 11:06 PM Subject: Non-urgent Medical Advice Question Hi Dr. Baquero and staffI was wondering if someone could forward me the results of the blood test I took on 10-19-2010? I'd like to find out how bad the Vitamin D and Thyroid hormone levels were... Thanks in advanceMark R. Amundsen Electronically signed by Clare Jennings, MA at 10/22/2010 8:07 AM Routing History 10/22/2010 8:07 AM From Clare Jennings, MA To Victor Henrique Baquero, MD Priority Routine
Appointment
Orders
001892
Sex Male
DOB 9/23/1959
Account # 078548433107 Patient Demographics Address 2025 TARBOLTON CIR FOLSOM CA 95630 Selected Appointment 10/22/2010 9:00 AM Provider Victor Baquero, MD, MD Department Fol Family Practice Phone 916-509-0158 (Home) 916-983-4484 (Work) E-mail Address mamundsen@sbcglobal.net
Plan UCD/B/S HMO
Financial Class P
Plan Number B72
Plan Phone 916-734-0739
Center None
Patient Information

Telephone Encounter
Reason for Call

Refill Request
Routing History
From To Priority
001893
Patient Email
Orders
DOB 9/23/1959
Encounter Messages MyChart message report Message [261811] From Mark Amundsen To Victor Baquero, MD Sent 10/25/2010 8:00 AM For Delivery 10/25/2010 8:00 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr Baquero and staffBody The thyroid medicine seems to be working, but it's slow going. I'm planning on going back to work tomorrow (Oct 26), but my work is asking for another note from my doctor excuaing my absence. Could you please forward a note via email authorizing my return to work on 26 Oct? I will have been out from 11 October to 26 October. If email isn't possible, I could come pick it up... Thanks in advanceMark Amundsen Encounter Messages Read Composed Y 10/25/2010 8:00 AM
From Mark Amundsen
Subject Non-urgent Medical Advice Question
Encounter Documentation Clare Jennings, MA 10/25/2010 9:09 AM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Mon Oct 25, 2010 8:00 AM Subject: Non-urgent Medical Advice Question Hi Dr Baquero and staffThe thyroid medicine seems to be working, but it's slow going. I'm planning on going back to work tomorrow (Oct 26), but my work is asking for another note from my doctor excuaing my absence. Could you please forward a note via email authorizing my return to work on 26 Oct? I will have been out from 11 October to 26 October. If email isn't possible, I could come pick it up...
001894
Center None
Patient Email
Encounter Messages MyChart message report Message [265366] From Victor Baquero, MD To Mark Amundsen Sent 10/27/2010 9:45 PM For Delivery 10/27/2010 9:45 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 11/3/2010 11:59 PM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, Body I put you on a very low dose of thyroid medication. If you don't notice much improvement at this point, consider taking 1 1/2 tablets every morning. Let me know if that helps. I have a letter for you to return to work as of the 26th. You can come pick it up or let my assistant know if you want her to fax it. ----- Message ----From: AMUNDSEN,MARK Sent: 10/27/10 06:37 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question
001895
Hi Dr BaqueroI have been on the thyroid medicine for 6 days now, and there hasn't been any improvement. The weakness in the legs has improved, I think due to the Vitamin D, but the shaking is a little worse, and the overall fatigue and confusion is still present. Do you have any other recommendations? From info on the web, it seems this medicine needs a week to work, but I thought it would have been getting better by now. Please advise - I am at home today at 916-983-2589. MyChart message report Message [264383] From Mark Amundsen To Victor Baquero, MD Sent 10/27/2010 6:37 AM For Delivery 10/27/2010 6:37 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody I have been on the thyroid medicine for 6 days now, and there hasn't been any improvement. The weakness in the legs has improved, I think due to the Vitamin D, but the shaking is a little worse, and the overall fatigue and confusion is still present. Do you have any other recommendations? From info on the web, it seems this medicine needs a week to work, but I thought it would have been getting better by now. Please advise - I am at home today at 916-983-2589. Encounter Messages Read Composed Y 10/27/2010 9:45 PM Y 10/27/2010 6:37 AM
Encounter Documentation Clare Jennings, MA 10/27/2010 8:20 AM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Wed Oct 27, 2010 6:37 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI have been on the thyroid medicine for 6 days now, and there hasn't been any improvement. The weakness in the legs has improved, I think due to the Vitamin D, but the shaking is a little worse, and the overall fatigue and confusion is still present. Do you have any other recommendations? From info on the web, it seems this medicine needs a week to work, but I thought it would have been getting better by now. Please advise - I am at home today at 916-983-2589. Electronically signed by Clare Jennings, MA at 10/27/2010 8:20 AM Routing History 10/27/2010 8:20 AM
001896
improvement was not noted, and symptoms are still apparent at 70% of original strength. Is it possible that Vitamin B12 takes additional time to absorb? Or is it possible that I need a larger dose? The only noted side effect was fairly severe headache on left side of head directly behind eye. Please advise, and report any blood test results received. Mark Amundsen Electronically signed by Clare Jennings, MA at 11/4/2010 8:24 AM Routing History 11/4/2010 3:58 PM 11/4/2010 3:47 PM 11/4/2010 8:24 AM From Clare Jennings, MA Epic User Clare Jennings, MA To Victor Henrique Baquero, MD
Appointment
Orders
DOB 9/23/1959
Account # 078548433115
Department Fol Lab
Financial Class P
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Future Appointments
001897
Unspecified backache Other testicular hypofunction Class: Chronic Brachial neuritis or radiculitis NOS ADVANCED OSTEOARTHRITIS OF THE LEFT HIP Class: Chronic DEPRESSIVE DISORDER
10/22/2010 1/19/2006 5/26/2006 4/30/2008

See lab


Encounter Closed By Closed By BAQUERO, VICTOR H Closed Date 11022010 Closed Time 13:50 Mark Amundsen (MRN8081369)
Appointment
Encounter-Level Documents: There are no encounter-level documents. Insurance Information Acct Number 078548433115 Financial Class P
001898
Y Y
11/12/2010 8:54 AM 11/12/2010 7:54 AM
Stephanie L Esparza, LVN Mark Amundsen
Mark Amundsen Victor Baquero, MD
RE: Non-urgent Medical Advice Question Non-urgent Medical Advice Question
Encounter Documentation Stephanie L Esparza, LVN 11/12/2010 8:54 AM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Fri Nov 12, 2010 7:54 AM Subject: Non-urgent Medical Advice Question Is it possible I have a bad hip implant? I looked up the symptoms, and 2 out of 7 are hypothyroidism and peripheral neuropathy (which sounds like what I have), Is it possible to find out if I have one of the recalled hip implants? Thanks for any info you can provide Mark Amundsen Electronically signed by Stephanie L Esparza, LVN at 11/12/2010 8:54 AM Created by Stephanie L Esparza, LVN on 11/12/2010 8:54 AM
Orders
Chart Cosign Required By Victor Baquero, MD
Patient Email
Encounter Messages MyChart message report Message [273177] From Victor Baquero, MD To Mark Amundsen Sent 11/5/2010 3:18 PM For Delivery 11/5/2010 3:18 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 11/5/2010 3:33 PM MyChart Mark Amundsen By Responsibility Audit Trail Message B12 was within normal limits. D is still halfway to normal. You need more D. Body ----- Message -----
001899
From: AMUNDSEN,MARK Sent: 11/4/10 03:47 PM To: Victor Henrique Baquero, MD Subject: RE: Non-urgent Medical Advice Question Hi Dr BaqueroThanks for the info - and another question. Was the B12 values within limits, or was that one of the ones not back yet? If that one is low, then we probably have our answer, and I just need to wait for it to fully absorb. If B12's not low, then maybe it's still the Vitamin D, and I need to take still more? Or maybe it's yet another problem? I seem to have a lot of problems... Thanks for your helpMark Amundsen ----- Message ----From: Victor Henrique Baquero, MD Sent: 11/04/2010 1:09 PM To: Mark Amundsen Subject: RE: Non-urgent Medical Advice Question Mark, Most of the tests are back and they are within normal limits. Your vitamin D levels have risen (25 currenlty) but I want them to go up to above 50. All other tests currently are within normal limits. I'm still waiting for some. I see that she did not do testosterone or cortisol because they are 8am tests. You should have these done at some time - first thing in the morning - non-fasting. The B12 gets absorbed slowly. Into the system. It's not a quick release shot. ----- Message ----From: AMUNDSEN,MARK Sent: 11/4/10 12:05 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Dr BaqueroAfter the Vitamin B12 injection, I noticed improvement of symptoms after approx 8 hours. However, further improvement was not noted, and symptoms are still apparent at 70% of original strength. Is it possible that Vitamin B12 takes additional time to absorb? Or is it possible that I need a larger dose? The only noted side effect was fairly severe headache on left side of head directly behind eye. Please advise, and report any blood test results received. Mark Amundsen MyChart message report From Mark Amundsen To Victor Baquero, MD Sent 11/4/2010 3:47 PM For Delivery 11/4/2010 3:47 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroMessage [272185]
001900
Body Thanks for the info - and another question. Was the B12 values within limits, or was that one of the ones not back yet? If that one is low, then we probably have our answer, and I just need to wait for it to fully absorb. If B12's not low, then maybe it's still the Vitamin D, and I need to take still more? Or maybe it's yet another problem? I seem to have a lot of problems... Thanks for your helpMark Amundsen ----- Message ----From: Victor Henrique Baquero, MD Sent: 11/04/2010 1:09 PM To: Mark Amundsen Subject: RE: Non-urgent Medical Advice Question Mark, Most of the tests are back and they are within normal limits. Your vitamin D levels have risen (25 currenlty) but I want them to go up to above 50. All other tests currently are within normal limits. I'm still waiting for some. I see that she did not do testosterone or cortisol because they are 8am tests. You should have these done at some time - first thing in the morning - non-fasting. The B12 gets absorbed slowly. Into the system. It's not a quick release shot. ----- Message ----From: AMUNDSEN,MARK Sent: 11/4/10 12:05 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Dr BaqueroAfter the Vitamin B12 injection, I noticed improvement of symptoms after approx 8 hours. However, further improvement was not noted, and symptoms are still apparent at 70% of original strength. Is it possible that Vitamin B12 takes additional time to absorb? Or is it possible that I need a larger dose? The only noted side effect was fairly severe headache on left side of head directly behind eye. Please advise, and report any blood test results received. Mark Amundsen MyChart message report Message [271961] From Victor Baquero, MD To Mark Amundsen Sent 11/4/2010 1:09 PM For Delivery 11/4/2010 1:09 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 11/5/2010 12:40 PM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, Body Most of the tests are back and they are within normal limits. Your vitamin D levels have risen (25 currenlty) but I want them to go up to above 50. All other tests currently are
001901
within normal limits. I'm still waiting for some. I see that she did not do testosterone or cortisol because they are 8am tests. You should have these done at some time - first thing in the morning - non-fasting. The B12 gets absorbed slowly. Into the system. It's not a quick release shot. ----- Message ----From: AMUNDSEN,MARK Sent: 11/4/10 12:05 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Dr BaqueroAfter the Vitamin B12 injection, I noticed improvement of symptoms after approx 8 hours. However, further improvement was not noted, and symptoms are still apparent at 70% of original strength. Is it possible that Vitamin B12 takes additional time to absorb? Or is it possible that I need a larger dose? The only noted side effect was fairly severe headache on left side of head directly behind eye. Please advise, and report any blood test results received. Mark Amundsen MyChart message report Message [271496] From Mark Amundsen To Victor Baquero, MD Sent 11/4/2010 12:05 AM For Delivery 11/4/2010 12:05 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Dr BaqueroMessage Body After the Vitamin B12 injection, I noticed improvement of symptoms after approx 8 hours. However, further improvement was not noted, and symptoms are still apparent at 70% of original strength. Is it possible that Vitamin B12 takes additional time to absorb? Or is it possible that I need a larger dose? The only noted side effect was fairly severe headache on left side of head directly behind eye. Please advise, and report any blood test results received. Mark Amundsen Encounter Messages Read Composed Y 11/5/2010 3:18 PM Y 11/4/2010 3:47 PM Y 11/4/2010 1:09 PM Y 11/4/2010 12:05 AM
Encounter Documentation Clare Jennings, MA 11/4/2010 8:24 AM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Thu Nov 4, 2010 12:05 AM Subject: Non-urgent Medical Advice Question Dr BaqueroAfter the Vitamin B12 injection, I noticed improvement of symptoms after approx 8 hours. However, further
001902
a metal bearing and a Summit stem... This system is also under investigation-see http://injury-law.freeadvice.com/defective_products/depuy-pinnaclehip-implants-failing.htm
Electronically signed by Clare Jennings, MA at 11/15/2010 3:48 PM Routing History 11/15/2010 3:48 PM From Clare Jennings, MA To Victor Henrique Baquero, MD Priority Routine
Created by Clare Jennings, MA on 11/15/2010 3:48 PM
Orders
Order Summary Future Orders LAB MISCELLANEOUS PROCEDURE [LAB001 Custom] Order #: 61638532
Expected By 11/19/10 Expires 11/19/11
Patient Email


Encounter Messages MyChart message report From Martina Randolph, MD To Mark Amundsen Sent 11/12/2010 11:11 AM For Delivery 11/12/2010 11:11 AM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 11/15/2010 10:14 AM MyChart Mark Amundsen By Responsibility Audit Trail Message Rx for Methadone is ready. Body Martina Dobrovodska Randolph, MD ----- Message ----From: AMUNDSEN,MARK Sent: 11/12/10 07:57 AM To: Victor Henrique Baquero, MD
Message [279135]
001903
Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI am also about due for a refill on Methadone. I will be out next Tuesday, so I would appreciate it if I could pick up a prescription Monday evening. I know you've been out, so I wanted to give you plenty of time to respond. Thanks ! Mark Amundsen MyChart message report Message [278776] From Mark Amundsen To Victor Baquero, MD Sent 11/12/2010 7:57 AM For Delivery 11/12/2010 7:57 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody I am also about due for a refill on Methadone. I will be out next Tuesday, so I would appreciate it if I could pick up a prescription Monday evening. I know you've been out, so I wanted to give you plenty of time to respond. Thanks ! Mark Amundsen Encounter Messages Read Composed Y 11/12/2010 11:11 AM Y 11/12/2010 7:57 AM
From Martina Randolph, MD Mark Amundsen
Encounter Documentation Stephanie L Esparza, LVN 11/12/2010 8:55 AM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Fri Nov 12, 2010 7:57 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI am also about due for a refill on Methadone. I will be out next Tuesday, so I would appreciate it if I could pick up a prescription Monday evening. I know you've been out, so I wanted to give you plenty of time to respond. Thanks ! Mark Amundsen
Electronically signed by Stephanie L Esparza, LVN at 11/12/2010 8:55 AM

From Stephanie L Esparza, LVN To Victor Henrique Baquero, MD Priority Routine
001904
Created by Stephanie L Esparza, LVN on 11/12/2010 8:55 AM Approved

Disp 200 Tab Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Class: Handwritten Rx Authorizing Provider: Martina Dobrovodska Randolph, MD Refills 0 Start 11/12/2010 End 12/7/2010
Patient Email
Orders
DOB 9/23/1959

Provider Stephanie L Esparza, LVN Department Fol Family Practice
Encounter Messages MyChart message report Message [278948] From Mark Amundsen To Victor Baquero, MD Sent 11/12/2010 9:04 AM For Delivery 11/12/2010 9:04 AM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi StephanieBody I called them this morning - I'm awaiting a callback. I'll keep y'all updated on what I find out about the hip replacement - this may be the cause of this chronic problem I've been having with fatigue and lack of strength. I'll keep you appraised... Regards, Mark Amundsen ----- Message ----From: Stephanie L Esparza, LVN Sent: 11/12/2010 8:54 AM To: Mark Amundsen Subject: RE: Non-urgent Medical Advice Question This is something you would need to contact the surgeon about. ----- Message ----From: AMUNDSEN,MARK Sent: 11/12/10 07:54 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question
001905
Is it possible I have a bad hip implant? I looked up the symptoms, and 2 out of 7 are hypothyroidism and peripheral neuropathy (which sounds like what I have), Is it possible to find out if I have one of the recalled hip implants? Thanks for any info you can provide Mark Amundsen
MyChart message report From Stephanie L Esparza, LVN To Mark Amundsen Sent 11/12/2010 8:54 AM For Delivery 11/12/2010 8:54 AM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 11/15/2010 10:14 AM MyChart Mark Amundsen By Responsibility Audit Trail Message This is something you would need to contact the surgeon about. Body ----- Message ----From: AMUNDSEN,MARK Sent: 11/12/10 07:54 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question
Message [278929]
Is it possible I have a bad hip implant? I looked up the symptoms, and 2 out of 7 are hypothyroidism and peripheral neuropathy (which sounds like what I have), Is it possible to find out if I have one of the recalled hip implants? Thanks for any info you can provide Mark Amundsen
MyChart message report Message [278767] From Mark Amundsen To Victor Baquero, MD Sent 11/12/2010 7:54 AM For Delivery 11/12/2010 7:54 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Is it possible I have a bad hip implant? I looked up the symptoms, and 2 out of 7 are Body hypothyroidism and peripheral neuropathy (which sounds like what I have), Is it possible to find out if I have one of the recalled hip implants? Thanks for any info you can provide Mark Amundsen Encounter Messages Read Composed Y 11/12/2010 9:04 AM
From Mark Amundsen
001906
30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 3 10/20/2010 1/18/2011 Levothyroxine (LEVOXYL) 50 mcg Tablet Sig - Route: Take 1 Tab by mouth every day. take on an empty stomach - ORAL Class: Pharmacy 100 Tab 1 9/22/2010 12/23/2010 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Pharmacy 100 Tab 0 10/20/2010 11/16/2010 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet (Discontinued) Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 200 Tab 0 11/12/2010 12/12/2010 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Class: Handwritten Rx 3 7/12/2010 11/16/2010 30 Tab Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg PO Tablet (Discontinued) Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy

Patient Email
Orders
DOB 9/23/1959

Encounter Messages MyChart message report Message [283877] From Victor Baquero, MD To Mark Amundsen Sent 11/17/2010 1:48 PM For Delivery 11/17/2010 1:48 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 11/17/2010 4:45 PM MyChart Mark Amundsen By Responsibility Audit Trail Message I've ordered a chromium and heavy metals panel. I did not see any tests we have to test Body Cobalt levels. You can schedule labs at your convenince. ----- Message ----From: AMUNDSEN,MARK
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Sent: 11/17/10 11:25 AM To: Victor Henrique Baquero, MD Subject: RE: Non-urgent Medical Advice Question Hi Dr BaqueroFrom what I've read, for the Depuy hip implants, these symptoms are caused by the Chromium and Cobalt ions and particles leaking out of the implant and getting into the bloodstream, causing heavy metal poisoning (metallosis). It further states there are blood tests to check the levels of both these contaminanants. (see next email) ----- Message ----From: Victor Henrique Baquero, MD Sent: 11/15/2010 6:15 PM To: Mark Amundsen Subject: RE: Non-urgent Medical Advice Question Mark, this is a hard one to pin down. I have several patients with implants (mostly breast implants) who describe similar symptoms. The hard part is actually diagnosing these as being the cause for the fatigue. It is possible but the solution would be to remove the hardware - which is not a real reasonable solution. If you are interested I can refer you to rheumatology and they may have some insight into this. Let me know. ----- Message ----From: AMUNDSEN,MARK Sent: 11/15/10 01:42 PM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Dr BaqueroSo how can I find out if my implant is failing? I have a feeling the metal ion/particles may be the issue with the fatigue, numbness, hypothyroidism, and peripheral neuropathy. I have request a copy of my med records - they will arrive in 10-15 days. It will confirm the model of hip implant. Is there anything we can do to make progress on this problem? I still have difficulty walking, shaking, and getting up. Regards, Mark Amundsen MyChart message report Message [283698] From Mark Amundsen To Victor Baquero, MD Sent 11/17/2010 11:25 AM For Delivery 11/17/2010 11:25 AM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody From what I've read, for the Depuy hip implants, these symptoms are caused by the Chromium and Cobalt ions and particles leaking out of the implant and getting into the
001908
bloodstream, causing heavy metal poisoning (metallosis). It further states there are blood tests to check the levels of both these contaminanants. (see next email) ----- Message ----From: Victor Henrique Baquero, MD Sent: 11/15/2010 6:15 PM To: Mark Amundsen Subject: RE: Non-urgent Medical Advice Question Mark, this is a hard one to pin down. I have several patients with implants (mostly breast implants) who describe similar symptoms. The hard part is actually diagnosing these as being the cause for the fatigue. It is possible but the solution would be to remove the hardware - which is not a real reasonable solution. If you are interested I can refer you to rheumatology and they may have some insight into this. Let me know. ----- Message ----From: AMUNDSEN,MARK Sent: 11/15/10 01:42 PM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Dr BaqueroSo how can I find out if my implant is failing? I have a feeling the metal ion/particles may be the issue with the fatigue, numbness, hypothyroidism, and peripheral neuropathy. I have request a copy of my med records - they will arrive in 10-15 days. It will confirm the model of hip implant. Is there anything we can do to make progress on this problem? I still have difficulty walking, shaking, and getting up. Regards, Mark Amundsen MyChart message report Message [281696] From Victor Baquero, MD To Mark Amundsen Sent 11/15/2010 6:15 PM For Delivery 11/15/2010 6:15 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 11/17/2010 11:20 AM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, this is a hard one to pin down. I have several patients with implants (mostly breast Body implants) who describe similar symptoms. The hard part is actually diagnosing these as being the cause for the fatigue. It is possible but the solution would be to remove the hardware - which is not a real reasonable solution. If you are interested I can refer you to rheumatology and they may have some insight into this. Let me know. ----- Message ----From: AMUNDSEN,MARK
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Sent: 11/15/10 01:42 PM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Dr BaqueroSo how can I find out if my implant is failing? I have a feeling the metal ion/particles may be the issue with the fatigue, numbness, hypothyroidism, and peripheral neuropathy. I have request a copy of my med records - they will arrive in 10-15 days. It will confirm the model of hip implant. Is there anything we can do to make progress on this problem? I still have difficulty walking, shaking, and getting up. Regards, Mark Amundsen MyChart message report Message [281275] From Mark Amundsen To Victor Baquero, MD Sent 11/15/2010 1:42 PM For Delivery 11/15/2010 1:42 PM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Dr BaqueroBody So how can I find out if my implant is failing? I have a feeling the metal ion/particles may be the issue with the fatigue, numbness, hypothyroidism, and peripheral neuropathy. I have request a copy of my med records - they will arrive in 10-15 days. It will confirm the model of hip implant. Is there anything we can do to make progress on this problem? I still have difficulty walking, shaking, and getting up. Regards, Mark Amundsen Encounter Messages Read Composed Y 11/17/2010 1:48 PM Y 11/17/2010 11:25 AM Y 11/15/2010 6:15 PM Y 11/15/2010 1:42 PM
Encounter Documentation Victor Baquero, MD, MD 11/17/2010 1:48 PM Addendum Addended by: BAQUERO, VICTOR H on: 11/17/2010 Modules accepted: Orders Clare Jennings, MA 11/15/2010 4:31 PM Signed From: AMUNDSEN,MARK
001910
To: Victor Henrique Baquero, MD Sent: Mon Nov 15, 2010 1:42 PM Subject: Non-urgent Medical Advice Question Dr BaqueroSo how can I find out if my implant is failing? I have a feeling the metal ion/particles may be the issue with the fatigue, numbness, hypothyroidism, and peripheral neuropathy. I have request a copy of my med records - they will arrive in 10-15 days. It will confirm the model of hip implant. Is there anything we can do to make progress on this problem? I still have difficulty walking, shaking, and getting up. Regards, Mark Amundsen Electronically signed by Clare Jennings, MA at 11/15/2010 4:31 PM Routing History 11/17/2010 11:37 AM 11/17/2010 11:25 AM 11/15/2010 4:31 PM From Clare Jennings, MA Epic User Clare Jennings, MA Victor Henrique Baquero, MD To Victor Henrique Baquero, MD Priority Routine Routine Routine
Orders
Order Summary Future Orders CHROMIUM,SERUM [LABNO Custom] Order #: 61537560 HEAVY METALS PNL 6,RFLX ARS FR [LAB001 Custom] Order #: 61537561 Expected By 11/17/10 11/17/10 Expires 11/17/11 11/17/11 Mark Amundsen (MRN 8081369)
Patient Email

Encounter Messages MyChart message report From Mark Amundsen To Victor Baquero, MD Sent 11/15/2010 1:37 PM For Delivery 11/15/2010 1:37 PM On Subject Non-urgent Medical Advice Question
Message [281271]
001911
Sex Male
DOB 9/23/1959
Account # 078548433115
Department Fol Lab
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Center None
Patient Email
Patient Email Encounter 11/17/2010 2:39 PM Provider Victor Baquero, MD, MD Department Fol Family Practice
Encounter Messages MyChart message report
Message [284640]
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From To Sent For Delivery On Subject PCP Last Read in MyChart By Responsibility Audit Trail Message Body
Victor Baquero, MD Mark Amundsen 11/17/2010 5:36 PM 11/17/2010 5:36 PM RE: Non-urgent Medical Advice Question Victor Baquero, MD, MD 11/23/2010 6:36 AM Mark Amundsen
I have no idea what the cost may be. You may want to contact UC Davis clinical laboratory to find out. ----- Message ----From: AMUNDSEN,MARK Sent: 11/17/10 11:38 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question I think the tests might be the way to go to determine whether this is the issue. However, if the tests are expensive, we may want to wait until the medical records come back to make sure I have the suspect implant. My immediate problem is insomnia. I'm not sleeping more than 45 minutes in a row. I'm reducing the vitamins for now, and picking up the Soma from the pharmacy. Mark Amundsen
MyChart message report Message [283718] Mark Amundsen From To Victor Baquero, MD Sent 11/17/2010 11:38 AM For Delivery 11/17/2010 11:38 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail I think the tests might be the way to go to determine whether this is the issue. Message However, if the tests are expensive, we may want to wait until the medical records come Body back to make sure I have the suspect implant. My immediate problem is insomnia. I'm not sleeping more than 45 minutes in a row. I'm reducing the vitamins for now, and picking up the Soma from the pharmacy. Mark Amundsen Encounter Messages Read Composed Y 11/17/2010 5:36 PM Y 11/17/2010 11:38 AM
Encounter Documentation Clare Jennings, MA 11/17/2010 2:39 PM Signed From: AMUNDSEN,MARK
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To: Victor Henrique Baquero, MD Sent: Wed Nov 17, 2010 11:38 AM Subject: Non-urgent Medical Advice Question I think the tests might be the way to go to determine whether this is the issue. However, if the tests are expensive, we may want to wait until the medical records come back to make sure I have the suspect implant. My immediate problem is insomnia. I'm not sleeping more than 45 minutes in a row. I'm reducing the vitamins for now, and picking up the Soma from the pharmacy. Mark Amundsen Electronically signed by Clare Jennings, MA at 11/17/2010 2:39 PM Routing History 11/17/2010 2:39 PM From Clare Jennings, MA To Victor Henrique Baquero, MD Priority Routine

Telephone Encounter
11/16/2010 4:06 PM
Reason for Call

Refill Request
Routing History
Created by
Approved
Disp Refills Start End 100 Tab 0 11/16/2010 12/28/2010 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10325 mg Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy Authorizing Provider: Victor Henrique Baquero, MD 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy Authorizing Provider: Victor Henrique Baquero, MD

Disp Refills Start End 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy
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PCP Responsibility Audit Trail Message Body
Dr BaqueroI contacted the Ortho Dept - they provided me info on my hip implant. They could not specify the model-the manufacturer is Depuy. They only make 2 models-the ASR (recalled), and the Pinnacle. It appears I have a 58MM Pinnacle hip implant cup, with a metal bearing and a Summit stem... This system is also under investigation-see http://injury-law.freeadvice.com/defective_products/depuy-pinnacle-hip-implantsfailing.htm
Encounter Messages Read Composed Y 11/15/2010 1:37 PM
From Mark Amundsen
Victor Baquero, MD, MD 11/19/2010 1:24 PM Signed Added test for cobalt.
Victor Baquero, MD, MD 11/19/2010 1:23 PM Signed Message copied by BAQUERO, VICTOR H on Fri Nov 19, 2010 1:23 PM -----Message from: DELEON, KELLY Created: Thu Nov 18, 2010 2:39 PM Regarding: COBALT URINE OR SERUM Hi Dr Baquero, Your pt was here today to pick up a 24 hr urine container for heavy metals and stated that we didn't have a test for Cobalt. Just an FYI, we do... Well ARUP does. If you want his urine tested for Cobalt, all you need to do is put it in as a Misc Test and we can send it off. That's where the heavy metals urine goes anyway. Please advise, thanks! Kelly DeLeon CPTII
From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Mon Nov 15, 2010 1:37 PM Subject: Non-urgent Medical Advice Question Dr BaqueroI contacted the Ortho Dept - they provided me info on my hip implant. They could not specify the model-the manufacturer is Depuy. They only make 2 models-the ASR (recalled), and the Pinnacle. It appears I have a 58MM Pinnacle hip implant cup, with 001915
Hi Dr BaqueroI received the cobalt test - is that level really bad, or just sorta bad? Also, symptoms continue. I did find something alarming - I had a leaking gallon can of carburator cleaner in the garage for approx 1 month. Finally found it and moved it outside last week. Don't know if fumes entered house. Could this be an issue? Fumes very bad in garage, but could not smell indoors. Please advise future plans for diagnosis... Thanks Mark Amundsen Electronically signed by Clare Jennings, MA at 12/1/2010 4:37 PM Routing History 12/1/2010 4:37 PM From Clare Jennings, MA To Victor Henrique Baquero, MD Priority Routine
Orders
Order Summary INTERNAL MED CLINIC REFERRAL [100020 Custom] Order #: 62101366
Patient Information
Contacts
Telephone Encounter
11/24/2010 9:35 AM
Reason for Call

Referral
Call Documentation
Tracy D Kasik 11/24/2010 1:36 PM Signed Referral processed.

Electronically signed by Tracy D Kasik at 11/24/2010 1:36 PM
Victor Baquero, MD, MD 11/24/2010 11:33 AM Signed Ok. It's not technically urgent but I would appreciate any effort to get him in soon. Thanks.
Tracy D Kasik 11/24/2010 9:37 AM Signed Per Sirgute at the Rheumatology clinic all urgent referrals must be a peer to peer only. Otherwise the referral will be triaged as routine at this time.
Electronically signed by Tracy D Kasik at 11/24/2010 9:37 AM
Routing History
11/24/2010 11:34 AM 11/24/2010 9:39 AM 11/24/2010 9:37 AM From Victor Henrique Baquero, MD Clare Jennings, MA Tracy D Kasik To P FOL REF FP Victor Henrique Baquero, MD P FOL MA FP Priority High High High
001916
Created by
Tracy D Kasik on 11/24/2010 9:35 AM

Disp Refills Start End 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 3 10/20/2010 1/18/2011 Levothyroxine (LEVOXYL) 50 mcg Tablet Sig - Route: Take 1 Tab by mouth every day. take on an empty stomach - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 100 Tab 1 9/22/2010 12/23/2010 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Pharmacy 100 Tab 0 11/16/2010 12/17/2010 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 200 Tab 0 11/12/2010 12/12/2010 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Class: Handwritten Rx
Orders Chart Cosign

Patient Email
Message [289951]
001917
Responsibility Audit Trail Message I placed a referral to rheum and requested them to expedite it. If symptoms persist and Body you need to be seen sooner follow up with me. Things generally show up with time. PS. The labs are not back yet in terms of the heavy metals. I'll keep you posted. ----- Message ----From: AMUNDSEN,MARK Sent: 11/23/10 06:43 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroSymptoms are getting worse again. Having difficulty controlling hand movements, and shaking is worse. What should I do from here? You mentioned Rheumatology. If they could help, let's please set it up. Mark Amundsen MyChart message report Message [289288] From Mark Amundsen To Victor Baquero, MD Sent 11/23/2010 6:43 AM For Delivery 11/23/2010 6:43 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody Symptoms are getting worse again. Having difficulty controlling hand movements, and shaking is worse. What should I do from here? You mentioned Rheumatology. If they could help, let's please set it up.
Mark Amundsen
Encounter Messages Read Composed Y 11/23/2010 1:36 PM Y 11/23/2010 6:43 AM
Encounter Documentation Clare Jennings, MA 11/23/2010 8:26 AM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Tue Nov 23, 2010 6:43 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroSymptoms are getting worse again. Having difficulty controlling hand movements, and shaking is worse. What should I do from here? You mentioned Rheumatology. If they could help, let's please set it up. Mark Amundsen
Routing History
From To Priority
001918
11/23/2010 8:26 AM
Clare Jennings, MA
Routine
Orders
Order Summary RHEUMATOLOGY REFERRAL [100071 Custom] Order #: 61779129
Orders Only
Patient Information
Patient Name Amundsen, Mark MRN 8081369 Sex Male DOB 9/23/1959 PATIENTPHONE 916-509-0158 Mark Amundsen (MRN 8081369)
Date 11/19/2010 Provider Victor Baquero, MD Department Fol Family Practice


SENDOUT URINE (61656577)
Ordered On 11/19/2010
Encounter Closed By
Appointment
001919
12/7/2010 4:42 PM 12/7/2010 4:12 PM 12/3/2010 12:11 PM 12/2/2010 9:35 AM
Clare Jennings, MA Tracy D Kasik Clare Jennings, MA Clare Jennings, MA
Victor Henrique Baquero, MD P FOL MA FP P FOL MA FP Victor Henrique Baquero, MD
Routine Routine Routine Routine
Created by

Orders Chart Cosign

Patient Email
Encounter Messages MyChart message report From Victor Baquero, MD To Mark Amundsen Sent 12/2/2010 4:22 PM For Delivery 12/2/2010 4:22 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD
Message [296927]
001920
Last Read in 12/10/2010 4:34 PM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark the levels are just slightly elevated. Im not certain that this would account for your Body symptoms. I'm going to request a consult with an internist to see if there are other avenues to pursue on your symptoms. You should be contacted soon. ----- Message ----From: AMUNDSEN,MARK Sent: 12/1/10 04:26 PM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI received the cobalt test - is that level really bad, or just sorta bad? Also, symptoms continue. I did find something alarming - I had a leaking gallon can of carburator cleaner in the garage for approx 1 month. Finally found it and moved it outside last week. Don't know if fumes entered house. Could this be an issue? Fumes very bad in garage, but could not smell indoors. Please advise future plans for diagnosis... Thanks Mark Amundsen MyChart message report Message [295745] From Mark Amundsen To Victor Baquero, MD Sent 12/1/2010 4:26 PM For Delivery 12/1/2010 4:26 PM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody I received the cobalt test - is that level really bad, or just sorta bad? Also, symptoms continue. I did find something alarming - I had a leaking gallon can of carburator cleaner in the garage for approx 1 month. Finally found it and moved it outside last week. Don't know if fumes entered house. Could this be an issue? Fumes very bad in garage, but could not smell indoors. Please advise future plans for diagnosis... Thanks Mark Amundsen Encounter Messages Read Composed Y 12/2/2010 4:22 PM Y 12/1/2010 4:26 PM
Non-urgent Medical Advice Question
Encounter Documentation Clare Jennings, MA 12/1/2010 4:37 PM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Wed Dec 1, 2010 4:26 PM Subject: Non-urgent Medical Advice Question
001921
Selected Appointment 12/8/2010 2:52 PM Department Ucd Pre-Reg
Center None
Patient Email


Message [301299]
001922
Message Body
Mark, The prescription is ready to pick up at our front desk. ----- Message ----From: AMUNDSEN,MARK Sent: 12/7/10 06:37 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr Baquero and staffIt's time for another refill on methadone. I will be out on Thursday, so I am hoping to pick up the prescription on Wednesday afternoon. Also, I have changed my pharmacy to the Walgreens on East Bidwell - here's the info2595 E Bidwell St,Folsom, CA 95630 (916) 817-6533 It's got a drive through, so no walking, which has become difficult and kind of a spectacle. Please let me know when the script is readyThanks! Mark Amundsen
MyChart message report Message [300617] From Mark Amundsen To Victor Baquero, MD Sent 12/7/2010 6:37 AM For Delivery 12/7/2010 6:37 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr Baquero and staffBody It's time for another refill on methadone. I will be out on Thursday, so I am hoping to pick up the prescription on Wednesday afternoon. Also, I have changed my pharmacy to the Walgreens on East Bidwell - here's the info2595 E Bidwell St,Folsom, CA 95630 (916) 817-6533 It's got a drive through, so no walking, which has become difficult and kind of a spectacle. Please let me know when the script is readyThanks! Mark Amundsen Encounter Messages Read Composed Y 12/7/2010 1:58 PM Y 12/7/2010 6:37 AM
001923
Clare Jennings, MA 12/7/2010 2:25 PM Addendum Left message that RX is at front desk
From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Tue Dec 7, 2010 6:37 AM Subject: Non-urgent Medical Advice Question Hi Dr Baquero and staffIt's time for another refill on methadone. I will be out on Thursday, so I am hoping to pick up the prescription on Wednesday afternoon. Also, I have changed my pharmacy to the Walgreens on East Bidwell - here's the info2595 E Bidwell St,Folsom, CA 95630 (916) 817-6533 It's got a drive through, so no walking, which has become difficult and kind of a spectacle. Please let me know when the script is readyThanks! Mark Amundsen
Electronically signed by Clare Jennings, MA at 12/7/2010 7:46 AM Routing History
12/7/2010 1:58 PM 12/7/2010 7:46 AM From Victor Henrique Baquero, MD Clare Jennings, MA To P FOL MA FP Victor Henrique Baquero, MD Priority Routine Routine
Created by Clare Jennings, MA on 12/7/2010 7:46 AM Approved Disp 200 Tab Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Class: Normal Authorizing Provider: Victor Henrique Baquero, MD
Refills 0
Start 12/7/2010
End 12/29/2010
Contacts
001924
12/07/2010 4:10 PM
Phone (Incoming)
916-983-2589 (H)
Telephone Encounter
12/2/2010 9:34 AM
Reason for Call

Referral
Call Documentation
Clare Jennings, MA 12/13/2010 12:09 PM Signed Left message that forms are at the front desk
Victor Baquero, MD, MD 12/13/2010 9:12 AM Signed Forms completed.

Clare Jennings, MA 12/8/2010 10:41 AM Signed Start date for his disability is 10/30/10 the end date is unknown at this time as per patient
Julie Stewart 12/8/2010 10:30 AM Signed Patient returning call from MA regarding either disability or fmla.
Electronically signed by Julie Stewart at 12/8/2010 10:30 AM
Victor Baquero, MD, MD 12/7/2010 4:49 PM Signed Left message on voice mail for Sirgute about the request for the consult.
Tracy D Kasik 12/7/2010 4:12 PM Signed Dr Baquero did a referral to the internal medicine clinic. Please clarify which dept you are wanting patient to be seen in? Per Sirgute at the Internal medical clinic 734-4685. Please notify her.
Electronically signed by Tracy D Kasik at 12/7/2010 4:12 PM
Clare Jennings, MA 12/7/2010 8:36 AM Signed Left message for patient to return call
Clare Jennings, MA 12/3/2010 12:11 PM Signed Left message for patient to return call, doctor is filling out his disability and FMLA forms but needs to know the date for the last day he worked and a projected back to work date.
Clare Jennings, MA 12/2/2010 9:35 AM Signed Patient faxed over disability and FMLA forms, they are in your in box with the business chart
Routing History
12/13/2010 9:12 AM 12/8/2010 10:41 AM 12/8/2010 10:30 AM 12/7/2010 4:49 PM
From Victor Henrique Baquero, MD Clare Jennings, MA Julie Stewart Victor Henrique Baquero, MD
To P FOL MA FP Victor Henrique Baquero, MD P FOL MA FP P FOL REF FP
Priority Routine Routine Routine Routine
001925
MRN 8081369
Sex Male
DOB 9/23/1959
Encounter Messages MyChart message report Message [320591] From Mark Amundsen To Victor Baquero, MD Sent 12/29/2010 8:55 PM For Delivery 12/29/2010 8:55 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Thanks Dr BaqueroBody That's what Rheum said as well - they were amazed it was going to take that long, I know Ortho is down a few docs as well - they bumped my appt back too. Mark Amundsen ----- Message ----From: Victor Henrique Baquero, MD Sent: 12/29/2010 1:10 PM To: Mark Amundsen Subject: RE: Non-urgent Medical Advice Question Mark, The prescription is ready to pick up at our front desk. I increased the qty to 240. Keep me posted on your symptoms. I've had a hard time getting patient in to rheum, access is tight now - one of the docs is out for a few months. ----- Message ----From: AMUNDSEN,MARK Sent: 12/28/10 10:29 PM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's about time for another refill on Methadone. I'll be out on Sunday, so I'm hoping to pick up a refill on Friday. I've been using more than normal - the right hip is getting worse. It seemed to start with the poor weather, but hasn't been abating as usual. I've been taking 9 per day now - 5 in the morning, 4 at night, versus 4 and 3. I may need to up the amount prescribed. The neuropathy has not abated - I've got an appt with Rheumatology in Feb. Regards, Mark Amundsen
001926
MyChart message report Message [320065] From Victor Baquero, MD To Mark Amundsen Sent 12/29/2010 1:10 PM For Delivery 12/29/2010 1:10 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 12/31/2010 2:41 PM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, Body The prescription is ready to pick up at our front desk. I increased the qty to 240. Keep me posted on your symptoms. I've had a hard time getting patient in to rheum, access is tight now - one of the docs is out for a few months. ----- Message ----From: AMUNDSEN,MARK Sent: 12/28/10 10:29 PM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's about time for another refill on Methadone. I'll be out on Sunday, so I'm hoping to pick up a refill on Friday. I've been using more than normal - the right hip is getting worse. It seemed to start with the poor weather, but hasn't been abating as usual. I've been taking 9 per day now - 5 in the morning, 4 at night, versus 4 and 3. I may need to up the amount prescribed. The neuropathy has not abated - I've got an appt with Rheumatology in Feb. Regards, Mark Amundsen MyChart message report Message [319521] From Mark Amundsen To Victor Baquero, MD Sent 12/28/2010 10:29 PM For Delivery 12/28/2010 10:29 PM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody It's about time for another refill on Methadone. I'll be out on Sunday, so I'm hoping to pick up a refill on Friday. I've been using more than normal - the right hip is getting worse. It seemed to start with the poor weather, but hasn't been abating as usual. I've been taking 9 per day now - 5 in the morning, 4 at night, versus 4 and 3. I may need to up the amount prescribed. The neuropathy has not abated - I've got an appt with Rheumatology in Feb.
001927
Regards, Mark Amundsen Encounter Messages Read Composed Y 12/29/2010 8:55 PM Y 12/29/2010 1:10 PM Y 12/28/2010 10:29 PM
From Mark Amundsen Victor Baquero, MD Mark Amundsen
To Victor Baquero, MD Mark Amundsen Victor Baquero, MD
Subject RE: Non-urgent Medical Advice Question RE: Non-urgent Medical Advice Question Non-urgent Medical Advice Question
Encounter Documentation Clare Jennings, MA 12/29/2010 7:37 AM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Tue Dec 28, 2010 10:29 PM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's about time for another refill on Methadone. I'll be out on Sunday, so I'm hoping to pick up a refill on Friday. I've been using more than normal - the right hip is getting worse. It seemed to start with the poor weather, but hasn't been abating as usual. I've been taking 9 per day now - 5 in the morning, 4 at night, versus 4 and 3. I may need to up the amount prescribed. The neuropathy has not abated - I've got an appt with Rheumatology in Feb. Regards, Mark Amundsen
Routing History
1/3/2011 7:54 AM 12/29/2010 8:55 PM 12/29/2010 7:38 AM From Clare Jennings, MA Epic User To Victor Henrique Baquero, MD Priority Routine Routine
Clare Jennings, MA
Routine

Disp 240 Tab Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Class: Handwritten Rx Authorizing Provider: Victor Henrique Baquero, MD Telephone/Refill Encounter
Refills 0
Start 12/29/2010
End 1/24/2011
001928
Telephone Encounter
12/28/2010 9:53 AM
Reason for Call

Refill Request
Routing History
12/28/2010 9:53 AM From Michele Melendez To Victor Henrique Baquero, MD Priority Routine
Created by
Michele Melendez on 12/28/2010 9:53 AM
Approved

Disp Refills Start End 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 3 10/20/2010 1/18/2011 Levothyroxine (LEVOXYL) 50 mcg Tablet Sig - Route: Take 1 Tab by mouth every day. take on an empty stomach - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 100 Tab 1 9/22/2010 12/23/2010 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Pharmacy 200 Tab 0 12/7/2010 1/6/2011 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL

Appointment
Orders
Sex Male
DOB 9/23/1959
Account # 038697465128 Patient Demographics Address 2025 TARBOLTON CIR FOLSOM CA 95630 Phone 916-509-0158 (Home) 916-983-4484 (Work) E-mail Address mamundsen@sbcglobal.net
001929
Telephone Encounter
Reason for Call

Refill Request
Routing History
1/21/2011 9:53 AM From Clare Jennings, MA To Victor Henrique Baquero, MD Priority Routine
Created by
Approved

Disp Refills Start End 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 100 Tab 1 9/22/2010 12/23/2010 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Pharmacy 100 Tab 0 12/28/2010 1/21/2011 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet (Discontinued) Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 240 Tab 0 12/29/2010 1/28/2011 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Class: Handwritten Rx

Patient Email
Orders
DOB 9/23/1959
001930
Encounter Messages MyChart message report Message [320996] From Mark Amundsen To Victor Baquero, MD Sent 12/30/2010 5:39 PM For Delivery 12/30/2010 5:39 PM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message HI Dr BaqueroBody I called UC Davis Med Center, and they said on the phone that y'all are closed on Thursday the 30th, and Friday the 31st. This is going to make it really hard to pick up my prescription on Friday. Is there any way someone could get it to me? I don't know if anyone goes in the building on "weekends", but I'd be happy to meet them. Thanks, Mark Amundsen Encounter Messages Read Composed Y 12/30/2010 5:39 PM
From Mark Amundsen
Encounter Documentation Clare Jennings, MA 1/3/2011 7:43 AM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Thu Dec 30, 2010 5:39 PM Subject: Non-urgent Medical Advice Question HI Dr BaqueroI called UC Davis Med Center, and they said on the phone that y'all are closed on Thursday the 30th, and Friday the 31st. This is going to make it really hard to pick up my prescription on Friday. Is there any way someone could get it to me? I don't know if anyone goes in the building on "weekends", but I'd be happy to meet them. Thanks, Mark Amundsen Electronically signed by Clare Jennings, MA at 1/3/2011 7:43 AM Routing History 1/3/2011 7:43 AM From Clare Jennings, MA To Victor Henrique Baquero, MD Priority Routine
Orders
Chart Cosign Accepted By Victor Henrique Baquero, MD Accepted On 1/10/2011 5:17 PM Mark Amundsen (MRN 8081369)
Patient Email
Patient Information
001931

Encounter Closed By Closed By CAI, XIAO Closed Date 02012011 Closed Time 17:08 Mark Amundsen (MRN 8081369) MRN 8081369 Sex Male DOB 9/23/1959 PATIENTPHONE 916-509-0158
Patient Email
Encounter Messages MyChart message report From Victor Baquero, MD To Mark Amundsen Sent 1/24/2011 10:27 AM For Delivery 1/24/2011 10:27 AM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 1/25/2011 11:57 PM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, Body The prescription is ready to pick up at our front desk. I appreciate the 3 days notice. Take care. ----- Message ----From: AMUNDSEN,MARK Sent: 1/24/11 07:10 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr Baquero-
Message [347757]
It's about time for another refill on Methadone. I will be out on Thursday, so I'm hoping to pick up a refill on Wednesday afternoon. I wanted to give y'all plenty of notice in case you were out of the office... Regards, Mark Amundsen MyChart message report From Mark Amundsen To Victor Baquero, MD Sent 1/24/2011 7:10 AM For Delivery 1/24/2011 7:10 AM Message [347354]
001932
On Subject PCP Responsibility Audit Trail Message Body
Non-urgent Medical Advice Question Victor Baquero, MD, MD
Hi Dr BaqueroIt's about time for another refill on Methadone. I will be out on Thursday, so I'm hoping to pick up a refill on Wednesday afternoon. I wanted to give y'all plenty of notice in case you were out of the office... Regards, Mark Amundsen
Encounter Messages Read Composed Y 1/24/2011 10:27 AM Y 1/24/2011 7:10 AM
Encounter Documentation Clare Jennings, MA 1/24/2011 9:49 AM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Mon Jan 24, 2011 7:10 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's about time for another refill on Methadone. I will be out on Thursday, so I'm hoping to pick up a refill on Wednesday afternoon. I wanted to give y'all plenty of notice in case you were out of the office... Regards, Mark Amundsen Electronically signed by Clare Jennings, MA at 1/24/2011 9:49 AM Routing History 1/24/2011 9:50 AM From Clare Jennings, MA To Victor Henrique Baquero, MD Priority Routine
Created by Clare Jennings, MA on 1/24/2011 9:49 AM Approved Disp 240 Tab Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Class: Handwritten Rx Authorizing Provider: Victor Henrique Baquero, MD
Refills 0
Start 1/24/2011
End 2/18/2011
001933
Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 240 Tab 0 1/24/2011 2/23/2011 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Class: Handwritten Rx

Patient Email
Orders
DOB 9/23/1959
Encounter Messages MyChart message report Message [365072] From Victor Baquero, MD To Mark Amundsen Sent 2/7/2011 7:09 PM For Delivery 2/7/2011 7:09 PM On Subject RE:consult report PCP Victor Baquero, MD, MD Last Read in 2/17/2011 11:00 AM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, thanks for the update. I placed an order for the nerve conduction study. Feel free Body to contact the referral coordinators in a few days if you havent been contacted to schedule the test. It should help get more information on the problem. Hopefully we can take care of it soon. Take care. ----- Message ----From: AMUNDSEN,MARK Sent: 2/7/11 10:07 AM To: Victor Henrique Baquero, MD Subject: RE:consult report Hi Dr BaqueroStill not doing well. Not much strength in legs, and no endurance. Arms seem to be doing better in last week or 2. Experiencing more vertigo side to side. Pain levels are up on both hips. I have a Neuro appt on the 17th. They said that you should request a nerve conduction test to help evaluate Neuro status. Don't know why the Primary has to schedule it. Could you please do so, and call me if you have any questions. Rheumatology thinks it's CIDP. Thanks!
001934
Mark Amundsen ----- Message ----From: Victor Henrique Baquero, MD Sent: 02/04/2011 12:28 PM To: Mark Amundsen Subject: consult report Mark. I got the report from your recent consult with the rheumatologist. He had some helpful recommendations - he felt that this was not a rheumatologic process but more likely a neurologic process. I wanted to hear from you how you are doing. I also wanted to refer you to a neurologist for consultation. At this point I'm going to place a referral to neurology. You should be contacted in the near future. Let me know how things are going. Dr. B MyChart message report Message [364002] From Mark Amundsen To Victor Baquero, MD Sent 2/7/2011 10:07 AM For Delivery 2/7/2011 10:07 AM On Subject RE:consult report PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody Still not doing well. Not much strength in legs, and no endurance. Arms seem to be doing better in last week or 2. Experiencing more vertigo side to side. Pain levels are up on both hips. I have a Neuro appt on the 17th. They said that you should request a nerve conduction test to help evaluate Neuro status. Don't know why the Primary has to schedule it. Could you please do so, and call me if you have any questions. Rheumatology thinks it's CIDP. Thanks! Mark Amundsen ----- Message ----From: Victor Henrique Baquero, MD Sent: 02/04/2011 12:28 PM To: Mark Amundsen Subject: consult report Mark. I got the report from your recent consult with the rheumatologist. He had some helpful recommendations - he felt that this was not a rheumatologic process but more likely a neurologic process. I wanted to hear from you how you are doing. I also wanted to refer you to a neurologist for consultation. At this point I'm going to place a referral to neurology. You should be contacted in the near future. Let me know how things are going. Dr. B MyChart message report From Victor Baquero, MD To Mark Amundsen Message [362099]
001935
Sent For Delivery On Subject PCP Last Read in MyChart By Responsibility Audit Trail Message Body
2/4/2011 12:28 PM 2/4/2011 12:28 PM consult report Victor Baquero, MD, MD 2/7/2011 9:58 AM Mark Amundsen
Mark. I got the report from your recent consult with the rheumatologist. He had some helpful recommendations - he felt that this was not a rheumatologic process but more likely a neurologic process. I wanted to hear from you how you are doing. I also wanted to refer you to a neurologist for consultation. At this point I'm going to place a referral to neurology. You should be contacted in the near future. Let me know how things are going.
Dr. B
Encounter Messages Read Composed Y 2/7/2011 7:09 PM Y 2/7/2011 10:07 AM Y 2/4/2011 12:28 PM Routing History 2/7/2011 10:19 AM
From Victor Baquero, MD Mark Amundsen Victor Baquero, MD
To Mark Amundsen Victor Baquero, MD Mark Amundsen
Subject RE:consult report
RE:consult report consult report
Priority Routine
Orders
Order Summary EMG/NCS [NEURO00007 Custom] Order #: 64704523
Appointment
Account # 078661756029
Phone 916-509-0158 (Home) 916-983-4484 (Work)
001936
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Center None
Patient Information

Telephone Encounter
2/4/2011 12:23 PM
Call Documentation
Victor Baquero, MD, MD 2/4/2011 12:28 PM Signed Reviewed rheumatology consult. chronic inflammatory demyelinating polyneuropathy (CIDP) may be a potential diagnosis. Will refer to neurology per consult recommendation.
Created by
Victor Henrique Baquero, MD on 2/4/2011 12:23 PM

Disp Refills Start End 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy
001937
30 Tab 1 2/16/2011 3/18/2011 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Pharmacy 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 100 Tab 1 2/1/2011 5/4/2011 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical 100 Tab 0 2/16/2011 3/19/2011 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 240 Tab 0 1/24/2011 2/18/2011 Methadone (DOLOPHINE) 10 mg Tablet (Discontinued) Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Class: Handwritten Rx

MUSK ANTIBODY (65131614) Ordered On 2/17/2011
Encounter Closed By
Patient Email
Message [379146]
001938
Mark, you may want to contact the manufacturer. You may contact ortho as well. ----- Message ----From: AMUNDSEN,MARK Sent: 2/17/11 11:09 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question ContinuedDoctor Oh confirmed muscle weakness but said it is unlikely it is CIDP, which is good because it is much more serious than Internet says it is. He also ran additional blood tests. Left hip is getting worse pain wise. I found out cobalt test that was run (urine) was not the recommended one - recommended one is blood test. There is none in UC Davis, Should I contact Ortho? Mark Amundsen
MyChart message report Message [377245] Mark Amundsen From To Victor Baquero, MD Sent 2/17/2011 11:09 AM For Delivery 2/17/2011 11:09 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message ContinuedBody Doctor Oh confirmed muscle weakness but said it is unlikely it is CIDP, which is good because it is much more serious than Internet says it is. He also ran additional blood tests. Left hip is getting worse pain wise. I found out cobalt test that was run (urine) was not the recommended one - recommended one is blood test. There is none in UC Davis, Should I contact Ortho? Mark Amundsen Encounter Messages Read Composed Y 2/18/2011 1:39 PM Y 2/17/2011 11:09 AM
Encounter Documentation Clare Jennings, MA 2/17/2011 11:10 AM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Thu Feb 17, 2011 11:09 AM Subject: Non-urgent Medical Advice Question ContinuedDoctor Oh confirmed muscle weakness but said it is unlikely it is CIDP, which is good because it is much more serious than Internet says it is. He also ran additional blood tests. Left hip is getting worse pain wise. I found out cobalt test that was run (urine) was not the recommended one recommended one is blood test. There is none in UC Davis, Should I contact Ortho? Mark Amundsen
001939
Electronically signed by Clare Jennings, MA at 2/17/2011 11:10 AM Routing History From 2/17/2011 11:10 AM Clare Jennings, MA Created by Clare Jennings, MA on 2/17/2011 11:10 AM To Victor Henrique Baquero, MD Priority Routine
Patient Email
Orders
DOB 9/23/1959
Encounter Messages MyChart message report From Victor Baquero, MD To Mark Amundsen Sent 2/18/2011 1:45 PM For Delivery 2/18/2011 1:45 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 2/18/2011 3:08 PM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, Body The prescription is ready to pick up at our front desk. Take care. ----- Message ----From: AMUNDSEN,MARK Sent: 2/17/11 11:05 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question
Message [379153]
Hi Dr BaqueroIt's about time for another refill- I will be out on Tuesday, but since you will be closed on Monday, I'm hoping to pick up a refill on Friday afternoon, I would have given more notice, but I just found out you will be closed. Went to Neuro today, they want a nerve conduction AND muscle test. Please let me know when to pick up the prescriptionThanks! Mark Amundsen MyChart message report From Mark Amundsen Victor Baquero, MD Message [377231]
001940
To Sent For Delivery On Subject PCP Responsibility Audit Trail Message Body
2/17/2011 11:05 AM 2/17/2011 11:05 AM Non-urgent Medical Advice Question Victor Baquero, MD, MD
Hi Dr BaqueroIt's about time for another refill- I will be out on Tuesday, but since you will be closed on Monday, I'm hoping to pick up a refill on Friday afternoon, I would have given more notice, but I just found out you will be closed. Went to Neuro today, they want a nerve conduction AND muscle test. Please let me know when to pick up the prescriptionThanks! Mark Amundsen
Encounter Documentation Clare Jennings, MA 2/17/2011 11:09 AM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Thu Feb 17, 2011 11:05 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's about time for another refill- I will be out on Tuesday, but since you will be closed on Monday, I'm hoping to pick up a refill on Friday afternoon, I would have given more notice, but I just found out you will be closed. Went to Neuro today, they want a nerve conduction AND muscle test. Please let me know when to pick up the prescriptionThanks! Mark Amundsen
Routing History From 2/17/2011 11:10 AM Clare Jennings, MA Created by Clare Jennings, MA on 2/17/2011 11:09 AM Approved
Priority Routine
Appointment
001941
30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 100 Tab 1 2/1/2011 5/4/2011 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical 0 2/16/2011 3/18/2011 100 Tab Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet (Discontinued) Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL Class: Pharmacy 240 Tab 0 3/14/2011 4/13/2011 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Class: Handwritten Rx

Patient Email
Orders
DOB 9/23/1959
Encounter Messages MyChart message report From Victor Baquero, MD To Mark Amundsen Sent 3/14/2011 12:24 PM For Delivery 3/14/2011 12:24 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 3/15/2011 6:40 AM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, Body The prescription is ready to pick up at our front desk. I'll be curious to hear his recommendations. Take care. ----- Message ----From: AMUNDSEN,MARK Sent: 3/14/11 06:28 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question
Message [406521]
001942
Hi Dr BaqueroIt's about time for another methadone refill. I'll be out on Thursday, so I'm hoping to pick up a refill on Wednesday afternoon. Also, I have my neuro consult on the 24th to discuss EMG test - keeping fingers crossed. Thanks for all the support...
Mark Amundsen
MyChart message report Message [405865] From Mark Amundsen To Victor Baquero, MD Sent 3/14/2011 6:28 AM For Delivery 3/14/2011 6:28 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody It's about time for another methadone refill. I'll be out on Thursday, so I'm hoping to pick up a refill on Wednesday afternoon. Also, I have my neuro consult on the 24th to discuss EMG test - keeping fingers crossed. Thanks for all the support... Mark Amundsen Encounter Messages Read Composed Y 3/14/2011 12:24 PM Y 3/14/2011 6:28 AM
Encounter Documentation Clare Jennings, MA 3/14/2011 8:14 AM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Mon Mar 14, 2011 6:28 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's about time for another methadone refill. I'll be out on Thursday, so I'm hoping to pick up a refill on Wednesday afternoon. Also, I have my neuro consult on the 24th to discuss EMG test - keeping fingers crossed. Thanks for all the support... Mark Amundsen Electronically signed by Clare Jennings, MA at 3/14/2011 8:14 AM Routing History 3/14/2011 8:15 AM Created by From Clare Jennings, MA To Victor Henrique Baquero, MD Priority Routine
001943
Clare Jennings, MA on 3/14/2011 8:14 AM Approved Disp 240 Tab Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Class: Handwritten Rx Authorizing Provider: Victor Henrique Baquero, MD
Refills 0
Start 3/14/2011
End 4/7/2011
Telephone Encounter
3/11/2011 9:22 AM
Reason for Call

Form Request
Call Documentation
Clare Jennings, MA 3/11/2011 4:45 PM Signed Left message that forms are at front desk
Victor Baquero, MD, MD 3/11/2011 4:15 PM Signed Forms completed. Thank you.
Clare Jennings, MA 3/11/2011 9:23 AM Signed Forms are in your in box with the business chart
Routing History
3/11/2011 4:15 PM 3/11/2011 9:23 AM
From Victor Henrique Baquero, MD Clare Jennings, MA To P FOL MA FP Victor Henrique Baquero, MD Priority Routine Routine
Created by

Disp Refills Start End 30 Tab 1 2/16/2011 3/18/2011 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 1 Tab by mouth 3 times daily. - ORAL Class: Pharmacy 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL
001944
11th), rather than Tuesday afternoon (the 12th). I fyou coul, please let me know via email or phone when it is ready to pick up. Also, bilateral foot pain and burning is getting worse - I don't suppose there is something different for that? Regards, Mark Amundsen Encounter Messages Read Composed Y 4/11/2011 2:20 PM Y 4/11/2011 12:55 PM Y 4/11/2011 12:11 AM
Encounter Documentation Clare Jennings, MA 4/11/2011 7:36 AM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Mon Apr 11, 2011 12:11 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI miscalculated the number of days Methadone I had left when I made my last request. I will be out on Tuesday morning - so I'm hoping to pick up a script Monday afternoon ( the 11th), rather than Tuesday afternoon (the 12th). I fyou coul, please let me know via email or phone when it is ready to pick up. Also, bilateral foot pain and burning is getting worse - I don't suppose there is something different for that? Regards, Mark Amundsen Electronically signed by Clare Jennings, MA at 4/11/2011 7:36 AM Routing History 4/11/2011 3:05 PM 4/11/2011 7:36 AM From Clare Jennings, MA Clare Jennings, MA To Victor Henrique Baquero, MD Victor Henrique Baquero, MD Priority Routine Routine
Patient Email
Orders
DOB 9/23/1959
Encounter Messages MyChart message report From Clare Jennings, MA To Mark Amundsen
Message [446746]
001945
4/11/2011 2:44 PM 4/11/2011 2:44 PM RE: Non-urgent Medical Advice Question Victor Baquero, MD, MD 4/12/2011 7:27 PM Mark Amundsen
Your prescription is ready for pick up and is at the front desk ----- Message ----From: AMUNDSEN,MARK Sent: 4/7/11 06:52 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's about time for another Methadone refill. I won't be out until Wednesday, so I'd like to pick up the script on Tuesday the 12th. I wanted to give y'all extra time cause of the weekend. Another message on medical status after this oneRegards, Mark Amundsen
MyChart message report Message [441673] From Mark Amundsen To Victor Baquero, MD Sent 4/7/2011 6:52 AM For Delivery 4/7/2011 6:52 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody It's about time for another Methadone refill. I won't be out until Wednesday, so I'd like to pick up the script on Tuesday the 12th. I wanted to give y'all extra time cause of the weekend. Another message on medical status after this oneRegards, Mark Amundsen Encounter Messages Read Composed DEL 4/11/2011 2:44 PM Y 4/7/2011 6:52 AM
From Clare Jennings, MA Mark Amundsen
001946

From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Thu Apr 7, 2011 6:52 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's about time for another Methadone refill. I won't be out until Wednesday, so I'd like to pick up the script on Tuesday the 12th. I wanted to give y'all extra time cause of the weekend. Another message on medical status after this oneRegards, Mark Amundsen
Electronically signed by Clare Jennings, MA at 4/7/2011 8:11 AM Routing History From 4/11/2011 12:47 PM Victor Henrique Baquero, MD 4/7/2011 8:12 AM Clare Jennings, MA Created by Clare Jennings, MA on 4/7/2011 8:11 AM Approved Disp 240 Tab Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Class: Handwritten Rx Authorizing Provider: Victor Henrique Baquero, MD Refills 0 Start 4/7/2011 End 5/4/2011 To P FOL MA FP Victor Henrique Baquero, MD Priority Routine Routine
Orders
Patient Email
001947
Encounter Messages MyChart message report Message [442317] From Victor Baquero, MD To Mark Amundsen Sent 4/7/2011 11:21 AM For Delivery 4/7/2011 11:21 AM On Subject RE: Test Result Question PCP Victor Baquero, MD, MD Last Read in 4/8/2011 1:17 PM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, Body Thanks for the update. Dr. Oh does keep me posted as well. Hopefully they can get to the bottom of this soon. Take care. ----- Message ----From: AMUNDSEN,MARK Sent: 4/7/11 06:57 AM To: Victor Henrique Baquero, MD Subject: Test Result Question Hi Dr BaqueroTests have been done-the nerve conduction test showed I have some sort of demylinating disease or condition, so they're testing for the usual suspects. None have come up positive so far. Still to come-Lyme, MS, Syphilis. Still haven't managed to get cobalt blood test done by UCD. Also having spinal tap done end of month-whoopee! Regards, Mark Amundsen MyChart message report Message [441679] From Mark Amundsen To Victor Baquero, MD Sent 4/7/2011 6:57 AM For Delivery 4/7/2011 6:57 AM On Subject Test Result Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody Tests have been done-the nerve conduction test showed I have some sort of demylinating disease or condition, so they're testing for the usual suspects. None have come up positive so far. Still to come-Lyme, MS, Syphilis. Still haven't managed to get cobalt blood test done by UCD. Also having spinal tap done end of month-whoopee! Regards, Mark Amundsen Encounter Messages Read Composed Y 4/7/2011 11:21 AM
From Victor Baquero, MD
To Mark Amundsen
Subject RE: Test Result Question
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4/7/2011 6:57 Mark AM Amundsen
Victor Baquero, MD
Test Result Question
Encounter Documentation Clare Jennings, MA 4/7/2011 8:10 AM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Thu Apr 7, 2011 6:57 AM Subject: Test Result Question Hi Dr BaqueroTests have been done-the nerve conduction test showed I have some sort of demylinating disease or condition, so they're testing for the usual suspects. None have come up positive so far. Still to come-Lyme, MS, Syphilis. Still haven't managed to get cobalt blood test done by UCD. Also having spinal tap done end of month-whoopee! Regards, Mark Amundsen Electronically signed by Clare Jennings, MA at 4/7/2011 8:10 AM Routing History 4/7/2011 8:11 AM From Clare Jennings, MA To Victor Henrique Baquero, MD Priority Routine

Orders Only
Date 3/29/2011 Provider Margaret Korzewski Department Vascular Center Clinic

Disp Refills Start End 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 100 Tab 1 2/1/2011 5/4/2011 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Historical 100 Tab 0 3/18/2011 4/18/2011 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. - ORAL
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CA 95817-9001
Center None
Patient Email


Encounter Messages MyChart message report Message [446695] Mark Amundsen From To Victor Baquero, MD Sent 4/11/2011 2:20 PM For Delivery 4/11/2011 2:20 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Thanks Dr BaqueroBody It's been awhile since I've been in, so I'll come on in. The feet are getting worse - it's spread to the left foot as well now, although it's still not as bad as the right. Still haven't heard back from Ortho - they may have had problems getting a new guy. Left hip (replaced) is slowly causing more pain, in a strange and new place ( right in the side), and seemingly in a pinpoint.. Falling apart, I guess... See you soonMark Amundsen ----- Message ----From: Victor Henrique Baquero, MD Sent: 04/11/2011 12:55 PM To: Mark Amundsen Subject: RE: Non-urgent Medical Advice Question Mark, the methadone is ready. I'd like to see you for the foot if it is worsening (or you can see the neurologist as well). There are medications that can help but they may have some side effects. It's best to discuss the options in person. Take care. ----- Message ----From: AMUNDSEN,MARK Sent: 4/11/11 12:11 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question
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Hi Dr BaqueroI miscalculated the number of days Methadone I had left when I made my last request. I will be out on Tuesday morning - so I'm hoping to pick up a script Monday afternoon ( the 11th), rather than Tuesday afternoon (the 12th). I fyou coul, please let me know via email or phone when it is ready to pick up. Also, bilateral foot pain and burning is getting worse - I don't suppose there is something different for that? Regards, Mark Amundsen MyChart message report Message [446481] From Victor Baquero, MD To Mark Amundsen Sent 4/11/2011 12:55 PM For Delivery 4/11/2011 12:55 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 4/11/2011 2:14 PM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, the methadone is ready. Body I'd like to see you for the foot if it is worsening (or you can see the neurologist as well). There are medications that can help but they may have some side effects. It's best to discuss the options in person. Take care. ----- Message ----From: AMUNDSEN,MARK Sent: 4/11/11 12:11 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI miscalculated the number of days Methadone I had left when I made my last request. I will be out on Tuesday morning - so I'm hoping to pick up a script Monday afternoon ( the 11th), rather than Tuesday afternoon (the 12th). I fyou coul, please let me know via email or phone when it is ready to pick up. Also, bilateral foot pain and burning is getting worse - I don't suppose there is something different for that? Regards, Mark Amundsen MyChart message report Message [445511] From Mark Amundsen To Victor Baquero, MD Sent 4/11/2011 12:11 AM For Delivery 4/11/2011 12:11 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody I miscalculated the number of days Methadone I had left when I made my last request. I will be out on Tuesday morning - so I'm hoping to pick up a script Monday afternoon ( the
001951
CA 95817-9001
Center None
Patient Email


Provider Andrew Kim Oh, MD, MD Department Carm Neurology
Encounter Messages MyChart message report Message [455898] Andrew Kim Oh, MD From To Mark Amundsen Sent 4/18/2011 1:45 PM For Delivery 4/18/2011 1:45 PM On Subject RE: Test Result Question PCP Victor Baquero, MD, MD Last Read in 4/18/2011 2:23 PM MyChart Mark Amundsen By Responsibility Audit Trail Message Hi Mark, Body The last blood tests I ordered were drawn on 3/24, the same day as our last visit together. The results of these 3/24 blood tests are all normal. I released them to MyChart and I sent a letter to you by US mail showing the normal results. See a copy of the body of the letter below but the formatting is gone. On each line, the first item is the name of the test, the second entry is the normal range, and the third entry is your result. All results were normal. The Lyme, MS, and syphilis tests are all part of the spinal tap, which has not been done yet. The MS test is a combined spinal fluid and blood test so yes you will need to get a blood draw on the same day as the spinal tap. -Dr. Oh
-------------------------------------------------------------------Mark Amundsen
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2017 Tarbolton Cir Folsom CA 95630 4/4/2011 Dear Mr. Amundsen, The results of the following blood tests are normal. Component Latest Ref Rng 3/24/2011 GANGLIOSIDE AB ASIALO-GM1 0 - 50 IV 25 GANGLIOSIDE AB GM1 0 - 50 IV 13 GANGLIOSIDE AB GD1A 0 - 50 IV 6 GANGLIOSIDE AB GD1B 0 - 50 IV 4 GANGLIOSIDE AB GQ1B 0 - 50 IV 9 SERUM PROTEIN ELECTROPHORESIS Normal pattern Normal pattern SERUM IMMUNOFIXATION Normal pattern Normal pattern MAG ANTIBODY, IgM 0 - 999 TU 0 SGPG ANTIBODY, IgM 0.00 - 0.99 IV 0.24 CRYOGLOBULIN 0 - 1 % 0 HEPATITIS C Ab SCREEN Nonreactive Nonreactive --------------------------------------------------------------------------
----- Message ----From: AMUNDSEN,MARK Sent: 4/18/11 07:11 AM To: Andrew Kim Oh, MD Subject: Test Result Question Hi Dr OhI've been waiting to see if the results from the rest of the blood tests are in, but nothing yet. This seems to be much longer than normal - maybe the email got rerouted? I'm still waiting on results for Lyme, MS, and Syphilis. I'd like to find these results before going in for the spinal tap. Also, the lab stated that the next blood tests should NOT be done the same day as the tap - but you said they should. Just wanted clarification on that point... Mark Amundsen MyChart message report From Mark Amundsen To Andrew Kim Oh, MD Sent 4/18/2011 7:11 AM For Delivery 4/18/2011 7:11 AM On Subject Test Result Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr OhBody Message [454973]
001953
I've been waiting to see if the results from the rest of the blood tests are in, but nothing yet. This seems to be much longer than normal - maybe the email got rerouted? I'm still waiting on results for Lyme, MS, and Syphilis. I'd like to find these results before going in for the spinal tap. Also, the lab stated that the next blood tests should NOT be done the same day as the tap - but you said they should. Just wanted clarification on that point...
Mark Amundsen
From Andrew Kim Oh, MD Mark Amundsen
To Mark Amundsen Andrew Kim Oh, MD
Test Result Question
Appointment
Orders
Sex Male
DOB 9/23/1959
Account # 078661756029 Patient Demographics Address 2025 TARBOLTON CIR FOLSOM CA 95630 Selected Appointment 4/14/2011 10:00 AM Provider Andrew Kim Oh, MD, MD Department Carm Neurology Phone 916-509-0158 (Home) 916-983-4484 (Work) E-mail Address mamundsen@sbcglobal.net
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5/4/2011 11:33 AM 5/4/2011 8:53 AM
From Victor Henrique Baquero, MD Clare Jennings, MA
To P FOL MA FP Victor Henrique Baquero, MD

Disp 240 Tab Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Class: Handwritten Rx Authorizing Provider: Victor Henrique Baquero, MD Refills 0 Start 5/4/2011 End 5/26/2011
Orders
Chart Cosign Accepted By Victor Henrique Baquero, MD Accepted On 5/4/2011 6:17 PM Mark Amundsen (MRN 8081369) MRN 8081369 Sex Male DOB 9/23/1959 PATIENTPHONE 916-509-0158
Patient Email
Encounter Messages MyChart message report Message [475073] From Mark Amundsen To Victor Baquero, MD Sent 5/3/2011 5:09 AM For Delivery 5/3/2011 5:09 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody I have found a place to perform the cobalt serum test in Folsom (Quest Diag).All they require is a lab request for the test from a doctor. It can even be on a prescription pad.I'd like to get the hip replacement eliminated as a possible source of the demylination.If you could provide the request, I would appreciate it. Also, I'm due for a refill on methadone. I will be out on Thursday, so I'd like to pick up both requests at the same time before then. Thanks, Mark Amundsen Encounter Messages Read Composed From Y 5/3/2011 5:09 Mark AM Amundsen Encounter Documentation
001955
Clare Jennings, MA 5/3/2011 8:14 AM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Tue May 3, 2011 5:09 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI have found a place to perform the cobalt serum test in Folsom (Quest Diag).All they require is a lab request for the test from a doctor. It can even be on a prescription pad.I'd like to get the hip replacement eliminated as a possible source of the demylination.If you could provide the request, I would appreciate it. Also, I'm due for a refill on methadone. I will be out on Thursday, so I'd like to pick up both requests at the same time before then. Thanks, Mark Amundsen Electronically signed by Clare Jennings, MA at 5/3/2011 8:14 AM Routing History 5/3/2011 8:15 AM
Appointment
Orders
DOB 9/23/1959
Encounter-Level Documents: There are no encounter-level documents. Insurance Information Acct Number 078661756052 1 Payor UCD Patient Insurance ID XEHJ00044785 Group Number PH0010 Financial Class P
001956
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Center None
001957
Test Result Question Victor Baquero, MD, MD
Hi Dr Oh and staffI was hoping that some or all of the test results from the lumbar puncture and blood draw on 04/28/2011 have been received. If they have, could you please forward the results to me as soon as you get a chance? Thanks
Mark Amundsen
Encounter Messages Read Composed Y 5/9/2011 7:33 PM Y 5/9/2011 3:15 PM Y 5/9/2011 2:38 PM
From Mark Amundsen Andrew Kim Oh, MD Mark Amundsen
To Andrew Kim Oh, MD Mark Amundsen Andrew Kim Oh, MD
RE: Test Result Question Test Result Question
Patient Email
Orders
DOB 9/23/1959
Encounter Messages MyChart message report Message [477560] From Victor Baquero, MD To Mark Amundsen Sent 5/4/2011 11:33 AM For Delivery 5/4/2011 11:33 AM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 5/5/2011 5:54 AM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, I have the prescription and lab request ready for you to pick up. Take care. Body
001958
----- Message ----From: AMUNDSEN,MARK Sent: 5/4/11 08:12 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI'm hoping to pick up a methadone prescription and a lab request for a cobalt blood test today. Please let me know via email or phone when these items are ready. Thanks! Mark Amundsen MyChart message report Message [477051] From Mark Amundsen To Victor Baquero, MD Sent 5/4/2011 8:12 AM For Delivery 5/4/2011 8:12 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody I'm hoping to pick up a methadone prescription and a lab request for a cobalt blood test today. Please let me know via email or phone when these items are ready. Thanks! Mark Amundsen Encounter Messages Read Composed Y 5/4/2011 11:33 AM Y 5/4/2011 8:12 AM
Clare Jennings, MA 5/4/2011 2:29 PM Signed Left message that RX is at front desk
From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Wed May 4, 2011 8:12 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI'm hoping to pick up a methadone prescription and a lab request for a cobalt blood test today. Please let me know via email or phone when these items are ready. Thanks! Mark Amundsen
Electronically signed by Clare Jennings, MA at 5/4/2011 8:53 AM Routing History
001959
Orders
Accepted On 5/13/2011 9:35 AM
Patient Email
Patient Email Encounter 5/9/2011 3:13 PM Provider Andrew Kim Oh, MD, MD Department Carm Neurology
Encounter Messages MyChart message report Message [484142] From Mark Amundsen To Andrew Kim Oh, MD Sent 5/9/2011 7:33 PM For Delivery 5/9/2011 7:33 PM On Subject RE: Test Result Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr OhBody I finally managed to get a cobalt blood test performed by an outside lab last Thursday. The results should be in either by tomorrow or in another week, depending on if they had to send it out. I will forward the results as soon as I receive them. I fyou would keep me appraised of the other tests, I would appreciate it... Regards, Mark Amundsen ----- Message ----From: Andrew Kim Oh, MD Sent: 05/09/2011 3:15 PM To: Mark Amundsen Subject: RE: Test Result Question Hi Mr. Amundsen, The CSF protein was normal (not elevated), which argues against CIDP. All the other CSF tests are normal or still pending. -Dr. Oh
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----- Message ----From: AMUNDSEN,MARK Sent: 5/9/11 02:38 PM To: Andrew Kim Oh, MD Subject: Test Result Question Hi Dr Oh and staffI was hoping that some or all of the test results from the lumbar puncture and blood draw on 04/28/2011 have been received. If they have, could you please forward the results to me as soon as you get a chance? Thanks Mark Amundsen MyChart message report Message [483644] Andrew Kim Oh, MD From To Mark Amundsen Sent 5/9/2011 3:15 PM For Delivery 5/9/2011 3:15 PM On Subject RE: Test Result Question PCP Victor Baquero, MD, MD Last Read in 5/9/2011 7:31 PM MyChart Mark Amundsen By Responsibility Audit Trail Message Hi Mr. Amundsen, Body The CSF protein was normal (not elevated), which argues against CIDP. All the other CSF tests are normal or still pending. -Dr. Oh
----- Message ----From: AMUNDSEN,MARK Sent: 5/9/11 02:38 PM To: Andrew Kim Oh, MD Subject: Test Result Question Hi Dr Oh and staffI was hoping that some or all of the test results from the lumbar puncture and blood draw on 04/28/2011 have been received. If they have, could you please forward the results to me as soon as you get a chance? Thanks
Mark Amundsen
MyChart message report From Mark Amundsen To Andrew Kim Oh, MD Sent 5/9/2011 2:38 PM For Delivery 5/9/2011 2:38 PM
Message [483551]
001961
5/13/2011 9:12 AM 5/13/2011 9:12 AM RE: Non-urgent Medical Advice Question Victor Baquero, MD, MD 5/16/2011 6:20 AM Mark Amundsen
Actually it came back with "none detected". I hope that helps you. ----- Message ----From: AMUNDSEN,MARK Sent: 5/13/11 08:40 AM To: Victor Henrique Baquero, MD Subject: RE: Non-urgent Medical Advice Question Hi ClaireThank you for getting back to me so quickly. If possible, could you find out the level of cobalt detected in the test ? It's something I'm going to have to track for a while, due to the hip replacement I received last year. I had a cobalt urinalysis done 6 months ago, and it was at 2.9... Thanks, Mark Amundsen ----- Message ----From: Clare Jennings, MA Sent: 05/13/2011 8:32 AM To: Mark Amundsen Subject: RE: Non-urgent Medical Advice Question Hi Mark, Dr. Baquero received your test results yesterday and they are negative for cobalt. If you have any questions please feel free to call the office. ----- Message ----From: AMUNDSEN,MARK Sent: 5/13/11 08:09 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI just wanted to check and see if the results for my Cobalt blood test have been received. The lab informed me the results would be transmitted straight to your office, and it's been over a week. Please let me know as soon as any results are received. Thanks for your assistance in this matterMark Amundsen
MyChart message report From Mark Amundsen To Victor Baquero, MD Sent 5/13/2011 8:40 AM For Delivery 5/13/2011 8:40 AM On
Message [489778]
001962
Subject PCP Responsibility Audit Trail Message Body
RE: Non-urgent Medical Advice Question Victor Baquero, MD, MD
Hi ClaireThank you for getting back to me so quickly. If possible, could you find out the level of cobalt detected in the test ? It's something I'm going to have to track for a while, due to the hip replacement I received last year. I had a cobalt urinalysis done 6 months ago, and it was at 2.9... Thanks, Mark Amundsen ----- Message ----From: Clare Jennings, MA Sent: 05/13/2011 8:32 AM To: Mark Amundsen Subject: RE: Non-urgent Medical Advice Question Hi Mark, Dr. Baquero received your test results yesterday and they are negative for cobalt. If you have any questions please feel free to call the office. ----- Message ----From: AMUNDSEN,MARK Sent: 5/13/11 08:09 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI just wanted to check and see if the results for my Cobalt blood test have been received. The lab informed me the results would be transmitted straight to your office, and it's been over a week. Please let me know as soon as any results are received. Thanks for your assistance in this matterMark Amundsen
MyChart message report Message [489765] From Clare Jennings, MA To Mark Amundsen Sent 5/13/2011 8:32 AM For Delivery 5/13/2011 8:32 AM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 5/13/2011 8:36 AM MyChart Mark Amundsen By Responsibility Audit Trail Message Hi Mark, Body Dr. Baquero received your test results yesterday and they are negative for cobalt. If you have any questions please feel free to call the office. ----- Message ----From: AMUNDSEN,MARK Sent: 5/13/11 08:09 AM
001963
To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI just wanted to check and see if the results for my Cobalt blood test have been received. The lab informed me the results would be transmitted straight to your office, and it's been over a week. Please let me know as soon as any results are received. Thanks for your assistance in this matterMark Amundsen MyChart message report Message [489705] From Mark Amundsen To Victor Baquero, MD Sent 5/13/2011 8:09 AM For Delivery 5/13/2011 8:09 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody I just wanted to check and see if the results for my Cobalt blood test have been received. The lab informed me the results would be transmitted straight to your office, and it's been over a week. Please let me know as soon as any results are received. Thanks for your assistance in this matterMark Amundsen
Encounter Messages Read Composed Y 5/13/2011 9:12 AM Y 5/13/2011 8:40 AM Y 5/13/2011 8:32 AM Y 5/13/2011 8:09 AM
From Clare Jennings, MA Mark Amundsen Clare Jennings, MA Mark Amundsen
Subject RE: Non-urgent Medical Advice Question RE: Non-urgent Medical Advice Question RE: Non-urgent Medical Advice Question Non-urgent Medical Advice Question
Encounter Documentation Clare Jennings, MA 5/13/2011 8:29 AM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Fri May 13, 2011 8:09 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI just wanted to check and see if the results for my Cobalt blood test have been received. The lab informed me the results would be transmitted straight to your office, and it's been over a week. Please let me know as soon as any results are received. Thanks for your assistance in this matterMark Amundsen
001964
If you would like to discuss this in person, please let me know, and I will request another appointment. Thanks for your assistanceMark Amundsen
Encounter Messages Read Composed Y 5/19/2011 5:40 PM Y 5/18/2011 1:54 PM
Subject RE: Visit Follow-up Question
Visit Follow-up Question
Patient Email
Orders
DOB 9/23/1959

Encounter Messages MyChart message report Message [491390] From Andrew Kim Oh, MD To Mark Amundsen Sent 5/15/2011 4:19 PM For Delivery 5/15/2011 4:19 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 5/16/2011 6:20 AM MyChart Mark Amundsen By Responsibility Audit Trail Message Hi Mr. Amundsen, Body The CSF protein was normal (not elevated), which argues against CIDP. All the other CSF tests are normal. -Dr. Oh
----- Message ----From: AMUNDSEN,MARK Sent: 5/13/11 08:11 AM To: Andrew Kim Oh, MD Subject: Non-urgent Medical Advice Question
001965
Hi Dr Oh and staffI just wanted to check and see if any other test results have been received. It's been over 2 weeks now since the tests were started, and I thought they should have been done by now - perhaps I'm mistaken. Please let me know of any results that have been received... Thanks for your assistance in this matterMark Amundsen MyChart message report Message [489720] From Mark Amundsen To Andrew Kim Oh, MD Sent 5/13/2011 8:11 AM For Delivery 5/13/2011 8:11 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr Oh and staffBody I just wanted to check and see if any other test results have been received. It's been over 2 weeks now since the tests were started, and I thought they should have been done by now - perhaps I'm mistaken. Please let me know of any results that have been received... Thanks for your assistance in this matterMark Amundsen Encounter Messages Read Composed Y 5/15/2011 4:19 PM Y 5/13/2011 8:11 AM
Patient Email
Orders
DOB 9/23/1959
Encounter Messages MyChart message report From Clare Jennings, MA To Mark Amundsen
Message [489850]
001966
5/19/2011 5:39 PM
Andrew Kim Oh, MD, MD
Carm Neurology
Encounter Messages MyChart message report Message [498532] From Andrew Kim Oh, MD To Mark Amundsen Sent 5/19/2011 5:40 PM For Delivery 5/19/2011 5:40 PM On Subject RE: Visit Follow-up Question PCP Victor Baquero, MD, MD Last Read in 5/20/2011 6:30 AM MyChart Mark Amundsen By Responsibility Audit Trail Message Hi Mr. Amundsen, Body I did want you to call for a return visit after these tests were done. Please call to set up an appointment. -Dr. Oh
----- Message ----From: AMUNDSEN,MARK Sent: 5/18/11 01:54 PM To: Andrew Kim Oh, MD Subject: Visit Follow-up Question Hi Dr Oh and staffSo, now I'm wondering where do I go from here? Are there any additional tests to be run, or will this just remain as undiagnosed? Please let me know what else I can do to troubleshoot this problem. If you would like to discuss this in person, please let me know, and I will request another appointment. Thanks for your assistanceMark Amundsen MyChart message report Message [496466] From Mark Amundsen To Andrew Kim Oh, MD Sent 5/18/2011 1:54 PM For Delivery 5/18/2011 1:54 PM On Subject Visit Follow-up Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr Oh and staffBody So, now I'm wondering where do I go from here? Are there any additional tests to be run, or will this just remain as undiagnosed? Please let me know what else I can do to troubleshoot this problem.
001967

DELETED: Weakness DELETED: Demyelinating neuropathy Class: Acute Preop testing Polyneuropathy Encounter Closed By Closed By OH, ANDREW Closed Date 05242011 2/17/2011 3/5/2011 3/29/2011 3/29/2011 Closed Time 09:18 Mark Amundsen (MRN 8081369) MRN 8081369 Sex Male DOB 9/23/1959 PATIENTPHONE 916-509-0158
Patient Email
Encounter Messages MyChart message report Message [507572] From Clare Jennings, MA To Mark Amundsen Sent 5/26/2011 4:03 PM For Delivery 5/26/2011 4:03 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 6/16/2011 11:10 AM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, Body Sorry I missed you when you came in for your prescription, I have the copy of your lab results at the front desk. You can pick it up anytime between the hours of 8-5. Thanks Christy ----- Message ----From: AMUNDSEN,MARK Sent: 5/23/11 03:08 PM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroHave a # of issues1. Need a refill for Methadone on Thursday May 26. I have been using 9-10 per day, versus 8 per day normal. Efficacy and duration dropping. Appt made to discuss options. Please adjust script as you see fit. 2. Breakthrough pain meds efficacy at 30%. Need to change to alternate med. If possible, provide new script on Thursday, otherwise discuss at appt. 3. Would like to get copy of cobalt test from lab. Please provide note authorizing release.
Thx Mark A
001968
MyChart message report Message [507436] From Victor Baquero, MD To Mark Amundsen Sent 5/26/2011 3:05 PM For Delivery 5/26/2011 3:05 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 5/26/2011 3:07 PM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, the methadone is ready to pick up. Body See me about the break through pain to discuss further. PS(i'll be on vacation from June 6-20th). I'll try to get you a copy of the result - otherwise you can request the copy - I don't think you need auth from me to get access to your records. If they do please ask my MA Christy to contact them and release results. ----- Message ----From: AMUNDSEN,MARK Sent: 5/23/11 03:08 PM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroHave a # of issues1. Need a refill for Methadone on Thursday May 26. I have been using 9-10 per day, versus 8 per day normal. Efficacy and duration dropping. Appt made to discuss options. Please adjust script as you see fit. 2. Breakthrough pain meds efficacy at 30%. Need to change to alternate med. If possible, provide new script on Thursday, otherwise discuss at appt. 3. Would like to get copy of cobalt test from lab. Please provide note authorizing release.
Thx Mark A
MyChart message report Message [502102] Mark Amundsen From To Victor Baquero, MD Sent 5/23/2011 3:08 PM For Delivery 5/23/2011 3:08 PM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody Have a # of issues1. Need a refill for Methadone on Thursday May 26. I have been using 9-10 per day, versus 8 per day normal. Efficacy and duration dropping. Appt made to discuss options. Please adjust script as you see fit. 2. Breakthrough pain meds efficacy at 30%. Need to change to alternate med. If possible, provide new script on Thursday, otherwise discuss at appt. 3. Would like to get copy of cobalt test from lab. Please provide note authorizing release. Thx Mark A Encounter Messages
001969
Read Composed Y 5/26/2011 4:03 PM Y 5/26/2011 3:05 PM Y 5/23/2011 3:08 PM
From Clare Jennings, MA Victor Baquero, MD Mark Amundsen
To Mark Amundsen Mark Amundsen Victor Baquero, MD
Clare Jennings, MA 5/26/2011 4:02 PM Signed I have a copy of the results and will inform the patient.

Victor Baquero, MD, MD 5/26/2011 3:06 PM Signed Christy, Can you pull up the cobalt results and copy for Mr. Amundsen. These were outside labs - they came by some time ago. I don't see that they were scanned.
From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Mon May 23, 2011 3:08 PM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroHave a # of issues1. Need a refill for Methadone on Thursday May 26. I have been using 9-10 per day, versus 8 per day normal. Efficacy and duration dropping. Appt made to discuss options. Please adjust script as you see fit. 2. Breakthrough pain meds efficacy at 30%. Need to change to alternate med. If possible, provide new script on Thursday, otherwise discuss at appt. 3. Would like to get copy of cobalt test from lab. Please provide note authorizing release. Thx Mark A
Electronically signed by Clare Jennings, MA at 5/23/2011 4:00 PM Routing History 5/26/2011 3:06 PM 5/23/2011 4:01 PM From Victor Henrique Baquero, MD Clare Jennings, MA To P FOL MA FP Victor Henrique Baquero, MD Priority Routine Routine
001970
Orders
Chart Cosign Accepted By Victor Henrique Baquero, MD Accepted On 5/26/2011 4:18 PM Mark Amundsen (MRN 8081369) MRN 8081369 Sex Male DOB 9/23/1959 PATIENTPHONE 916-509-0158
Patient Email
Encounter Messages MyChart message report Message [502540] From Victor Baquero, MD To Mark Amundsen Sent 5/23/2011 7:10 PM For Delivery 5/23/2011 7:10 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 5/25/2011 10:23 AM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, Body Your last xray was 1 year ago. It would be good to get an updated image. I've placed an order for the xray of both hips. Come in anytime during working hours to have it done before your follow up with me. Take care. ----- Message ----From: AMUNDSEN,MARK Sent: 5/23/11 03:19 PM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BPain level (4-5) is up on right hip. Left hip at pain level 2 (same). Have appt made, wondering if a x-ray of right hip is called for to evaluate new damage. If possible, before appt on June 20th so we can discuss? Please let me know what I need to do to accomplish this if needed. Thanks! Mark A P.S. Limit on msgs is tough! MyChart message report From Mark Amundsen To Victor Baquero, MD Sent 5/23/2011 3:19 PM For Delivery 5/23/2011 3:19 PM On Message [502117]
001971
Subject PCP Responsibility Audit Trail Message Body
Hi Dr BPain level (4-5) is up on right hip. Left hip at pain level 2 (same). Have appt made, wondering if a x-ray of right hip is called for to evaluate new damage. If possible, before appt on June 20th so we can discuss? Please let me know what I need to do to accomplish this if needed. Thanks! Mark A P.S. Limit on msgs is tough!
Encounter Messages Read Composed Y 5/23/2011 7:10 PM Y 5/23/2011 3:19 PM
Encounter Documentation Clare Jennings, MA 5/23/2011 3:58 PM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Mon May 23, 2011 3:19 PM Subject: Non-urgent Medical Advice Question Hi Dr BPain level (4-5) is up on right hip. Left hip at pain level 2 (same). Have appt made, wondering if a x-ray of right hip is called for to evaluate new damage. If possible, before appt on June 20th so we can discuss? Please let me know what I need to do to accomplish this if needed. Thanks! Mark A P.S. Limit on msgs is tough! Electronically signed by Clare Jennings, MA at 5/23/2011 3:58 PM Routing History 5/23/2011 3:59 PM From Clare Jennings, MA To Victor Henrique Baquero, MD Priority Routine
Orders
Order Summary HIPS BILATERAL WITH PELVIS [RAD001 Custom] Order #: 70096790 Canceled Orders HIP 2+ VIEWS, LEFT + HIP 2+ VIEWS, RIGHT [RAD001 Custom] Order #: 69057091
Patient Email
Patient Email Encounter Provider Department
001972
Refill Request
Routing History
6/3/2011 9:02 AM From Stephanie L Esparza, LVN To Victor Henrique Baquero, MD Priority Routine
Created by
Stephanie L Esparza, LVN on 6/3/2011 9:01 AM
Approved
Disp 100 Tab Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10325 mg Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed. - ORAL Class: Pharmacy Authorizing Provider: Victor Henrique Baquero, MD Refills 1 Start 6/3/2011 End 8/16/2011

Disp Refills Start End 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 100 Tab 1 4/29/2011 7/30/2011 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Pharmacy 240 Tab 0 5/26/2011 6/25/2011 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Class: Handwritten Rx

Patient Email
Orders
DOB 9/23/1959
Encounter Messages MyChart message report From Mark Amundsen To Victor Baquero, MD Sent 5/25/2011 4:57 PM For Delivery 5/25/2011 4:57 PM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD
Message [506020]
001973
Hi Dr Baquero and staffI'll be in for the x-rays when I come in to pick up my scripts. I wanted to make sure y'all received my message about needing a methadone refill tomorrow, and about requesting a note I can take to the lab so I can get a copy of the cobalt report. Thanks Mark Amundsen
From Mark Amundsen
Victor Baquero, MD, MD 5/27/2011 4:01 PM Signed Message addressed.

From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Wed May 25, 2011 4:57 PM Subject: Non-urgent Medical Advice Question Hi Dr Baquero and staffI'll be in for the x-rays when I come in to pick up my scripts. I wanted to make sure y'all received my message about needing a methadone refill tomorrow, and about requesting a note I can take to the lab so I can get a copy of the cobalt report. Thanks Mark Amundsen
Electronically signed by Clare Jennings, MA at 5/26/2011 2:25 PM Routing History 5/26/2011 2:25 PM From Clare Jennings, MA To Victor Henrique Baquero, MD Priority Routine

Contacts
Type Contact Phone
001974
05/26/2011 1:13 PM
Phone (Incoming)
916-983-2589 (H)
Telephone Encounter
Reason for Call

Refill Request
Call Documentation
Veronica Arriaga 5/26/2011 1:13 PM Signed He is calling for a refill of Methadone (DOLOPHINE) 10 mg Tablet. He did not call his pharmacy for a refill already. He requests call when ready to p/u.
Patient also states the Norco Rx is not helping him. Can you please call in a different prescription.
Electronically signed by Veronica Arriaga at 5/26/2011 1:13 PM
Routing History
5/26/2011 2:23 PM 5/26/2011 1:14 PM From Clare Jennings, MA Veronica Arriaga To Victor Henrique Baquero, MD P FOL MA FP Priority Routine Routine
Created by
Veronica Arriaga on 5/26/2011 1:13 PM
Approved
Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Class: Handwritten Rx Authorizing Provider: Victor Henrique Baquero, MD

Disp Refills Start End 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 100 Tab 0 4/29/2011 5/30/2011 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 100 Tab 1 4/29/2011 7/30/2011 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Pharmacy 240 Tab 0 5/4/2011 5/26/2011 Methadone (DOLOPHINE) 10 mg Tablet (Discontinued) Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Class: Handwritten Rx
Office Visit
Orders
001975
Approved Disp 7 Tab Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Class: Normal Authorizing Provider: Victor Henrique Baquero, MD Refills 0 Start 7/13/2011 End 8/9/2011
Letter (Out)
Orders
Letters Letter Information BAQUERO, VICTOR H on 7/8/2011 Status Sent
Routing Information Mark Amundsen (MRN 8081369)
Patient Email
DOB 9/23/1959
Patient Email Encounter 6/29/2011 6:01 PM Provider Andrew Kim Oh, MD, MD Department Carm Neurology
Encounter Messages MyChart message report Message [601070] From Andrew Kim Oh, MD To Mark Amundsen Sent 6/30/2011 9:58 AM For Delivery 6/30/2011 9:58 AM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 10/10/2011 7:46 AM MyChart Mark Amundsen By Responsibility Audit Trail Message 916-734-3588 is the only contact number I have for Neurology appointment scheduling Body at the UC Davis Medical Center location. ----- Message ----From: AMUNDSEN,MARK Sent: 6/30/11 05:56 AM To: Andrew Kim Oh, MD Subject: RE: Non-urgent Medical Advice Question Hi Dr OhI wasn't going to start steriods, unless I got approval from you, so I'll wait until hearing from Neuro HQ. Do you happen to have the contact info for the neuro department head, or should I just contact the department contact number? Regards, Mark Amundsen
001976
----- Message ----From: Andrew Kim Oh, MD Sent: 06/29/2011 6:02 PM To: Mark Amundsen Subject: RE: Non-urgent Medical Advice Question Hi Mark, I think you are going to potentially muddy the picture if you play around with a trial of steroids before you have even seen the neurology specialist. Please don't. -Dr. Oh ----- Message ----From: AMUNDSEN,MARK Sent: 6/29/11 08:06 AM To: Andrew Kim Oh, MD Subject: Non-urgent Medical Advice Question Hi Dr OhI have not received any contact or info from Neuro HQ. In discussing case with Dr. Baquero, we came to conclusion that trying steroids for 2 weeks to assess impact would have minimal consequences. I am hoping you would concur with this conclusion. I have not contacted Neuro HQ due to loss of contact data. Please forward contact info, and opinion on steroid trial. Thanks, Mark Amundsen MyChart message report Message [600669] From Mark Amundsen To Andrew Kim Oh, MD Sent 6/30/2011 5:56 AM For Delivery 6/30/2011 5:56 AM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr OhBody I wasn't going to start steriods, unless I got approval from you, so I'll wait until hearing from Neuro HQ. Do you happen to have the contact info for the neuro department head, or should I just contact the department contact number? Regards, Mark Amundsen ----- Message ----From: Andrew Kim Oh, MD Sent: 06/29/2011 6:02 PM To: Mark Amundsen Subject: RE: Non-urgent Medical Advice Question Hi Mark, I think you are going to potentially muddy the picture if you play around with a trial of steroids before you have even seen the neurology specialist. Please don't. -Dr. Oh ----- Message ----From: AMUNDSEN,MARK
001977
Sent: 6/29/11 08:06 AM To: Andrew Kim Oh, MD Subject: Non-urgent Medical Advice Question Hi Dr OhI have not received any contact or info from Neuro HQ. In discussing case with Dr. Baquero, we came to conclusion that trying steroids for 2 weeks to assess impact would have minimal consequences. I am hoping you would concur with this conclusion. I have not contacted Neuro HQ due to loss of contact data. Please forward contact info, and opinion on steroid trial. Thanks, Mark Amundsen MyChart message report Message [600310] From Andrew Kim Oh, MD To Mark Amundsen Sent 6/29/2011 6:02 PM For Delivery 6/29/2011 6:02 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 10/10/2011 7:46 AM MyChart Mark Amundsen By Responsibility Audit Trail Message Hi Mark, Body I think you are going to potentially muddy the picture if you play around with a trial of steroids before you have even seen the neurology specialist. Please don't. -Dr. Oh ----- Message ----From: AMUNDSEN,MARK Sent: 6/29/11 08:06 AM To: Andrew Kim Oh, MD Subject: Non-urgent Medical Advice Question Hi Dr OhI have not received any contact or info from Neuro HQ. In discussing case with Dr. Baquero, we came to conclusion that trying steroids for 2 weeks to assess impact would have minimal consequences. I am hoping you would concur with this conclusion. I have not contacted Neuro HQ due to loss of contact data. Please forward contact info, and opinion on steroid trial. Thanks, Mark Amundsen MyChart message report From Mark Amundsen To Andrew Kim Oh, MD Sent 6/29/2011 8:06 AM For Delivery 6/29/2011 8:06 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr OhMessage [598912]
001978
Center None
Appointment
Sex Male

DOB 9/23/1959
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Center None
Patient Email

001979
Encounter Messages MyChart message report Message [626306] From Victor Baquero, MD To Mark Amundsen Sent 7/18/2011 5:56 PM For Delivery 7/18/2011 5:56 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 10/7/2011 5:56 AM MyChart Mark Amundsen By Responsibility Audit Trail Message Sounds good. See me before the next refill is due. We'll rectify the dose and do our due Body diligence and make sure there are no problems with the heart conduction. ----- Message ----From: AMUNDSEN,MARK Sent: 7/18/11 03:32 PM To: Victor Henrique Baquero, MD Subject: RE: Non-urgent Medical Advice Question Yikes Will do, Dr Baquero. It's probably a good idea anyhow. BTW, I guess it got slipped that we upped the dose of Methadone to 9 per day on the last visit. The last refill was for 8 per day. Next refill, I'll send a short reminder to update the chart. Thanks againMark Amundsen ----- Message ----From: Victor Henrique Baquero, MD Sent: 07/14/2011 8:03 PM To: Mark Amundsen Subject: RE: Non-urgent Medical Advice Question Mark, Thanks for the update. I wanted to let you know. There are new screening guidlenes regarding methadone risks and now cardiac monitoring is being recommended. Please schedule a follow up before your next refill date to check the heart. We need an EKG to evaluate potential problems with the heart rhythm that the methadone can cause. ----- Message ----From: AMUNDSEN,MARK Sent: 7/14/11 03:46 AM To: Victor Henrique Baquero, MD Subject: RE: Non-urgent Medical Advice Question Thanks Dr BaqueroAs an update, talked with Dr Oh about steroids. He advised against it unless approved
001980
by Neuro HQ. I'm still attemtpting to get approval. Will keep you advised on their reply... Regards, Mark Amundsen ----- Message ----From: Victor Henrique Baquero, MD Sent: 07/13/2011 12:32 PM To: Mark Amundsen Subject: RE: Non-urgent Medical Advice Question Mark, The prescription is ready to pick up at our front desk. I've dated it for the 16th since it's a bit early. You can turn it in on Saturday. Take care. ----- Message ----From: AMUNDSEN,MARK Sent: 7/13/11 02:18 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI'm about out of the methadone prescription. I will be out on Sunday the 17th of July, so I'd like to pick up a refill script this Friday afternoon. Thanks for your attention in this matter... Regards, Mark Amundsen MyChart message report Message [625936] From Mark Amundsen To Victor Baquero, MD Sent 7/18/2011 3:32 PM For Delivery 7/18/2011 3:32 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Yikes Body Will do, Dr Baquero. It's probably a good idea anyhow. BTW, I guess it got slipped that we upped the dose of Methadone to 9 per day on the last visit. The last refill was for 8 per day. Next refill, I'll send a short reminder to update the chart. Thanks againMark Amundsen ----- Message ----From: Victor Henrique Baquero, MD Sent: 07/14/2011 8:03 PM To: Mark Amundsen Subject: RE: Non-urgent Medical Advice Question Mark, Thanks for the update.
001981
I wanted to let you know. There are new screening guidlenes regarding methadone risks and now cardiac monitoring is being recommended. Please schedule a follow up before your next refill date to check the heart. We need an EKG to evaluate potential problems with the heart rhythm that the methadone can cause. ----- Message ----From: AMUNDSEN,MARK Sent: 7/14/11 03:46 AM To: Victor Henrique Baquero, MD Subject: RE: Non-urgent Medical Advice Question Thanks Dr BaqueroAs an update, talked with Dr Oh about steroids. He advised against it unless approved by Neuro HQ. I'm still attemtpting to get approval. Will keep you advised on their reply... Regards, Mark Amundsen ----- Message ----From: Victor Henrique Baquero, MD Sent: 07/13/2011 12:32 PM To: Mark Amundsen Subject: RE: Non-urgent Medical Advice Question Mark, The prescription is ready to pick up at our front desk. I've dated it for the 16th since it's a bit early. You can turn it in on Saturday. Take care. ----- Message ----From: AMUNDSEN,MARK Sent: 7/13/11 02:18 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI'm about out of the methadone prescription. I will be out on Sunday the 17th of July, so I'd like to pick up a refill script this Friday afternoon. Thanks for your attention in this matter... Regards, Mark Amundsen MyChart message report From Victor Baquero, MD To Mark Amundsen Sent 7/14/2011 8:03 PM For Delivery 7/14/2011 8:03 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 10/7/2011 5:57 AM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, Body Thanks for the update. Message [621973]
001982
I wanted to let you know. There are new screening guidlenes regarding methadone risks and now cardiac monitoring is being recommended. Please schedule a follow up before your next refill date to check the heart. We need an EKG to evaluate potential problems with the heart rhythm that the methadone can cause. ----- Message ----From: AMUNDSEN,MARK Sent: 7/14/11 03:46 AM To: Victor Henrique Baquero, MD Subject: RE: Non-urgent Medical Advice Question Thanks Dr BaqueroAs an update, talked with Dr Oh about steroids. He advised against it unless approved by Neuro HQ. I'm still attemtpting to get approval. Will keep you advised on their reply... Regards, Mark Amundsen ----- Message ----From: Victor Henrique Baquero, MD Sent: 07/13/2011 12:32 PM To: Mark Amundsen Subject: RE: Non-urgent Medical Advice Question Mark, The prescription is ready to pick up at our front desk. I've dated it for the 16th since it's a bit early. You can turn it in on Saturday. Take care. ----- Message ----From: AMUNDSEN,MARK Sent: 7/13/11 02:18 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI'm about out of the methadone prescription. I will be out on Sunday the 17th of July, so I'd like to pick up a refill script this Friday afternoon. Thanks for your attention in this matter... Regards, Mark Amundsen MyChart message report Message [620303] From Mark Amundsen To Victor Baquero, MD Sent 7/14/2011 3:46 AM For Delivery 7/14/2011 3:46 AM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Thanks Dr BaqueroBody As an update, talked with Dr Oh about steroids. He advised against it unless approved by Neuro HQ. I'm still attemtpting to get approval. Will keep you advised on their reply... Regards, Mark Amundsen
001983
----- Message ----From: Victor Henrique Baquero, MD Sent: 07/13/2011 12:32 PM To: Mark Amundsen Subject: RE: Non-urgent Medical Advice Question Mark, The prescription is ready to pick up at our front desk. I've dated it for the 16th since it's a bit early. You can turn it in on Saturday. Take care. ----- Message ----From: AMUNDSEN,MARK Sent: 7/13/11 02:18 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI'm about out of the methadone prescription. I will be out on Sunday the 17th of July, so I'd like to pick up a refill script this Friday afternoon. Thanks for your attention in this matter... Regards, Mark Amundsen MyChart message report Message [619087] From Victor Baquero, MD To Mark Amundsen Sent 7/13/2011 12:32 PM For Delivery 7/13/2011 12:32 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 10/7/2011 5:57 AM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, Body The prescription is ready to pick up at our front desk. I've dated it for the 16th since it's a bit early. You can turn it in on Saturday. Take care. ----- Message ----From: AMUNDSEN,MARK Sent: 7/13/11 02:18 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI'm about out of the methadone prescription. I will be out on Sunday the 17th of July, so I'd like to pick up a refill script this Friday afternoon. Thanks for your attention in this matter... Regards, Mark Amundsen
001984
MyChart message report Message [618209] From Mark Amundsen To Victor Baquero, MD Sent 7/13/2011 2:18 AM For Delivery 7/13/2011 2:18 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody I'm about out of the methadone prescription. I will be out on Sunday the 17th of July, so I'd like to pick up a refill script this Friday afternoon. Thanks for your attention in this matter... Regards, Mark Amundsen Encounter Messages Read Composed Y 7/18/2011 5:56 PM Y 7/18/2011 3:32 PM Y 7/14/2011 8:03 PM Y 7/14/2011 3:46 AM Y 7/13/2011 12:32 PM Y 7/13/2011 2:18 AM
From Victor Baquero, MD Mark Amundsen Victor Baquero, MD Mark Amundsen Victor Baquero, MD Mark Amundsen
To Mark Amundsen Victor Baquero, MD Mark Amundsen Victor Baquero, MD Mark Amundsen Victor Baquero, MD
RE: Non-urgent Medical Advice Question RE: Non-urgent Medical Advice Question RE: Non-urgent Medical Advice Question RE: Non-urgent Medical Advice Question Non-urgent Medical Advice Question
Encounter Documentation Clare Jennings, MA 7/13/2011 8:24 AM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Wed Jul 13, 2011 2:18 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI'm about out of the methadone prescription. I will be out on Sunday the 17th of July, so I'd like to pick up a refill script this Friday afternoon. Thanks for your attention in this matter... Regards, Mark Amundsen Electronically signed by Clare Jennings, MA at 7/13/2011 8:24 AM Routing History 7/18/2011 4:08 PM 7/14/2011 8:40 AM 7/13/2011 8:25 AM From Clare Jennings, MA Clare Jennings, MA Clare Jennings, MA To Victor Henrique Baquero, MD Victor Henrique Baquero, MD Victor Henrique Baquero, MD Priority Routine Routine Routine
001985
8/10/2011 7:50 AM
Mark Amundsen
Victor Baquero, MD
Encounter Documentation Clare Jennings, MA 8/10/2011 7:57 AM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Wed Aug 10, 2011 7:50 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroShould I make a separate appointment to see you, or will I see you on EKG day? I'm not quite sure... Mark Amundsen Electronically signed by Clare Jennings, MA at 8/10/2011 7:57 AM Routing History 8/10/2011 7:57 AM From Clare Jennings, MA To Victor Henrique Baquero, MD Priority Routine
Patient Email
Orders
DOB 9/23/1959
Encounter Messages MyChart message report From Victor Baquero, MD To Mark Amundsen Sent 8/9/2011 2:51 PM For Delivery 8/9/2011 2:51 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 10/7/2011 5:56 AM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, Body The prescription is ready to pick up at our front desk. See you next week. ----- Message -----
Message [662252]
001986
From: AMUNDSEN,MARK Sent: 8/9/11 06:40 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's time for another refill on methadone. Please remember that on the last office visit, we upped the dosage to 9 10mg pills per day - for a total of 270 pills per subscription. I will be out on Thorsday, so I'd like to pick up the script on Wednesday afternoon. Regards, Mark Amundsen P.S. EKG scheduled for 8-16-2010 MyChart message report Message [661076] From Mark Amundsen To Victor Baquero, MD Sent 8/9/2011 6:40 AM For Delivery 8/9/2011 6:40 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody It's time for another refill on methadone. Please remember that on the last office visit, we upped the dosage to 9 10mg pills per day - for a total of 270 pills per subscription. I will be out on Thorsday, so I'd like to pick up the script on Wednesday afternoon. Regards, Mark Amundsen
P.S. EKG scheduled for 8-16-2010
Encounter Documentation Clare Jennings, MA 8/9/2011 7:57 AM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Tue Aug 9, 2011 6:40 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's time for another refill on methadone. Please remember that on the last office visit, we upped the dosage to 9 10mg pills per day - for a total of 270 pills per subscription. I will be out on Thorsday, so I'd like to pick up the script on Wednesday afternoon. Regards, Mark Amundsen
001987
Encounter Messages MyChart message report Message [664074] From Victor Baquero, MD To Mark Amundsen Sent 8/10/2011 1:15 PM For Delivery 8/10/2011 1:15 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 10/7/2011 5:56 AM MyChart Mark Amundsen By Responsibility Audit Trail Message See me when you get the EKG. The ekg will be planned during the visit with me. Body ----- Message ----From: AMUNDSEN,MARK Sent: 8/10/11 07:50 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroShould I make a separate appointment to see you, or will I see you on EKG day? I'm not quite sure... Mark Amundsen MyChart message report Message [663213] From Mark Amundsen To Victor Baquero, MD Sent 8/10/2011 7:50 AM For Delivery 8/10/2011 7:50 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody Should I make a separate appointment to see you, or will I see you on EKG day? I'm not quite sure...
Mark Amundsen
From Victor Baquero, MD
To Mark Amundsen
001988
Sent For Delivery On Subject PCP Responsibility Audit Trail Message Body
8/20/2011 10:32 AM 8/20/2011 10:32 AM Visit Follow-up Question Victor Baquero, MD, MD
I'd like to know why this approval on steroid therapy has to take so long to be accomplished. After waiting a month to get an appointment with Dr Richman, now I have to wait still further for a decision to be made. While I realize that a full review of the case may be optimal, I feel that a decision needs to be made regarding steriod therapy now in order to fulfill patient needs.
(Continued)
Subject RE: Visit Follow-up Question Visit Follow-up Question
Created by Andrew Kim Oh, MD on 8/22/2011 9:41 AM
Patient Email
Orders
DOB 9/23/1959
Encounter Messages MyChart message report Message [678512] From Victor Baquero, MD To Mark Amundsen Sent 8/19/2011 1:11 PM For Delivery 8/19/2011 1:11 PM On Subject RE: Visit Follow-up Question PCP Victor Baquero, MD, MD Last Read in 8/20/2011 10:25 AM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, Body Ideally you should contact Neurology and see if you can get on steroids. I dont mind doing the prescription. If they plan to do further testing starting you on steroids can
001989
change the picture and thus eliminate the chance of getting an accurate diagnosis. Send him a MyChart message or contact the staff. That would be best. We can otherwise consider a trial of steroids towards the end of next week. ----- Message ----From: AMUNDSEN,MARK Sent: 8/19/11 05:23 AM To: Victor Henrique Baquero, MD Subject: Visit Follow-up Question Hi Dr BaqueroI have been to see the head of Neurology to see about getting steriod therapy going to alleviate my symptoms. As far as I knew, all the new doctor was supposed to do was to make a decision on the viability of steriod therapy in my case. Unforunately, he has evidently decided to start from the beginning of the case, including communicating with the technician who performed the EMG, and perhaps retesting some of the blood tests. Continued MyChart message report Message [677772] From Mark Amundsen To Victor Baquero, MD Sent 8/19/2011 5:23 AM For Delivery 8/19/2011 5:23 AM On Subject Visit Follow-up Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody I have been to see the head of Neurology to see about getting steriod therapy going to alleviate my symptoms. As far as I knew, all the new doctor was supposed to do was to make a decision on the viability of steriod therapy in my case. Unforunately, he has evidently decided to start from the beginning of the case, including communicating with the technician who performed the EMG, and perhaps retesting some of the blood tests.
Continued
Subject RE: Visit Follow-up Question
Visit Follow-up Question
Stephanie L Esparza, LVN 8/19/2011 8:39 AM Addendum From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Fri Aug 19, 2011 5:23 AM Subject: Visit Follow-up Question
Hi Dr BaqueroI have been to see the head of Neurology to see about getting steriod therapy going to alleviate my symptoms. As far as I knew, all the new doctor was supposed to do was to make a decision on the viability of steriod therapy in my case. Unforunately, he has evidently decided to start from the beginning of the case, including communicating with the technician who performed the EMG, and perhaps retesting some of the blood tests.
001990
Disp Refills 240 Tab 0 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. 9 daily. - ORAL Class: Handwritten Rx Authorizing Provider: Victor Henrique Baquero, MD
Start 9/2/2011
End 9/29/2011
Patient Email
Orders
DOB 9/23/1959
Patient Email Encounter 8/22/2011 9:41 AM Provider Andrew Kim Oh, MD, MD Department Carm Neurology
Encounter Messages MyChart message report Message [680725] From Andrew Kim Oh, MD To Mark Amundsen Sent 8/22/2011 9:43 AM For Delivery 8/22/2011 9:43 AM On Subject RE: Visit Follow-up Question PCP Victor Baquero, MD, MD Last Read in 10/10/2011 7:46 AM MyChart Mark Amundsen By Responsibility Audit Trail Message Hello Mr. Amundsen, Body My opinion is that steroids are not likely to help you. However, I want you to see Dr. Richman, who has more expertise in this area, to get his opinion. -Dr. Oh
----- Message ----From: AMUNDSEN,MARK Sent: 8/20/11 10:32 AM To: Andrew Kim Oh, MD Subject: Visit Follow-up Question I'd like to know why this approval on steroid therapy has to take so long to be accomplished. After waiting a month to get an appointment with Dr Richman, now I have to wait still further for a decision to be made. While I realize that a full review of the case may be optimal, I feel that a decision needs to be made regarding steriod therapy now in order to fulfill patient needs. (Continued) MyChart message report From Mark Amundsen To Andrew Kim Oh, MD Message [679440]
001991
There are no encounter-level documents. Insurance Information Acct Number 038697465094 1 Payor UCD Patient Insurance ID XEHJ00044785 Group Number PH0010 Plan UCD/B/S HMO Plan Number B72 Plan Address PO BOX 179001 SACRAMENTO, CA 95817-9001 Plan Phone 916-734-0739 PreAuth Phone 916-734-0739 Financial Class P
Center None
Patient Email
Encounter Messages MyChart message report Message [700144] From Victor Baquero, MD To Mark Amundsen Sent 9/2/2011 11:29 AM For Delivery 9/2/2011 11:29 AM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 10/7/2011 5:56 AM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, Body The prescription will be ready to pick up at our front desk on Tuesday. Take care. . ----- Message ----From: AMUNDSEN,MARK
001992
Sent: 9/2/11 08:35 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's almost time for a methadone refill. Since there is a holiday Monday, I figured I would give y'all extra time to fill it. I will be out on Wednesday, so if I could pick up a refill on Tuesday afternoon, that would be great. Still waiting on Neuro HQ for info, and hanging in there... Mark Amundsen MyChart message report Message [699701] From Mark Amundsen To Victor Baquero, MD Sent 9/2/2011 8:35 AM For Delivery 9/2/2011 8:35 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody It's almost time for a methadone refill. Since there is a holiday Monday, I figured I would give y'all extra time to fill it. I will be out on Wednesday, so if I could pick up a refill on Tuesday afternoon, that would be great. Still waiting on Neuro HQ for info, and hanging in there... Mark Amundsen Encounter Messages Read Composed Y 9/2/2011 11:29 AM Y 9/2/2011 8:35 AM
Encounter Documentation Clare Jennings, MA 9/2/2011 8:51 AM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Fri Sep 2, 2011 8:35 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's almost time for a methadone refill. Since there is a holiday Monday, I figured I would give y'all extra time to fill it. I will be out on Wednesday, so if I could pick up a refill on Tuesday afternoon, that would be great. Still waiting on Neuro HQ for info, and hanging in there... Mark Amundsen Electronically signed by Clare Jennings, MA at 9/2/2011 8:51 AM Routing History 9/2/2011 8:52 AM From Clare Jennings, MA To Victor Henrique Baquero, MD Priority Routine
001993
Thanks, Mark Amundsen Encounter Messages Read Composed Y 9/30/2011 7:23 AM Y 9/29/2011 5:45 PM Y 9/29/2011 3:17 AM
Encounter Documentation Clare Jennings, MA 9/29/2011 8:43 AM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Thu Sep 29, 2011 3:17 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI am due for a refill on Methadone. The methadone ran out early due to the short prescription of 240 issued last month. Please recall that at last appointment, the prescription was increased to 9 per day/270 per month. Sorry about the short notice - I will be out on Friday night, so I'd like to pick it up Friday afternoon. Thanks, Mark Amundsen Electronically signed by Clare Jennings, MA at 9/29/2011 8:43 AM Routing History 9/29/2011 8:44 AM From Clare Jennings, MA To Victor Henrique Baquero, MD Priority Routine
Created by Clare Jennings, MA on 9/29/2011 8:43 AM Approved Disp Refills 270 Tab 0 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. 9 daily. - ORAL Class: Handwritten Rx Authorizing Provider: Victor Henrique Baquero, MD Start 9/29/2011 End 10/25/2011
Office Visit
Orders
Selected Appointment 9/27/2011 10:00 AM Provider David P Richman, MD, MD
Department Neurology Faculty Acc
Insurance Information Acct Number 038697465094 1 Payor UCD
001994
Class: Pharmacy 30 Tab 11 8/16/2011 Levothyroxine (SYNTHROID) 75 mcg Tablet Sig - Route: Take 1 Tab by mouth every morning before a meal. take on an empty stomach - ORAL Class: Pharmacy 270 Tab 0 9/29/2011 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. 9 daily. - ORAL Class: Handwritten Rx
8/15/2012
10/29/2011
Orders Chart Cosign

Patient Email
Encounter Messages MyChart message report Message [756099] Mark Amundsen From To Victor Baquero, MD Sent 9/30/2011 7:23 AM For Delivery 9/30/2011 7:23 AM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Thanks Dr BaqueroBody I'll be sending in some forms for disability, and a review of my appointment with the Neuro dept's upper level... Mark Amundsen ----- Message ----From: Victor Henrique Baquero, MD Sent: 09/29/2011 5:45 PM To: Mark Amundsen Subject: RE: Non-urgent Medical Advice Question Mark, The prescription is ready to pick up at our front desk. ----- Message ----From: AMUNDSEN,MARK Sent: 9/29/11 03:17 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question
001995
Hi Dr BaqueroI am due for a refill on Methadone. The methadone ran out early due to the short prescription of 240 issued last month. Please recall that at last appointment, the prescription was increased to 9 per day/270 per month. Sorry about the short notice - I will be out on Friday night, so I'd like to pick it up Friday afternoon. Thanks, Mark Amundsen MyChart message report From Victor Baquero, MD To Mark Amundsen Sent 9/29/2011 5:45 PM For Delivery 9/29/2011 5:45 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 10/25/2011 4:29 PM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, Body The prescription is ready to pick up at our front desk. ----- Message ----From: AMUNDSEN,MARK Sent: 9/29/11 03:17 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI am due for a refill on Methadone. The methadone ran out early due to the short prescription of 240 issued last month. Please recall that at last appointment, the prescription was increased to 9 per day/270 per month. Sorry about the short notice - I will be out on Friday night, so I'd like to pick it up Friday afternoon. Thanks, Mark Amundsen MyChart message report Message [753985] From Mark Amundsen To Victor Baquero, MD Sent 9/29/2011 3:17 AM For Delivery 9/29/2011 3:17 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody I am due for a refill on Methadone. The methadone ran out early due to the short prescription of 240 issued last month. Please recall that at last appointment, the prescription was increased to 9 per day/270 per month. Sorry about the short notice - I will be out on Friday night, so I'd like to pick it up Friday afternoon. Message [755552]
001996
Sent: 10/7/11 05:59 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr Baquero and staffI wanted to doublecheck the status of the disability, FMLA, and disabled placard paperwork I faxed in last week for your review and completion. I just wanted to make sure it was received, and possibly get an estimate on completion? Thanks for your attention in this matterMark Amundsen MyChart message report Message [767467] From Mark Amundsen To Victor Baquero, MD Sent 10/7/2011 5:59 AM For Delivery 10/7/2011 5:59 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr Baquero and staffBody I wanted to doublecheck the status of the disability, FMLA, and disabled placard paperwork I faxed in last week for your review and completion. I just wanted to make sure it was received, and possibly get an estimate on completion? Thanks for your attention in this matterMark Amundsen Encounter Messages Read Composed Y 10/10/2011 5:35 PM Y 10/10/2011 7:18 AM Y 10/7/2011 2:27 PM Y 10/7/2011 5:59 AM
Encounter Documentation Clare Jennings, MA 10/7/2011 7:30 AM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Fri Oct 7, 2011 5:59 AM Subject: Non-urgent Medical Advice Question Hi Dr Baquero and staffI wanted to doublecheck the status of the disability, FMLA, and disabled placard paperwork I faxed in last week for your review and completion. I just wanted to make sure it was received, and possibly get an estimate on completion? Thanks for your attention in this matterMark Amundsen
001997
Routing History 10/10/2011 7:32 AM 10/7/2011 7:30 AM From Clare Jennings, MA

Clare Jennings, MA

Priority Routine
Routine

Telephone Encounter
10/4/2011 9:32 AM
Reason for Call

Work Release Disability Form Completion
Call Documentation
Clare Jennings, MA 10/11/2011 8:49 AM Signed Left message that forms are at the front desk
Victor Baquero, MD, MD 10/10/2011 5:57 PM Signed Form completed.

Clare Jennings, MA 10/4/2011 9:32 AM Signed Forms are in your in box with the business chart
Routing History
10/10/2011 5:57 PM 10/4/2011 9:32 AM From Victor Henrique Baquero, MD Clare Jennings, MA To P FOL MA FP Victor Henrique Baquero, MD Priority Routine Routine
Created by

Disp Refills Start End 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 100 Tab 1 8/16/2011 11/16/2011 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL
001998
Y Y
10/25/2011 4:56 PM 10/25/2011 8:23 AM
Victor Baquero, MD Mark Amundsen
Encounter Documentation Clare Jennings, MA 10/25/2011 9:00 AM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Tue Oct 25, 2011 8:23 AM Subject: Non-urgent Medical Advice Question Hi Dr Baquero and staffIt's time for another refill on my Methadone prescription. I will be out on Friday morning, so if I can pick it up on Thursday afternoon, that would be great. Please remember that the current prescription is for 270 10 mg tablets. Thanks for your attention in this matterMark Amundsen Electronically signed by Clare Jennings, MA at 10/25/2011 9:00 AM Routing History 10/25/2011 9:01 AM From Clare Jennings, MA To Victor Henrique Baquero, MD Priority Routine

Disp Refills 270 Tab 0 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. 9 daily. - ORAL Class: Handwritten Rx Authorizing Provider: Victor Henrique Baquero, MD Start 10/25/2011 End 11/4/2011
Patient Email
Orders
DOB 9/23/1959

Encounter Messages MyChart message report From Victor Baquero, MD To Mark Amundsen Sent 10/10/2011 12:08 PM For Delivery 10/10/2011 12:08 PM On
Message [771163]
001999
Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 10/12/2011 8:47 AM MyChart Mark Amundsen By Responsibility Audit Trail Message Yes, you should be on antibiotics, ill call some over. See me this week if it does not Body improve. Often these need drainage. Costco. ----- Message ----From: AMUNDSEN,MARK Sent: 10/10/11 07:45 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Sorry Dr BaqueroOne more thing - the epidermoid cyst on my shoulder blew up this weekend-worked it all weekend and got all the contents out, including cyst material. The infection has subsided, and seems healed. Should I be on antibiotics due to my hip replacement? Later on, I should probably get it removed - I know it can't be removed while infected. Mark Amundsen MyChart message report Message [770282] From Mark Amundsen To Victor Baquero, MD Sent 10/10/2011 7:45 AM For Delivery 10/10/2011 7:45 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Sorry Dr BaqueroBody One more thing - the epidermoid cyst on my shoulder blew up this weekend-worked it all weekend and got all the contents out, including cyst material. The infection has subsided, and seems healed. Should I be on antibiotics due to my hip replacement? Later on, I should probably get it removed - I know it can't be removed while infected. Mark Amundsen Encounter Messages Read Composed Y 10/10/2011 12:08 PM Y 10/10/2011 7:45 AM
Encounter Documentation Clare Jennings, MA 10/10/2011 8:03 AM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Mon Oct 10, 2011 7:45 AM Subject: Non-urgent Medical Advice Question Sorry Dr BaqueroOne more thing - the epidermoid cyst on my shoulder blew up this weekend-worked it all weekend and got all the contents out, including cyst material. The infection has subsided, and seems healed. Should I be on antibiotics due to my hip replacement? Later on, I should probably get it removed - I know it can't be removed
002000
while infected. Mark Amundsen


Created by Clare Jennings, MA on 10/10/2011 8:03 AM Approved Disp 20 Tab Trimethoprim 160 mg/Sulfamethoxazole 800 mg (BACTRIM DS) 800-160 mg Tablet Sig - Route: Take 1 Tab by mouth 2 times daily. - ORAL Class: Pharmacy Authorizing Provider: Victor Henrique Baquero, MD Refills 0 Start 10/10/2011 End 10/20/2011
Pharmacy Selected For Prescriptions COSTCO PHARMACY # 765 | 1800 CAVITT COURT | FOLSOM | CA | 95630
Orders
Patient Email
Encounter Messages MyChart message report Message [770265] From Mark Amundsen To Victor Baquero, MD Sent 10/10/2011 7:33 AM For Delivery 10/10/2011 7:33 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Dr. B Body Brief summary of rebuttal - cannot believe hip damage could cause numbness, pain, and burning in feet, lack of reflex/sharp pain responses (legs and arms), fatigue/weakness in arms/back, and fatigue/weakness in legs mainfesting in a single night. Previous hip issues displayed slowly increasing pain and other symptoms, which took years to become intolerable. All current symptoms match DP diagnosis exactly - including
002001
blood/CS fluid tests.

Mark Amundsen
Encounter Messages Read Composed Y 10/10/2011 7:33 AM
From Mark Amundsen
Encounter Documentation Clare Jennings, MA 10/10/2011 7:34 AM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Mon Oct 10, 2011 7:33 AM Subject: Non-urgent Medical Advice Question Dr. B Brief summary of rebuttal - cannot believe hip damage could cause numbness, pain, and burning in feet, lack of reflex/sharp pain responses (legs and arms), fatigue/weakness in arms/back, and fatigue/weakness in legs mainfesting in a single night. Previous hip issues displayed slowly increasing pain and other symptoms, which took years to become intolerable. All current symptoms match DP diagnosis exactly - including blood/CS fluid tests. Mark Amundsen Electronically signed by Clare Jennings, MA at 10/10/2011 7:34 AM Routing History 10/10/2011 7:35 AM From Clare Jennings, MA To Victor Henrique Baquero, MD Priority Routine
Orders
Chart Cosign Accepted By Victor Henrique Baquero, MD Accepted On 10/31/2011 5:22 PM Mark Amundsen (MRN 8081369)
Patient Email

Message [772050]
002002
Subject PCP Last Read in MyChart By Responsibility Audit Trail Message Body
RE: Non-urgent Medical Advice Question Victor Baquero, MD, MD 10/25/2011 4:30 PM Mark Amundsen
Mark, Thank you, form is complete. I'll give it to Christy to get to you. I agree, follow up with ortho next or we can seek a second opinion with neurology. ----- Message ----From: AMUNDSEN,MARK Sent: 10/10/11 07:18 AM To: Victor Henrique Baquero, MD Subject: RE: Non-urgent Medical Advice Question Hi Dr BaqueroI think the best thing would be to put down Oct 1, 2012 as the end date. I don't think it will be ending anytime soon. The last visit to neuro HQ ended with Dr. stating cause of fatigue and weakness is hip damage. I disagree, and have written a rebuttal, which I will deliver when picking up paperwork. I'll contact Ortho, as right hip much worse - very bad this weekend.For disability paperwork (and FMLA), please use Oct 1, 2012, or latest date possible. Mark Amundsen ----- Message ----From: Victor Henrique Baquero, MD Sent: 10/07/2011 2:27 PM To: Mark Amundsen Subject: RE: Non-urgent Medical Advice Question Mark, it is done (99%). What I need from you is a duration for the dissability. I was looking through records but don't see a recent duration. They want to know when you will be able to return to work or when the dissability will end. ----- Message ----From: AMUNDSEN,MARK Sent: 10/7/11 05:59 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr Baquero and staffI wanted to doublecheck the status of the disability, FMLA, and disabled placard paperwork I faxed in last week for your review and completion. I just wanted to make sure it was received, and possibly get an estimate on completion? Thanks for your attention in this matterMark Amundsen
MyChart message report From Mark Amundsen To Victor Baquero, MD Sent 10/10/2011 7:18 AM For Delivery 10/10/2011 7:18 AM On Subject RE: Non-urgent Medical Advice Question
Message [770250]
002003
PCP Responsibility Audit Trail Message Body
Hi Dr BaqueroI think the best thing would be to put down Oct 1, 2012 as the end date. I don't think it will be ending anytime soon. The last visit to neuro HQ ended with Dr. stating cause of fatigue and weakness is hip damage. I disagree, and have written a rebuttal, which I will deliver when picking up paperwork. I'll contact Ortho, as right hip much worse - very bad this weekend.For disability paperwork (and FMLA), please use Oct 1, 2012, or latest date possible. Mark Amundsen ----- Message ----From: Victor Henrique Baquero, MD Sent: 10/07/2011 2:27 PM To: Mark Amundsen Subject: RE: Non-urgent Medical Advice Question Mark, it is done (99%). What I need from you is a duration for the dissability. I was looking through records but don't see a recent duration. They want to know when you will be able to return to work or when the dissability will end. ----- Message ----From: AMUNDSEN,MARK Sent: 10/7/11 05:59 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr Baquero and staffI wanted to doublecheck the status of the disability, FMLA, and disabled placard paperwork I faxed in last week for your review and completion. I just wanted to make sure it was received, and possibly get an estimate on completion? Thanks for your attention in this matterMark Amundsen
MyChart message report Message [768461] From Victor Baquero, MD To Mark Amundsen Sent 10/7/2011 2:27 PM For Delivery 10/7/2011 2:27 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 10/10/2011 7:10 AM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, it is done (99%). Body What I need from you is a duration for the dissability. I was looking through records but don't see a recent duration. They want to know when you will be able to return to work or when the dissability will end. ----- Message ----From: AMUNDSEN,MARK
002004
Encounter Messages MyChart message report From Victor Baquero, MD To Mark Amundsen Sent 10/25/2011 4:56 PM For Delivery 10/25/2011 4:56 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 10/25/2011 4:59 PM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, Body The prescription is ready to pick up at our front desk. ----- Message ----From: AMUNDSEN,MARK Sent: 10/25/11 08:23 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr Baquero and staff-
Message [798028]
It's time for another refill on my Methadone prescription. I will be out on Friday morning, so if I can pick it up on Thursday afternoon, that would be great. Please remember that the current prescription is for 270 10 mg tablets. Thanks for your attention in this matterMark Amundsen
MyChart message report Message [796565] From Mark Amundsen To Victor Baquero, MD Sent 10/25/2011 8:23 AM For Delivery 10/25/2011 8:23 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr Baquero and staffBody It's time for another refill on my Methadone prescription. I will be out on Friday morning, so if I can pick it up on Thursday afternoon, that would be great. Please remember that the current prescription is for 270 10 mg tablets. Thanks for your attention in this matterMark Amundsen Encounter Messages Read Composed
From
To
Subject
002005
Plan UCD/B/S HMO
Financial Class P
Plan Number B72
Plan Phone 916-734-0739
Center None
Patient Information
Telephone Encounter
10/26/2011 11:25 AM
Reason for Call

Refill Request
Routing History
10/26/2011 11:26 AM From Clare Jennings, MA To Victor Henrique Baquero, MD Priority Routine
Created by
Approved
Disp 100 Tab Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10325 mg Tablet Sig - Route: Take 1 Tab by mouth every 4 to 6 hours if needed. - ORAL Class: Pharmacy Authorizing Provider: Victor Henrique Baquero, MD Refills 1 Start 10/26/2011 End 1/25/2012

Disp Refills Start End 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg
002006
(MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 100 Tab 1 8/16/2011 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Pharmacy 30 Tab 11 8/16/2011 Levothyroxine (SYNTHROID) 75 mcg Tablet Sig - Route: Take 1 Tab by mouth every morning before a meal. take on an empty stomach - ORAL Class: Pharmacy 270 Tab 0 10/25/2011 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. 9 daily. - ORAL Class: Handwritten Rx
11/16/2011
8/15/2012
11/24/2011

Patient Email
Orders
DOB 9/23/1959

Encounter Messages MyChart message report From Mark Amundsen To Victor Baquero, MD Sent 10/27/2011 7:36 PM For Delivery 10/27/2011 7:36 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Thanks Dr BaqueroBody I will do so imediately... Mark Amundsen ----- Message ----From: Victor Henrique Baquero, MD Sent: 10/27/2011 1:18 PM To: Mark Amundsen Subject: RE: Non-urgent Medical Advice Question Mark ,
Message [802691]
Before trying the prednisone, I'd like to get recent labs. Prednisone can raise the blood sugar and before I start you on it I want to get a recent blood sugar - last done over 1 year ago. In addition i'd like to check other factors that may contribute to your symptoms. If all labs are normal we'll proceed with the prednisone. Schedule fasting morning labs. ----- Message -----
002007
From: AMUNDSEN,MARK Sent: 10/26/11 07:50 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroSymptoms got worse last night - shaking's back, and walking more difficult. Is there any way I can try the steroids to evaluate their effectiveness? I feel like there is no other recourse. I understand prednesone is the standard treatment, but you may have more accurate info. BTW, my pharmacy is now Walgreens... Mark Amundsen MyChart message report Message [801859] From Victor Baquero, MD To Mark Amundsen Sent 10/27/2011 1:18 PM For Delivery 10/27/2011 1:18 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 10/27/2011 7:36 PM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark , Body Before trying the prednisone, I'd like to get recent labs. Prednisone can raise the blood sugar and before I start you on it I want to get a recent blood sugar - last done over 1 year ago. In addition i'd like to check other factors that may contribute to your symptoms. If all labs are normal we'll proceed with the prednisone. Schedule fasting morning labs. ----- Message ----From: AMUNDSEN,MARK Sent: 10/26/11 07:50 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroSymptoms got worse last night - shaking's back, and walking more difficult. Is there any way I can try the steroids to evaluate their effectiveness? I feel like there is no other recourse. I understand prednesone is the standard treatment, but you may have more accurate info. BTW, my pharmacy is now Walgreens... Mark Amundsen MyChart message report Message [798770] From Mark Amundsen To Victor Baquero, MD Sent 10/26/2011 7:50 AM For Delivery 10/26/2011 7:50 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody Symptoms got worse last night - shaking's back, and walking more difficult. Is there any
002008
way I can try the steroids to evaluate their effectiveness? I feel like there is no other recourse. I understand prednesone is the standard treatment, but you may have more accurate info. BTW, my pharmacy is now Walgreens... Mark Amundsen Encounter Messages Read Composed Y 10/27/2011 7:36 PM Y 10/27/2011 1:18 PM Y 10/26/2011 7:50 AM
Encounter Documentation Clare Jennings, MA 10/26/2011 8:58 AM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Wed Oct 26, 2011 7:50 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroSymptoms got worse last night - shaking's back, and walking more difficult. Is there any way I can try the steroids to evaluate their effectiveness? I feel like there is no other recourse. I understand prednesone is the standard treatment, but you may have more accurate info. BTW, my pharmacy is now Walgreens... Mark Amundsen Electronically signed by Clare Jennings, MA at 10/26/2011 8:58 AM Routing History 10/26/2011 8:58 AM
Created by Clare Jennings, MA on 10/26/2011 8:58 AM Pharmacy Selected For Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630
Orders
Order Summary Future Orders Expected By 10/27/11 LIPID PANEL WITH DLDL REFLEX [LABNO Custom] Order #: 75516223 VITAMIN B12 [LABNO Custom] Order #: 10/27/11 75516276 Expires 10/26/12 10/26/12 Mark Amundsen (MRN 8081369)
Patient Email

002009
Pharmacist. I will be out on Friday, so would like to pick up prescription on Thursday afternoon. I will send separate message on Prednesone. Thanks! Mark Amundsen

Created by Clare Jennings, MA on 11/15/2011 8:13 AM Approved Disp Refills 270 tablet 0 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx Authorizing Provider: Victor Henrique Baquero, MD Start 11/15/2011 End 12/8/2011
Patient Email
Orders
DOB 9/23/1959

Encounter Messages MyChart message report Message [822774] From Victor Baquero, MD To Mark Amundsen Sent 11/9/2011 1:25 PM For Delivery 11/9/2011 1:25 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 11/15/2011 12:36 AM MyChart Mark Amundsen By Responsibility Audit Trail Message Prednisone called in. Follow instructions. Take in morning only. Watch your intake as Body the appetite does increase. ----- Message ----From: AMUNDSEN,MARK Sent: 11/9/11 08:29 AM To: Victor Henrique Baquero, MD
002010
Subject: RE: Non-urgent Medical Advice Question Hi Dr BaqueroWill restart thyroid meds and retest in six weeks - but didn't notice much change last time. Am I okay to start the steroids now? If so, could you submit them to Walgreens? Thanks, Mark Amundsen ----- Message ----From: Victor Henrique Baquero, MD Sent: 11/04/2011 4:43 PM To: Mark Amundsen Subject: RE: Non-urgent Medical Advice Question I refilled the thyroid. After taking it for 6 weeks retest levels. Labs ordered. Take care. . ----- Message ----From: AMUNDSEN,MARK Sent: 11/4/11 08:09 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI ran out of the Thyroxine, and forgot to get it refilled. I'll put in for a refill today, if I can find the number. I also wanted to let you know- Walgreens would not fill the entire Methadone script.. They said it could only be a months worth, and the script was written for 2 every 6 hours/8 per day. Cont MyChart message report Message [821882] From Mark Amundsen To Victor Baquero, MD Sent 11/9/2011 8:29 AM For Delivery 11/9/2011 8:29 AM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody Will restart thyroid meds and retest in six weeks - but didn't notice much change last time. Am I okay to start the steroids now? If so, could you submit them to Walgreens? Thanks, Mark Amundsen ----- Message ----From: Victor Henrique Baquero, MD Sent: 11/04/2011 4:43 PM To: Mark Amundsen Subject: RE: Non-urgent Medical Advice Question I refilled the thyroid. After taking it for 6 weeks retest levels. Labs ordered. Take care. .
002011
----- Message ----From: AMUNDSEN,MARK Sent: 11/4/11 08:09 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI ran out of the Thyroxine, and forgot to get it refilled. I'll put in for a refill today, if I can find the number. I also wanted to let you know- Walgreens would not fill the entire Methadone script.. They said it could only be a months worth, and the script was written for 2 every 6 hours/8 per day. Cont MyChart message report Message [815591] Victor Baquero, MD From To Mark Amundsen Sent 11/4/2011 4:43 PM For Delivery 11/4/2011 4:43 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 11/9/2011 8:26 AM MyChart Mark Amundsen By Responsibility Audit Trail Message I refilled the thyroid. After taking it for 6 weeks retest levels. Labs ordered. Take care. . Body ----- Message ----From: AMUNDSEN,MARK Sent: 11/4/11 08:09 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI ran out of the Thyroxine, and forgot to get it refilled. I'll put in for a refill today, if I can find the number. I also wanted to let you know- Walgreens would not fill the entire Methadone script.. They said it could only be a months worth, and the script was written for 2 every 6 hours/8 per day. Cont MyChart message report From Mark Amundsen To Victor Baquero, MD Sent 11/4/2011 8:09 AM For Delivery 11/4/2011 8:09 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message [814326]
002012
Message Body
Hi Dr BaqueroI ran out of the Thyroxine, and forgot to get it refilled. I'll put in for a refill today, if I can find the number. I also wanted to let you know- Walgreens would not fill the entire Methadone script.. They said it could only be a months worth, and the script was written for 2 every 6 hours/8 per day. Cont
Encounter Messages Read Composed Y 11/9/2011 1:25 PM Y 11/9/2011 8:29 AM Y 11/4/2011 4:43 PM Y 11/4/2011 8:09 AM
Encounter Documentation Victor Baquero, MD, MD 11/9/2011 1:25 PM Addendum Addended by: BAQUERO, VICTOR H on: 11/9/2011 Modules accepted: Orders Clare Jennings, MA 11/4/2011 8:37 AM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Fri Nov 4, 2011 8:09 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI ran out of the Thyroxine, and forgot to get it refilled. I'll put in for a refill today, if I can find the number. I also wanted to let you know- Walgreens would not fill the entire Methadone script.. They said it could only be a months worth, and the script was written for 2 every 6 hours/8 per day. Cont Electronically signed by Clare Jennings, MA at 11/4/2011 8:37 AM Routing History 11/9/2011 8:39 AM 11/4/2011 8:37 AM From Clare Jennings, MA Clare Jennings, MA To Victor Henrique Baquero, MD Victor Henrique Baquero, MD Priority Routine Routine

Disp Refills Start End 30 Tab 11 11/4/2011 11/3/2012 Levothyroxine (SYNTHROID) 75 mcg Tablet Sig - Route: Take 1 Tab by mouth every morning before a meal. take on an empty stomach - ORAL Class: Pharmacy Authorizing Provider: Victor Henrique Baquero, MD 20 tablet 0 11/9/2011 11/22/2011 PredniSONE (DELTASONE) 20 mg Tablet Sig - Route: Take by mouth. Take 3 pills every morning for 3 days then 2 for 3 days then 1 for 3 days then 1/2 for 4 days. - ORAL
002013
Class: Pharmacy Authorizing Provider: Victor Henrique Baquero, MD Pharmacy Selected For Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630
Orders
Order Summary Canceled Orders TSH WITH FREE T4 REFLEX [LABNO Custom] Order #: 75872998
Patient Email


Encounter Messages MyChart message report Message [815524] From Victor Baquero, MD To Mark Amundsen Sent 11/4/2011 4:13 PM For Delivery 11/4/2011 4:13 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 11/9/2011 8:25 AM MyChart Mark Amundsen By Responsibility Audit Trail Message Noted, Body Just make sure you specify the correct dose/qty on the refill requests to make sure everything goes smoothly. Take care. . ----- Message ----From: AMUNDSEN,MARK Sent: 11/4/11 08:14 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Dr BCould you put a note in the chart for the Methadone prescription for 270 10mg tablets / 3 every 8 hours - 9 per day. That way I don't think they could screw it up anymore. Next's months will probably be early, since they shorted me. They promised to inform you. Please let me know if I'm good to go for the steroids... Mark Amundsen
002014
MyChart message report Message [814333] From Mark Amundsen To Victor Baquero, MD Sent 11/4/2011 8:14 AM For Delivery 11/4/2011 8:14 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Dr BBody Could you put a note in the chart for the Methadone prescription for 270 10mg tablets / 3 every 8 hours - 9 per day. That way I don't think they could screw it up anymore. Next's months will probably be early, since they shorted me. They promised to inform you. Please let me know if I'm good to go for the steroids... Mark Amundsen Encounter Messages Read Composed Y 11/4/2011 4:13 PM Y 11/4/2011 8:14 AM
Encounter Documentation Clare Jennings, MA 11/4/2011 8:36 AM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Fri Nov 4, 2011 8:14 AM Subject: Non-urgent Medical Advice Question Dr BCould you put a note in the chart for the Methadone prescription for 270 10mg tablets / 3 every 8 hours - 9 per day. That way I don't think they could screw it up anymore. Next's months will probably be early, since they shorted me. They promised to inform you. Please let me know if I'm good to go for the steroids... Mark Amundsen Electronically signed by Clare Jennings, MA at 11/4/2011 8:36 AM Routing History 11/4/2011 8:37 AM From Clare Jennings, MA To Victor Henrique Baquero, MD Priority Routine

Disp Refills 270 Tab 0 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 3 Tabs by mouth every 8 hours. 9 daily. - ORAL Class: Historical Authorizing Provider: Victor Henrique Baquero, MD Start 11/4/2011 End 11/15/2011
Appointment
Orders
002015
Amundsen, Mark
8081369
Male
9/23/1959
916-509-0158
Encounter Messages MyChart message report From Victor Baquero, MD To Mark Amundsen Sent 11/16/2011 1:33 PM For Delivery 11/16/2011 1:33 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 12/8/2011 5:17 AM MyChart Mark Amundsen By Responsibility Audit Trail Message Thanks for the update. Body ----- Message ----From: AMUNDSEN,MARK Sent: 11/15/11 12:56 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question
Message [834164]
Hi Dr BaqueroHave restarted Levo and taken Prednesone for 5 days. Pred seems to be helping, but I know it will rev u up on high dose. Food intake normal. Output less/slower than normal. Many side effects - upset stomach, more energy, and all other medications seem to be less or ineffective, including Methadone and Ibuprofen. Pain level up. Meds effect seemed to lessen with reduced dosage-keeping fingers crossed. Mark A. MyChart message report Message [830518] From Mark Amundsen To Victor Baquero, MD Sent 11/15/2011 12:56 AM For Delivery 11/15/2011 12:56 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody Have restarted Levo and taken Prednesone for 5 days. Pred seems to be helping, but I know it will rev u up on high dose. Food intake normal. Output less/slower than normal. Many side effects - upset stomach, more energy, and all other medications seem to be less or ineffective, including Methadone and Ibuprofen. Pain level up. Meds effect seemed to lessen with reduced dosage-keeping fingers crossed. Mark A. Encounter Messages Read Composed
From
To
Subject
002016
Y Y
11/16/2011 1:33 PM 11/15/2011 12:56 AM
Victor Baquero, MD Mark Amundsen
Encounter Documentation Clare Jennings, MA 11/15/2011 8:15 AM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Tue Nov 15, 2011 12:56 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroHave restarted Levo and taken Prednesone for 5 days. Pred seems to be helping, but I know it will rev u up on high dose. Food intake normal. Output less/slower than normal. Many side effects - upset stomach, more energy, and all other medications seem to be less or ineffective, including Methadone and Ibuprofen. Pain level up. Meds effect seemed to lessen with reduced dosage-keeping fingers crossed. Mark A. Electronically signed by Clare Jennings, MA at 11/15/2011 8:15 AM Routing History 11/15/2011 8:15 AM From Clare Jennings, MA To Victor Henrique Baquero, MD Priority Routine
Patient Email
Orders
DOB 9/23/1959

Encounter Messages MyChart message report From Victor Baquero, MD To Mark Amundsen Sent 11/16/2011 1:15 PM For Delivery 11/16/2011 1:15 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 12/8/2011 5:17 AM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, Body The prescription is ready to pick up at our front desk.
Message [834109]
002017
----- Message ----From: AMUNDSEN,MARK Sent: 11/15/11 12:45 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's about time for another refill on Methadone. Last refill was short due to Pharmacist/Insurance. Refill should be for 270 10mg tablets/9 tablets per day/ 3 tablets every 8 hours. This should ensure compliance by Pharmacist. I will be out on Friday, so would like to pick up prescription on Thursday afternoon. I will send separate message on Prednesone. Thanks! Mark Amundsen MyChart message report Message [830514] From Mark Amundsen To Victor Baquero, MD Sent 11/15/2011 12:45 AM For Delivery 11/15/2011 12:45 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody It's about time for another refill on Methadone. Last refill was short due to Pharmacist/Insurance. Refill should be for 270 10mg tablets/9 tablets per day/ 3 tablets every 8 hours. This should ensure compliance by Pharmacist. I will be out on Friday, so would like to pick up prescription on Thursday afternoon. I will send separate message on Prednesone. Thanks! Mark Amundsen Encounter Messages Read Composed Y 11/16/2011 1:15 PM Y 11/15/2011 12:45 AM
Encounter Documentation Clare Jennings, MA 11/15/2011 8:13 AM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Tue Nov 15, 2011 12:45 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's about time for another refill on Methadone. Last refill was short due to Pharmacist/Insurance. Refill should be for 270 10mg tablets/9 tablets per day/ 3 tablets every 8 hours. This should ensure compliance by
002018
Mark Amundsen Electronically signed by Clare Jennings, MA at 12/8/2011 7:40 AM Routing History 12/8/2011 7:41 AM From Clare Jennings, MA To Victor Henrique Baquero, MD Priority Routine

Disp Refills 270 tablet 0 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx Authorizing Provider: Victor Henrique Baquero, MD Start 12/8/2011 End 1/3/2012
Patient Email
Orders
DOB 9/23/1959
Encounter Messages MyChart message report Message [844073] From Victor Baquero, MD To Mark Amundsen Sent 11/22/2011 2:21 PM For Delivery 11/22/2011 2:21 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 12/8/2011 5:16 AM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark at this point I would like to see how you do over the next few weeks without the Body Prednisone. The steroids are a double edged sword and long-term use is generally not advised. In the future we can consider injectable Prednisone as a different alternative. However I would like to wait at least 2 months before we do that. ----- Message ----From: AMUNDSEN,MARK Sent: 11/22/11 08:03 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroJust about out of Prednesone - wondering where I go from here. Improvement noted
002019
under meds, but decreased along with dosage. High dosage caused many side effects, including exaggerated OCD symptoms and sleeplessness. Please advise what to do next. Thanks! Mark Amundsen MyChart message report Message [843034] From Mark Amundsen To Victor Baquero, MD Sent 11/22/2011 8:03 AM For Delivery 11/22/2011 8:03 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody Just about out of Prednesone - wondering where I go from here. Improvement noted under meds, but decreased along with dosage. High dosage caused many side effects, including exaggerated OCD symptoms and sleeplessness. Please advise what to do next. Thanks! Mark Amundsen Encounter Messages Read Composed Y 11/22/2011 2:21 PM Y 11/22/2011 8:03 AM
Encounter Documentation Clare Jennings, MA 11/22/2011 8:17 AM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Tue Nov 22, 2011 8:03 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroJust about out of Prednesone - wondering where I go from here. Improvement noted under meds, but decreased along with dosage. High dosage caused many side effects, including exaggerated OCD symptoms and sleeplessness. Please advise what to do next. Thanks! Mark Amundsen Electronically signed by Clare Jennings, MA at 11/22/2011 8:17 AM Routing History 11/22/2011 8:18 AM From Clare Jennings, MA To Victor Henrique Baquero, MD Priority Routine
Patient Email
Orders
Patient Information Patient Name MRN Sex
DOB
PATIENTPHONE
002020
12/11/2011 12:44 PM
From Kimberly Davis Williams
Priority Routine
Created by
Kimberly Davis Williams on 12/11/2011 12:41 PM

Disp Refills Start End 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 11 11/4/2011 11/3/2012 Levothyroxine (SYNTHROID) 75 mcg Tablet Sig - Route: Take 1 Tab by mouth every morning before a meal. take on an empty stomach - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 100 Tab 1 8/16/2011 11/16/2011 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Pharmacy 270 tablet 0 12/8/2011 1/7/2012 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx
Patient Email
Orders
DOB 9/23/1959

Encounter Messages MyChart message report From Victor Baquero, MD To Mark Amundsen Sent 12/8/2011 12:23 PM For Delivery 12/8/2011 12:23 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 12/9/2011 4:35 PM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, the prescription is ready to pick up at the front desk Body ----- Message ----From: AMUNDSEN,MARK
Message [868214]
002021
Sent: 12/8/11 05:24 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's about time for another refill on methadone. I will be out next Tuesday, so if I could pick up the script on Monday afternoon, that would be appreciated. Refill should be for 270 10mg tablets/9 tablets per day/ 3 tablets every 8 hours. This should ensure compliance by Pharmacist. Back to gimpy/"normal" due to stoppage of Prednesone. All side effects have ceased. Meds working again. Unable to tell whether increased energy was due to repair or steroids. Mark Amundsen MyChart message report Message [867406] From Mark Amundsen To Victor Baquero, MD Sent 12/8/2011 5:24 AM For Delivery 12/8/2011 5:24 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody It's about time for another refill on methadone. I will be out next Tuesday, so if I could pick up the script on Monday afternoon, that would be appreciated. Refill should be for 270 10mg tablets/9 tablets per day/ 3 tablets every 8 hours. This should ensure compliance by Pharmacist. Back to gimpy/"normal" due to stoppage of Prednesone. All side effects have ceased. Meds working again. Unable to tell whether increased energy was due to repair or steroids. Mark Amundsen Encounter Messages Read Composed Y 12/8/2011 12:23 PM Y 12/8/2011 5:24 AM
Encounter Documentation Clare Jennings, MA 12/8/2011 7:40 AM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Thu Dec 8, 2011 5:24 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's about time for another refill on methadone. I will be out next Tuesday, so if I could pick up the script on Monday afternoon, that would be appreciated. Refill should be for 270 10mg tablets/9 tablets per day/ 3 tablets every 8 hours. This should ensure compliance by Pharmacist. Back to gimpy/"normal" due to stoppage of Prednesone. All side effects have ceased. Meds working again. Unable to tell whether increased energy was due to repair or steroids.
002022
Amundsen, Mark
8081369
Male
9/23/1959
916-509-0158
Encounter Messages MyChart message report Message [901512] From Mark Amundsen To Victor Baquero, MD Sent 1/3/2012 8:54 AM For Delivery 1/3/2012 8:54 AM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Thanks Dr BaqueroBody I'll make an appointment. I sent off to Neuro, but haven't heard back yet... Mark Amundsen ----- Message ----From: Victor Henrique Baquero, MD Sent: 01/03/2012 8:39 AM To: Mark Amundsen Subject: RE: Non-urgent Medical Advice Question Mark, I have the methadone prescription ready to pick up. In terms of where to go from here with her symptoms, I would recommend a followup with me to reevaluate everything and have a discussion on what would be the most appropriate next step. I would like to get an update on your current status. Do contact neurology as well for advice. Take care. ----- Message ----From: AMUNDSEN,MARK Sent: 12/30/11 09:37 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI wanted to check and make sure I'll be able to get a refill next week - I'll be out on Thursday, and I know everyone takes vacation this time of yearAlso, big question - where do I go from here with my illness - any suggestions? I'll also recheck with Neuro, but I'd like to know if anything else can be done. Thanks for all your help in this matterMark Amundsen MyChart message report From Victor Baquero, MD To Mark Amundsen Sent 1/3/2012 8:39 AM For Delivery 1/3/2012 8:39 AM On Message [901463]
002023
RE: Non-urgent Medical Advice Question Victor Baquero, MD, MD 1/3/2012 9:06 AM Mark Amundsen
Mark, I have the methadone prescription ready to pick up. In terms of where to go from here with her symptoms, I would recommend a followup with me to reevaluate everything and have a discussion on what would be the most appropriate next step. I would like to get an update on your current status. Do contact neurology as well for advice. Take care. ----- Message ----From: AMUNDSEN,MARK Sent: 12/30/11 09:37 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI wanted to check and make sure I'll be able to get a refill next week - I'll be out on Thursday, and I know everyone takes vacation this time of yearAlso, big question - where do I go from here with my illness - any suggestions? I'll also recheck with Neuro, but I'd like to know if anything else can be done. Thanks for all your help in this matterMark Amundsen
MyChart message report Message [899402] From Mark Amundsen To Victor Baquero, MD Sent 12/30/2011 9:37 AM For Delivery 12/30/2011 9:37 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody I wanted to check and make sure I'll be able to get a refill next week - I'll be out on Thursday, and I know everyone takes vacation this time of yearAlso, big question - where do I go from here with my illness - any suggestions? I'll also recheck with Neuro, but I'd like to know if anything else can be done. Thanks for all your help in this matterMark Amundsen Encounter Messages Read Composed Y 1/3/2012 8:54 AM Y 1/3/2012 8:39 AM Y 12/30/2011 9:37 AM
002024
Encounter Documentation Clare Jennings, MA 1/3/2012 8:09 AM Signed From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Fri Dec 30, 2011 9:37 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI wanted to check and make sure I'll be able to get a refill next week - I'll be out on Thursday, and I know everyone takes vacation this time of yearAlso, big question - where do I go from here with my illness - any suggestions? I'll also recheck with Neuro, but I'd like to know if anything else can be done. Thanks for all your help in this matterMark Amundsen Electronically signed by Clare Jennings, MA at 1/3/2012 8:09 AM Routing History 1/3/2012 8:58 AM 1/3/2012 8:09 AM
From Clare Jennings, MA Clare Jennings, MA To Victor Henrique Baquero, MD Victor Henrique Baquero, MD Priority Routine Routine
Created by Clare Jennings, MA on 1/3/2012 8:09 AM Approved Disp Refills 270 tablet 0 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx Authorizing Provider: Victor Henrique Baquero, MD
Start 1/3/2012
End 1/25/2012
Telephone Encounter
12/11/2011 12:41 PM
Provider Kimberly Davis Williams Department Carm Urgent Care
Reason for Call

Medication/Prescription Refill clarificaton on methadone prescription
Call Documentation
Kimberly Davis Williams 12/11/2011 12:44 PM Signed ON CALL NOTE: In 12/20/11 spoke with CVS Pharmacy who was requesting clarification on methadone prescription. Pharmacist stated that the mg was not stated on prescription. Reviewed prior prescriptions. Gave verbal okay to fill dose same as prior, which is methadone 10mg take 3 tablets by mouth every 8 hours. 9 daily.
Electronically signed by Kimberly Davis Williams at 12/11/2011 12:44 PM
Routing History
002025
Created by Yelena Tsvirinko on 1/25/2012 8:54 AM Approved

Disp Refills 270 tablet 0 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx Authorizing Provider: Victor Baquero, MD Start 1/25/2012 End 2/17/2012
Patient Email
Orders
DOB 9/23/1959

Encounter Messages MyChart message report Message [905853] From Andrew Kim Oh, MD To Mark Amundsen Sent 1/4/2012 9:22 PM For Delivery 1/4/2012 9:22 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 12/13/2012 2:00 PM MyChart Mark Amundsen By Responsibility Audit Trail Message Hi Mr. Amundsen, Body Dr. Richman felt that hip arthritis is limiting your physical abilities rather than neuropathy limiting your physical abilities. Therefore, please approach your primary care doctor for a referral to the orthopedic department to discuss treatment options for your hip arthritis. I know you already had the one hip replaced but your other hip is starting to become arthritic as well. At any rate, there is really no treatment available for your kind of neuropathy but arthritis is potentially treatable so please explore this avenue further with your primary care doctor. -Dr. Oh ----- Message ----From: AMUNDSEN,MARK Sent: 12/30/11 09:42 AM To: Andrew Kim Oh, MD Subject: Non-urgent Medical Advice Question Hi Dr OhI'm still here, and still disabled. I wanted to check with you to find out if I have any other options in regards to treatment of my condition. Neuro downtown was not a satisfactory
002026
conclusion IMO, and I'd like to know if there are any options I can explore to help control my illness. Regards, Mark Amundsen MyChart message report Message [899410] From Mark Amundsen To Andrew Kim Oh, MD Sent 12/30/2011 9:42 AM For Delivery 12/30/2011 9:42 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr OhBody I'm still here, and still disabled. I wanted to check with you to find out if I have any other options in regards to treatment of my condition. Neuro downtown was not a satisfactory conclusion IMO, and I'd like to know if there are any options I can explore to help control my illness. Regards, Mark Amundsen Encounter Messages Read Composed Y 1/4/2012 9:22 PM Y 12/30/2011 9:42 AM
Encounter Documentation Victor Baquero, MD, MD 1/9/2012 6:30 PM Signed From: AMUNDSEN,MARK To: Andrew Kim Oh, MD Sent: Fri Dec 30, 2011 9:42 AM Subject: Non-urgent Medical Advice Question Hi Dr OhI'm still here, and still disabled. I wanted to check with you to find out if I have any other options in regards to treatment of my condition. Neuro downtown was not a satisfactory conclusion IMO, and I'd like to know if there are any options I can explore to help control my illness. Regards, Mark Amundsen
Routing History
1/4/2012 9:23 PM From Andrew Kim Oh, MD To Victor Henrique Baquero, MD Priority Routine
Patient Email
Orders
DOB
PATIENTPHONE
002027
Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 11 11/4/2011 11/3/2012 Levothyroxine (SYNTHROID) 75 mcg Tablet Sig - Route: Take 1 Tab by mouth every morning before a meal. take on an empty stomach - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 100 Tab 1 8/16/2011 11/16/2011 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Pharmacy 270 tablet 0 1/3/2012 1/25/2012 Methadone (DOLOPHINE) 10 mg Tablet (Discontinued) Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx

Patient Email
Orders
DOB 9/23/1959

Encounter Messages MyChart message report From Victor Baquero, MD To Mark Amundsen Sent 1/25/2012 5:28 PM For Delivery 1/25/2012 5:28 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 1/25/2012 7:03 PM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, the prescription is done. You may pick it up at the front desk. Body ----- Message ----From: AMUNDSEN,MARK Sent: 1/25/12 05:26 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr Baquero-
Message [947479]
002028
It's about time for another refill on methadone. I will be out on Sunday night or Monday morning, so I'm hoping to pick up a script on Friday afternoon. Evetything's about the same - minor variations in weakness and pain, but nothing to get worked up over. Right hip's cysts seem to be growing - every once in a while, they double me over, but all in all not too bad. Feet seem to be getting worse - left foot has just about caught up with right foot.
Mark Amundsen
MyChart message report Message [945688] From Mark Amundsen To Victor Baquero, MD Sent 1/25/2012 5:26 AM For Delivery 1/25/2012 5:26 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody It's about time for another refill on methadone. I will be out on Sunday night or Monday morning, so I'm hoping to pick up a script on Friday afternoon. Evetything's about the same - minor variations in weakness and pain, but nothing to get worked up over. Right hip's cysts seem to be growing - every once in a while, they double me over, but all in all not too bad. Feet seem to be getting worse - left foot has just about caught up with right foot. Mark Amundsen Encounter Messages Read Composed Y 1/25/2012 5:28 PM Y 1/25/2012 5:26 AM
Encounter Documentation Yelena Tsvirinko 1/25/2012 8:54 AM Signed From: AMUNDSEN,MARK To: Victor Baquero, MD Sent: Wed Jan 25, 2012 5:26 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's about time for another refill on methadone. I will be out on Sunday night or Monday morning, so I'm hoping to pick up a script on Friday afternoon. Evetything's about the same - minor variations in weakness and pain, but nothing to get worked up over. Right hip's cysts seem to be growing - every once in a while, they double me over, but all in all not too bad. Feet seem to be getting worse - left foot has just about caught up with right foot. Mark Amundsen Electronically signed by Yelena Tsvirinko at 1/25/2012 8:54 AM Routing History 1/25/2012 8:54 AM From Yelena Tsvirinko To Victor Baquero, MD Priority Routine
002029
Telephone Encounter
2/21/2012 3:05 PM
Provider Victor Baquero, MD, MD Department Fol Endocrine
Reason for Call

Refill Request
Routing History
2/21/2012 3:05 PM From Cory O'Dell To Victor Baquero, MD Priority Routine
Created by
Cory O'Dell on 2/21/2012 3:05 PM
Approved
Disp 60 tablet Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 tablets by mouth every day at bedtime. - ORAL Class: Pharmacy Authorizing Provider: Jeffrey A Applebaum, MD Refills 0 Start 2/21/2012 End 5/30/2012

Disp Refills Start End 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 100 tablet 1 1/25/2012 2/24/2012 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet Sig - Route: Take 1 tablet by mouth every 4 to 6 hours if needed. - ORAL Class: Pharmacy 30 Tab 11 11/4/2011 11/3/2012 Levothyroxine (SYNTHROID) 75 mcg Tablet Sig - Route: Take 1 Tab by mouth every morning before a meal. take on an empty stomach - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 100 Tab 1 8/16/2011 2/21/2012 Carisoprodol (SOMA) 350 mg Tablet (Discontinued) Sig - Route: Take 2 Tabs by mouth every day at bedtime. - ORAL Class: Pharmacy 270 tablet 0 2/21/2012 3/22/2012 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx

Patient Email
Orders
DOB 9/23/1959
002030
Encounter Messages MyChart message report Message [990635] From Victor Baquero, MD To Mark Amundsen Sent 2/17/2012 2:26 PM For Delivery 2/17/2012 2:26 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 12/13/2012 2:01 PM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, Body The prescription is ready to pick up at our front desk on Tuesday. Take care. ----- Message ----From: AMUNDSEN,MARK Sent: 2/17/12 08:40 AM To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr Baquero and staffIt's almost time for another refill on methadone - I will be out next Wednesday, so if I could pick up a refill on Tuesday afternoon, I would be grateful. I wanted to send this in early in case you were out next week. Thanks!
Mark Amundsen
MyChart message report Message [989743] From Mark Amundsen To Victor Baquero, MD Sent 2/17/2012 8:40 AM For Delivery 2/17/2012 8:40 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr Baquero and staffBody It's almost time for another refill on methadone - I will be out next Wednesday, so if I could pick up a refill on Tuesday afternoon, I would be grateful. I wanted to send this in early in case you were out next week. Thanks! Mark Amundsen Encounter Messages Read Composed Y 2/17/2012 2:26 PM Y 2/17/2012 8:40 AM
002031
Dannel Cameron 2/17/2012 4:42 PM Addendum Patient picked up prescription/known
From: AMUNDSEN,MARK To: Victor Baquero, MD Sent: Fri Feb 17, 2012 8:40 AM Subject: Non-urgent Medical Advice Question Hi Dr Baquero and staffIt's almost time for another refill on methadone - I will be out next Wednesday, so if I could pick up a refill on Tuesday afternoon, I would be grateful. I wanted to send this in early in case you were out next week. Thanks! Mark Amundsen
Electronically signed by Clare Jennings, MA at 2/17/2012 9:18 AM Routing History 2/17/2012 9:19 AM From Clare Jennings, MA To Victor Baquero, MD Priority Routine

Disp Refills 270 tablet 0 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx Authorizing Provider: Victor Baquero, MD Telephone/Refill Encounter
Start 2/21/2012
End 3/14/2012
Telephone Encounter
1/26/2012 11:21 AM
Call Documentation
Teresa Finer 1/26/2012 11:22 AM Signed Left message for Mr. Amundsen to return call. Prescription ready for pick-up.
Electronically signed by Teresa Finer at 1/26/2012 11:22 AM
Created by
Teresa Finer on 1/26/2012 11:21 AM
002032
Class: Pharmacy 30 Tab 11 11/4/2011 Levothyroxine (SYNTHROID) 75 mcg Tablet Sig - Route: Take 1 Tab by mouth every morning before a meal. take on an empty stomach - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 60 tablet 0 2/21/2012 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 tablets by mouth every day at bedtime. - ORAL Class: Pharmacy 270 tablet 0 3/14/2012 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx
11/3/2012
11/16/2011
5/23/2012
4/13/2012

Patient Email
Orders
DOB 9/23/1959
Encounter Messages MyChart message report Message [1036298] From Clare Jennings, MA To Mark Amundsen Sent 3/14/2012 9:21 AM For Delivery 3/14/2012 9:21 AM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 12/13/2012 2:00 PM MyChart Mark Amundsen By Responsibility Audit Trail Message Your prescription is at the front desk, you can pick it up any time between 8-5. Body ----- Message ----From: AMUNDSEN,MARK Sent: 3/13/2012 6:08 PM PDT To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's about time for another refill on Methadone. I will be out Sunday morning (the 18th), so I'd like to pick up a prescription Saturday. Therefore, I would like to pick up the script on Friday the 16th. Please let me know when this is available... Thanks in advanceMark Amundsen
002033
MyChart message report From Victor Baquero, MD To Mark Amundsen Sent 3/14/2012 8:15 AM For Delivery 3/14/2012 8:15 AM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 3/14/2012 10:32 AM MyChart Mark Amundsen By Responsibility Audit Trail Message I'll have it ready tomorrow. Body Take care. ----- Message ----From: AMUNDSEN,MARK Sent: 3/13/2012 6:08 PM PDT To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question
Message [1036098]
Hi Dr BaqueroIt's about time for another refill on Methadone. I will be out Sunday morning (the 18th), so I'd like to pick up a prescription Saturday. Therefore, I would like to pick up the script on Friday the 16th. Please let me know when this is available... Thanks in advanceMark Amundsen MyChart message report Message [1035467] From Mark Amundsen To Victor Baquero, MD Sent 3/13/2012 6:08 PM For Delivery 3/13/2012 6:08 PM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody It's about time for another refill on Methadone. I will be out Sunday morning (the 18th), so I'd like to pick up a prescription Saturday. Therefore, I would like to pick up the script on Friday the 16th. Please let me know when this is available... Thanks in advanceMark Amundsen Encounter Messages Read Composed Y 3/14/2012 9:21 AM Y 3/14/2012 8:15 AM Y 3/13/2012 6:08 PM
From Clare Jennings, MA Victor Baquero, MD Mark Amundsen
To Mark Amundsen Mark Amundsen Victor Baquero, MD
Gloria J Newton 3/15/2012 4:20 PM Signed

Pt. Picked up prescription and showed I.D. Gloria J Newton
002034
Pt. Filled out a Medical Release Form to get paperwork done in July 2010. Electronically signed by Gloria J Newton at 3/15/2012 4:20 PM

Triplicate written. Please notify patient. Electronically signed by Victor Baquero, MD at 3/14/2012 8:15 AM
From: Mark Amundsen To: Victor Baquero, MD Sent: 3/13/2012 6:08 PM PDT Subject: Non-urgent Medical Advice Question Hi Dr Baquero- It's about time for another refill on Methadone. I will be out Sunday morning (the 18th), so I'd like to pick up a prescription Saturday. Therefore, I would like to pick up the script on Friday the 16th. Please let me know when this is available... Thanks in advance- Mark Amundsen 
Electronically signed by Clare Jennings, MA at 3/14/2012 7:47 AM Routing History 3/14/2012 8:15 AM 3/14/2012 7:48 AM
From Victor Baquero, MD Clare Jennings, MA To P FOL MA FP Victor Baquero, MD Priority Routine Routine
Created by Clare Jennings, MA on 3/14/2012 7:47 AM Approved Disp Refills 270 tablet 0 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx Authorizing Provider: Victor Baquero, MD Start 3/14/2012 End 4/10/2012
Patient Email
Orders
DOB 9/23/1959
Encounter Messages MyChart message report From Mark Amundsen To Victor Baquero, MD Sent 3/13/2012 6:12 PM For Delivery 3/13/2012 6:12 PM
Message [1035474]
002035
Hi Dr BaqueroI have another request-I would like to get a copy of the pprwrk for a visit to your office around July 2010 for a right foot ailment (swelling/burning/pain). It may help me in attaining disability retirement. Is that something that can be printed there? Could I get a copy when picking up my prescription? Thanks for any infoMark Amundsen
From Mark Amundsen

See patient message. Requesting records. Electronically signed by Victor Baquero, MD at 3/14/2012 8:20 AM
From: Mark Amundsen To: Victor Baquero, MD Sent: 3/13/2012 6:12 PM PDT Subject: Non-urgent Medical Advice Question Hi Dr Baquero- I have another request-I would like to get a copy of the pprwrk for a visit to your office around July 2010 for a right foot ailment (swelling/burning/pain). It may help me in attaining disability retirement. Is that something that can be printed there? Could I get a copy when picking up my prescription? Thanks for any info- Mark Amundsen 
Electronically signed by Clare Jennings, MA at 3/14/2012 7:47 AM Routing History 3/14/2012 8:20 AM 3/14/2012 7:47 AM From Victor Baquero, MD Clare Jennings, MA To P FOL MED RECORDS FP/IM/PEDS Victor Baquero, MD Priority Routine Routine
Orders
Chart Cosign Accepted By Victor Baquero, MD
Patient Information

002036
Mark Amundsen Encounter Messages Read Composed Y 4/11/2012 11:42 AM
From Mark Amundsen
Encounter Documentation Clare Jennings, MA 4/11/2012 11:51 AM Signed From: Mark Amundsen To: Victor Baquero, MD Sent: 4/11/2012 11:42 AM PDT Subject: Non-urgent Medical Advice Question Hi Clare and Dr BaqueroJust wanted to check and see if you received my message about a methadone refill. I will be out tomorrow morning, so I'm hoping to pick one up this afternoon. Thanks for your attention in this matterMark Amundsen Electronically signed by Clare Jennings, MA at 4/11/2012 11:51 AM Routing History From 4/11/2012 11:51 AM Clare Jennings, MA Created by Clare Jennings, MA on 4/11/2012 11:51 AM To Victor Baquero, MD Priority Routine
Orders
Chart Cosign Accepted By Victor Baquero, MD Accepted On 4/16/2012 6:08 PM Mark Amundsen (MRN 8081369)
Patient Email

Message [1087606]
002037
Mark, The prescription is ready to pick up at our front desk. ----- Message ----From: AMUNDSEN,MARK Sent: 4/10/2012 7:19 AM PDT To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's time for another refill on Methadone. I will be out Thursday, so I'm hoping to pick up a refill Wednesday afternoon. Things about the same-pain level average, but tiredness and exhaustion levels up. Maybe when the sun shines, I'll be a little better. Regards, Mark Amundsen
MyChart message report Message [1084325] From Mark Amundsen To Victor Baquero, MD Sent 4/10/2012 7:19 AM For Delivery 4/10/2012 7:19 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody It's time for another refill on Methadone. I will be out Thursday, so I'm hoping to pick up a refill Wednesday afternoon. Things about the same-pain level average, but tiredness and exhaustion levels up. Maybe when the sun shines, I'll be a little better. Regards, Mark Amundsen Encounter Messages Read Composed Y 4/11/2012 1:15 PM Y 4/10/2012 7:19 AM

Electronically signed by Gloria J Newton at 4/11/2012 2:44 PM
Yelena Tsvirinko 4/10/2012 8:08 AM Signed
From: Mark Amundsen To: Victor Baquero, MD Sent: 4/10/2012 7:19 AM PDT Subject: Non-urgent Medical Advice 002038
Question Hi Dr Baquero- It's time for another refill on Methadone. I will be out Thursday, so I'm hoping to pick up a refill Wednesday afternoon. Things about the same-pain level average, but tiredness and exhaustion levels up. Maybe when the sun shines, I'll be a little better. Regards, Mark Amundsen 
Electronically signed by Yelena Tsvirinko at 4/10/2012 8:08 AM Routing History 4/10/2012 8:09 AM From Yelena Tsvirinko To Victor Baquero, MD Priority Routine
Created by Yelena Tsvirinko on 4/10/2012 8:08 AM Approved Disp Refills 270 tablet 0 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx Authorizing Provider: Victor Baquero, MD
Start 4/10/2012
End 5/3/2012
Telephone Encounter
4/5/2012 5:02 PM
Reason for Call

Refill Request
Routing History
4/5/2012 5:04 PM From Kimberly Anderson, MA To Victor Baquero, MD Priority Routine
Created by
Kimberly Anderson, MA on 4/5/2012 5:02 PM
Approved
Disp Refills 100 tablet 0 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10325 mg Tablet Sig - Route: Take 1 tablet by mouth every 4 to 6 hours if needed for pain. - ORAL Class: Pharmacy Authorizing Provider: Gertrudes Perlas Montemayor, MD Start 4/5/2012 End 5/29/2012

Disp Refills Start End 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL
002039
From: Mark Amundsen To: Victor Baquero, MD Sent: 5/3/2012 9:44 AM PDT Subject: Non-urgent Medical Advice Question Hi Dr Baquero- It's about time for another refill on Methadone. I will be out next Wednesday early, so I'd like to pick up a script for refill on Tuesday May 8th. I'm selling my house, but trying to stay in Folsom. Looking for a nice condo, easier to take care of. Happen to know of any? Thanks for all your help in this matter Mark Amundsen 
Electronically signed by Clare Jennings, MA at 5/3/2012 10:21 AM Routing History 5/3/2012 10:21 AM
From Clare Jennings, MA To Victor Baquero, MD Priority Routine
Created by Clare Jennings, MA on 5/3/2012 10:21 AM Approved Disp Refills 270 tablet 0 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx Authorizing Provider: Victor Baquero, MD Start 5/3/2012 End 5/29/2012
Patient Email
Orders
DOB 9/23/1959
Encounter Messages MyChart message report Message [1087331] From Mark Amundsen To Victor Baquero, MD Sent 4/11/2012 11:42 AM For Delivery 4/11/2012 11:42 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Clare and Dr BaqueroBody Just wanted to check and see if you received my message about a methadone refill. I will be out tomorrow morning, so I'm hoping to pick one up this afternoon. Thanks for your attention in this matter-
002040
From: Mark Amundsen To: Victor Baquero, MD Sent: 5/29/2012 12:09 PM PDT Subject: Non-urgent Medical Advice Question Hi Dr Baquero- It's about time for another Methadone refill. I will be out Saturday morning, so I would like to pick up a refill script on Friday the 1st of June. Thank you for your attention in this matter Mark Amundsen 
Electronically signed by Clare Jennings, MA at 5/29/2012 12:40 PM Routing History From 5/29/2012 12:41 PM Clare Jennings, MA Created by Clare Jennings, MA on 5/29/2012 12:40 PM Approved Disp Refills 270 tablet 0 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx Authorizing Provider: Victor Baquero, MD Start 5/29/2012 End 6/25/2012 To Victor Baquero, MD Priority Routine
Patient Email
Orders
DOB 9/23/1959
Message [1133840]
002041
Message Body
Mark, The triplicate prescription will be ready to pick up on Monday. Thank you for the timely request. Sorry, no leads on a condo. ----- Message ----From: AMUNDSEN,MARK Sent: 5/3/2012 9:44 AM PDT To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's about time for another refill on Methadone. I will be out next Wednesday early, so I'd like to pick up a script for refill on Tuesday May 8th. I'm selling my house, but trying to stay in Folsom. Looking for a nice condo, easier to take care of. Happen to know of any? Thanks for all your help in this matterMark Amundsen
MyChart message report Message [1133339] From Mark Amundsen To Victor Baquero, MD Sent 5/3/2012 9:44 AM For Delivery 5/3/2012 9:44 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody It's about time for another refill on Methadone. I will be out next Wednesday early, so I'd like to pick up a script for refill on Tuesday May 8th. I'm selling my house, but trying to stay in Folsom. Looking for a nice condo, easier to take care of. Happen to know of any? Thanks for all your help in this matterMark Amundsen Encounter Messages Read Composed Y 5/3/2012 12:27 PM Y 5/3/2012 9:44 AM

002042
Reason for Call

Refill Request
Routing History
5/29/2012 3:34 PM From Aneeka Dibble To Victor Baquero, MD Priority Routine
Created by
Aneeka Dibble on 5/29/2012 3:33 PM
Approved
Disp Refills 100 tablet 0 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10325 mg Tablet Sig - Route: Take 1 tablet by mouth every 4 to 6 hours if needed for pain. - ORAL Class: Pharmacy Authorizing Provider: Victor Baquero, MD Start 5/29/2012 End 7/19/2012

Disp Refills Start End 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 11 11/4/2011 11/3/2012 Levothyroxine (SYNTHROID) 75 mcg Tablet Sig - Route: Take 1 Tab by mouth every morning before a meal. take on an empty stomach - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 60 tablet 0 2/21/2012 5/23/2012 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 tablets by mouth every day at bedtime. - ORAL Class: Pharmacy 270 tablet 0 5/3/2012 5/29/2012 Methadone (DOLOPHINE) 10 mg Tablet (Discontinued) Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx

Patient Email
Orders
DOB 9/23/1959
Encounter Messages MyChart message report From Victor Baquero, MD To Mark Amundsen
Message [1181649]
002043
5/30/2012 9:32 AM 5/30/2012 9:32 AM RE: Non-urgent Medical Advice Question Victor Baquero, MD, MD 12/13/2012 1:59 PM Mark Amundsen
Mark, The prescription is ready to pick up at our front desk. ----- Message ----From: AMUNDSEN,MARK Sent: 5/29/2012 12:09 PM PDT To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's about time for another Methadone refill. I will be out Saturday morning, so I would like to pick up a refill script on Friday the 1st of June. Thank you for your attention in this matterMark Amundsen
MyChart message report Message [1179465] From Mark Amundsen To Victor Baquero, MD Sent 5/29/2012 12:09 PM For Delivery 5/29/2012 12:09 PM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody It's about time for another Methadone refill. I will be out Saturday morning, so I would like to pick up a refill script on Friday the 1st of June. Thank you for your attention in this matterMark Amundsen
Encounter Messages Read Composed Y 5/30/2012 9:32 AM Y 5/29/2012 12:09 PM
Triplicate written. Please notify patient. 002044

Encounter Messages MyChart message report From Victor Baquero, MD To Mark Amundsen Sent 6/25/2012 9:14 AM For Delivery 6/25/2012 9:14 AM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 12/13/2012 1:59 PM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, Body The prescription is ready to pick up at our front desk. tc ----- Message ----From: AMUNDSEN,MARK Sent: 6/25/2012 8:46 AM PDT To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr Baquero-
Message [1228884]
It's time for another refill on Methadone. I will be out on Wednesday morning, so I'm hoping to pick up a script on Tuesday. Sorry for the short notice, but I didn't notice I was getting so low until this weekend. Thank you for your attention in this matterMark Amundsen MyChart message report Message [1228761] From Mark Amundsen To Victor Baquero, MD Sent 6/25/2012 8:46 AM For Delivery 6/25/2012 8:46 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody It's time for another refill on Methadone. I will be out on Wednesday morning, so I'm hoping to pick up a script on Tuesday. Sorry for the short notice, but I didn't notice I was getting so low until this weekend. Thank you for your attention in this matterMark Amundsen
002045
Joseph Jernigan 6/25/2012 4:29 PM Signed
Pt came in picked up prescription.

Electronically signed by Joseph Jernigan at 6/25/2012 4:29 PM

From: Mark Amundsen To: Victor Baquero, MD Sent: 6/25/2012 8:46 AM PDT Subject: Non-urgent Medical Advice Question Hi Dr Baquero- It's time for another refill on Methadone. I will be out on Wednesday morning, so I'm hoping to pick up a script on Tuesday. Sorry for the short notice, but I didn't notice I was getting so low until this weekend. Thank you for your attention in this matter Mark Amundsen 
Created by Clare Jennings, MA on 6/25/2012 9:01 AM Approved Disp Refills 270 tablet 0 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx Authorizing Provider: Victor Baquero, MD
Start 6/25/2012
End 7/17/2012
Telephone Encounter
5/30/2012 9:32 AM
002046
30 Tab 11 11/4/2011 Levothyroxine (SYNTHROID) 75 mcg Tablet Sig - Route: Take 1 Tab by mouth every morning before a meal. take on an empty stomach - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 60 tablet 0 5/30/2012 Carisoprodol (SOMA) 350 mg Tablet (Discontinued) Sig - Route: Take 2 tablets by mouth every day at bedtime. - ORAL Class: Pharmacy 0 6/25/2012 270 tablet Methadone (DOLOPHINE) 10 mg Tablet (Discontinued) Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx
11/3/2012
11/16/2011
7/19/2012
7/17/2012

Patient Email
Orders
DOB 9/23/1959

Encounter Messages MyChart message report Message [1268538] From Mark Amundsen To Victor Baquero, MD Sent 7/17/2012 12:48 PM For Delivery 7/17/2012 12:48 PM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr Baquero-It's time for another refill on Methadone. I will be out on Saturday, so I'd Body like to pick up a script on Friday afternoon. I also submitted refill requests for Soma and hydrocodone through Walgreens. Thank you for your attention in this matter-Mark Amundsen Encounter Messages Read Composed Y 7/17/2012 12:48 PM
From Mark Amundsen
Julie Stewart 7/19/2012 4:47 PM Signed
Patient picked up written rx, verified id with CDL

002047
Patient informed that RX is at the front desk


From: Mark Amundsen To: Victor Baquero, MD Sent: 7/17/2012 12:48 PM PDT Subject: Non-urgent Medical Advice Question Hi Dr Baquero-It's time for another refill on Methadone. I will be out on Saturday, so I'd like to pick up a script on Friday afternoon. I also submitted refill requests for Soma and hydrocodone through Walgreens. Thank you for your attention in this matter-Mark Amundsen 
Electronically signed by Clare Jennings, MA at 7/17/2012 1:27 PM Routing History 7/19/2012 1:01 PM 7/17/2012 1:29 PM
Created by Clare Jennings, MA on 7/17/2012 1:28 PM Approved Disp Refills Start 60 tablet 0 7/17/2012 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 tablets by mouth every day at bedtime. - ORAL Class: Pharmacy Authorizing Provider: Victor Baquero, MD 270 tablet 0 7/17/2012 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx Authorizing Provider: Victor Baquero, MD 100 tablet 0 7/17/2012 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO 10) 10-325 mg per tablet Sig - Route: Take 1 tablet by mouth every 4 to 6 hours if needed for pain. - ORAL Class: Pharmacy Authorizing Provider: Victor Baquero, MD Pharmacy Selected For Prescriptions WALGREENS DRUG STORE 09048 | 2595 E BIDWELL ST | FOLSOM | CA | 95630 End 8/22/2012
8/8/2012
8/16/2012
Patient Email
Orders
DOB 9/23/1959
002048
Sig - Route: Take 1 tablet by mouth every 4 to 6 hours if needed for pain. - ORAL Class: Pharmacy Authorizing Provider: Victor Baquero, MD

Disp Refills Start End 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 11 11/4/2011 11/3/2012 Levothyroxine (SYNTHROID) 75 mcg Tablet Sig - Route: Take 1 Tab by mouth every morning before a meal. take on an empty stomach - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 60 tablet 0 7/17/2012 8/22/2012 Carisoprodol (SOMA) 350 mg Tablet (Discontinued) Sig - Route: Take 2 tablets by mouth every day at bedtime. - ORAL Class: Pharmacy 60 tablet 0 7/19/2012 10/19/2012 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 tablets by mouth every day at bedtime. - ORAL Class: Pharmacy 270 tablet 0 8/8/2012 9/7/2012 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx

Patient Email
Orders
DOB 9/23/1959

Encounter Messages MyChart message report Message [1317051] From Mark Amundsen To Victor Baquero, MD Sent 8/9/2012 7:51 AM For Delivery 8/9/2012 7:51 AM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Thanks Dr BaqueroBody It turns out I'm not going to Reno after all - my brother decided I would be too much of a bother. I'm moving in with a neighbor. And yes, the boxes are flying out of Home Depot -
002049
lots of people downsizing. I need to come in and talk about some things... once this gets settled... Thanks againMark ----- Message ----From: Victor Henrique Baquero, MD Sent: 8/8/2012 5:12 PM PDT To: Mark Amundsen Subject: RE: Non-urgent Medical Advice Question Thanks for the heads up and for the offer. Interestingly, you are the second person offering me washers and driers this week. If I find out that someone needs one I'll let you know. Thank you. I'll have the prescription ready on Friday. ----- Message ----From: AMUNDSEN,MARK Sent: 8/8/2012 3:24 PM PDT To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI have a pharmaceutical issue. Although I know this isn't recommended, I've been having to up my methadone dose significantly in the last week, due to a number of people and organizations flaking on helping me move out of the house. I will probably be out on Sunday or Monday if I continue, which I don't really have a choice. I am hoping to get a refill on Methdone Friday. This issue will not, repeat NOT, manifest itself again. On another note, please let me know if you need any household goods - I've got WAYYY too much...particularly a washer dryer, and pool table Mark MyChart message report Message [1316376] From Victor Baquero, MD To Mark Amundsen Sent 8/8/2012 5:12 PM For Delivery 8/8/2012 5:12 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 12/13/2012 1:59 PM MyChart Mark Amundsen By Responsibility Audit Trail Message Thanks for the heads up and for the offer. Interestingly, you are the second person Body offering me washers and driers this week. If I find out that someone needs one I'll let you know. Thank you. I'll have the prescription ready on Friday. ----- Message ----From: AMUNDSEN,MARK Sent: 8/8/2012 3:24 PM PDT To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr Baquero-
002050
I have a pharmaceutical issue. Although I know this isn't recommended, I've been having to up my methadone dose significantly in the last week, due to a number of people and organizations flaking on helping me move out of the house. I will probably be out on Sunday or Monday if I continue, which I don't really have a choice. I am hoping to get a refill on Methdone Friday. This issue will not, repeat NOT, manifest itself again. On another note, please let me know if you need any household goods - I've got WAYYY too much...particularly a washer dryer, and pool table Mark MyChart message report Message [1316089] From Mark Amundsen To Victor Baquero, MD Sent 8/8/2012 3:24 PM For Delivery 8/8/2012 3:24 PM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody I have a pharmaceutical issue. Although I know this isn't recommended, I've been having to up my methadone dose significantly in the last week, due to a number of people and organizations flaking on helping me move out of the house. I will probably be out on Sunday or Monday if I continue, which I don't really have a choice. I am hoping to get a refill on Methdone Friday. This issue will not, repeat NOT, manifest itself again. On another note, please let me know if you need any household goods - I've got WAYYY too much...particularly a washer dryer, and pool table Mark Encounter Messages Read Composed Y 8/9/2012 7:51 AM Y 8/8/2012 5:12 PM Y 8/8/2012 3:24 PM
Julie Stewart 8/10/2012 2:57 PM Signed
Patient picked up paperwork, CDL verified.

From: Mark Amundsen To: Victor Baquero, MD Sent: 8/8/2012 3:24 PM PDT Subject: Non-urgent Medical Advice Question Hi Dr Baquero- I have a pharmaceutical issue. Although I know this isn't recommended, I've been having to up my methadone dose significantly in the last week, due to a number of people and organizations flaking on helping me move out of the house. I will probably be out on Sunday or Monday if I continue, which I don't really have a choice. I am hoping to get a refill on Methdone Friday. This issue will not, repeat NOT, manifest itself again. On another note, please let me know if 002051
you need any household goods - I've got WAYYY too much...particularly a washer dryer, and pool table Mark 
Electronically signed by Clare Jennings, MA at 8/8/2012 4:01 PM Routing History 8/8/2012 4:01 PM From Clare Jennings, MA To Victor Baquero, MD Priority Routine
Created by Clare Jennings, MA on 8/8/2012 4:01 PM Approved Disp Refills 270 tablet 0 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx Authorizing Provider: Victor Baquero, MD
Start 8/8/2012
End 9/6/2012
Telephone Encounter
7/19/2012 11:09 AM
Reason for Call

Refill Request
Routing History
7/19/2012 11:10 AM
From Clare Jennings, MA To Victor Baquero, MD Priority Routine
Created by
Approved
Disp Refills 60 tablet 0 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 tablets by mouth every day at bedtime. - ORAL Class: Pharmacy Authorizing Provider: Victor Baquero, MD 0 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO 10) 10- 100 tablet 325 mg per tablet Sig - Route: Take 1 tablet by mouth every 4 to 6 hours if needed for pain. - ORAL Class: Pharmacy Authorizing Provider: Victor Baquero, MD Start 7/19/2012 End 9/24/2012
7/19/2012
8/22/2012

Disp Refills Start End 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy
002052
new script Thursday (today). Also, I forgot to tell you - I have moved 2 houses up the street (2025 Tarbolton Cir), and am now at 916-983-4484 - perhaps y'all left a message about the refill at the old number. Thank you for your attention in this matter Mark Amundsen 
Electronically signed by Michele Melendez at 9/6/2012 10:07 AM Routing History
9/6/2012 3:03 PM 9/6/2012 10:07 AM From Michele Melendez Michele Melendez To Victor Baquero, MD Victor Baquero, MD Priority Routine Routine
Created by Michele Melendez on 9/6/2012 10:07 AM Approved Disp Refills 270 tablet 0 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx Authorizing Provider: Victor Baquero, MD Start 9/6/2012 End 9/28/2012
Patient Email
Orders
DOB 9/23/1959
Encounter Messages MyChart message report Message [1363905] From Mark Amundsen To Victor Baquero, MD Sent 9/4/2012 6:41 AM For Delivery 9/4/2012 6:41 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody It's time for another refill on Methadone. I will be out on Friday, so I'd like to pick up a refill on Thirsday afternoon. I need to come in for a consult. I'm having severe pains in my wrists, of all locations. Hoping there might be something that can be done. I have been using them as little as possible, but they're pretty damn important...
002053
Regards,
Mark Amundsen
Encounter Messages Read Composed From Y 9/4/2012 6:41 Mark AM Amundsen
Encounter Documentation Michele Melendez 9/4/2012 8:14 AM Signed From: Mark Amundsen To: Victor Baquero, MD Sent: 9/4/2012 6:41 AM PDT Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's time for another refill on Methadone. I will be out on Friday, so I'd like to pick up a refill on Thirsday afternoon. I need to come in for a consult. I'm having severe pains in my wrists, of all locations. Hoping there might be something that can be done. I have been using them as little as possible, but they're pretty damn important... Regards, Mark Amundsen
Electronically signed by Michele Melendez at 9/4/2012 8:14 AM
Routing History
9/4/2012 8:15 AM From Michele Melendez To Victor Baquero, MD Priority Routine
Created by Michele Melendez on 9/4/2012 8:14 AM

Patient Name Amundsen, Mark MRN 8081369 Sex Male DOB 9/23/1959 PATIENTPHONE 916-509-0158 Mark Amundsen (MRN8081369)
Telephone Encounter
8/22/2012 9:46 AM
Reason for Call

Refill Request
Routing History
8/22/2012 9:47 AM From Clare Jennings, MA To Victor Baquero, MD Priority Routine
Created by
Approved
Disp 60 tablet Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 tablets by mouth every day at bedtime. - ORAL Class: Pharmacy Authorizing Provider: Victor Baquero, MD Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO 10) 10- 100 tablet 325 mg per tablet Refills 0 Start 8/22/2012 End 11/22/2012
8/22/2012
9/24/2012
002054
Approved
Disp Refills 0 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO 10) 10- 100 tablet 325 mg per tablet Sig - Route: Take 1 tablet by mouth every 4 to 6 hours if needed for pain. - ORAL Class: Pharmacy Authorizing Provider: Victor Baquero, MD 60 tablet 0 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 tablets by mouth every day at bedtime. - ORAL Class: Pharmacy Authorizing Provider: Victor Baquero, MD Start 9/24/2012 End 10/22/2012
9/24/2012
10/22/2012

Disp Refills Start End 60 tablet 0 8/22/2012 11/22/2012 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 tablets by mouth every day at bedtime. - ORAL Class: Pharmacy 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 11 11/4/2011 11/3/2012 Levothyroxine (SYNTHROID) 75 mcg Tablet Sig - Route: Take 1 Tab by mouth every morning before a meal. take on an empty stomach - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 60 tablet 0 7/19/2012 9/24/2012 Carisoprodol (SOMA) 350 mg Tablet (Discontinued) Sig - Route: Take 2 tablets by mouth every day at bedtime. - ORAL Class: Pharmacy 270 tablet 0 9/6/2012 10/6/2012 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx

Patient Email
Orders
DOB 9/23/1959
Message [1370955]
002055
RE: Non-urgent Medical Advice Question Victor Baquero, MD, MD 12/13/2012 1:59 PM Mark Amundsen
Sounds good. See you soon. ----- Message ----From: AMUNDSEN,MARK Sent: 9/6/2012 2:20 PM PDT To: Victor Henrique Baquero, MD Subject: RE: Non-urgent Medical Advice Question Hi Dr BaqueroI'll make sure to update both sets of info while I'm there. I still need to make an appt for the wrist thing, although it seems to be getting better. And no jokes about what I'm using my wrists for... Mark Amundsen ----- Message ----From: Victor Henrique Baquero, MD Sent: 9/6/2012 1:37 PM PDT To: Mark Amundsen Subject: RE: Non-urgent Medical Advice Question Mark, The prescription is ready to pick up at our front desk. Be sure to update your address with our front desk staff as well. They do not let the physicians change demographic information - too much responsibility I guess. ----- Message ----From: AMUNDSEN,MARK Sent: 9/6/2012 2:20 AM PDT To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI just wanted to send a quick reminder about the need for a new methadone prescription. I will be out Friday morning (tomorrow), so I'd like to pick up a new script Thursday (today). Also, I forgot to tell you - I have moved 2 houses up the street (2025 Tarbolton Cir), and am now at 916-983-4484 - perhaps y'all left a message about the refill at the old number. Thank you for your attention in this matterMark Amundsen
MyChart message report From Mark Amundsen To Victor Baquero, MD Sent 9/6/2012 2:20 PM For Delivery 9/6/2012 2:20 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD
Message [1370787]
002056
Hi Dr BaqueroI'll make sure to update both sets of info while I'm there. I still need to make an appt for the wrist thing, although it seems to be getting better. And no jokes about what I'm using my wrists for... Mark Amundsen ----- Message ----From: Victor Henrique Baquero, MD Sent: 9/6/2012 1:37 PM PDT To: Mark Amundsen Subject: RE: Non-urgent Medical Advice Question Mark, The prescription is ready to pick up at our front desk. Be sure to update your address with our front desk staff as well. They do not let the physicians change demographic information - too much responsibility I guess. ----- Message ----From: AMUNDSEN,MARK Sent: 9/6/2012 2:20 AM PDT To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI just wanted to send a quick reminder about the need for a new methadone prescription. I will be out Friday morning (tomorrow), so I'd like to pick up a new script Thursday (today). Also, I forgot to tell you - I have moved 2 houses up the street (2025 Tarbolton Cir), and am now at 916-983-4484 - perhaps y'all left a message about the refill at the old number. Thank you for your attention in this matterMark Amundsen
MyChart message report Message [1370653] From Victor Baquero, MD To Mark Amundsen Sent 9/6/2012 1:37 PM For Delivery 9/6/2012 1:37 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 12/13/2012 1:59 PM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, Body The prescription is ready to pick up at our front desk. Be sure to update your address with our front desk staff as well. They do not let the physicians change demographic information - too much responsibility I guess. ----- Message ----From: AMUNDSEN,MARK
002057
Sent: 9/6/2012 2:20 AM PDT To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI just wanted to send a quick reminder about the need for a new methadone prescription. I will be out Friday morning (tomorrow), so I'd like to pick up a new script Thursday (today). Also, I forgot to tell you - I have moved 2 houses up the street (2025 Tarbolton Cir), and am now at 916-983-4484 - perhaps y'all left a message about the refill at the old number. Thank you for your attention in this matterMark Amundsen MyChart message report Message [1369432] From Mark Amundsen To Victor Baquero, MD Sent 9/6/2012 2:20 AM For Delivery 9/6/2012 2:20 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody I just wanted to send a quick reminder about the need for a new methadone prescription. I will be out Friday morning (tomorrow), so I'd like to pick up a new script Thursday (today). Also, I forgot to tell you - I have moved 2 houses up the street (2025 Tarbolton Cir), and am now at 916-983-4484 - perhaps y'all left a message about the refill at the old number. Thank you for your attention in this matterMark Amundsen Encounter Messages Read Composed Y 9/6/2012 3:09 PM Y 9/6/2012 2:20 PM Y 9/6/2012 1:37 PM Y 9/6/2012 2:20 AM
Caroline Garcia 9/6/2012 3:32 PM Signed
Patient picked up prescription. Verified ID by CA DL

Electronically signed by Caroline Garcia at 9/6/2012 3:32 PM
Michele Melendez 9/6/2012 10:07 AM Signed
From: Mark Amundsen To: Victor Baquero, MD Sent: 9/6/2012 2:20 AM PDT Subject: Non-urgent Medical Advice Question Hi Dr Baquero- I just wanted to send a quick reminder about the need for a new methadone prescription. I will be out Friday morning (tomorrow), so I'd like to pick up a 002058
Victor Baquero, MD
10/1/2012 4:42 PM Mark Amundsen (MRN8081369)

Patient Information
Telephone Encounter
9/28/2012 5:03 PM
Call Documentation
Pt. Picked up prescription and showed I.D.

Created by
Gloria J Newton on 9/28/2012 5:03 PM

Disp Refills Start End 60 tablet 0 8/22/2012 11/22/2012 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 tablets by mouth every day at bedtime. - ORAL Class: Pharmacy 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 11 11/4/2011 11/3/2012 Levothyroxine (SYNTHROID) 75 mcg Tablet Sig - Route: Take 1 Tab by mouth every morning before a meal. take on an empty stomach - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 60 tablet 0 9/24/2012 12/25/2012 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 tablets by mouth every day at bedtime. - ORAL Class: Pharmacy 100 tablet 0 9/24/2012 10/24/2012 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO 10) 10-325 mg per tablet Sig - Route: Take 1 tablet by mouth every 4 to 6 hours if needed for pain. - ORAL Class: Pharmacy 270 tablet 0 9/28/2012 10/28/2012 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx
Patient Email
Orders
DOB 9/23/1959
Patient Email Encounter

Provider Department
002059
9/28/2012 11:05 AM
Fol Family Practice
Encounter Messages MyChart message report From Victor Baquero, MD To Mark Amundsen Sent 9/28/2012 1:14 PM For Delivery 9/28/2012 1:14 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 12/13/2012 1:59 PM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, Body The prescription is ready to pick up at our front desk. Take care.
Message [1424929]
----- Message ----From: AMUNDSEN,MARK Sent: 9/28/2012 9:54 AM PDT To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's time for another Methadone refill. I will be out on Wednesday, so I would like to pick up a script on Tuesday afternoon (Oct 2). I wanted to give you a couple of days advance notice. I figured out the wrist pain issue - it was a task I recently started performing, and have since stopped. I think combined with the cane use, it was too much for my wrists...
Mark Amundsen
MyChart message report Message [1424479] From Mark Amundsen To Victor Baquero, MD Sent 9/28/2012 9:54 AM For Delivery 9/28/2012 9:54 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody It's time for another Methadone refill. I will be out on Wednesday, so I would like to pick up a script on Tuesday afternoon (Oct 2). I wanted to give you a couple of days advance notice. I figured out the wrist pain issue - it was a task I recently started performing, and have since stopped. I think combined with the cane use, it was too much for my wrists...
002060
Mark Amundsen Encounter Messages Read Composed Y 9/28/2012 1:14 PM Y 9/28/2012 9:54 AM
Encounter Documentation Clare Jennings, MA 9/28/2012 11:05 AM Signed From: Mark Amundsen To: Victor Baquero, MD Sent: 9/28/2012 9:54 AM PDT Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's time for another Methadone refill. I will be out on Wednesday, so I would like to pick up a script on Tuesday afternoon (Oct 2). I wanted to give you a couple of days advance notice. I figured out the wrist pain issue - it was a task I recently started performing, and have since stopped. I think combined with the cane use, it was too much for my wrists... Mark Amundsen Electronically signed by Clare Jennings, MA at 9/28/2012 11:05 AM Routing History From 9/28/2012 11:06 AM Clare Jennings, MA Created by Clare Jennings, MA on 9/28/2012 11:05 AM Approved
Disp Refills 270 tablet 0 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx Authorizing Provider: Victor Baquero, MD Telephone/Refill Encounter
Priority Routine
Start 9/28/2012
End 10/23/2012
Telephone Encounter
9/24/2012 3:39 PM
Reason for Call

Refill Request
Routing History
9/24/2012 3:41 PM 9/24/2012 3:40 PM From Clare Jennings, MA Clare Jennings, MA To Victor Baquero, MD Victor Baquero, MD Priority Routine Routine
Created by
002061
10/1/2012 2:25 PM
Call Documentation
Pharmacy informed
Okay to refill early.

Fax from pharmacy stating that patient is asking for a early fill on his Methadone. He is six days early he said he has moved and had to use a little more, please advise. Pharmacy is Walgreens, phone 916-817-6533
Routing History
10/1/2012 4:27 PM 10/1/2012 2:28 PM
Created by

Disp Refills Start End 60 tablet 0 8/22/2012 11/22/2012 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 tablets by mouth every day at bedtime. - ORAL Class: Pharmacy 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 11 11/4/2011 11/3/2012 Levothyroxine (SYNTHROID) 75 mcg Tablet Sig - Route: Take 1 Tab by mouth every morning before a meal. take on an empty stomach - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 60 tablet 0 9/24/2012 12/25/2012 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 tablets by mouth every day at bedtime. - ORAL Class: Pharmacy 100 tablet 0 9/24/2012 10/24/2012 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO 10) 10-325 mg per tablet Sig - Route: Take 1 tablet by mouth every 4 to 6 hours if needed for pain. - ORAL Class: Pharmacy 270 tablet 0 9/28/2012 10/28/2012 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx
Orders Chart Cosign

Accepted By Accepted On
002062
Amundsen, Mark
8081369
Male
9/23/1959
916-509-0158
Encounter Messages MyChart message report From Victor Baquero, MD To Mark Amundsen Sent 10/23/2012 9:01 AM For Delivery 10/23/2012 9:01 AM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 12/13/2012 1:59 PM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, Body Prescription will be ready to pick up on Thursday. Take care. . ----- Message ----From: AMUNDSEN,MARK Sent: 10/23/2012 8:10 AM PDT To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question
Message [1462225]
Hi Dr BaqueroIt's about time for another refill on the Methadone prescription. As I will be going to Reno to visit my brother this weekend, I would like to pick up a script Thursday afternoon to be filled on Friday, so I can leave first thing. Also, if you could write a short note letting the pharmacy know the circumstances, they shouldn't have to call about an early refill. As an aside, arthritis is really bad, in many areas. Both hands, right knee, right ankle, back, and usual places. Could be progression? Should I come in? Recommendations? Mark Amundsen MyChart message report Message [1462080] From Mark Amundsen To Victor Baquero, MD Sent 10/23/2012 8:10 AM For Delivery 10/23/2012 8:10 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody It's about time for another refill on the Methadone prescription. As I will be going to Reno to visit my brother this weekend, I would like to pick up a script Thursday afternoon to be filled on Friday, so I can leave first thing. Also, if you could write a short note letting the pharmacy know the circumstances, they shouldn't have to call about an early refill. As an aside, arthritis is really bad, in many areas. Both hands, right knee, right ankle, back, and usual places. Could be progression? Should I come in? Recommendations? Mark Amundsen
002063
Dannel Cameron 10/25/2012 11:00 AM Signed
Patient picked up prescription. known

Electronically signed by Dannel Cameron at 10/25/2012 11:00 AM
From: Mark Amundsen To: Victor Baquero, MD Sent: 10/23/2012 8:10 AM PDT Subject: Non-urgent Medical Advice Question Hi Dr Baquero- It's about time for another refill on the Methadone prescription. As I will be going to Reno to visit my brother this weekend, I would like to pick up a script Thursday afternoon to be filled on Friday, so I can leave first thing. Also, if you could write a short note letting the pharmacy know the circumstances, they shouldn't have to call about an early refill. As an aside, arthritis is really bad, in many areas. Both hands, right knee, right ankle, back, and usual places. Could be progression? Should I come in? Recommendations? Mark Amundsen 
Created by Clare Jennings, MA on 10/23/2012 8:57 AM Approved Disp Refills 270 tablet 0 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx Authorizing Provider: Victor Baquero, MD
Start 10/23/2012
End 11/20/2012
Telephone Encounter
10/22/2012 9:21 AM
002064
Reason for Call

Refill Request
Routing History
10/22/2012 9:23 AM 10/22/2012 9:22 AM
From Clare Jennings, MA Clare Jennings, MA
To Victor Baquero, MD Victor Baquero, MD
Created by
Approved
Disp Refills 0 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO 10) 10- 100 tablet 325 mg per tablet Sig - Route: Take 1 tablet by mouth every 4 to 6 hours if needed for pain. - ORAL Class: Pharmacy Authorizing Provider: Victor Baquero, MD 60 tablet 0 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 tablets by mouth every day at bedtime. - ORAL Class: Pharmacy Authorizing Provider: Victor Baquero, MD Start 10/22/2012 End 11/19/2012
10/22/2012
11/19/2012

Disp Refills Start End 60 tablet 0 8/22/2012 11/22/2012 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 tablets by mouth every day at bedtime. - ORAL Class: Pharmacy 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 11 11/4/2011 11/3/2012 Levothyroxine (SYNTHROID) 75 mcg Tablet Sig - Route: Take 1 Tab by mouth every morning before a meal. take on an empty stomach - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 60 tablet 0 9/24/2012 10/22/2012 Carisoprodol (SOMA) 350 mg Tablet (Discontinued) Sig - Route: Take 2 tablets by mouth every day at bedtime. - ORAL Class: Pharmacy 100 tablet 0 9/24/2012 10/22/2012 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO 10) 10-325 mg per tablet (Discontinued) Sig - Route: Take 1 tablet by mouth every 4 to 6 hours if needed for pain. - ORAL Class: Pharmacy 270 tablet 0 9/28/2012 10/28/2012 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx

DOB 9/23/1959
Telephone Encounter
002065
Medication Problem
Call Documentation
Sheri L Barr, RN 11/19/2012 12:31 PM Signed
Appt made.
Electronically signed by Sheri L Barr, RN at 11/19/2012 12:31 PM
Request appointment please

Sheri L Barr, RN 11/19/2012 11:37 AM Signed
Mark Amundsen is a 53yr old male 3 patient identifiers used. Per: patient Reason for Call: Medication problem Symptoms: Patient feels his Methadone is not effective anymore. It has been decreasing in the last couple weeks. He wonders if he can get an appt with Dr. Baquero or can the medicine be increased. He also sent a my chart message. Homecare and/or Medications given: none Advice: Consult MD Pain: no Pain location and 1-10: na Disposition: Consult with MD-can this be handled over the phone or can I use spots this week? Is 15 min ok? Per: patient verbalizes agreement to plan. Agrees to callback with any increase in symptoms/concerns or questions. Sheri Barr RN PCN Triage
Electronically signed by Sheri L Barr, RN at 11/19/2012 11:37 AM
Routing History
11/19/2012 12:05 PM 11/19/2012 11:37 AM
From Victor Baquero, MD Sheri L Barr, RN To Sheri L Barr, RN Victor Baquero, MD Priority Routine Routine
Created by
Sheri L Barr, RN on 11/19/2012 11:32 AM

Disp Refills Start End 60 tablet 0 8/22/2012 11/22/2012 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 tablets by mouth every day at bedtime. - ORAL Class: Pharmacy 8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL
002066
Class: Pharmacy 60 tablet 0 Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 tablets by mouth every day at bedtime. - ORAL Class: Pharmacy 100 tablet 0 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO 10) 10-325 mg per tablet Sig - Route: Take 1 tablet by mouth every 4 to 6 hours if needed for pain. - ORAL Class: Pharmacy 270 tablet 0 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx
10/22/2012
1/22/2013
10/22/2012
11/21/2012
10/23/2012
11/22/2012
Orders Chart Cosign

Appointment
Center None
002067
Management Folsom
Patient Email


Encounter Messages MyChart message report Message [1509544] From Victor Baquero, MD To Mark Amundsen Sent 11/19/2012 12:23 PM For Delivery 11/19/2012 12:23 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 12/13/2012 1:59 PM MyChart Mark Amundsen By Responsibility Audit Trail Message Yes, I would like to see you to discuss options. If I dont see you this week I'll refill the Body current dose until we can meet. ----- Message ----From: AMUNDSEN,MARK Sent: 11/19/2012 12:10 AM PST To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's about time for another refill on Methadone. I will be out early Friday morning, but since I am assuming you will be closed Thursday and Friday, I'm hoping I can pick up a refill prescription on Wednesday. I'll have to check to make sure y'all are there this week. Methadone is not working very well. Seems to be working only 21-22 hrs versus normal 24. Would like to increase dosage - should I come in to discuss? Thanks, Mark Amundsen MyChart message report From Mark Amundsen To Victor Baquero, MD Sent 11/19/2012 12:10 AM For Delivery 11/19/2012 12:10 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message [1508519]
002068
Message Body
Hi Dr BaqueroIt's about time for another refill on Methadone. I will be out early Friday morning, but since I am assuming you will be closed Thursday and Friday, I'm hoping I can pick up a refill prescription on Wednesday. I'll have to check to make sure y'all are there this week. Methadone is not working very well. Seems to be working only 21-22 hrs versus normal 24. Would like to increase dosage - should I come in to discuss? Thanks, Mark Amundsen
Encounter Documentation Clare Jennings, MA 11/19/2012 8:57 AM Signed From: Mark Amundsen To: Victor Baquero, MD Sent: 11/19/2012 12:10 AM PST Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's about time for another refill on Methadone. I will be out early Friday morning, but since I am assuming you will be closed Thursday and Friday, I'm hoping I can pick up a refill prescription on Wednesday. I'll have to check to make sure y'all are there this week. Methadone is not working very well. Seems to be working only 21-22 hrs versus normal 24. Would like to increase dosage - should I come in to discuss? Thanks, Mark Amundsen Electronically signed by Clare Jennings, MA at 11/19/2012 8:57 AM Routing History 11/19/2012 8:58 AM From Clare Jennings, MA To Victor Baquero, MD Priority Routine
Created by Clare Jennings, MA on 11/19/2012 8:57 AM Refused Disp Refills 270 tablet 0 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx Reason for Refusal: Patient needs appointment Refused By: Victor Baquero, MD Start 11/19/2012 End 12/19/2012
Orders
Patient Email
Mark Amundsen (MRN 8081369) DOB PATIENTPHONE
002069
Victor Baquero, MD
1/2/2013 5:44 PM Mark Amundsen (MRN 8081369)

Patient Email

Encounter Messages MyChart message report Message [1541957] From Mark Amundsen To Victor Baquero, MD Sent 12/11/2012 3:38 PM For Delivery 12/11/2012 3:38 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody This sounds like a solid plan. I would ask that if there is any way to expedite the pain management request, perhaps that could be done? The situation is getting worse again, although it was okay for a couple of days. I think the weather is causing most of the fluctuation, although I have also stopped drinking coffee as an experiment. I am going to be out of methadone around Friday evening, due to the decreasing efficacy. I am hoping I can pick up a script Friday morning sometime, so the pharmacy can straighten out any questions they may have. Thanks again for the assistance with the pain clinic... Mark Amundsen ----- Message ----From: Victor Henrique Baquero, MD Sent: 12/7/2012 2:43 PM PST To: Mark Amundsen Subject: RE: Non-urgent Medical Advice Question Mark, I placed a referral for the pain clinic to contact you. I would like to get their opinion on how best to change the management of pain medications and see if there is other treatment options as well. After the consultation we can make the appropriate changes. ----- Message ----From: AMUNDSEN,MARK Sent: 12/7/2012 9:25 AM PST To: Victor Henrique Baquero, MD Subject: RE: Non-urgent Medical Advice Question Hi Dr BaqueroThat would be great - hopefully, they can act soon. Back pain has lessened since "evacuation", but is still there. Keeping fingers crossed... Mark Amundsen
002070
----- Message ----From: Victor Henrique Baquero, MD Sent: 12/7/2012 8:32 AM PST To: Mark Amundsen Subject: RE: Non-urgent Medical Advice Question Mark, Ideally I would like to consult with our pain clinic. Can I refer you to them for medication management and recommendations? ----- Message ----From: AMUNDSEN,MARK Sent: 12/6/2012 8:08 AM PST To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroHaving another failure of pain meds to control pain. Worst pain in lower back (new, 2 days), with elevated pain in normal areas (hips, knees, ankles,feet).Took laxative this morning to make sure back pain isn't constipation. Titrating methadone works somewhat, but not much. Don't know what to do - hoping for suggestions. Awaiting your recommendations... Regards, Mark Amundsen P.S. What does increased metabolism suggest? (from thyroid blood test) MyChart message report Message [1536895] From Victor Baquero, MD To Mark Amundsen Sent 12/7/2012 2:43 PM For Delivery 12/7/2012 2:43 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 12/12/2012 6:35 PM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, Body I placed a referral for the pain clinic to contact you. I would like to get their opinion on how best to change the management of pain medications and see if there is other treatment options as well. After the consultation we can make the appropriate changes. ----- Message ----From: AMUNDSEN,MARK Sent: 12/7/2012 9:25 AM PST To: Victor Henrique Baquero, MD Subject: RE: Non-urgent Medical Advice Question Hi Dr BaqueroThat would be great - hopefully, they can act soon. Back pain has lessened since "evacuation", but is still there. Keeping fingers crossed... Mark Amundsen ----- Message ----From: Victor Henrique Baquero, MD
002071
Sent: 12/7/2012 8:32 AM PST To: Mark Amundsen Subject: RE: Non-urgent Medical Advice Question Mark, Ideally I would like to consult with our pain clinic. Can I refer you to them for medication management and recommendations? ----- Message ----From: AMUNDSEN,MARK Sent: 12/6/2012 8:08 AM PST To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroHaving another failure of pain meds to control pain. Worst pain in lower back (new, 2 days), with elevated pain in normal areas (hips, knees, ankles,feet).Took laxative this morning to make sure back pain isn't constipation. Titrating methadone works somewhat, but not much. Don't know what to do - hoping for suggestions. Awaiting your recommendations... Regards, Mark Amundsen P.S. What does increased metabolism suggest? (from thyroid blood test) MyChart message report Message [1536096] From Mark Amundsen To Victor Baquero, MD Sent 12/7/2012 9:25 AM For Delivery 12/7/2012 9:25 AM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody That would be great - hopefully, they can act soon. Back pain has lessened since "evacuation", but is still there. Keeping fingers crossed... Mark Amundsen ----- Message ----From: Victor Henrique Baquero, MD Sent: 12/7/2012 8:32 AM PST To: Mark Amundsen Subject: RE: Non-urgent Medical Advice Question Mark, Ideally I would like to consult with our pain clinic. Can I refer you to them for medication management and recommendations? ----- Message ----From: AMUNDSEN,MARK Sent: 12/6/2012 8:08 AM PST To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroHaving another failure of pain meds to control pain. Worst pain in lower back (new, 2 days), with elevated pain in normal areas (hips, knees, ankles,feet).Took laxative this morning to make sure back pain isn't constipation. Titrating methadone works somewhat,
002072
but not much. Don't know what to do - hoping for suggestions. Awaiting your recommendations... Regards, Mark Amundsen P.S. What does increased metabolism suggest? (from thyroid blood test) MyChart message report Message [1535967] From Victor Baquero, MD To Mark Amundsen Sent 12/7/2012 8:32 AM For Delivery 12/7/2012 8:32 AM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 12/13/2012 1:59 PM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, Body Ideally I would like to consult with our pain clinic. Can I refer you to them for medication management and recommendations? ----- Message ----From: AMUNDSEN,MARK Sent: 12/6/2012 8:08 AM PST To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroHaving another failure of pain meds to control pain. Worst pain in lower back (new, 2 days), with elevated pain in normal areas (hips, knees, ankles,feet).Took laxative this morning to make sure back pain isn't constipation. Titrating methadone works somewhat, but not much. Don't know what to do - hoping for suggestions. Awaiting your recommendations... Regards, Mark Amundsen P.S. What does increased metabolism suggest? (from thyroid blood test) MyChart message report Message [1534038] From Mark Amundsen To Victor Baquero, MD Sent 12/6/2012 8:08 AM For Delivery 12/6/2012 8:08 AM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody Having another failure of pain meds to control pain. Worst pain in lower back (new, 2 days), with elevated pain in normal areas (hips, knees, ankles,feet).Took laxative this morning to make sure back pain isn't constipation. Titrating methadone works somewhat, but not much. Don't know what to do - hoping for suggestions. Awaiting your recommendations... Regards, Mark Amundsen P.S. What does increased metabolism suggest? (from thyroid blood test) Encounter Messages
002073
Read Composed Y 12/11/2012 3:38 PM Y 12/7/2012 2:43 PM Y 12/7/2012 9:25 AM Y 12/7/2012 8:32 AM Y 12/6/2012 8:08 AM
From Mark Amundsen Victor Baquero, MD Mark Amundsen Victor Baquero, MD Mark Amundsen
To Victor Baquero, MD Mark Amundsen Victor Baquero, MD Mark Amundsen Victor Baquero, MD
Subject RE: Non-urgent Medical Advice Question RE: Non-urgent Medical Advice Question RE: Non-urgent Medical Advice Question RE: Non-urgent Medical Advice Question Non-urgent Medical Advice Question
Encounter Documentation Clare Jennings, MA 12/11/2012 3:54 PM Signed Addended by: JENNINGS, CLARE on: 12/11/2012 03:54 PM Modules accepted: Orders Electronically signed by Clare Jennings, MA at 12/11/2012 3:54 PM Clare Jennings, MA 12/6/2012 8:10 AM Signed From: Mark Amundsen To: Victor Baquero, MD Sent: 12/6/2012 8:08 AM PST Subject: Non-urgent Medical Advice Question Hi Dr BaqueroHaving another failure of pain meds to control pain. Worst pain in lower back (new, 2 days), with elevated pain in normal areas (hips, knees, ankles,feet).Took laxative this morning to make sure back pain isn't constipation. Titrating methadone works somewhat, but not much. Don't know what to do - hoping for suggestions. Awaiting your recommendations... Regards, Mark Amundsen P.S. What does increased metabolism suggest? (from thyroid blood test) Electronically signed by Clare Jennings, MA at 12/6/2012 8:10 AM Routing History 12/11/2012 3:54 PM 12/7/2012 9:48 AM 12/6/2012 8:10 AM From Clare Jennings, MA Clare Jennings, MA Clare Jennings, MA To Victor Baquero, MD Victor Baquero, MD Victor Baquero, MD Priority Routine Routine Routine
Orders
Order Summary PAIN MANAGEMENT REFERRAL [100048 Custom] Order #: 92474465
Appointment
Account # 078872030115
002074
Encounter Messages MyChart message report Message [1545775] From Mark Amundsen To Victor Baquero, MD Sent 12/13/2012 2:09 PM For Delivery 12/13/2012 2:09 PM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody Just wanted to make sure my message about a refill on methadone got through. Also, I wanted to check and see what you thought about trying one of the treatments for the neuropathy - I doubt the pain clinic will handle that, but maybe so. The two drugs I was recommended were Gabapentin and Pregabalin - they seem to work well for the other person I know who has neuropathy... Mark Amundsen Encounter Messages Read Composed Y 12/13/2012 2:09 PM
From Mark Amundsen
Encounter Documentation Clare Jennings, MA 12/13/2012 4:01 PM Signed From: Mark Amundsen To: Victor Baquero, MD Sent: 12/13/2012 2:09 PM PST Subject: Non-urgent Medical Advice Question Hi Dr BaqueroJust wanted to make sure my message about a refill on methadone got through. Also, I wanted to check and see what you thought about trying one of the treatments for the neuropathy - I doubt the pain clinic will handle that, but maybe so. The two drugs I was recommended were Gabapentin and Pregabalin - they seem to work well for the other person I know who has neuropathy... Mark Amundsen
Routing History 12/13/2012 4:01 PM From Clare Jennings, MA To Victor Baquero, MD Priority Routine
Orders
Chart Cosign Accepted By Accepted On
002075
Class: Pharmacy 270 tablet Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx
12/14/2012
1/13/2013

Orders Chart Cosign

Appointment
Plan UCD/B/S HMO
Financial Class P
Plan Number B72
Plan Phone 916-734-0739
Center None
002076
Patient Information
Contacts
Telephone Encounter
12/14/2012 10:55 AM
Reason for Call

Refill Request
Call Documentation
Darlene Fischer 12/14/2012 2:29 PM Signed
Pt picked up Rx. Verified ID by DOB/Pt is known by this clinic.

Electronically signed by Darlene Fischer at 12/14/2012 2:29 PM
Left message that RX is at the front desk

Erica F Wilson 12/14/2012 10:58 AM Signed
He is calling for a refill of Methadone (DOLOPHINE) 10 mg Tablet. The instructions are: Take 3 tablets by mouth every 8 hours. 9 daily. He requests to pick up.
Electronically signed by Erica F Wilson at 12/14/2012 10:58 AM
Routing History
12/14/2012 12:58 PM 12/14/2012 11:06 AM 12/14/2012 10:58 AM From Victor Baquero, MD Clare Jennings, MA Erica F Wilson To P FOL MA FP Victor Baquero, MD P FOL MA FP Priority Routine Routine Routine
Created by
Erica F Wilson on 12/14/2012 10:55 AM
Approved
Disp 270 tablet Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx Authorizing Provider: Victor Baquero, MD Refills 0 Start 12/14/2012 End 1/2/2013

Disp 60 tablet Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 tablets by mouth every day at bedtime. - ORAL Class: Pharmacy 60 tablet Carisoprodol (SOMA) 350 mg Tablet Sig - Route: Take 2 tablets by mouth every day at bedtime. - ORAL Class: Pharmacy Refills 0 Start 8/22/2012 End 11/22/2012
11/19/2012
2/19/2013
002077
8 Cap 1 7/12/2010 5/24/2012 Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule Sig - Route: Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. ORAL Class: Pharmacy 30 Tab 11 7/12/2010 7/12/2011 Fenofibrate (TRICOR) 145 mg PO Tablet Sig - Route: Take 1 Tab by mouth every morning after a meal. - ORAL Class: Pharmacy 30 Tab 3 11/16/2010 11/16/2011 Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet Sig - Route: Take 1 Tab by mouth every morning. - ORAL Class: Pharmacy 100 tablet 0 11/19/2012 12/19/2012 Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO 10) 10-325 mg per tablet Sig - Route: Take 1 tablet by mouth every 4 to 6 hours if needed for pain. - ORAL Class: Pharmacy 270 tablet 0 11/20/2012 12/14/2012 Methadone (DOLOPHINE) 10 mg Tablet (Discontinued) Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx
Orders Chart Cosign

Patient Email
Encounter Messages MyChart message report Message [1547480] From Mark Amundsen To Victor Baquero, MD Sent 12/14/2012 1:23 PM For Delivery 12/14/2012 1:23 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody Thanks for all that. I will give the B vitamin supplement a try - I thought we had done that a year or so ago, but maybe that was for something else. As I recall, it might have been just B12 for the thyroid problem. Anyhow, it's a cheap,easy, and quick try-always the first thing to do. Stopping coffee did not work - but the good news is, I can go back on coffee!! Have a great holiday season - I'll let you know what happens on the B supplement... Mark Amundsen
002078
----- Message ----From: Victor Henrique Baquero, MD Sent: 12/14/2012 1:11 PM PST To: Mark Amundsen Subject: RE: Non-urgent Medical Advice Question Mark, the prescription is ready to pick up. My assistant will notify pharmacy to authorize the early refill. Yes, we can consider gabapentin or Lyrica for the neuropathy. However initially I would like to see if you have improvement from taking a B complex vitamin. Especially one that is rich in vitamin B6, B9, B12. B. vitamins arr necessary for proper nerve functioning. ----- Message ----From: AMUNDSEN,MARK Sent: 12/13/2012 11:57 PM PST To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi DocSorry to keep messaging, but I had an additional problem. Today's dose did not work at all, and I don't have any left to give it a kick in the pants. Could you call the pharmacy to tell them it's okay to fill the script? Otherwise, it'll take most of the day to get it authorized. The pharmacy is Walgreen's at 916-817-6533Thanks Mark Amundsen MyChart message report From Victor Baquero, MD To Mark Amundsen Sent 12/14/2012 1:11 PM For Delivery 12/14/2012 1:11 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 12/14/2012 1:16 PM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, the prescription is ready to pick up. Body My assistant will notify pharmacy to authorize the early refill. Message [1547449]
Yes, we can consider gabapentin or Lyrica for the neuropathy. However initially I would like to see if you have improvement from taking a B complex vitamin. Especially one that is rich in vitamin B6, B9, B12. B. vitamins arr necessary for proper nerve functioning. ----- Message ----From: AMUNDSEN,MARK Sent: 12/13/2012 11:57 PM PST To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi DocSorry to keep messaging, but I had an additional problem. Today's dose did not work at all, and I don't have any left to give it a kick in the pants. Could you call the pharmacy to tell them it's okay to fill the script? Otherwise, it'll take most of the day to get it authorized. The pharmacy is Walgreen's at 916-817-6533-
002079
Thanks Mark Amundsen MyChart message report Message [1546598] From Mark Amundsen To Victor Baquero, MD Sent 12/13/2012 11:57 PM For Delivery 12/13/2012 11:57 PM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi DocBody Sorry to keep messaging, but I had an additional problem. Today's dose did not work at all, and I don't have any left to give it a kick in the pants. Could you call the pharmacy to tell them it's okay to fill the script? Otherwise, it'll take most of the day to get it authorized. The pharmacy is Walgreen's at 916-817-6533Thanks Mark Amundsen Encounter Messages Read Composed Y 12/14/2012 1:23 PM Y 12/14/2012 1:11 PM Y 12/13/2012 11:57 PM
Encounter Documentation Clare Jennings, MA 12/14/2012 9:31 AM Signed From: Mark Amundsen To: Victor Baquero, MD Sent: 12/13/2012 11:57 PM PST Subject: Non-urgent Medical Advice Question Hi DocSorry to keep messaging, but I had an additional problem. Today's dose did not work at all, and I don't have any left to give it a kick in the pants. Could you call the pharmacy to tell them it's okay to fill the script? Otherwise, it'll take most of the day to get it authorized. The pharmacy is Walgreen's at 916-817-6533Thanks Mark Amundsen Electronically signed by Clare Jennings, MA at 12/14/2012 9:31 AM Routing History 12/14/2012 9:31 AM From Clare Jennings, MA To Victor Baquero, MD Priority Routine
Patient Email
Orders
DOB 9/23/1959
002080
Pt picked up Rx. Verified ID by DOB/Pt is known by this clinic.

Electronically signed byDarlene Fischer on 12/14/2012 2:29 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter

He is calling for a refill of Methadone (DOLOPHINE) 10 mg Tablet. The instructions are: Take 3 tablets by mouth every 8 hours. 9 daily. He requests to pick up.
Electronically signed byErica F Wilson on 12/14/2012 10:58 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: Mark Amundsen To: Victor Baquero, MD Sent: 12/13/2012 11:57 PM PST Subject: Non-urgent Medical Advice Question Hi DocSorry to keep messaging, but I had an additional problem. Today's dose did not work at all, and I don't have any left to give it a kick in the pants. Could you call the pharmacy to tell them it's okay to fill the script? Otherwise, it'll take most of the day to get it authorized. The pharmacy is Walgreen's at 916-817-6533Thanks Mark Amundsen Electronically signed byClare Jennings, MA on 12/14/2012 9:31 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
002081
Polyneuropathy Priority: High Medication refill
3/29/2011 1/5/2013 Mark Amundsen (MRN 8081369) MRN 8081369 Sex Male DOB 9/23/1959 PATIENTPHONE 916-509-0158
Patient Email
Encounter Messages MyChart message report Message [1567253] From Mark Amundsen To Victor Baquero, MD Sent 1/2/2013 2:56 PM For Delivery 1/2/2013 2:56 PM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody It's time for another refill on methadone. Sorry for the short notice, but I got my days mixed up. I will be out on Sunday night or early Monday morning. I'd like to pick up a script on Friday for refill Sunday. Also, if you could have your assistant call the pharmacy (Walgreens (916)817-6533 to authorize an early refill, that would be great. Will send second message with statusRegards, Mark Amundsen Encounter Messages Read Composed From Y 1/2/2013 2:56 Mark PM Amundsen Encounter Documentation
Left authorization for early refill on pharmacy's voice mail

Okay to authorize refill.

Ok to authorize a early refill? What date can patient fill RX?

002082
Jasvir K Bhele 1/4/2013 2:25 PM Signed
Pt states phar always gives him a problem when he refills his meds early.Pt would like for you to call walgreens in folsom to let them know that it's ok to refill rx 4 days early. Pt is requesting a call back when done 509-0158


From: Mark Amundsen To: Victor Baquero, MD Sent: 1/2/2013 2:56 PM PST Subject: Non-urgent Medical Advice Question Hi Dr Baquero- It's time for another refill on methadone. Sorry for the short notice, but I got my days mixed up. I will be out on Sunday night or early Monday morning. I'd like to pick up a script on Friday for refill Sunday. Also, if you could have your assistant call the pharmacy (Walgreens (916) 817-6533 to authorize an early refill, that would be great. Will send second message with status Regards, Mark Amundsen 
Electronically signed by Clare Jennings, MA at 1/2/2013 3:10 PM Routing History
1/4/2013 1/4/2013 1/4/2013 1/3/2013 1/2/2013 7:50 PM 2:57 PM 2:25 PM 1:22 PM 3:10 PM From Victor Baquero, MD Clare Jennings, MA Jasvir K Bhele Victor Baquero, MD Clare Jennings, MA To P FOL MA FP Victor Baquero, MD P FOL MA FP P FOL MA FP Victor Baquero, MD Priority Routine Routine Routine Routine Routine
Created by Clare Jennings, MA on 1/2/2013 3:10 PM Approved Disp Refills 270 tablet 0 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 3 tablets by mouth every 8 hours. 9 daily. - ORAL Class: Handwritten Rx Authorizing Provider: Victor Baquero, MD Start 1/2/2013 End 1/29/2013
Patient Email
Orders
DOB
PATIENTPHONE
002083
Amundsen, Mark
8081369
Male
9/23/1959
916-509-0158
Encounter Messages MyChart message report Message [1570270] From Mark Amundsen To Victor Baquero, MD Sent 1/3/2013 11:48 PM For Delivery 1/3/2013 11:48 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody I'm also hoping you can have your assistant call the pharmacy today to authorize the early refill-they seem to be picky about that... Mark Amundsen ----- Message ----From: Victor Henrique Baquero, MD Sent: 1/2/2013 5:42 PM PST To: Mark Amundsen Subject: RE: Non-urgent Medical Advice Question Mark, I appreciate the update. I may recommend you contact 1-800-2-UCDAVIS. That is the number to our referral coordinators who may be of assistance in helping you get an earlier appointment. Continue the B. vitamin. Hopefully we can get you in sooner. PS. I will have the methadone. Prescription ready by Friday. ----- Message ----From: AMUNDSEN,MARK Sent: 1/2/2013 3:07 PM PST To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroStatus update - have scheduled appointment for pain clinic Feb 22- earliest avail. Been taking vitamin B complex, no change yet. Got stomach flu last week, lost a few days methadone due to evacuation-everyone here had it,so I didn't come in. Pain still bad, meds still not very effective. Only thing seems to help is clearance with laxatives and no eating till taking dose-tough to schedule. I'll keep you updated. Regards, Mark Amundsen MyChart message report From Mark Amundsen To Victor Baquero, MD Sent 1/3/2013 11:21 AM For Delivery 1/3/2013 11:21 AM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Message [1568921]
002084
Thanks Dr BaqueroI'll give the phone # a try- pain management sounds like they're REALLY swamped. I'll keep on the B complex... Mark Amundsen ----- Message ----From: Victor Henrique Baquero, MD Sent: 1/2/2013 5:42 PM PST To: Mark Amundsen Subject: RE: Non-urgent Medical Advice Question Mark, I appreciate the update. I may recommend you contact 1-800-2-UCDAVIS. That is the number to our referral coordinators who may be of assistance in helping you get an earlier appointment. Continue the B. vitamin. Hopefully we can get you in sooner. PS. I will have the methadone. Prescription ready by Friday. ----- Message ----From: AMUNDSEN,MARK Sent: 1/2/2013 3:07 PM PST To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr BaqueroStatus update - have scheduled appointment for pain clinic Feb 22- earliest avail. Been taking vitamin B complex, no change yet. Got stomach flu last week, lost a few days methadone due to evacuation-everyone here had it,so I didn't come in. Pain still bad, meds still not very effective. Only thing seems to help is clearance with laxatives and no eating till taking dose-tough to schedule. I'll keep you updated. Regards, Mark Amundsen
MyChart message report Message [1567741] From Victor Baquero, MD To Mark Amundsen Sent 1/2/2013 5:42 PM For Delivery 1/2/2013 5:42 PM On Subject RE: Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Last Read in 1/3/2013 11:45 PM MyChart Mark Amundsen By Responsibility Audit Trail Message Mark, I appreciate the update. I may recommend you contact 1-800-2-UCDAVIS. That Body is the number to our referral coordinators who may be of assistance in helping you get an earlier appointment. Continue the B. vitamin. Hopefully we can get you in sooner. PS. I will have the methadone. Prescription ready by Friday. ----- Message ----From: AMUNDSEN,MARK Sent: 1/2/2013 3:07 PM PST To: Victor Henrique Baquero, MD Subject: Non-urgent Medical Advice Question Hi Dr Baquero-
002085
Status update - have scheduled appointment for pain clinic Feb 22- earliest avail. Been taking vitamin B complex, no change yet. Got stomach flu last week, lost a few days methadone due to evacuation-everyone here had it,so I didn't come in. Pain still bad, meds still not very effective. Only thing seems to help is clearance with laxatives and no eating till taking dose-tough to schedule. I'll keep you updated. Regards, Mark Amundsen MyChart message report Message [1567285] From Mark Amundsen To Victor Baquero, MD Sent 1/2/2013 3:07 PM For Delivery 1/2/2013 3:07 PM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr BaqueroBody Status update - have scheduled appointment for pain clinic Feb 22- earliest avail. Been taking vitamin B complex, no change yet. Got stomach flu last week, lost a few days methadone due to evacuation-everyone here had it,so I didn't come in. Pain still bad, meds still not very effective. Only thing seems to help is clearance with laxatives and no eating till taking dose-tough to schedule. I'll keep you updated. Regards, Mark Amundsen Encounter Messages Read Composed Y 1/3/2013 11:48 PM Y 1/3/2013 11:21 AM Y 1/2/2013 5:42 PM Y 1/2/2013 3:07 PM
From Mark Amundsen Mark Amundsen Victor Baquero, MD Mark Amundsen
To Victor Baquero, MD Victor Baquero, MD Mark Amundsen Victor Baquero, MD
Encounter Documentation Clare Jennings, MA 1/2/2013 3:09 PM Signed From: Mark Amundsen To: Victor Baquero, MD Sent: 1/2/2013 3:07 PM PST Subject: Non-urgent Medical Advice Question Hi Dr BaqueroStatus update - have scheduled appointment for pain clinic Feb 22- earliest avail. Been taking vitamin B complex, no change yet. Got stomach flu last week, lost a few days methadone due to evacuation-everyone here had it,so I didn't come in. Pain still bad, meds still not very effective. Only thing seems to help is clearance with laxatives and no eating till taking dose-tough to schedule. I'll keep you updated. Regards, Mark Amundsen
Routing History
1/4/2013 7:46 AM 1/2/2013 3:09 PM
From Clare Jennings, MA Clare Jennings, MA
To Victor Baquero, MD Victor Baquero, MD
Created by
002086


Electronically signed byVictor Baquero, MD on 1/3/2013 1:22 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: Mark Amundsen To: Victor Baquero, MD Sent: 1/2/2013 2:56 PM PST Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's time for another refill on methadone. Sorry for the short notice, but I got my days mixed up. I will be out on Sunday night or early Monday morning. I'd like to pick up a script on Friday for refill Sunday. Also, if you could have your assistant call the pharmacy (Walgreens (916)817-6533 to authorize an early refill, that would be great. Will send second message with statusRegards, Mark Amundsen Electronically signed byClare Jennings, MA on 1/2/2013 3:10 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: Mark Amundsen To: Victor Baquero, MD Sent: 1/2/2013 3:07 PM PST Subject: Non-urgent Medical Advice Question Hi Dr BaqueroStatus update - have scheduled appointment for pain clinic Feb 22- earliest avail. Been taking vitamin B complex, no change yet. Got stomach flu last week, lost a few days methadone due to evacuation-everyone here had it,so I didn't come in. Pain still bad, meds still not very effective. Only thing seems to help is clearance with laxatives and no eating till taking dose-tough to schedule. I'll keep you updated. Regards, Mark Amundsen Electronically signed byClare Jennings, MA on 1/2/2013 3:09 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because
002087
Encounter Closed By
Closed By MUNOZ, MIRIAM Closed Date 01072013 Closed Time 11:32
Patient Email
Patient Email Encounter 1/7/2013 8:51 AM Provider Clare Jennings, MA Department Fol Family Practice
Encounter Messages MyChart message report Message [1573008] From Mark Amundsen To Victor Baquero, MD Sent 1/6/2013 9:45 PM For Delivery 1/6/2013 9:45 PM On Subject Non-urgent Medical Advice Question PCP Victor Baquero, MD, MD Responsibility Audit Trail Message Hi Dr Baquero and ChristyBody I was going to get my methadone prescription refilled this weekend, but the Walgreen's pharmacy (916-817-6533) informed me that they were not called to confirm the early refill. Could y'all be sure to call them Monday morning to authorize the early refill? I've been told the authorization has already been made, just the phone call needs to be completed. If you could email me via Mychart when the call has been made, I would appreciate it... Regards, Mark Amundsen Encounter Messages Read Composed From Y 1/6/2013 9:45 Mark PM Amundsen
Encounter Documentation Clare Jennings, MA 1/7/2013 8:51 AM Signed From: Mark Amundsen To: Victor Baquero, MD Sent: 1/6/2013 9:45 PM PST Subject: Non-urgent Medical Advice Question Hi Dr Baquero and ChristyI was going to get my methadone prescription refilled this weekend, but the Walgreen's pharmacy (916-8176533) informed me that they were not called to confirm the early refill. Could y'all be sure to call them Monday morning to authorize the early refill? I've been told the authorization has already been made, just the phone call needs to be completed. If you could email me via Mychart when the call has been made, I would appreciate it... Regards,
002088
Mark Amundsen Electronically signed by Clare Jennings, MA at 1/7/2013 8:51 AM Created by Clare Jennings, MA on 1/7/2013 8:51 AM
Orders
QuickLinks


1/5/2013 5:49 PM
Department Emergency - Pavilion
Attending Provider Kelly P Owen, MD Discharge Date/Time 01/05/13 2043 Unit EMERGENCY - PAVILION Admitting Provider Hospital Service Emergency Dept Registration Room/Bed ED CHAIRS1-8/F-CH4 Admission Type Auth/Cert Status Incomplete Admission Status Discharged (Confirmed) Admission Date/Time 01/05/13 1750 Service Area UCDHS SERVICE AREA Referring Provider

Arrival Information
Arrival 1/5/2013 5:50 PM Means of Arrival Ambulatory Escorted By Self
Triage Information
Date/Time 01/05/13 1750 01/05/13 1758 01/05/13 1800 All ED Notes Event Triage Started Full Triage Started Triage Completed User RICH, KELLY KITTLE, KELLY KITTLE, KELLY Comments
ED Note Information Chief Complaint

Medication/Prescription Refill needs methadone refilled
Diagnoses
Medication refill V68.1
Problem Unspecified backache Other testicular hypofunction Priority: Low Noted Resolved
002089
Class: Chronic Brachial neuritis or radiculitis NOS ADVANCED OSTEOARTHRITIS OF THE LEFT HIP Priority: High Class: Chronic DEPRESSIVE DISORDER
10/22/2010 1/19/2006
5/26/2006 4/30/2008

See lab
7/12/2010

Priority: Medium Class: Acute High arch 7/12/2010 2/17/2011 3/5/2011 3/29/2011 3/29/2011 1/5/2013 Date Reviewed: 1/5/2013
Noted 5/1/2006 Type Reactions Itching

DELETED: Weakness DELETED: Demyelinating neuropathy Class: Acute Preop testing Polyneuropathy Priority: High Medication refill
8/16/2011
7/15/2004
Hives

All Inpatient Notes

Current Location Flowsheet Triage Vitals Flowsheet Custom Formula Data Flowsheet Full Triage Start Flowsheet Focused Exam Flowsheet Triage Dispo Flowsheet Suspected Infection Flowsheet ED Med Reconciliation Flowsheet

None
Chart Reviewed By
Kerrin Jordan on 1/5/2013 8:48 PM
002090
Telephone Encounter
1/8/2013 2:57 PM
Provider Victor Baquero, MD, MD Department Cdm Acc (Ellison)
Reason for Call

Chronic Disease Management (CDM) Care Coordination
Call Documentation
Derika Faamausili 1/8/2013 2:59 PM Signed
Spoke to pt, scheduled for the health education class, Achieving a healthy wt on 4/17. Pt would like a call back in early March to schedule for the Chronic Pain class. Best, Derika Faamausili Community Health Program Representative Center for Chronic Disease Care Management and Education UC Davis Health System 916-734-2907 http://www.chronicdisease.ucdavis.edu
Electronically signed by Derika Faamausili at 1/8/2013 2:59 PM
Routing History
1/8/2013 2:59 PM From Derika Faamausili To Priscilla Saldana Priority Routine
Created by
Derika Faamausili on 1/8/2013 2:57 PM

002091
UC Davis Medical Group

Folsom Family Practice 251 Turnpike Drive Folsom, CA 95630 916-985-9300
PRIOR AUTHORIZATION REQUEST REQUESTING PHYSICIAN: Victor Baquero, MD Fax#: (530) 889 0636 PATIENT INFORMATION: Name: Mark Amundsen DOB: 9/23/1959 AGE: 46yr
Address: 2017 Tarbolton Cir Folsom, CA 95630 Phone: 916-983-2589 (home) ID#: W142637665 Insurance: Payor: AUSHC Plan: AETNA-PPO/POS Product Type: *No Product type* Medication and Strength: Cymbalta Duration and Quantity: 60 mg 1 po daily. Diagnosis: Adjustment disorder with depression. Chronic pain. Indicate medications previously tried and failed: Failed fluoxetine. Clinical reasons for requested drug: Interested in treating mood and chronic pain.
002092
.... '
UNIVERSITY OF CALIFORNIA, DAVIS
BERKELEY.
DAVIS.
IRVINE.
LOS ANGELES.
RIVERSIDE.
SAN DIEGO.
SAN FRANCISCO
SANTA BARBARA.
SANTA CRUZ
SCHOOL OF MEDICINE DAVIS, CALIFORNIA 95616 DEPARTMENT OF ANESTHESIOLOGY UCD Pain Management Center 2315 Stockton Blvd. AND PAIN MEDICINE
Sacrarnenlo. California 95817

Phone' (916) 7347246 Fax: (916) 7345033
April 22, 2002
Victor Baquero, M.D. UCD Medical Group, Folsom 251 Turnpike Drive Folsom, California 95630 Re: Patient Name: Medical Record #: Date of Birth: Date of Evaluation: Amundsen, Mark R. 8081369 9/23/59 4/22/03
Dear Dr. Baquero: It was a pleasure to see your patient, Mark R. Amundsen, today in consultation at the University of California, Davis Center for Pain Medicine. As you know, the patient is a 43-year-old male being evaluated today for constant low back pain with radiating pain clown the left leg. The pain has been present for approximately 10 years. He states that the pain initially started after performing several sit ups on a chronic basis. Approximately two years ago, the patient claims that his pain became more constant, especially dunng extended periods where he was sitting. Approximately one year ago, he noticed that the pain was constant at 3 to 4 on the VAS pain scale and would increase to 6 to 7 with stabbing pains at night and intermittently during the day. He states that it had progressed to point where he could not sit for more than one-half hour due to the increase in his back and left lower extremity pain. The patient denies any acute trauma as the inciting incident to his back or left lower extremity pain. The pain is present constantly (100% of the time). The patient described the pain as shooting, burning and numbness. The pain intensity is currently rated as a VAS of 6 anchored at 0 by "no pain" and at 10 by "the most severe pain imaginable". The average pain for the last week has been a VAS of 6/10. At its best, it is 3/10; and at its worst, 7/10. RELIEVING AND AGGRAVATING FACTORS Relieving factors for the patient's pain is lying down, medication and relaxation. The pain is aggravated by sitting and bowel movements (because the patient has to sit while having bowel movements). The pain is unchanged by standing, walking, exercise, thinking about something else, coughing, sneezing and urination.
002093
-,---------------.----------------------------=-
',
Mark R. Amundsen Medical Record #: 808 13 69 Date of Evaluation: 4/22/03 Page 2 of 5 FUNCTIONAL LIMITATIONS: The patient has avoided participating in recreation, having sexual relations and driving. The patient can sit for 25 minutes and stand for 1 hour before the pain limits this activity. The patient states that he often lies down because of pain. CURRENT MEDICATIONS: 1. Vicodin 5/500 four tablets q.h.s. 2. Cyclobenzaprine 10 mg q.h.s. FAILED PAIN MEDICATIONS: Meclofenarnate. The patient states it had no affect.
ALLERGIES: Ibuprofen causes hives, rash and swelling. The patient goes on to state that again the meclofenamate did not cause any of the reactions listed for ibuprofen. PREVIOUS TREATMENTS: 1. Traction made the pain worse, November 2002. 2. Physical therapy in November 2002 3. Exercise in November 2002. PREVIOUS DIAGNOSTIC STUDIES: 1. There is a lumbar spine x-ray dated September 13, 2002. No significant radiographic abnormality identified in the lumbar spine for the patient's chronologie age. 2. MRI of the lumbosacral spine dated December 20, 2002. Degenerative changes noted at the L3-4 facets bilaterally. Degenerative changes at the L4-5 facets. An annular tear was noted at the L5-S1 disk along the posterior and left side of the annulus without disk protrusion. The S1 roots were unremarkable. The L5 roots were unremarkable. No evidence of lateral herniated disk . REVIEW OF SYSTEMS: The patient admits to chest pain. The patient states he has chest pain with stressful events and was previously on Prozac. He states this has been worked up and was not cardiac in nature. The patient admits to left-sided back pain, left hip pain and left leg muscle weakness.
Constitutional Sx: no fevers, no unplanned weight loss Eyes: no double or blurred vision ENT: no loss of hearing, no difficultyswallowlnq Herne/l.vrnph: no bleeding gums or low platelet count Endocrine: no known thyroid disease or heat/cold intolerance Skin: no rashes or other lesions RespirajQ[y: no shortness of breath, no wheezing Cardiovascular: no palpitations GI: no constipation, abdominal pain, nausealvomiting, diarrhea GU: no urinary retention, dysuria, sexual dysfunction Musculoskeletal: no joint or muscle pain
002094
-,--------,------------------
~-
,;
Mark R. Amundsen Medical Record #: 808 13 69 Date of Evaluation: 4/22/03 Page 3 of 5 Neuro: no loss of consciousness, blackouts, memory loss, seizures, trouble walking, dizziness, or fatigue Behavioral: no sleep disturbance, loss of interest in activities/hobbies, difficulty concentrating, feelings of guilt or depressed mood OTHER PAIN PROBLEMS: The patient has pain in both knees wh~n getting up and bending. PRIOR MEDICAL HISTORY: The patient states that he has had obsessive-compulsive personality disorder. The patient does not have a prior history of high blood pressure, angina, heart attack, asthma, chronic cough, diabetes, stroke, cancer, seizures or epilepsy, kidney disease, liver disease, arthritis, bleeding problems . ALL SURGERIES AND APPROXIMATE DATES: 1. Tonsillectomy in June 1965. 2. Left inguinal hernia repair in January 1987. PSYCHOSOCIAL HISTORY: Educational Level: The patient's highest educational level achieved was high school graduate. Legal Issues: The patient does not have current claims or litigation related to his pain problem. Psychological Treatments: The patient denies a present or past history of psychiatric, psychological or social work evaluations or treatments for any problems including the current pain problem. . The patient denies a present or past history of suicide ideation or attempt. Substance Abuse History: The patient denies a history of substance abuse of alcohol, heroin, cocaine, amphetamines or other illicit substances. The patient admits to smoking 19 years, 1)1, packs a day. He quit 10 years ago. Employment: The patient was previously employed full-time. He has unfortunately unemployed for the past week. The patient's employment has not been affected by the present pain condition. The patient is a computer field engineer. FAMILY LIVING CIRCUMSTANCES: The patient is currently living with his spouse and children. FAMILY HISTORY: The patient denies a family history of migraines, back pain, suicide or psychiatric illness. PHYSICAL EXAMINATION: BP 118/81 Pulse 84 Resp 18 Weight 243.2 pounds 02 Sat 97% Constitutional: Normally developed, no deformities, well groomed. Initially, when talking to the patient, he had very poor eye contact. As examination progressed, the patient had very appropriate eye contact and a very witty sense of humor.
002095
-------------------------
, .: Mark R. Amundsen Medical Record #: 808 13 69 Date of Evaluation: 4/22/03 Page 4 of 5 Skin: No lesions, new scars, bruising, or rashes noted lungs: Chest expansion normal, clear to auscultation without wheezes or rales Heart: Regular rate and rhythm - normal S1, S2, no murmur, rub, gallop Abdominal: Nontender to palpation, nondistended, no rebound tenderness Musculoskeletal: GaiUStation- normal free, heel toe walking, normal tandem gait, not antalgic Psych: Oriented to time, person, and place. Normal attention span and concentration Neuro: DTR's bilaterally symmetrical biceps, triceps and brachioradialis 0, patella 2+, ankle 2+. Babinski's are downgoing bilaterally. Motor: Bulk - normal, tone - normal, abnormal movements - none. Strength 5/5 throughout the bilateral lower extremities. Sensory: Intact to light touch and pinprick and bilateral lower extremities. No allodynia, hyperalgesia or summation to pinprick was noted . Back: lumbar spine mobility was full passively and through active range of motion during forward flexion, lateral flexion to the right and lateral flexion to the left. The patient did experience pain with hyperextension and also lateral rotation to the left. Supine and sitting straight leg raises were negative bilaterally. Patrick's test was negative bilaterally. Patrick's test did elicit both right and leg groin pain during the testing. Mvofascial exam: There were no trigger points or palpable bands noted over the cervical, thoracic or lumbar paraspinal muscles. There was no significant pain to palpation or percussion over the cervical, thoracic or lumbar paraspinals or over the spinous processes themselves.
Pain behaviors: The patient exhibited no more grimacing, guarding, and/or holding on to objects for support than other patients with similar conditions . MEDICAL DECISION MAKING ASSESSMENT AND DIFFERENTIAL DIAGNOSIS: 1. lumbar degenerative disk disease. 2. lumbar radiculitis. 3. lumbar facet arthropathy. 4. Obsessive-compulsive personality disorder. RISK OF COMORBIDITIES: At this time, there is no significant risk factor that the patient's condition poses to our current proposed treatment and evaluation plan. RECOMMENDATIONS: 1. Today during the office consultation, we personally reviewed the MRI films. After further discussion, the patient again does have some radicular signs to his low back and also left lower extremity pain. In addition, there is also the component of neuropathic pain associated with his current condition. In order to help alleviate some of the patient's current pain, especially the pain going down the leg, we are proposing to perform a translaminar lumbar epidural steroid injection. We may perform a series of these in order to get the maximum effect.
002096
"
Mark R. Amundsen Medical Record #: 808 13 69 Date of Evaluation: 4/22/03 Page 5 of 5 2. If the patient has significant pain relief from the lumbar epidural steroid injections, we may consider performing a left L5 selective nerve root block with a nerve stimulator in order to initially test to see if we can reproduce in the dermatomal distribution where the patient normally has his pain. Once we can locate that with the Stirnuplex needle, we would then inject a solution for a selective nerve root block at that level. Again, this would be performed if the lumbar epidural steroid injections were suboptimal in their efficacy. If the left L5 selective nerve root block did show significant improvement in the patient's pain, then we would recommend performing a left pulsed radiofrequency of the L5 dorsal root ganglion (versus a left S1 depending on the effects noted during the Stimuplex selective nerve root blocks). 3. Again, there is significant neuropathic component associated with the patient's current pain. We have written a prescription for the patient to start on Topamax 25 mg p.o. q.h.s. He was given an instruction sheet, which details the method in which he should titrate up on the Topamax. He was instructed that if he has side effects from the medication he should then stop at the point where he is and decrease the medication in the same manor in which he increased it. After further discussion, the patient had no history of renal stones or glaucoma in his past medical history. One added benefit also from the Topamax may be that in a small percentage of patients that it also promotes weight loss. 4. In addition to the above listed interventional procedure, we are recommending initiating the patient in a physical therapy program. Interventions such as the above listed epidural steroid injections are more efficacious when they are coupled with increase in activity, such as being involved in a physical therapy program for back strengthening, as well as aerobic conditioning. 5. If the patient continues to have ongoing axial back pain, then we will at that time consider performing a diagnostic medial branch block on the more symptomatic side. The patient was instructed and educated on all aspects of the plan of care. The patient acknowledged the plan of care. Thank you for allowing us to participate in the care of your patient. Should you have any questions or concerns regarding the recommended care plan, please do not hesitate to contact' me. Sincerely,
eftr
Gagan Mahajan, M.D. Assistant Professor UCD Pain Management Center WF/pe101 xc: Medical Records UCD Pain Management Clinic Shadow File
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002097

BERKELEY' HAVIS. IRVI:-<I. LOSANCELES MERCED RlVER.'>IDE
SCHOOL OF MEDICINE DEPARTMENT OF NEUROLOGICAL 4860 Y STREET, SUITE 3740 SACRAMENTO.CA 95817 (916) 734-365H FAX: (916) 452-2580
UC DAVIS MEDICAL CENTER

SURGERY
February 21,2003 Victor Baquero, M.D. UCDMG - Folsom 251 Turn Pike Dr. Folsom, CA 95630
RE: DOB: MR#: DOS:
AMUNDSEN, MARK 09/23/59 808 1369 02/21/03
Dear Dr. Baquero: I got to see your patient Mark Amundsen in consultation for low back and leg pain. His main problem today seemed to be back pain that radiates down his left leg to the thigh and the knee. The MR1 in initial review is pretty unremarkable, however, given his symptom complex lateralizing to the L3-L4 root and the fact that his knee jerk was a little decreased on the left compared to right, I looked more carefully at the MRI, and there was a far lateral disk herniation at L3-L4 on the left which might explain his symptom complex. Therefore, I still do not think he needs a surgery for these disks as it is fraught with difficulty particularly since the dorsal root ganglion is there, and I can make things worse. He is not that symptomatic. I am hoping that he will improve with therapy or with an epidural steroid injection. In fact, that is my main hope for him and given that he is DC Davis capitated, he will need to get that referral through you, his PCP, to the Pain Management Service. They do have a fast track service, perhaps you can get him into that for an epidural steroid shot. He is not excited about the prospects of surgery, nor do I think he needs one at this point, but at least I am pretty sure why he is having his symptoms. Sincerely,
JCW:mhnltmwc cc:
022103JW
Medical Records, Departmental Chart
002098

BERKEll\' 1),\\'1"
IRVIl':E
SCHOOL OF MEDICINE DEPARTMENT OF NEUROLOGICAL 4860 Y STREET, SUITE 3740 SACRAMENTO, CA 95X 17 (916) 734-3658 FAX: (916) 452-2580
UC DAVIS MEDICAL SURGERY
CENTER
February 21, 2003 Victor Baquero, M.D. UCDMG - Folsom 251 Turn Pike Dr. Folsom, CA 95630
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RE: AMUNDSEN, MARK DOB: 09123/59 MR#<.808 13 59DOS: '02121/03 Dear Dr. Baquero: Chief complaint: Low back pain radiating to the left and right leg. History of Present Illness: Patient is a 43-year-old right handed male who complains oflow back pain for about nine years. Getting worse the last year. Pain radiates to the left leg all the time and sometimes to the right leg. Pain stops at the level of the knee. Occasionally, pain goes to the toes. Pain feels like a dull burning all the time. After sitting for long periods of time, he feels a sharp stabbing that radiates down the leg. Pain today is 4 out of 10. Pain varies between 3 to 7 on a scale of I to 10. Pain is better with laying down, with medications, and worse with sitting for more than 20 minutes and standing for prolonged periods of time. Had physical therapy but did not help. Denies epidural steroid injections. Allergies: He is allergic to ibuprofen where he gets hives and swelling . Medications: He is taking Vicodin 3 p.o. q.h.s., Flexeril 1 q.h.s., and Prozac 40 mg q.d. Past Medical History: Left inguinal hernia in 1986, tonsillectomy in 1970. Family History: He does not know about his father's whereabouts. Mother died at 75 years old from COPD. One brother who is 30 years old and healthy, one sister 46 years old and healthy. Social History: He is a field engineer. He smoked for 16 years, quit 11 years ago. He drinks alcohol socially. He lives in Folsom with his wife and three stepchildren .
.--------_._---------------------------------------
002099
RE: AMUNDSEN, MARK DOB: 09/23/59 MR#: 808 13 59 DOS: 02/21/03 Page 2 Review of Systems: He has increased his weight the last two months about IS pounds. He denies any shortness of breath, any chest pain, any urine or bowel dysfunction. Denies any blood in the urine or stool. Physical Examination: Vitals: Blood pressure 124/86, temperature 36.1, pulse 88, respirations 16, weight 243 pounds. Alert and oriented X 3, in no acute distress. GCS is 15. Strength in both lower extremities 5/5. Pinprick sensation is intact in both lower extremities. Cerebellar is normal. Gait is intact. Speech is normal. Cranial nerves II through XII intact. Babinski sign negative. Deep tendon reflexes lower extremities 2+ all around. .
Radiographic Data: MRI on December 20, 2002 revealed no significant findings. Some moderate L3-L4 disk bulging . Assessment: Low back spondylosis. Plan: Discussed epidural steroid treatment in order to decrease the disk swelling. Patient was advised to request pain management also from his primary care physician, also patient encouraged to do physical therapy and stretching exercises. Return to clinic p.r.n. Sincerely,
Sotiris Papamichail, PAC Dept. of Neurological Surgery JCW /SP:mhn/tmwc cc: 022103JW
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Medical Records Departmental Chart
002100
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SCHOOL OF MEDICINE DAVIS, CALIFORNIA 95616
RECEIVED
AUG- 27 2003
BERKELEY. DAVIS .IFIVINE.
LOS ANGELES. RIVERSIDE. SAN DIEGO SAN FRANCISCO
SANTA BARBARA. SANTA CRUZ
DEPARTMENT OF ANESTHESIOLOGY AND PAIN MEDICINE UCD Pain Management Center 2315 StocktonBlvd. Sacramento, California 95817 Phone: (916)734-7246 Fax' (916)734-5033
July 21, 2003 Victor Baquero, M.D. UC Davis Medical Group 251 Turn Pike Drive Folsom, CA 95630 Re: Patient Name: Medical Record #: Date of Birth: Date of Evaluation: Procedure: Amundson, Mark 8081569 09/23/59 07/21/03 Lumbar epidural steroid injection with fluoroscopy
Dear Dr. Baquero: We had the pleasure of treating your patient, Mark Amundson, today at the University of California ..Davis Center for Pain Medicine. As you know, the patient is a 43-year-old male with a history of lower back pain, more on the left side. The pain started minimally ten years ago and worsened within the past two years. The patient's pain is described as burninq, sharp and shooting.
The pain intensity is currently rated as a VAS of 4/1 0 anchored at 0 by "no pain" and at 10 by "the most severe pain imaginable." The average pain for the last week has been a VAS of 5/10. CURRENT HEALTH PROBLEMS: The patient states that he currently has no other health problems. RESULTS OF MOST RECENT PRIOR PROCEDURES: I The patient did not undergo procedural intervention related to the current pain problem at the UC Davis Center for Pain Medicine at the last visit.
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The patient denies a personal or family history of prior anesthesia problems. IThe patient has had nothing to eat or drink for eight hours. The patient denies a history stridor, snoring and sleep apnea. .
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002101
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Mark Amundson Medical Record #: Date of Evaluation: Page 2 of 3
8081569 07/21/03
CURRENT MEDICATIONS: 1. Vic:odin 5/500 four q.h.s. 2. Flexeril 10 mg one q.h.s. ALLERGIES: Ibuprofen causes rash, swelling and hives. PHYSICAL EXAMINATION: Preprocedural vital signs BP 132/87 Pulse 79 Resp 16 02 Sat 99% Postprocedural vital signs BP 158/97 Pulse 69 Resp 12 02 Sat 98% Airway: Mallampati Class III. Neck ROM - full. Thyroid-Mentum Distance in fingerbreadths - 4. Lungs: Chest expansion normal, clear to auscultation without wheezes or rales. Heart: Regular rate and rhythm - normal S 1, S2, no murmur, rub, or gallop. ASA Physical Status: II 1Normal 11Mild Systemic Disease 111Complex Systemic Disease IVCritical .VMoribund PREPROCEDURAL DIAGNOSIS AND ASSESSMENT: 1. Lumbar degenerative disk disease. 2. Lumbar radiculitis. 3. Lumbar facet arthropathy. 4. Obsessive-compulsive personality disorder. 5. Obesity. POSTPROCEDURAL DIAGNOSIS AND ASSESSMENT: 1. Lumbar degenerative disk disease. 2. Lumbar radiculitis. 3. Lumbar facet arthropathy. 4. Obsessive-compulsive personality disorder. 5. Obesity. NAME OF PROCEDURE: Lumbar epidural steroid injection with fluoroscopy. Informed Consent: The patient's condition and proposed procedures, risks, and alternatives were discussed with the patient. The patient's questions were answered. The patient appeared to understand and chose to proceed. Informed consent was obtained. SEDATION GIVEN: None.
002102
,
Mark Amundson Medical Record #: Date of Evaluation: Page 3 of 3
8081569 07121103
PROCEDURE IN DETAIL: This is the first procedure of the first series that the patient is undergoing. After obtaiining written consent, a 22gauge IV hep lock was placed. The patient was taken back to the fluoroscopy suite and placed in a prone position with a pillow under the abdomen to decrease the lumbar lordosis. The skin overlying the lumbosacral area was prepped and draped in an aseptic fashion. The L5S 1 vertebral interspace was identified by AP fluoroscopy. The skin and subcutaneous tissue overlying the target site of injection was anesthetized using 3 ml of 1% lidocaine with a 25-gauge, 1Y:ziinch needle. An 18-gauge, 3Y:z-inchTuohy needle was advanced under fluoroscopic guidance towards the epidural space using a midline approach. The epidural space was identified using a loss of resistance to air technique. After negative aspiration for heme or CSF, a total of 8 cc of Omnipaque 180 was injected. A lumbar epidurogram was conflrrned using AP fluoroscopy. After negative aspiration for heme or CSF, 10 ml of a solution containing 2 ml of 40 mg/ml (80 mg) triamcinolone and 8 ml Omnipaque 180 :.vas injected in increments. The needle was then retracted approximately halfwa~ and the needle track was flushed with 1 ml of 1% lidocaine. There were no apparent new sensory deficits in the lower extremities present folloWing the procedure: A sterile bandage was placed over the injection site. . t The heart rate, pulse oximetry, and blood pressure were continuously monitored throughout the procedure. There were no apparent complications. The patient tolerated the procedure well and was carefully escorted to the recovery room in stable condition. After meeting discharge criteria, the patient was discharged home. RECOMMENDATIONS: 1. We will plan to have the patient follow up in four to six weeks for a repeat injection. I 2. No medications were prescribed at today's visit. I The patient was instructed and educated on all aspects of the plan of care. 1ihe patient acknowledged the plan of care. Thank you for allowing us to participate in the care of your patient. Should you have any questions or concerns regarding the recommended care plan, please do not hesitate to contact us. I Sincerely,
I
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~jan'M.D. Assistant Professor UC Davis Pain Management LWG/pe1'12 xc:
Center
Lana Wania-Galicla, Clinical Pain Fellow
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002103
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002107

Folsom Family Practice 251 Turnpike Drive Folsom, CA 95630 916-985-9300
February 14, 2007
Mark Amundsen 2017 Tarbolton Cir Folsom, CA 95630 MRN: 8081369
To whom it may concern: Mark Amundsen was out on January 22-25 due to illness.
Sincerely,
VICTOR BAQUERO, M.D.
002108

FOLSOM FAMILY PRACTICE 251 Turnpike Drive Folsom, CA 95630 916-985-9300
April 30, 2008 Name: Mark Amundsen Condition being treated with controlled medication: Norco, Methadone Important informational points: Prescriptions for all controlled medications are monitored by the DEA. All medications can have side effects. If you are experiencing a suspected side effect, you should discuss it with your doctor. Opioid medications (narcotics) do not cure pain conditions. Their purpose is to improve your physical and vocational functioning. Many controlled medication can be habit-forming. Requirements Only one physician can prescribe these medications. Having more than one prescriber will constitute grounds for dismissal from the Medical Group. You must use only one pharmacy. Pharmacy: Costco Take medications as prescribed and only as prescribed. Lost or stolen prescriptions will not be replaced. Forged or altered prescriptions constitute grounds for dismissal. Treatment discussions can occur only during scheduled appointments. Prescriptions for controlled medications can be refilled only during normal business hours. Agreement I understand and will abide by the above requirements. I understand that failure to do so may lead to my dismissal from U.C. Davis Medical Group, folsom . The standard procedure for dismissal is to be given a tapering dose of medications and a reference list of other community physicians. _________________________________ Patients Signature April 30, 2008 _________________________________ Physician's Signature April 30, 2008
002109

May 21, 2009 PHYSICIAN'S MEDICAL NOTE regarding: Mark Amundsen To Whom It May Concern: Mark Amundsen was evaluated at UCDavis Medical Group on 5/21/2009. Please excuse from work. He can return on 5/26/09.
Gertrudes P. Montemayor MD Family Practice UCDavis Medical Group, Folsom
002110

Date: 6/2/2009 To whom it may concern:
This is to certify that Mark Amundsen was examined on 5/26/2009 and was not able to work from May 29th through June 3rd due to illness.
VICTOR BAQUERO, M.D.,
002111

FOLSOM FAMILY PRACTICE 251 Turnpike Drive Folsom CA 95630 916-985-9300
Date: 10/12/2010 To: Whom this may concern From: Nancy Jaeger, MD
This is to certify that Mark Amundsen was examined on 10/12/2010 and has missed 10/11/10 from work; patient should return to work on 10/14/10 without restrictions when full duties may be resumed.
Nancy Jaeger, MD
002112

FOLSOM FAMILY PRACTICE 251 Turnpike Drive Folsom CA 95630 916-985-9300
October 26, 2010
Mark Amundsen 2017 Tarbolton Cir Folsom CA 95630
To whom it may concern: Mark Amundsen may return to clinic as of October 26, 2010. He may resume full duties.
Sincerely,
002113
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PHONE, ( ) BIRTH, 09/23/59 SEX, M HP, BLS CONTRACT TYPE, 1 OTHER COV, N PRIM/SEC, CARRIER, ORIGINAL EFF, 06/30/03 EMP GRP, BS20MH0197 DMND #' J00044785BLS-Ol HP TERM DATE, PCP NAME, BAQUERO, VICTOR SITE, PRODUCT CODE, FROM PCP CLINIC THRU * HP-OPTION FROM THRU 0813 9 06/30/03 * BS20230U 06/30/03 * BS20200U 06/30/03 06/29/03
COPAY 15.00 10.00
PF8~PAGE FORWARD PF12~REFRESH PF5=ADD NOTES PF6=VIEW NOTES MSG, END OF PCP/PHP INFORMATION 4- 1 Sess-1 152.79.1.130
PF7~PAGE
BACK
PF11=RETURN
BRWS
LBPODOHO
7/1
002116
Time: Pt said that one of the doctors involved in his Fondaparinux study changed his L hip dressing at around 1800 on 12/20. The patient forgot that Encarnacion Arenas, RN, changed his dressing at around midnight on 12/20, and told his MD that it had not been changed in a couple of days. I charted the dressing change but noted that it was "per pt report". Darcey C. Arnold, RN Electronically signed by Darcey Arnold, RN at 12/21/2009 12:44 AM Nurse Assessment signed by Darcey Arnold, RN at 12/20/09 1951 Author: Darcey Arnold, RN Service: (none) Author Type: 12/20/09 1951 12/20/09 1951 Filed: Note Time:
ASSESSMENT NOTE
.NURSE: (RN or LVN)
Note Started:
12/20/2009, 1951
Initial assessment completed and recorded in EMR. Report received from day shift nurse and orders reviewed. Plan of Care reviewed and appropriate, discussed with patient. Darcey Chloe Arnold RN
Electronically signed by Darcey Arnold, RN at 12/20/2009 7:51 PM D/C Summaries signed by Jonathan G Eastman, MD at 12/20/09 1758 Service: (none) Author Author: Jonathan G Eastman, MD Type: 12/20/09 1801 12/18/09 0000 Filed: Note Time: PATIENT: AMUNDSEN, MARK LOCATION: D14O MR #: 8081369 SEX: M AGE: 50 DOB: 09/23/1959 ADMISSION DATE: 12/15/2009 DISCHARGE DATE: 12/18/2009 INPATIENT DISCHARGE SUMMARY ADMISSION DIAGNOSIS: Left hip degenerative joint disease. POSTOPERATIVE DIAGNOSIS: Same. PROCEDURE PERFORMED: Left total hip arthroplasty. HISTORY OF PRESENT ILLNESS: Mr. Amundsen is a 50-year-old male with an approximately six-month history of severe left hip pain. He ultimately failed conservative treatment with pain medications and activity modification. After discussion of the risks and benefits of the procedure, it was felt appropriate to proceed with a left total hip arthroplasty. HOSPITAL COURSE: Mr. Amundsen presented to the UC Davis Medical Center on 12/15/09. He underwent the abovementioned operation. He tolerated the procedure well and there were no difficulties. His postoperative *PHYSICIAN: RESIDENT
002117
course was unremarkable. He was transferred to the Orthopaedic Floor after an appropriate stay in the Postanesthesia Care Unit. His pain was initially controlled with intravenous pain medication. This was weaned and transitioned to an oral pain medication regimen as tolerated. He did have a Pain Pharmacy consult for assistance with this as he does have a history of prior methadone use. He was set up with an appropriate regimen that he was tolerating well. His diet was advanced as tolerated. His Foley catheter placed at the time of surgery was discontinued on postoperative day number two. His wound was checked on postoperative day two and found to be clean, dry and intact and without evidence of infection. He had daily dressing changes thereafter and the dressings were saved per the Arixtra study protocol. He received a consult by Physical and Occupational Therapy for gait mobility and training and was progressing well with this. At the time of discharge, Mr. Amundsen was afebrile. His vital signs were stable. His pain was well controlled with oral pain medications. He was tolerating a diet well without nausea or vomiting. He was urinating on his own accord without urinary retention or incontinence. He was progressing well in therapy and needed more therapy to get back to a safe level to return home. He is medically stable for discharge to a skilled nursing facility at this time. FOLLOW-UP PLAN: He will follow up with Dr. Tamurian in the Orthopaedic Oncology Clinic in two to three weeks. He was given the number 734-2700 to make/verify his follow-up appointment. DISCHARGE INSTRUCTIONS: 1. He is weight-bearing as tolerated on his left lower extremity. 2. He should follow posterior hip precautions, including no flexion past 90 degrees, no adduction past the midline and no internal rotation of his left lower extremity. 3. He is able to shower starting on postoperative day number five. 4. He should not soak or submerge his wound under water until further advised. 5. He should monitor for signs and symptoms of infection including fevers, chills, nausea, vomiting, redness, swelling, or drainage from his wound. DISCHARGE MEDICATIONS: 1. Soma, 350 mg tablets, one p.o. q. eight hours p.r.n. spasm. 2. Valium, 5 mg tablets, one p.o. q. eight hours p.r.n. anxiety/spasm. 3. Benadryl 25 mg, one p.o. q. six hours p.r.n. itching or insomnia. 4. Colace, 100 mg tablets, one p.o. b.i.d. for constipation, hold for loose stools. 5. Ferrous sulfate, 300 mg tablets, one p.o. t.i.d. 6. Prozac, 40 mg tablets, one p.o. q. a.m. 7. Methadone 40 mg p.o. daily at 8:00 a.m. 8. Methadone 40 mg p.o. daily at 4:00 p.m. 9. Methadone 50 mg tablet, one p.o. daily at 10:00 p.m. 10. Oxycodone, 20 mg tablets, one p.o. q. three hours p.r.n. pain. 11. Senna, two tabs p.o. q. h.s. 12. Arixtra 2.5 mg injected subcutaneously daily for seven more days, ending 12/25/09.
THIS WAS ELECTRONICALLY SIGNED - 12/20/2009 5:56 PM PST BY: MD RESIDENT DEPARTMENT OF ORTHOPAEDIC SURGERY JE:dmc(usa236) D: 12/18/2009 T: 12/18/2009 02:39 PM
JONATHAN EASTMAN,
002118
Hi Dr Baquero and TeriJust a quick reminder - I need a refill on my Methadone today. I shot an email off last week, but with Christmas and all, I thought I'd send a reminder. The hip replacement is going pretty well - I can't walk without the walker yet, but I'm getting around pretty good with it. The wound seems to be healing nicely, and hopefully I'll gt the staples out on the next visit. Next milestone - skiing in 2011 !! Mark Amundsen P.S. Please call or shoot me an email when the prescription is ready, would you? Thanks!
Electronically signed byClare Jennings, MA on 12/28/2009 10:23 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. D/C Summaries signed by Murali Adusumalli, MD at 12/28/09 0940 Author: Murali Adusumalli, Service: (none) Author MD Type: 12/21/09 0000 12/28/09 0943 Filed: Note Time: PATIENT: AMUNDSEN, MARK LOCATION: MR #: 8081369 SEX: M AGE: 50 DOB: 09/23/1959 ADMISSION DATE: 12/19/2009 DISCHARGE DATE: 12/21/2009 INPATIENT DISCHARGE SUMMARY PRINCIPLE DIAGNOSES DURING HOSPITALIZATION: 1. Anemia. 2. Status post left total hip replacement. HISTORY OF PRESENT ILLNESS: This is a 50-year-old gentleman who had a total hip replacement on 12/16 and was without complication, who was discharged to a skilled nursing facility for rehab. He had been on a trial medication with randomized control with Arixtra (fondaparinux). He denies any melena or bright red blood per rectum or hematemesis. Please see the Admission for further details. IMAGING STUDIES, PROCEDURES, AND LABS DURING HOSPITALIZATION: At time of admission, hemoglobin 7.1. At time of discharge, hemoglobin 8.6. HOSPITAL COURSE: A 50-year-old gentleman admitted with anemia. Hemoglobin 7.1 at the time of admission. He was not symptomatic. Given concern for acute bleeding and postop anemia, he was given 2 units of packed red blood cells. Post-transfusion hemoglobin was 8.5 and 8.6 and remained stable. He did not have any other symptoms of bleeding. Orthopaedic Surgery evaluated the wound site and did not feel there was any evidence of acute bleeding. He overall had stable symptoms. PT/OT evaluated the patient prior to discharge and cleared the patient for discharge home. DISCHARGE MEDICATIONS: *PHYSICIAN: FACULTY
002119
He was continued on all of his previous medications including: 1. Methadone daily at previous dose, 130 mg daily. 2. Prozac 40 mg daily. 3. Norco as needed. 4. Soma nightly. 5. Diazepam p.r.n. 6. Benadryl p.r.n. 7. Docusate 100 mg b.i.d. 8. Iron sulfate 300 mg one tablet three times a day. 9. Protonix 40 mg daily. 10. Senna two tabs nightly. 11. Fondaparinux, study medication. 12. Oxycodone p.r.n. DISCHARGE EXAM: Afebrile, blood pressure 105/57, pulse 70, respirations 16. Comfortable in no apparent distress. Heart: Regular rate and rhythm. No murmurs. Abdomen: Nontender. Left lower extremity edema, 1+ left lower extremity over right. Hip is nontender. There is no significant induration or swelling. FOLLOWUP: Patient to follow up with Orthopaedics and primary care physician as previous. DISCHARGE TIME: Thirty-five minutes.
THIS WAS ELECTRONICALLY SIGNED - 12/28/2009 9:40 AM PST BY: MD ATTENDING DEPARTMENT OF INTERNAL MEDICINE MA:cr(usa281) D: 12/21/2009 T: 12/21/2009 04:44 PM C#: 4837370
MURALI ADUSUMALLI,
Electronically signed by Murali Adusumalli, MD at 12/28/2009 9:40 AM Revision history:

> 12/28/09 0943 Discharge Summary (0108) revision by Murali Adusumalli, MD 12/21/09 1705 Discharge Summary (0108) filed by Murali Adusumalli, MD
Progress Notes Hi Dr Baquero and TeriJust a quick reminder - I need a refill on my Methadone today. I shot an email off last week, but with Christmas and all, I thought I'd send a reminder. The hip replacement is going pretty well - I can't walk without the walker yet,
002120
MRN:
8081369,
Patient
Last,
First:
AMUNDSEN,
MARK
QCOD: Coding Summary Form
Page I of 1
Coding Summary Form

Plltlent Name: MRN: AMUNDSEN,MARK 8081369 Fadllty~ Admission Dx: Admis:fion Date~
Medical
Rl!!cards
Payor; Reimburscment;
06, Contracts
~J,717,13
715.35 1'2/15/2009
Account #: 010016806878
DRG: 470 - M~OR JOlNT ~EPLACE;.MENT OR

REATTACHMENT OF LOWER ~XtREMfty W/O MeC
Sex: M ece, 09/23/1959
Olschuge elite:
12/18/2009
MOe;:
Weight: AHlOS:
08
2.0613
L.os: 3 Attending
Age:. SOy Patient Tvpe:

VisIt TYlJe.
Prevteen
lOS84~ TAMURIAN, ROBERT
3.8
GM~OS: 3.5 Discharge Status:: 10,SNF Coding Status: JNCOMP
____
,DX__
2
e.OA
Y
N
Code
715.35
285.1
Desc..ription
LocalOstecarthrosts NOS Pelvic!Thlgh
Acute Posthemorrhagic Anemia
Px
1 2
Code
81.51
Descri ption
Total,Hlp Replacement Hlp 6earlng Surface, Metal-On-Metal
Date
12/15/2009 J 2/15/2009
Surgeon
10884, TAMURIAN, ROBERTM 10884, TAMURIAN, ROBERTM
OlJ.lli
CPT
Notes
Code
Description
Modifier Assigned Date
SVC Date
SiJrgeon
Note Type
Memo
Coder: RMejla 11/20/20Q9
http://quantim:8080/topaz/temp/J26'1357098306,html
12n0/2009 002121
02/20/2013 MRN: 8081369, Patient Last, First:
01,15,13
PM
Page 1 of
ANrrnillJSEN.
MARK
QCQD: Coding Summary Form
Page 1 of 1
Coding Summary Form

p.tient Hlme; HRN; Account #: AMUNOSEN, MARK 8081369 010017423467
Fal;ility;
AdmiSsion Dx;
Medical aeeeres
285.9
Payor: Reimbunementl
DRG:
06, Contracts 8,918.23 81Z - RED BLOOD MCC
Admission Date:
12/191l009
CEl:L DISORDERS W/O
seX:
Discharge
Dilte:
12/21/2009
MDC: Weight: A"'LOS: GMLOS:
,.
OOB: 09/23/1959
l.!05! 2 A.ttending Provider: 10970, ADUSUMAL:tl"

MURAL{
O."Sl 3.7
Age: SOy
Patient Type: Visit Type:
2.8
COMPLETE
Discharge Status:
01,015. to berne or
self C<!Ire
Coding Stltus;
Dx
1 2 3
POA Code Description

"'--'285":1-Acute,posthemorrhaol(~Anemla,~~~~ V43.64 Y 311 Hlp Replacement Status DepressiveDisorder NEe _
Px
1
Code
99.04
Description
Trilnsfuslon of Pacl<ed Cells
Date
12,119/20M
Surgeon
10171, Technician,Admin
CPT
Notes
Code
Description
Modifier Assigned Date

COder: ethan 01/16/2010
SVC Date
Surgeon Memo
Note Tvpe
http://quantim:8080/topazltemp/1263693508928,html
1116/2010
002122
-MCEL20BPF1/13~MEN[j MRNO:
UCDMC MANAGED CARE ELIGIBILITY SSN: FIRST: MARK R 95630
ELG BRWS PAGE: 01 DMNDl-9: MI: ERISA: ELIG STAT: A ACTIVE STAT DATE: 02/16/02
~lEMBER 10: 5580604790001 LAST NAME: AMUNDSEN
ADDRESS: 2017 TARBOLTON CIRCLE FOLSOM CA
PHONE: (916)440-8673 BIRTH: 09/23/59 SEX: M CONTRACT T"E: 2 OTHER COv: N PRIM/SEC: CP.RRIER: ORIGINAL EoF: 02/16/02 EMP GRP: BS20MH0091 DMND #: 558060479BLS-02 HP TERM DATE: PCP NAME: BAQUERO, VICTOR SITE: PRODUCT CODE:
PCP CLTUIC FRO~1 THRU '" HP-OPTION FROt-1 THRU
08139
02/16;02
BS20200U
02/16/02
PF8~PAGE FORWARD PF12~REFRESH PFl1=RETURN BRWS PF5=ADD NOTES PF6=VIEW NOTES MSG: END OF PCP/PHP INFORMATION 4- 1 Sess-l 152.79.1.130 LBT3DOHO
PF7=PAGE BACK
7/1
---------_._,--------------
002123
:,\
,'7
SAN DIEGO. SAN FRANCISCO
MAY 162003
I
RECEMID
M~dicalRecords
BERKELEY. DAVIS IRVINE LOS ANGELES. RIVERSIDE. SANTA BARBARA. SANTA CRUZ
SCHOOL OF MEOICINE DAVIS, CALIFORNIA 95616 DEPARTMENT OF ANESTHESIOLOGY AND PAIN MEDICINE UCD Pain Managemenl Center 2315 Stockton Blvd. Sacramento, California 95817 Phone. (916) 7347246 Fax: (916) 7345033
April 22, 2002 Victor Baquero, M.D, UCD Medical Group, Folsom 251 Turnpike Drive Folsom, California 95630 Re: Patient Medical Date of Date of Name: Record #:. Birth: Evaluation: Amundsen, Mark R. 8081369 9/23/59 4/22/03
Dear Dr, Baquero: It was a pleasure to see your patient, Mark R. Amundsen, today in consultation at the University of California, Davis Center for Pain Medicine, As you know, the patient is a 43-year-old male being evaluated today for constant low back pain with radi~ting pain down the left leg, The pain has been present for approximately 10 years, He states that the pain initially started after performing several sit ups on a chronic basis. Approximately two years ago, the patient claims that his pain became more constant, especially during extended periods where he was sitting. Approximately one year ago, he noticed that the pain was constant at 3 to 4 on the VAS pain scale and would increase to 6 to 7 with stabbing pains at night and intermittently during the day, He states that it had progressed to point where he could not sit for more than one-half hour due to the increase in his back and left lower extremity pain. The patient de hies any acute trauma as the inciting incident to his back or left lower extremity pain,
I
The pain is present constantly (100% of the time), The patient described the pain as shooting, burning and numbness. The pain intensity is currently rated as Y.;ASof 6 anchored at 0 by "no pain" and at 10 by "the most severe pain imaginable". IThe average pain for the last week has been a VAS of 6/10. At its best, it is 3/10; and at its worst, 7/10.
RELIEVING AND AGGRAVATING FACTORS Relievinq factors for the patient's pain is lying down, medication and relaxation. The pain is aggravated by sitting and bowel movements (because the patient has to sit while having bowel movements). I The pain is unchanged by standing, walking, exercise, thinking about something el coughinq, sneezing and urination, .
\ e,VN
002124
-----------------------
Mark R. Amundsen Medical Record #: 808 13 69 Date of Evaluation: 4/22/03 Page 2 of 5
FUNCTIONAL LIMITATIONS: The patient has avoided participating in recreation, having sexual relations and driving. The patient can sit for 25 minutes and stand for 1 hour before the pain llrnitsjthis activity. The patient states that he often lies down because of pain. CURRENT MEDICATIONS: 1. Vicodin 5/500 four tablets q.h.s. 2. Cyclobenzaprine 10 mg q.h.s. FAILED PAIN MEDICATIONS: ::::::':~te. The patient states it had no affect.
Ibuprofen causes hives, rash and swellinq, The patient goes on to state that again the meclofenamate did not cause any of the reactions listed for ibuprofen. PREVIOUS 1. Traction 2. Physical 3. Exercise TREATMENTS: made the pain worse, November 2002. therapy in November 2002 in November 2002.
PREVIOUS DIAGNOSTIC STUDIES: 1. Them is a lumbar spine x-ray dated September 13, 2002. No significant radioqraphic abnormality identified in the lumbar spine for the patient's chronologic age. I 2. MRI of the lumbosacral spine dated December 20, 2002. Degenerative changes noted at the L3-4 facets bilaterally, Degenerative changes at the L4-5 facets. An annu'ar tear was noted at the L5-S1 disk along the posterior and left side of the annulus without disk protrusion. The S1 roots were unremarkable. The L5 roots were unremarkable. No evidence of lateral herniated disk. REVIEW OF SYSTEMS: The patient admits to chest pain. The patient states he has chest pain with stressful events and was previously on Prozac. He states this has been worked up and was not cardiac in nature. The patient admits to [eft-sided back pain, left hip pain and left leg muscle weakness.
I
Constitutional Sx: no fevers, no unplanned weight loss Eyes: no double or blurred vision ENT: no loss of hearing, no difficulty swallowing Heme/Lymph: no bleeding gums or low platelet count Endocrine: no known thyroid disease or heat/cold intolerance Skin: no rashes or other lesions Respiratc[y: no shortness of breath, no wheezing Cardiovascular: no palpitations GI: no constipation, abdominal pain, nausea/vomiting, diarrhea GU: no urinary retention, dysuria, sexual dysfunction Musculoskeletal: no joint or muscle pain
002125
Neuro: no loss of consciousness, blackouts, memory loss, seizures, trouble lalking, dizziness, or fatigue Behavioral: no sleep disturbance, loss of interest in activities/hobbies, difficulty concentratinq, feelings of guilt or depressed mood OTHER PAIN PROBLEMS: The patient has pain in both knees when getting up and bending. PRIOR MEDICAL HISTORY: The patient states that he has had obsessive-compulsive personality disorder. The . I patient does not have a prior history of high blood pressure, angina, heart attack, asthma, chronic cough, diabetes, stroke, cancer, seizures or epilepsy, kidney disease, liver disease, arthritis, bleeding problems. ALL SURGERIES AND APPROXIMATE DATES: 1. Tonsillectomy in June 1965. 2. Left inguinal hernia repair in January 1987. PSYCHOSOCIAL HISTORY: Educational Level: The patient's highest educational level achieved was high school graduate. .
Legal Issues: The patient does not have current claims or litigation related to his pain problem.
Psychological Treatments: The patient denies a present or past history of psychiatric, psychological or social work evaluations or treatments for any problems incl8ding the current pain problem. The patient denies a present or past history of suicide ideation or attempt. Substance Abuse History: The patient denies a history of substance abuse of alcohol, heroin, cocaine, amphetamines or other illicit substances. The patient admits to smoking 19 years, 1Y, packs a day. He quit 10 years ago.
Employment: The patient was previously employed full-time. He has unfortunately unemployed for the past week. The patient's employment has not been affe'cted by the present pain condition. The patient is a computer field engineer. FAMILY LIVING CIRCUMSTANCES: The patient is currently living with his spouse and children. FAMILY HISTORY: The patient denies a family history of migraines, back pain, suicide or psychiatric illness. PHYSICAL EXAMINATION: BP 118/81 Pulse 84 Resp 18 Weight 243.2 pounds 02 Sat 97% Constitutional: Normally developed, no deformities, well groomed. Initially, when talking to the patient, he had very poor eye contact. As examination progressed, th'e patient had very appropriate eye contact and a very witty sense of humor.
002126
I
I
Skin: No lesions, new scars, bruising, or rashes noted Lungs: Chest expansion normal, clear to auscultation without wheezes or rales Heart: Regular rate and rhythm - normal S1, S2, no murmur, rub, gallop Abdominal: Nontender to palpation, nondistended, no rebound tenderness Musculoskeletal: GaitlStation- normal free, heel toe walking, normal tandem gait, not antalgic I Psych: Oriented to time, person, and place. Normal attention span and concentration Neuro: DTR's bilaterally symmetrical biceps, triceps and brachioradialis 0, patella 2+, ankle 2+. Babinski's are downgoing bilaterally. . Motor: Bulk - normal, tone - normal, abnormal movements - none. Strength 5/5 throughout the bilateral lower extremities. Sensorv: Intact to light touch and pinprick and bilateral lower extremities. No allodynia, hyperalgesia or summation to pinprick was noted.
Back: Lumbar spine mobility was full passively and through active range of motion during forward flexion, lateral flexion to the right and lateral flexion to the left.1 The patient did experience pain with hyperextension and also lateral rotation to the left. Supine and sitting straight leg raises were negative bilaterally. Patrick's test iwas negative bilaterally. Patrick's test did elicit both right and leg groin pain during the ~ng.
Mvofascial exam: There were no trigger points or palpable bands noted overl the cervical, thoracic or lumbar paraspinal muscles. There was no significant pain to palpation or percussion over the cervical, thoracic or lumbar paraspinals or over the spinous processes themselves. .1 Pain behaviors: The patient exhibited no more grimacing, guarding, and/or holding on to objects for support than other patients with similar conditions. MEDICAL DECISION MAKING ASSESSMENT AND DIFFERENTIAL DIAGNOSIS: 1. Lumbar degenerative disk disease. 2. Lumbar radiculitis. 3. Lumbar facet arthropathy. 4. Obsessive-compulsive personality disorder. RISK OF COMORBIDITIES: At this time, there is no significant risk factor that the patient's condition poses to our current proposed treatment and evaluation plan. RECOMMENDATIONS: 1. Today during the office consultation, we personally reviewed the MRI films. After further discussion, the patient again does have some radicular signs to his low back and also left lower extremity pain. In addition, there is also the component of neuropathic pain associated with his current condition. In order to help alleviate some of the patient's current pain, especially the pain going down the leg, we are proposing to perform a translaminar lumbar epidural steroid injection. We may perform a series of these in order to get the maximum effect.
I I
002127
Mark R. Amundsen Medical Record #: 808 13 69 Date of Evaluation: 4/22/03 Page 5 of 5 2.
If the patient has significant pain relief from the lumbar epidural steroid injections, we may consider performing a left L5 selective nerve root block with a nerve stimulator in order to initially test to see if we can reproduce in the dermatomal distribution where the patient normally has his pain. Once we can locate that with th~ Stimuplex needle, we would then inject a solution for a selective nerve root block at that level. Again, this would be performed if the lumbar epidural steroid injections w~re suboptimal in their efficacy. If the left L5 selective nerve root block did show significant improvement in the patient's pain, then we would recommend performing a left pulsed radiofrequency of the L5 dorsal root ganglion (versus a left S1 depending on the effects noted during the Stimuplex selective nerve rootlblocks). 3. Again, there is significant neuropathic component associated with the patient's current pain. We have written a prescription for the patient to start on Toparnax 25 m!l p.o. q.h.s .. He was given an instruction sheet, which details the method in which he should titrate up on the Topamax. He was instructed that if he has side effects from the medication he should then stop at the point where he is and decrease the medication in the same manor in which he increased it. After further discussion, the patient had no history of renal stones or glaucoma in his past medical history. One added_benefit also from the Topamax may be that ina smallpercentage of patients that it also promotes weight loss. 4. In addition to the above listed interventional procedure, we are recommending initiating the patient in a physical therapy program. Interventions such as the above listed epidural steroid injections are more efficacious when they are coupled with increase in activity, such as being involved in a physical therapy prograrri for back strengthening, as well as aerobic conditioning. 5. If the patient continues to have ongoing axial back pain, then we will at that time consider performing a diagnostic medial branch block on the more symptomatic
side.
The patient was instructed and educated on all aspects of the plan of care. The patient acknowledged the plan of care. Thank you for allowing us to participate in the care of your patient. Should ~ou have any questions or concerns regarding the recommended care plan, please do not hesitate to contact me. Sincerely,
Gagan Mahajan, M.D. Assistant Professor UCD Pain Management Center WF/pe101 xc: Medical Records UCD Pain Management Clinic Shadow File
002128
915 508 8911 lV25/2002

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DIAGNOSTIC
LAWRENCE J. ElUSON
91 e993-2599
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PT LOCATI9N: NAME: AMUNDSEN, MARK DOB: I MR#': 8081369 MD EXAM DATE': REQUE$TINGPHYSICIAN: VICTOR HENRIQUEBAQUERO,
MRI,LUMBOSACRAL SPINE: INDICATION: ,

'
Left-sided TECHNIQUE:
L5 radiculopathy,
MRI'of the lumbosacral spine performed'with nonenhancedT1 and T2-weighted ~equences, FINDINGS:
sagittal
a~d axial
The Ll-2' ana '2-3 Leve Ls are unremarkable, At L3-4 unremarkable but there are 'degenerative ,changes of ',bilaterallY, ,moderate, 'degre~, " " , '
the 'disk is the facets "
I,
: At' L4-5," the disk, is unremarkable but ,there are, degenerati,ve , changes of moderate degree involving the facets, There is no , evidence of compression of either of the L5 roots within dhe wide ': neural foramina or wi thin 'the spinal' canal. .. : At' ,L5- Sl there is an an~lUlar tear invol v i nq the, posterior and left .s i.dc of the annulus" without disk protrusi'on, The Sl r oot.s are unremarkable'. Again, the L5' roots are unremarkable. No evidence of a lateral', herniated disk to account for symptoms, IMPRESSION: OTHERTHAt\!THE AJ.\lNULAR TEAR INVOLVINGTHE L5-S1 DISK TO 'I THE'LEFT' OF THE MIDLINE, AND THE DEGENERATIVE CHANAGES'OF THE" 'FACETS, NO ABNORMALITY IS SEEN. ' Dictated By: RichardE, Latchaw, Exam(s),Reviewed By And Findings Confirmed By: Richard E, Latchaw, , ~eport'S~gned By: Richard E: Latchaw, REL/kg' 80-122002
" P: T:
23-Dec-2002 21-Dec-02 '1,0: 50 D: 121-D~C-02 10: 43
II
2'3-Dec-20D2
I
I,
i
002130
UNIVERSITY
BERKJc.LE.Y Tl.>"\'l~
OF CALIFORNIA,
IR\'I:\E LU".\NCFLFS
DAVIS
RIVERSIDE' S,.\NDIIcCO' SAI'FR-\:-'CbCO
,
SAI':TA BARBARA
MAR 12 2003
Medlca\RecorCi
,
,
~AN IA CR\J7
MIcR<...ED
SCHOOL OF MEDICINE DEPARTMENT OF NEUROLOGICAL 4860 Y STREET, SUITE 374() SACRAMENTO. CA 95817 (916) 734-3658 FAX: (916) 4522580
UC DAVIS MEDICAL SURGERY
CENTER
February 21, 2003 Victor Baquero, M.D. UCDMG - Folsom 251 Turn Pike Dr. Folsom. CA 95630 RE:
DOB: 09/23/59
AMUNDSEN, MARK
MR#: 808 13 69 DOS: 02121103 Dear Dr. Baquero: I got to see your patient Mark Amundsen in consultation for low back and leg pain. His main problem today seemed to be back pain that radiates down his left leg to the thigh ~nd the knee. The MR! in initial review is pretty unremarkable, however, given his symptom complex lateralizing to the L3-L4 root and the fact that his knee jerk was a little decreased on the left compared to right, I looked more carefully at the MR!, and there was a far lateral disk herniation at L~- L4 on the left which might explain his symptom complex. Therefore, I still do not think he needs a surgery for -.these disks as it is fraught with difficulty particularly since the dorsal root ganglion is there, and I can make things worse. He is not that symptomatic. I am hoping that he will improve with.therapy or with an epidural steroid injection. In fact, that is my main hope for him and gi~en that he is UC Davis capitated, he will need to get that referral through you, his PCP, to the PainlManagement Service. They do have a fast track service, perhaps you can get him into that for an epidural steroid shot. He is not excited about the prospects of surgery, nor do I think he needs one at this point, but at least I am pretty sure why he is having his symptoms . . Sinc.~rely,
Jose h Assi tar Professor Dept. Neurological Surgery JCW:mhn/tmwc cc: 022l03JW
Medical Records. Departmental Chart
002131
J-l:JNIVERSITY
Bf:RKRLEY DA'\I~
OF CALIFORNIA,
IR\rl"t\'E
0
\JI:-RCED
DAVIS
RIYFRS1DE SA:" DIECO SA'\! FRANCI-;CO
RBCBJVm) MAR 12 2003
LUSA.'JGEL.I:.:'>
SCHOOL OF MEDlC[NE DEPARTMENT OF NEUROl OGIC,\L 4860 Y STREET, SUITE 3740 SACRAMENTO;CA 95817 (916) 734-3658 FAX. (916) 452-2580
SURGERY
February 2 L 2003 Victor Baquero, M.D. UCDMG - Folsom 251 Tum Pike Dr. Folsom, CA 95630 RE: DOB: MR#: DOS: AMUNDSEN, MARK
09/23/59
808 13 59
02/21103
Dear Dr. Baquero: Chief complaint: Low back pain radiating to the left and right leg. History of Present Illness: Patient is a 43-year-old right handed male who complains of low back pain for about rune years. Getting worse the last year. Pain radiates to the left leg an the time and sometimes to the right leg. Pain stops at the level of the knee. Occasion any, pairi goes to the toes. Pain feels like a dun burning an the time. After sitting for long periods of time, hb feels a sharp stabbing that radiates down the leg. Pain today is 4 out of 10. Pain varies between 3 to 7 on a scale of 1 to 10. Pain is better with laying down, with medications, and worse with sitting for more than 20 minutes and standing for prolonged periods of time. Had physical therapy but did not help. Denies epidural steroid injections. Allergies: He is anergic to ibuprofen where he gets hives and swelling. Medications:
He is taking Vicodin 3 p.o. q.h.s., Flexeril I q.h.s., and Prozac 40 mg q.d.
Past Medical History: Left inguinal hernia in 1986. tonsillectomy in 1970.
I
I
Family History: He does not know about his father's whereabouts. Mother died at 75 years old from COPD. One brother. who is 30 years old and healthy, one sister 46 years oldl and healthy. .Social History: He is a field engineer. He smoked for 16 years, quit II years ago, He drinks alcohol socially. He lives in Folsom with his wife and three stepchildren.
002132
-,---------------------------------------------------------------------------
RE: AMUNDSEN, MARK DaB: 09123/59 MR#: 8081359 DOS: 02121103 Page 2
MAR 12 2003
Medical Records
I I
Review of Systems: He has increased his weight the last two months about 15 pounds. He denies any shortness of breath, any chest pain, any urine or bowel dysfunction. Denies any blood m the
~m~.
Physical Examination: Vitals: Blood pressure 124/86, temperature 36.1, pulse 88, respirations 16, weight 243 pounds. Alert and oriented X 3, in no acute distress. GCS is 15. Strength in both lower extremities 5/5. Pinprick sensation is intact in both lower extremities. Cerebellat is normal. Gait is intact. Speech is normal. Cranial nerves II through XII intact. Babinski sign negative. Deep tendon reflexes lower extremities 2+ all around.
Radiographic Data: MRI on December 20, 2002 revealed no significant findings. Some moderate L3-L4 disk bulging. Assessment: Low back spondylosis.
Plan: Discussed epidural steroid treatment in order to decrease the disk swelling. I Patient was advised to request pain management also from his primary care phys~~ient encouraged to do physical therapy and stretching exercises. Return to clinic p.r.n. Sincerely,
Sotiris Papamichail, PAC Dept. of Neurological Surgery JCW /Sf'nuhn/tmwc cc: 022103JW
\--
Medical Records Departmental Chart
--------------------------
002133
-MCEL20BPF1/ 13=MENU MRNO,
ELG BRWS PAGE, 01 DMNDl-9, J00044785 MI, ERISA, ELIG STAT, A ACTIVE STAT DATE, 06/30/03
OTHER ID, 8081369 MEMBER ID, J000447850000 LAST NAME, AMUNDSEN 2017 TARBOLTON FOLSOM CIR CA
ADDRESS,
PHONE, ( HP, BLS ) BIRTH, 09/23/59 SEX, M CARRIER, CONTRACT TYPE, 1 OTHER COV, N PRIM/SEC, ORIGINAL EFF, 06/30/03 EMP GRP, BS20MH0197 DMND #, J00044785BLS-Ol HP TERM DATE, PCP NAME, BAQUERO, VICTOR SITE, PRODUCT CODE, FROM PCP CLINIC THRU * HP-OPTION FROM THRU 08139 06/30/03 * BS20230U 06/30/03 * BS20200U 06/30/03 06/29/03
CO PAY 15.00 10.00
PF8=PAGE FORWARD PF12=REFRESH PF5=AOD NOTES PF6=VIEW NOTES MSG, END OF PCP/PHP INFORMATION 4-<> 1 Sess-1 152.79.1.130
PF7=PAGE
BACK
PFl1=RETURN LAW6DOHO
BRWS 7/]
002134
-MCEL20BPF1/13~MENU MRNO:
UCDMC MANAGED CARE ELIGIBILITY SSN: 549250762 FIRST: MARK R 95630
ELG BRWS PAGE: 01
OTHER ID: 8081369 MEMBER ID: J000447850000 LAST NAME: AMUNDSEN 2017 TARBOLTON FOLSOM CIR CA
ML
DMNDl-9:
J00044785
ADDRESS:
ERISA: ELIG STAT: A ACTIVE STAT DATE: 06/30/03
) BIRTH: 09/23/59 SEX: M HP: BLS PHONE: ( PRIM/SEC: CARRIER: CONTRACT TYPE: 1 OTHER COV: N EMP GRP: BS20MH0197 DMND ~: J00044785BLS-Ol ORIGINAL EFF: 06130/03 HP TERM DATE: PCP NAME: BAQUERO, VICTOR SITE: PRODUCT CODE: THRU FROM PCP CLINIC THRU * HP-OPTION FROM 06/30/03 08139 * BS20230U 06130/03 * BS20200U 06130/03 06/29/03
CO PAY 15.00 10.00
MSG: 4-
PF8~PAGE FORWARD PF12~REFRESH PF5~ADD NOTES PF6~VIEW NOTES END OF PCP/PHP INFORMATION 1 Sess-1 152.79.1.130
PF7~PAGE
BACK
PF11~RET~"J
BRWS
LAMODOHO
7/1
002135
-MCEL20BPF1(13=MENU MRNO,
OTHER ID, 8081369 MEMBER ID, J000447850000 LAST NAME, AMUNDSEN 2017 TARBOLTON FOLSOM CIR CA
UCDMC MANAGED CARE ELIGIBILITY 549250762 MARK R 95630
ELG BRWS PAGE, 01 DMNDl-9, J00044785 MI. ERISA,,.....;"" ELIG STA : A ACTIVE STAT DA ,06(30(03
ADDRESS,
) PHONE, ( BIRTH, 09(23(59 SEX, M HP, BLS CONTRACT TYPE, 1 OTHER COV, N PRIM(SEC, CARRIER, ORIGINAL EFF, 06(30(03 EMP GRP, BS20MH0197 DMND #, J00044785BLS-Ol HP TERM DATE, PCP NAME, BAQUERO, VICTOR SITE, PRODUCT CODE, FROM PCP CLINIC THRU * HP-OPTION FROM THRU 08139 06(30(03 * BS20230U 06(30(03 * BS20200U 06(30(03 06(29(03
COPAY 15.00 10.00
PF8=PAGE FORWARD PF12=REFRESH PF5=ADD NOTES PF6=VIEW NOTES MSG, END OF PCP(PHP INFORMATION 4- 1 Sess-l 152.79.1.130
PF7=PAGE
BACK
PFll=RETURN LAVIDOHO
BRWS 7(1
002136
-MCEL20BPF1/13=MENU
OTHER MRNO, ,8081369 MEMBEo/iD/J009'447850000 LAST NPu'lE, AMUlJDSENj

I
mcVl
UCDMC MANAGED CARE ELIGIBILITY SSN, 549250762 fIRST, MARK R 95630
ELG BRWS PAGE, 01
ADDRESS,
2017 T RBOL;ON./c'IR FOLSO
CA
) PHONE, ( BIRTH, 09/23/59 SEX, M HP, BLS CARRIER' CONTRACT TYPE' 1 OTHER COV, N PRIM/SEC, EMP GRP, BS20MH0197 DMND #, J00044785BLS-Ol ORIGINAL EFF' 06/30/03 HP TERM DATE, PCP NAME, BAQUERO, VICTOR SITE, PRODUCT CODE, PCP CLINIC FROM THRU * HP-OPTION FROM THRU 08139 06/30/03 * BS20230U 06/30/03 * BS20200U 06/30/03 06/29/03
CO PAY 15,00 10,00
PF8=PAGE FORWARD PFI2=REFRESH PF5=ADD NOTES PF6=VIEW NOTES MSG, END OF PCP/PHP INFORMATION 4'- 1 Sess-1 152,79,1.130
PF7=PAGE
BACK
PF11=RETURN LAUADOHO
BRWS 7/1
002137
-MCEL20BPF1/13=MENU MRNO,
OTHER ID, 8081369 MEMBER ID, J000447850000 LAST NAME, AMUNDSEN :2017 TARBOLTON FOLSOM CI R CA
ADDRESS,
PHONE, ( ) BIRTH, 09/23/59 SEX, M HP, BLS CARRIER, CONTRACT TYPE, 1 OTHER COV, N PRIM/SEC, ORIGINAL EFF, 06/30/03 EMP GRP, BS20MH0197 DMND #, J00044785BLS-Ol HP TERM DATE, PCP NAME, BAQUERO, VICTOR SITE, PRODUCT CODE, FROM PCP CLINIC THRU * HP-OPTION FROM THRU 08139 06/30/03 * BS20230U 06/30/03 * BS20200U 06/30/03 06/29/03
COPAY 15.00 10.00
PF8=PAGE FORWARD PF12=REFRESH PF5=ADD NOTES PF6=VIEW NOTES MSG, END OF PCP/PHP INFORMATION 4- 1 Sess-1 152.79.1.130
PF7=PAGE
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BRWS
LAU2DOHO
7/1
002138
-~lCEL20BPF1/ 13"MENU MRNO,
UCDMC MANAGED CARE ELIGIBILITY SSN, 549250762 FIRST, MARK R
OTHER ID, 8081369 MEMBER ID, J000447850000 LAE:T NAME, AMUNDSEN 2017 TAR BOLTON FOLSOM CIR CA
ADDRESS,
95630
PHONE, ( ) HP, BLS BIRTH, 09/23/59 SEX, M CONTRACT TYPE, 1 OTHER COV, N PRIM/SEC, CARRIER, ORIGINAL EFF, 06/30/03 EMP GRP, BS20MH0197 DMND #' J00044785BLS-Ol HP TERM DATE, PCP NAME, BAQUERO, VICTOR SITE, PRODUCT CODE, FROM PCP CLINIC THRU * HP-OPTION FROM THRU 08139 06/30/03 * BS20230U 06/30/03 * BS20200U 06/30/03 06/29/03
COPAY 15.00 10.00
PF7"PAGE
BACK
4-
MSG, END OF PCP/PHP
PF8"PAGE FORWARD PFl2"REFRESH PF5"ADD NOTES PF6"VIEW NOTES INFORMATION

152.79.1.130
PFll"RETURN
BRWS
1 Sess-l
LASADOHO
7/1
002139
.1
. "-
SUBJECTIVE, Mark Amundsen is here
HEALTH SYSTEM
FOLSOM
LOCATION, IMFFOL SEX, MAGE, 43 DOB, 09/23/1959 CLINIC NOTE
UCDAVIS
.-
PATIENT, AMUNDSEN, MARK MR #' 8081369 DATE OF SERVICE, 07/22/2003 FOLSOM
for several
reasons.
For the past SlX months, he has not taken any antidepressants and feels llke he may need to start back on the them. Several months ago/ he was seeing a therapist who recommended that since the Prozac that he had been on for several years was no longer worklng, he should see a psychiatrist, not his primary care doctor and try a different medicatlon. psychiatrist put him on Zoloft and he felt very detached, He took them for about three weeks and ultimately stopped it. It was difficult being able to follow up with the psychiatrist. Did not continue any medications for the past six months. Six months ago his mom passed away and three weeks ago his wife passed away. Three months ago he was la~d from his work. He reports that on Prozac he did quite well and is thinking about potentially trying it again. He also reports having epidural back lTIJection yesterday and he is having about 30% relief of symptoms after one day. No complications. Lastly, he wants advice on potential hemorrhoids. He has had them on and off for a couple of years. He does not do any activities where he does any serious weight-lifting. He does not sit very much because it bothers his back. He is usually never constipated and the hemorrhoids have really never bled. There has been a little blood tinge on the toilet paper on occasion and they are often times mildly itchy, but not very symptomatic. OBJECTIVE, Vitals: Normal as noted. Well-nourished, well-developed, pleasant male. No apparent distress. In good spirits initially when talking about his current life stressors. He had a little breakdown and cried for a little while. Then he seemed to collect himself and perk up again. Affect is appropriate. Good amplitude. Mood seems to be a little down, but mildly hypothymic. Skin, perianal region, demonstrates a medium-sized nonthrombosed external hemorrhoid at the 1 o'clock positlon. It is nontender to the touch and there is no surrounding erythema. Rectal exam was not done. ASSESSMENT/PLAN, 1. ADJUSTMENT DISORDER WITH MILD ANXIETY AND DEPRESSION, GRIEVING THE LOSS OF HIS WIFE AND HIS MOTHER. Currently, not seeing a therapist. Advised that this would be a good idea to restart back with the therapist. Started hlffi on Prozac 20 mg and then increase to 40 mg after a week or two. He is to follow up with me in three months. 2. CHRONIC LUMBAR PAIN WITH RADICULOPATHY. Seatus pose epidural steroid ~njection one day. Havlng some improvement.
251 TURNPIKE DRIVE. FOLSOM, CA 95630 PIIONE (916) 985-9300 FAX (916) 355-1219
-;----,--------------------
MED RECORDS
FILE COPY
002140
HEALTH SYSTEM
FOLSOM
UCDAVIS
LOCATION, IMFFOL SEX, MAGE, 43 DOB, 09/23/1959
PATIENT, AMUNDSEN, MARK MR #' 8081369 DATE OF SERVICE, 07/22/2003
3. EXTERNAL HEMORRHOIDS, currently not active. Discussed management opt~ons of hemorrholds. Was given Anusol He. Use when symptomatic. Consider referral to Colorectal Surgery if these persist. THIS WAS ELECTRONICALLY SIGNED VICTOR HENRI QUE BAQUERO, MD PCN FOLSOM FAMILY AND COMMUNITY MEDICINE - 07/24/2003 1:34 PM PST BY:
VHB,rrp
(usa146)
D, T,
C#,
07/22/2003 07/23/2003
107714
05,25 01,09
PM PM
_1
'.__--
25\ TURNPIKE DRIVE. FOLSOM, CA 95630 PHONE (916) 985-9300 FAX (916)355-1219
MED RECORDS
FILE COpy
002141
Lumbar epidural steroid injection VICTOR HENRIQUE BAQUERO, MD 251 TURNPIKE DRIVE FOLSOM, CA 95630 Dear Dr. Baquero: We had the pleasure of treating your patient, Mark Amundsen, today at the University of California, Davis Center for Pain Medicine. As you know, the patient is a 43-year-old male with a history of chronic lower back pain and left-sided sciatic pain. The pain started approximately 9 years ago while doing sit-ups. It has become progressively worse, especially over the past 2 years with no specific reason. The patient's pain is described as shooting, dull, aching, throbbing. The pain intensity is currently rated as a VAS of 4 (0 to 10) anchored at 0 by "no pain" and at 10 by "the most severe pain imaginable." The average pain for the last week has been a VAS of 3 (0 to 10). CURRENT HEALTH PROBLEMS: The patient states that he currently has none. RESULTS OF MOST RECENT PRIOR PROCEDURES: The patient underwent epidural steroid injection. He noted approximately 65% relief for 2 months. No significant side effects from prior procedure. He reports the prior procedure being very helpful. It got rid of most of his leg pain and reduced his daytime pain considerably. He only uses pain meds at nighttime to assist with sleeping. The patient denies a personal or family history of prior anesthesia problems. The patient has had nothing to eat or drink for 8 hours. The patient denies a history of stridor/snoring/sleep apnea. CURRENT MEDICATIONS: 1. Vicodin. 2. Prozac. 3. Cyclobenzaprine. ANTICOAGULANT MEDICATIONS: None. ALLERGIES: IBUPROFEN. PHYSICAL EXAMINATION: Preprocedural vital signs Pain 4 out of 10 BP 121/86 Pulse 70 Resp 16 O2 Sat 95% Postprocedural vital signs Pain 3 out of 10 BP 135/90 Pulse 64 Resp 16 O2 Sat 97% Airway: Mallampati Class 2. Neck ROM - full. Thyroid-Mentum Distance in fingerbreadths - 3. Lungs: Chest expansion normal, clear to auscultation without wheezes or rales. Heart: Regular rate and rhythm - normal S1, S2, no murmur, rub, or gallop. ASA Physical Status: I I. Normal II. Mild Systemic Disease III. Complex Systemic Disease IV. Critical V. Moribund
002142
PREPROCEDURAL DIAGNOSIS AND ASSESSMENT: 1. Lumbar degenerative disk disease. 2. Lumbar radiculitis. 3. Lumbar facet arthropathy. 4. Obsessive-compulsive personality disorder. 5. Obesity. POSTPROCEDURAL DIAGNOSIS AND ASSESSMENT: 1. Lumbar degenerative disk disease. 2. Lumbar radiculitis. 3. Lumbar facet arthropathy. 4. Obsessive-compulsive personality disorder. 5. Obesity. NAME OF PROCEDURE: L5-S1 lumbar epidural steroid injection. Informed Consent: The patient's condition and proposed procedures, risks, and alternatives were discussed with the patient or responsible party. The patient's/responsible party's questions were answered. The patient/responsible party appeared to understand and chose to proceed. Informed consent was obtained. SEDATION REPORT: Sedation given: None. PROCEDURE IN DETAIL: This is the second procedure of the first series that the patient is undergoing. After obtaining written consent, a 22-gauge IV hep lock was placed. The patient was taken back to the fluoroscopy suite and placed in a prone position with a pillow under the abdomen to decrease the lumbar lordosis. The skin overlying the lumbosacral area was prepped and draped in an aseptic fashion. The L5-S1 vertebral interspace was identified by AP fluoroscopy. The skin and subcutaneous tissue overlying the target site of injection was anesthetized using 3 mL of 1% lidocaine with a 25-gauge, 1-inch needle. A 20-gauge, 3-inch Tuohy needle was advanced under fluoroscopic guidance towards the epidural space using a midline approach. The epidural space was identified using a loss of resistance to air technique. After negative aspiration for heme or CSF, a total of 1 mL of Omnipaque 180 was injected. A lumbar epidurogram was confirmed using AP fluoroscopy. After negative aspiration for heme or CSF, 10 mL of a solution containing 2 mL of 40 mg/mL (80 mg) triamcinolone and 8 mL 300 Omnipaque was injected in increments. Dye spread was noted from the S2 level up to the L4 level, left slightly greater than right. The needle was then retracted approximately halfway and the needle track was flushed with 1 mL of PF saline. There were no apparent new sensory deficits in the lower extremities present following the procedure. A sterile bandage was placed over the injection site. The heart rate, pulse oximetry, and blood pressure were continuously monitored throughout the procedure. There were no apparent complications. The patient tolerated the procedure well and was carefully escorted to the recovery room in stable condition. After meeting discharge criteria, the patient was discharged home. RECOMMENDATIONS: A. We will plan to have the patient follow up 6 to 8 weeks for a repeat lumbar epidural steroid injection. The patient has noted significant improvement after his initial injection. He has about 2 months of relief. He will continue with his home therapy programs and medications as needed. If he continues to notice improvement and his pain continues to resolve, he may defer his repeat injection to a later date. B. No medications were prescribed at today's visit. The patient was instructed and educated on all aspects of the plan of care. The patient acknowledged the plan of care. Thank you for allowing us to participate in the care of your patient. Should you have any questions regarding the above treatment plan, please do not hesitate to contact us.
002143
Sincerely,
GARY COLLINS, MD CLINICAL FELLOW DEPARTMENT OF ANESTHESIOLOGY & PAIN MEDICINE THIS WAS ELECTRONICALLY SIGNED - 09/09/2003 7:08 AM PST BY:
THIS WAS ELECTRONICALLY SIGNED - 09/09/2003 11:18 PM PST BY: ASSISTANT PROFESSOR OF CLINICAL ANESTHESIA GC:cf(trs030e) D: 09/08/2003 07:58 PM T: 09/09/2003 05:36 AM C#: 162377 cc: GAGAN MAHAJAN, MD GARY COLLINS, MD Links Previous Version Transcription Type Pain Referral Letter (2942) Electronically Signed
GAGAN MAHAJAN, MD
ID 438322
Lumbar epidural steroid injection VICTOR HENRIQUE BAQUERO, MD 251 TURNPIKE DRIVE FOLSOM, CA 95630 Dear Dr. Baquero: We had the pleasure of treating your patient, Mark Amundsen, today at the University of California, Davis Center for Pain Medicine. As you know, the patient is a 43-year-old male with a history of chronic lower back pain and left-sided sciatic pain. The pain started approximately 9 years ago while doing sit-ups. It has become progressively worse, especially over the past 2 years with no specific reason. The patient's pain is described as shooting, dull, aching,
002144
throbbing. The pain intensity is currently rated as a VAS of 4 (0 to 10) anchored at 0 by "no pain" and at 10 by "the most severe pain imaginable." The average pain for the last week has been a VAS of 3 (0 to 10). CURRENT HEALTH PROBLEMS: The patient states that he currently has none. RESULTS OF MOST RECENT PRIOR PROCEDURES: The patient underwent epidural steroid injection. He noted approximately 65% relief for 2 months. No significant side effects from prior procedure. He reports the prior procedure being very helpful. It got rid of most of his leg pain and reduced his daytime pain considerably. He only uses pain meds at nighttime to assist with sleeping. The patient denies a personal or family history of prior anesthesia problems. The patient has had nothing to eat or drink for 8 hours. The patient denies a history of stridor/snoring/sleep apnea. CURRENT MEDICATIONS: 1. Vicodin. 2. Prozac. 3. Cyclobenzaprine. ANTICOAGULANT MEDICATIONS: None. ALLERGIES: IBUPROFEN. PHYSICAL EXAMINATION: Preprocedural vital signs Pain 4 out of 10 BP 121/86 Pulse 70 Resp Postprocedural vital signs Pain 3 out of 10 BP 135/90 Pulse 64 Resp
16
O2 Sat 95%
16
O2 Sat 97%
Airway: Mallampati Class 2. Neck ROM - full. Thyroid-Mentum Distance in fingerbreadths - 3. Lungs: Chest expansion normal, clear to auscultation without wheezes or rales. Heart: Regular rate and rhythm - normal S1, S2, no murmur, rub, or gallop. ASA Physical Status: I I. Normal II. Mild Systemic Disease III. Complex Systemic Disease IV. Critical V. Moribund PREPROCEDURAL DIAGNOSIS AND ASSESSMENT: 1. Lumbar degenerative disk disease. 2. Lumbar radiculitis.
002145
3. 4. 5.
Lumbar facet arthropathy. Obsessive-compulsive personality disorder. Obesity.
POSTPROCEDURAL DIAGNOSIS AND ASSESSMENT: 1. Lumbar degenerative disk disease. 2. Lumbar radiculitis. 3. Lumbar facet arthropathy. 4. Obsessive-compulsive personality disorder. 5. Obesity. NAME OF PROCEDURE: L5-S1 lumbar epidural steroid injection. Informed Consent: The patient's condition and proposed procedures, risks, and alternatives were discussed with the patient or responsible party. The patient's/responsible party's questions were answered. The patient/responsible party appeared to understand and chose to proceed. Informed consent was obtained. SEDATION REPORT: Sedation given: None. PROCEDURE IN DETAIL: This is the second procedure of the first series that the patient is undergoing. After obtaining written consent, a 22-gauge IV hep lock was placed. The patient was taken back to the fluoroscopy suite and placed in a prone position with a pillow under the abdomen to decrease the lumbar lordosis. The skin overlying the lumbosacral area was prepped and draped in an aseptic fashion. The L5-S1 vertebral interspace was identified by AP fluoroscopy. The skin and subcutaneous tissue overlying the target site of injection was anesthetized using 3 mL of 1% lidocaine with a 25-gauge, 1-inch needle. A 20-gauge, 3-inch Tuohy needle was advanced under fluoroscopic guidance towards the epidural space using a midline approach. The epidural space was identified using a loss of resistance to air technique. After negative aspiration for heme or CSF, a total of 1 mL of Omnipaque 180 was injected. A lumbar epidurogram was confirmed using AP fluoroscopy. After negative aspiration for heme or CSF, 10 mL of a solution containing 2 mL of 40 mg/mL (80 mg) triamcinolone and 8 mL 300 Omnipaque was injected in increments. Dye spread was noted from the S2 level up to the L4 level, left slightly greater than right. The needle was then retracted approximately halfway and the needle track was flushed with 1 mL of PF saline. There were no apparent new sensory deficits in the lower extremities present following the procedure. A sterile bandage was placed over the injection site. The heart rate, pulse oximetry, and blood pressure were continuously monitored throughout the procedure. There were no apparent complications. The patient tolerated the procedure well and was carefully escorted to the recovery room in stable condition. After meeting discharge criteria, the patient was discharged home. RECOMMENDATIONS:
002146
A. We will plan to have the patient follow up 6 to 8 weeks for a repeat lumbar epidural steroid injection. The patient has noted significant improvement after his initial injection. He has about 2 months of relief. He will continue with his home therapy programs and medications as needed. If he continues to notice improvement and his pain continues to resolve, he may defer his repeat injection to a later date. B. No medications were prescribed at today's visit. The patient was instructed and educated on all aspects of the plan of care. The patient acknowledged the plan of care. Thank you for allowing us to participate in the care of your patient. Should you have any questions regarding the above treatment plan, please do not hesitate to contact us. Sincerely,
GARY COLLINS, MD CLINICAL FELLOW DEPARTMENT OF ANESTHESIOLOGY & PAIN MEDICINE THIS WAS ELECTRONICALLY SIGNED - 09/09/2003 7:08 AM PST BY:
THIS WAS ELECTRONICALLY SIGNED - 09/09/2003 11:18 PM PST BY: GAGAN MAHAJAN, MD ASSISTANT PROFESSOR OF CLINICAL ANESTHESIA
GC:cf(trs030e) D: 09/08/2003 07:58 PM T: 09/09/2003 05:36 AM C#: 162377 cc: GAGAN MAHAJAN, MD GARY COLLINS, MD Display only: Transcription (438322) on 9/8/2003 7:58 PM by Gary J Collins Document history: Transcription (438322) on 9/8/2003 7:58 PM by Gary J Collins Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed.
002147
HEALTH SYSTEM
PAIN MANAGEMENT
September 08, 2003
UCDAVIS
CENTER
RE: MR#: DOB: Date AMUNDSEN, MARK 8081369 09/23/1959 of Service: 09/08/2003
Lumbar
epidural
steroid
injection MD
VICTOR HENRI QUE BAQUERO, 251 TURNPIKE DRIVE FOLSOM, CA 95630
Dear Dr. Baquero: We had the pleasure of treating your patient, Mark Amundsen, today at the University of California, Davis Center for Pain Medicine. As you know, the patient is a 43-year-old male with a history of chronic lower back pain and left-sided sciatic pain. The pain started approximately 9 years ago while doing sit-ups. It has become progressively worse, especially over the past 2 years with no specific reason. The patient's pain is described as shooting, dull, aching, throbb"ng. The pain intensity is currently rated as a VAS of 4 (0 to 10) anchored at 0 by "no pain" and at 10 by "the most severe pain imaginable. The average pain for the last week has been a VAS of 3 (0 to 10) .
1/
CURRENT HEALTH PROBLEMS: The patient states that he currently
has none.
RESULTS OF MOST RECENT PRIOR PROCEDURES: The patient underwent epidural steroid injection. He noted approximately 65% relief for 2 months. No significant side effects from prior procedure. He reports the prior procedure being very helpful. It got rid of most of his leg pain and reduced his daytime pain considerably. He only uses pain meds at nighttime to assist with sleeping. The patient denies a personal or family history of prior anesthesia problems. The patient has had nothing to eat or drink for B hours. The patient denies a history of stridor/snoring/sleep apnea. CURRENT MEDICATIONS, 1. Vicodin. 2. Prozac. 3. Cyclobenzaprine. ANTICOAGULANT None. MEDICATIONS:
Pain Management Center 4860 Y Street, Suite 5200. Sacramento, California 95817-1418 (916) 734-7246. Fax (916) 734-5033 CHART COpy
002148
"
RE, AMUNDSEN, MR#, 8081369 Page 2
MARK
ALLERGIES, IBUPROFEN. PHYSICAL EXAMINATION: signs 70 Resp 16 02 Sat 95%
Preprocedural vital Pain 4 out of 10 BP 121/86 pulse
Postprocedural vital signs Pain 3 out of 10 BP 135/90 Pulse 61 Resp
16
02 Sat 97%
Airway: Mallampati Class 2. Neck ROM - full. Thyroid-Mentum Distance in. fingerbreadths - 3. Lungs: Chest expansion normal, clear to auscultation without wheezes or rales. Heart: Regular rate and rhythm - normal SI, 82, no murmur, rub, or gallop. ASA Physical Status, I I. Normal II. Mild Systemic Disease III. Complex Systemic Disease IV. Critical V. Moribund PREPROCEDURAL DIAGNOSIS AND ASSESSMENT: 1. Lumbar degenerative disk disease. 2. Lumbar radiculitis. 3. Lumbar facet arthropathy. 4. Obsessive-compulsive personality disorder. 5. Obesity. POSTPROCEDURAL DIAGNOSIS AND ASSESSMENT, 1. Lumbar degenerative disk disease. 2. Lumbar radiculitis. 3. Lumbar facet arthropathy. 4. Obsessive-compulsive personality disorder. 5. Obesity. NAME OF PROCEDURE: LS-Sl lumbar epidural
steroid
injection.
Informed Consent: The patient's condition and proposed procedures, risks, and alternatives were discussed with the patient or responsible party. The patient's/responsible party's questions were answered. The patient/responsible party appeared to understand and chose to proceed. Informed Consent was obtained. SEDATION REPORT:
002149
LQ
RE, AMUNDSEN, MR#, 8081369 Page 3
MARK
Sedation
given:
None.
PROCEDURE IN DETAIL, This is the second procedure undergoing.
of the first
series
that the patient
is
After obtaining written consent, a 22-gauge IV hep lock was placed. The patient was taken back to the fluoroscopy suite and placed in a prone position with a pillow under the abdomen to decrease the lumbar lordosis. The skin overlying the lumbosacral area was prepped and draped in an aseptic fashion. The LS-Sl vertebral interspace was identified by AP fluoroscopy. The skin and subcutaneous tissue overlying the target site of injection was anesthetized using 3 mL of 1% lidocaine with a 2S-gauge, l~-inch needle. A 20-gauge, 3~-inch Tuohy needle was advanced under fluoroscopic gUldance towards the epidural space using a midline approach. The epidural space was identified using a loss of resistance to air technique. After negative aspiration for heme or eSF, a total of 1 mL of Omnipaque 180 was injected. A lumbar epidurogram was confirmed using AP fluoroscopy. After negative aspiration for heme or eSF, 10 mL of a solution containing 2 mL of 40 mg/mL (SO mg) triamcinolone and 8 mL 300 Omnipaque was injected in increments. Dye spread was noted from the S2 level up to the L4 level, left slightly greater than right. The needle was then retracted approximately halfway and the needle track was flushed with 1 mL of PF saline. There were no apparent new sensory deficits in the lower extremities present following the procedure. A sterile bandage was placed over the injection site. The heart rate, pulse oximetry, and blood pressure were continuously monitored throughout the procedure. There were no apparent complications. The patient tolerated the procedure well and was carefully escorted to the recovery room in stable condition. After meeting discharge criteria, the patient was discharged home. RECOMMENDATIONS, A. We will plan to have the patient follow up 6 to 8 weeks for a repeat lumbar epidural steroid injection. The patient has noted significant improvement after his initial injection. He has about 2 months of relief. He will continue with his home therapy programs and medications as needed. If he continues to notice improvement and his pain continues to resolve, he may defer his repeat injection to a later date. B. No medications were prescribed at today's visit. The patient was instructed and educated on all aspects care. The patient acknowledged the plan of care. of the plan of
002150

September 08, 2003 Lumbar epidural steroid VICTOR HENRI QUE BAQUERO, 251 TURNPIKE DRIVE FOLSOM, CA 95630 Dear Dr. Baquero:
HEALTH SYSTEM
PAIN MANAGEMENT
UCDAVIS
SEP 122003
CENTER
RE, AMUNDSEN, MARK MR#, 8081369 DOB: 09/23/1959 I Date of Service, 09/08/2003
injection MD
We had the pleasure of treating your patient, Mark Amundsen, Foday at the Uni ve r s i t.y of California, Davis Center for Pain Medicine'l As you know, t:he patient is a 43-year-old male with a history of chronic lower back pain and left-sided sciatic pain. The pain starte1d app r ox ; matel y 9 years ago while doing si t-ups. It has becomel progressively worse, especially over the past 2 years with specific reason. The patient's pain is described as shooting, dull, abhing, throbbing.
nd
The pain intensity 18 currently rated as a VAS of 4 (0 to 10) anchored at 0 by \ \ no pain" and at 10 by "the most severe pain imaginable. . , The average pa i.n for the last week has been a VAS of 3 (0 to '10) .
I I
CURRENT HEALTH PROBI,EMS, The pat ient states that he currently
has none.
RESULTS OF MOST RECENT PRIOR PROCEDURES, The patient underwent epidural steroid injection. He noted approximately 65% relief for 2 months. No significant side effects I from prior procedure. He reports the prior procedure being very helpful. It got rid of most of his leg pain and reduced his daytime pain considerably. He only uses pain meds at nighttime to as~ist with sleeping. I The patient denies a personal or family history of prlor anesthesia , problems. The patient has had nothing to eat or drink for 8 hours. The pat ient denies a history of stridor (snoring (sleep apnea. CURRENT MEDICATIONS, 1. v.i cod i n . 2. Prozac. 3. Cyclobenzaprine. ANTICOP,GULANT None. MEDICATIONS,
jlr'
95817-1418 COPY FOR GAGAN
Pain Management Center 4860 Y Street, Suite 5200. Sacramento, California (916) 734-7246. Fax (916) 734-5033
.,----------_.-----------------
MAHAJAN
002151
RE, MR#,
AMUNDSEN, 8081369
MARK signs 70 Resp 16 02 Sat 95%
Page 2
ALLERGIES, IBUPROFEN. PHYSICAL EXAMINATION,
Preprocedural vital Pain 4 out of 10 BP 121/86 Pulse
postprocedural vital signs Pain 3 out of 10 BP 135/90 Pulse 64 Resp
16
02 Sat 97%
Airway, Mallampati Class 2. Neck ROM - full. Thyroid-Mentum Distance in fingerbreadths - 3. I Lungs: Chest expansion normal, clear to auscultation without wheezes or rales. Heart: Regular rate and rhythm - normal SI, 82, no murmur, ~ub, or gallop.
ASAPhysical Status: I I. Normal II. Mild Systemic Disease III. Complex Systemic Disease IV. Critical v. Moribund PREPROCEDURAL DIAGNOSIS AND ASSESSMENT, 1. Lumbar degenerative disk disease. 2. Lumbar radicul i ti s , 3. Lumbar facet arthropathy.
4.
5.
Obsessive-compulsive personality disorder.

Obesity.
POSTPROCEDURAL DIAGNOSIS AND ASSESSMENT, 1. Lumbar degenerative disk disease. 2. Lumbar radicul i ti s . 3. Lumbar facet arthropathy. 4. Obsesslve-compulsive personality disorder. 5. Obesity. NAME OF PROCEDURE, L5-S1 lumbar epidural
steroid
lnjection.
Informed Consent: The patient's condltion and proposed procedures, risks, and alternatives were d i s cus se d with the patient or relsponsible party_ The patientls/responsible partyls questlons were ansJered. The patient/responsible party appeared to understand and chos~ to proceed. Informed consent was obtained. SEDATION REPORT,
.,
002152
-------_.-------------------
RE, MR#,
AMUNDSEN, 8081369
DETAIL,
MARK
procedure of the first series that the patient is
Page 3
Sedation
PROCEDURE
given:
IN
None.
~~~:r~~i~~e
second
After obtaining written consent, a 22-gauge IV hep lock was placed. The patient was taken back to the fluoroscopy suite and place~ in a I prone position with a pillow under the abdomen to decrease the lumbar lordosis. The skin overlying the lumbosacral area was preppeb and was draped in an aseptic fashion. The L5 -81 vertebral interspacel identif ied by AP fluoroscopy. The skin and subcutaneous tis slue l overlying the target site of injection was anesthetized using 3 mL of 1% lidocaine with a 25-gauge, l;,,-inchneedle.
A 20-gauge, 3~-inch Tuohy needle was advanced under fluoroscopic guidance towards the epidural space using a rru d Li rie approaCh.j The epidural space was i de nt i t aed using a loss of resistance to a1lr technique. After negative aspiration for heme or CSF, a tot all , of 1 mL of Omnipaque 180 was injected. A lumbar epidurogram was con fi rmed using AP fluoroscopy. After negative as p i rat i o n for heme or ICSF, 10 mL of a solution containing 2 mL of 40 mg/mL (80 mg) triamci~olone and 8 mL 300 Omnipaque was injected in increments. Dye spread wals noted from the S2 level up to the L4 level, left slightly greater t'han right. The needle was then retracted approximately halfway ~nd the needle track was flushed with 1 mL of PF saline. There were rio apparent new sensory defici ts in the lower ex t r erm t i es presen~t following the procedure. A sterile bandage was placed over the injection site.
The heart rate, pulse oximetry, and blood pressure were continuously moni tared throughout the procedure. There were no apparent j complications. The patient tolerated the procedure well and was carefully escorted to the recovery room in stable condition. After meeting discharge criteria, the patient was discharged home.
RECOMMENDATIONS,
A. We will plan to have the patient follow up 6 to 8 weeks for a repeat lumbar epidural steroid injection. The patient has noted significant improvement after his initial injection. He has ~bout 2 months of relief. He will continue with his home therapy pr06rams and me~icatio~s as needed. If he continues to notice improvementl and his pa i n co n t t nu es to resolve, he may defer his repeat injection to a later elate. B. No medlcations were prescribed at today's visit. The patient was instructed and educated on all aspects care. The patient acknowledged the plan of care. of the plan of
002153
-,------------,----------------
RE,
MR#,
AMUNDSEN,
8081369
MARK
Page 4
Thank you for allowing us to participate in the care of your patient. Should you have any questions regarding the above treatment plan, please do not hesitate to contact us.
s i nce.reIy ,
GARY COLLINS, MD CLINIClIL FELLOW DEPARTMENT OF ANESTHESIOLOGY

THIS WAS ELECTRONICALLY
& PAIN MEDICINE

09/09/2003 7,08 AM PST BY,
SIGNED
THIS
WAS ELECTRONICALLY
SIGNED
09/09/2003
11,18
PM PST
BY,
GAGAN r1AHAJAN, MD ASSISTANT PROFESSOR
OF CLINICAL
ANESTHESIA
D,
T, C#,
09/08/2003 09/09/2003 162377
07,58
05,36
PM
AM
cc .
GAGA.'J MAHAJAN, MD GARY COLLINS, MD
002154
Display only: Transcription (717662) on 12/1/2003 5:52 PM by Victor Baquero Document history: Transcription (717662) on 12/1/2003 5:52 PM by Victor Baquero Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes PATIENT: AMUNDSEN, MARK LOCATION: IMFFOL MR #: 8081369 SEX: M AGE: 44 DATE OF SERVICE: 10/03/2003 DOB: 09/23/1959 FOLSOM CLINIC NOTE SUBJECTIVE: Mark Amundsen is here for followup regarding his cervicalgia. He had a second injection in the lumbar back with less relief this time than the last time. However, he has been in less pain. He is functioning better. He is able to walk around. He can sit for more than 30 minutes before being uncomfortable. He is doing back exercises that are also helping him along. He is currently taking about 2-1/2 Norco at 10/325 per day and taking one Flexeril at nighttime. Mood-wise, he is doing a lot better. The Prozac at 40 mg is helping him. He has a better outlook. He is now looking for jobs and is optimistic about the future. He says overall mood he went from a 3 to a 6. He is still having a little bit difficult time occasionally. He still cries every now and then. He is seeing a counselor on a monthly basis to go over the grief. For his grief it has been almost a year since his wife's passing and he seems to be moving along pretty good. He is not ready to date at his point. He has noticed some decreased sexual performance with the Prozac but at this point is not concerned. He does state his mind is slightly scattered as well. He attributes it to the Prozac. OBJECTIVE: Vitals: Normal noted. Well-nourished, well-developed, pleasant male in no apparent distress. Skin is warm and moist. Thought process and concentration are normal. He is laughing and smiling in the office. He affect appears to be full amplitude and mood euthymic. He certainly has more coloration. He is leaner and fitter and appears more alive and alert compared to last visit. ASSESSMENT AND PLAN: 1. Radiculopathy along the left leg. Continue seeing Pain Management. Advised him to try to back off the Vicodin if possible and will try to transition him over to anti-inflammatories along with the Flexeril. 2. Mood-wise, he is improved on the Prozac; however, not yet at what I would consider remission. Advised him that he may want to increase the dose to 60 mg daily if he finds that he plateaus at this level. He is to continue seeing the counselor for his grief reaction. 3. Weight loss of 30 pounds due to exercise and dieting. Praised him for his efforts and advised him to continue the good work. 4. Health care maintenance. Will follow up for a physical in the near future. Screening blood work was ordered. In addition, ordered a testosterone level given the fact he has been on chronic opiates and has some symptoms that may be due to testosterone deficiency.
THIS WAS ELECTRONICALLY SIGNED - 10/06/2003 12:58 PM PST BY:
VICTOR HENRIQUE
002155
BAQUERO, MD PCN FOLSOM FAMILY AND COMMUNITY MEDICINE
Links Previous Version Transcription Type Folsom Clinic Note (7721)

Electronically Signed ID 526373 Date and Time 10/3/2003 1:39 PM Author Victor Baquero
Document Text LOCATION: IMFFOL PATIENT: AMUNDSEN, MARK MR #: 8081369 SEX: M AGE: 44 DATE OF SERVICE: 10/03/2003 DOB: 09/23/1959 FOLSOM CLINIC NOTE SUBJECTIVE: Mark Amundsen is here for followup regarding his cervicalgia. He had a second injection in the lumbar back with less relief this time than the last time. However, he has been in less pain. He is functioning better. He is able to walk around. He can sit for more than 30 minutes before being uncomfortable. He is doing back exercises that are also helping him along. He is currently taking about 2-1/2 Norco at 10/325 per day and taking one Flexeril at nighttime. Mood-wise, he is doing a lot better. The Prozac at 40 mg is helping him. He has a better outlook. He is now looking for jobs and is optimistic about the future. He says overall mood he went from a 3 to a 6. He is still having a little bit difficult time occasionally. He still cries every now and then. He is seeing a counselor on a monthly basis to go over the grief. For his grief it has been almost a year since his wife's passing and he seems to be moving along pretty good. He is not ready to date at his point. He has noticed some decreased sexual performance with the Prozac but at this point is not concerned. He does state his mind is slightly scattered as well. He attributes it to the Prozac. OBJECTIVE: Vitals: Normal noted. Well-nourished, well-developed, pleasant male in no apparent distress. Skin is warm and moist. Thought process and concentration are normal. He is laughing and smiling in the office. He affect appears to be full amplitude and mood euthymic. He certainly has more coloration. He is leaner and
002156
fitter and appears more alive and alert compared to last visit. ASSESSMENT AND PLAN: 1. Radiculopathy along the left leg. Continue seeing Pain Management. Advised him to try to back off the Vicodin if possible and will try to transition him over to anti-inflammatories along with the Flexeril. 2. Mood-wise, he is improved on the Prozac; however, not yet at what I would consider remission. Advised him that he may want to increase the dose to 60 mg daily if he finds that he plateaus at this level. He is to continue seeing the counselor for his grief reaction. 3. Weight loss of 30 pounds due to exercise and dieting. Praised him for his efforts and advised him to continue the good work. 4. Health care maintenance. Will follow up for a physical in the near future. Screening blood work was ordered. In addition, ordered a testosterone level given the fact he has been on chronic opiates and has some symptoms that may be due to testosterone deficiency.
Display only: Transcription (526373) on 10/3/2003 1:39 PM by Victor Baquero Document history: Transcription (526373) on 10/3/2003 1:39 PM by Victor Baquero Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes September 08, 2003 RE: AMUNDSEN, MARK MR#: 8081369 DOB: 09/23/1959 Date of Service: 09/08/2003
002157
HEALTH SYSTEM
FOLSOM
PATIENT: AMUNDSEN, MARK MR II: 8081369 DATE OF SERVICE: 10/03/2003 FOLSOM CLINIC NOTE
UCDAVIS
LOCATION:
SEX: MAGE:
IMFFOL
44
DOB:
09/2311959
SUBJECTIVE: Mark Amundsen is here for fo11owup regarding his cervicalgia. He had a second lnjectlon in the lumbar back with less relief this time than the last time. However, he has been in less pain. He is functioning better. He is able to walk around. He can sit for more than 30 minutes before belng uncomfortable. He is doing back exercises that are also helping him along. He is currently taklng about 2-1/2 Norco at 10/325 per day and taking one F1exeri1 at nighttime. Mood-wise, he is doing a lot better. The Prozac at 40 mg is helping hlffi. He has a better outlook. He is now looking for jobs and is optim~stic about the future. He says overall mood he went from a 3 to a 6. He is still having a little bit difficult time occasionally. He still cries every now and then. He 15 seeing a counselor on a monthly basis to go over the grief. For his grief it has been almost a year since his wife's passing and he seems to be moving along pretty good. He 18 not ready to date at his point. He has noticed some decreased sexual performance wlth the Prozac but at this point is not concerned. He does state his mind is slight]y scattered as well. He attributes it to the Prozac. OBJECTIVE: Vitals: Normal noted. Well-nourished, well-developed, pleasant male in no apparent distress. Skin is warm and moist. Thought process and concentration are normal. He is laughing and smillng in the office. He affect appears to be full amplitude and mood euthymic. He certainly has more coloration. He is leaner and fItter and appears more alive and alert compared to last visit. ASSESSMENT AND PLAN:
1. RadIculopathy along the left leg. Continue seeIng Pain Management. Advised him to try to back off the Vicodin if possible and will try to transition him over to anti-inflammatories along with the Flexeril. 2. Mood-wise, he is Improved on the Prozaci however, not yet at what I would consider remission. Advised him that he may want to increase the dose to 60 mg daily if he finds that he plateaus at this level. He lS to continue seeing the counselor for his grief reaction. 3. Weight loss of 30 pounds due to exercise and dieting. Praised him for his efforts and advised him to continue the good work. 4. Health care maintenance. Will follow up for a physical in the near future. ScreenIng blood work was ordered. In addltlon, ordered a testosterone level given the fact he has been on chronlc opiates and has some symptoms that may be due to testosterone deficiency. !
251 TURNPIKE DRIVE. PHONE (916) 985-9300.
FOLSOM, CA 95630 FAX (916) 355-1219

MF'.[) RF'.rORf1S F'TT.F'.ropy
002158
HEALTH SYSTEM
FOLSOM
PATIENT:
I~R
UCDAVIS
#:
AMUNDSEN,
8081369
MARK
DATE OF SERVICE:
10/03/2003 - 10/06/2003 12:58
LOCATION: IMFFOL SEX: MAGE: 41 DOB: 09/23/1959 PM PST BY:
THIS WAS ELECTRONICALLY SIGNED VICTOR HENRIQUE BAQUERO, MD PCN FOLSOM FAMILY AND COMMUNITY
MEDICINE
VHB:dkb(usa162) D: T: C#: 10/03/2003 10/06/2003 195615 01: 39 PM 11: 02 AM
251 TURNPIKE DRIVE. FOLSOM, CA 95630 PHONE (916) 985-9300 FAX (916) 355-1219
MF,[) Rcr.OROS F'TT.F. ropy
002159
UC DAVIS MEDICAL CENTER CLINICAL LABORATORY Ralph Green, M.D. Director CLINIC COPY: UCDMG FOLSOM UNIT#: 8081369 . ACCT#,: 07963657.6107;'
-. f "
LABORATORY
REPOJt
~CEIVEL'
o~~32003
LOC: OPCLN.
PATIENT:
~A:- -
-.', '
AMUNDSEN. MARl(
.-: :';, .
.'~
-;
~."~.'
.DOB: 09/23/59 AGE!SX::44/M ',<'
SPEC #: 1003,CI00578R
COLL: RECD: STATUS: PANEL
10/03/03-0920 10/03/03-1040
COMPLETE
PT PHONE: SUBM DR:
916-983-2589 BAQUERO,VICTOR UCDMG FOLSOM

I
ORDERED:
CCP, LIPID
"Nor~al .',;
>C'Cp:i'~f" . '.:'~ :,<{.
A'
:::'"
:~Flag Reference
. .c.,
.j..... ...
"', ..
:.,,'
,,~ ,
:{
,,~, CALC TuM' .~.,.

PROTEIN ALBUMIN
SODIUM .PQTASSIUM:d,. CHLORIDE CARBON DIOXIDE UREA NITROGEN CREATININE' .. GLUCOSE "':'.,,;.;::
.L .. I
I I
10.8
I.
\1')il>
140
,'.:,,3 .6,
'Id::
..... .
". 1135t145 mEq/L .. 1 .13,3f.5.0 .mEq/L .. ;.:.' I 195-i10 mEq/L '.1 124-~2mEq/L ...:.. 1 118-2 mg/dL 1 ... O. 5fl. 3ing/dL
104
28 17
.. J.:,,,,.
.. 1
.. 11
. II' .
-I
..': 97~
58 " O. 7 YES
.. ... 1"
I 6.5 ''I-' . .":.','.3.8

I
",J'19
.. 1
.'~':::: }\ST . .c.'"
ALK PHOS
>1,:
TOTAL BILIRUBIN LIPID PANEL, FASTING CHOLESTEROL HDL LDL
CHOL:Hj)L'
(CALC)
adul t val ue < 200 49
'1 I
'1""":1 I ....11
1.
I[
." :I~i~:~tt~ .. ~j~~,>;"

I
... 1 '1.
170-~10 mg/dL. 18.6.;-10. 5'mg/dL
..,,,,',,
Xl ~~;t~ .~!~;/d~:
H
135-115 U/L
.:>Ie" . "'.::
I
I.
.....
153
:,11 .~ ..~:.
'1
:1 .
mg/dL
'23611
.1
10-200 mg/dL
I:
I
i
.. .. ..w,
TRIGLYCERIDE
11
'I
~:i :~,'~6
I >= 35 mg.! dL
m!j'!dL
135-160 mg/dL
pvr+ tlu l\s \a'\O'~

University of California, Davis, Medical Center 95817 ~ 2315 Stockton Blvd. (916) 734-0500 / FAX Sacramento, California (916) 734-5665
f rdJ / ~:
J--&;-(p;~<Vv
/~
______ReSUlts
ok
______ /.k!rSQ ~Ue~dod
______F/l) "Pf'O~ntr!:,1h parent
R,eSults as -------D'SCUSSed rosufts' .
'p ' expeet~
O/(~~Je
------!'r<Jst:;t~on ~,~}~nt of r/l$ults "''''cum .

Report: Pr1nted: XCLINICPCN 10/07/03-0605 10/06/03-10/07/03
I
For activ~ty:
,
!
** CONTINUED
ON NEXT
PAGE
**
FINAL REPORT
I 002160
"
UC DAVIS
LABORATORY REPol
MEDICAL CENTER CLINICAL LABORATORY Ralph Green, M.D. Director CLINIC COPY: UCDMG FOLSOM PAGE 2
PATIENT: .AMmrnSEN,MARK
., ~. " - .;.
"
..
"
,~';:'
'.\~-:'
", ,>,'-'
'.::~.;:'
UNIT#:i,80813,69
,,:;, ." :t~(Cont~nued};;'

I
SPEC #: 1003:S00025R
COLL: RECD: STATUS:
10/03/03-0920 10/03/03-1040
COMPLETE
PT PHONE: SU5M DR:
916-983-2589 BAQUERO,VI~TOR UCDMG FOLSOM
ORDERED:
TESTOSTIlRON,BIO
Test
,.".,: '., .,
,<,,':
..
Re~ult:,;: 192".:<
... ,_.Flag;:~
J1-;,~eren~~ '" 350.-890:'ng/dL:.,:..,,,., ...
TESTOSTERONE, BIOAVAILABLE (*a)
>.TESTOSTERONE
I I I I I I I I I I I
1.1.:
i-., LI.
INTERPRETATION: Testosterone
concentrations of testosterone in both sexes during the first week of life average about 25 ng/dL. In male infants, values increase sharply in the second week to a maximum (mean about 175 ng/dL) at about two months, which lasts until about six months of age. In female infants, values decrease in the first week and remain lo~ throughout Serum
early childhood. Levels age. increase during puberty
values,
and are related
to pubertal
stage
rather
ito
;
adult
than
chronological
I Tanner Stage Serum Testosterone (ng/dL) I or Age (yrs) Male Female I ------------------.-----------.----I I (7 mos-9 yrs) Less than 30 Less than 10 I II (10-13) Less than 150 Less than 30 I III (14-15) 100 - 320 Less than 35 I IV, V (16-19) 200 - 970 15 - 40 I 20-39 yrs 400 - 1080 15 - 70 I 40-59 yrs 350 - 890 4 - 70 I 60 and over 350 - 720 4 - 60 I I To convert to nmol/L, mU~~iply ng/dL by 0.0347
> :.
I
I ,
I
,,
.
.!.
;
1
I
I
~'ALBUMm,' " TESTOSTERONE,BIOAVAILABLE
..,_ .....
SEX HORMONE. BINDING
....,..
..
I. -., I I I I I I I I
1
GLOBULIN ...
".W'.
. 4:4
19
:,,,;,,1 ~\'~~.6~~~~t,
i, "
119.6 I L I 130.5-681.7 ng/dL TEST INFORMATION: Testosterone, Bioavailable ! The concentration of Bioavailable Testosterone i~ derived from a mathematical expression based on constant~ for the binding of Testosterone to Sex Hormone Binding Globulin
and Albumin.
>
TESTOSTERONE;
FREE
43 .. 8 TEST INFORMATION:
. ; I;., Testosterone,
L "J Free
47 ';9,244.!O
I
I
pg/mL
(*a.l
Performed 500 Chipeta Way

of Californi"" Blvd. Davis,
by: ARUP Laboratories Salt Lake City, Utah

Medical Center 95817
- E. ASHWOOD,MD 84108 (800)242-2787

Report: Printed:
University (916)
2315 Stockton 734-0500
aecxaeenco , California 734-5665
XCLINICP~N 10/07/03-0605 10/06/03-10/07/03 I

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** CONTINUED
ON NEXT
PAGE
**
FINAL
REPORT
-----------_.--------------
002161
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AMUNDSEN,MARK
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I
Stockton
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734-5665
For act2v2ty:
** CONTINUED ON NEXT PAGE **
FINAL
REPORT
I
I,
002162

UC DAVIS
LABORATORY
Ralph
CLINIC
REPO~
LABORATORY PAGE 4
MEDICAL CENTER CLINICAL
Green,
COPY:
M.D. Director
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734-0500
Sacramento,
(!l16) 734-5665
Report: Printed:
XCLINICPCN lO/07/P3-0605 10/06/03-10/07/03 t
For activity:
** END OF REPORT
**
FINAL REPORT
,I
002163
cc: LANA WANIA-GALICIA, MD

Display only: Transcription (822628) on 1/5/2004 5:57 PM by Lana Louie Wania-Galicia Document history: Transcription (822628) on 1/5/2004 5:57 PM by Lana Louie Wania-Galicia
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes PATIENT: AMUNDSEN, MARK LOCATION: IMFFOL MR #: 8081369 SEX: M AGE: 44 DATE OF SERVICE: 12/01/2003 DOB: 09/23/1959 FOLSOM CLINIC NOTE SUBJECTIVE Mark Amundsen is here for follow up on labs. He also reports left- sided hip pain radiates to the groin. Clicking and locking sometimes and some morning stiffness on the hips. This pain has been chronic and radicular symptoms are better. The hip pain has not really been well relieved by the opioid medication. OBJECTIVE Vitals normal and noted. Well-nourished, well-developed, pleasant male in no apparent distress. Skin: Warm and moist. Back exam: Stable. Hip exam: Reveals tenderness and limited range of motion with flexion, internal and external rotation, and abduction. Left hip was not examined. ASSESSMENT AND PLAN 1. Follow up on lab work. Discussed cholesterol results. Borderline lipids: Recommended dietary changes and exercise. Recheck in the next few months. 2. Hypotestosteronism due to chronic opioid use most likely: Will replace with AndroGel 5 mg to skin q.d. Recheck lab work in one month. 3. Left-sided hip pain somewhat chronic: X-rays were ordered. Follow up in ________ time. Continue current medication. Consider NSAIDs and prescribed Ultram 50 mg p.o. q.i.d. p.r.n. Consider referral to Orthopaedics given the chronic nature of his hip pain. 4. Radicular symptoms improved at this point: Continue current treatment as needed.
THIS WAS ELECTRONICALLY SIGNED - 12/04/2003 7:20 AM PST BY: BAQUERO, MD PCN FOLSOM FAMILY AND COMMUNITY MEDICINE
VICTOR HENRIQUE
002164
HEALTH SYSTEM
FOLSOM
LOCATlON:: IMFFOL SEX: M ,AGE: 44 DOB: 09/23/1959 CLINIC NOTE
UCDAVIS
PATl ENT: AMUNDSEN, MARK ME #: 8081369 DATE OF SERVICE: 12/01/2003 FOLSOM
SUBJECTIVE M(?rk Amundsen is here for follow up on labs. He also reports leftsided hi p pain radiates to the groin. Clicking and locking sometimes and some morning stiffness on the hips. This pain has been chronic and radicular symptoms are better. The hip pain has not really been well relleved by the opioid medication. OBJECTIVE Vitals normal and noted. Well-nourished, well-developed, pleasant male in no apparent distress. Skin: Warm and moist. Back exam: Stable. HlP exam: Reveals tenderness and limited range of motion with flexion, internal and external rotatioD, and abduction. Left hip was not examined. ASSESSMENT &~D PL~~ 1. Follow up on lab work. Discussed cholesterol results. Borderline lipids: Recommended dietary changes and exercise. JRecheck in the next few months. 2. Hypot.e s t os t er-oru arr; due to chronic opioid use most Li.ke ly. Will repJace with AndroGel 5 mg to skin q.d. Recheck lab work in one month. --3. Left-sided hip pain somewhat chronic: X-rays were ordered. Follow up in time. Con t.Lnue current medication. Cons'ider NSAIDs and prescribed Ultram so mg q.i.d. p.r.n. Consider referral to Orthopaedics given the chronic nature of his hip pa'i,n . 4. Radicular syrnpt.orns. improved at this point: cont anuo curr,ent treatment as needed.
p.o.
THI5 WAS ELECTRONICALLY SIGNED VICTOR HENPIQUE BAQUERO, MD PCN FOLSO~l FAMILY AND COMMUNITY
- 12/04/2003
7:20 AM PST BY:
MEDICINE
VHB:sa(usa161bJ D: T:
C~:
12/01/2003 12/01/2003
::'(15170
05:52 08:17
PM PM
FOLSOM, CA 95630 FAX (916) 355-1219

MF.D RF',lORDS F'TT,F', ropy
002165

Document Text LOCATION: IMFFOL PATIENT: AMUNDSEN, MARK MR #: 8081369 SEX: M AGE: 44 DATE OF SERVICE: 12/01/2003 DOB: 09/23/1959 FOLSOM CLINIC NOTE SUBJECTIVE Mark Amundsen is here for follow up on labs. He also reports leftsided hip pain radiates to the groin. Clicking and locking sometimes and some morning stiffness on the hips. This pain has been chronic and radicular symptoms are better. The hip pain has not really been well relieved by the opioid medication. OBJECTIVE Vitals normal and noted. Well-nourished, well-developed, pleasant male in no apparent distress. Skin: Warm and moist. Back exam: Stable. Hip exam: Reveals tenderness and limited range of motion with flexion, internal and external rotation, and abduction. Left hip was not examined. ASSESSMENT AND PLAN 1. Follow up on lab work. Discussed cholesterol results. Borderline lipids: Recommended dietary changes and exercise. Recheck in the next few months. 2. Hypotestosteronism due to chronic opioid use most likely: Will replace with AndroGel 5 mg to skin q.d. Recheck lab work in one month. 3. Left-sided hip pain somewhat chronic: X-rays were ordered. Follow up in ________ time. Continue current medication. Consider NSAIDs and prescribed Ultram 50 mg p.o. q.i.d. p.r.n. Consider referral to Orthopaedics given the chronic nature of his hip pain. 4. Radicular symptoms improved at this point: Continue current treatment as needed.
THIS WAS ELECTRONICALLY SIGNED - 12/04/2003 7:20 AM PST BY: VICTOR HENRIQUE BAQUERO, MD PCN FOLSOM FAMILY AND COMMUNITY MEDICINE
002166
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes January 05, 2004 RE: AMUNDSEN, MARK MR#: 8081369 DOB: 09/23/1959 Date of Service: 01/05/2004 LEFT L4-L5 AND L5-S1 LUMBAR FACET JOINT INJECTION VICTOR HENRIQUE BAQUERO, MD UC DAVIS MEDICAL GROUP FOLSOM 251 TURNPIKE DRIVE FOLSOM, CA 95630 Dear Dr. Baquero: We had the pleasure of treating your patient, Mark Amundsen, today at the University of California, Davis Center for Pain Medicine. As you know, the patient is a 44-year-old male with a history of chronic low back pain, which radiates down to the left posterolateral aspect of his left lower extremity down to the knee. It started nine years ago while he was doing sit ups and has progressively increased in severity and frequency over the past two years. The patient's pain is described as sharp, shooting and cutting. The pain intensity is currently rated as a VAS of 3/10 (0 to 10) anchored at 0 by "no pain" and at 10 by "the most severe pain imaginable." The average pain for the last week has been a VAS of 4- 5/10 (0 to 10). CURRENT HEALTH PROBLEMS: The patient states that he currently has no health problems. RESULTS OF MOST RECENT PRIOR PROCEDURES: The patient had his second lumbar epidural steroid injection done on 9/8/03, which provided only 10% relief for three weeks. He had excellent results from his first LES, which helped his leg pain -- now does not have leg pain. Neither the first nor second LES have helped the LBP. The patient denies a personal or family history of prior anesthesia problems. The patient has had nothing to eat or drink for eight hours. The patient denies a history of stridor, snoring or sleep apnea. CURRENT MEDICATIONS: 1. Fluoxetine. 2. Flexeril. 3. Norco. ANTICOAGULANT MEDICATIONS: None.
002167
ALLERGIES: Ibuprofen, which results in hives and swelling. PHYSICAL EXAMINATION: Preprocedural vital signs VAS 3/10 BP 124/84 Pulse 87 Resp 16 O2 Sat 97% Postprocedural vital signs VAS 1/10 BP 127/89 Pulse 70 Resp 16 O2 Sat 99% Airway: Mallampati Class II. Neck ROM full. Thyroid-Mentum Distance in fingerbreadths 3 cm. Lungs: Chest expansion normal, clear to auscultation without wheezes or rales. Heart: Regular rate and rhythm - normal S1, S2, no murmur, rub, or gallop. ASA Physical Status: II I. Normal II. Mild Systemic Disease III. Complex Systemic Disease IV. Critical V. Moribund PREPROCEDURAL DIAGNOSIS AND ASSESSMENT: 1. Lumbar facet arthropathy. 2. Lumbar degenerative disc disease. 3. Lumbar radiculitis. 4. Obsessive compulsive personality disorder. 5. Obesity. POSTPROCEDURAL DIAGNOSIS AND ASSESSMENT: 1. Lumbar facet arthropathy. 2. Lumbar degenerative disc disease. 3. Lumbar radiculitis. 4. Obsessive compulsive personality disorder. 5. Obesity. NAME OF PROCEDURE: Left L4-L5 and L5-S1 intraarticular facet joint injection. Informed Consent: The patient's condition and proposed procedures, risks, and alternatives were discussed with the patient. The patient's questions were answered. The patient appeared to understand and chose to proceed. Informed consent was obtained. SEDATION REPORT: None. PROCEDURE IN DETAIL: This is the first procedure of the first series that the patient is undergoing. After obtaining written consent, a 22-gauge IV hep lock was placed. The patient was taken back to the fluoroscopy suite and placed in a prone position with a pillow under the abdomen to decrease the lumbar lordosis and to facilitate needle entry into the facet joints. The skin overlying the lumbosacral area was prepped and draped in an aseptic fashion. The upper lumbar facet joints are more vertically oriented and, therefore, visualized on direct AP fluoroscopy. The more inferior facet joints lay at a more oblique angle (with the L5-S1 joint approaching a frontal plane orientation). Adequate visualization of the lower facet joints was achieved by a combination of rotating the fluoroscope and rolling the patient towards the contralateral side. Optimal position occurred when the joint line was first visualized. The facet joints were identified radiographically directly adjacent to the superior articular process of the caudad vertebrae. The skin overlying the target sites of injection was anesthetized using 3 ml of 1% lidocaine with a 25-gauge, 1 inch needle. A 22-gauge, 3.5-inch spinal needle with a bent tip was advanced towards the L4-5 and L5-S1 facet joints on the left side under fluoroscopic guidance. The firm posterior capsule had its characteristic feel and the needle was advanced a few additional millimeters beyond the joint capsule into the joint space, but not into the articular cartilage. After the joint space was entered and aspiration was
002168
negative for heme or CSF, 0.5 ml of Omnipaque 180 was injected demonstrating a characteristic facet arthrogram. After negative aspiration for heme or CSF, 0.5 ml of a solution containing 10 mg of triamcinolone and 0.5 ml of bupivacaine 0.25% was slowly injected at each site. The needles was then removed. The heart rate, pulse oximetry, and blood pressure were continuously monitored throughout the procedure. There were no complications. The patient tolerated the procedure well and was carefully escorted to the recovery room in stable condition. The VAS was 3/10 before the procedure and 0-1/10 ten minutes after the procedure. After meeting discharge criteria, the patient was discharged home. RECOMMENDATIONS/TREATMENT PLAN: 1. The patient will follow up in four to six weeks for the second left L4-L5 and L5-S1 intraarticular facet joint injections. He was also instructed to call and postpone his appointment to a later date if he has substantial relief with minimal to no pain at the time of his next visit. 2. No medications were prescribed at today's visit. 3. The patient was also encouraged and advised to continue with a strengthening and exercise regimen, which is a critical aspect in the overall management of his pain and rehabilitation. The patient was instructed and educated on all aspects of the plan of care. The patient acknowledged the plan of care. Thank you for allowing us to participate in the care of your patient. Should you have any questions regarding the above treatment plan, please do not hesitate to contact us. Sincerely, LANA WANIA-GALICIA, MD CLINICAL FELLOW DEPARTMENT OF ANESTHESIOLOGY & PAIN MEDICINE THIS WAS ELECTRONICALLY SIGNED - 01/09/2004 6:09 PM PST BY:
THIS WAS ELECTRONICALLY SIGNED - 01/10/2004 4:22 PM PST BY: ASSISTANT PROFESSOR OF CLINICAL ANESTHESIA ATTENDING PHYSICIAN LW:ts(trs029e) D: 01/05/2004 05:57 PM T: 01/06/2004 09:25 AM C#: 304228 cc: LANA WANIA-GALICIA, MD Links Previous Version Transcription Type Pain Referral Letter (2942) Electronically Signed
Document Text January 05, 2004 MR#: 8081369 DOB: 09/23/1959
GAGAN MAHAJAN, MD
ID 822628
RE:
AMUNDSEN, MARK
002169
Date of Service: 01/05/2004
LEFT L4-L5 AND L5-S1 LUMBAR FACET JOINT INJECTION VICTOR HENRIQUE BAQUERO, MD UC DAVIS MEDICAL GROUP FOLSOM 251 TURNPIKE DRIVE FOLSOM, CA 95630 Dear Dr. Baquero: We had the pleasure of treating your patient, Mark Amundsen, today at the University of California, Davis Center for Pain Medicine. As you know, the patient is a 44-year-old male with a history of chronic low back pain, which radiates down to the left posterolateral aspect of his left lower extremity down to the knee. It started nine years ago while he was doing sit ups and has progressively increased in severity and frequency over the past two years. The patient's pain is described as sharp, shooting and cutting. The pain intensity is currently rated as a VAS of 3/10 (0 to 10) anchored at 0 by "no pain" and at 10 by "the most severe pain imaginable." The average pain for the last week has been a VAS of 45/10 (0 to 10). CURRENT HEALTH PROBLEMS: The patient states that he currently has no health problems. RESULTS OF MOST RECENT PRIOR PROCEDURES: The patient had his second lumbar epidural steroid injection done on 9/8/03, which provided only 10% relief for three weeks. He had excellent results from his first LES, which helped his leg pain -- now does not have leg pain. Neither the first nor second LES have helped the LBP. The patient denies a personal or family history of prior anesthesia problems. The patient has had nothing to eat or drink for eight hours. The patient denies a history of stridor, snoring or sleep apnea. CURRENT MEDICATIONS: 1. Fluoxetine. 2. Flexeril. 3. Norco. ANTICOAGULANT MEDICATIONS: None. ALLERGIES: Ibuprofen, which results in hives and swelling. PHYSICAL EXAMINATION: Preprocedural vital signs VAS 3/10 BP 124/84 Pulse Postprocedural vital signs VAS 1/10 BP 127/89 Pulse
87 70
Resp Resp
16 16
O2 O2
Sat 97% Sat 99%
002170
Airway: Mallampati Class II. Distance in fingerbreadths 3 Lungs: Chest expansion normal, or rales. Heart: Regular rate and rhythm gallop.
ASA Physical Status: II I. Normal II. Mild Systemic Disease III. Complex Systemic Disease IV. Critical V. Moribund PREPROCEDURAL DIAGNOSIS AND ASSESSMENT: 1. Lumbar facet arthropathy. 2. Lumbar degenerative disc disease. 3. Lumbar radiculitis. 4. Obsessive compulsive personality disorder. 5. Obesity. POSTPROCEDURAL DIAGNOSIS AND ASSESSMENT: 1. Lumbar facet arthropathy. 2. Lumbar degenerative disc disease. 3. Lumbar radiculitis. 4. Obsessive compulsive personality disorder. 5. Obesity. NAME OF PROCEDURE: Left L4-L5 and L5-S1 intraarticular facet joint injection. Informed Consent: The patient's condition and proposed procedures, risks, and alternatives were discussed with the patient. The patient's questions were answered. The patient appeared to understand and chose to proceed. Informed consent was obtained. SEDATION REPORT: None. PROCEDURE IN DETAIL: This is the first procedure of the first series that the patient is undergoing. After obtaining written consent, a 22-gauge IV hep lock was placed. The patient was taken back to the fluoroscopy suite and placed in a prone position with a pillow under the abdomen to decrease the lumbar lordosis and to facilitate needle entry into the facet joints. The skin overlying the lumbosacral area was prepped and draped in an aseptic fashion. The upper lumbar facet joints are more vertically oriented and, therefore, visualized on direct AP fluoroscopy. The more inferior facet joints lay at a more oblique angle (with the L5-S1 joint approaching a frontal plane orientation). Adequate visualization of the lower facet joints was achieved by a combination of rotating the fluoroscope and rolling the patient towards the contralateral side. Optimal position occurred when the joint line was first visualized. The facet joints were identified radiographically directly adjacent to the superior articular process of the caudad vertebrae. The skin overlying the target sites of injection was anesthetized using 3 ml of
002171
1% lidocaine with a 25-gauge, 1 inch needle. A 22-gauge, 3.5-inch spinal needle with a bent tip was advanced towards the L4-5 and L5-S1 facet joints on the left side under fluoroscopic guidance. The firm posterior capsule had its characteristic feel and the needle was advanced a few additional millimeters beyond the joint capsule into the joint space, but not into the articular cartilage. After the joint space was entered and aspiration was negative for heme or CSF, 0.5 ml of Omnipaque 180 was injected demonstrating a characteristic facet arthrogram. After negative aspiration for heme or CSF, 0.5 ml of a solution containing 10 mg of triamcinolone and 0.5 ml of bupivacaine 0.25% was slowly injected at each site. The needles was then removed. The heart rate, pulse oximetry, and blood pressure were continuously monitored throughout the procedure. There were no complications. The patient tolerated the procedure well and was carefully escorted to the recovery room in stable condition. The VAS was 3/10 before the procedure and 0-1/10 ten minutes after the procedure. After meeting discharge criteria, the patient was discharged home. RECOMMENDATIONS/TREATMENT PLAN: 1. The patient will follow up in four to six weeks for the second left L4-L5 and L5-S1 intraarticular facet joint injections. He was also instructed to call and postpone his appointment to a later date if he has substantial relief with minimal to no pain at the time of his next visit. 2. No medications were prescribed at today's visit. 3. The patient was also encouraged and advised to continue with a strengthening and exercise regimen, which is a critical aspect in the overall management of his pain and rehabilitation. The patient was instructed and educated on all aspects of the plan of care. The patient acknowledged the plan of care. Thank you for allowing us to participate in the care of your patient. Should you have any questions regarding the above treatment plan, please do not hesitate to contact us. Sincerely,
THIS WAS ELECTRONICALLY SIGNED - 01/10/2004 4:22 PM PST BY: GAGAN MAHAJAN, MD ASSISTANT PROFESSOR OF CLINICAL ANESTHESIA ATTENDING PHYSICIAN LW:ts(trs029e) D: 01/05/2004 05:57 PM T: 01/06/2004 09:25 AM C#: 304228
002172
HEALTH SYSTEM
January
05, 2004
UCDAVIS
RE, MR#, DOB, Date
AMUNDSEN, MARK 8081369 09/23/1959 of Service, Ol/05/2004
LEFT L4-L5
AND L5-Sl
LUMBAR
FACET
JOINT
INJECTION
VICTOR HENRI QUE BAQUERO, MD UC DAVIS MEDICAL GROUP - FOLSOM 25l TURNPIKE DRIVE FOLSOM, CA 95630
Dear Dr. Baquero: We had the pleasure of treating your patient, Mark Amundsen, today at the University of California, Davis Center for Pain Medicine. As you know, the patient is a 44-year-old male with a history of chronic low back pain, which radiates down to the left posterolateral aspect of his left lower extremity down to the knee. It started nine years ago while he was doing sit ups and has progressively increased in severity and frequency over the past two years. The patient's pain is described as sharp, shooting and cutting. The pain intensity is currently rated as a VAS of 3/10 (0 to 10) anchored at a by "no pain" and at 10 by "the most severe pain imaginable." The average pain for the last week has been a VAS of 45/10 (O to 10). CURRENT HEALTH PROBLEMS, The patient states that he currently
has no health
problems .
RESULTS OF MOST RECENT PRIOR PROCEDURES, The patient had his second lumbar epidural steroid injection done on 9/S/03, which provided only 10% relief for three weeks. He had excellent results from his first LES, which helped his leg pain -- now does not have leg pain. Neither the first nor second LES have helped the LBP. The patient denies a personal or family history of prior anesthesia problems. The patient has had nothing to eat or drink for eight hours. The patient denies a history of stridor, snoring or sleep apnea. CURRENT MEDICATIONS, 1. Fluoxet ine.
2. 3. F1exeri 1. Norco.
Pain Management Center 4860 Y Street, Suue 5200. Sacramento. California (916) 734-7246. Fax (9]6) 734-5033
95817-1418
MEDICAL
RECORDS
COPY
002173
1"-
"RE,
MR#,
AMUNDSEN, 8081369
MARK
Page 2
ANTICOAGULANT None. ALLERGIES, Ibuprofen, PHYSICAL
MEDICATIONS,
which
results
in hives
and swelling.
EXAMINATION,
Preprocedural vital signs VAS 3/10 BP 124/84 Pulse Postprocedural vital signs VAS 1/10 BP 127/89 pulse
87 70
Resp Resp
16 16
02 02
Sat 97% Sat 99%
Airway: Mallampati Class II. Neck ROM - full. Thyroid-Mentum Distance in fingerbreadths - 3 em . Lungs: Chest expansion normal, clear to auscultation without wheezes or rales. Heart: Regular gallop. ASA Physical Status, II T. Normal II. Mild Systemic Disease III. Complex Systemic Disease IV. Cri t ieal V. Moribund PREPROCEDURAL DIAGNOSIS AND ASSESSMENT, 1. Lumbar facet arthropathy. 2. Lumbar degenerative disc disease. 3. Lumbar radiculitis . 4. Obsessive compulsive personality disorder. 5. Obesity. POSTPROCEDURAL DIAGNOSIS AND ASSESSMENT, 1. Lumbar facet arthropathy. 2. Lumbar degenerative disc disease. 3. Lumbar radiculitis. 4. Obsessive compulsive personali~y disorder. S. Obesity. NAME OF PROCEDURE, Left L4-LS and LS-Sl rate and rhythm - normal 51, 52, no murmur, rub, or
intraarticular
facet
joint
injection.
Informed Consent: The patient's condition and proposed procedures, risks, and alternatives were discussed with the patient. The patient's questions were answered. The patient appeared to understand and chose to proceed. Informed consent was obtained. SEDATION PROCEDURE REPORT, None.
IN DETAIL,
002174
.' -
RE,
MR#,
AMUNDSEN,
8081369
MARK
Page 3
This is the first procedure undergo ing .
of the first
series
that the patient
is
After obtaining written consent, a 22-gauge IV hep lock was placed. The patient was taken back to the fluoroscopy suite and placed in a prone position with a pillow under the abdomen to decrease the lumbar lordosis and to facilitate needle entry into the facet joints. The skin overlying the lumbosacral area was prepped and draped in an aseptic fashion. The upper lumbar facet joints are more vertically oriented and, therefore, visualized on direct AP fluoroscopy. The more inferior facet joints lay at a more oblique angle (with the L5-S1 joint approaching a frontal plane orientation). Adequate visualization of the lower facet joints was achieved by a combination of rotating the fluoroscope and rolling the patient towards the contralateral side. Optimal position occurred when the joint line was first visualized. The facet joints were identified radiographically directly adjacent to the superior articular process of the caudad vertebrae. The skin overlying the target sites of injection was anesthetized using 3 ml of 1% lidocaine with a 25-gauge, 1~ inch needle. A 22-gauge, 3.5-inch spinal needle with a bent tip was advanced towards the L4-5 and L5-S1 facet joints on the left side under fluoroscopic guidance. The firm posterior capsule had its characterlstic feel and the needle was advanced a few additional millimeters beyond the joint capsule into the joint space, but not into the articular cartilage. After the joint space was entered and aspiration was negative for heme or eSF, 0.5 ml of Omnipaque 180 was injected demonstrating a characteristic facet arthrogram. After negative aspiration for heme or eSF, 0.5 ml of a solution containing 10 mg of triamcinolone and 0.5 ml of bupivacaine 0.25% was slowly injected at each site. The needles was then removed. The heart rate, pulse oximetry, and blood pressure were continuously monitored throughout the procedure. There were no complications. The patient tolerated the procedure well and was carefully escorted to the recovery room in stable condition. The VAS was 3/10 before the procedure and 0-1/10 ten minutes after the procedure. After meeting discharge criteria, the patient was discharged home. RECOMMENDATIONS/TREATMENT PLAN,
1. The patient will follow up in four to six weeks for the second left L4-L5 and L5-S1 intraarticular facet joint injections. He was also instructed to call and postpone his appointment to a later date if he has substantial relief with minimal to no pain at the time of his next visit. 2. No medications were prescribed at today's visit. 3. The patient was also encouraged and advised to continue with a strengthening and exercise regimen, which is a critical aspect in the overall management of his pain and rehabilitation.
002175
RE,
MR#,
AMUNDSEN,
8081369
MARK
Page 4
The patient was instructed and educated on all aspects care. The patient acknowledged the plan of care.
of the plan
of
Thank you for allowing us to participate in the care of your patient. Should you have any questions regarding the above treatment plan, please do not hesitate to contact us. Sincerely,
THIS WAS ELECTRONICALLY SIGNED - 01/10/2004 GAGAN MAHAJAN, MD ASSISTANT PROFESSOR OF CLINICAL ANESTHESIA ATTENDING PHYSICIAN
LW,ts(trs02ge) D, T, C#, 01/05/2004 01/06/2004 304228 05,57 09,25 PM AM
4:22
PM PST BY:
ce,
LANA WANIA-GALICIA,
MD
002176
January os, 2004 LEFT L4-L5
HEALTH SYSTEM
RE, MR#, DOB, Date
UCDAVIS
AMUNDSEN, MARK 8081369 09/23/1959 of Service' 01/05/2004 INJECTION.
~rnlVED .
JAN 1 5 2004
.".lleal
Record
AND L5-S1
LUMBAR
FACET JOINT
VICTOR HENRIQUE BAQUERO, MD UC DAVIS MEDICAL GROUP - FOLSOM 251 TURNPIKE DRIVE FOLSOM, CA 95630 Dear Dr. B,aquero:
We had the pleasure of treating your patient, Mark Amundsen, today at the University of California, Davis Center for Pain Medicine. As you know, the patient is a 44-year~old male with a history of chronic low back pain, which radiates down to the left posterolateral aspect of his left lower extremity down to the knee. It started nine years ago while he was doing sit ups and has progressively increased in severity and frequency over the past two years. The patient's pain lS described as sharp, shootlng and cutting. The pain intensity is currently rated as a VAS of 3/10 (0 to 10) anchored at 0 by "no pain/ and at 10 by "the most severe pain imaginable." The average pain for the last week has been a VAS of 45 / 1 0 (0 to 1 0) .
!
CURRENT HEALTH PROBLEMS, The pac Len t states that he currently
has no health
problems.
RESULT~3 OF MOST RECENT PRIOR PROCEDURES, The patient had his second lumbar epidural steroid injectIon ,done on 9/8/03., which provided only 10% relief for three weeks. He had excellent re su l t.s from his first. LES, which helped his leg pain -- now does not have leg pain. Neither the first nor second LES have' helped
t.be LBP.
The patient denies a personal or family hlstory of prior anesthesia problems. The patient has had nothing to eat or drink for eight hours. The patient denies a history of stridor, snoring or s~eep apnea. CURRENT MEDICATIONS, 1. Fluoxetine. 2. F'lexeril. 3. Norco.
Pain Management Center 4860 Y Street, Suite 5200. Sacramento, California (916) 734-7246 Fax (916) 734-5033
95817-1418
COpy FOR LANA
WANIA-GALICIA
002177
RE,
MR#,
AI~UNDSEN, MARK
80813 69
in h i ve s and swelling.
87 70
Page 2
ANTICOAGULANT None. ALLERGIES, Ibuprofen, PHYSICAL
MEDICATIONS,
which results EXAMINATION,
Prepro cedu r a l vital signs pulse 124/84 VAS 3/10 BP Postpr:Jcedural vital SIgns puIs r; 127/89 VAS 1/10 BP
Resp Resp
16 16
02 02
Sat 97% Sat 99%
Airway: Mallampati Class II. Distance ~n fingerbreadths - 3 Lungs: Chest expansion normal, or ral es. Heart: Regular rate and rhythm gallop. ASA Physical Status, II
Neck ROM - full. Thyroid~Ment~m em. clear to auscultation withoutlwheezes - normal 81, 82, no murmur, rub, or
T.
II. III. IV. V.
Normal
Mild Systemic Disease Complex Systemic Disease Critical Moribund
PREPROCEDURAL DIAGNOSIS AND ASSESSMENT, 1. Lumbar facet arthropathy. 2. Lumbar degenerative disc disease. 3. Lumbar radiculi tis. 4. Obsessive compulsive personality disorder. 5. Obesity. POSTPROCEDURAL.DIAGNOSIS AND ASSES8MENT: 1. Lumbar facet arthropathy. 2. Lumbar degenerative disc disease. 3. Lumbar radiculi tis. 4. Jbsessive,compulsive personallty disorder. 5. Obesity. NAME OF PROCEDURE, Left L4-L5 and L5-S1
intraarticular
facet
joint
injection.
Informed Consent: The patient's condition and proposed procedures, risks, and alternatives were discussed with the patient. The patient's questions were answered. The patient appeared to understand and chose to proceed. Informed consent was obtained. SEDATI ON REPORT, PROCEDURE None.
IN DETAIL,
002178
v RE, MR#, A~1UNDSEN, 80813 69
MARK
of the first series that the patJent is
Page 3
This is the undergoing.
first procedure
After obtaining written consent, a 22-gauge IV hep lock was placed. I ' The patient was taken back to the fluoroscopy au i t e and place d lTI a l prone posltion with a pillow under the abdomen to decrease the lumbar , I lordosis and to facilitate needle entry into t he f a ce t; Join~sl' Th e skin overlying the lumbosacral area was prepped and draped In an
v
aseptic fashion.
The upper lumbar facet joints are more vertically
oriented and, therefore, visualized on direct AP fluoroscopy. The more inferior facet joints lay at a more oblique angle (with the L5-S1 joint approaching a frontal plane orientation). Adequate visual :i.zat ton of the low2r facet joints was achieved by a con;binat ion of r ot a t Lnq .t he fluoroscope andv ro l Linq the patient towards the contralateral side. Optimal position occurred when the joint line ~as first visualized.
The facet joints were identified radiographically directly a9jacent to the superior articular process of the caudad vertebrae. The skin overlying the target sites of injection was anesthetized usirig 3 ml of 1% lidocaine with a 25-gauge, 1~ inch needle. A 22-gauge, 3.js-inch spinal needle with a bent tip was advanced towards the L4-5 ~nd L5-S1 facet =ioints on the left side under fluoroscoplc guidance. ~he firm posterior capsule had lts characterlstic feel and the needle ras advanced a few additional millimeters beyond the joint capsule into the joint space, but not into the articular cartilage. After; the j oint space was entered and aspirat ion was negative for heme or CSF, 0.5 ml of Omnipaque 180 was injected demonstrating a characte1ristic facet arthrogram. After negative aspiration for heme or CSF,j O.S ml of a solution containing 10 mg of triamcinolone and 0.5 ml of] bupivacaine 0.25% was slowly injected at each site. The needles was then r emovecl.
The heart rate, pulse oximetry, and blood pressure were contiLuoUSlY monitored throughout the procedure. There were no comp l ieat ichs. The , I ~ patient. tolerated the procedure well and was carefully escorted to the , recovery room in stable condition. The VASwas 3/10 before the procedure and 0-1/10 ten minutes after the procedure. After beeting discharge c r iteria, the patient was discharged home. I
RECOMME:NDATIONS (TREATMENT PLAN,
1. The patient will follow up in four to six weeks for the , second left L4-L5 and L5-S1 intraarticular facet joint lnJectlons. He was also instructed to call and postpone his appointment to a latkr date ~f he tlas substantlal rellef wlth minimal to no paln at the t~me of hls ne;.:t visit. 2. ~o medlcations were prescribed at today's visit. 3. The patient was also encouraged and advised to continue with a strengthening and exerc~se regimen, which is a critical aspect in the overall management of his pain and rehabilitat 10n.
of the
plan
of
002179
-,----------_.------------------
RE :
P,MUND SEN,
MR#,
6081369
1'JlARK
Page"4
Thank you for allowing us to participate in the care of your patient. Should you have any questions regarding the above treatment plan, please do not hesitate to contact us. Sincer ely
I
LANA WANIA-GALICIA, MD CLINICAL FELLOW DEPARTMENT OF ANESTHESIOLOGY & PAIN MEDICINE THIS WAS ELECTRONICALLY SIGNED 01/09/2004 6,09
PM PST BY,
THIS
WAS
ELECTRONICALLY
SIGNED
01/10/2004
4,22
PM PST
BY,
GAGAN MAHAJAN, MD ASSISTANT PROFESSOR ATTENDING PHYSICIAN

LW,ts(trs02ge) D, T, C#, 01/05/2004 01/06/2004 304228
OF CLINICAL
ANESTHESIA
05,57 09,25
PM AM
cc,
LANA WANIA-GALICIA,
MD
002180
-,----------------------------
Display only: Transcription (1024158) on 3/2/2004 3:22 PM by Gary J Collins Document history: Transcription (1024158) on 3/2/2004 3:22 PM by Gary J Collins Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes PATIENT: AMUNDSEN, MARK LOCATION: IMFFOL MR #: 8081369 SEX: M AGE: 44 DATE OF SERVICE: 02/13/2004 DOB: 09/23/1959 FOLSOM CLINIC NOTE SUBJECTIVE: Mark Amundsen is here for follow up on his chronic back pain. He says he has not had significant relief with the epidural injections. He currently takes about 4 Norco's 10/325 at night and he has about 4-1/2 hours of pain relief. He says the Ultram was not very effective. His pain is exacerbated by sitting and some activity. He does a lot of computer work; however, he is currently not employed. He is looking for jobs and is concerned about ability to function in a competitive environment. He also states that his AndroGel was not covered. OBJECTIVE: Vitals: Normal and noted. Well-nourished, well-developed, pleasant male. No apparent distress. Thought processes and concentration are normal. Back exam deferred other than shows full range of motion of the back with mild paraspinal discomfort. Normal neurologic exam, upper and lower extremities. ASSESSMENT/PLAN: 1. CHRONIC BACK PAIN. Has a facet arthropathy and degenerative disc disease. It is recommended he still follow up with Pain Management and will refer to Ortho Spine for further evaluation. 2. PAIN CONTROL. Will start on OxyContin 20 mg 1 p.o. b.i.d. for just q.h.s. Follow up with me to see if there is improvement. 3. DISCUSSED POTENTIAL FOR GOING ON DISABILITY DISCUSSED. Would like referral for him to be seen by Ortho Spine and he is to inquire about the implications of disability. 4. ANDROGEL HAS NOT BEEN COVERED. We will submit a prior authorization to his insurance company. He is definitely hypogonadic with low testosterone levels.
THIS WAS ELECTRONICALLY SIGNED - 02/16/2004 4:20 PM PST BY: BAQUERO, MD PCN FOLSOM FAMILY AND COMMUNITY MEDICINE
VICTOR HENRIQUE
Links Previous Version
002181
ID 965421
PATIENT: AMUNDSEN, MARK LOCATION: IMFFOL MR #: 8081369 SEX: M AGE: 44 DATE OF SERVICE: 02/13/2004 DOB: 09/23/1959 FOLSOM CLINIC NOTE SUBJECTIVE: Mark Amundsen is here for follow up on his chronic back pain. He says he has not had significant relief with the epidural injections. He currently takes about 4 Norco's 10/325 at night and he has about 4-1/2 hours of pain relief. He says the Ultram was not very effective. His pain is exacerbated by sitting and some activity. He does a lot of computer work; however, he is currently not employed. He is looking for jobs and is concerned about ability to function in a competitive environment. He also states that his AndroGel was not covered. OBJECTIVE: Vitals: Normal and noted. Well-nourished, well-developed, pleasant male. No apparent distress. Thought processes and concentration are normal. Back exam deferred other than shows full range of motion of the back with mild paraspinal discomfort. Normal neurologic exam, upper and lower extremities. ASSESSMENT/PLAN: 1. CHRONIC BACK PAIN. Has a facet arthropathy and degenerative disc disease. It is recommended he still follow up with Pain Management and will refer to Ortho Spine for further evaluation. 2. PAIN CONTROL. Will start on OxyContin 20 mg 1 p.o. b.i.d. for just q.h.s. Follow up with me to see if there is improvement. 3. DISCUSSED POTENTIAL FOR GOING ON DISABILITY DISCUSSED. Would like referral for him to be seen by Ortho Spine and he is to inquire about the implications of disability. 4. ANDROGEL HAS NOT BEEN COVERED. We will submit a prior authorization to his insurance company. He is definitely hypogonadic with low testosterone levels.
002182

PATIENT:
l~R II:
HEALTH SYSTEM
FOLSOM
UCDAVIS
LOCATION: 'IMFFOL
SEX: l~ :AGE: 44
AMUNDSEN,
MARK 02/13/2004 FOLSOM CLINIC NOTE
8081369
DATE OF SERVICE:
DOB: 09/23/1959
SUBJECTIVE: Mark Am1Jndsen is
here
for
follow
up on his
crrr ona c back pain.
He says he has not had significant relief with the epidural inJections. He currently takes about 4 Norco's 10/325 at night and he has about 4-1/2 hours of pain relief. He says the Ultram was not very effective. His pain is exacerbated by sitting and some activity. He does a tot of computer work; however, he is currently not employed. He is looking for jobs and is concerned about ability to function in a competi~lve environment. He also states that his AndroGel was not covered. OBJECTIVE, Vitals: Normal and noted. Well-nourished, well-developed, pleasant male. No apparent distress. Thought processes and concentration are normal. Back exam deferred other than shows full range of motIon of the bac~ with mild paraspinal dIscomfort. Normal neurologic exam, upper and lower extremities. ASSESSMENT/PLAN, 1, CHRONIC BACK PAIN. Has a facet arthropathy and deg~nerative d"sc disease. It is recommended he still follow up with Pain Management and will refer to Ortho SpIne for further evaluation. 2, PAIN CONTROL. Will start on OxyContin 20 mg 1 p,o. b.i.d, for just q.h.s. Follow up with me to see if there is improvement. 3. DISCUSSED POTENTIAL FOR GOING ON DISABILITY DISCUSSED. Would like referral for him to be seen by Ortho Spine and he is to inquire, about the implications of disability. 4, ANDROGEL HAS NOT BEEN COVERED. We will submit a prior authorizaOon to hIS insurance company. He IS defInitely hypogonadic wIth low testosterone levels. .
THIS WAS ELECTRONICALLY SIGNED VICTOR HENRI QUE BAQUERO, MD PCN FOLSOM FI'.[1ILY ,o.liD COMHUNITY MEDICINE
- 0211612004
4:20 PM PST BY,
251 TURNPIKE DRIVE. FOLSOM, CA 95630 PHONE (916) 985-9300 FAX (916) 355-1219'MF',n RF,C':ORns FTCF'. C':OPY
002183

PATIENT:
HR #:
HEALTH SYSTEM
FOLSOM
MARK LOCATION: IMFFOL SEX: H AGE.: 44 OOB: 09/23/1959
UCDAVIS
AMUNDSEN,
8081369
DATE OF SERVICE:
02/13/2004
VH8:rp(usaJ.46bl
0: T: C#:
02/13/2004 04:53 PH CJ2/16/2004 08:49 AM 358330
25 I TURNPIKE DRIVE. PHONE (916) 985-9300'
FOLSOM, CA 95630 FAX (916) 355-1219

MF:D RF,r()RnS FTT,F, ropy
002184
Clinic. Continue Norco for now. He did not have any benefits from the OxyContin and felt no relief. Continue Aleve for now. Was given Neurontin 300 mg to start q.h.s. Increase dose to b.i.d. and then ultimately t.i.d. and see if that helps for neuropathic or neurologic type pain. Follow up with me accordingly. 2. FILLED OUT DISABILITY FORMS for his chronic lumbar pain. 3. GERD SYMPTOMS. Recommended over-the-counter Prilosec or H2 blockers. 4. OTHER BRIEF SOMATIC QUESTIONS that were answered in the office. Overall, spent 25 minutes. More than half the time was spent with patient filling out paperwork.
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes March 02, 2004 RE: AMUNDSEN, MARK MR#: 8081369 DOB: 09/23/1959 Date of Service: 03/02/2004 VICTOR HENRIQUE BAQUERO, MD 251 TURNPIKE DRIVE FOLSOM, CA 95630 Dear Dr. Baquero: We had the pleasure of evaluating your patient, Mark Amundsen, today in follow-up at the University of California, Davis Center for Pain Medicine. As you know, the patient is a 44-year-old male who is being evaluated for left-sided lower back pain primarily and a small amount of right-sided back pain. He states that the pain radiates through his buttocks into the posterior thigh. He is also complaining of anterior groin pain and deep hip pain. Symptoms started approximately three years ago and have been gradually getting worse in frequency and intensity.
002185
The pain is present constantly. The patient describes the pain as burning and cutting. The pain intensity is currently rated as a VAS of 3/10 anchored at 0 by "no pain" and at 10 by " the most severe pain imaginable". The average pain for the last week has been a VAS of 4/10. The patient notes a 50% improvement since coming to the Pain Clinic. During the past seven days the patient states that the current medication/treatment regimen has resulted in a 10% reduction in pain. CURRENT MEDICATIONS: 1. Norco. 2. Oxycodone. STOPPED MEDICATIONS: 1. Flexeril. 2. Topamax. 3. Metformin. ALLERGIES: Motrin. PAST SOCIAL AND FAMILY HISTORY: During the past month, the patient avoided going to work, physically exercising, participating in recreation, and driving because of pain. During the past month, the patient was able to walk eight blocks, sit for 35 minutes, and stand for one hour before pain became the limiting factor. Prior family history was reviewed. REVIEW OF SYSTEMS: The patient admits to diarrhea, sexual dysfunction, urinary retention and difficulty urinating, back pain, joint pain, muscle pain, difficulty falling and remaining asleep and feeling depressed. Constitutional: Sx: no fevers, no unplanned weight loss Eyes: no double or blurred vision ENT: no loss of hearing, no difficulty swallowing Heme/Lymph: no bleeding gums, or low platelet count Endocrine: no known thyroid disease or heat/cold intolerance Skin: no rashes or other lesions Respiratory: no shortness of breath, no wheezing Cardiovascular: no chest pain or palpitations GI: no constipation, abdominal pain, nausea/vomiting Neuro: no loss of consciousness, blackouts, memory loss, muscle weakness, seizures, trouble walking, dizziness, or fatigue Behavioral: No loss of interest in activities/hobbies, difficulty concentrating, feelings of guilt RESULTS OF MOST RECENT PROCEDURE: The patient underwent a left L4-5 and L5-S1 intraarticular facet joint injection. He reported no significant change in his symptoms. He reports no adverse side effects from prior injections. PHYSICAL EXAM: BP: 3/10 Pulse: 108/72 Resp: 68 Weight: 12 O2 Sat: 96% Normally developed, no deformities, well groomed. Oriented to time, person, and place. Normal attention span and concentration. Neuro is intact to pinprick and light touch sensation in the bilateral lower extremities in the L2 through S2 dermatomes. Gait is not antalgic. Manual muscle testing is 5/5 bilateral lower extremities in all planes. Straight leg raising in the sitting position and supine position is negative bilaterally. Patrick's test is negative bilaterally. In the left hip, the patient has increased pain with external rotation significantly greater than internal rotation. He describes this pain as deep into the hip joint. Piriformis test is negative for gluteal pain but this reproduces groin pain. MEDICAL DECISION MAKING ASSESSMENT: 1. Lumbar radiculitis. Primary he describes these symptoms in the left S1 distribution, but he is also noting new symptoms in the right S1 distribution. 2. Lumbar degenerative disc disease. 3. Lumbar facet arthropathy.
002186
4. Hip osteoarthritis. 5. Urinary retention. RECOMMENDATIONS/TREATMENT PLAN: 1. Repeat MRI of the L-spine to rule out progression of L5-S1 degenerative disc. Also, rule out central stenosis, which may be causing progression of his radicular symptoms and/or urinary retention problems. MRI LUMBAR SPINE 3/5/04: TECHNIQUE: Proton T1, T2-weighted, and fat suppressed fast spin-echo sagittal and proton transaxial images were obtained through the lumbosacral spine. FINDINGS: No paraspinal masses are evident. No significant disc protrusion or disc bulge is seen. No foraminal or osseous spinal stenosis is evident. No paraspinal abnormalities are detected. Impression: UNREMARKABLE MRI OF THE LUMBOSACRAL SPINE FOR AGE. 2. Trial of left S1 selective nerve root block. If the patient is noting improvement with these procedures, we may progress to pulsed radiofrequency of the dorsal root ganglion at this level. 3. The patient will follow up in orthopedic clinic on 4/9/04 for further evaluation of his left hip osteoarthritis. 4. Urinary retention. The patient is instructed to follow up with his primary care physician to rule out urinary tract etiology to his urinary retention symptoms. This may include the prostate as a source. The patient was instructed and educated on all aspects of the plan of care. The patient acknowledged the plan of care. Thank you for allowing us to participate in the care of your patient. Should you have any questions or concerns regarding the recommended care plan, please do not hesitate to contact us. Sincerely,
THIS WAS ELECTRONICALLY SIGNED - 03/09/2004 10:11 AM PST BY: ASSISTANT PROFESSOR OF CLINICAL ANESTHESIA ATTENDING PHYSICIAN GC:ts(trs029e) D: 03/02/2004 03:22 PM T: 03/02/2004 06:47 PM C#: 379855 cc: GAGAN MAHAJAN, MD
GAGAN MAHAJAN, MD
002187
Links Previous Version Transcription Type Pain Referral Letter (2941)

Electronically Signed ID 1024158 Date and Time 3/2/2004 3:22 PM Author Gary J Collins
VICTOR HENRIQUE BAQUERO, MD 251 TURNPIKE DRIVE FOLSOM, CA 95630 Dear Dr. Baquero: We had the pleasure of evaluating your patient, Mark Amundsen, today in follow-up at the University of California, Davis Center for Pain Medicine. As you know, the patient is a 44-year-old male who is being evaluated for left-sided lower back pain primarily and a small amount of right-sided back pain. He states that the pain radiates through his buttocks into the posterior thigh. He is also complaining of anterior groin pain and deep hip pain. Symptoms started approximately three years ago and have been gradually getting worse in frequency and intensity. The pain is present constantly. The patient describes the pain as burning and cutting. The pain intensity is currently rated as a VAS of 3/10 anchored at 0 by "no pain" and at 10 by " the most severe pain imaginable". The average pain for the last week has been a VAS of 4/10. The patient notes a 50% improvement since coming to the Pain Clinic. During the past seven days the patient states that the current medication/treatment regimen has resulted in a 10% reduction in pain. CURRENT MEDICATIONS: 1. Norco. 2. Oxycodone. STOPPED MEDICATIONS: 1. Flexeril. 2. Topamax. 3. Metformin. ALLERGIES: Motrin. PAST SOCIAL AND FAMILY HISTORY: During the past month, the patient avoided going to work, physically exercising, participating in recreation, and driving because of pain. During the past month, the patient was able to walk eight blocks, sit for 35 minutes, and stand for one hour before pain became the limiting factor. Prior family history was reviewed.
002188
REVIEW OF SYSTEMS: The patient admits to diarrhea, sexual dysfunction, urinary retention and difficulty urinating, back pain, joint pain, muscle pain, difficulty falling and remaining asleep and feeling depressed. Constitutional: Sx: no fevers, no unplanned weight loss Eyes: no double or blurred vision ENT: no loss of hearing, no difficulty swallowing Heme/Lymph: no bleeding gums, or low platelet count Endocrine: no known thyroid disease or heat/cold intolerance Skin: no rashes or other lesions Respiratory: no shortness of breath, no wheezing Cardiovascular: no chest pain or palpitations GI: no constipation, abdominal pain, nausea/vomiting Neuro: no loss of consciousness, blackouts, memory loss, muscle weakness, seizures, trouble walking, dizziness, or fatigue Behavioral: No loss of interest in activities/hobbies, difficulty concentrating, feelings of guilt RESULTS OF MOST RECENT PROCEDURE: The patient underwent a left L4-5 and L5-S1 intraarticular facet joint injection. He reported no significant change in his symptoms. He reports no adverse side effects from prior injections. PHYSICAL EXAM: BP: 3/10 Pulse: 108/72 Resp: 68 Weight: 12 O2 Sat: 96% Normally developed, no deformities, well groomed. Oriented to time, person, and place. Normal attention span and concentration. Neuro is intact to pinprick and light touch sensation in the bilateral lower extremities in the L2 through S2 dermatomes. Gait is not antalgic. Manual muscle testing is 5/5 bilateral lower extremities in all planes. Straight leg raising in the sitting position and supine position is negative bilaterally. Patrick's test is negative bilaterally. In the left hip, the patient has increased pain with external rotation significantly greater than internal rotation. He describes this pain as deep into the hip joint. Piriformis test is negative for gluteal pain but this reproduces groin pain. MEDICAL DECISION MAKING ASSESSMENT: 1. Lumbar radiculitis. Primary he describes these symptoms in the left S1 distribution, but he is also noting new symptoms in the right S1 distribution. 2. Lumbar degenerative disc disease. 3. Lumbar facet arthropathy. 4. Hip osteoarthritis. 5. Urinary retention. RECOMMENDATIONS/TREATMENT PLAN: 1. Repeat MRI of the L-spine to rule out progression of L5-S1 degenerative disc. Also, rule out central stenosis, which may be causing progression of his radicular symptoms and/or urinary retention problems. MRI LUMBAR SPINE 3/5/04:
002189
TECHNIQUE: Proton T1, T2-weighted, and fat suppressed fast spin-echo sagittal and proton transaxial images were obtained through the lumbosacral spine. FINDINGS: No paraspinal masses are evident. No significant disc protrusion or disc bulge is seen. No foraminal or osseous spinal stenosis is evident. No paraspinal abnormalities are detected. Impression: UNREMARKABLE MRI OF THE LUMBOSACRAL SPINE FOR AGE.
2. Trial of left S1 selective nerve root block. If the patient is noting improvement with these procedures, we may progress to pulsed radiofrequency of the dorsal root ganglion at this level. 3. The patient will follow up in orthopedic clinic on 4/9/04 for further evaluation of his left hip osteoarthritis. 4. Urinary retention. The patient is instructed to follow up with his primary care physician to rule out urinary tract etiology to his urinary retention symptoms. This may include the prostate as a source.
The patient was instructed and educated on all aspects of the plan of care. The patient acknowledged the plan of care. Thank you for allowing us to participate in the care of your patient. Should you have any questions or concerns regarding the recommended care plan, please do not hesitate to contact us. Sincerely,
THIS WAS ELECTRONICALLY SIGNED - 03/09/2004 10:11 AM PST BY: GAGAN MAHAJAN, MD ASSISTANT PROFESSOR OF CLINICAL ANESTHESIA ATTENDING PHYSICIAN GC:ts(trs029e) D: 03/02/2004 03:22 PM T: 03/02/2004 06:47 PM C#: 379855 cc: GAGAN MAHAJAN, MD
002190
'-
HEALTH SYSTEM
PAIN MANAGEMENT
March 02, 2004
UCDAVIS
CENTER
RE, MR#, DOB, Date AMUNDSEN, MARK 8081369 09/23/1959 of Service, 03/02/2004
VICTOR HENRI QUE BAQUERO, 251 TURNPIKE DRIVE FOLSOM, CA 95630 Dear Dr. Baquero:
MD
We had the pleasure of evaluating your patient, Mark Amundsen, today in follow-up at the University of California, Davis Center for Pain Medicine. As you know, the patient is a 44-year-old male who is being evaluated for left-sided lower back pain primarily and a small amount of right-sided back pain. He states that the pain radiates through his buttocks into the posterior thigh. He is also complaining of anterior groin pain and deep hip pain. Symptoms started approximately three years ago and have been gradually getting worse in frequency and intensity. The pain is present constantly. The patient describes the pain as burning and cutting. The pain intensity is currently rated as a VAS of 3/10 anchored at 0 by "no pain" and at 10 by " the most severe pain imaginable". The average pain for the last week has been a VAS of 4/10. The patient notes a 50% improvement since corning to the Pain Clinic. During the past seven days the patient states that the current medication/treatment regimen has resulted in a 10% reduction in pain . CURR3NT MEDICATIONS, 1. Norco. 2. Oxycodone. STOPPED MEDICATIONS, 1. Flexeril. 2. Topamax. 3. Metformin. ALLERGIES, Motrin.
PAST SOCIAL AND FAMILY HISTORY, During the past month, the patient avoided going to work, physically exercising, participating in recreation, and driving because of pain. During the past month, the patient was able to walk eight blocks, sit for 35 minutes, and stand for one hour before pain became the limiting factor. Prior family history was reviewed.
Pain Management Center 4860 Y Street. Suite 5200. Sacramento. California (916) 734-7246 Fax (916) 734-5033
95817-1418
MEDICAL
RECORDS
COPY
002191
RE:
.~ MR#:
lIMUNDSEN, MARK 8081369
Page 2
REVIEW OF SYSTEMS: The patient admits to diarrhea, sexual dysfunction, urinary retention and difficulty urinating, back pain, joint pain, muscle pain, difficulty falling and remaining asleep and feeling depressed. Constitutional: Sx: no fevers, no unplanned weight loss Eyes: no double or blurred vision ENT: no loss of hearing, no difficulty swallowing Heme/Lymph: no bleeding gums, or low platelet count Endocrine: no known thyroid disease or heat/cold intolerance Skin: no rashes or other lesions Respiratory: no shortness of breath, no wheezing Cardiovascular: no chest pain or palpitations GI: no constipation, abdominal pain, nau~ea/vomiting Neuro: no loss of consciousness, blackouts, memory loss, muscle weakness, seizures, trouble walking, dizziness, or fatigue Behavioral: No loss of interest in activities/hobbies, difficulty concentrating, feelings of guilt RESULTS OF MOST RECENT PROCEDURE: The patient underwent a left L4-5 and L5-S1 Lntraarticular facet joint injection. He reported no significant change in his symptoms. He reports no adverse side effects from prior injections. PHYS ICAL EXAM: BP: 3/10 Pulse: 108/72 Resp: 68 Weight: 12 02 Sat: 96% Normally developed, no deformities, well groomed. Or~ented to time, person, and place. Normal attention span and concentration. Neuro is intact to pinprick and light touch sensation in the bilateral lower extremities in the L2 through 52 dermatomes. Gait is not antalgic. Manual muscle testing is 5/5 bilateral lower extremities in all planes. Straight leg raising in the sitting position and supine position is negative bilaterally. Patrick's test is negative bilaterally. In the left hip, the patient has increased pain with external rotation significantly greater than internal rotation. He describes this pain as deep into the hip joint. Piriformis test is negative for gluteal pain but this reproduces groin pain. MEDICAL DECISION MAKING
ASSESSMENT:
1. Lumbar radiculitis. Primary he describes these symptoms in the left 81 distribution, but he is also noting new symptoms in the right 51 distribution. 2. Lumbar degenerative'disc disease. 3. Lumbar facet arthropathy. 4. Hip osteoarthritis. 5. Urinary retention.
002192
RE,
'". MR#,
AMUNDSEN,
8081369 3
MARK
page
RECOMMENDATIONS/TREATMENT PLAN, 1. Repeat MRI of the L-spine to rule out progression of LS-Sl degenerative disc. Also, rule out central stenosis, which may be causing progression of his radicular symptoms and/or urinary retention problems. MRI LUMBAR TECHNIQUE, SPINE 3/5/04,
Proton TI, T2-weighted, and fat suppressed and proton transaxial images were obtained spine . FINDINGS,
fast spin-echo sagittal through the lumbosacral
No paraspinal masses are evident. No significant disc protrusion or dLsc bulge is seen. No foraminal or osseous spinal stenosis is evident. No paraspinal abnormalities are detected. Impress ion: UNREI~RKABLE
MRI OF THE LUMBOSACRAL
SPINE
FOR AGE"
2. Trial of left 81 selective nerve root block. If the patient is noting improvement with these procedures, we may progress to pulsed radiofrequencyof the dorsal root ganglion at this level. 3" The patient will follow up in orthopedic clinic on 4/9/04 for further evaluation of his left hip osteoarthritis. 4. Urinary retention. The patient is instructed to follow up with his primary care physician to rule out urinary tract etiology to his urinary retention symptoms. This may include the prostate as a source.
The Qatient was instructed and educated on all aspects care. The patient acknowledged the plan of care.
of the plan
of
Thank you for allowing us to participate in the care of your patient. Should you have any questions or concerns regarding the recommended care plan, please do not hesitate to contact us. Sincerely,
GARY COLLINS, MD CLINICAL FELLOW DEPARTMENT OF ANESTHESIOLOGY & PAIN MEDICINE THIS WAS ELECTRONICALLY SIGNED - 03/03/2004 1,34
PM PST BY,
002193
RE:
'". MR#:
AMUNDSEN,
8081369
MARK
Page 4
THIS WAS ELECTRONICALLY SIGNED - 03/09/2004 GAGAN MAHAJAN, MD ASSISTANT PROFESSOR OF CLINICAL ANESTHESIA ATTENDING PHYSICIAN
GC:ts D:
10:11 AM PST BY:
(trs02ge)
03/02/2004 03/02/2004 379855
03:22 PM
T: C#:
06:47
PM
cc:
GAGAN MAHAJAN,
MD
002194
-".-..-_------------------------
.,
March 02,
2004 Baquero:
RBCEJV1ID
I
HEALTH SYSTEM
CENTER
RE, MR#, DOB, Date
UCDAVIS
MAR 1 1 2004
MedJ.calReeords
PAIN MANAGEMENT
AMUNDSEN, MARK 8081369 09/23/1959 of Service, 03/02/2004
VICTOR HENRI QUE BAQUERO, 251 TURNPIKE DRIVE FOLSOM, CA 95630 Dear Dr-.
MD
We had the pleasure of eve I ue t a nq your pa c i.er.t , Mar-k Amundsen, Loduy in follow-up at the University of California, Davis Center fqr pain Medicine. As you know the pati ent is a 44-year-old male who is be ing evaluated for left-sided lower back pain primarily and a smal!l amount of right-sided back pain. He states that the pain radiates through his buttocks into the posterior thigh. He is also complaining of anterior groin pain and deep hip pain. Symptoms started app roxamat e l y three years ago and have been gradually getting worse in .f re quency and intensity.
f
The pain is present. constantly. The patient describes the pain as bu.r-n i nq and cutting. The pain intensity is currently rated as a VAS of 3/10 anchored at 0 by "no pain" and at 10 by " the most -aever e pain imaginable The average pain for the last week has been a VAS of 4/10. The patient notes a 50% improvement since coming to the Paln Clinic. During the past seven days the patient states that the current. medication/treatment regimen has resulted in a 10% reduction an pain.
I I
CURRENT MEDI CATIONS, 1. Norco. 2. Oxycodone. STOPPED MED{CATIONS, 1. Flexeri 1. 2. Topamax. 3. Met f o rrn i n . ALLERGIES, Motrin.
PAST SOCIAL AND FAMILY HISTORY, During the past month, the patient avoided going to work, physically exercising, participating in recreation, and driving because of pain. During ,the past month, the patient was able to walk eight blocks, sit for 35 minutes, and stand for one hour before paln became the limiting factor. Prior family history was reviewed.
Pain Management Center 4860 Y Street, Suite 5200. Sacramento. California (916) 734-7246. Fax (916) 734-5033
95817-1418
COPY FOR GAGAN
MAHAJAN
002195
RE: MR#:
AMUNDSEN, 808136'9
MARK
Page 2
REVIEW
OF SYSTEMS:
The patient admits to diarrhea, sexual dysfunction, urinary retention and difficulty urinating, back paiD, joint palo, muscle pain, difficulty falling and remaining asleep and feeling depressed. Constitutional: SX: no fevers, no unplanned weight loss Eyes: no double or blurred vision ENT: DO loss of hearing, no difficulty swallowing Heme/Lymph: no bleeding gums, or low platelet count Endocrine: no known thyroid disease or heat/cold intolerance' Skin: no rashes or other lesions Respiratory: no shortness of breath, no whee~ing Cardiovascular: no chest pain or palpitations Gl: no constipation, abdominal pain, nausea/vomiting Neuro: no loss of consciousness, blackouts, memory loss, muscle weakness, se i zure s , trouble wa lk t nq , d i zz i ne ss , or fatigue Behavioral: No loss of interest in ac t.Lv i t re s y h obb i e a , difficulty concentrating, feelings of guilt
RESULTS OF MOST RECENT PROCEDURE:
The patient underwent a left L4-S and LS-S1 intraarticular facet joint injection. He reported no significant change in his s~nptoms. He repor t s no adverse side effects from prior injections.
PHYSIC1IL BP: 3/10 EXAM:
Pulse: 108/72 Resp: 68 Weight: 12 02 Sat: 96% Normally developed, no de f o r-rni t i es , well groomed. Oriented to time, person, and place. Normal attention span and concentration. Neuro is intact to pinprick and light touch sensation in the bilateral lower extremities in the L2 through 82 dermatomes. Gait is riot antalgic. Manual muscle testing is 5/5 bilateral lower extremities in all planes.
Straight leg raising in the sitting p o s i t i on and supine position is negative bilaterally. Patiick's test is negative bilaterally. In the left hip, the patient has increased pain with external rotation significantly greater than internal rotation. He describes this pain as deep into 'the hip joint. Piriformis test is negative for gluteal pain but this reproduces groin pain.
MEDICAL DECISION MAKING
ASSESSMENT:
1. Lumbar radiculitis. Primary he describes these symptoms in the left 81 dist.ribut ion, but he is also noting new symptoms ln the right 81 distribution. 2. Lumbar degeneratlve disc disease. 3. Lumbar facet arthropathy. 4. HlP osteoarthrltis. 5. Urinary retention.
fit:
I
002196
RE,
AMUNDSEN,
MARK
MR#, 80813b9 Page 3
PLAN,
RECOMMENDATIONS/TREATMENT
1. Repeat MRI of the L-spine to rule out progression of LS-Sl degenerative disc. Also, rule out central stenosis, which may be causin~1 progression of his radicular symptoms and/or urinary retention problems.
MRI LU~IBAR SPINE
3/5/04,
TECHNIQUE,
Proton TI, T2-weighted, and fat suppressed and proton transaxial images were obtained spine.
FINDINGS,
fast spin-echo sagittal through the lumbosacral
NO paraspinal masses are evident. No significant disc protrusion or disc bulge is seen. No foraminal or osseous spinal stenosis is evident. No parasplnal abnormalIties are detected. Impression:
UNREMAJ1KABLE MRI OF THE LUMBOSACRAL SPINE FOR AGE.
2. Trial of left 81 selective nerve root block. If the patient is noting improvement with these procedures, we may progress to pulsed radiofrequencyof the dorsal root ganglion at this level. 3. The pat lent wlll follow up in orthopedic clinic on 4/9/04 for further evaluation of his left hip osteoarthritls. 4. Urinary retention. The patient is instructed to follow up with his primary care physician to rule out urinary tract etiology to hIS urinary retent~on symptoms. This may include the prostate as a source.
The pat ient was instructed and educated on all aspects care. The patient acknowledged the plan of care.
of the plan
of
Thank you for allowing us to participate in the care of your patient. Should you have any questIons or concerns regarding the recommended care plan, please do not hesitate to contact us. Sincerely,
GARY COLLINS, MD CLINICAL FELLOW DEPARTMENT THIS OF ANESTHESIOLOGY SIGNED WAS ELECTRONICALLY
& PAIN MEDICINE - 03/03/2004
1,34 PM PST
BY,
002197
--------------------------------
M1UNDSEN, 808136"9
MARK
" Page 4
THIS ~;S ELECTRONICALLY SIGNED - 03/09/2004 10:11 AM PST BY, GAGAN r1 AHAJ AN, MD ASSISTANT PROFESSOR OF CLINICAL ANESTHESIA ATTENDING PHYSICIAN GC:ts (t.r-ao z s e l 03/02/2004 03:22 PM 03/02/2004 06:47 PM
,.79855
cc:
GAGAN MAHAJAN,
MD
t,
------.
002198
JAMES RESSLER, PAC SENIOR PHYSICIAN ASSISTANT ORTHOPAEDICS ORTHOPAEDIC SURGERY
THIS WAS ELECTRONICALLY SIGNED - 04/13/2004 1:45 PM PST BY: ROLANDO F ROBERTO, MD
JR:ck(trs109c) D: 04/09/2004 01:30 PM T: 04/09/2004 09:50 PM C#: 431519
Display only: Transcription (1162910) on 4/9/2004 1:30 PM by James Paul Ressler Document history: Transcription (1162910) on 4/9/2004 1:30 PM by James Paul Ressler Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes PATIENT: AMUNDSEN, MARK LOCATION: IMFFOL MR #: 8081369 SEX: M AGE: 44 DATE OF SERVICE: 04/05/2004 DOB: 09/23/1959 FOLSOM CLINIC NOTE SUBJECTIVE: Mark Amundsen is here because of several reasons. 1. Chronic lumbar pain with radiculitis. Sees Pain Management. He has disability forms to complete in the office. Would like to know if there is alternative treatments to what he is taking. Currently doing Norco 10/325 anywhere from 1 to 3-1/2 at nighttime only. He takes Aleve. That also seems to help. In addition, he is concerned about increasing doses of the opiates. He wonders about alternative medicines. 2. Has GERD type symptoms that are intermittent, more pronounced when he is laying flat on his stomach. He feels food come up to his throat. OBJECTIVE: Vitals: Normal and noted. Well-nourished, well-developed, pleasant male. No apparent distress. Exam is unchanged. Slightly overweight. Abdominal exam was deferred. ASSESSMENT/PLAN: 1. CHRONIC RADICULITIS, LUMBAGO. Continue to follow up with Pain Clinic. Continue Norco for now. He did not have any benefits from the OxyContin and felt no relief. Continue Aleve for now. Was given Neurontin 300 mg to start q.h.s. Increase dose to b.i.d. and then ultimately t.i.d. and see if that helps for neuropathic or neurologic type pain. Follow up with me accordingly. 2. FILLED OUT DISABILITY FORMS for his chronic lumbar pain. 3. GERD SYMPTOMS. Recommended over-the-counter Prilosec or H2 blockers. 4. OTHER BRIEF SOMATIC QUESTIONS that were answered in the office. Overall, spent 25 minutes. More than half the time was spent with patient filling out paperwork.
002199
THIS WAS ELECTRONICALLY SIGNED - 04/06/2004 12:32 PM PST BY: BAQUERO, MD PCN FOLSOM FAMILY AND COMMUNITY MEDICINE
VICTOR HENRIQUE

Document Text PATIENT: AMUNDSEN, MARK LOCATION: IMFFOL MR #: 8081369 SEX: M AGE: 44 DATE OF SERVICE: 04/05/2004 DOB: 09/23/1959 FOLSOM CLINIC NOTE SUBJECTIVE: Mark Amundsen is here because of several reasons. 1. Chronic lumbar pain with radiculitis. Sees Pain Management. He has disability forms to complete in the office. Would like to know if there is alternative treatments to what he is taking. Currently doing Norco 10/325 anywhere from 1 to 3-1/2 at nighttime only. He takes Aleve. That also seems to help. In addition, he is concerned about increasing doses of the opiates. He wonders about alternative medicines. 2. Has GERD type symptoms that are intermittent, more pronounced when he is laying flat on his stomach. He feels food come up to his throat.
OBJECTIVE: Vitals: Normal and noted. Well-nourished, well-developed, pleasant male. No apparent distress. Exam is unchanged. Slightly overweight. Abdominal exam was deferred. ASSESSMENT/PLAN: 1. CHRONIC RADICULITIS, LUMBAGO. Continue to follow up with Pain
002200
Amundsen, Mark (MRN808W)

Transcription :ryp_~
Folsom Clinic Note (7721) Final Copy This document
CONFIDENTIAL, NOT FO_COMC

Sja!!!s
Available
MEDICAL RECORD
IQ 1147514-1
Author BAQUERO, HENRIQUE VICTOR
replaces
document
1147514
rra !1SC ri ptio ILL e xt

PATIENT: AMUNDSEN, MARK LOCATION: IMFFOL MR #: 8081369 SEX: MAGE: 44
DATE OF SERVICE: FOLSOM CLINIC NOTE 04/05/2004 008: 09/23/1959
~:UBJECTIVE :
Nark Amundsen
is here because
of several
reasons.
1. Chronic lumbar pain w~th rad~culitis. Sees Pain Management. He has d~sability forms to complete in the offJ.ce. would like to know if there lS alternative treatments to what he is taking. Currently doing Norco 10/325 anywhere from 1 to 3-1/2 at nighttime only. He takes Aleve. That also seems to help. In addLtJ.on, he is concerned about increaslng doses of the opiates. He wonders about alternatJ.ve medicines. 2. Has GERD flat on hls type symptoms that are stomach. He feels food intermJ.ttent. more pronounced come up to his throat. when he 1S laying
OBJECTIVE: Vltals: Normal and apparent dlstress. deferred.
noted. Well-nourlshed, well-developed, Exam 15 unchanged. Sllghtly overweight.
pleasant male. Abdominal exam
No was
ASSESSMENT/PLAN: 1. CHRONIC ~~DICULITIS. LUMBAGO. Contlnue to follow up wJ.th Pain Clinic. Contlnue ttor co for now. He d.i.d not have any bene f a t s f rom the OxyContin and felt no relief. Cont.i.nue Aleve for now. Was qa ven Neu r ont an 300 mg to start q.h.s. Increase dose to b.l.d. and then ultJ.mately t.i.d. and see if that helps for neuropathlc or neurologlc type paln. Follow up wlth me accordingly. ~'. FILLED OUT DISABILITY FO~MS for Ins chr oru.c lumbar pe i n , 3. GERD SYMPTOMS. Recommended over-the-counter Prllosec or H2 blockers. 4. OTHER BRIEF SOMATIC QUESTIONS that were answered ln the office. Overall, spent out paperwork. 25 mJ.nuts. More than half the tlme was spent wlth patint f11ling
THIS
WAS
ELECTRONICALLY
SIGNED
- 04/06/2004
12:32
PM PST BY:
HENRIQlJE BAQUERO,
MD
MEDICINE
VICTOR
PCN FOLSOM FAMILY AND COMMUNITY
VHB:rp(usa146bj II: 1', 04/05/2004 04/06/200, 425739 05:13 PM D6: 16 AM
c#:
Onginal
Documentation:
0000 04/05/2004
Folsom CliniC Note (7721) By: BAQUERO,
VICTOR
HENRIQUE
UC DAVIS HEALTH SYSTEM Printed by Barber, Beverly J 4/8/04 0958
Page 1002201 of I
--_ . _------------------=

SUBJECTIVE, Mark Amundsen
HEALTH SYSTEM
FOLSOM
UCDAVIS
.'
I,OCATION: IMFFOL
SEX: 11 AGE.: 44
PATIENT: AMUNDSEN, MARK l'lR #: 8081369 DATE OF SERVICE: 04/05/:004 FOLSOM CLINIC NOTE
DOB: 09/23/1959
is here because
of several
reasons.
1. Chronic lumbar pain with radiculitis. Sees Pain Management. He has da sabill ty forms to complete in the off ice. Would 1ike to know 'if there is alternative treatments to what he is takIng. Current Ii dOIng Norco 10/325 anywhere from 1 to 3-1/2 at nighttime only. He takes Aleve. ~hat also seems to help. In addition, he IS concerned about increasing doses of the opiates. He wonders about alternative medicines. 2. Has GERD type symptoms that a.re intermittent, more pronounced when he is laying flat on his stomach. He feels food come up to his t.hroat . OBJECTIVE, Vitals: Normal and noted. Well-nourished well-developed, pleasant male. No apparent distress. Exam is unchanged. Slightly overwelght. Abdominal exam was deferred.
f
ASSESSMENT/PLAN, 1. CHRONIC RADICULITIS, LUMBAGO. Cont2nue to follow up with Pain Clinic. Continue Norco f9r now. He did not have any benefits from the OxyContlI1 and felt no relief. Continue Aleve for now. Was glven Neurontln 300 mg to start q.h.s. Increase dose to b.i.d. and then ultimately t.i.d. and see if that helps for neuropathic or neurologic type pain. Follow up with me accordingly. 2. FILLED OUT DISABILITY FORMS for his chron2c lumbar pain. 3. GERD SYMPTOMS. Recommended over-the-counter Prilosec or H2 blo~ker,3 . 4. OTHE~ BRIEF SOMATIC QUESTIONS that were answered in the office. Overall, spent 25 minutes. More than half the time was spent with patient fililng out paperwork.
I I
THIS
WAS
EL.ECTRONICALLY
SIGNED
04/06/2004
12:32
PM PST
BY:
VICTOR '{ENRIQUE BAQUERO, NO PCN FOL,3011 FAMILY AND CONMUNITY MEDICINE
----_ ..
251 rURNPIKE DRIVE. FOLSOM, CA 95630 PHONE (916) 985-9300 FAX (916) 355-12 I9
002202
_--------------------

pr,TIEI'IT:
HP #: 8081369
HEALTH SYSTEM
FOLSOM
LOCATION:. I~JFFOL SEX: M ' AGE: ,],] DOB: 09/23/1959
UCDAVIS
AMUNDSEN, MARK 04/05/2004
DATE :OF S~RVICE:
VHB:rp(usa146b)
I): T: C#:
04/05/2004 04/06/2004 425739
05:13 06:16
PM AM
251 TURNPIKE DRIVE. FOLSOM, CA 95630 PHONE (916) 985-9300 FAX (9 I 6) 355-1219
MF.n RP,r:ORns F'TT,F.
rnpy
002203
THIS WAS ELECTRONICALLY SIGNED - 05/05/2004 10:55 AM PST BY: PAUL G KREIS, MD ASSOC CLINICAL PROF; MEDICAL DIRECTOR, DIVISION OF PAIN MEDICINE ATTENDING PHYSICIAN LW:kl(trs091d) D: 04/29/2004 04:47 PM T: 04/29/2004 06:37 PM C#: 459848 cc: PAUL G KREIS, MD LANA WANIA-GALICIA, MD Display only: Transcription (1237596) on 4/29/2004 4:47 PM by Lana Louie Wania-Galicia Document history: Transcription (1237596) on 4/29/2004 4:47 PM by Lana Louie Wania-Galicia Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Consults PATIENT: AMUNDSEN, MARK LOCATION: ORTCAR MR #: 8081369 SEX: M AGE: 44 DATE OF SERVICE: 04/09/2004 DOB: 09/23/1959 CARMICHAEL CONSULTATION Chief complaint: Low back pain, left leg pain, left groin pain. Dear Dr. Baquero: I evaluated Mr. Mark Amundsen in consultation, per your request. HPI: This is a 44-year-old Caucasian male, 6 foot 1, 223 pounds, with a history of chronic low back pain and left leg radiculopathy for 3 and 9 years, respectively, associated with left groin pain that has been evaluated in the past with a multiplicity of workups, including x-rays that had been taken recently by you, which I have personally reviewed today. Thirteenth of September 2002, limited view: The AP and lateral spot view shows some minimal degenerative changes to the L5-S1 segment but otherwise normal. He has also had bilateral hip films, AP pelvis, and bilateral lateral of the hips from December 1, 2003, showing mild to early moderate DJD. The patient has had persistent complaints of low back pain, which had been primarily relieved with the use of epidural steroid injections, which had been accomplished at the Pain Management Center at UC-Davis Medical Center. His next epidural is scheduled now for April 2004. During these epidural injection, he has had symptomatic relief of his left leg radiculopathy, but they have been, yet, been unable to help him with his current complaints that center around his left leg pain. The patient has been on a plethora of medications, including Vicodin, OxyContin, Norco, Topamax, Prozac, meclofenamate all with some minimal symptomatic improvement. He denied any bowel or bladder symptomatology. He has no other constitutional symptoms consisting of fever, chills, night sweat, or weight loss. He has a normal appetite. He has no history of any carcinomas. His alleviating factors are primarily with the epidurals. His aggravating factors are primarily prolonged sitting. He denied any bowel or bladder symptomatology, no history of incontinence. He has no foot drop that he has noted on either foot. The patient has undergone a recent MRI on 03/05/04 of the LS spine, and is not showing any significant
002204
areas of stenosis, either centrally or the lateral foramen. There is a previous MRI showing annular tear at L5S1 but otherwise unremarkable. That was done in 2002. Medications are as listed above. Allergies to ibuprofen, producing welts. Surgeries: Hernia repair on the left side in 1987. Tonsillectomy in 1967. He has a history of right and left ankle fractures, the right x4, in 78, 82, 87, and 96, and the left from 1994, all closed reduced, with cast treatment. He is a previous smoker, quit in 1999, occasional alcohol, no drugs. Unknown last tetanus, with no blood transfusion. He has completed the 12th grade. Was in the military as an E6, honorably discharged, is widowed, currently living in Folsom without children. He denied any diabetes or thyroid disease. His review of systems is positive for occasional shortness of breath with exercising. History of GI complaints, primarily surrounding diarrhea and constipation with complaints of migraine headaches. His family history shows a father was deceased, unknown causes. Mother deceased from lung cancer age 75. He has two siblings, 47 and 39, in apparent good health, respectively. Family history is significant for the carcinoma, as stated above. Denies any coronary artery disease. No other back complaints listed. No other family history of back problems listed. Physical examination: 6 foot 1, 223 pounds. Respirations 18 and unlabored. LS spine examination shows a full range of motion in all fields with no restrictions. Has pain maximally at the end point of lateral rotational bend. He is knee to straight-leg raise was 90 degrees, downgoing Babinski, no clonus. His muscle group strength in the lower extremities were symmetrically equal at 5/5. Sensation is normal to light touch. He has full range of motion of both hip joints without restrictions and no pain. He has tenderness to palpation along the paravertebral musculature that extends in a bandlike fashion in a bell-like manner around the L3-5 segment. Dorsalis pedis and posterior tib pulses are 2+. He has negative figure-of-four. Impression and plan: Chronic low back pain with underlying mild degenerative disk disease of the L5-S1 segment, with L4-5 or L5-1 left leg radiculopathy. No neurological deficit is noted. Plan: At this point, I would continue with conservative modalities, as he has been doing. Primarily, he has been successful with epidural steroid injections. If he should persist with continued left leg radiculopathy, we would, again, reevaluate. In regard to his hip pathology, he has mild to moderate osteoarthritis. He would not be a good surgical candidate for a total hip arthroplasty. I would monitor that on a interim basis. Should you have any questions or require further information, please feel free to contact me. Thank you, again, for allowing us to participate in his evaluation. Sincerely yours,
THIS WAS ELECTRONICALLY SIGNED - 04/12/2004 1:39 PM PST BY: SENIOR PHYSICIAN ASSISTANT ORTHOPAEDICS ORTHOPAEDIC SURGERY
JAMES RESSLER, PAC
THIS WAS ELECTRONICALLY SIGNED - 04/13/2004 1:45 PM PST BY: JR:ck(trs109c) D: 04/09/2004 01:30 PM T: 04/09/2004 09:50 PM C#: 431519
ROLANDO F ROBERTO, MD
002205
Links Previous Version Transcription Type Carmichael Consult (6804)

Electronically Signed ID 1162910 Date and Time 4/9/2004 1:30 PM Author James Paul Ressler
Document Text PATIENT: AMUNDSEN, MARK LOCATION: ORTCAR MR #: 8081369 SEX: M AGE: 44 DATE OF SERVICE: 04/09/2004 DOB: 09/23/1959 CARMICHAEL CONSULTATION Chief complaint: Low back pain, left leg pain, left groin pain. Dear Dr. Baquero: I evaluated Mr. Mark Amundsen in consultation, per your request. HPI: This is a 44-year-old Caucasian male, 6 foot 1, 223 pounds, with a history of chronic low back pain and left leg radiculopathy for 3 and 9 years, respectively, associated with left groin pain that has been evaluated in the past with a multiplicity of workups, including x-rays that had been taken recently by you, which I have personally reviewed today. Thirteenth of September 2002, limited view: The AP and lateral spot view shows some minimal degenerative changes to the L5-S1 segment but otherwise normal. He has also had bilateral hip films, AP pelvis, and bilateral lateral of the hips from December 1, 2003, showing mild to early moderate DJD. The patient has had persistent complaints of low back pain, which had been primarily relieved with the use of epidural steroid injections, which had been accomplished at the Pain Management Center at UC-Davis Medical Center. His next epidural is scheduled now for April 2004. During these epidural injection, he has had symptomatic relief of his left leg radiculopathy, but they have been, yet, been unable to help him with his current complaints that center around his left leg pain. The patient has been on a plethora of medications, including Vicodin, OxyContin, Norco, Topamax, Prozac, meclofenamate all with some minimal symptomatic improvement. He denied any bowel or bladder symptomatology. He has no other constitutional symptoms consisting of fever, chills, night sweat, or weight loss. He has a normal appetite. He has no history of any carcinomas. His alleviating factors are primarily with the epidurals. His aggravating factors are primarily prolonged sitting. He denied any bowel or bladder symptomatology, no history of incontinence. He has no foot drop that he has noted on either foot. The patient has undergone a recent MRI on 03/05/04 of the LS spine, and is not showing any significant areas of stenosis, either centrally or the lateral foramen. There is a previous MRI showing annular tear at L5-S1 but otherwise unremarkable. That was done in 2002. Medications are as listed above.
002206
Allergies to ibuprofen, producing welts. Surgeries: Hernia repair on the left side in 1987. Tonsillectomy in 1967. He has a history of right and left ankle fractures, the right x4, in 78, 82, 87, and 96, and the left from 1994, all closed reduced, with cast treatment. He is a previous smoker, quit in 1999, occasional alcohol, no drugs. Unknown last tetanus, with no blood transfusion. He has completed the 12th grade. Was in the military as an E6, honorably discharged, is widowed, currently living in Folsom without children. He denied any diabetes or thyroid disease. His review of systems is positive for occasional shortness of breath with exercising. History of GI complaints, primarily surrounding diarrhea and constipation with complaints of migraine headaches. His family history shows a father was deceased, unknown causes. Mother deceased from lung cancer age 75. He has two siblings, 47 and 39, in apparent good health, respectively. Family history is significant for the carcinoma, as stated above. Denies any coronary artery disease. No other back complaints listed. No other family history of back problems listed. Physical examination: 6 foot 1, 223 pounds. Respirations 18 and unlabored. LS spine examination shows a full range of motion in all fields with no restrictions. Has pain maximally at the end point of lateral rotational bend. He is knee to straight-leg raise was 90 degrees, downgoing Babinski, no clonus. His muscle group strength in the lower extremities were symmetrically equal at 5/5. Sensation is normal to light touch. He has full range of motion of both hip joints without restrictions and no pain. He has tenderness to palpation along the paravertebral musculature that extends in a bandlike fashion in a bell-like manner around the L3-5 segment. Dorsalis pedis and posterior tib pulses are 2+. He has negative figure-of-four. Impression and plan: Chronic low back pain with underlying mild degenerative disk disease of the L5-S1 segment, with L4-5 or L5-1 left leg radiculopathy. No neurological deficit is noted. Plan: At this point, I would continue with conservative modalities, as he has been doing. Primarily, he has been successful with epidural steroid injections. If he should persist with continued left leg radiculopathy, we would, again, reevaluate. In regard to his hip pathology, he has mild to moderate osteoarthritis. He would not be a good surgical candidate for a total hip arthroplasty. I would monitor that on a interim basis. Should you have any questions or require further information, please feel free to contact me. Thank you, again, for allowing us to participate in his evaluation. Sincerely yours,
THIS WAS ELECTRONICALLY SIGNED - 04/12/2004 1:39 PM PST BY:
002207
THIS WAS ELECTRONICALLY SIGNED - 05/20/2004 1:38 PM PST BY: JEFFREY ALAN APPLEBAUM, MD PCN FOLSOM FAMILY AND COMMUNITY MEDICINE
Display only: Transcription (1314478) on 5/19/2004 4:32 PM by Jeffrey Applebaum Document history: Transcription (1314478) on 5/19/2004 4:32 PM by Jeffrey Applebaum Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes April 29, 2004 RE: AMUNDSEN, MARK MR#: 8081369 DOB: 09/23/1959 Date of Service: 04/29/2004 SACRAL TRANSFORAMINAL EPIDURAL INJECTION VICTOR HENRIQUE BAQUERO, MD UC-DAVIS MEDICAL GROUP FOLSOM PRIMARY 251 TURNPIKE DRIVE FOLSOM, CALIFORNIA 95630 Dear Dr. Baquero: We had the pleasure of treating your patient, Mark Amundsen, today at the University of California, Davis Center for Pain Medicine. As you know, the patient is a 44-year-old male with a history of chronic lower back pain which is worse on the left than the right side. It radiates down to the posterior aspect of his buttocks and also reports a component of radiation down the anterior aspect of his left lower extremity. He reports that it is worsened by driving extended period of time and by prolonged sitting. The patient's pain is described as burning, cramping, sharp, shooting. The pain intensity is currently rated as a VAS of 3-4(0 to 10) anchored at 0 by "no pain" and at 10 by "the most severe pain imaginable." The average pain for the last week has been a VAS of 3- 4(0 to 10). CURRENT HEALTH PROBLEMS: The patient states that he currently has arthritis. RESULTS OF MOST RECENT PRIOR PROCEDURES: The patient did not undergo procedural intervention related to the current pain problem at the UC Davis Center for Pain Medicine at the last visit; however, he had a left L4-L5, and L5-S1 intraarticular facet joint injection on 01/05/04 which provided no relief of his pain.
002208
The patient denies a personal or family history of prior anesthesia problems. The patient has had nothing to eat or drink for 8 hours. CURRENT MEDICATIONS: 1. Norco. 2. Prozac. 3. Testosterone. ANTICOAGULANT MEDICATIONS: None. ALLERGIES: Ibuprofen which results in hives. PHYSICAL EXAMINATION: Preprocedural vital signs VAS 3-4/10. BP 131/72. Pulse 65. Resp 16. O2 Sat 97%. Postprocedural vital signs VAS 1.5/10. BP 138/84. Pulse 61. Resp 16. O2 Sat 99%. Airway: Mallampati Class II. Neck ROM full. Thyroid-Mentum Distance in fingerbreadths 3 cm. Lungs: Chest expansion normal, clear to auscultation without wheezes or rales. Heart: Regular rate and rhythm - normal S1, S2, no murmur, rub, or gallop. ASA Physical Status: II I. Normal II. Mild Systemic Disease III. Complex Systemic Disease IV. Critical V. Moribund PREPROCEDURAL DIAGNOSIS AND ASSESSMENT: 1. Lumbar radiculitis. 2. Lumbar degenerative disc disease. 3. Lumbar facet arthropathy. 4. History of hip osteoarthritis. 5. History of urinary retention. POSTPROCEDURAL DIAGNOSIS AND ASSESSMENT: 1. Lumbar radiculitis. 2. Lumbar degenerative disc disease. 3. Lumbar facet arthropathy. 4. History of hip osteoarthritis. 5. History of urinary retention. NAME OF PROCEDURE: Left S1 selective nerve root block. Informed Consent: The patient's condition and proposed procedures, risks, and alternatives were discussed with the patient. The patient's questions were answered. The patient appeared to understand and chose to proceed. Informed consent was obtained. SEDATION REPORT: None. PROCEDURE IN DETAIL: This is the first procedure of the first series that the patient is undergoing. After obtaining written consent, a 22-gauge IV hep lock was placed. The patient was taken back to the fluoroscopy suite and placed in a prone position with a pillow under the pelvis to decrease the lumbar lordosis. The skin overlying the lumbosacral area was prepped and draped in an aseptic fashion. The fluoroscope was used to identify the L3, L4 and L5 vertebral bodies and then the sacrum on the AP projection. Visualization of the sacral foramen was aided by medial to lateral and cephalad to caudad
002209
repositioning of the fluoroscope so that the anterior and posterior radiolucent circles (sacral foramen) were aligned. The skin and subcutaneous tissue overlying the target site of injection was then anesthetized using 3 ml of 1% lidocaine with a 25-gauge, 1 1/2 inch needle. A 25-gauge, 3 1/2-inch spinal needle with a bent tip was advanced under fluoroscopic guidance until it gently touched the posterior sacral bone above the foramen. After redirecting the needle into the left S1 foramen, the advancing needle passed through the anterior sacral canal, as evidenced by the typical "pop" through the foraminal ligament. Fluoroscopic imaging in the lateral plane helped prevent entry into the pelvis. After negative aspiration for heme or CSF, a total of 2 ml of Omnipaque 180 was injected under live AP fluoroscopy, demonstrating absence of vascular uptake. AP and lateral images demonstrated an excellent S1 neurogram. Pain provocation by the injected contrast material was negative. After negative aspiration for heme or CSF, 3 ml of a solution containing 1 ml of 40mg/ml (40mg) triamcinolone, 1.5 ml of 0.25% bupivacaine, and 0.5 ml of Omnipaque 300 contrast was injected in increments. The needle was then retracted approximately halfway and the needle track was flushed with 1 ml of 1% lidocaine. A sterile bandage was placed over the injection site. There were no new sensory deficits present in the lower extremities. The heart rate, pulse oximetry, and blood pressure were continuously monitored throughout the procedure. There were no apparent complications. The patient tolerated the procedure well and was carefully escorted to the recovery room in stable condition. The VAS was 3-4/10 before the procedure and 1/10 ten minutes after the procedure. After meeting discharge criteria, the patient was discharged home. RECOMMENDATIONS: A. We will plan to have the patient follow up in 4-6 weeks for a repeat left S1 selective nerve root block. He was instructed to call and postpone this appointment to a later date if he has substantial relief with minimal to no pain at the time of his next appointment. B. No medications were prescribed at today's visit. C. The patient was also apprised that if he gets good relief from this series of left S1 selective nerve root blocks then we will proceed with pulsed radiofrequency ablation of the involved left S1 dorsal root ganglion. D. The patient was also encouraged to continue with his home exercise which is a critical aspect in the patient's overall pain management. The patient was instructed and educated on all aspects of the plan of care. The patient acknowledged the plan of care. Thank you for allowing us to participate in the care of your patient. Should you have any questions regarding the above treatment plan, please do not hesitate to contact us. Sincerely, LANA WANIA-GALICIA, MD CLINICAL FELLOW DEPARTMENT OF ANESTHESIOLOGY & PAIN MEDICINE THIS WAS ELECTRONICALLY SIGNED - 05/03/2004 5:00 PM PST BY:
THIS WAS ELECTRONICALLY SIGNED - 05/05/2004 10:55 AM PST BY: PAUL G KREIS, MD ASSOC CLINICAL PROF; MEDICAL DIRECTOR, DIVISION OF PAIN MEDICINE ATTENDING PHYSICIAN LW:kl(trs091d) D: 04/29/2004 04:47 PM T: 04/29/2004 06:37 PM C#: 459848 cc: PAUL G KREIS, MD LANA WANIA-GALICIA, MD Links
002210
Previous Version Transcription Type Pain Referral Letter (2942) Electronically Signed Document Text April 29, 2004 RE: AMUNDSEN, MARK MR#: 8081369 DOB: 09/23/1959 Date of Service: 04/29/2004 ID 1237596 Date and Time 4/29/2004 4:47 PM Author Lana Louie Wania-Galicia
SACRAL TRANSFORAMINAL EPIDURAL INJECTION VICTOR HENRIQUE BAQUERO, MD UC-DAVIS MEDICAL GROUP FOLSOM PRIMARY 251 TURNPIKE DRIVE FOLSOM, CALIFORNIA 95630 Dear Dr. Baquero: We had the pleasure of treating your patient, Mark Amundsen, today at the University of California, Davis Center for Pain Medicine. As you know, the patient is a 44-year-old male with a history of chronic lower back pain which is worse on the left than the right side. It radiates down to the posterior aspect of his buttocks and also reports a component of radiation down the anterior aspect of his left lower extremity. He reports that it is worsened by driving extended period of time and by prolonged sitting. The patient's pain is described as burning, cramping, sharp, shooting. The pain intensity is currently rated as a VAS of 3-4(0 to 10) anchored at 0 by "no pain" and at 10 by "the most severe pain imaginable." The average pain for the last week has been a VAS of 34(0 to 10). CURRENT HEALTH PROBLEMS: The patient states that he currently has arthritis. RESULTS OF MOST RECENT PRIOR PROCEDURES: The patient did not undergo procedural intervention related to the current pain problem at the UC Davis Center for Pain Medicine at the last visit; however, he had a left L4-L5, and L5-S1 intraarticular facet joint injection on 01/05/04 which provided no relief of his pain. The patient denies a personal or family history of prior anesthesia problems. The patient has had nothing to eat or drink for 8 hours. CURRENT MEDICATIONS: 1. Norco. 2. Prozac. 3. Testosterone. ANTICOAGULANT MEDICATIONS: None.
002211
ALLERGIES: Ibuprofen which results in hives. PHYSICAL EXAMINATION: Preprocedural vital signs VAS 3-4/10. BP 131/72. Pulse Postprocedural vital signs VAS 1.5/10. BP 138/84. Pulse Airway: Mallampati Class II. Distance in fingerbreadths 3 Lungs: Chest expansion normal, or rales. Heart: Regular rate and rhythm gallop.
65. 61.
Resp Resp
16. 16.
O2 O2
Sat 97%. Sat 99%.
ASA Physical Status: II I. Normal II. Mild Systemic Disease III. Complex Systemic Disease IV. Critical V. Moribund PREPROCEDURAL DIAGNOSIS AND ASSESSMENT: 1. Lumbar radiculitis. 2. Lumbar degenerative disc disease. 3. Lumbar facet arthropathy. 4. History of hip osteoarthritis. 5. History of urinary retention. POSTPROCEDURAL DIAGNOSIS AND ASSESSMENT: 1. Lumbar radiculitis. 2. Lumbar degenerative disc disease. 3. Lumbar facet arthropathy. 4. History of hip osteoarthritis. 5. History of urinary retention. NAME OF PROCEDURE: Left S1 selective nerve root block. Informed Consent: The patient's condition and proposed procedures, risks, and alternatives were discussed with the patient. The patient's questions were answered. The patient appeared to understand and chose to proceed. Informed consent was obtained. SEDATION REPORT: None.
PROCEDURE IN DETAIL: This is the first procedure of the first series that the patient is undergoing. After obtaining written consent, a 22-gauge IV hep lock was placed. The patient was taken back to the fluoroscopy suite and placed in a prone position with a pillow under the pelvis to decrease the lumbar lordosis. The skin overlying the lumbosacral area was prepped and draped in an aseptic fashion. The fluoroscope was used to identify the L3, L4 and L5 vertebral bodies and then the sacrum on the AP projection. Visualization of the sacral foramen was aided by medial
002212
to lateral and cephalad to caudad repositioning of the fluoroscope so that the anterior and posterior radiolucent circles (sacral foramen) were aligned. The skin and subcutaneous tissue overlying the target site of injection was then anesthetized using 3 ml of 1% lidocaine with a 25-gauge, 1 1/2 inch needle. A 25-gauge, 3 1/2-inch spinal needle with a bent tip was advanced under fluoroscopic guidance until it gently touched the posterior sacral bone above the foramen. After redirecting the needle into the left S1 foramen, the advancing needle passed through the anterior sacral canal, as evidenced by the typical "pop" through the foraminal ligament. Fluoroscopic imaging in the lateral plane helped prevent entry into the pelvis. After negative aspiration for heme or CSF, a total of 2 ml of Omnipaque 180 was injected under live AP fluoroscopy, demonstrating absence of vascular uptake. AP and lateral images demonstrated an excellent S1 neurogram. Pain provocation by the injected contrast material was negative. After negative aspiration for heme or CSF, 3 ml of a solution containing 1 ml of 40mg/ml (40mg) triamcinolone, 1.5 ml of 0.25% bupivacaine, and 0.5 ml of Omnipaque 300 contrast was injected in increments. The needle was then retracted approximately halfway and the needle track was flushed with 1 ml of 1% lidocaine. A sterile bandage was placed over the injection site. There were no new sensory deficits present in the lower extremities. The heart rate, pulse oximetry, and blood pressure were continuously monitored throughout the procedure. There were no apparent complications. The patient tolerated the procedure well and was carefully escorted to the recovery room in stable condition. The VAS was 3-4/10 before the procedure and 1/10 ten minutes after the procedure. After meeting discharge criteria, the patient was discharged home. RECOMMENDATIONS: A. We will plan to have the patient follow up in 4-6 weeks for a repeat left S1 selective nerve root block. He was instructed to call and postpone this appointment to a later date if he has substantial relief with minimal to no pain at the time of his next appointment. B. No medications were prescribed at today's visit. C. The patient was also apprised that if he gets good relief from this series of left S1 selective nerve root blocks then we will proceed with pulsed radiofrequency ablation of the involved left S1 dorsal root ganglion. D. The patient was also encouraged to continue with his home exercise which is a critical aspect in the patient's overall pain management. The patient was instructed and educated on all aspects of the plan of care. The patient acknowledged the plan of care. Thank you for allowing us to participate in the care of your patient. Should you have any questions regarding the above treatment plan, please do not hesitate to contact us. Sincerely,
002213
HEALTH SYSTEM
April 29, 2004 RE,
MR#,
UCDAVIS
AMUNDSEN, MARK 8081369 DOB, 09/23/1959 Date of Service, 04/29/2004
SACRAL
TRANSFORAMINAL
EPIDURAL
INJECTION
VICTOR HENRI QUE BAQUERO, MD UC-DAVIS MEDICAL GROUP - FOLSOM 251 TURNPIKE DRIVE FOLSOM, CALIFORNIA 95630
PRIMARY
'.
Dear Dr.
Baquero:
We had the pleasure of treating your patient, Mark Amundsen, today at the University of California, Davis Center for Pain Medicine. As you know, the patient is a 44-year-old male with a history of chronic lower back pain which is worse on the left than the right side. It radiates down to the posterior aspect of his buttocks and also reports a component of radiation down the anterior aspect of his left lower extremity. He reports that it is worsened by driving extended period of time and by prolonged sitting. The patient's pain is described as burning, cramping, sharp, shooting. The pain intensity is currently rated as a VAS of 3-4{O to 10) anchored at 0 by "no pain" and at 10 by "the most severe pain imaginable." The average pain for the last week has been a VAS of 34(Oto10).
CURRENT HEALTH PROBLEMS, The patient states that he currently
has arthritis.
RESULTS OF MOST RECENT PRIOR PROCEDURES, The patient did not undergo procedural intervention related to the current pain problem at the UC Davis Center for Pain Medicine at the last visit; however, he had a left L4-LS, and LS-Sl intraarticular facet joint injection on 01/05/04 which provided no relief of his pain. The patient denies a personal or family history of prior anesthesia problems. The patient has had nothing to eat or drink for 8 hours. CURRENT MEDICATIONS, 1. Norco.
2. Prozac.
3.
Testosterone. MEDICATIONS, None.
ANTICOAGULANT
Pain Management Center 4860 Y Street, Suite 5200. Sacramento, California (916) 734-7246 Fax (916) 734-5033
95817-1418
........,.-
MEDICAL
RECORDS
COpy
002214
RE,
MR#,
AMUNDSEN, 8081369
MARK
Page 2
ALLERGIES: Ibuprofen which PHYSICAL
results
in hives.
EXAMINATION,
Preprocedural vital signs VAS 3-4/10. BP 131/72. Postprocedural vital signs VAS 1.5/10. BP 138/84.
Pulse Pulse
65. 61.
Resp Resp
16. 16.
02
sat Sat
97%.
02
99%.
Airway: Mallampati Class II. Distance in fingerbreadths - 3 Lungs: Chest expansion normal, or rales . Heart: Regular rate and rhythm gallop.
Neck ROM - full. Thyroid-Mentum em. clear to auscultation without wheezes - normal 51, 52, no murmur, rub, or
ASA Physical Status, II I. Normal II. Mild Systemic Disease III. Complex Systemic Disease IV. Critical V. Moribund PREPROCEDURAL 1. Lumbar 2. Lumbar 3. Lumbar 4. History 5. History DIAGNOSIS AND ASSESSMENT, radiculitis. degenerative disc disease. facet arthropathy. of hip osteoarthritis. of urinary retention .
POSTPROCEDURAL DIAGNOSIS AND ASSESSMENT, 1. Lumbar radiculitis. 2. Lumbar degenerative disc disease. 3. Lumbar facet arthropathy. 4. History of hip osteoarthritis. 5. History of urinary retention. NAME OF PROCEDURE: LefL 81 selective nerve
root block.
Informed Consent: The patient's condltion and proposed procedures, risks, and alternatives were discussed with the patient. The patjent's questions were answered. The patient appeared to understand and chose to proceed. Informed consent was obtained. SEDATION REPORT, None.
PROCEDURE IN DETAIL, This is the first procedure undergoing.
of the first
series
that
the patient
is
002215
RE,
MR#,
AMUNDSEN,
8081369
MARK
Page 3
After obtaining written consent, a 22-gauge IV hep lock was placed. The patient was taken back to the fluoroscopy suite and placed in a prone position with a pillow under the pelvis to decrease the lumbar lordosis. The skin overlying the lumbosacral area was prepped and draped in an aseptic fashion. The fluoroscope was used to identify the L3, L4 and L5 vertebral bodies and then the sacrum on the A? projection. Visualization of the sacral foramen was aided by medial to lateral and cephalad to caudad repositioning of the fluoroscope so that the anterior and posterior radiolucent circles (sacral foramen) were aligned. The skin and subcutaneous tissue overlying the target site of injection was then anesthetized using 3 ml of 1% lidocaine with a 2S-gauge, 1 1/2 inch needle. A 2S-gauge, 3 1/2-inch spinal needle with a bent tip was advanced under fluoroscopic guidance until it gently touched the posterior sacral bone above the foramen. After redirecting the needle into the left 81 foramen, the advancing needle passed through the anterior sacral canal, as evidenced by the typical "popl! through the foraminal ligament. Fluoroscopic imaging in the lateral plane helped prevent entry into the pelvis. After negative aspiration for heme or esp, a total of 2 ml of Omnipaque 180 was injected under live AP fluoroscopy, demonstrating absence of vascular uptake. AP and lateral images demonstrated an excellent 81 neurogram. Pain provocation by the injected contrast material was negative. After negative aspiration for heme or esp, 3 ml of a solution containing 1 ml of 40mg/ml (40mg) triamcinolone, 1.5 ml of 0.25% bupivacaine, and 0.5 ml of Omnipaque 300 contrast was injected in increments. The needle was then retracted approximately halfway and the needle track was flushed with 1 ml of 1% lidocaine. A sterile bandage was placed over the injection site. There were no new sensory deficits present in the lower extremities . The heart rate, pulse oximetry, and blood pressure were continuously monitored throughout the procedure. There were no apparent complications. The patient tolerated the procedure well and was carefully escorted to the recovery room in stable condition. The VAS was 3-4/10 before the procedure and 1/10 ten minutes after the procedure. After meeting discharge criteria, the patient was discharged home. RECOMMENDATIONS, A. We will plan to have the patient follow up in 4-6 weeks for a repeat left 81 selective nerve root block. He was instructed to call and postpone this appointment to a later date if he has substantial relief with minimal to no pain at the time of his next appointment. B. No medications were prescribed at today's visit. C. The patient was also apprised that if he gets good relief from this series of left 81 selective nerve root blocks then we will proceed with pulsed radiofrequency ablation of the involved left 81 dorsal root ganglion.
002216
RE: AMUNDSEN, MR#: 8081369 Page 4
MARK
D. The patient was also encouraged to continue with his home exercise which is a critical aspect in the patient's overall pain management. The patient was instructed and educated on all aspects care. The patient acknowledged the plan of care. of the plan of
THIS WAS ELECTRONICALLY SIGNED - 05/05/2004 10:55 AM PST BY: PAUL G KREIS, MD ASSOC CLINICAL PROF; MEDICAL DIRECTOR, DIVISION OF PAIN MEDICINE ATTENDING PHYSICIAN LW:kl(trs091dl D: T: C#: cc: 04/29/2004 04:47 PM 04/29/2004 06:37 PM 459846 PAUL G KREIS, MD LANA WANIA-GALICIA,
MD
002217
-.
April .29, 2004 SACRAL
HEALTH SYSTEM
CENTER
RE, MR#, DOB: Date
UCDAVIS
RECEIVED
MAY ~ 1 2004
PAIN MANAGEMENT
AMUNDSEN, MARK 8081369 09/23/1959 of Service, 04/29/2004
TRANSFORAMINAL
EPIDURAL
INJECTION
VICTOR HENRI QUE BAQUERO, MD UC-DAVIS MEDICAL GROUP - FOLSOM 251 TURNPIKE DRIVE FOLSOM, CALIFORNIA 95630 Dear D::-. Baquero:
PRIMARY
We had the pleasure of treating your patient, Mark Amundsen, today at the Un.i.verslty of California, Davis Center for Pain Medicine. As you know, t:11e patient is a 44-year-old male with a history of chronic lower back pain which is worse on the left than the right side. It radiates down to the posterior aspect of his buttocks and also reports a component of radiation down the anterior aspect of his left lower extrem:Lty. He reports that it is worsened by driving extended period of time and by prolonged Sl tting. The patient s pain is described as bur n i nq cramping, sharp shooti ng.
I f f
The pain intensity is currently rated as a VAS of 3-4 (0 to 10) anchored at 0 by \ \ no pain" and at 10 by \, the most severe pa i n imaginable.' The average pain for the last week has been a VAS of 34 (0 to 10).
f
CURRENT HEALTH PROBLEMS, The pat.ient states that he currently
has arthritis.
RESULTE: OF MOST RECENT PRIOR PROCEDURES, The patient did not undergo procedural intervention curr.ent pain problem at the UCDavis Center for Pain last visit; however, he had a left L4-L5, and LS-S1 facet joint injection on 01/05/04 which provided no pain.
related t9 the l\fedicine' at the intraarticular relief of his
The pat lent denies a personal or family hlstory of prior anesthesia problems. The patient has had nothing to eat or drink for 8 hours. CURRENT MEDICATIONS: 1. Norco. 2. Prozac. 3. Testosterone. ANTICOAGULANT MEDICATIONS, None.
Pain Management Center 4860 Y Street, SUite 5200. Sacramento. California (916) 734-7246. Fax (9 J 6) 734-5033
/~
95817-1418 COPY FOR PAUL KREIS
002218
RE,
MR#,
AMUNDSEN, 8081369
MARK
~n hives. pulse Pulse 65. 61. Resp Resp 16. 16.
02 02 Sat Sat 97%. 99%.
Page 2
ALLERGI ES, Ibuprofen which PHYSICAL
results
EXAMINATION,
Preprocedural vital signs VAS 3-4/10. BP 131/72. Postprocedural vital signs VAS 1.5/10. BP 138/84.
Airway, Mallampati Class II. Distance in f~ngerbreadths - 3 Lungs: Chest expansion normal, or r a Le s . Heart: Regular rate and rhythm gallop.
Neck ROM - full. Thyroid-Mentum em. clear to auscultation without wheezes - normal 81, 82, no murmur, rub, or
ASA Physical Status, II I. Normal II. Mild Systemic Disease III. Complex Systemic Disease IV. erit leal V. Moribund PREPROCEDURAL DIAGNOSIS AND ASSESSMENT, 1. Lumbar radiculitis. 2. Lumbar degenerative disc disease. 3. Lumbar facet arthropathy. 4. History of hip osteoarthritis. 5. History of urinary retention. POSTPROCEDURAL DIAGNOSIS AND ASSESSMENT, 1. Lumbar radiculitis. 2. Lumbar degenerative disc di sease. 3. Lumbar facet arthropathy. 4. Hi s t or-y of hip osteoarthritis. 5. History of urinary retention. NAME OF' PROCEDURE, Left 81 selective nerve
root block.
Informed Consent: The patient's condltion and proposed procedures, risks, and alternatives were discussed with the patient. The patient's questions were answered. The patient appeared to understand and chose to proceed. Informed consent was obtained. SEDATION REPORT, None.
PROCEDURE IN DETAIL, This is the first procedure undergoing.
of the first
series
that
the patient
is
002219
RE,
MR#,
~iUNDSEN,
8081369
MARK
Page 3
After obtaining written consent, a 22 -gauge IV hep lock was placed. The patient was taken back to the fluoroscopy suite and placed in a prone positlon with a pillow under the pelvis to decrease the lumbar lordosis. The skin overlying the lumbosacral area was prepped and draped in an aseptic fashion. The fluoroscope was used to ldentify the L3, L4 and L5 vertebral bodies and then the sacrum on the AP projection. Visualization of the sacral foramen was aided by medial to lateral and cephalad to caudad repasi tioning of the f1 uoroscope so that the anterior and posterior radiolucent circles (sacral foramen) were aligned. The skin and subcutaneous tissue overlying the target site of injection was then anesthetized using 3 ml of 1% lidocaine with a 25-gauge, 1 1/2 inch needle. A 25-gauge, 3 1/2-inch spinal needle_with a bent tip was advanced under fluoroscopic guidance until it gently touched the posterior sacral bone above the-foramen. After redirecting the needle into the left 81 foramen, the advancing needle passed through the anterior sacral canal, as evidenced by the typical pop t.hrough the f o r arru na L ligament. Fluoroscopic imaging in the lateral plane helped prevent entry into the pelvis. After negative aspiration for heme or C5F, a total of 2 ml of Omnipaque 180 was injected under live AP fluoroscopy, demonstrating absence of vascular uptake. AP and lateral images demonstrated an excellent 81 neurogram. Pain provocation by the injected contrast material was negative. After negative aspiration for heme or C5F, 3 ml of a solution containing 1 ml of 40mg/ml (40mg) triamcinolone, 1.5 ml of 0.25% bupivac:aine, and 0.5 ml of Omnipaque 300 contrast was inj ected in anc rernent s . The needle was then retracted app r ox ima t.e Ly halfway and the needle track was flushed with 1 ml of 1% lidocaine. A sterile bandage was placed over the injection site. There were no new sensory deficits present in the lower extremities.
II II
The heart rate, pulse oximetry, and blood pressure were continuously monitored throughout the procedure. There were no apparent complications. The patlent tolerated the procedure well and was carefully escorted to the recovery room in stable condition. The VAS was 3-4/10 before the'procedure and 1/10 ten minutes aILer the procedure. After meeting discharge criteria, the patient was discharged home. RECOMMENDATIONS, A. We will plan to have the patient follow up in 4~6 weeks for a repeat left Sl selective nerve root block. He was instructed to call and postpone this appolntment to a later date if he has substantial relief wlth minlmal to no pain at the time of his next appointment. B. No medlcations were prescribed at today's visit. C. The patient was also apprised that if he gets good rellef from this series of left 51 selective nerve root blocks then we will proceed with pulsed radiofrequency ablation of the involved left 81 dorsal root ganglion.
002220
RE,
MR#,
AMUNDSEN,
8081369
MARK
of the plan of
Page 4
D. The patient was also encouraged to continue with his home exercise which is a critical aspect in the patientrs overall pain
management.
LANA -~~NIA-GALICIA, MD CLINICAL FELLOW DEPARTMENT OF ANESTHESIOLOGY & PAIN MEDICINE THIS w.~S ELECTRONICALLY SIGNED - 05/03/2004 5,00 PM PST BY,
THIS w.~S ELECTRONICALLY SIGNED - 05/05/2004 10,55 AM PST BY, PAUL G KREI S, MD ASSOC CLINICAL PROF; MEDICAL DIRECTOR, DIVISION OF PAIN MEDIC1NE ATTENDING PHYSICIAN
LW,kl D, T, C#,
t tr s os i d)
04/29/2004 04/29/2004 ',59848 04,47 06,37 PM PM
cc .
PAUL G KREIS, MD LANA WANIA-GALICIA,
MD
002221
Back Exam: no midline tenderness in the lumbosacral spine, ROM intact, no muscle spasm and no paraspinous muscle tenderness. Hip range of motion is normal and does not reproduce pain. Straight leg raise is negative bilaterally.DTR+1 bilateral. Assessment: 1.CHRONIC DEBILITATING BACK PAIN,failed elavil, ultram, norco, oxycontin, darvocet, NSAIDs, neurontin, flexeril, steroid injections, PT. 2.DEPRESSION-well controlled. Plan: See Orders. See Patient Education section. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> JESSICA J SHAW Thu Jun 24, 2004 4:37 PM this was a repeat.me >> JESSICA J SHAW Thu Jun 24, 2004 8:54 AM Encounter initiated. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> JESSICA J SHAW Wed Jun 23, 2004 9:59 AM Encounter initiated. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes PATIENT: AMUNDSEN, MARK LOCATION: IMFFOL MR #: 8081369 SEX: M AGE: 44 DATE OF SERVICE: 05/19/2004 DOB: 09/23/1959 FOLSOM CLINIC NOTE SUBJECTIVE: The patient was carrying a 15 pound elderly dog when he slipped and fell, landing on his buttock and back area. He has had a prior back problem. He has seen Dr. Baquero and has undergone physical therapy in the past and is on medication but is taking Norco 10/325, five tabs all at once at night. His back is tender to palpation and percussion in the left lumbar area from a contusion. No other significant changes. ASSESSMENT: Contusion to the lumbar area in a fall in a patient with underlying chronic lumbar syndrome. PLAN: Decrease the Norco, maximum of two to three tabs in the evening. Start Indocin 25 mg, one t.i.d., #60, no refills; Ambien 10 mg, one at h.s. p.r.n. sleep, #20; Flexeril 10 mg, half to one b.i.d. to t.i.d. p.r.n. spasm, #60, no refill. Discussed precautions against falling and injury. Ice or heat to the affected area and follow up with PCP for possible further physical therapy if persistent problem.
002222
THIS WAS ELECTRONICALLY SIGNED - 05/20/2004 1:38 PM PST BY: APPLEBAUM, MD PCN FOLSOM FAMILY AND COMMUNITY MEDICINE
JEFFREY ALAN
Links Previous Version Transcription Type Folsom Clinic Note (7721) Electronically Signed Document Text LOCATION: IMFFOL PATIENT: AMUNDSEN, MARK MR #: 8081369 SEX: M AGE: 44 DATE OF SERVICE: 05/19/2004 DOB: 09/23/1959 FOLSOM CLINIC NOTE SUBJECTIVE: The patient was carrying a 15 pound elderly dog when he slipped and fell, landing on his buttock and back area. He has had a prior back problem. He has seen Dr. Baquero and has undergone physical therapy in the past and is on medication but is taking Norco 10/325, five tabs all at once at night. His back is tender to palpation and percussion in the left lumbar area from a contusion. No other significant changes. ASSESSMENT: Contusion to the lumbar area in a fall in a patient with underlying chronic lumbar syndrome. PLAN: Decrease the Norco, maximum of two to three tabs in the evening. Start Indocin 25 mg, one t.i.d., #60, no refills; Ambien 10 mg, one at h.s. p.r.n. sleep, #20; Flexeril 10 mg, half to one b.i.d. to t.i.d. p.r.n. spasm, #60, no refill. Discussed precautions against falling and injury. Ice or heat to the affected area and follow up with PCP for possible further physical therapy if persistent problem.
ID 1314478 Date and Time 5/19/2004 4:32 PM Author Jeffrey Applebaum
002223
HEALTH SYSTEM
FOLSOM
PATIENT: AMUNDSEN, MARK MR #: 8081369 DATE OF SERVICE: 05/19/2004 FOLSOM CLINIC NOTE dog when he He has had a
Norco No
UCDAVIS
LOCATION:
SEX: DOB: MAGE:
IMFFOL
44
09/2311959
SUBJECTIVE, The pat lent was carrying a 15 pound elderly slipped and fell, landing on his buttock and back area.
prior back problem. physical therapy in He the has seen past and Dr. Baquero and is on medication left lumbar area
has undergone but is taking
10/325,
five tabs all at once at night.
His back is tender

from
to
palpation and percussion in the other significant changes. ASSESSMENT: Contusion to the
a contusion.
lumbar
area
in a fall
in
a patient
with
underlying
chronic
lumbar
syndrome.
of two to three t.i.d., #60, no tabs in refills; the Ambien
PLAN. Decrease evening. Start
the Norco, maximum Indocin 25 mg, one
10
mg, one at h.s. p.r.n.
sleep,
#20; Flexeril
10 mg, half
to one b.i.d.
to t.i.d. p.r.n. spasm, #60, no refill. fallIng and injury. Ice or heat to the
Discussed precautIons against affected area and follow up
with PCP for possible
further physical
therapy
if persistent
problem.
THIS
WAS
El.,ECTRONICALLY
SIGNED
OS/20/2004
1:38 PM PST
BY,
JEFFREY ALAtJ APPLEBAUN, MD peN FOLSOM FAMILY AND COMMUNITY MEDICINE
Jp..A: wav .(usa 127)
D: T: C#:
05/19/2004 OS/20/2004 488882
04:32 PM 06:38 AM
FOLSOM, CA 95630 FAX (916) 355-1219

M!Cf) R!CrORf)S FT L~. ropy
002224
------------------------------
of a time. ROS: as above History: I did review patients past medical and family/social history. Objective: Back Exam: no midline tenderness in the lumbosacral spine, ROM intact, no muscle spasm and no paraspinous muscle tenderness. Hip range of motion is normal and does not reproduce pain. Straight leg raise is negative bilaterally.DTR+1 bilateral. Assessment: 1.CHRONIC DEBILITATING BACK PAIN,failed elavil, ultram, norco, oxycontin, darvocet, NSAIDs, neurontin, flexeril, steroid injections, PT. Fu with spine clinic. Duragesic trial. Glucosamine. 2.DEPRESSION-well controlled. Plan: See Orders. See Patient Education section. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions.
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Visit Notes Paton, Carol A 7/9/2004 10:59 am Vital signs taken, allergies verified, screened for pain, med hx taken (if appropriate), Carol A Paton, MA Electronically signed by Paton, Carol A at 7/9/2004 10:59 am Progress Notes Patient presents with: Back Pain Subjective: Mark Amundsen is a(n) 44yr old male who presents for chronic complaint of low back pain for the past 3 year(s). He associates the onset of pain with no known injury. The pain is described as moderate, altrnating in character. Since its onset the pain is increasing. Associated symptoms: pain radiating to the left upper leg and lower leg . Symptoms are exacerbated by sitting and improved by heat and previous steroid injection, Norco works 50% of a time. ROS: as above History: I did review patients past medical and family/social history. Objective:
002225
C#:
629285
cc: VICTOR HENRIQUE BAQUERO, MD, PCN FOLSOM

Display only: Transcription (1695029) on 8/31/2004 12:49 PM by Kenten P-K Wang Document history: Transcription (1695029) on 8/31/2004 12:49 PM by Kenten P-K Wang
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> JESSICA J SHAW Wed Aug 11, 2004 4:34 PM Encounter initiated. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> AMANDA S RANEY Tue Aug 3, 2004 10:11 AM Encounter initiated. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> CAROL A PATON Mon Jul 19, 2004 11:21 AM Encounter initiated. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Visit Notes SHAW, JESSICA J 7/15/2004 9:22 am Vital signs taken, allergies verified, screened for pain, med hx taken (if appropriate). Jessica J Shaw, MA Electronically signed by SHAW, JESSICA J at 7/15/2004 9:22 am Progress Notes Patient presents with: Back Pain Subjective: Mark Amundsen is a(n) 44yr old male who presents for chronic complaint of low back pain for the past 3 year(s). He associates the onset of pain with no known injury. The pain is described as moderate, altrnating in character. Since its onset the pain is increasing. Associated symptoms: pain radiating to the left upper leg and lower leg. Norco not working. Sitting worsens the pain. Pain shoots to the left porsterior-lateral region to the ankle. Ocational numbness. no weakness. Tried PT and Pain clinic without success. Symptoms are exacerbated by sitting and improved by heat and previous steroid injection, Norco works 50%
002226
Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Visit Notes GROVES, SHERI L 9/14/2004 8:33 am Vital signs taken, allergies verified, screened for pain, med hx taken (if appropriate), cc was taken. Sheri L Groves, MA Electronically signed by GROVES, SHERI L at 9/14/2004 8:33 am Progress Notes Mark Amundsen is a 44yr year old male who is here for the following reason: follow up on dissability. Needs forms filled out. Chronic lumbago/sciatica. Stable on meds. Needs refill. Seeing spine clinic. Optimistic with new stretches and PT that was requested. OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Neuro: Gait normal. Reflexes normal and symmetric. Sensation and strength grossly normal. Musculoskeletal: back:unchanged. ASSESSMENT: 724.2 LUMBAGO (primary encounter diagnosis) Note: Continue PT and spine clinic. Plan: NORCO 10 MG-325 MG ORAL TAB Filled dissability forms extended until 1/1/05 110.4 DERMATOPHYTOSIS OF FOOT. Mocassin type. Plan: KETOCONAZOLE 2 % TOP CREA Spent greater than 25 minutes face to face with patient, over half the time was spent counseling.
PLAN: See Orders. Follow up in office if not better. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> PAULA DORN Fri Sep 10, 2004 12:30 PM LAST REFILL 8/17/04 Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes PATIENT: AMUNDSEN, MARK LOCATION: SPINE MR #: 8081369 SEX: M AGE: 44 DATE OF SERVICE: 08/31/2004 DOB: 09/23/1959 ORTHOPAEDICS CLINIC NOTE
002227
LINKING LANGUAGE: The patient seen and examined per referral of Dr. Victor Baquero in Folsom, California. CHIEF COMPLAINT: Low back pain. HISTORY OF PRESENT ILLNESS: This is a 44-year-old Caucasian male with complaints of low back pain on the left side extending down to his left leg. It started about three years ago in 2001 with no apparent cause. He states the initial low back pain started approximately ten years ago while exercising, has perhaps worsened for the past three years. The pain is located in the low back, left hip and leg. The pain is described as burning, sharp and electric-like and occurs all the time. Activities that decrease pain include lying down and resting. Activities that increase the pain include sitting and standing. Activities that does not change the pain include exercising, bending, lifting, coughing, sneezing, or bowel movements. Functional limitations include going to work, socializing with friends, participating in recreation, and exercising. Previous treatments have included physical therapy (which provided no relief), ice (which provides moderate relief), traction (which provides no relief), TENS unit (which provides no relief). She has been injected with steroids four separate times here at UC Davis Medical Center which provided moderate to no relief. His first injection, he states, was to the disc which provided about 50% relief of his pain. He said that the injection was a facet injection which provided no relief. He also had an S1 injection which provided one day of relief. DIAGNOSTIC STUDIES: Previous diagnostic studies have included an MRI. ALLERGIES: Ibuprofen, morphine sulfate. CURRENT MEDICATIONS: Prozac 40 mg daily (provides no relief), methocarbamol 750 mg twice a day (provides a little bit of relief), Norco 10 mg 4 pills a day (provides moderate amount of relief), naproxen 220 mg four times a day (provides a little bit of relief), AndroGel 50 mg daily (provides no relief). PAST MEDICAL HISTORY: Minor health problems. PAST SURGICAL HISTORY: Tonsillectomy, hernia repair. FAMILY HISTORY: Mother dies of lung cancer at age 75. He has two siblings all in good health in their 40s. Family history is significant for lung cancer. SOCIAL HISTORY: He is not currently working. He last worked in April 2003 in computer network administration. He is currently applying for Social Security benefits with the State of California. He drinks alcoholic drinks two per week for the last 23 years. He has quit smoking, about 12 years ago. He used to smoke a pack-and-a-half a day for 17 years. He denies using street drugs. He has a high school diploma. He was in the Navy and honorably discharged. He lives alone in a house in Folsom. He has no children. He is widower. His wife died last year of breast cancer. REVIEW OF SYSTEMS: The history intake form was reviewed with the patient. He answered "yes" to feeling easily fatigued for the past two years, difficulty exercising due to weakness for two years, shortness of breath with trouble breathing with exercise for two years, intermittent loose stools for the past 44 years where he usually had two stools a day. He has weakness in his limb for the past two years. He has morning stiffness, joint pain and pain worse at night for the past three years. He has no equipment needs. He is independent with all activities of daily living. Pain diagram shows aching pain staring from the left iliac crest that radiates down the posterior thigh into his calf. He also has some left-sided anterior thigh or hip aching pain. PHYSICAL EXAMINATION: Weight 222x lb, blood pressure 133/80, temperature 36.8, pulse 69, respirations 16. Pain is rated at 3/10 in the left lower back. General: This is a well-developed, wellnourished male in no acute distress, alert and oriented and cooperative on the examination. His affect appeared bright and easy to laugh. His breathing was non-labored and non-dyspneic. His gait was non-antalgic. His coordination was normal. His reflexes were 2+ in bilateral knee, ankle and medial hamstrings. He had no ankle clonus bilaterally. Manual muscle testing did not reveal any focal weakness. He had 5/5 strength in hip flexors, hip abductors, hip adductors, knee extensors, ankle dorsiflexors, ankle everters, big toe extensors. Of note, on hip adduction patient had significant groin pain bilaterally. Single-leg bridging did not reveal any hamstring cramping or instability. His sensory test did not reveal any focal deficits in the lower limbs. Cardiovascular exam did not show any edema in the lower limbs. Skin examination did not show any rashes bilaterally.
002228
Musculoskeletal exam did not show any focal atrophy in the lower limbs. Structural exam did not show any significant iliac crest height difference or leg length discrepancy. Range of motion of the lumbar spine showed no significant pain with flexion. He was able to get his fingertips close to his foot. Extension and side-bending cause slight pain in both the right and the left hip region. Range of motion of his hips shows pain with hip internal rotation bilaterally and with faber maneuvers bilaterally. He has a lot of groin pain, especially on faber maneuver. Flexibility testing showed significant tightness of his hip adductors. His hamstrings were mildly tight with popliteal angle around 30 degrees. No tension test with straight leg raising and slump testing did not reproduce his symptoms. AP pelvic glide did not cause a significant amount of pain; however, there was discomfort with that maneuver. Palpatory exam did not reveal any lymphadenopathy. There was no significant tenderness along the spinous process. There is mild tenderness along the paraspinal muscles. There was slight tenderness along the left sacral notch compared to the right. Palpation at the insertion site on the pubic rami showed significant tenderness. IMAGING: MRI of the lumbar spine dated 12/20/02 showed degenerative changes of the facets and the disc of L5-S1 with a mild aneuric tear with shifting to the left of midline. A second set of MRI at the lumbar spine dated 3/5/04 showed unremarkable MRI of the lumbosacral spine for his age. I reviewed both to the MRI studies on Stentor and agree with the above findings. IMPRESSION: This is a 44-year-old male with low back pain that radiates down the left side, especially towards the hip. Imaging does not explain the source of his pain. He may have facet-mediated pain at the low back. He may also have left SI joint and hip joint pain. On physical examination, there was significant muscular tightness, especially along the hip adductors. He states he has been trying to strengthening his hip adductors without stretching them and over the past three years his hip pain has gotten worse and when he does not do the exercises the hip pain improves. I feel that the muscular tightness may be contributing to the mechanical changes in the joints which may result in arthritis in the hips and SI joint. RECOMMENDATIONS: 1) A physical therapy program was recommended for the patient to work on adductor stretching and strengthening of the hip abductors. Also recommended was a stretching program for the hip flexors and a strengthening procedure for the hip extensors. I feel that with normalization and balancing of the hip musculature that hip joint mechanics will eventually improve and his hip or SI joint pain will also improve. 2) The patient is currently being followed by the Anesthesia Pain Service for steroid injections. The patient is currently rethinking whether the injections are really helping him. The sites of injection should be directed more towards the joints such as the SI joint and hip joint. These injections should be considered for symptomatic relief. 3) I have asked the patient to follow up with me after his physical therapy program. At that time, and evaluation of the patient's symptoms will be made and, if indicated or if no improvements, consideration for electrodiagnostic testing may be made. Total time spent with patient including history, physical exam and coordination of care was 60 minutes. Of that time, over 75% was spent in face-to-face consultation.
THIS WAS ELECTRONICALLY SIGNED - 09/02/2004 10:29 AM PST BY: ASSISTANT PROFESSOR DEPARTMENT OF PHYSICIAL MEDICINE & REHABILITATION
KENTEN WANG, DO
KW:jm(usa160) D: 08/31/2004 12:49 PM T: 09/01/2004 10:12 PM C#: 629285 cc: VICTOR HENRIQUE BAQUERO, MD, PCN FOLSOM
002229
Links Previous Version Transcription Type Orthopaedics Clinic Note (2721)

Electronically Signed ID 1695029 Date and Time 8/31/2004 12:49 PM Author Kenten P-K Wang
Document Text LOCATION: SPINE PATIENT: AMUNDSEN, MARK MR #: 8081369 SEX: M AGE: 44 DATE OF SERVICE: 08/31/2004 DOB: 09/23/1959 ORTHOPAEDICS CLINIC NOTE LINKING LANGUAGE: The patient seen and examined per referral of Dr. Victor Baquero in Folsom, California. CHIEF COMPLAINT: Low back pain.
HISTORY OF PRESENT ILLNESS: This is a 44-year-old Caucasian male with complaints of low back pain on the left side extending down to his left leg. It started about three years ago in 2001 with no apparent cause. He states the initial low back pain started approximately ten years ago while exercising, has perhaps worsened for the past three years. The pain is located in the low back, left hip and leg. The pain is described as burning, sharp and electric-like and occurs all the time. Activities that decrease pain include lying down and resting. Activities that increase the pain include sitting and standing. Activities that does not change the pain include exercising, bending, lifting, coughing, sneezing, or bowel movements. Functional limitations include going to work, socializing with friends, participating in recreation, and exercising. Previous treatments have included physical therapy (which provided no relief), ice (which provides moderate relief), traction (which provides no relief), TENS unit (which provides no relief). She has been injected with steroids four separate times here at UC Davis Medical Center which provided moderate to no relief. His first injection, he states, was to the disc which provided about 50% relief of his pain. He said that the injection was a facet injection which provided no relief. He also had an S1 injection which provided one day of relief. DIAGNOSTIC STUDIES: ALLERGIES: Previous diagnostic studies have included an MRI.
Ibuprofen, morphine sulfate. Prozac 40 mg daily (provides no relief), twice a day (provides a little bit of relief), a day (provides moderate amount of relief), times a day (provides a little bit of relief), (provides no relief). Minor health problems. Tonsillectomy, hernia repair.
CURRENT MEDICATIONS: methocarbamol 750 mg Norco 10 mg 4 pills naproxen 220 mg four AndroGel 50 mg daily PAST MEDICAL HISTORY:
PAST SURGICAL HISTORY:
FAMILY HISTORY: Mother dies of lung cancer at age 75. He has two siblings all in good health in their 40s. Family history is
002230
significant for lung cancer. SOCIAL HISTORY: He is not currently working. He last worked in April 2003 in computer network administration. He is currently applying for Social Security benefits with the State of California. He drinks alcoholic drinks two per week for the last 23 years. He has quit smoking, about 12 years ago. He used to smoke a pack-and-a-half a day for 17 years. He denies using street drugs. He has a high school diploma. He was in the Navy and honorably discharged. He lives alone in a house in Folsom. He has no children. He is widower. His wife died last year of breast cancer. REVIEW OF SYSTEMS: The history intake form was reviewed with the patient. He answered "yes" to feeling easily fatigued for the past two years, difficulty exercising due to weakness for two years, shortness of breath with trouble breathing with exercise for two years, intermittent loose stools for the past 44 years where he usually had two stools a day. He has weakness in his limb for the past two years. He has morning stiffness, joint pain and pain worse at night for the past three years. He has no equipment needs. He is independent with all activities of daily living. Pain diagram shows aching pain staring from the left iliac crest that radiates down the posterior thigh into his calf. He also has some left-sided anterior thigh or hip aching pain. PHYSICAL EXAMINATION: Weight 222x lb, blood pressure 133/80, temperature 36.8, pulse 69, respirations 16. Pain is rated at 3/10 in the left lower back. General: This is a well-developed, wellnourished male in no acute distress, alert and oriented and cooperative on the examination. His affect appeared bright and easy to laugh. His breathing was non-labored and non-dyspneic. His gait was non-antalgic. His coordination was normal. His reflexes were 2+ in bilateral knee, ankle and medial hamstrings. He had no ankle clonus bilaterally. Manual muscle testing did not reveal any focal weakness. He had 5/5 strength in hip flexors, hip abductors, hip adductors, knee extensors, ankle dorsiflexors, ankle everters, big toe extensors. Of note, on hip adduction patient had significant groin pain bilaterally. Single-leg bridging did not reveal any hamstring cramping or instability. His sensory test did not reveal any focal deficits in the lower limbs. Cardiovascular exam did not show any edema in the lower limbs. Skin examination did not show any rashes bilaterally. Musculoskeletal exam did not show any focal atrophy in the lower limbs. Structural exam did not show any significant iliac crest height difference or leg length discrepancy. Range of motion of the lumbar spine showed no significant pain with flexion. He was able to get his fingertips close to his foot. Extension and side-bending cause slight pain in both the right and the left hip region. Range of motion of his hips shows pain with hip internal rotation bilaterally and with faber maneuvers bilaterally. He has a lot of groin pain, especially on faber maneuver. Flexibility testing showed significant tightness of his hip adductors. His hamstrings were mildly tight with popliteal angle around 30 degrees. No tension test with straight leg raising and slump testing did not reproduce his symptoms. AP pelvic glide did not cause a significant amount of pain; however, there was discomfort with that maneuver. Palpatory exam did not reveal any lymphadenopathy. There was no significant tenderness along the spinous process. There is mild tenderness along the paraspinal muscles. There was slight tenderness along the left sacral notch
002231
compared to the right. Palpation at the insertion site on the pubic rami showed significant tenderness. IMAGING: MRI of the lumbar spine dated 12/20/02 showed degenerative changes of the facets and the disc of L5-S1 with a mild aneuric tear with shifting to the left of midline. A second set of MRI at the lumbar spine dated 3/5/04 showed unremarkable MRI of the lumbosacral spine for his age. I reviewed both to the MRI studies on Stentor and agree with the above findings. IMPRESSION: This is a 44-year-old male with low back pain that radiates down the left side, especially towards the hip. Imaging does not explain the source of his pain. He may have facet-mediated pain at the low back. He may also have left SI joint and hip joint pain. On physical examination, there was significant muscular tightness, especially along the hip adductors. He states he has been trying to strengthening his hip adductors without stretching them and over the past three years his hip pain has gotten worse and when he does not do the exercises the hip pain improves. I feel that the muscular tightness may be contributing to the mechanical changes in the joints which may result in arthritis in the hips and SI joint. RECOMMENDATIONS: 1) A physical therapy program was recommended for the patient to work on adductor stretching and strengthening of the hip abductors. Also recommended was a stretching program for the hip flexors and a strengthening procedure for the hip extensors. I feel that with normalization and balancing of the hip musculature that hip joint mechanics will eventually improve and his hip or SI joint pain will also improve. 2) The patient is currently being followed by the Anesthesia Pain Service for steroid injections. The patient is currently rethinking whether the injections are really helping him. The sites of injection should be directed more towards the joints such as the SI joint and hip joint. These injections should be considered for symptomatic relief. 3) I have asked the patient to follow up with me after his physical therapy program. At that time, and evaluation of the patient's symptoms will be made and, if indicated or if no improvements, consideration for electrodiagnostic testing may be made. Total time spent with patient including history, physical exam and coordination of care was 60 minutes. Of that time, over 75% was spent in face-to-face consultation.
THIS WAS ELECTRONICALLY SIGNED - 09/02/2004 10:29 AM PST BY: KENTEN WANG, DO ASSISTANT PROFESSOR DEPARTMENT OF PHYSICIAL MEDICINE & REHABILITATION
KW:jm(usa160) D: T: 08/31/2004 12:49 PM 09/01/2004 10:12 PM
002232
....- -
!'
UNIVERSITY OF CALIFORNIA MEDICAL CENTER SACRAMENTO, CALIFORNIA CLINIC NOTE (page 1 of 4)

PATIENT: AMUNDSEN, MARK 8081369 DATE OF SERVICE: 08/31/2004 ORTHOPAEDICS CLINIC NOTE per referral of Dr. LOCATION: SPINE SEX MAGE: 44 DOB: 09/23/1959
MR~:
The patient seen and examined LINKING LANGUAGE: Folsom, California. Victor Baquero in CHIEP COMPLAINT: Low back pain.
HISTORY OF PRESENT ILLNESS: This is a 44-year-old Caucasian male with complaints of low'back pain on the left side extending down to his left leg. It started about three years ago ~n 2001 with no apparent cause. He states the initial low back pain sLarLed approximaLely ten years ago while exercising, has perhaps worsened for the past three years. The pain is located in the low back, left hip and leg. The pain is described as burning, sharp and electric-like and occurs all the time. Activities that decrease pain include lying down and resting. Activities that increase the pain include sitting and standing. Activities that does not change the pain include exercising, bending, lifting, coughing, sneezing, or bowel movements. Functional limitations include going to work, socializing with friends, participating in recreation, and exercising. Previous treatments have included physical therapy (which provided no relief), ice (which provides moderate relief), traction (which provides no relief), TENS unit (which provides no relief). She has been injected with steroids four separate times here at DC Davis Medical Center which prov~ded moderate to no relief. His first injection, he states, was to the disc which provided about 50% relief of his pain. He said that the injection was a facet injection which provided no relief. He also had an 81 injection which provided one day of relief. DIAGNOSTIC ALLERG IES: STUDIES: Ibuprofen, Previous morphine diagnostic sulfate. studies have included an MRI.
CURRENT MEDICATIONS: Prozac 40 mg daily (provides no relief), methocarbamol 750 mg twice a day (provides a little bit of relief) Norco 10 mg 4~ pills a day (provides moderate amount of relief), naproxen 220 mg four times a day (provides a little bit of relief) AndroGel 50 mg daily (provides no relief) . PAST MEDICAL PAST SURGICAL HISTORY, HISTORY: Minor health problems. hernia repair.
Tonsillectomy,
FAMILY HISTORY: Mother dies of lung cancer at age 75. He has two siblings all in good health in their 408. Family history is sign~ficant for lung cancer.
MR ~:8081369
002233
UNIVERSITY OF CALIFORNIA MEDICAL CENTER SACRAMENTO, CALIFORNIA CLINlCNOTE

(Page 2 of 4)
PATIENT, AMUNDSEN, MARK 8081369 08/31/2004 LOCATION,
SEX, MAGE,
SPINE
44
MR #,
DATE OF SERVICE,
DOS,
09/23/1959
SOCIAL HISTORY: He is not currently working. He last worked in April 2003 in computer network administration. He is currently applying for Social Security benefits with the State of California. He drinks alcoholic drinks - two per week - 'for the last 23 years. He has quit smoking, about 12 years ago. He used to smoke a pack-and-a-half a day for 17 years. He denies using street drugs. He has a high school diploma. He was in the NavY,and honorably discharged. He lives alone in a house in Folsom. He has no children. He is widower. His wife died last year of breast cancer. REVIEW OF SYSTEMS: The history intake form was reviewed with the patient. He answered "yes" to feeling easily fatigued for the past two years, difficulty exercising due to weakness for two years, shortness of breath with trouble breathing with exercise for two years, intermittent loose stools for the past 44 years where he usually had two stools a day. He has weakness in his limb for the past two years. He has morning stiffness, joint pain and pain worse at night for the past three years. He has no equipment needs. He is ~ndependent with all activities of daily living. Pain diagram shows aching pain staring from the left iliac crest that radiates down the posterior thigh into his calf. He also has some left-sided anterior thigh or hip aching pain.
PHYSICAL EXAMINATION, Weight 222x lb, blood pressure 133/80,
temperature 36.8, pulse 69, respirations 16. Pain is rated at 3/10 in the left lower back. General: This is a well-developed, wellnourished male in no acute distress, alert and oriented and cooperative on the examination. His affect appeared bright and easy to laugh. His breathing was non-labored and non-dyspneic. His gait was non-antalgic. His coordination was normal. His reflexes were 2+ in bilateral knee, ankle and medial hamstrings. He had no ankle clonus bilaterally. Manual muscle testing did not reveal any focal weakness. He had 5/5 strength in hlP flexors, hip abductors, hip adductors, knee extensors, ankle dorsiflexors, ankle everters, big toe extensors. Of note, on hip adduction patient had significant groin pain bilaterally. Single-leg bridging did not reveal any hamstring cramping or instability. His sensory test did not reveal any focal deficits in the lower limbs. Cardiovascular exam did not show any edema in the lower limbs. Skin examination did not show any rashes bilaterally. Musculoskeletal exam did not show any focal atrophy in the lower limbs. Structural exam did not show any significant iliac crest height difference or leg length discrepancy. Range of mOLion of the lumbar spine showed no significant pain with flexion. He was able
002234
UNIVERSITY OF CALIFORNIA MEDICAL CENTER SACRAMENTO, CALIFORNIA CLINIC NOTE

(Page3 of 4)
PATIENT, AMUNDSEN, MARK #, 8081369 DATE OF SERVICE, 08/31/2004 LOCATION, SPINE SEX, MAGE' 44 DOB, 09/23/1959
MR
to get his fingertips close to his foot. Extension and side-bending cause slight pain in both the right and the left hip region. Range of motion of his hips shows pain with hip internal rotation bilaterally and with faber maneuvers bilaterally. He has a lot of groin pain, especially on faber maneuver. Flexibility testing showed significant tightness of his hip adductors. HlS hamstrings were mildly tight with popliteal angle around 30 degrees. No tension test with straight leg raising and slump testing did not reproduce his symptoms. AP pelvic glide did not cause a significant amount of pain; however, there was discomfort with that maneuver. palpatory exam did not reveal any lymphadenopathy. There was no significant tenderness along the spinous process. There is mild tenderness along the paraspinal muscles. There was slight tenderness along the left sacral notch compared to the right. Palpation at the insertion site on the pubic rami showed significant tenderness. IMAGING, MRI of the lumbar spine dated 12/20/02 showed degenerative changes of the facets and the disc of LS-Sl with a mild aneuric tear with shifting to the left of midline. A second set of MRI at the lumbar spine dated 3/S/04 showed unremarkable MRI of the lumbosacral spine for his age. I reviewed both to the MRI studies on Stentor and agree with the above findings. IMPRESSION: This is a 44-year-old male with low back pain that radiates down the left side, especially towards the hip. Imaging does not explain the source of his pain. He may have facet-mediated pain at the low back. He may also have left S1 joint and hip joint pain. On physical examination, there was significant muscular tightness, especially along the hip adductors. He states he has been trying to strengthening his hip adductors without stretching them and over the past three years his hip pain has gotten worse and when he does not do the exercises the hip pain improves. I feel that the muscular tightness may be contributing to the mechanical changes in the joints which may result in arthritis in the hips and S1 joint. RECOMMENDATIONS: 1) A physical therapy program was recommended for the patient to work on adductor stretching and strengthening of the hip abductors. Also recommended was a stretching program for the hip flexors and a strengthening procedure for the hip extensors. I feel that with normalization and balancing of the hip musculature that hip joint mechanics will eventually improve and his hip or SI joint pain will also improve. 2) The patient is currently being followed by the Anesthesia Pain Service for steroid injections. The patient is currently rethinking whether the injections are really helping him . The sites of injection should be dlrected more towards the joints such
002235
'.
UNIVERSITY OF CALIFORNIA MEDICAL CENTER SACRAMENTO, CALIFORNIA CLINIC NOTE (Page 4 of 4)

PATIENT, AMUNDSEN, MARK MR #, 8081369 DATE OF SERVICE, 08(31(2004
as the 81 joint and hip joint. These injections
LOCATION, SPINE SEX, MAGE, 44 DOB, 09(23( 1959

should be considered
for symptomatic relief. 3) I have aske~ the patient to follow up with me after his physical therapy program. At that time, and evaluation of the patient's symptoms will for be made and,
1 indicated
testing physical
or
if
no be made.
improvements, Total in time
consIderation spent with patient
electrodiagnostic history,
may exam
including
and
coordination
face-to-face
of care was 60 minutes.

consultation.
Of that time, over
75% was spent
THIS WAS ELECTRONICALLY KENTEN WANG, DO ASSISTANT PROFESSOR DEPARTMENT OF PHYSICIAL
SIGNED
- 09/02/2004
10,29 AM PST BY,
MEDICINE
& REHABILITATION
KW,jm(usa160) D, T,
C# ,
08(31(2004 09(01(2004 629285 VICTOR
12,49 10,12
PM PM
cc,
HENRIQUE
BAQUERO,
MD,
PCN FOLSOM
002236
LAST FILLED 2/25/05 Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> TARA L SHAVER Fri Feb 25, 2005 11:33 AM Encounter initiated. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> SHERI L GROVES Thu Feb 3, 2005 11:55 AM LAST FILLED 12/15/04 LAST FILLED 1/10/05 Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Visit Notes GROVES, SHERI L 2/1/2005 8:03 am Vital signs taken, allergies verified, screened for pain, med hx taken (if appropriate), cc was taken. Sheri L Groves, MA
Progress Notes Mark Amundsen is a 45yr year old male who is here for the following reason: 1. Back is getting better. Doing PT daily - now on his own and is able to do more exercice. He is excited about the improvement. Seeks extension of dissability. Plans to return to work in the near future. 2. Intermittent palpitations. Felt it last night. Pauses in beats and a hard beat afterwards. Only notices at nighttime. No other symptoms or limitations. Never problematic. 3. Recurrent nose bleeds. Has had nose cauterized. These are almost daily. Been using vaseline. OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Nose: nasal septal scabs. Neck: Neck supple. No adenopathy, thyroid symmetric, normal size. Heart: normal rate and regular rhythm, no murmurs, clicks, or gallops. Lumbar spine: exam unchanged. ASSESSMENT: 724.5 BACKACHE NOS Note: Chronic lumbago. improving. The current medical regimen is effective; continue present plan and medications. Extended dissability until End of February. Form filled out. 785.1 PALPITATIONS Note: None observed. Discussed care and warning signs. Plan: Will set up with Holter monitor 784.7 EPISTAXIS
002237
Note: referral to ENT. Prominent vomeral vascularity. Plan: Discussed care and warning signs. Spent greater than 25 minutes face to face with patient, over half the time was spent counseling. PLAN: See Orders. Follow up in office if not better.
Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions.
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> HELEN BEVAN Tue Jan 11, 2005 10:54 AM Encounter initiated. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> SHERI L GROVES Mon Jan 10, 2005 4:29 PM Encounter initiated. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> SHERI L GROVES Mon Dec 20, 2004 2:59 PM Encounter initiated. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> SHERI L GROVES Tue Nov 23, 2004 11:49 AM Encounter initiated. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> TRINIDAD RAYA-ROWE Mon Nov 1, 2004 10:52 AM Encounter initiated. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> PAULA DORN Thu Oct 7, 2004 9:39 AM last refill 9/14/04 Chart Review Routing History
002238
Telephone Encounter >> AMANDA S RANEY Tue Jul 12, 2005 9:12 AM Encounter initiated. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> SHERI L GROVES Mon Jun 20, 2005 4:48 PM Encounter initiated. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> SHERI L GROVES Tue May 31, 2005 8:27 AM Encounter initiated. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> SHERI L GROVES Wed May 4, 2005 4:53 PM Encounter initiated. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> SHERI L GROVES Tue Apr 12, 2005 9:48 AM Encounter initiated. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes March 24, 2005 RE: AMUNDSEN, MARK MR#: 8081369 DOB: 09/23/1959 Date of Service: 03/24/2005 VICTOR HENRIQUE BAQUERO, MD Dear Dr. Baquero: Chief complaint: 1) Nasal obstruction. 2) Epistaxis. History: This is a 45-year-old male with a history of epistaxis since he was approximately ten years old. The patient reports that this epistaxis occurs intermittently. He reports that he has been cauterized every five years and has significant improvement in the epistaxis after the cauterization. He has been having epistaxis recently, though, and his last nose bleed was yesterday. This seems to resolve with some pressure. He also reports that when he blows his nose he can start bleeding. He does report that he does digitally manipulate
002239
his intranasal cavity. He has tried nasal saline and petroleum jelly on his nose in the past, however, does not use this continuously. He denies any hypertension or any other bleeding problems. He denies any nasal masses or any surgeries on his nose in the past. He does report nasal obstruction. He reports that his right side is worse than his left side. He also complains that his right ala collapses when he takes in a deep breath. This is annoying to him; however, it has not significantly affected his life. In addition, the patient reports pain behind his right eye. This seems to improve with anti-sinus medications; however, it does return. He denies any green discharge or any other evidence of sinusitis. Past medical history, past surgical history, medications, allergies, and social history are all per the intake sheets that were all reviewed. On his physical exam, the patient was normocephalic, atraumatic. His pupils were equally round and reactive to light. His nose and sinuses revealed no significant external deformity. His nose is narrow and tall. His caudal septum is deviated to the right with a slight bend of the posterior septum to the left. There are no mucosal lesions or masses. On examination of his septum on the left in Kiesselbach's plexus there is noted to be some increased vascularity and some redness in the area. There is no active bleeding and no masses or ulcerations noted. There is no sinus tenderness and no mucopurulent discharge. There are no further lesions posteriorly in his nasal cavity. Neck exam reveals no neck adenopathy or masses with no thyroid enlargement or masses. Oral cavity reveals lip, gingiva, and oral mucosa normal. No acute dental infections, and the hard palate is normal. His ear reveals external auditory canals are clear bilaterally. Tympanic membrane intact. No effusion or infection, and clinical normal speech perception. Salivary glands revealed normal parotid and submandibular glands. Neurologic exam revealed cranial nerves II through XII grossly intact. Respiratory exam revealed breathing comfortably. Cardiac exam was no cyanosis or edema. Assessment: 1) Epistaxis. 2) Nasal obstruction. 3) Right ethmoid pain. Plan: 1) The patient underwent a cauterization with silver nitrate sticks in the ENT Clinic of the left Kiesselbach's plexus. 2) Patient was instructed to use nasal saline approximately six times a day as well as petroleum jelly on a Q-tip to the left nasal septum every day. I have ordered a CT scan to assess his sinuses for any disease. 3) I discussed the options of treatment for the nasal obstruction with the patient. We will discuss this more in the future after the CT scan of the sinuses. Should he request a septoplasty, possibly an alar procedure may be indicated. Sincerely,
YOAV HAHN, MD RESIDENT DEPARTMENT OF OTOLARYNGOLOGY THIS WAS ELECTRONICALLY SIGNED - 03/26/2005 2:30 PM PST BY:
THIS WAS ELECTRONICALLY SIGNED - 03/31/2005 5:52 PM PST BY: CLINICAL PROFESSOR DEPARTMENT OF OTOLARYNGOLOGY YH:waw(usa127) D: 03/24/2005 02:34 PM T: 03/24/2005 02:43 PM C#: 934933
MANSFIELD F SMITH, MD
002240
Links Previous Version Transcription Type Otolaryngology Referral Letter (2811)

Electronically Signed ID 2516294 Date and Time 3/24/2005 2:34 PM Author Yoav Hahn
VICTOR HENRIQUE BAQUERO, MD Dear Dr. Baquero: Chief complaint: 1) Nasal obstruction. 2) Epistaxis.
History: This is a 45-year-old male with a history of epistaxis since he was approximately ten years old. The patient reports that this epistaxis occurs intermittently. He reports that he has been cauterized every five years and has significant improvement in the epistaxis after the cauterization. He has been having epistaxis recently, though, and his last nose bleed was yesterday. This seems to resolve with some pressure. He also reports that when he blows his nose he can start bleeding. He does report that he does digitally manipulate his intranasal cavity. He has tried nasal saline and petroleum jelly on his nose in the past, however, does not use this continuously. He denies any hypertension or any other bleeding problems. He denies any nasal masses or any surgeries on his nose in the past. He does report nasal obstruction. He reports that his right side is worse than his left side. He also complains that his right ala collapses when he takes in a deep breath. This is annoying to him; however, it has not significantly affected his life. In addition, the patient reports pain behind his right eye. This seems to improve with anti-sinus medications; however, it does return. He denies any green discharge or any other evidence of sinusitis. Past medical history, past surgical history, medications, allergies, and social history are all per the intake sheets that were all reviewed. On his physical exam, the patient was normocephalic, atraumatic. pupils were equally round and reactive to light. His
His nose and sinuses revealed no significant external deformity. His nose is narrow and tall. His caudal septum is deviated to the right with a slight bend of the posterior septum to the left. There are no mucosal lesions or masses. On examination of his septum on the left in Kiesselbach's plexus there is noted to be some increased vascularity and some redness in the area. There is no active bleeding and no masses or ulcerations noted. There is no sinus tenderness and no mucopurulent discharge. There are no further lesions posteriorly
002241
in his nasal cavity. Neck exam reveals no neck adenopathy or masses with no thyroid enlargement or masses. Oral cavity reveals lip, gingiva, and oral mucosa normal. No acute dental infections, and the hard palate is normal. His ear reveals external auditory canals are clear bilaterally. Tympanic membrane intact. No effusion or infection, and clinical normal speech perception. Salivary glands revealed normal parotid and submandibular glands. Neurologic exam revealed cranial nerves II through XII grossly intact. Respiratory exam revealed breathing comfortably. Cardiac exam was no cyanosis or edema. Assessment: pain. 1) Epistaxis. 2) Nasal obstruction. 3) Right ethmoid
Plan: 1) The patient underwent a cauterization with silver nitrate sticks in the ENT Clinic of the left Kiesselbach's plexus. 2) Patient was instructed to use nasal saline approximately six times a day as well as petroleum jelly on a Q-tip to the left nasal septum every day. I have ordered a CT scan to assess his sinuses for any disease. 3) I discussed the options of treatment for the nasal obstruction with the patient. We will discuss this more in the future after the CT scan of the sinuses. Should he request a septoplasty, possibly an alar procedure may be indicated. Sincerely,
YOAV HAHN, MD RESIDENT DEPARTMENT OF OTOLARYNGOLOGY THIS WAS ELECTRONICALLY SIGNED - 03/26/2005 2:30 PM PST BY:
THIS WAS ELECTRONICALLY SIGNED - 03/31/2005 5:52 PM PST BY: MANSFIELD F SMITH, MD CLINICAL PROFESSOR DEPARTMENT OF OTOLARYNGOLOGY YH:waw(usa127) D: 03/24/2005 02:34 PM T: 03/24/2005 02:43 PM C#: 934933
Display only: Transcription (2516294) on 3/24/2005 2:34 PM by Yoav Hahn Document history: Transcription (2516294) on 3/24/2005 2:34 PM by Yoav Hahn Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> SHERI L GROVES Mon Mar 21, 2005 4:36 PM
002242
HEALTH SYSTEM
DEPARTMENT
March 24, 2005
UCDAVIS
OF OTOLARYNGOLOGY
AMUNDSEN, MARK RE: MR#: 8081369 DOB: 09/23/1959 Date of Service: 03/24/2005
VICTOR
HENRIQUE
BAQUERO,
MD
Dear Dr. Baquero: Chief complaint: 1) Nasal obstruction. 2) Epistaxis.
H~story: This is a 45-year-old male with a history of epistaxis since he was approximately ten years old. The patient reports that this epistaxis occurs intermittently. He reports that he has been cauterized every five years and has significant improvement in the epistaxis after the cauterization. He has been having epistaxis recently, though, and his last nose bleed was yesterday. This seems to resolve with some pressure. He also reports that when he blows his nose he can start bleeding. He does report that he does digitally manipulate his intranasal cavity. He has tried nasal saline and petroleum jelly on his nose in the past, however, does not use this continuously. He denies any hypertension or any other bleeding problems. He denies any nasal masses or any surgeries on his nose in the past. He does report nasal obstruction. He reports that his right side is wor-se than his left side. He also complains that his right ala collapses when he takes in a deep breath. This is annoying to him; however, it has not significantly affected his life. In addition, the patient reports pain behind his right eye. This seems to improve with anti-sinus medications; however, it does return. He denies any green discharge or any other evidence of sinusitis. Past medical history, past surgical hlstory, medlcations, allergies, and social history are all per the intake sheets that were all
r-ev Lewed .
On his physical exam, the patient was normocephalic, pupils were equally round and reactive to light.
atraumatic.
His
His nose and sinuses revealed no significant external deformity. His nose is narrow and tall. His caudal septum is deviated to the right with a slight bend of the posterior septum to the left. There are no mucosal lesions or masses. On examination of his septum on the left in Kiesselbach's plexus there is noted to be some increased vascularity and some redness in the area. There is no active bleeding and no masses or ulcerations noted. There is no sinus tenderness and no mucopurulent discharge. There are no further lesions posteriorly DEPARTMENT OF OTOLARYNGOLOGY 252/ Stockton Boulevard, SUite 5200. Sacramento, California (916) 734-5400 Fox (9] 6) 451-8124
95817-1418
........._--------------------------
MEDICAL
RECORDS
COpy
002243
RE:
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MR#:
AMUNDSEN, 8081369
MARK
Page
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in his nasal cavity. Neck exam reveals no neck adenopathy or masses with no thyroid enlargement or masses. Oral cavity reveals lip, gingiva, and oral mucosa normal. No acute dental infections, and the hard palate is normal. His ear reveals external auditory canals are clear bilaterally. Tympanic membrane intact. No effusion or infection, and clinical normal speech perception. Salivary glands revealed normal parotid and submandlbular glands. Neurologic exam revealed cranial nerves II through XII grossly intact. Respiratory exam revealed breathing comfortably. Cardiac exam was no cyanosis or edema. Assessment: paln. 1) Epistaxis. 2) Nasal obstruction. 3) Right ethmoid
Plan: 1) The patient underwent a cauterizat~on with silver nitrate sticks in the ENT Clinic of the left Kiesselbach's plexus. 2) Patient was instructed to use nasal saline approximately six times a day as well as petroleum jelly on a Q-tip to the left na~al septum every day. I have ordered a CT scan to assess his sinuses for any disease. 3) I discussed the options of treatment for the nasal obstruction with the patient. We will discuss this more in the future after the CT scan of the sinuses. Should he reque'~t a s'ept?p'lasty, possibly an alar procedure may be indicated. Sincerely,
YOAV HAHN, MD RESIDENT DEPARTMENT OF OTOLARYNGOLOGY THIS WAS ELECTRONICALLY SIGNED
- 03/26/2005
2:30
PM PST BY:
THIS WAS ELECTRONICALLY SIGNED MANSFIELD F SMITH, MD CLINICAL PROFESSOR DEPARTMENT OF OTOLARYNGOLOGY
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March 24, 2005 VICTOR HENRIQUE BAQUERO, Dear Dr. Baquero: Chief complaint:
HEALTH SYSTElv!
RE:
UCDAVIS
APR
III
2003
DEPARTMENT
OF OTOLARYNGOLOGY
AMUNDSEN, MARK MR#: 8081369 DOB: 09/23/1959 Date of Service: 03/24/2005
MD
1) Nasal
obstruction.
2) Epistaxis.
History: This is a 45-year-old male with a history of epistaxis since he was approximately ten years old. The patient reports that this epistaxis occurs intermittently. He reports that he has been cauterized every five years and has significant improvement in the epistaxis after the cauterization. He has been having epistaxis recently, though and his last nose bleed was yesterday. This seems to resolve with some pressure. He also reports that when he blows his nose he can start bleeding. He does report that he does digitally manipulate his intranasal cavity. He has tried nasal saline and petroleum jelly on his nose in the past, however, does not use this continuously. He denies any hypertension or any other bleeding problems. He denies any nasal masses or any surgeries on his nose in the past.
I
He does report nasal obstruction. He reports that his right side is worse than his left side. He also complains that his right ala collapses when he takes in a deep breath. This is annoying to him; however, it has not significantly affected his life. In addition, the patient reports pain behind his right eye. This seems to improve with anti~sinus medications; however, it does return. He denies any green discharge or any other evidence of sinusitis. Past medical history, past surgical history, medications, allergies, and social history are all per the intake sheets that were all reviewed. On his physical exam, the patient was normocephalic, pupils were equally round and reactive to light. atraumatic. His
His nose and sinuses revealed no significant external deformity. His nose is narrow and tall. His caudal septum is deviated to the right with a slight bend of the posterior septum to the left. There are no mucosal lesions or masses. On examination of his septum on the left in Ki e sse Lba ch I s plexus there is noted to be some increased vascularity and some redness in the area. There is no active bleeding and no masses or ulcerations noted. There is no sinus tenderness and no mucopurulent discharge. There are no further lesions posteriorly DEPARTMENT OF OTOLARYNGOLOGY 2521 Stockton Boulevard, Suite 5200. Sacramento, California (916)734-5400. Fax (916) 451-8124
95817-1418
---------_.---------------------
002247
.-"
Page 2
RE: lIMUNDSEN, MARK MR#: 8081369
in his nasal cavity. Neck exam reveals no neck adenopathy or masses with no thyroid enlargement or masses. Oral cavity reveals lip, gingiva, and oral mucosa normal, No acute dental infections, and the hard palate is normal. His ear reveals external auditory canals are clear bilaterally. Tympanic membrane intact. No effusion or infection, and clinical normal speech perception. Salivary glands revealed normal parotid and submandibular glands. Neurologic exam revealed cranial nerves II through XII grossly intact. Respiratory exam revealed breathing comfortably. Cardiac exam was no cyanosis or edema. Assessment: pain. 1) Epistaxis. 2) Nasal obstruction. 3) Right ethmoid
Plan: 1) The patient underwent a cauterization with silver nitrate sticks in the ENT Clinic of the left Kiesselbach's plexus. 2) Patient was instructed to use nasal saline approximately six times a day as well as petroleum jelly on a Q-tip to the left nasal septum every day. I have ordered a CT scan to assess his sinuses for any disease. 3) I discussed the options of treatment for the nasal obstruction with the patient. We will discuss this more in the future after the CT scan of the sinuses. Should he request a'septoplasty, possibly an alar procedure may be indicated. Sincerely,
YOAV HAHN, MD RESIDENT DEPART/1ENT OF OTOLARYNGOLOGY THIS ~~S ELECTRONICALLY SIGNED
- 03/26/2005
2:30 PM PST BY:
THIS WAS ELECTRONICALLY SIGNED MANSFIELD F SMITH, MD CLINICI,L PROFESSOR DEPARnlENT OF OTOLARYNGOLOGY
YH:waw(usa127)
- 03/31/2005 5:52 PM PST BY:
D: T, C#:
03/24/2005 02:34 PM 03/24/2005 02:43 PM 934933
002248
Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> SHERI L GROVES Mon Oct 31, 2005 11:25 AM Encounter initiated. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> MANUELA NUNEZ Mon Oct 24, 2005 10:04 AM Encounter initiated. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> SHERI L GROVES Mon Oct 3, 2005 4:20 PM Encounter initiated. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> SHERI L GROVES Thu Sep 8, 2005 10:55 AM Encounter initiated. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> SHERI L GROVES Mon Aug 22, 2005 4:59 PM Encounter initiated. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> SHERI L GROVES Wed Aug 3, 2005 9:36 AM Encounter initiated. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> SHERI L GROVES Tue Jul 12, 2005 9:50 AM Encounter initiated. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed.
002249
I reviewed past medical, social and medication history during the visit. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> BEVERLY A BLAGG Tue Jan 3, 2006 3:15 PM He is calling for a refill of norco. He did call his pharmacy for a refill already. He states that the dose is 10325mg and the instructions are: 1 q 4-6 hours. He requests Send to preferred pharmac y. He is calling for a refill of flexeril. He did call his pharmacy for a refill already. He states th at the dose is 10mg and the instructions are: 1 bid. He requests Send to preferred pharmacy. pharmac y has faxed several times.
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> KIRA RYCROFT Mon Jan 2, 2006 2:26 PM Encounter initiated. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> FALISHA L CLAY Mon Dec 12, 2005 1:43 PM Dr. Baquero it's has been done. I received another request. So this a error. >> FALISHA L CLAY Mon Dec 12, 2005 1:41 PM Encounter initiated. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> FALISHA L CLAY Mon Dec 12, 2005 10:04 AM Encounter initiated. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> SHERI L GROVES Thu Dec 8, 2005 10:01 AM Encounter initiated. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> SHERI L GROVES Thu Nov 17, 2005 10:30 AM Encounter initiated. Chart Review Routing History
002250
Referral was done on 1/20/06. Please have patient call Brian at 985-9372 to schedule appt. >> SHERI L GROVES Tue Feb 7, 2006 9:17 AM tracy has referral been done. >> VICTOR H BAQUERO Mon Feb 6, 2006 5:14 PM Please contact. Ortho referral was done on 1/19. Please give him the phone number to call. 2. May discontinue methadone. I will call in 8 norco per day. He will need a follow up to discuss alternative medications to the methadone. >> SHERI L GROVES Mon Feb 6, 2006 2:33 PM methadone is bothering Patient he is going to fax in information for you. >> BRENDA J FALLON Mon Feb 6, 2006 2:28 PM patient needs to get his norco adjusted and the methadone. please call and advise. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Visit Notes TAYLOR, ERNESTINE 1/19/2006 8:42 am Vital signs taken, allergies verified, screened for pain, med hx taken (if appropriate), Ernestine Taylor, MA
Electronically signed by TAYLOR, ERNESTINE at 1/19/2006 8:42 am
Progress Notes Mark Amundsen is a 46yr year old male who is here for the following reason: Follow up on right hip pain. Status post physical therapy, stretches help but do not clear symptoms continuosly. Seen by ortho and spine clinic. Started riding bike daily and doing exercise. Stretches daily. Taking 70mg of norco daily. Interested in other treatment. OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Skin: Skin color, texture, turgor normal. No rashes or lesions. Neuro: Gait normal. Reflexes normal and symmetric. Sensation and strength grossly normal. Musculoskeletal: right hip, tender to palpation with internal and external rotation. ASSESSMENT: 726.5 ENTHESOPATHY OF HIP (primary encounter diagnosis) Note: Discussed care and warning signs. Chronic condition. continue exercise. Follow up with ortho for reevaluation. Plan: METHADONE 5 MG TAB, ORTHOPEDIC-GENERAL REFERRAL, BACLOFEN 10 MG TAB 724.2 LUMBAGO Note: Expect improvement with time. Stretches discussed. NSAIDs, ice or heat may help with symptoms. Avoid activities that exacerbate pain. Consider physical therapy. Follow-up if not better. Plan: NORCO 10 MG-325 MG TAB for breakthrough pain. PLAN: See Orders. Follow up in office if not better. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions.
002251
I reviewed past medical, family/social and medication history during the visit. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes PATIENT: AMUNDSEN, MARK LOCATION: ORTFOL MR #: 8081369 SEX: M AGE: 46 DATE OF SERVICE: 02/13/2006 DOB: 09/23/1959 FOLSOM CLINIC NOTE HISTORY: Mr. Amundsen is a 46-year-old, currently unemployed male, who has a long history of low back, left posterior pelvic and thigh pain intermittently. About three years ago, he had a series of epidural steroids, which significantly improved his symptoms. Nevertheless, he remains dependent on NSAIDs and fairly heavy dose of narcotics. Currently, his symptoms are of left-sided sacroiliac pain with some radiation down the posterior thigh, occasionally below the knee. He does not have any bladder or bowel symptoms or any known motor weakness. Secondary complaint is of groin or inguinal pain, which is exacerbated by rotation of the hip. This also has been present for some time. PRESENT MEDICATIONS: Prozac, Norco. ALLERGIC HISTORY: Patient states that he is allergic to Motrin and methadone, but it is likely that these are more reflective of intolerance than true allergy. PHYSICAL EXAMINATION: Large-statured, healthy-appearing male who is a good historian and seems to be in a talkative and jovial mood today. He has a mildly antalgic limp, but can walk on his toes and heels. He can forward flex and bend at the hips to touch the floor without difficulty. Straight leg raising is negative in the sitting position. Rotation and other motions of the right hip are within normal limits and pain free. Examination of the left hip reveals absent internal rotation, as well as mild limitation of external rotation, which is painful. Flexion also causes some pain. He does not have a flexion contracture. Deep tendon reflexes are symmetrical. Motor strength is 5/5 bilaterally. X-RAYS: Patient's x-rays show degenerative arthritis of the hips, left greater than right. RECOMMENDATIONS: The patient is on considerable medication at the time and I gathered his symptoms have not greatly increased in severity, but are rather a chronic complaint. It is likely that there will be progression of his hip arthritis, but the rate of progression is unknown. Currently, I think for a man in his age group and with his other diagnoses, it is best that he exhaust medical options before embarking on total joint replacement. I have asked that he return to see me in a few months to reassess his situation. If he is still symptomatic at that time, we may consider an MRI, as he has reported an occasional snapping sensation about the hip. Today, I could not detect that, but it is possible he may have iliotibial band friction syndrome or some other variant. It is more likely that he has the rather common degenerative joint disease. At any rate, we will consider an MRI if his symptoms suggest labral tear, impingement and so on. THIS WAS ELECTRONICALLY SIGNED - 02/14/2006 9:48 AM PST BY: PROFESSOR PCN FOLSOM NETWORK ORTHOPAEDICS H DAVID MOEHRING, MD
002252
HDM:lmw(usa217) D: 02/13/2006 12:43 PM T: 02/14/2006 09:27 AM C#: 1622170 cc: VICTOR HENRIQUE BAQUERO, MD Electronically signed byH. David Moehring on 2/14/2006 9:49 AM Links Previous Version Transcription Type Folsom Clinic Note (7721) Electronically Signed Document Text LOCATION: ORTFOL PATIENT: AMUNDSEN, MARK MR #: 8081369 SEX: M AGE: 46 DATE OF SERVICE: 02/13/2006 DOB: 09/23/1959 FOLSOM CLINIC NOTE HISTORY: Mr. Amundsen is a 46-year-old, currently unemployed male, who has a long history of low back, left posterior pelvic and thigh pain intermittently. About three years ago, he had a series of epidural steroids, which significantly improved his symptoms. Nevertheless, he remains dependent on NSAIDs and fairly heavy dose of narcotics. Currently, his symptoms are of left-sided sacroiliac pain with some radiation down the posterior thigh, occasionally below the knee. He does not have any bladder or bowel symptoms or any known motor weakness. Secondary complaint is of groin or inguinal pain, which is exacerbated by rotation of the hip. This also has been present for some time. PRESENT MEDICATIONS: Prozac, Norco. ID 4057369 Date and Time 2/13/2006 12:43 PM Author H. David Moehring
ALLERGIC HISTORY: Patient states that he is allergic to Motrin and methadone, but it is likely that these are more reflective of intolerance than true allergy. PHYSICAL EXAMINATION: Large-statured, healthy-appearing male who is a good historian and seems to be in a talkative and jovial mood today. He has a mildly antalgic limp, but can walk on his toes and heels. He can forward flex and bend at the hips to touch the floor without difficulty. Straight leg raising is negative in the sitting position. Rotation and other motions of the right hip are within normal limits and pain free. Examination of the left hip reveals absent internal rotation, as well as mild limitation of external rotation, which is painful. Flexion also causes some pain. He does not have a flexion contracture. Deep tendon reflexes are symmetrical. Motor strength is 5/5 bilaterally.
002253
X-RAYS: Patient's x-rays show degenerative arthritis of the hips, left greater than right. RECOMMENDATIONS: The patient is on considerable medication at the time and I gathered his symptoms have not greatly increased in severity, but are rather a chronic complaint. It is likely that there will be progression of his hip arthritis, but the rate of progression is unknown. Currently, I think for a man in his age group and with his other diagnoses, it is best that he exhaust medical options before embarking on total joint replacement. I have asked that he return to see me in a few months to reassess his situation. If he is still symptomatic at that time, we may consider an MRI, as he has reported an occasional snapping sensation about the hip. Today, I could not detect that, but it is possible he may have iliotibial band friction syndrome or some other variant. It is more likely that he has the rather common degenerative joint disease. At any rate, we will consider an MRI if his symptoms suggest labral tear, impingement and so on.
HDM:lmw(usa217) D: 02/13/2006 12:43 PM T: 02/14/2006 09:27 AM C#: 1622170 cc: VICTOR HENRIQUE BAQUERO, MD Display only: Transcription (4057369) on 2/13/2006 12:43 PM by H. David Moehring Document history: Transcription (4057369) on 2/13/2006 12:43 PM by H. David Moehring Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> SHERI L GROVES Tue Feb 7, 2006 1:50 PM Pt was informed 2/7/06 at 150pm. Sheri Groves, MA >> SHERI L GROVES Tue Feb 7, 2006 11:06 AM A message was left on 2/7/06 at 1105am, for pt to call back. >> TRACY D KASIK Tue Feb 7, 2006 10:00 AM
002254
, ..
PATIENT:
MR
HEALTH SYSTEM
FOLSOM
UCDAVIS
LOCATION: ORTFOL SEX: MAGE: 46 DOB: 09/23/1959
AMUNDSEN,
MARK 02/13/2006FOLSOM CLINIC NOTE
#:
8081369
DATE OF SERVICE:
HISTORY: Mr. Amundsen is a 46-year-old, currently unemployed male, who has a long history of low back, lett posterior pelvic and thigh pain intermittently. About three years ago, he had a series of epidural steroids, which significantly improved his symptoms. Nevertheless, he remains dependent on NSAIDs and fairly heavy dose of narcotics. Currently, his symptoms are of left-sided sacroiliac pain with some radiation down the posterior t.h i qh; occasionally below the knee. He does not have any bladder or bowel symptoms or any known motor weakness. Secondary complaint is of groin or inguinal pain, which is exacerbated by rotation of the hip. This also has been present for some time. PRESENT MEDICATIONS: Prozac, Norco. and
ALLERGIC HISTORY: patient states that he is allergic to Motrin methadone, but it is likely that these are more reflective of Lnt.o Le rance than true allergy.
PHYSICAL EXAMINATION: Large-statured, healthy-appearing male who is a good historian and seems to be in a talkative and jovial mood today. He has a mildly antalgic limp, but can walk on his toes and heels. He can forward flex and bend at the hips to touch the floor without difficulty. Straight leg raising is negative in the sitting position. Rotation and other motions of the right hip are within normal limits and pain free. Examination of the left hip reveals absent internal rotation, as well as mild limitation of external rotation, which is painful. Flexion also causes some pain. He does not have a flexion contracture. Deep tendon reflexes are symmetrical. Motor strength is 5/5 bilaterally. X-RAYS: Patient's x-rays left greater than right. show degenerative arthritis of the hips,
RECOMMENDATIONS: The patient is on considerable medication at the time and I gathered his symptoms have not greatly increased in severity, but are rather a chronic complaint. It is likely that there will be progression of his hip arthritis, but the rate of progression is unknown. Currently, I think for a man in his age group and with his other diagnoses: it is best that he exhaust medical options before embarking on total joint replacement. I have asked that he return to see me in a few months to reassess his situation. If he is still symptomatic at that time, we may consider an MRI, as he has reported an occasional snapping sensation about the hip. Today, I could not detect that, but it is possible he may have iliotibial band friction syndrome or some other variant. It is more likely that he has the rather common degenerative joint disease. At any rate, we will consider an MRI if his symptoms suggest labral tear, impingement and so on. 251 TURNPIKE DRIVE. PHONE (916) 985-9300. FOLSOM, CA 95630 FAX (916) 355-1219
002255

PATIENT:
MR
HEALTH SYSTEM
FOLSOM
UCDAVIS
LOCATION: ORTFOL SEX: MAGE: 46 DOB: 09/23/1959
AMUNDSEN, MARK 8081369 DATE OF SERVICE: 02/13/2006
#:
THIS
WAS ELECTRONICALLY
SIGNED
02/14/2006
9: 48 AM 'PST BY:
H DAVID MOEHRING, MD PROFESSOR PCN FOLSOM NETWORK ORTHOPAEDICS
HDM: Lmw (usa217) D: T: C#: cc: 02/13/2006 02/14/2006 1622170 12:43 PM 09:27 AM
VICTOR HENRI QUE BAQUERO, MD
-_..._...
FOLSOM, CA 95630 FAX (916) 355-1219

ropy
FOR VT("T'OR RAO[JF:RO
_-----------------------
002256
UCDAVIS
FOLSOM
PATIENT:
MR
HEALTH SYSTEM
DOB:
~CErlG:;)
FEB Z 42006
~ rr'3 .. 1I~..,. .... ~ .II..,,"-3:Cr~.J
I'~"-~~-
,.......
r......
#:
AMUNDSEN,
MARK
02/13/2006
8081369
LOCATION: ORTFOL , SEX: MAGE: 46

09/23YI959
DATE OF SERVICE:
FOLSOM
CLINIC
NOTE
HISTORY: Mr. Amundsen is a 46-year-old, currently unemployed ~ale, who has a long history of low back, left posterior pelvic and yhigh pain intermittently. About three years ago, he had a series of epidural steroids, which significantly improved his symptoms. , Nevertheless he remains dep.endent on NSAIDs and fairly heavy dose of narcotics. ~urrently, his ~ymptoms are of left-sided sacroili~c pain I with some radiation down the posterior thigh, occasionally below the I knee. He does not have any bladder or bowel symptoms or any known motor weakness. Secondary complaint is of groin or inguinal pkin, which is exacerbated by rotation of the hip. This also has be~n present for some time. PRESENT MEDICATIONS: Prozac, Norco. and
ALLERGIC HISTORY: Patient states that he is allergic to Motrin methadone, but it is likely that these are more reflective of intolerance than true allergy.
PHYSICAL EXAMINATION: Large-statured, healthy-appearing male Iwho is a good historian and seems to be in a talkative and jovial mood ,today. He has a mildly antalgic limp, but can walk on his toes and heels. He can forward flex and bend at the hips to touch the floor with~ut difficulty. Straight leg raising is negative in the sitting position. Rotation and other motions of the right hip are wi thin normal 11imits and pain free. Examination of the left hip reveals absent internal rotation, as well as mild limitation of external rotation, wh~ch is painful. Flexion also causes some pain. He does not have a flexion contracture. Deep tendon reflexes are symmetrical. Motor sttength is 5/5 bilaterally.
~~~Y:~ea~:~i~~~~Sr:;~~~s
show degenerative
arthritis
of the jiPS,
RECOMMENDATIONS: The patient is on considerable medication at the time and I gathered his symptoms have not greatly increased iri severity, but are rather a chronic complaint. It is likely that there will be progression of his hip arthritis, but the rate of progression is unknown. Currently, I think for a map in his age group and with his other diagnoses, it is best that he exhaust medical optioAs before embarking on total joint replacement.
I have asked that he return to see me in a few months to reassess his situation. If he is still symptomatic at that time, we may c6nsider an MRI, as he has reported an occasional snapping sensation about the hip. Today, I could not detect that, but it is possible he mciy have iliotibial band friction syndrome or some other variant. It is more likely that he has the rather common degenerative joint disea~e. At any rate, we will consider an MRI if his symptoms suggest lab~al tear, impingement and so on. 251 TURNPIKE DRlVE. PHONE (916) 985-9300. FOLSOM, CA 95630 FAX (916) 355-1219
MP.rl RP.r,ORrlS PTT,P. r,opy
002257
,. ,
PATIENT,
MR
HEALTH SYSTEM
FOLSOM
UCDAVIS
LOCATION, ORTI'OL SEX, M I AGE, 46 DOB, 09/23/1959

I
#,
DATE
AMUNDSEN, MARK 8081369 OF SERVICE, 02/13/2006
THIS
W,~S ELECTRONICALLY
SIGNED
02/14/2006
9,48
AM PST
BY,
H DAVID MOEHRING, MD PROFESSOR PCN FOLSOM NETWORK ORTHOPAEDICS
HDM, Lmw (usa217) D, T, C#, cc, 02/13/2006 02/14/2006 1622170 VICTOR 12,43 PM 09,27 AM
HENRI QUE BAQUERO,
MD
_.
FOLSOM, CA 95630 FAX (916) 355-1219

NF,f)
RF:r:m=lnS
('Clpy
002258
Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> SHERI L GROVES Mon Feb 27, 2006 4:20 PM Encounter initiated. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Visit Notes RHODEWALT, TERI L 2/24/2006 7:54 am Vital signs taken, allergies verified, screened for pain, med hx taken Teri L Rhodewalt, MA Electronically signed by RHODEWALT, TERI L at 2/24/2006 7:54 am Progress Notes Mark Amundsen is a 46yr year old male who is here for the following reason: Follow up on chonic hip pain. Wants to discuss medications. Pain present despite medications. Seen by ortho recently. Trying to stay active. Current outpatient prescriptions prior to 2/24/06: NORCO 10 MG-325 MG TAB, 1-2 po q 6 hours. Max 8 per day., Disp: 250, Rfl: 0 FLUOXETINE 40 MG CAP, take 1 capsule (40mg) by oral route once daily in the morning, Disp: 30, Rfl: 6 BACLOFEN 10 MG TAB, 1 PO TID PRN, Disp: 90, Rfl: 2 ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET, 2 PACKETS DAILY, Disp: 300.00, Rfl: 3 DISCONTD: CYCLOBENZAPRINE 10 MG TAB, take 1 tablet (10mg) by oral route 2 times per day, Disp: 60, Rfl: 3 DISCONTD: KETOCONAZOLE 2 % TOPICAL CREAM, apply by topical route once daily to the affected area (s), Disp: 90G, Rfl: 1 DISCONTD: FENTANYL 25 MCG/HR 72 HR TRANSDERM PATCH, apply q 3 days., Disp: 10, Rfl: 0 DISCONTD: AMBIEN 10 MG TAB, 1 TABLET AT BEDTIME AS NEEDED, Disp: 10, Rfl: 0 DISCONTD: ALEVE 220 MG TAB, 1 TABLET EVERY 12 HOURS AS NEEDED, Disp: 60, Rfl: 0
OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Skin: Skin color, texture, turgor normal. No rashes or lesions. Musculoskeletal: stable ASSESSMENT: 726.5 ENTHESOPATHY OF HIP (primary encounter diagnosis) Note: Left hip. Chronic. Discussed at length various treatment options. Has exhausted most of the opiate options, failed Ultram and has gastritis with NSAIDs. Consider Glucosamine. Will refer to pain mgmt. Plan: PAIN MANAGEMENT REFERRAL, MR LOWER EXTREMITY JOINT WITH / WITHOUT CONTRAST Discussed with the patient and all questioned fully answered. He will call me if any problems arise. PLAN: See Orders. Follow up in office if not better. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his medical care. No guarantees were made regarding his medical care or treatment outcome.
002259
724.5 BACKACHE NOS (primary encounter diagnosis) Note: Chronic lumbago with suspected left L4-5 radiculitis. Reviewed pain management note. Awating MRI results. Advanced osteo arthritis of left hip but also suspect nerve involvement. Continue physical therapy, will modify medications. Plan: TORADOL ORAL 10 MG TAB, METHADONE 5 MG TAB, SOMA 350 MG TAB Per patient methadone at 10 bid caused sedation and constipation. He admits that he thought it would work like the norco and he may have taken more when he was in pain. Risks and benefits discussed in detail. Take 1 every day and advance to bid. This will help for baseline pain. Continue norco for acute pain. Discontinue Baclofen. Soma trial instead. Discussed care and warning signs. Discussed with the patient and all questioned fully answered. He will call me if any problems arise. Will follow up with MRI in 2 weeks. 724.2 LUMBAGO Note: as above. Plan: NORCO 10 MG-325 MG TAB PLAN: See Orders. Follow up in office if not better. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his medical care. No guarantees were made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> SHERI L GROVES Fri Apr 14, 2006 4:15 PM Encounter initiated. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes March 28, 2006 RE: AMUNDSEN, MARK MR#: 8081369 DOB: 09/23/1959 Date of Service: 03/28/2006 VICTOR HENRIQUE BAQUERO, MD 251 TURN PIKE DRIVE FOLSOM, CA 95630 Dear Dr. Baquero: It was a pleasure to see your patient, Mark R Amundsen, today in follow-up at the University of California, Davis Center for Pain Medicine. As you know, the patient is a 46-year-old male being evaluated today for left low lumbar pain and hip pain. The patient has been treated in our clinic before and responded favorably to the first left S1 transforaminal epidural steroid injection. However, subsequent procedures were unsuccessful in providing relief. The patient has also recently undergone consultation in the Spine Clinic and Orthopaedics. The patient states that his lumbar and hip pain radiates mostly down the posterior aspect proximal to the knee and also somewhat to the anterior aspect of the proximal one-third of his thigh. The majority of his radicular symptoms have resolved since his epidural steroid injection, however. The patient's pain started in 1992, and in 2003 he first sought treatment. The pain is present constantly (100% of the time). The patient describes the pain as pins and needles, sharp, shooting and cutting. The pain intensity is currently rated as a VAS of 3.5 anchored at 0 by "no pain" and at 10 by "the most severe pain imaginable". The average pain for the last week has been a VAS of 3/10. At its best, it is 3/10; and at its worst, 4.5/10.
002260
RELIEVING AND AGGRAVATING FACTORS Relieving factors for the patient's pain are lying down, medications, relaxation. The pain is aggravated by sitting. The pain is unchanged by standing, walking, exercise, thinking about something else, coughing/sneezing, urination, bowel movements. FUNCTIONAL LIMITATIONS: The patient has avoided driving. The patient can walk 15 blocks, sit for 10 minutes and stand for 1 hour before the pain limits this activity. The patient states that he is often forced to lie down because of pain. CURRENT MEDICATIONS: 1. Norco 10/325. He is taking approximately 8 per day. 2. Baclofen 10 mg 3 times a day. 3. Testosterone gel one packet per day. 4. Fluoxetine 40 mg one per day. 5. Naprosyn two tablets twice a day. 6. Occasional Tylenol use. FAILED PAIN MEDICATIONS: 1. Morphine sulfate causes itching. 2. Ibuprofen, welts. 3. Methadone, inability to concentrate, falling asleep, pain. 4. Fentanyl patch, patient was allergic to the patch material and "didn't work." 5. Patient has also tried MS Contin and he had itching reaction. 6. Soma and Flexeril worked for less than 24 hours. Patient denies use of OxyContin or oxycodone. ALLERGIES: 1. Morphine sulfate. 2. Ibuprofen. 3. Fentanyl. 4. Methadone. As described above. PREVIOUS TREATMENTS: Patient had a transforaminal epidural steroid injection in 2003 which provided near 100% relief of his radicular symptoms. Heat treatments were tried and produced moderate pain relief. Traction actually increased the pain, physical therapy and exercise were tried and produced no pain relief. PREVIOUS DIAGNOSTIC STUDIES: The patient has a lumbar MRI report, date of service 03/05/2004, which is generally an unremarkable MRI for his age. Also seen is a pelvis plain view which the report notes bilateral osteoarthritis, exam date 02/13/2006. Also of the lumbar spine, plain films, 02/13/2006, the report notes mild degenerative changes, disc space is preserved, mild osteophyte formation, facet joints unremarkable, sacroiliac joints appear normal. We do have more plain films, 2-view, with the pelvis, exam date 12/01/2003, which show mild bilateral osteoarthritis of the hips. The patient has a pending 04/21/2006 left hip MRI. REVIEW OF SYSTEMS: The patient admits to back pain, joint pain, muscle weakness. Constitutional Sx: no fevers, no unplanned weight loss Eyes: no double vision or blurred vision ENT: no loss of hearing, no difficulty swallowing Heme/Lymph: no bleeding gums or low platelet count Endocrine: no known thyroid disease or heat/cold intolerance Skin: no rashes or other lesions Respiratory: no shortness of breath, no wheezing Cardiovascular: no chest pain or palpitations GI: no constipation, abdominal pain, nausea/vomiting, diarrhea GU: no urinary retention, dysuria, sexual dysfunction Musculoskeletal: no muscle pain Neuro: no loss of consciousness, blackouts, memory loss, seizures, trouble walking, dizziness or fatigue Behavioral: no difficulty falling or remaining asleep, loss of interest in activities/hobbies, difficulty concentrating, feelings of guilt or depressed mood
002261
PRIOR MEDICAL HISTORY: The patient denies a prior history of high blood pressure, angina, asthma, stroke, cancer, diabetes, heart attack, chronic cough, psychological or psychiatric problems, seizures or epilepsy, kidney disease, liver disease, arthritis, or bleeding problems. ALL SURGERIES AND APPROXIMATE DATES: Tonsillectomy in 1965, inguinal hernia repair in 1986. Denies any complications. PSYCHOSOCIAL HISTORY: Educational Level: The patient's highest educational level achieved was high school graduate. Legal Issues: The patient does not have current claims for litigation related to his pain problem. Psychological Treatments: The patient has taken a grief course in 2003. The patient denies a present or past history of suicide ideation or attempt. Substance Abuse History: The patient denies a history of substance abuse of alcohol, amphetamines, heroin, cocaine, or other illicit substances. The patient quit a 30-pack-year history 14 years ago. Employment: The patient is currently employed part time. The patient's employment has been affected by the present pain condition. The patient's current occupation is as a systems and network administrator. FAMILY LIVING CIRCUMSTANCES: The patient is currently living with his children. FAMILY HISTORY: The patient denies all pertinent family history. PHYSICAL EXAMINATION: BP 138/91 Pulse 80 Resp 16 Weight 225 pounds O2 Sat 99% Temperature 98.8 Constitutional: Obese, normally developed, no deformities, well groomed. Skin: No lesions, new scars, bruising, or rashes noted. Eyes: Sclerae normal, pupils equal, and reactive with normal accommodation, extraocular movements intact. ENT: External inspection of ears and nose reveals no apparent abnormalities. Lungs: Chest expansion normal, clear to auscultation without wheezes or rales. Heart: Regular rate and rhythm normal S1, S2, no murmur, rub, gallop. Abdominal: Nontender to palpation, nondistended, no rebound tenderness. Musculoskeletal: Gait/station normal free, heel-toe walking, normal tandem gait, not antalgic. Psych: Oriented. Normal attention span and concentration. Neuro: DTRs symmetrical biceps 1+, brachioradialis 1+, triceps 1+, patellar 2+, ankle 2+, Babinski's are downgoing. Motor: Bulk normal, tone normal, abnormal movements none, strength 5/5 throughout the lower extremities. Sensory: Intact to light touch grossly. No allodynia elicited all dermatomes. Back: Active range of motion was generally full for forward flexion, extension and lateral flexion. There was no spinal tenderness, no paraspinal tenderness. In supine position, patient was evaluated for femoral or inguinal herniation but no masses were felt on either side. The patient's adductor compartment corresponding to gracilis versus rectus femoris was tender to deep palpation and reproduced a majority of this patient's primary complaint. Interestingly, continued pressure at this area provided relief to the patient associated with numbness and paresthesias down his left leg. Multiple provocations aimed at isolating hip arthritis were well tolerated, while external rotation and stretching of the adductor compartment was uncomfortable for the patient. Piriformis maneuvers were nonprovocative, as were adduction of the hip. Hip flexion, and especially hip flexion in external rotation, was poorly tolerated with the left leg, although the right leg was unaffected. MEDICAL DECISION MAKING
002262
REVIEW OF OLD MEDICAL RECORDS: Imaging reports as detailed above. A Folsom clinic note dated 02/13/2006 from Dr. Moehring, notes that the patient does have low back and left posterior pelvic and thigh pain intermittently, and the patient remains dependent on NSAIDs and "fairly heavy doses of narcotics." Symptoms are left-sided sacroiliac pain with some radiation down the posterior thigh, occasionally below the knee, and is exacerbated by rotation of the hip. His medications were Prozac and Norco and Dr. Moehring notes that his allergies are more reflective of intolerance than true allergies. Examination of the left hip reveals absent internal rotation as well as mild limitation of external rotation, which is painful, and that he recommends that, as his symptoms have not greatly increased in severity, it is best that he exhaust medical options before embarking on total joint replacement, that it was possible the patient has an iliotibial band friction syndrome or some variant rather than a common degenerative joint disease, and that they are considering an MRI for his symptoms suggestive of labral tear impingement. A 02/13/2006 progress note states that the patient is on Norco 10/325, fluoxetine 40 mg caps daily, baclofen 10 mg t.i.d., AndroGel and fentanyl 25-mcg transdermal patch, Ambien and Aleve were all discontinued and that the assessment was enthesopathy of the hip. Also reviewed was our last procedure note from 04/29/2004 indicating that he had S1 transforaminal epidural steroid injection. Also reviewed were labs, including a testosterone level of 119.6, which is low, collection date 10/03/2003. ASSESSMENT AND DIFFERENTIAL DIAGNOSIS: 1. Left groin pain, unknown etiology. 2. Bilateral hip osteoarthritis. 3. Hypogonadism secondary to chronic opioid use. 4. Lumbar degenerative disc disease. 5. Lumbar radiculitis history. 6. Obesity. RISK OF COMORBIDITIES: At this juncture, we believe that the patient's constitutional status adds minimal additional risk and complexity to our overall proposed evaluation and treatment. The patient is not currently a candidate for procedural intervention, as more diagnostic studies need to be completed. RECOMMENDATIONS and/or TREATMENT PLAN: The patient is scheduled for an MR of the left hip joint on 04/21/2006. We gave the patient an MRI request to add the left pelvis, including the upper one-third of the proximal thigh, in order to more closely evaluate his adductor compartment, and to look for any tears or inflammatory process. The patient has been tried on multiple opioids in the past. He is currently taking 8 Norco a day, which suggest that a long-acting agent is probably necessary and more appropriate. It is unclear whether this patient's side effects are true allergies or just poor tolerability as starting doses are not known. Many times, a medication is better tolerated by starting with low doses and proceeding with a slow upward titration. For example, methadone causing problems with coordination, could be possibly be avoided with this low and slow approach. Methadone is a good medication, as it is long-acting, cheap, and thought to reduce neuropathic symptoms and hyperalgesia due to its NMDA antagonism. Thus, retrialing some of these medications might be appropriate. Oxycodone might not have been tried, thus OxyContin is another option that could be tried. We counseled the patient that physical therapy is likely going to be a mainstay in his treatment, as if our diagnostic suspicion is confirmed, there is no procedural intervention that would provide substantial relief to the patient. As we do not have a firm diagnosis however, a physical therapy referral was not generated. We will have the patient follow up in the clinic for further evaluation and treatment after the left hip and pelvis MRI studies are completed. The patient was instructed and educated on all aspects of the plan of care. The patient acknowledged the plan of care. Thank you for allowing us to participate in the care of your patient. Should you have any questions or concerns regarding the recommended care plan, please do not hesitate to contact us. Sincerely,
002263
THIS WAS ELECTRONICALLY SIGNED - 05/21/2006 10:32 PM PST BY: ATTENDING PHYSICIAN JMM:kma(trs196) D: 03/28/2006 05:16 PM T: 03/29/2006 07:15 AM C#: 1728098 cc: JASON M MILLER, MD Electronically signed byJason M Miller, MD on 5/21/2006 10:33 PM Electronically signed byLana Louie Wania-Galicia, MD on 5/21/2006 10:33 PM Links Previous Version Transcription Type Pain Letter (2914)
Electronically Signed ID 4289094 Date and Time 3/28/2006 5:16 PM
LANA WANIA-GALICIA, MD
Author Jason M Miller
VICTOR HENRIQUE BAQUERO, MD 251 TURN PIKE DRIVE FOLSOM, CA 95630 Dear Dr. Baquero: It was a pleasure to see your patient, Mark R Amundsen, today in follow-up at the University of California, Davis Center for Pain Medicine. As you know, the patient is a 46-year-old male being evaluated today for left low lumbar pain and hip pain. The patient has been treated in our clinic before and responded favorably to the first left S1 transforaminal epidural steroid injection. However, subsequent procedures were unsuccessful in providing relief. The patient has also recently undergone consultation in the Spine Clinic and Orthopaedics. The patient states that his lumbar and hip pain radiates mostly down the posterior aspect proximal to the knee and also somewhat to the anterior aspect of the proximal one-third of his thigh. The majority of his radicular symptoms have resolved since his epidural steroid injection, however. The patient's pain started in 1992, and in 2003 he first sought treatment. The pain is present
002264
constantly (100% of the time). The patient describes the pain as pins and needles, sharp, shooting and cutting. The pain intensity is currently rated as a VAS of 3.5 anchored at 0 by "no pain" and at 10 by "the most severe pain imaginable". The average pain for the last week has been a VAS of 3/10. At its best, it is 3/10; and at its worst, 4.5/10. RELIEVING AND AGGRAVATING FACTORS Relieving factors for the patient's pain are lying down, medications, relaxation. The pain is aggravated by sitting. The pain is unchanged by standing, walking, exercise, thinking about something else, coughing/sneezing, urination, bowel movements. FUNCTIONAL LIMITATIONS: The patient has avoided driving. The patient can walk 15 blocks, sit for 10 minutes and stand for 1 hour before the pain limits this activity. The patient states that he is often forced to lie down because of pain. CURRENT MEDICATIONS: 1. Norco 10/325. He is taking approximately 8 per day. 2. Baclofen 10 mg 3 times a day. 3. Testosterone gel one packet per day. 4. Fluoxetine 40 mg one per day. 5. Naprosyn two tablets twice a day. 6. Occasional Tylenol use. FAILED PAIN MEDICATIONS: 1. Morphine sulfate causes itching. 2. Ibuprofen, welts. 3. Methadone, inability to concentrate, falling asleep, pain. 4. Fentanyl patch, patient was allergic to the patch material and "didn't work." 5. Patient has also tried MS Contin and he had itching reaction. 6. Soma and Flexeril worked for less than 24 hours. Patient denies use of OxyContin or oxycodone. ALLERGIES: 1. Morphine sulfate. 2. Ibuprofen. 3. Fentanyl. 4. Methadone. As described above. PREVIOUS TREATMENTS: Patient had a transforaminal epidural steroid injection in 2003 which provided near 100% relief of his radicular symptoms. Heat treatments were tried and produced moderate pain relief. Traction actually increased the pain, physical therapy and exercise were tried and produced no pain relief. PREVIOUS DIAGNOSTIC STUDIES: The patient has a lumbar MRI report, date of service 03/05/2004, which is generally an unremarkable MRI for his age. Also seen is a pelvis plain view which the report notes bilateral osteoarthritis, exam date 02/13/2006. Also of the lumbar spine, plain films, 02/13/2006, the report notes mild degenerative changes, disc space is preserved, mild osteophyte formation, facet joints unremarkable, sacroiliac joints
002265
appear normal. We do have more plain films, 2-view, with the pelvis, exam date 12/01/2003, which show mild bilateral osteoarthritis of the hips. The patient has a pending 04/21/2006 left hip MRI. REVIEW OF SYSTEMS: The patient admits to back pain, joint pain, muscle weakness. Constitutional Sx: no fevers, no unplanned weight loss Eyes: no double vision or blurred vision ENT: no loss of hearing, no difficulty swallowing Heme/Lymph: no bleeding gums or low platelet count Endocrine: no known thyroid disease or heat/cold intolerance Skin: no rashes or other lesions Respiratory: no shortness of breath, no wheezing Cardiovascular: no chest pain or palpitations GI: no constipation, abdominal pain, nausea/vomiting, diarrhea GU: no urinary retention, dysuria, sexual dysfunction Musculoskeletal: no muscle pain Neuro: no loss of consciousness, blackouts, memory loss, seizures, trouble walking, dizziness or fatigue Behavioral: no difficulty falling or remaining asleep, loss of interest in activities/hobbies, difficulty concentrating, feelings of guilt or depressed mood PRIOR MEDICAL HISTORY: The patient denies a prior history of high blood pressure, angina, asthma, stroke, cancer, diabetes, heart attack, chronic cough, psychological or psychiatric problems, seizures or epilepsy, kidney disease, liver disease, arthritis, or bleeding problems. ALL SURGERIES AND APPROXIMATE DATES: Tonsillectomy in 1965, inguinal hernia repair in 1986. complications.
Denies any
PSYCHOSOCIAL HISTORY: Educational Level: The patient's highest educational level achieved was high school graduate. Legal Issues: The patient does not have current claims for litigation related to his pain problem. Psychological Treatments: The patient has taken a grief course in 2003. The patient denies a present or past history of suicide ideation or attempt. Substance Abuse History: The patient denies a history of substance abuse of alcohol, amphetamines, heroin, cocaine, or other illicit substances. The patient quit a 30-pack-year history 14 years ago. Employment: The patient is currently employed part time. The patient's employment has been affected by the present pain condition. The patient's current occupation is as a systems and network administrator. FAMILY LIVING CIRCUMSTANCES: The patient is currently living with his children.
002266
FAMILY HISTORY: The patient denies all pertinent family history. PHYSICAL EXAMINATION: BP 138/91 Pulse 80 Resp 16 Weight 225 pounds O2 Sat 99% Temperature 98.8 Constitutional: Obese, normally developed, no deformities, well groomed. Skin: No lesions, new scars, bruising, or rashes noted. Eyes: Sclerae normal, pupils equal, and reactive with normal accommodation, extraocular movements intact. ENT: External inspection of ears and nose reveals no apparent abnormalities. Lungs: Chest expansion normal, clear to auscultation without wheezes or rales. Heart: Regular rate and rhythm normal S1, S2, no murmur, rub, gallop. Abdominal: Nontender to palpation, nondistended, no rebound tenderness. Musculoskeletal: Gait/station normal free, heel-toe walking, normal tandem gait, not antalgic. Psych: Oriented. Normal attention span and concentration. Neuro: DTRs symmetrical biceps 1+, brachioradialis 1+, triceps 1+, patellar 2+, ankle 2+, Babinski's are downgoing. Motor: Bulk normal, tone normal, abnormal movements none, strength 5/5 throughout the lower extremities. Sensory: Intact to light touch grossly. No allodynia elicited all dermatomes. Back: Active range of motion was generally full for forward flexion, extension and lateral flexion. There was no spinal tenderness, no paraspinal tenderness. In supine position, patient was evaluated for femoral or inguinal herniation but no masses were felt on either side. The patient's adductor compartment corresponding to gracilis versus rectus femoris was tender to deep palpation and reproduced a majority of this patient's primary complaint. Interestingly, continued pressure at this area provided relief to the patient associated with numbness and paresthesias down his left leg. Multiple provocations aimed at isolating hip arthritis were well tolerated, while external rotation and stretching of the adductor compartment was uncomfortable for the patient. Piriformis maneuvers were nonprovocative, as were adduction of the hip. Hip flexion, and especially hip flexion in external rotation, was poorly tolerated with the left leg, although the right leg was unaffected.
MEDICAL DECISION MAKING REVIEW OF OLD MEDICAL RECORDS: Imaging reports as detailed above. A Folsom clinic note dated 02/13/2006 from Dr. Moehring, notes that the patient does have low back and left posterior pelvic and thigh pain intermittently, and the patient remains dependent on NSAIDs and "fairly heavy doses of narcotics." Symptoms are left-sided sacroiliac pain with some radiation down the posterior thigh, occasionally below the knee, and is exacerbated by rotation of the hip. His medications were Prozac and Norco and Dr. Moehring notes that his allergies are more reflective of intolerance than true allergies. Examination of the
002267
left hip reveals absent internal rotation as well as mild limitation of external rotation, which is painful, and that he recommends that, as his symptoms have not greatly increased in severity, it is best that he exhaust medical options before embarking on total joint replacement, that it was possible the patient has an iliotibial band friction syndrome or some variant rather than a common degenerative joint disease, and that they are considering an MRI for his symptoms suggestive of labral tear impingement. A 02/13/2006 progress note states that the patient is on Norco 10/325, fluoxetine 40 mg caps daily, baclofen 10 mg t.i.d., AndroGel and fentanyl 25-mcg transdermal patch, Ambien and Aleve were all discontinued and that the assessment was enthesopathy of the hip. Also reviewed was our last procedure note from 04/29/2004 indicating that he had S1 transforaminal epidural steroid injection. Also reviewed were labs, including a testosterone level of 119.6, which is low, collection date 10/03/2003. ASSESSMENT AND DIFFERENTIAL DIAGNOSIS: 1. Left groin pain, unknown etiology. 2. Bilateral hip osteoarthritis. 3. Hypogonadism secondary to chronic opioid use. 4. Lumbar degenerative disc disease. 5. Lumbar radiculitis history. 6. Obesity. RISK OF COMORBIDITIES: At this juncture, we believe that the patient's constitutional status adds minimal additional risk and complexity to our overall proposed evaluation and treatment. The patient is not currently a candidate for procedural intervention, as more diagnostic studies need to be completed. RECOMMENDATIONS and/or TREATMENT PLAN: The patient is scheduled for an MR of the left hip joint on 04/21/2006. We gave the patient an MRI request to add the left pelvis, including the upper one-third of the proximal thigh, in order to more closely evaluate his adductor compartment, and to look for any tears or inflammatory process. The patient has been tried on multiple opioids in the past. He is currently taking 8 Norco a day, which suggest that a long-acting agent is probably necessary and more appropriate. It is unclear whether this patient's side effects are true allergies or just poor tolerability as starting doses are not known. Many times, a medication is better tolerated by starting with low doses and proceeding with a slow upward titration. For example, methadone causing problems with coordination, could be possibly be avoided with this low and slow approach. Methadone is a good medication, as it is long-acting, cheap, and thought to reduce neuropathic symptoms and hyperalgesia due to its NMDA antagonism. Thus, retrialing some of these medications might be appropriate. Oxycodone might not have been tried, thus OxyContin is another option that could be tried. We counseled the patient that physical therapy is likely going to be a mainstay in his treatment, as if our diagnostic suspicion is confirmed, there is no procedural intervention that would provide substantial relief to the patient. As we do not have a firm diagnosis
002268
however, a physical therapy referral was not generated. We will have the patient follow up in the clinic for further evaluation and treatment after the left hip and pelvis MRI studies are completed. The patient was instructed and educated on all aspects of the plan of care. The patient acknowledged the plan of care. Thank you for allowing us to participate in the care of your patient. Should you have any questions or concerns regarding the recommended care plan, please do not hesitate to contact us. Sincerely,
THIS WAS ELECTRONICALLY SIGNED - 05/21/2006 10:32 PM PST BY: LANA WANIA-GALICIA, MD ATTENDING PHYSICIAN
JMM:kma(trs196) D: 03/28/2006 05:16 PM T: 03/29/2006 07:15 AM C#: 1728098 cc: JASON M MILLER, MD
Display only: Transcription (4289094) on 3/28/2006 5:16 PM by Jason M Miller Document history: Transcription (4289094) on 3/28/2006 5:16 PM by Jason M Miller
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> SHERI L GROVES Fri Mar 24, 2006 3:22 PM Encounter initiated. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> BEVERLY A BLAGG Thu Mar 2, 2006 3:38 PM He is calling for a refill of norco. He did call his pharmacy for a refill already. He states that the dose is 10325mg and the instructions are: 1-2 q 6 hrs. He requests Send to preferred pharmacy. Prescription sent on 02-27-06 was not picked up due to the quantity was #135 and should be #250. Ph armacy faxed over request today. Chart Review Routing History
002269
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LAWRENCE J. ELLISON
2315 Sio ckloo Blvd. (916) 70:3-2100 (916) 70:3-2254 (fax) Services: A'iglo/lntervenlional,CT,MR
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002271
>> BRENDA J FALLON Mon May 22, 2006 10:40 AM Patient has pmc appointment on 5/25/06? >> SHERI L GROVES Mon May 22, 2006 9:49 AM Please call Patient with an appointment for this week. >> VICTOR H BAQUERO Mon May 22, 2006 9:46 AM Please see my message below. I can refill norco or soma. He has tried so much in the past. Perhaps h e knows what works better before I write for it . >> CARLA BOSWELL Mon May 22, 2006 8:33 AM Patient called in and needs a refill on norco and soma and he also needs another RX because what he is using is not working. Please advise. >> VICTOR H BAQUERO Fri May 19, 2006 4:02 PM He has a long history of pain medications that he has taken in the past. Is there something that he thinks will work for him. Otherwise follow up in office to discuss medication . >> SHERI L GROVES Fri May 19, 2006 2:18 PM Please advise pain medication is not working, thank you. >> SHERI L GROVES Thu May 18, 2006 2:19 PM Results were given. Pain medication is not working. >> JULIE STEWART Thu May 18, 2006 1:47 PM He is calling for the results of MRI done at UC Davis last month. He would like a phone call back. Patient also would like to discuss medication change.
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Visit Notes GROVES, SHERI L 5/1/2006 2:07 pm Vital signs taken, allergies verified, screened for pain, pharmacy varified, cc was taken. Sheri L Groves Electronically signed by GROVES, SHERI L at 5/1/2006 2:07 pm Progress Notes Mark Amundsen is a 46yr year old male who is here for the following reason: Woke up sat morning and pain was "through the roof". 2 days prior he mowed the lawn but he is not sure that that was the cause of the pain. Taking 10-12 norco daily, baclofen not helping. Reports that he is awaiting MRI ordered by pain clinic. Exercises daily - which helps. Some radiation along left posterior lateral thigh to knee. Weakness at times. OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Extremities: no cyanosis, clubbing, or edema. Skin: Skin color, texture, turgor normal. No rashes or lesions. Neuro: Gait normal. Reflexes normal and symmetric. Sensation and strength grossly normal. Normal quad and achilles reflexes - 2+ symmetric. Mental Status: mild dysthymia from chronic symptoms. ASSESSMENT:
002272
Display only: Transcription (4635661) on 6/1/2006 2:46 PM by H. David Moehring, MD Document history: Transcription (4635661) on 6/1/2006 2:46 PM by H. David Moehring, MD Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Addended by: BAQUERO, VICTOR H on: 6/6/2006 3:09:54 PM Modules accepted: Orders, Medications, Level of Service >> ANDREA A TINSEY Thu Jun 1, 2006 12:23 PM Called and left tmessage to have pt call back and make appt. Will fax Pa letter today to insurance. Andrea A Tinsey, MA >> VICTOR H BAQUERO Wed May 31, 2006 5:02 PM Pa done. Follow up to discuss alternative pain medications in the office. >> HELEN BACA Wed May 31, 2006 2:45 PM PA form under new letter. >> BRENDA J FALLON Wed May 31, 2006 2:01 PM Patient was seen in office on 5/26/06 and perscribed dilaudid(generic). Patient picked up medication on Sunday and started medication. Patient has no relief with medication and wants to know what to do next? Patient wanted to let you know that he didn't have any side effects ( states he is allergi c to a lot of stuff. Patient also needs to know what the status of prior authorization on celexia? P lease advise. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Visit Notes GROVES, SHERI L 5/26/2006 2:26 pm Vital signs taken, allergies verified, screened for pain, pharmacy varified, cc was taken. Sheri L Groves
Progress Notes Mark Amundsen is a 46yr year old male who is here for the following reason: 1. Recent nose bleeding. History of bilateral cautery. The left side is bleeding spontaneously. Lasts about 5 minutes. Some are lasting 30 minutes. No allergic rhinitis symptoms. Not on aspirin. Happening about 3 times a week spontaneously. Using vaseline and has tried Afrin with mixed results. 2. Regarding chronic hip pain. Has sampled through the gamut of NSAIDs, opiates and even muscle relaxants with out satisfactory relief. Reports that while on Prozac he does better. Believes he is beginning to experience poopout. Interested in other SSRI or SNRI. OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Nose: Mild erythema, scab on left medial vomeral surface.
002273
Mental Status: Mild dysthymia. Musculoskeletal: deferred. ASSESSMENT: 784.7 EPISTAXIS (primary encounter diagnosis) Note: For nose bleeds, apply pressure to affected side for several minutes. If not resolving consider Afrin nasal spray or sudafed. Use vaseline bid to moisturize nares. If not resolving consider ENT referral for cautery. Plan: ENT CLINIC REFERRAL 311 DEPRESSIVE DISORDER Note: Has done well on Prozac in the past. Plan: CYMBALTA 30 MG CAP, CYMBALTA 60 MG CAP Will transition off prozac and try cymbalta for mood and pain. Discussed care and warning signs. Follow up in 3-4 weeks. 726.5 ENTHESOPATHY OF HIP Note: stable. Discussed alternative pain medications at length. None of the long acting opiates seem to help. He is currently doing better and plans to follow up with ortho next week. Dilaudid given for acute axacerbations. Discussed care and warning signs. Plan: DILAUDID 2 MG TAB PLAN: See Orders. Follow up in office if not better. Spent greater than 25 minutes face to face with patient, over half the time was spent counseling. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his medical care. No guarantees were made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> JULIE A WILSON Tue May 23, 2006 10:54 AM Encounter initiated. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> BRENDA J FALLON Tue May 23, 2006 11:30 AM Patient notified of medication refill and doctor message. Patient has appointment with pcp on 5/26/0 6. >> JULIE A WILSON Tue May 23, 2006 11:09 AM Left voicemail for pt to return call.Julie Wilson, MA >> VICTOR H BAQUERO Tue May 23, 2006 9:26 AM Norco refilled. I would recommend he go to pain clinic. They may have other options for pain relief for him. >> BRENDA J FALLON Mon May 22, 2006 4:26 PM Patient would like to get refill on norco and the soma states his back/hip is killing him. Patient h as appointment scheduled with pcp on Friday 5/26/06. Patient does not know if he should keep appoint ment with pmc. Please call when done.
002274
Previous Version Transcription Type Folsom Clinic Note (7721) Electronically Signed Document Text PATIENT: AMUNDSEN, MARK LOCATION: ORTFOL MR #: 8081369 SEX: M AGE: 46 DATE OF SERVICE: 06/01/2006 DOB: 09/23/1959 FOLSOM CLINIC NOTE SUBJECTIVE: Mark is back to discuss the results of his MRI. The latter showed extensive degenerative arthritis of the left hip, as well as cyst formation. Currently, he reports that his pain is only 3-4 or 5/10, but then states that the Vicodin is no longer working well. OBJECTIVE: Physical examination is unchanged from that recorded previously, except the patient seems to have more pain with any attempt at rotation of the left hip. He is neurovascularly intact. RADIOGRAPHS: DIAGNOSIS: MRI and radiographs are reviewed. Degenerative arthritis, left hip. ID 4635661 Date and Time 6/1/2006 2:46 PM Author H. David Moehring, MD
RECOMMENDATIONS: The patient is scheduled for another MRI for some reason. It would seem to me that the source of the discomfort is obvious, that being advanced degenerative arthritis revealed on his MRI, and subtly on his plain radiographs of the pelvis and hip. At any rate, he is quite young relatively speaking and, therefore, we want to make sure that he has exhausted medical treatment. Therefore, if his symptoms increase in severity or change in quality and he so desires, we will consider left hip replacement.
002275
Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his medical care. No guarantees were made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes PATIENT: AMUNDSEN, MARK LOCATION: ORTFOL MR #: 8081369 SEX: M AGE: 46 DATE OF SERVICE: 06/01/2006 DOB: 09/23/1959 FOLSOM CLINIC NOTE SUBJECTIVE: Mark is back to discuss the results of his MRI. The latter showed extensive degenerative arthritis of the left hip, as well as cyst formation. Currently, he reports that his pain is only 3-4 or 5/10, but then states that the Vicodin is no longer working well. OBJECTIVE: Physical examination is unchanged from that recorded previously, except the patient seems to have more pain with any attempt at rotation of the left hip. He is neurovascularly intact. RADIOGRAPHS: MRI and radiographs are reviewed. DIAGNOSIS: Degenerative arthritis, left hip. RECOMMENDATIONS: The patient is scheduled for another MRI for some reason. It would seem to me that the source of the discomfort is obvious, that being advanced degenerative arthritis revealed on his MRI, and subtly on his plain radiographs of the pelvis and hip. At any rate, he is quite young relatively speaking and, therefore, we want to make sure that he has exhausted medical treatment. Therefore, if his symptoms increase in severity or change in quality and he so desires, we will consider left hip replacement. THIS WAS ELECTRONICALLY SIGNED - 06/02/2006 11:29 AM PST BY: PROFESSOR PCN FOLSOM NETWORK ORTHOPAEDICS H DAVID MOEHRING, MD
Electronically signed byH. David Moehring, MD on 6/2/2006 11:29 AM Links
002276
HEALTH SYSTEM
FOLSOM
LOCATION: ORTFOL SEX: MAGE: 46 DOB: 09/23/1959 CLINIC NOTE
UCDAVIS
PATIENT: AMUNDSEN, MARK MR #: 8081369 DATE OF SERVICE: 06/01/2006 FOLSOM
SUBJECTIVE: Mark is back to discuss latter showed extensive degenerative well as cyst formation.
the results of his MRI. The arthritis of the left hip, as
Currently, he reports that his pain is only 3-4 or 5/10, states that the Vicodin is no longer working well.
but
then
OBJECTIVE: Physical examination is unchanged from that recorded previously, except the patient seems to have more pain with any attempt at rotation of the left hip. He is neurovascularly intact. RADIOGRAPHS: DIAGNOSIS: MRI and radiographs Degenerative arthritis, are reviewed. left hip.
RECOMMENDATIONS: The patient is scheduled for another MRI for Some reason. It would seem to me that the source of the discomfort is obvious, that being advanced degenerative arthritis revealed on his 1 MRI , and-subtly on his plain radiographs of the pelvis and hip. At any rate, he is quite young relatively speaking and, therefore, we want to make sure that he has exhausted medical treatment. Therefore, if his symptoms increase in severity or change in quality and he so desires, we will consider left hip replacement.
THIS WAS ELECTRONICALLY H DAVID MOEHRING, MD PROFESSOR PCN FOLSOM NETWORK ORTHOPAEDICS
SIGNED
~ 06/02/2006
11:29 AM PST BY:
HDM:dhs(usa124) D: T: C#: 06/01/2006 06/02/2006 1885294 02:46 PM 06:13 AM
FOLSOM, CA 95630 FAX (916) 355-1219

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Ambulatory Care Center 4860 Y Street. Suite 0500 (916) '134-0055. (916) 734-0650 (taxi Services Lower Level: Mamrno, Ultrasound
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Service. First Floor: Plain Film

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002278
Prozac (which he seemed to have already heard about), but he still wants to chat. Could you please call him back, or failing that, call the prescription into another pharmacy? The Walgreen's at 2595 E />Bidwell St Folsom, CA 95630 (916)817-6533 would be fine. I know they're trying to protect me, but they seem to be a little overboard. Please let me know what happensThanks/> Mark P.S. That new SSNRI has a copay of $50 - I guess they really don't want to use it... Display only: Transcription (RH4252792) on 6/7/2006 5:27 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Visit Notes GROVES, SHERI L 6/6/2006 2:39 pm Vital signs taken, allergies verified, screened for pain, pharmacy varified, cc was taken. Sheri L Groves
Progress Notes Mark Amundsen is a 46yr year old male who is here for the following reason: Follow up on left hip pain. Saw Dr. Mooring and recommended hip replacement. Has questions on indication. Cymbalta has not been covered yet. Still having a hard time getting pain relief on oral medications. Has tried just about everything. OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Skin: Skin color, texture, turgor normal. No rashes or lesions. Musculoskeletal: unchanged. Mood: euthymic to dysthymic at times. ASSESSMENT: 726.5 ENTHESOPATHY OF HIP (primary encounter diagnosis) Note: discussed results, care, medications, non-surgical options, etc. Plan: will follow up with pain clinic for localized injections if these disorder not help follow up with ortho for hip raplacement. Continue current medications. When available start Cymbalta.
PLAN: See Orders. Follow up in office if not better.
002279
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> BRENDA J FALLON Wed Jun 7, 2006 3:56 PM Patient states perscription that was sent to pharmacy yesterday , the pharmacisit is hesitating on f illing it. Please advise. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi Dr BaqueroThe Longs pharmacy received the refill prescription for the Norco, but they are hesitant to refill it due to the reduced frequency - they said they wanted to talk with you first. I tried explaining about the Prozac (which he seemed to have already heard about), but he still wants to chat. Could you please call him back, or failing that, call the prescription into another pharmacy? The Walgreen's at 2595 E />Bidwell St Folsom, CA 95630 (916)817-6533 would be fine. I know they're trying to protect me, but they seem to be a little overboard. Please let me know what happensThanks/> Mark P.S. That new SSNRI has a copay of $50 - I guess they really don't want to use it... Transcription Type Unstructured to Doctor Preliminary Document Text Hi Dr BaqueroThe Longs pharmacy received the refill prescription for the Norco, but they are hesitant to refill it due to the reduced frequency - they said they wanted to talk with you first. I tried explaining about the ID RH4252792 Date and Time 6/7/2006 5:27 PM
002280
and good advice, I think I will stop working now. Display only: Transcription (RH4267839) on 6/8/2006 9:00 PM Document history: Transcription (RH4267839) on 6/8/2006 9:00 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi allThe prescription refill I received from Dr Baquero on Tuesday was not filled yet - the pharmacy wants to confirm with him, but they haven't been too diligent. I'm out of pain medication, and the weekend approaches. Could Sherrie or Dr Baquero call the pharmacy and tell them to get off their you know what? If there are any questions, please call any time at 916-983-2589, or 916-337-0490 (cell). Thanks! Mark Amundsen Transcription Type Unstructured to Office
Document Text Hi allThe prescription refill I received from Dr Baquero on Tuesday was not filled yet - the pharmacy wants to confirm with him, but they haven't been too diligent. I'm out of pain medication, and the weekend approaches. Could Sherrie or Dr Baquero call the pharmacy and tell them to get off their you know what? If there are any questions, please call any time at 916-983-2589, or 916-337-0490 (cell). Thanks! Mark Amundsen Display only: Transcription (RH4267830) on 6/8/2006 7:06 PM
002281
Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> SHERI L GROVES Wed Jun 21, 2006 4:34 PM Encounter initiated. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes It's not pronounced yet - and the symptoms reduce if I quit the activities that cause them, as opposed to the hip. I'll come by tomorrow to pick up the script - thanks again for all the help!! Mark Amundsen Links Previous Version Transcription Type Unstructured to Doctor Preliminary Document Text It's not pronounced yet - and the symptoms reduce if I quit the activities that cause them, as opposed to the hip. I'll come by tomorrow to pick up the script - thanks again for all the help!! Mark Amundsen Display only: Transcription (RH4302409) on 6/15/2006 3:35 PM Document history: Transcription (RH4302409) on 6/15/2006 3:35 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes keep me posted. and good advice, I think I will stop working now. Links Previous Version Transcription Type Unstructured to Doctor
Preliminary
ID RH4302409
ID RH4267839
Document Text keep me posted.
002282
I have changed the pharmacy I'm using to save some money - the Costco pharmacy had the same drugs as Longs for less than 50% of the cost, and even Walgreens was 30% cheaper. Anyway, the new pharmacy info isCostco Pharmacy />1800 Cavitt Road Folsom, CA 95630 Pharmacy Phone # 916-850-1005 Fax # 916-850-1023 This change should be for all my prescriptions please call me if there are any questions, and thanks!! Mark Amundsen 916-983-2589 /> P.S. I have submitted refills for Norco, Soma, and Prozac - thought I'd give you a heads up...
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Thanks Doctor - I'll check with them later today - had to work very late or really early tonight... Mark Links Previous Version Transcription Type Unstructured to Doctor Preliminary
Document Text Thanks Doctor - I'll check with them later today - had to work very late or really early tonight... Mark ID RH4401688 Date and Time 6/30/2006 4:41 AM
Display only: Transcription (RH4401688) on 6/30/2006 4:41 AM Document history: Transcription (RH4401688) on 6/30/2006 4:41 AM Chart Review Routing History
002283
Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter >> JULIE STEWART Thu Jul 20, 2006 11:15 AM Patient request refills go to Costco, Folsom >> CORY O'DELL Wed Jul 19, 2006 9:53 AM Dr. Patient. Requesting norco ten days early. >> CORY O'DELL Wed Jul 19, 2006 8:15 AM Encounter initiated. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Howdy allThis message should go to Sherrie, Dr. Baquero's />assistant... I have changed the pharmacy I'm using to save some money - the Costco pharmacy had the same drugs as Longs for less than 50% of the cost, and even Walgreens was 30% cheaper. Anyway, the new pharmacy info isCostco Pharmacy />1800 Cavitt Road Folsom, CA 95630 Pharmacy Phone # 916-850-1005 Fax # 916-850-1023 This change should be for all my prescriptions please call me if there are any questions, and thanks!! Mark Amundsen 916-983-2589 /> P.S. I have submitted refills for Norco, Soma, and Prozac - thought I'd give you a heads up... Transcription Type Unstructured to Office
Preliminary
ID RH4531514
Document Text Howdy allThis message should go to Sherrie, Dr. Baquero's />assistant...
002284
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Mark Amundsen is a 47yr year old male who is here for the following reason: Increasing hip pain. Started working this week. Sits 90% of the time. There is some aggravation of hip pain with the increased activity with travel. BP 100/62 | Pulse 72 | Resp 10 | Wt 216 lbs 3.2 oz (98.1kg) OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Mental Status: euthymic. Musculoskeletal: left hip pain. Exam stable. Current outpatient prescriptions: METHADONE 10 MG TAB, 8 po daily FLUOXETINE 40 MG CAP, 1 po daily NORCO 10 MG-325 MG TAB, 10-14 daily SOMA 350 MG TAB, 1 po tid. ASSESSMENT: 726.5 ENTHESOPATHY OF HIP (primary encounter diagnosis) Note: end stage osteoarthritis. On chronic pain medications. Urged him to follow up with ortho to discuss hip replacement as he is on high doses of opiates and is still in pain. Affecting his life and functioning. Continue methadone for baseline. Norco as needed. Soma as needed for spasms. Discussed care and warning signs. Plan: ALEVE 220 MG TAB SOMA 350 MG TAB, NORCO 10 MG-325 MG TAB 723.4 BRACHIAL NEURITIS NOS Note: Left cervical radiculopathy - radiating to left arm. Plan: he mentioned this at the end of the visit. Suspects may be due to head positioning since he was "watching a lot of tv in bed" with his neck kinked lately. Discussed care and warning signs. Follow up if not better. 311 DEPRESSIVE DISORDER Note: improved. Plan: Discussed care and warning signs. The current medical regimen is effective; continue present plan and medications. Spent greater than 25 minutes face to face with patient, over half the time was spent counseling. PLAN: See Orders. Follow up in office if not better. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his medical care. No guarantees were made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit. Electronically signed byVictor Baquero, MD on 10/27/2006 6:01 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Visit Notes GROVES, SHERI L 10/27/2006 9:18 am
002285
Progress Notes Mark Amundsen is a 47yr year old male who is here for the following reason: 1. Follow up on medications. Taking about 10 norco and 8-10 methadone daily. Pain controlled unless he overdoes it. No side effects on medications. 2. About 3 times he has had episodes of epigastric malaise, decreased appetite, some constipation, no nausea or vomiting, fever or chills. No melena. Not taking Aleve regularly. THen it resoleves. Current outpatient prescriptions: SOMA 350 MG TAB, 1 po tid, Disp: 90, Rfl: 3 NORCO 10 MG-325 MG TAB, 2 po q 4 hours. Max 10 per day., Disp: 300, Rfl: 1 FLUOXETINE 40 MG CAP, take 1 capsule (40mg) by oral route once daily in the morning, Disp: 30, Rfl: 6 ALEVE 220 MG TAB, take 1 tablet (220mg) by oral route every 12 hours as needed, Disp: , Rfl: 0 GLUCOSAMINE 1,000 MG TAB, , Disp: , Rfl: 0 METHADONE 10 MG TAB, Take 2 po every 6 hours (max 8 daily), Disp: 240, Rfl: 0 BP 110/82 | Pulse 70 | Resp 10 | Wt 215 lbs 4.8 oz (97.7kg) OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Skin: Skin color, texture, turgor normal. No rashes or lesions. Neuro: normal exam. Mental Status: Appearance/Cooperation: alert, oriented times 3 and well groomed and dressed Attitude: pleasant Behavior :normal Speech: normal volume, rate, and pitch Mood (pt's report) :euthymic Affect: full and appropriate Musculoskeletal: left hip exam unchanged. Still has limitations in range of motion and pain. Abdomen: BS normal. Abdomen soft, non-tender. No masses or organomegaly. ASSESSMENT: 726.5 ENTHESOPATHY OF HIP Note: current medication regimen effective. Discussed that he should try to lower the Norco dose, pain clinic referral initiated. Will follow up with ortho. Plan: SED RATE WESTERGREN, ANTI-NUCLEAR AB (ANA), RHEUMATOID FACTOR, PAIN MANAGEMENT REFERRAL Discussed care and warning signs. The current medical regimen is effective; continue present plan and medications. 536.8 STOMACH FUNCTION DIS NEC Note: non-specific suspect may be related to upper respiratory illness, viral syndromes vs gastritis vs possible IBS. Discussed care and warning signs. Check labs. Discussed with Mark and all questions and concerns were fully answered. He will call me or followup in the office if any problems arise. Plan: CELIAC REFLEXIVE PANEL V77.99 SCREENING-ENDOC/NUT/MET/IMMUN NEC Note: Plan: BLOOD COUNT, COMPREHENSIVE METABOLIC PANEL, LIPID PANEL WITH DLDL REFLEX, URINALYSIS-CHEM ONLY, TSH WITH FREE T4 REFLEX, PSA SCREEN PLAN: See Orders. Follow up in office if not better. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions.
002286
Glad you feel better. I'll pay attention to the refill request. Display only: Transcription (RH7155985) on 5/18/2007 12:59 PM Document history: Transcription (RH7155985) on 5/18/2007 12:59 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Mark Amundsen is a 47yr year old male who is here for the following reason: Follow up on medication. Socially not doing as well, because he got fired 2 weeks ago. Thinks the prozac is not working anymore. Reports more symptoms of not letting thing go. Has been on Prozac for 10 years. It seems to poop out every 3 years. Zoloft was not effective. Insurance did not cover Effexor. Patient Active Problem List: BACKACHE NOS [724.5] TESTICULAR HYPOFUNC NEC [257.2] BRACHIAL NEURITIS NOS [723.4] ENTHESOPATHY OF HIP [726.5] DEPRESSIVE DISORDER [311] Current outpatient prescriptions: METHADONE 10 MG TAB, Take 2 po every 6 hours (max 8 daily) NORCO 10 MG-325 MG TAB, 2 po q 4 hours. Max 10 per day. FLUOXETINE 40 MG CAP, take 1 capsule (40mg) by oral route once daily in the morning SOMA 350 MG TAB, 1 po tid ALEVE 220 MG TAB, take 1 tablet (220mg) by oral route every 12 hours as needed ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET, 2 PACKETS DAILY GLUCOSAMINE 1,000 MG TAB, BP 102/64 | Pulse 68 | Resp 12 | Wt 225 lbs (102.1kg) OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Eyes: conjunctivae and corneas clear. PERRL, EOM's intact. Fundi benign. Mental Status: Appearance/Cooperation: alert, oriented times 3 and well groomed and dressed Attitude: pleasant Behavior :normal Mood (pt's report) :ahedonia Affect: full and appropriate and flat Thought Process: logical and goal directed Musculoskeletal: stable. ASSESSMENT: 309.24 ADJUSTMENT DISORDER WITH ANXIETY (primary encounter diagnosis) Note: recent stressors. Decreased mood. Discussed care and treatment plan. Request follow up in 4 weeks. Encouraged counseling and exercise as well as stress management. Plan: CELEXA 40 MG TAB I've explained to him that drugs of the SSRI class can have side effects such as weight gain, sexual dysfunction, insomnia, headache, nausea. These medications are generally effective at alleviating symptoms of anxiety and/or depression. Let me know if significant side effects do occur.
002287
726.5 ENTHESOPATHY OF HIP Note: The current medical regimen seems effective; continue present plan and medications. Requested he follow up with pain clinic - hoever he may be with out health insurance in a few days. Discussed medication use. He seems to go through the medication in less than the prescribed time. He will follow instrurctions on the bottle. Discussed care and warning signs. Discussed with Mark and all questions and concerns were fully answered. He will call me or followup in the office if any problems arise. Plan: METHADONE 10 MG TAB 724.5 BACKACHE NOS Note: as above. Plan: METHADONE 10 MG TAB 723.4 BRACHIAL NEURITIS NOS Note: left C 6-7 As above. Discussed physical therapy. Exercises. Pain management consult and ultimately spine clinic consult. Plan: PHYSICAL THERAPY REFERRAL Spent greater than 25 minutes face to face with patient, over half the time was spent counseling. PLAN: See Orders. Follow up in office if not better. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his/her medical care. No guarantees were made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit. Electronically signed byVictor Baquero, MD on 4/21/2007 2:32 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Mark, I called it in while in the office - it should be there. Start with 1/2 pill for 1 week then 1 daily thereafter. Links Previous Version Transcription Type Unstructured to Doctor Preliminary
Document Text Mark,
ID RH6888093
I called it in while in the office - it should be there. Start with 1/2 pill for 1 week then 1 daily thereafter.
Chart Review Routing History
002288
Telephone Encounter Methadone prescription written. Given to April. MARTINA RANDOLPH, M.D. Electronically signed byMartina Dobrovodska Randolph, MD on 6/22/2007 11:13 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: Amundsen,Mark Sent: 06/22/2007 10:17 AM Hi Dr Baquero and staffIt's about refill time for the Methadose prescription again - it's a day or so early, but I know the new procedures take a little longer. Also, I wanted to let you know I have stopped the Celexa, and restarted the Prozac. While the Celexa seemed to work well for a week or two, it failed soon after that. Since it's been two months, it should be long enough for the Prozac to start working again. I'm keeping my fingers crossed. Thanks for all the assistance, Dr. BaqueroMark Amundsen Electronically signed byCherry Mendoza on 6/22/2007 10:49 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi Dr Baquero and staffIt's about refill time for the Methadose prescription again - it's a day or so early, but I know the new procedures take a little longer. Also, I wanted to let you know I have stopped the Celexa, and restarted the Prozac. While the Celexa seemed to work well for a week or two, it failed soon after that. Since it's been two months, it should be long enough for the Prozac to start working again. I'm keeping my fingers crossed. />Thanks for all the assistance, Dr. BaqueroMark Amundsen

Preliminary
ID RH7606587
Document Text Hi Dr Baquero and staffIt's about refill time for the Methadose prescription again - it's a day or so early, but I know the new procedures take a little longer. Also, I wanted to let you know I have stopped the Celexa, and restarted the Prozac. While
002289
Progress Notes No problem Mark. I hope you have a great weekend also!
/>Cherry, MA

Document Text No problem Mark. I hope you have a great weekend also!
ID RH8293290
/>Cherry, MA Display only: Transcription (RH8293290) on 8/31/2007 3:50 PM Document history: Transcription (RH8293290) on 8/31/2007 3:50 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Note transferred to Relay Health. Electronically signed byCherry Mendoza on 8/31/2007 10:06 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Triplicate written. Please notify patient. Electronically signed byVictor Baquero, MD on 8/31/2007 8:09 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter ----- Message # 1 ----From: Amundsen,Mark Sent: 08/29/2007 5:43 PM Hi Dr Baquero and CherryIt's about time for the monthly Methadone refill- not a huge hurry, but I will run out this weekend sometime. Thanks for all your assistance in this matterMark Amundsen Electronically signed byCherry Mendoza on 8/30/2007 8:23 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed.
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release it today. In any case, thank you for your diligence.... /> Mark Amundsen
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Patient notified via VM. Electronically signed byCherry Mendoza on 9/18/2007 1:52 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Prescription called in. Electronically signed byVictor Baquero, MD on 9/18/2007 1:07 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter He is calling for a refill of NORCO. He did not call his pharmacy for a refill already. He states that the dose is please check and the instructions are: as indicated. He requests a phone call when is ready. He has a Rx for METHADONE ready but he is llergic to it . Please revise the Rx. Electronically signed byOrquidia Siu on 9/18/2007 12:09 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed.
002291
they sent in a prescription request, but haven't received confirmation yet. As they lose them sometimes, I was hoping you could look to see whether there is a request pending. I will be running out tomorrow, so I hope it can be refilled soon. Thanks for all your help/> Mark Amundsen Transcription Type Unstructured to Doctor
Document Text Hi Dr Baquero and CherryCostco pharmacy has informed me they sent in a prescription request, but haven't received confirmation yet. As they lose them sometimes, I was hoping you could look to see whether there is a request pending. I will be running out tomorrow, so I hope it can be refilled soon. Thanks for all your help/> Mark Amundsen
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi Dr Baquero and CherryI picked up a refill for Methadose last week - however, it was post dated for the 28th of Sept, and I ran out last night. I am hoping that you can either write another one for a one day supply, or maybe call the Costco pharmacy at 850-1005 to release it today. In any case, thank you for your diligence.... /> Mark Amundsen Transcription Type Unstructured to Doctor Preliminary Document Text Hi Dr Baquero and CherryI picked up a refill for Methadose last week - however, it was post dated for the 28th of Sept, and I ran out last night. I am hoping that you can either write another one for a one day supply, or maybe call the Costco pharmacy at 850-1005 to
ID RH8583901 Date and Time 9/27/2007 7:25 AM
002292
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Triplicate written. Please notify patient. Electronically signed byVictor Baquero, MD on 10/22/2007 5:13 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Left message for patient to call back. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Prescription called in. I got the request - however according to my records he was not due to receive a refill to later this week. Let him know that I expect the refills to last a full month. If this is not the case he should follow up in the office to discuss medication use. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Patient is calling to check on status of refills again. Patient states costco has been faxing refill request to our office since 10/10/07. Patient states he even sent a relay health message to make sure request was received. Patient states he needs norco 10mg-325mg, 2 po q 4 hours maximum 10 tablets per day. Patient also needs refill on soma 350 mg tablets, 1 tablet tid. Please notify patient when done. Electronically signed byBrenda J Fallon on 10/16/2007 3:21 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Patient is checking on status of refills for Norco and Soma. Please advise Electronically signed byDeborah L Hughes on 10/16/2007 11:53 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Patient calling for refill status of his NORCO and SOMA to Costco. Electronically signed byOrquidia Siu on 10/15/2007 3:48 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi Dr Baquero and CherryCostco pharmacy has informed me
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Thanks CherryI usually include that there's no hurry, but I guess I forgot this time. Thanks for everything, and I'll remember for next time.
Mark
Links Previous Version Transcription Type Provider Initiated Preliminary

Document Text Thanks CherryI usually include that there's no hurry, but I guess I forgot this time. Thanks for everything, and I'll remember for next time.
ID RH8922576
Mark Display only: Transcription (RH8922576) on 10/23/2007 3:00 PM Document history: Transcription (RH8922576) on 10/23/2007 3:00 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Thanks Cherry - I appreciate that. Have a great day! Mark Links Previous Version Transcription Type Unstructured to Doctor
Preliminary
ID RH8898083
Date and Time 10/23/2007 11:06 AM
Document Text Thanks Cherry - I appreciate that. Have a great day! Mark
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Note transferred to Relay Health. Electronically signed byCherry Mendoza on 10/23/2007 9:36 AM
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Mark Amundsen Display only: Transcription (RH9465897) on 12/10/2007 4:35 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hello there Mr. Amundsen, your prescription was refilled by Dr. Baquero today. Have a good weekend! Cherry, MA Links Previous Version Transcription Type Unstructured to Doctor Preliminary
Document Text Hello there Mr. Amundsen, your prescription was refilled by Dr. Baquero today. Have a good weekend!
ID RH9185214
Cherry, MA Display only: Transcription (RH9185214) on 11/16/2007 4:23 PM Document history: Transcription (RH9185214) on 11/16/2007 4:23 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Patient notified. Electronically signed byCherry Mendoza on 11/16/2007 4:22 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Triplicate written. Please notify patient. Electronically signed byVictor Baquero, MD on 11/16/2007 2:44 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Patient notified. Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes
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Cherry, MA Links Previous Version Transcription Type Unstructured to Doctor

Document Text You are very welcome. Have a happy holiday also! Cherry, MA Display only: Transcription (RH9496272) on 12/14/2007 9:20 AM Document history: Transcription (RH9496272) on 12/14/2007 9:20 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter

Electronically signed byVictor Baquero, MD on 12/13/2007 12:42 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi Dr Baquero and CherryIt's about time for another refill - i won't need the refill until the 15th, so any time this week would be fine - I just wanted to give y'all plenty of time. Thanks for all your help!! Mark Amundsen Transcription Type Unstructured to Doctor Preliminary Document Text Hi Dr Baquero and CherryID RH9465897 Date and Time 12/10/2007 4:35 PM
It's about time for another refill - i won't need the refill until the 15th, so any time this week would be fine - I just wanted to give y'all plenty of time. Thanks for all your help!!
002296
Transcription Type Unstructured to Doctor Preliminary
ID RH9797226
Document Text Hi Dr Baquero and Cherry- I just wanted to check to see that you got my message about a refill on Methadone - I will be out of medication on Thursday(today), so I'm hoping I can pick up a prescription today. Thanks for all your help! Mark Amundsen Display only: Transcription (RH9797226) on 1/10/2008 2:18 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Prescription called in already.

Electronically signed byVictor Baquero, MD on 1/9/2008 5:22 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi Dr Baquero and Cherry- It's about time for another refill on Methadone - I won't need it until Thursday, so any time before then would be great. Hope your holiday was fantastic! Thanks! Mark Amundsen Transcription Type Unstructured to Doctor Preliminary
Document Text Hi Dr Baquero and Cherry- It's about time for another refill on Methadone - I won't need it until Thursday, so any time before then would be great. Hope your holiday was fantastic! Thanks! Mark Amundsen
ID RH9758574
Display only: Transcription (RH9758574) on 1/7/2008 3:17 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Note transferred to Relay Health.

Electronically signed byCherry Mendoza on 12/14/2007 4:57 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes You are very welcome. Have a happy holiday also!
002297
Patient picked up prescription already.

Electronically signed byCherry Mendoza on 1/15/2008 10:12 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter

Electronically signed byVictor Baquero, MD on 1/10/2008 12:29 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hello Mr Amundsen, sorry for the late reply. Your refill request was routed to Dr. Baquero. You can go ahead and expect the refill to be ready after lunch (1:30pm). You can go ahead and come by from around that time until 4:45pm. Thanks.
Cherry, MA
Links Previous Version Transcription Type Unstructured to Doctor Preliminary Document Text Hello Mr Amundsen, sorry for the late reply. Your refill request was routed to Dr. Baquero. You can go ahead and expect the refill to be ready after lunch (1:30pm). You can go ahead and come by from around that time until 4:45pm. Thanks. Cherry, MA Display only: Transcription (RH9797225) on 1/10/2008 8:18 AM Document history: Transcription (RH9797225) on 1/10/2008 8:18 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi Dr Baquero and Cherry- I just wanted to check to see that you got my message about a refill on Methadone - I will be out of medication on Thursday(today), so I'm hoping I can pick up a prescription today. Thanks for all your help! Mark Amundsen
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Telephone Encounter
----- Message # 1 ----From: Amundsen,Mark Sent: 01/29/2008 11:24 PM Hi Dr Baquero- Sorry for the multiple messages. I also wanted to let you know the Prozac never did work after I started on it again. Things are fairly critical in this area. Is there an alternative I haven't tried? (Preferably low cost). Perhaps I should make an appointment? So far I've been on Prozac 40mg, Celexa, and I think Zoloft. I'm thinking maybe Effexor... Thanks again, Mark Amundsen
----- Message # 1 ----From: Amundsen,Mark Sent: 01/29/2008 10:55 PM Hi Dr Baquero and Cherry- I wanted to email you early on a refill, because I think I'll be out of Methadone next Monday. I know it's a few days early, but I've been using more during the bad weather. Also, I've been having increasing problems around both knees and hands. I'm pretty sure it's arthritis, and since I can't do anything for the arthritis on the hips, I'm assuming the same for the knees and hands. Thanks for any info you can provide- Mark Amundsen
Electronically signed byCherry Mendoza on 1/30/2008 9:54 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi Dr Baquero- Sorry for the multiple messages. I also wanted to let you know the Prozac never did work after I started on it again. Things are fairly critical in this area. Is there an alternative I haven't tried? (Preferably low cost). Perhaps I should make an appointment? So far I've been on Prozac 40mg, Celexa, and I think Zoloft. I'm thinking maybe Effexor... Thanks again, Mark Amundsen Transcription Type Unstructured to Doctor Preliminary
Document Text Hi Dr Baquero- Sorry for the multiple messages. I also wanted to let you know the Prozac never did work after I started on it again. Things
ID RH10038089
are fairly critical in this area. Is there an alternative I haven't tried? (Preferably low cost). Perhaps I should make an appointment? So far I've been on Prozac 40mg, Celexa, and I think Zoloft. I'm thinking maybe Effexor... Thanks again, Mark Amundsen
002299
Vitals taken, allergies verified, pharmacy verified, and pain assessed. Cherry Mendoza, MA
Electronically signed by CHERRY MENDOZA at Tue Feb 19, 2008 1:42 PM
Telephone Encounter
Patient has refills, but it is 8 days early.

Electronically signed byClare Jennings, MA on 2/1/2008 9:08 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Thanks Cherry - I will consult Dr Baquero on the arthritis and the SSRI's at the appointment...so don't worry about the second message. /> Mark Amundsen Links Previous Version Transcription Type Unstructured to Doctor
Document Text Thanks Cherry - I will consult Dr Baquero on the arthritis and the SSRI's at the appointment...so don't worry about the second message. /> Mark Amundsen Display only: Transcription (RH10038079) on 1/30/2008 3:37 PM Document history: Transcription (RH10038079) on 1/30/2008 3:37 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Note transferred to Relay Health. Patient notified.

Electronically signed byCherry Mendoza on 1/30/2008 2:49 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Refill will be ready to pick up on Friday. Also request follow up evaluation. I need to see him at least every 6 months while he is on the medications for evaluation.
Electronically signed byVictor Baquero, MD on 1/30/2008 12:51 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed.
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Sent: 02/20/2008 6:31 PM Hi Dr Baquero- I have been doing price comparisons - they seem to have equalized the prices according to how well the meds work and their equivalant dosages - pretty sneaky! I did find a fairly good deal- Costco 8mg hydromorphone 100 ea for $66.00 - which should equal 300 of the 10/325 hydrocodone in usage. However, the price difference wasn't spectacular.($50) It takes a couple of days to get as well. So, I guess maybe I should switch to whatever you feel will work the best - the prices seem to equate. I do ask that whatever is proscribed, the least amount of pills to take is best. Also, I will be out of the Methadone next Monday - I'm hoping to get a refill on those as well by then. I have not picked up the Effexor yet - going to get them all at the same time probably. Thanks for everything- Mark Amundsen
Electronically signed byCherry Mendoza on 2/21/2008 9:06 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes
Chief Complaint Patient presents with Medication Follow Up methadone, norco, soma, and prozac
Mark Amundsen is a 48yr year old male who is here for the following reason: Follow up on hip. Worse. Is able to pop his left hip in and out at times. Still has no insuracne coverage. He reports feeling excessive guilt, depressed mood, insomnia, impaired concentration for the last few months. Currently on Cymbalta for the past few weeks with minimal improvement. Cannot afford it. In the past has tried fluoxetine. Recent stressors include: no work, home, retationship, financial issues, chronic pain. He does not report mood lability. Review of Systems: Constitutional: negative.
History Substance Use Topics Tobacco Use: Alcohol Use: Patient Active Problem List Diagnoses BACKACHE NOS TESTICULAR HYPOFUNC NEC BRACHIAL NEURITIS NOS ENTHESOPATHY OF HIP DEPRESSIVE DISORDER Current outpatient prescriptions Medication NORCO 10 MG-325 MG TAB
Code 724.5 257.2 723.4 726.5 311 Sig 2 po q 4 hours. Max 10 per
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SOMA 350 MG TAB METHADONE 10 MG TAB ALEVE 220 MG TAB ANDROGEL 1 % (25 MG) TRANSDERMAL PACKET GLUCOSAMINE 1,000 MG TAB
day. 1 po tid Take 2 po every 6 hours (max 10 daily) take 1 tablet (220mg) by oral route every 12 hours as needed 2 PACKETS DAILY
BP 120/82 | Pulse 72 | Temp (Src) 36.4 C (97.6 F) (Tympanic) | Resp 12 | Wt 100.971 kg (222 lb 9.6 oz) OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Skin: negative. Mental Status: dydthymic. No suicidal ideation. Blunted affect. Musculoskeletal: stable. Left hip pain. ASSESSMENT: 726.5 ADVANCED OSTEOARTHRITIS OF THE LEFT HIP (primary encounter diagnosis) Comment: end stage osteo arthritis of left hip. No insurance. Unable to pursue surgical options. Plan: The current medical regimen is effective; continue present plan and medications. Risks and benefits discussed in detail. 311 DEPRESSIVE DISORDER Comment: Discussed care and treatment plan. Request follow up in 3 weeks. Encouraged counseling and exercise as well as stress management. Plan: EFFEXOR XR 75 MG 24 HR CAP I've explained to him that drugs of the SSRI class can have side effects such as weight gain, sexual dysfunction, insomnia, headache, nausea. These medications are generally effective at alleviating symptoms of anxiety and/or depression. Let me know if significant side effects do occur. PLAN: See Orders. Discussed care and warning signs with Mark and all questions and concerns were fully answered. He will call or followup in the office if any problems arise. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his/her medical care. No guarantees were made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit.
Electronically signed byVictor Baquero, MD on 2/19/2008 5:42 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Visit Notes CHERRY MENDOZA Tue Feb 19, 2008 1:42 PM
002302
From: Amundsen,Mark Sent: 03/03/2008 7:56 AM Hi Dr Baquero- I wanted to let you know about the results of the prescription changes we attempted last visit. 1. The switch to Effexor seems to be working well. I am feeling much better in mood and general health. I did experience some initial hyperactivity, which may have been getting used to the pill, or just getting caught up on my projects. It seems to have leveled out nicely now. 2. The Hydromorphone did not work at all, at any dose. The pharmacist supplied 4mg tablets instead of 8mg - I hadn't looked to see what you had prescribed, but it worked out well, as the price of these was half of the 8mg. The only thing Hydromorphone caused was severe allergic itching, all over. It took a while to find out whether it was that or the Effexor. I'd like to give another try at a Hydrocodone substitute - perhaps we could try the other med you suggested (I can't remember what it was). If this doesn't work, than maybe converting some of the Hydrocodone to Methadone is the better way to go. Let me know what you think- Mark Amundsen
----- Message # 2 ----From: Amundsen,Mark Sent: 02/21/2008 5:19 PM Oops - didn't know about it being triplicate. It better work fantastic to make up for the extra driving. I'll email in two weeks to update on the hydromorphone and the Effexor. Thanks for all the helpMark Amundsen
Mark. THe hydromorphone is also a triplicate. Not as convenient as norco. I wrote 1 month out for you to try it. The methadone is ready as well.
002303
suggested in the office ( I can't remember what that was), or another Norco prescription as recommended. Please call if there is any confusion 916-983-2589 Thanks- Mark Amundsen
Will resume norco.

----- Message # 2 ----From: Amundsen,Mark Sent: 03/04/2008 1:33 PM Hi Dr Baquero-
Norco is more affordable - but I thought there was something else you wanted to try before going back to the Norco. If not, I guess Norco would be the best choice,,, Mark Amundsen

Thanks for the update. Find out what is more affordable - vicodin or norco (I would prefer the norco because of the lower tylenol content).
----- Message # 1 -----
002304
Triplicate written. Please notify patient. Effexor 150 called in.

Sent: 03/12/2008 3:25 PM Hi Dr Baquero and Cherry= It's about time for another refill- I will be out of Methadone on Monday, so hopefully I can pick up a scrip before then. Also, I'm about due on a refll on Effexor XR - Dr Baquero was going to up it from 75MG's to 150 MG's, so a new prescription will have to be called in. Thanks for all your assistance... Mark Amundsen

I called in the norco.

----- Message # 1 ----From: Amundsen,Mark Sent: 03/05/2008 3:49 PM Hi Dr Baquero and Cherry- I'm hoping you got my last message about the Norco - I don't have anything left that works, so hopefully Dr Baquero can call in a prescription, either the one he
002305
----- Message # 1 ----From: Amundsen,Mark Sent: 04/23/2008 9:54 AM Hi Dr Baquero- I am going to be out of Methadone and Norco on Monday the 28th. I know it's early, but they haven't been working very well lately. I am hoping that you can increase the number of Methadone to 400 per month, and reduce the number of Norco by an equivalent amount, since the Norco seems to work less well than the Methadone, and I have been throwing up the Norco fairly regularly - and it will save a little money as well. If this amount doesn't work for you, than I leave it to yor judgement as to how to modify the amount. Please let me know if this is okay, or other arrangements should be made. Since both items will have different amounts, new prescriptions for both wil have to be established. Thanks in advance Dr Baquero... Mark Amundsen P.S. I have stopped taking the Effexor XR - it was too up and down, especially if I missed a dose. I'm trying the prozac again - it's been three months since I took it last, so maybe thats enough... Mark Amundsen
Electronically signed byCherry Mendoza on 4/23/2008 10:08 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi Dr Baquero- I am going to be out of Methadone and Norco on Monday the 28th. I know it's early, but they haven't been working very well lately. I am hoping that you can increase the number of Methadone to 400 per month, and reduce the number of Norco by an equivalent amount, since the Norco seems to work less well than the Methadone, and I have been throwing up the Norco fairly regularly - and it will save a little money as well. If this amount doesn't work for you, than I leave it to yor judgement as to how to modify the amount. Please let me know if this is okay, or other arrangements should be made. Since both items will have different amounts, new prescriptions for both wil have to be established. Thanks in advance Dr Baquero... Mark Amundsen P.S. I have stopped taking the Effexor XR - it was too up and down, especially if I missed a dose. I'm trying the prozac again - it's been three months since I took it last, so maybe thats enough... Mark Amundsen Transcription Type Unstructured to Doctor Preliminary Document Text Hi Dr Baquero- I am going to be out of Methadone and Norco on Monday the 28th. I know it's early, but they haven't been working very well lately. I am hoping that you can increase the number of Methadone to 400 per month, and reduce the number of Norco by an equivalent amount, since the Norco seems to work less well than the Methadone, and I have been throwing up the Norco fairly regularly - and it will save a little ID RH11029740 Date and Time 4/23/2008 9:54 AM
002306
money as well. If this amount doesn't work for you, than I leave it to yor judgement as to how to modify the amount. Please let me know if this is okay, or other arrangements should be made. Since both items will have different amounts, new prescriptions for both wil have to be established. Thanks have stopped taking especially if I missed a dose. months since I took in advance Dr Baquero... Mark Amundsen P.S. I the Effexor XR - it was too up and down, I'm trying the prozac again - it's been three it last, so maybe thats enough... Mark Amundsen
Patient was notified through Relay Health and patient picked up prescription.
Electronically signed byCherry Mendoza on 4/8/2008 11:38 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hello Mr Amundsen! Your rx is ready to be picked up. You can pick it up whenever you can. Thanks.
Cherry, MA

Document Text Hello Mr Amundsen! Your rx is ready to be picked up. You can pick it up whenever you can. Thanks.
ID RH10798950
Cherry, MA Display only: Transcription (RH10798950) on 4/4/2008 3:35 PM Document history: Transcription (RH10798950) on 4/4/2008 3:35 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter

Electronically signed byVictor Baquero, MD on 4/4/2008 12:53 PM
002307
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes VICTOR BAQUERO, M.D., MD Wed Mar 5, 2008 4:26 PM Signed I called in the norco. Links Previous Version Transcription Type Unstructured to Doctor
Preliminary
ID RH10429646
Document Text VICTOR BAQUERO, M.D., MD Wed Mar 5, 2008 4:26 PM Signed I called in the norco.
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes VICTOR BAQUERO, M.D., MD Mon Mar 3, 2008 6:20 PM Signed Thanks for the update. Find out what is more affordable - vicodin or norco (I would prefer the norco because of the lower tylenol content). Links Previous Version Transcription Type Unstructured to Doctor Preliminary
Document Text VICTOR BAQUERO, M.D., MD Mon Mar 3, 2008 6:20 PM Signed Thanks for the update. Find out what is more affordable - vicodin or norco (I would prefer the norco because of the lower tylenol content).
ID RH10389119
Display only: Transcription (RH10389119) on 3/4/2008 9:22 AM Document history: Transcription (RH10389119) on 3/4/2008 9:22 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes VICTOR BAQUERO, M.D., MD Thu Feb 21, 2008 9:35 AM Signed
002308
Mark.
THe hydromorphone is also a triplicate. Not as convenient as norco. I wrote 1 month out for you to try it. The methadone is ready as well. Links Previous Version Transcription Type Unstructured to Doctor Preliminary
Document Text VICTOR BAQUERO, M.D., MD Thu Feb 21, 2008 9:35 AM Signed Mark.
ID RH10273250
THe hydromorphone is also a triplicate. Not as convenient as norco. I wrote 1 month out for you to try it. The methadone is ready as well.
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Thanks Cherry-I'll pick it up tomorrow... Mark Links Previous Version Transcription Type Unstructured to Doctor
Document Text Thanks Cherry-I'll pick it up tomorrow... Mark Display only: Transcription (RH10505594) on 3/13/2008 10:26 PM Document history: Transcription (RH10505594) on 3/13/2008 10:26 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
002309
Follow up in 1-2 months. Discussed care and warning signs with Mark and all questions and concerns were fully answered. He will call or followup in the office if any problems arise.
PLAN: See Orders. Discussed care and warning signs with Mark and all questions and concerns were fully answered. He will call or followup in the office if any problems arise. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his/her medical care. No guarantees were made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit.
Electronically signed byVictor Baquero, MD on 4/30/2008 2:24 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Visit Notes CHERRY MENDOZA Wed Apr 30, 2008 1:37 PM Vitals taken, allergies verified, pharmacy verified, and pain assessed. Cherry Mendoza, MA
Electronically signed by CHERRY MENDOZA at Wed Apr 30, 2008 1:37 PM
Progress Notes VICTOR BAQUERO, M.D., MD Fri Apr 25, 2008 5:07 PM Signed Mark,
I'll need to meet with you to discuss the medication. Please schedule with me next week. I'll prescribe enough methadone until you can see me. I sent you a message but the computer crashed thereafter. I presumed you did not get it. Links Previous Version Transcription Type Unstructured to Doctor Preliminary
Document Text VICTOR BAQUERO, M.D., MD Fri Apr 25, 2008 5:07 PM Signed Mark,
ID RH11051977
I'll need to meet with you to discuss the medication.
002310
Please schedule with me next week. I'll prescribe enough methadone until you can see me. I sent you a message but the computer crashed thereafter. I presumed you did not get it. Display only: Transcription (RH11051977) on 4/28/2008 11:06 AM Document history: Transcription (RH11051977) on 4/28/2008 11:06 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter


Mark, I'll need to meet with you to discuss the medication. Please schedule with me next week. I'll prescribe enough methadone until you can see me. I sent you a message but the computer crashed thereafter. I presumed you did not get it.
----- Message # 1 ----From: Amundsen,Mark Sent: 04/24/2008 9:03 PM Hi Dr Baquero and Cherry- I just wanted to make sure you received my last message - I will be out of Methadose on Sunday or Monday. I know it is faster than usual, but the Norco has been ineffective. I was hoping we could do what we discussed last visit - increasing the Methadone, and reducing the Norco, perhaps to 400 Methadone, and a corresponding reduction in Norco. Or another amount as you can suggest. Thanks for your attention in this matter- Mark Amundsen
Electronically signed byCherry Mendoza on 4/25/2008 10:34 AM
002311
Unstructured to Doctor Preliminary
RH11120872
5/1/2008 10:02 AM
Document Text Hello Mr Amundsen, Dr. Baquero called in your Soma yesterday just FYI. BTW I will be moving so just FYI in a couple of weeks if you see someone else's name don't be suprised. Take care Mr Amundsen! />Cherry, MA Display only: Transcription (RH11120872) on 5/1/2008 10:02 AM Document history: Transcription (RH11120872) on 5/1/2008 10:02 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
----- Message # 1 ----From: Amundsen,Mark Sent: 04/30/2008 3:27 PM Hi Dr Baquero- While I was in today, I forgot to request a refill for Soma along with the refill for Norco- could you please call that one in as well? Thanks a million!!! Mark
Electronically signed byCherry Mendoza on 4/30/2008 5:00 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes
Mark Amundsen is a 48yr year old male who is here for the following reason: Follow up on medications. Left hip is getting worse. Now almost clicks out of joint routinely. Feels more bone on bone rather than clicking. Pain has increased. Having side effects with the norco. Requests decreasing dose and increasing Methadone. Stopped effexor due to side effects. Restarted fluoxetine 1 week ago. Doing well. Review of Systems: Constitutional: negative. CV: negative. Resp: negative.
002312
History Substance Use Topics Tobacco Use: Alcohol Use: Patient Active Problem List Diagnoses BACKACHE NOS TESTICULAR HYPOFUNC NEC BRACHIAL NEURITIS NOS ADVANCED OSTEOARTHRITIS OF THE LEFT HIP DEPRESSIVE DISORDER Current outpatient prescriptions Medication NORCO 10 MG-325 MG TAB FLUOXETINE 40 MG CAP
Code 724.5 257.2 723.4 726.5 311
METHADONE 10 MG TAB SOMA 350 MG TAB METHADONE 10 MG TAB ALEVE 220 MG TAB
Sig 1 po q 4 hrs for pain. take 1 capsule (40 mg) by oral route once daily in the morning Take 12 daily (120mg) 1 po tid Take 2 po every 6 hours (max 10 daily) take 1 tablet (220mg) by oral route every 12 hours as needed
C (98.5 F) (Tympanic) | Resp 12 | Wt 103.103 kg (227 lb BP 124/80 | Pulse 68 | Temp (Src) 36.9 4.8 oz) OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Skin: Skin color, texture, turgor normal. No rashes or lesions. Mental Status: normal though process. Normal mood. Musculoskeletal: stable. ASSESSMENT: 726.5 ENTHESOPATHY OF HIP REGION Comment: ongoing. Progressive. Has no insurance. Unable to order tests or follow up with ortho until he is employed due to cost. Plan: METHADONE 10 MG TAB, NORCO 10 MG-325 MG TAB Increase methadone to 12-13 daily. Will use norco for as needed only. Filled out pain agreement. 724.5 BACKACHE UNSPECIFIED Comment: as above. Plan: METHADONE 10 MG TAB 311 DEPRESSIVE DISORDER Comment: The current medical regimen is effective; continue present plan and medications. Plan: FLUOXETINE 40 MG CAP
002313
Thanks Cherry - I'll pick it up today... Mark Amundsen Display only: Transcription (RH11282466) on 5/16/2008 10:21 AM Document history: Transcription (RH11282466) on 5/16/2008 10:21 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter


----- Message # 1 ----From: Amundsen,Mark Sent: 05/14/2008 5:57 AM Hi Dr Baquero- I have been using about 13 Methadone per day, which has mostly done the trick. I haven't been missing the Norco at all. However, I will be out of the Methadone on Saturday, so I would like to get a refill before Friday. I'll get refills for the other meds through the pharmacy... Thanks again Mark Amundsen P.S. The Prozac still seems to be working - yaay!!
Electronically signed byCherry Mendoza on 5/14/2008 4:57 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hello Mr Amundsen, Dr. Baquero called in your Soma yesterday just FYI. BTW I will be moving so just FYI in a couple of weeks if you see someone else's name don't be suprised. Take care Mr Amundsen! />Cherry, MA Links Previous Version Transcription Type
ID Date and Time
002314
Left message that written rx is ready for pick up.

Electronically signed byJulie Stewart on 6/9/2008 9:20 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter

Electronically signed byVictor Baquero, MD on 6/6/2008 5:15 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi Dr Baquero and Cherry- It's about time for another refill - I will be out on Wednesday next week, but wanted to give you a few days notice in case you were out of the office or something. Thank you for your attention in this matter... Mark Amundsen Transcription Type Unstructured to Doctor Preliminary Document Text Hi Dr Baquero and Cherry- It's about time for another refill - I will be out on Wednesday next week, but wanted to give you a few days notice in case you were out of the office or something. Thank you for your attention in this matter... Mark Amundsen Display only: Transcription (RH11578076) on 6/6/2008 12:44 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Thanks Cherry - I'll pick it up today... Mark Amundsen Links Previous Version Transcription Type Unstructured to Doctor
Preliminary
ID RH11578076
ID RH11282466
Document Text
002315
Hi Mandy and Dr. Baquero- Sorry about the repeat messages - I'm usually not the one who checks phone messages, so receiving them is kind of iffy. Cherry used to reply to the email when the script was ready. Also, Dr Baquero forgot that we increased the amount of Methadone from 300 to 390 last month - it's no problem now, I'll just be a little early refilling next month. I'll remind him then, too. Thanks for all your help, and the quick response!! Mark Amundsen
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi Dr Baquero and Cherry- I just wanted to send a reminder that I am out of Methadone today - I'm hoping you can provide a refill script sometime soon. Please let me know when this has been performed... Thanks! Transcription Type Unstructured to Doctor Preliminary Document Text Hi Dr Baquero and Cherry- I just wanted to send a reminder that I am out of Methadone today - I'm hoping you can provide a refill script sometime soon. Please let me know when this has been performed... Thanks! Display only: Transcription (RH11623524) on 6/11/2008 5:56 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi Cherry- Happy Monday! I thought since I usually have a tough time remembering on Monday what I was doing last week, I would send in another request for a refill on Methadone. I probably should have waited until this week to requested it anyway. Thanks for everything!! Mark Amundsen Transcription Type Unstructured to Doctor Preliminary
Document Text Hi Cherry- Happy Monday! I thought since I usually have a tough time remembering on Monday what I was doing last week, I would send in another request for a refill on Methadone. I probably should have waited until this week to requested it anyway. Thanks for everything!! Mark Amundsen
ID RH11623524
ID RH11593765
002316
Mark, I have you perscription ready. have a great weekend. /> mandy Links Previous Version Transcription Type Unstructured to Doctor Preliminary Document Text Mark, I have you perscription ready. have a great weekend. /> mandy
Display only: Transcription (RH11793540) on 6/27/2008 10:52 AM Document history: Transcription (RH11793540) on 6/27/2008 10:52 AM ID RH11793540 Date and Time 6/27/2008 10:52 AM

Dr. Baquero, please check the amount, according to the patient, he states that you guys upped the amount to the 390 from 300. He said he will be out on Monday. Thank you
Electronically signed byMandy Chilson on 6/26/2008 9:14 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi Mandy and Dr. Baquero- Sorry about the repeat messages - I'm usually not the one who checks phone messages, so receiving them is kind of iffy. Cherry used to reply to the email when the script was ready. Also, Dr Baquero forgot that we increased the amount of Methadone from 300 to 390 last month - it's no problem now, I'll just be a little early refilling next month. I'll remind him then, too. Thanks for all your help, and the quick response!! Mark Amundsen Transcription Type Unstructured to Doctor Preliminary
Document Text
ID RH11637977
002317
Document Text Hi Dr Baquero and Mandy- It's about tim for another refill - I'll be out on Saturday or Sunday, so any time before Friday would be great. Thanks for your attention in this - I'll be sure to make an appt in October... Mark Amundsen Display only: Transcription (RH12545093) on 9/3/2008 1:19 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Thanks - I'll make one in October, unless I need to come in for anything else sooner... Mark Amundsen Links Previous Version Transcription Type Unstructured to Doctor Preliminary
Document Text Thanks - I'll make one in October, unless I need to come in for anything else sooner...
ID RH12269562
Mark Amundsen Display only: Transcription (RH12269562) on 8/11/2008 3:54 PM Document history: Transcription (RH12269562) on 8/11/2008 3:54 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hey Mark, I left a message but wanted to send this to you as well. :) Your Methadone is ready for pick up. />Take care, Mandy Links Previous Version Transcription Type Unstructured to Doctor
Document Text
002318
Hey Mark, I left a message but wanted to send this to you as well. :) Your Methadone is ready for pick up. />Take care, Mandy
Left message informing patient.

Please notify patient of prescription being ready for pick-up. Thanks.

Electronically signed byNancy Jaeger, MD on 7/23/2008 5:13 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Yes, patient usually takes 4 tabs 3 times a day; 10-12 pills per day of methadone. Please call patient when written and ready for pick up.
Electronically signed byJulie Stewart on 7/23/2008 2:44 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Please clarify dosing--Methadone should be dosed every 8 hrs for pain control; is he atking 4 tabs TID?
Electronically signed byNancy Jaeger, MD on 7/23/2008 2:38 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Patient notified via RH.

Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes
002319
Mark Amundsen Links Previous Version Transcription Type Unstructured to Doctor

Document Text Hi MandyYes, I realize it's a bit early this month - However, let me point out two things. There were 31 days last month, and the refill usually goes day 5 to day 4, so the normal refill this month should be on the 9th, not the 11th. Also, I used more pills than normal this month due to contracting a jaw infection due to dental work. The dentist offered pain pills, but since I am only supposed to get them from 1 doctor, I turned them down. If Dr Baquero would like to check with the dentist, his name is Dr Judd at 916-983-1999 />However, I will understand if Dr Baquero wishes to wait until the regular time, but the regular time should be the 9th, not the 11th... /> Thanks! Mark Amundsen Display only: Transcription (RH12576584) on 9/5/2008 8:33 AM Document history: Transcription (RH12576584) on 9/5/2008 8:33 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
It's about tim for another refill - I'll be out on Saturday or Sunday, so any time before Friday would be great. Thanks for your attention in this - I'll be sure to make an appt in October...
Mark Amundsen
Electronically signed byMandy Chilson on 9/3/2008 8:28 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi Dr Baquero and Mandy- It's about tim for another refill - I'll be out on Saturday or Sunday, so any time before Friday would be great. Thanks for your attention in this - I'll be sure to make an appt in October... Mark Amundsen Transcription Type Unstructured to Doctor Preliminary ID RH12545093 Date and Time 9/3/2008 1:19 AM
002320

Electronically signed byMandy Chilson on 9/9/2008 8:18 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Please notify. Triplicate will be ready on the 9th. As mentioned on the pain contract. Prescriptions are to last the entire month. Any changes to the normal use should be discussed in the office.
Hi MandyYes, I realize it's a bit early this month - However, let me point out two things. There were 31 days last month, and the refill usually goes day 5 to day 4, so the normal refill this month should be on the 9th, not the 11th. Also, I used more pills than normal this month due to contracting a jaw infection due to dental work. The dentist offered pain pills, but since I am only supposed to get them from 1 doctor, I turned them down. If Dr Baquero would like to check with the dentist, his name is Dr Judd at 916-983-1999 However, I will understand if Dr Baquero wishes to wait until the regular time, but the regular time should be the 9th, not the 11th... Thanks!
Mark Amundsen
Electronically signed byMandy Chilson on 9/5/2008 9:54 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi MandyYes, I realize it's a bit early this month - However, let me point out two things. There were 31 days last month, and the refill usually goes day 5 to day 4, so the normal refill this month should be on the 9th, not the 11th. Also, I used more pills than normal this month due to contracting a jaw infection due to dental work. The dentist offered pain pills, but since I am only supposed to get them from 1 doctor, I turned them down. If Dr Baquero would like to check with the dentist, his name is Dr Judd at 916-983-1999 />However, I will understand if Dr Baquero wishes to wait until the regular time, but the regular time should be the 9th, not the 11th... /> Thanks!
002321
ID RH13038484
Document Text hi Mark, The rx is ready for your pick-up. have a great day />Teri

From RH
Electronically signed byTeri L Rhodewalt on 10/6/2008 9:55 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Please notify. Triplicate will be ready on the 9th. As mentioned on the pain contract. Prescriptions are to last the entire month. />Any changes to the normal use should be discussed in the office. Links Previous Version Transcription Type Unstructured to Doctor Preliminary
Document Text Please notify. Triplicate will be ready on the 9th. As mentioned on the pain contract. Prescriptions are to last the entire month. />Any changes to the normal use should be discussed in the office. Display only: Transcription (RH12622384) on 9/9/2008 8:17 AM Document history: Transcription (RH12622384) on 9/9/2008 8:17 AM
ID RH12622384
002322
Unstructured to Doctor Preliminary Document Text Thanks Dr Baquero-
RH13372651
11/3/2008 12:47 PM
I did a little checking - seems there's nothing important on that side - everything's on the right. Still, I'll make an appointment - could be diverticulitis.... Mark Display only: Transcription (RH13372651) on 11/3/2008 12:47 PM Document history: Transcription (RH13372651) on 11/3/2008 12:47 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter

He is calling for a refill of SOMA . He did call his pharmacy for a refill already. He states that the dose is 350mg and the instructions are: as directed . He requests Send to preferred pharmacy. He is calling for a refill of NORCO. He did call his pharmacy for a refill already. He states that the dose is 10mg and the instructions are: as directed . He requests Send to preferred pharmacy.
Patient is out of both these meds and need to get today please let the patient know when ordered
Electronically signed byCharles W Griffin on 10/17/2008 2:55 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Left message for patient to pick up prescription at our front desk

Electronically signed byTeri L Rhodewalt on 10/7/2008 10:24 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes hi Mark, The rx is ready for your pick-up. have a great day />Teri Links Previous Version
002323
Hi TeriThanks for the refill - I guess Costco dropped the ball again, cause I called them on Friday evening, and they said it hadn't arrived...Oh wellThanks again, Mark
Received a faxed refill request from pharmacy, showing last fill date of. 10172008.
Electronically signed byIdania E Baca on 11/13/2008 2:38 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes It's ready to pick up. Links Previous Version Transcription Type Unstructured to Doctor
Document Text It's ready to pick up. Display only: Transcription (RH13392241) on 11/3/2008 3:08 PM Document history: Transcription (RH13392241) on 11/3/2008 3:08 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Thanks Dr BaqueroI did a little checking - seems there's nothing important on that side - everything's on the right. Still, I'll make an appointment - could be diverticulitis.... Mark Links Previous Version Transcription Type
ID Date and Time
002324
Preliminary Document Text Mark, it's ready. Display only: Transcription (RH13774227) on 12/1/2008 9:55 AM Document history: Transcription (RH13774227) on 12/1/2008 9:55 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi Teri- I talked to the Costco pharmacy, and they are still insisting that they haven't received a fax from your office. Either Costco lost it, or it is floating around wherever misplaced faxes go. Please resend the refill authorization to Costco - they said they have already resent the refill request this morning... Thanks, Mark Transcription Type Unstructured to Doctor Preliminary Document Text Hi Teri- I talked to the Costco pharmacy, and they are still insisting that they haven't received a fax from your office. Either Costco lost it, or it is floating around wherever misplaced faxes go. Please resend the refill authorization to Costco - they said they have already resent the refill request this morning... Thanks, Mark Display only: Transcription (RH13608780) on 11/17/2008 1:21 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi TeriThanks for the refill - I guess Costco dropped the ball again, cause I called them on Friday evening, and they said it hadn't arrived...Oh wellThanks again, Mark Links Previous Version Transcription Type Unstructured to Doctor Preliminary Document Text ID RH13591868 Date and Time 11/17/2008 1:09 PM
002325
Unstructured to Doctor Preliminary
RH14183669
12/23/2008 9:24 AM
Document Text Your rx is ready good sir... Merry Christmas, />Mandy Display only: Transcription (RH14183669) on 12/23/2008 9:24 AM Document history: Transcription (RH14183669) on 12/23/2008 9:24 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Left messages at both numbers

Electronically signed byDeborah L Hughes on 12/22/2008 3:43 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter

will be out of Methadone on Friday or Saturday - however, I will be leaving to go to my brothers house on Wednesday. I am hoping you can write out a prescription before Wednesday so I won't have to come back to town. Please let me know when to come in.... Thanks! Mark Amundsen
Electronically signed byMandy Chilson on 12/22/2008 8:13 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Mark, it's ready. Links Previous Version Transcription Type Unstructured to Doctor
002326
Display only: Transcription (RH14446258) on 1/13/2009 12:22 PM Document history: Transcription (RH14446258) on 1/13/2009 12:22 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter

The placard is a possibility. I would like to see you to discuss medications, symptoms, etc.
Electronically signed byVictor Baquero, MD on 1/13/2009 12:09 PM Electronically signed byVictor Baquero, MD on 1/13/2009 12:11 PM Links Previous Version Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Hi Dr Baquero and AmandaI have started a new job, which is really good, except the parking is downtown, and quite a ways away. As my hip is getting worse, I am hoping I would be able to receive a handicapped placard to use until I get the hip replaced. I'd also like to make an appointment for a checkup, but I'd like to wait until after the insurance kicks in to do so. Please let me know whether a placard is a possibility. Thanks for all your helpMark Amundsen
Electronically signed byMandy Chilson on 1/13/2009 8:50 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Your rx is ready good sir... Merry Christmas, />Mandy Links Previous Version Transcription Type ID Date and Time
002327
Electronically signed byMandy Chilson on 1/20/2009 8:57 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi Dr Baquero and Amanda- I wanted to let y'all know that I will be needing a refill on Methadone - I will be out of medication on Wednesday. I'm sending this a little early since I will be out of town on Tuesday, and I know y'all are closed on Monday. I will make an appointment after Feb 1st to talk about the handicapped placard - I'll have coverage by then. Thanks- Mark Amundsen Transcription Type Unstructured to Doctor Preliminary Document Text Hi Dr Baquero and Amanda- I wanted to let y'all know that I will be needing a refill on Methadone - I will be out of medication on Wednesday. I'm sending this a little early since I will be out of town on Tuesday, and I know y'all are closed on Monday. I will make an appointment after Feb 1st to talk about the handicapped placard - I'll have coverage by then. Thanks- Mark Amundsen Display only: Transcription (RH14514579) on 1/16/2009 9:42 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes The placard is a possibility. I would like to see you to discuss medications, symptoms, etc Go ahead and call the office to schedule an appt. thank you Mandy Links Previous Version Transcription Type Unstructured to Doctor
ID RH14514579
Document Text The placard is a possibility. I would like to see you to discuss medications, symptoms, etc Go ahead and call the office to schedule an appt. thank you Mandy
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Hi Dr Baquero and Amanda- It's about time for another refill. I won't be out until next Tuesday, but I thought I would give you plenty of time, since there is so many holidays in the next week. Thanks for all your assistance... Mark Amundsen
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Mark, No worries, that's why i'm here. :) />Take care, Mandy Links Previous Version Transcription Type Unstructured to Doctor Preliminary Document Text Mark, No worries, that's why i'm here. :)
/>Take care, Mandy

Prescription done.
Electronically signed byGertrudes Perlas Montemayor, MD on 1/20/2009 10:25 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Hi Dr Baquero and Amanda- I wanted to let y'all know that I will be needing a refill on Methadone - I will be out of medication on Wednesday. I'm sending this a little early since I will be out of town on Tuesday, and I know y'all are closed on Monday. I will make an appointment after Feb 1st to talk about the handicapped placard - I'll have coverage by then. Thanks- Mark Amundsen
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Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Visit Notes ELIZABETH ESPINUEVA, MA Wed Feb 18, 2009 4:21 PM Patient roomed, chief complaint noted, allergies verified, blood pressure, pulse, respiration, and weight obtained, screened for pain, and pharmacy verified. Elizabeth Espinueva, M.A.
Electronically signed by ELIZABETH ESPINUEVA, MA at Wed Feb 18, 2009 4:21 PM
Telephone Encounter
Pt called back and scheduled with Dr.Baquero for 4:00 pm today

Electronically signed byJasvir K Bhele on 2/18/2009 11:37 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Request urgent care or evaluation with any available provider. Otherwise ok to schedule with me at 4pm.
Patient called and states that he has been extremelly nautious, he said that he is belching what ever he eats for at least 11 to 12 hours. He can't go to the bathroom. He thinks everything is shutting down on him. There are no avalible appt left for today. Please call patient.
Electronically signed byDannel Cameron on 2/18/2009 9:03 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Thanks Mandy - I'll have to sneak out a little early to pick it up, but that shouldn't be a problem... Have a great long weekend yourself!! Mark Links Previous Version Transcription Type Unstructured to Doctor Preliminary Document Text Thanks Mandy - I'll have to sneak out a little early to pick it up, ID RH14915117 Date and Time 2/13/2009 10:22 AM
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but that shouldn't be a problem... Have a great long weekend yourself!! Mark Display only: Transcription (RH14915117) on 2/13/2009 10:22 AM Document history: Transcription (RH14915117) on 2/13/2009 10:22 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter

Let him know the triplicate will be ready to pick up Tuesday morning.
Hi Dr Baquero and AmandaIt's about time for another refill. I won't be out until next Tuesday, but I thought I would give you plenty of time, since there is so many holidays in the next week. Thanks for all your assistance... Mark Amundsen
Electronically signed byMandy Chilson on 2/11/2009 12:06 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi Dr Baquero and Amanda- It's about time for another refill. I won't be out until next Tuesday, but I thought I would give you plenty of time, since there is so many holidays in the next week. Thanks for all your assistance... Mark Amundsen Transcription Type Unstructured to Doctor Preliminary
Document Text
ID RH14881986
002331
Progress Notes Glad to hear you are back to normal. Take care. Links Previous Version Transcription Type Unstructured to Doctor Preliminary
Document Text Glad to hear you are back to normal. Take care. Display only: Transcription (RH15024928) on 2/20/2009 10:05 AM Document history: Transcription (RH15024928) on 2/20/2009 10:05 AM
ID RH15024928
Chief Complaint Patient presents with Stomach Problem no appetite, no BM, belch after eating and nausia X4days, H/A Hip Pain Handicap plaque
Mark Amundsen is a 49yr year old male who is here for the following reason: 4 days with malaise. No appetite. Belching. Limited GI activity. Mild discomfort - dull constant epigastric pain. Tried activia a few days ago. Also reports having a massive headache the whole weekend which resolved today. Feeling better today. No vomiting. Normal urination. Maintaining hydration. No fever or chills. Has been taking NSAIDs daily as well his usual opiates for his hip pain. Review of Systems: Constitutional: negative. CV: negative. Resp: negative. GI: constipation.
History Substance Use Topics Tobacco Use: Alcohol Use: Patient Active Problem List Diagnoses BACKACHE NOS TESTICULAR HYPOFUNC NEC BRACHIAL NEURITIS NOS ADVANCED OSTEOARTHRITIS OF THE LEFT HIP
Code 724.5 257.2 723.4 726.5
002332
DEPRESSIVE DISORDER CHRONIC PAIN MEDICATION AGREEMENT
311 719.45
Current outpatient prescriptions prior to encounter Medication Sig Dispense NORCO 10 MG-325 MG TAB 1 po q 4 hrs for pain. 100 METHADONE 10 MG TAB Take 12 daily (120mg) 390 ALEVE 220 MG TAB take 1 tablet (220mg) by oral route every 12 hours as needed
Refill 1 0 0
C (97.3 F) (Tympanic) | Resp 16 | Wt 98.294 kg (216 lb BP 106/84 | Pulse 76 | Temp (Src) 36.3 11.2 oz) OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Abdomen: BS normal. Abdomen soft, sigmoid fullness which extends to ascending colon and mild fullness over cecal region. No guarding or rebound. No masses or organomegaly. Skin: Skin color, texture, turgor normal. No rashes or lesions. Gait: limping along. ASSESSMENT: 789.09 Abdominal Pain, Other Specified Site (primary encounter diagnosis) Comment: New problem. reviewed xrays with Mr. Amundsen - no acute findings. Consistent with constipation. Discussed care and warning signs with Mark and all questions and concerns were fully answered. He will call or followup in the office if any problems arise. Plan: ABDOMEN 1 VIEW Trial of over the counter medications. Fiber. 726.5 ADVANCED OSTEOARTHRITIS OF THE LEFT HIP Comment: reviewed films. DMV form filled out for temporary dissability. Has limited range of motion due to severe arthritis. Will follow up with ortho for total hip replacement. PLAN: See Orders. Discussed care and warning signs with Mark and all questions and concerns were fully answered. He will call or followup in the office if any problems arise. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his/her medical care. No guarantees were made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit.
Electronically signed byVictor Baquero, MD on 2/18/2009 8:25 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Patient Instructions
Try Miralax twice a day. Magnesium citrate - to clear the bowels. Both are over the counter.
Electronically signed byVictor Baquero, MD on 2/18/2009 5:14 PM
002333
It's here on my desk />Hope you had a great weekend. Mandy


Electronically signed byVictor Baquero, MD on 3/16/2009 10:08 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi Dr Baquero and AmandaIt's time for another refill on Methadone. I will be out on Monday, and I would like to pick up a refill script either Friday morning at 8:00, or Monday, as I have off that day. Thanks for all y'all do for me - working is killing me! /> Mark Amundsen P.S. The magnesium citrate did the job - and then some...had to take a whole bottle though. Transcription Type Unstructured to Doctor Preliminary
Document Text Hi Dr Baquero and AmandaID RH15344238 Date and Time 3/12/2009 11:41 AM
It's time for another refill on Methadone. I will be out on Monday, and I would like to pick up a refill script either Friday morning at 8:00, or Monday, as I have off that day. Thanks for all y'all do for me - working is killing me! /> Mark Amundsen P.S. The magnesium citrate did the job - and then some...had to take a whole bottle though. Display only: Transcription (RH15344238) on 3/12/2009 11:41 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed.
002334
Thanks for all your helpMark Amundsen

Electronically signed byMandy Chilson on 4/9/2009 11:35 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi Dr Baquero and Amanda- It's about that time again for another Methadone refill. I will be out on next Tuesday, but I'm hoping to pick up the prescription Monday night unless it's done earlier. I have to take off early from work to get there in time. If it's done before then, maybe I could pick it up Monday morning before work... Thanks for all your help- Mark Amundsen Transcription Type Unstructured to Doctor Preliminary
Document Text Hi Dr Baquero and Amanda- It's about that time again for another Methadone refill. I will be out on next Tuesday, but I'm hoping to pick up the prescription Monday night unless it's done earlier. I have to take off early from work to get there in time. If it's done before then, maybe I could pick it up Monday morning before work... Thanks for all your help- Mark Amundsen ID RH15798116 Date and Time 4/9/2009 10:33 AM
Display only: Transcription (RH15798116) on 4/9/2009 10:33 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Mark it is READY YEAH.... :) It's here on my desk />Hope you had a great weekend. Mandy Links Previous Version Transcription Type Unstructured to Doctor Preliminary Document Text Mark it is READY YEAH.... :) ID RH15378240 Date and Time 3/16/2009 2:09 PM
002335
Electronically signed byMandy Chilson on 5/7/2009 11:35 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Mark, What in the world were you doin up at 1213 am? :} /> I have your rx ready for pick up. Take care, and hope you had a great Easter.
Mandy

Document Text Mark, ID RH15830013 Date and Time 4/13/2009 10:24 AM
What in the world were you doin up at 1213 am? :} /> I have your rx ready for pick up. Take care, and hope you had a great Easter. Mandy
Prescription is ready. MARTINA RANDOLPH, M.D.

Electronically signed byMartina Dobrovodska Randolph, MD on 4/9/2009 11:51 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
It's about that time again for another Methadone refill. I will be out on next Tuesday, but I'm hoping to pick up the prescription Monday night unless it's done earlier. I have to take off early from work to get there in time. If it's done before then, maybe I could pick it up Monday morning before work...
002336
lb) | SpO2 97%

Electronically signed by ANEEKA NALDOZA, MA at Thu May 21, 2009 1:33 PM
Progress Notes Thanks Mandy! Mark Links Previous Version Transcription Type Unstructured to Doctor
Preliminary
ID RH16270780
Document Text Thanks Mandy! Mark



It's time for another refill on Methadone. Please let me know via email when it is available. Also, I am hoping you can specify that I am taking 13 per day versus 12, as the amount prescribed works out to 30 days at 13 per day. They had me pay for a few extra days cause they said the script was for 32 days. even when it was not... Thanks! Mark Amundsen
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Plan: C DIFFICILE TOXIN A & B EIA, CULTURE GASTROINTESTINAL, BACTI, CRYPTOSPORIDIUM/GIARDIA FA, BLOOD COUNT, COMPREHENSIVE METABOLIC PANEL, SED RATE WESTERGREN 558.9U Colitis Comment: as above. Plan: C DIFFICILE TOXIN A & B EIA, CULTURE GASTROINTESTINAL, BACTI, CRYPTOSPORIDIUM/GIARDIA FA, BLOOD COUNT, COMPREHENSIVE METABOLIC PANEL, SED RATE WESTERGREN PLAN: See Orders. Discussed care and warning signs with Mark and all questions and concerns were fully answered. He will call or followup in the office if any problems arise. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his/her medical care. No guarantees were made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit.
Electronically signed byVictor Baquero, MD on 5/26/2009 8:50 PM Links Previous Version Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Visit Notes MANDY CHILSON Tue May 26, 2009 3:00 PM CC and vitals were taken, allergies and pharmacy verified, and screening for pain completed. Mandy Chilson, MA Electronically signed by MANDY CHILSON at Tue May 26, 2009 3:00 PM Progress Notes
SUBJECTIVE: Mark Amundsen is a 49yr old male. He is a patient of Dr. Baquero. Issue 1: He complains of bodyaches, tiredness, nausea, diarrhea (5 stools per day) usually constipated due to methadone, fatigue. Symptoms have been present for 5 days. Symptoms are not worsening. Feeling better. He has tried sleeping with some improvement. Fever:Yes-not measured, now resolved Asthma history: no Sick contacts: no Issue 2: He complains of diarrhea that started 4 days ago. Symptoms are improving. Stool frequency: 5-10 per day
002338
Stool quality: watery. Blood in stool: no Nocturnal diarrhea:yes - 2 times this week. Associated abdominal pain:Yes-gas pain Fever or chills:yes - as above Recent travel or antibiotics:no Tried OTC medications:no Weight loss:yes - lost 10 lbs. Recent URI:yes - as above Recent sick exposures:no Family history of GI cancer or Inflammatory bowel disease:no
Patient Active Problem List Diagnoses BACKACHE NOS TESTICULAR HYPOFUNC NEC BRACHIAL NEURITIS NOS ADVANCED OSTEOARTHRITIS OF THE LEFT HIP DEPRESSIVE DISORDER CHRONIC PAIN MEDICATION AGREEMENT
Code 724.5 257.2 723.4 726.5 311 719.45
Allergies to medications: reviewed and updated Medications: reviewed and updated Social History History Substance Use Topics Tobacco Use: Alcohol Use:
Occasional cigar Twice a month
REVIEW OF SYSTEMS General: some tiredness (not able to work and needs a note), weight loss as above, decreased appetite. Head: no headaches, no dizziness or syncope. Lungs: no dyspnea. CV: no new exertional chest pain OBJECTIVE: BP 110/78 | Pulse 89 | Temp (Src) 36.4 C (97.5 F) (Tympanic) | Resp 12 | Wt 92.534 kg (204 lb) | SpO2 97% He appears well, in no apparent distress. Alert and oriented times three, pleasant and cooperative. Eyes: no conjunctivitis Ears: normal Nose: normal Oropharynx: benign Neck: supple no adenopathy Chest: clear, no wheeze, no rales Skin: no rash Abdomen: soft & nontender. No organomegaly, masses, guarding or rebound. Bowel sounds are normal.
002339
DATA: Detailed chart review was provided. Review was helpful in medical decision making. ASSESSMENT AND PLAN AS DISCUSSED WITH Mr. Amundsen: 465.9C Acute URI (primary encounter diagnosis) Comment: improving Plan: Discussed routine URI care with Mr. Amundsen and all questions and concerns were fully answered. He will call me or followup in the office if any problems arise. Recommend symptomatic therapy. May use acetaminophen as needed according to package directions. 787.91 Diarrhea Comment: improving Plan: Increase oral fluid intake. Discussed hydration. Use Imodium AD (available over-the-counter) as directed. Signs and symptoms of dehydration discussed. Go STAT to nearest hospital emergency department if high fever, dehydration, marked weakness, fainting, increased abdominal pain, blood in stool or vomiting occur. Follow up for stool studies if diarrhea persists. Routine medication risks, complications, and contraindications reviewed. Mr. Amundsen understands and accepts the medication(s). Call or return to clinic prn if these symptoms worsen or fail to improve as anticipated. Reviewed pertinent history with Mr. Amundsen: Past medical history: Yes Social history: Yes Family history: no I have updated any new information in EpicCare. Barriers to learning assessed: none. Mr. Amundsen verbalized understanding of teaching and instructions. No guarantees were made regarding medical care or treatment outcome. Counseling time about 5 minutes. Mr. Amundsen was seen and examined by GIGI MONTEMAYOR, M.D.
Electronically signed byGertrudes Perlas Montemayor, MD on 5/21/2009 8:55 PM Links Previous Version Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Patient Instructions
INFORMATION FOR MANAGEMENT OF VOMITING AT HOME Drink small amounts (1/4 cup) of clear fluid-gaterade or pedialyte, frequently (every 10-15 minutes) as tolerated. Avoid milk and solids until no vomiting for 12 hours. Then advance diet as tolerated. Please report to emergency room if develop dizziness, blood in vomit or passing out.
Electronically signed byGertrudes Perlas Montemayor, MD on 5/21/2009 1:50 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Visit Notes ANEEKA NALDOZA, MA Thu May 21, 2009 1:33 PM vitals signs taken, allergies verified, screened for pain, aneeka s. naldoza, MA BP 110/78 | Pulse 89 | Temp (Src) 36.4 C (97.5 F) (Tympanic) | Resp 12 | Wt 92.534 kg (204
002340
Mark Amundsen
Rx called in and patient notified.

Electronically signed byCory O'Dell on 5/28/2009 4:18 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Patient states that pharmacy has not received perscription via fax yet. Please advise when done.
Electronically signed byBrenda J Fallon on 5/28/2009 3:44 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
LEFT MESSAGE FOR PT TO RETURN CALL.

Electronically signed byCory O'Dell on 5/28/2009 8:29 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Please notify. Culture is positive for C. Diff - as expected. Called in antibiotics to his pharmacy. Take for 2 weeks. Also take probiotics. Follow up if not better.
Electronically signed byVictor Baquero, MD on 5/28/2009 8:11 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes
Chief Complaint Patient presents with Diarrhea off and on x's week, pt is feeling very "yucky"
Mark Amundsen is a 49yr year old male who is here for the following reason: Diarrhea for the past 8 days. Came in last week and had upper respiratory illness and early diarrhea symptoms. Has had a low grade temperature. Was better towards the end of last week but is worse now. Still on medications. Stools are watery, foul smelling, no blood. Cramping with associated discomfort. Limited appetite. No nausea or vomiting. Simple diet. 3 weeks ago was on
002341
amoxicillin for a tooth infection. Review of Systems: Constitutional: fatigue. CV: negative. Resp: negative. Musculoskeletal: negative.
History Substance Use Topics Tobacco Use: Alcohol Use: Patient Active Problem List Diagnoses BACKACHE NOS TESTICULAR HYPOFUNC NEC BRACHIAL NEURITIS NOS ADVANCED OSTEOARTHRITIS OF THE LEFT HIP DEPRESSIVE DISORDER CHRONIC PAIN MEDICATION AGREEMENT Current outpatient prescriptions prior to encounter Medication Sig METHADONE 10 MG TAB Take 13 daily (130mg) SOMA 350 MG TAB 1 po tid NORCO 10 MG-325 MG TAB 1 po q 4 hrs for pain. ALEVE 220 MG TAB take 1 tablet (220mg) by oral route every 12 hours as needed
Code 724.5 257.2 723.4 726.5 311 719.45
Dispense 390 100 100
Refill 0 1 1 0
C (99.7 F) (Tympanic) | Wt 92.08 kg (203 lb) BP 124/78 | Pulse 80 | Temp (Src) 37.6 OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Heart: normal rate and regular rhythm, no murmurs, clicks, or gallops. Lungs: clear to auscultation. Abdomen: BS normal to hyperactive. Abdomen soft, mild sensitivity along left lower quadrant. No guarding or rebound. No peritoneal signs. No masses or organomegaly. Skin: Skin color, texture, turgor normal. No rashes or lesions. Rectal: deferred. ASSESSMENT: 787.91 Diarrhea Comment: New problem. Suspect possible C. Diff. See orders. Discussed fluids and electrolyte replacement. Will order labs to eplore the possibility of colitis. I have recommended Pedialyte, Gatorade, soups, water, BRAT diet and to advance diet as tolerated. He is to return to the office if symptoms persist or worsen; I have alerted him to call if the following symptoms develop: High fever, dehydration, marked weakness, fainting, increased abdominal pain, blood in stool or vomit. Contact precautions discussed.
002342
Mandy Links Previous Version Transcription Type Unstructured to Doctor

Document Text Mark, Your rx and letter is ready for pick up. I'm glad to see that you are doing better. :) Take care, Mandy Display only: Transcription (RH16758487) on 6/2/2009 1:39 PM Document history: Transcription (RH16758487) on 6/2/2009 1:39 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter

Triplicate written. Please notify patient. Letter written.

Just wanted to let you know that it's time for a refill on Methadone. Also, I am starting to feel normal again after the C-Diff. The trots stopped Sunday morning, but It took a little longer to get my strength back. I will go back to work tomorrow (Wednesday) or Thursday. Speaking of this, my work asked for another note to finish my absence up - I'm hoping that maybe you could write up a note excusing me the 29th of May through the 3rd of June. Hopefully, I can pick up the note along with the prescription. Thanks for everything, especially for making me better after the C-Diff. I just didn't know how bad going 15 times a day could make you feel...
002343
Telephone Encounter
Patient came in and picked up RX

RX ready for pick up, left message for patient to return call
Pt would like to know if his Methadone (DOLOPHINE) 10 mg PO Tablet is ready to pick up?
Electronically signed byErica F Wilson on 6/29/2009 1:51 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Marc, I'll have the prescription ready by monday. Take care. Links Previous Version Transcription Type Unstructured to Doctor Preliminary Document Text Marc, I'll have the prescription ready by monday. Take care. Display only: Transcription (RH17243165) on 6/26/2009 3:00 PM Document history: Transcription (RH17243165) on 6/26/2009 3:00 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Mark, Your rx and letter is ready for pick up. I'm glad to see that you are doing better. :) Take care, ID RH17243165 Date and Time 6/26/2009 3:00 PM
002344
Visit Notes MICHAEL DELACUEVA, LVN Wed Sep 16, 2009 10:40 AM Pt. Roomed. VS taken. Meds, allergies, and pharm reviewed. Michael Dela Cueva LVN. Electronically signed by MICHAEL DELACUEVA, LVN at Wed Sep 16, 2009 10:40 AM Telephone Encounter
I have attempted to contact the patient: left message to return my call on answering machine.
Electronically signed byMelanie McLaughlin on 9/15/2009 3:00 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter

Electronically signed byVictor Baquero, MD on 9/15/2009 1:56 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes
Chief Complaint Patient presents with Hip Problem Refill Request
Subjective: Mark Amundsen is a 49yr year old male who is here for the following reason: Increased hip pain. "something happened about 2-3 weeks ago". Sharp twinges of pain. Requesting evaluation with ortho. Review of Systems: Constitutional: negative.
History Substance Use Topics Tobacco Use: Alcohol Use: Patient Active Problem List Diagnoses BACKACHE NOS TESTICULAR HYPOFUNC NEC BRACHIAL NEURITIS NOS ADVANCED OSTEOARTHRITIS OF THE LEFT HIP DEPRESSIVE DISORDER CHRONIC PAIN MEDICATION AGREEMENT C. Difficile Diarrhea
Code 724.5 257.2 723.4 726.5 311 719.45 008.45AL
002345
Current outpatient prescriptions prior to encounter Medication Sig Dispense Hydrocodone 10 Take 1 Tab by mouth 100 mg/Acetaminophen 325 mg every 4 hours if (NORCO) 10-325 mg PO Tablet needed for pain. ALEVE 220 MG TAB take 1 tablet (220mg) by oral route every 12 hours as needed
Refill 1 0
BP 122/80 | Pulse 74 | Temp (Src) 36.6 C (97.9 F) (Tympanic) | Resp 10 | Wt 93.441 kg (206 lb) | SpO2 99% OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Mental Status: euthymic. Musculoskeletal: stable. ASSESSMENT: 726.5 ADVANCED OSTEOARTHRITIS OF THE LEFT HIP (primary encounter diagnosis) Comment: follow up with ortho. The current medical regimen is effective; continue present plan and medications. Plan: ORTHOPEDIC-GENERAL REFERRAL PLAN: See Orders. Discussed care and warning signs with Mark and all questions and concerns were fully answered. He will call or followup in the office if any problems arise. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his/her medical care. No guarantees were made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit.
Electronically signed byVictor Baquero, MD on 8/20/2009 1:36 PM Links Previous Version Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Visit Notes ANEEKA NALDOZA, MA Thu Aug 20, 2009 8:16 AM vitals signs taken, allergies verified, screened for pain, aneeka s. naldoza, MA BP 122/80 | Pulse 74 | Temp (Src) 36.6 C (97.9 F) (Tympanic) | Resp 10 | Wt 93.441 kg (206 lb) | SpO2 99%
Electronically signed by ANEEKA NALDOZA, MA at Thu Aug 20, 2009 8:16 AM
Progress Notes Referral done. Please notify patient. Also he will need xrays done in order for ortho to process the referral. Notify patient. Orders
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If you could have someone call or email when it is ready, that would be great! Thank, Mark Amundsen
Electronically signed byClare Jennings, MA on 10/9/2009 8:40 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi Dr Baquero- It's about time for another refill on Methadone - I'll be out next Monday or Tuesday. If you could have someone call or email when it is ready, that would be great! Thank, Mark Amundsen Transcription Type Unstructured to Doctor Preliminary Document Text Hi Dr Baquero- It's about time for another refill on Methadone - I'll be out next Monday or Tuesday. If you could have someone call or email when it is ready, that would be great! Thank, Mark Amundsen Display only: Transcription (RH19683265) on 10/9/2009 8:20 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Visit Notes MICHAEL DELACUEVA, LVN Thu Sep 17, 2009 10:47 AM I processed the HAR for this patient's surgery on 1/12/2010 for Left Total Hip Arthoplasty (27130) with a Diagnosis of Hip Degenerative Joint Disease ICD9 (715.15). Patient will return for preoperative appointment on . Michael Delacueva Electronically signed by MICHAEL DELACUEVA, LVN at Thu Sep 17, 2009 10:47 AM Progress Notes ID RH19683265 Date and Time 10/9/2009 8:20 AM
Dear VICTOR BAQUERO, M.D., I had the pleasure of evaluating Mark Amundsen in the Adult Reconstruction clinic today at the University of California, Davis Health System today, at your request. As you may recall, Mark Amundsen is a 49yr old male has been experiencing a 6month history of insidious onset left hip severe pain. Mark Amundsen describes a dull aching pain with occasional mechanical symptoms that are exacerbated by weight bearing activities and activities of daily living. They rate their pain as 10 out of 10. There has been no improvement with conservative management and radiographic data indicated degenerative joint disease. Mark Amundsen presents for evaluation and management of their joint disease. PMH: has no past medical history on file. PSH: has no past surgical history on file.
Allergies: Allergies as of 09/16/2009 - reviewed 09/16/2009
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Allergen Morphine Fentanyl
Reaction Hives
Noted 07/15/2004 05/01/2006
Family History: family history is not on file. Social History: ROS: 14 system review was completed and was negative except as noted in the HPI. C (97.1 F) (Tympanic) | Resp 18 | Ht 1.854 m Vital Signs: BP 107/81 | Pulse 81 | Temp (Src) 36.2 (6' 1") | Wt 90.719 kg (200 lb) General: AAOX3, No acute distress, normal affect and disposition HEENT: Normocephalic, Extraocular movements intact. Focused examination of the Left lower extremity was performed. Full hip, knee, and ankle ROM was present. There was no regional adenopathy detected nor any skin changes present. The hip revealed negative flexion contracture and positive severe pain at the extremes of motion was encountered. Knee exam revealed negative crepitus, negative joint line tenderenss and 0 effusion. The ligamentous exam revealed negative pseudolaxity. Foot alinment was wnl. Distal neurovascular exam was normal with 5/5 motor and intact sensation within the autogenous zones of the femoral, sciatic, deep and superficial peroneal, and tibial nerves. DTR's were 2+ and posterior tibial and dorsalis pedis peripheral pulses were 2+. Evaluation of Gait revealed a positive trendelenburg sign/gait and an antalgic gait was observed. Radiographic Data: Bilateral weight bearing x-rays of the Left Hip reveal severe degenerative joint disease. Assessment: Mark Amundsen is a 49yr old male with severe degenerative joint disease of the Lefthip . We discussed the options for treating arthritis including medical management, physiotherapy, injection, and surgery. Given that Mark Amundsen has exhausted conservative management, I recommend Total Joint Arthroplasty of the Lefthip . We will schedule for UCD and request preoperative optimization through a preoperative consultation with you. In the interim, our TJA coordinator will schedule Mark Amundsenl for the peri-operative patient information class and they will return to UC Davis @ my adult reconstruction clinic one week prior to their surgery date for a pre-operative evaluation. We will schedule the procedure once pre-operative optimization has been achieved. Thank you for the referral and the opportunity to participate in the care of your patient. If you have any questions regarding my treatment recommendations don't hesitate to call. Robert M. Tamurian, MD Assistant Professor Chief, Orthopaedic Oncology Service Deparment of Orthopaedic Surgery University of California, Davis Health System
Electronically signed byRobert Michael Tamurian, MD on 9/16/2009 11:45 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed.
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Physician ID # 10884, Pager 3059 Attending Physician Assistant Professor Chief, Orthopaedic Oncology Service Deparment of Orthopaedic Surgery University of California, Davis Health System
Electronically signed byRobert Michael Tamurian, MD on 12/15/2009 5:56 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes filed by Staff Doctor at 12/15/09 0429 Author: Staff Doctor Service: (none) Filed: 12/15/09 0429 Note Time: 12/15/09 0428 Author Type: ACTIVE - (HISTORICAL)
Scan on: 12/15/2009 4:28 AM by: - QUESTIONNAIRE Progress Notes filed by Staff Doctor at 12/15/09 0429 Author: Staff Doctor Service: (none) Filed: 12/15/09 0429 Note Time: 12/15/09 0428
Author Type:
ACTIVE - (HISTORICAL)
Scan on: 12/15/2009 4:28 AM by: - CONSENT TO OPERATION
Progress Notes
CC: Left hip pain HPI: Mark Amundsen is a 50 yr old male has been experiencing a 6month history of insidious onset left hip severe pain. Mark Amundsen describes a dull aching pain with occasional mechanical symptoms that are exacerbated by weight bearing activities and activities of daily living. They rate their pain as 10 out of 10. There has been no improvement with conservative management and radiographic data indicated degenerative joint disease. Mark Amundsen presents for evaluation and management of their joint disease. PMH: has no past medical history on file.depression, chronic pain PSH: Inguinal hernia repair
Family History: family history is not on file. Social History: Prior tobacco and alcohol use. Denies illicit drug use. ROS: 14 system review was completed and was negative except as noted in the HPI.
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Vital Signs:Temp: 36.8 C (98.3 F) (12/14 1352) Temp src: Tympanic (12/14 1352) Pulse: 76 (12/14 1352) BP: 142/80 mmHg (12/14 1352) Resp: 18 (12/14 1352) SpO2: -Height: 1.854 m (6' 1") (12/14 1352) Wt - Scale: 99.338 kg (219 lb) (12/14 1352) General: AAOX3, No acute distress, normal affect and disposition HEENT: Normocephalic, Extraocular movements intact. Lungs are clear to auscultation bilaterally Heart is regular rate and rhythym. Focused examination of the Left lower extremity was performed. Full hip, knee, and ankle ROM was present. There was no regional adenopathy detected nor any skin changes present. The hip revealed negative flexion contracture and positive severe pain at the extremes of motion was encountered. Knee exam revealed negative crepitus, negative joint line tenderenss and 0 effusion. The ligamentous exam revealed negative pseudolaxity. Foot alinment was wnl. Distal neurovascular exam was normal with 5/5 motor and intact sensation within the autogenous zones of the femoral, sciatic, deep and superficial peroneal, and tibial nerves. DTR's were 2+ and posterior tibial and dorsalis pedis peripheral pulses were 2+. Evaluation of Gait revealed a positive trendelenburg sign/gait and an antalgic gait was observed. Radiographic Data: Bilateral weight bearing x-rays of the Left Hip reveal severe degenerative joint disease. Assessment: Mark Amundsen is a 50yr old male with severe degenerative joint disease of the Lefthip . We discussed the options for treating arthritis including medical management, physiotherapy, injection, and surgery. Given that Mark Amundsen has exhausted conservative management, I recommend Total Joint Arthroplasty of the Lefthip . He is scheduled for this on 12/15/2009. All of the patient's questions and concerns were answered and addressed and he is amenable with the treatment plan. Informed consent was obtained. We will plan on doing a metal on metal construct. He will be enrolled in the Arixtra study postoperatively for DVT prophylaxis.
Electronically signed byJonathan G Eastman, MD on 12/14/2009 5:48 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Visit Notes ROSEMARY BRIXIE, RN Mon Dec 14, 2009 2:31 PM PREOPERATIVE INSTRUCTIONS AND INFORMATION FOR ADULTS
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INSTRUCTIONS FOR DAY OF SURGERY/PROCEDURE: Remember to follow the Fasting (NPO) Guidelines (see below). Arrange for someone else to transport you home after your surgery/procedure. Your surgery/procedure will be cancelled if you have not arranged for someone else to bring you home. Do not smoke or drink alcohol. Take a bath or shower on the morning of your surgery/procedure. DO NOT apply cosmetics, creams or lotion after bathing. DO NOT bring valuables or jewelry (including your wedding ring) with you on the day of surgery/procedure. Wear comfortable clothing that either zips or buttons in front. Bring your UC Davis blue card or some form of ID with you. Bring your CPAP machine for sleep apnea if you use one.
FASTING (NPO) GUIDELINES FOR ADULTS NO solid food, dairy products, chewing gum, juice with pulp (e.g. Orange Juice) after midnight. On the Morning of Surgery/Procedure: You may drink clear liquids until 2 hours prior to the time of arrival. Clear liquids include water, clear fruit juice (no pulp), carbonated beverages, and black coffee or tea without cream or milk. Do not drink any alcohol containing beverages. Take only these medications with a sip of water on the morning of surgery: As instructed by MD CONTACT INFORMATION: You will receive a phone call between 2-5 p.m. for the Same Day Surgery Center, or 12 noon-6 p.m. for the Main Operating Room (OR) on the work-day before your surgery/procedure date to confirm the time of check-in and location for your surgery/procedure. For questions, regarding the time of your surgery/procedure please call: (916) 734-8973 for Main Hospital, (916) 703-5299 or (916) 703-5300 for Same Day Surgery Center. For general questions or concerns, or if you havent heard from the operating room, please call or page your clinic manager or nurse manager at: 916-734-2700 CHECK-IN LOCATIONS FOR DAY OF SURGERY Main Hospital Surgery at 2315 Stockton Blvd., Sacramento, CA 95817
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You will have been told to check-in to either: Tower One (Pre Op Surgery Registration) Room 1670 Main OR One (University Surgery Center) Room 1322A Park in Parking Structure #1 (corner of Colonial Way and Stockton Blvd). Cost is $1.50 per day when validated. Same Day Surgery Center 4845 2nd Avenue, Sacramento, CA 95817 Park in Parking Structure #2 (corner of 49th and Y Streets) next to the Lawrence Ellison Ambulatory Care Center. Cost is $1.50 per day when validated. Electronically signed by ROSEMARY BRIXIE, RN at Mon Dec 14, 2009 2:31 PM VIN PLOYNGAM, LVN Mon Dec 14, 2009 1:52 PM Pt roomed, Vital signs taken, medication, allergys, pain score and pharmacy reviewed Vin Ployngam LVN Electronically signed by VIN PLOYNGAM, LVN at Mon Dec 14, 2009 1:52 PM Telephone Encounter
Left message that RX is ready


Hi Dr BaqueroIt's time for another refill on Methadone. I should be out on Thursday, so I'm hoping to pick up a prescription then. Sorry I didn't give more warning, but I got really busy today. Please have someone call or email when the script is ready for pickup... Thanks! Mark Amundsen
Electronically signed byClare Jennings, MA on 12/2/2009 8:23 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because
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Author: Patricia L Bailey, RN Service: Filed: 12/15/09 1638 Note Time:
(none) 12/15/09 1633
Author Type:
.NURSE: (RN or LVN)
PACU NURSE PROGRESS NOTE Note Started: 12/15/2009, 1633
Data: pt c/o pain 10/10 L hip, agitated Action: medicating pt with dilaudid per prn order, set up pts dilaudid pca Response: pt less agitated doseing off to sleep continues to rate pain 10/10-continuing to monitor and medicated Patricia L Bailey, RN Electronically signed by Patricia L Bailey, RN at 12/15/2009 4:38 PM Nurse Progress signed by Patricia L Bailey, RN at 12/15/09 1633 Author: Patricia L Bailey, RN Service: (none) Author Type: 12/15/09 1633 12/15/09 1632 Filed: Note Time:
PACU ADMIT NURSING NOTE
.NURSE: (RN or LVN)
Note Started:
12/15/2009, 1632
Received patient from OR at 1541 hours via bed. Monitor and Alarms on. Patient awake. Patricia L Bailey, RN
Electronically signed by Patricia L Bailey, RN at 12/15/2009 4:33 PM Procedures signed by Robert Michael Tamurian, MD at 12/15/09 1508 Author: Robert Michael Service: Orthopedics Author Tamurian, MD Type: 12/15/09 1508 12/15/09 1506 Filed: Note Time:
Pre-procedure Diagnoses 1. DJD (degenerative joint disease) of hip [715.15] Post-procedure Diagnoses 1. DJD (degenerative joint disease) of hip [715.15]
*PHYSICIAN: FACULTY
Procedures 1. TOTAL HIP ARTHROPLASTY [27130 (CPT)] Assistants: Eastman, Jonathan MD Anesthesia: GETA + Regional IVF: 2L Crystalloid, 1L Colloid, 0 PRBC's EBL: 600 cc UOP: 200 cc Findings: Severe Degenerative Arthritis of the HIP Specimen: Arthritic Joint surface from Acetabulum and Femoral Head Drains: none Complications: None Outcome: Stable to PACU
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Post-Operative Plan: Routine post-operative THA protocol. First post-op visit in 2-3 weeks in the Orthopaedic Clinic Weight Bearing Status: As Tolerated Components: Dupuy Summit Femur: Size: 7, extended offset: yes Gription Acetabulum: Size: 58mm, Acetabular Screw Fixation : no Liner: Metal/metal: yes X-linked Poly: elevated rim liner : no Femoral Head: 40mm with 5mm Neck length OPERATING ROOM RECORD/ OPERATING NOTE
Note Started: 12/15/2009, 1507 Date of Service: 12/15/2009 Procedure Performed/Description: Same as above Operating Room Procedure Presence: I was physically present for the entire procedure.
The information contained on this form is true and accurate to the best of my knowledge. Further, I understand that if I misrepresent, falsify or conceal information regarding my participation in the professional service described above, I may be subject to fine, imprisonment, or civil penalty under applicable federal laws. Electronically signed by: Robert M. Tamurian, MD Physician ID # 10884, Pager 3059 Attending Physician Assistant Professor Chief, Orthopaedic Oncology Service Deparment of Orthopaedic Surgery University of California, Davis Health System Electronically signed by Robert Michael Tamurian, MD at 12/15/2009 3:08 PM Nurse Assessment signed by Gita Vaid, RN at 12/15/09 0741 Author: Gita Vaid, RN Service: (none) Filed: 12/15/09 0741 Note Time: 12/15/09 0741 Author Type: .NURSE: (RN or LVN)
ADMIT NURSING NOTE Note Started: 12/15/2009, 0741 . Patient admitted at 723 hours as a direct admit and accompanied by his friend for scheduled surgery. Pt condition stable . patient oriented to room and unit. Admission Assessment Done.Gita Vaid RN
Electronically signed by Gita Vaid, RN at 12/15/2009 7:41 AM Progress Notes
Mark Amundsen is a 50yr old male was counseled today regarding risks and benefits of total hip arthroplasty including but not exclusive to: wear, loosening, infection, stiffness, dislocation,leg length discrepancy, persistent pain, prosthetic clicking or squeaking, periprosthetic fracture,dvt,pe,medical and/or cardiac perioperative complications, death, need for revision surgery and she elected to proceed. Pre-op eval, H&P, informed consent completed today. This patient was seen, evaluated, and care plan was developed with the resident on day of service, 12/14/2009. I agree with the assessment and plan as outlined in the resident's note. Report electronically signed by: Robert M. Tamurian, MD
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Scan on: 12/23/2009 2:26 PM by: Robert Michael Tamurian, MD [195644588] - BEDSIDE MONITOR RHYTHM STRIP Telephone Encounter
Hi Dr Baquero and TeriIts about time for another refill on Methadone. I know its early , but this is due to the horrible weather we have had, and due to the hip replacement I had on December 15h, 2009!!!!!!! YYEEEAAAHHH!!! They tried to move it back to the end of March, but when I said No way , they offered Dec 15th, and I took it. The surgeon totally underestimated the amount of pain meds the procedure would require, even though we had discussed it extensively before the procedure. Other than that everything was A-OK, I;m getting around quite well with the walker, but Im still spending most of my time in bed. Anyway, if I could get a refill on Thursday the 24th, or Monday the 28th, that would be great, I figured yall would be out on of those weeks anyhow,,, Regards, Mark Amundsen
Electronically signed byClare Jennings, MA on 12/23/2009 2:05 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi Dr Baquero and TeriIts about time for another refill on Methadone. I know its early , but this is due to the horrible weather we have had, and due to the hip replacement I had on December 15h, 2009!!!!!!! YYEEEAAAHHH!!! They tried to move it back to the end of March, but when I said No way , they offered Dec 15th, and I took it. The surgeon totally underestimated the amount of pain meds the procedure would require, even though we had discussed it extensively before the procedure. Other than that everything was A-OK, I;m getting around quite well with the walker, but Im still spending most of my time in bed. Anyway, if I could get a refill on Thursday the 24th, or Monday the 28th, that would be great, I figured yall would be out on of those weeks anyhow,,, Regards, /> Mark Amundsen Transcription
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communication record creation was suppressed. Procedures filed by Robert Michael Tamurian, MD at 12/23/09 1427 Service: (none) Author Author: Robert Michael Tamurian, MD Type: 12/23/09 1427 12/23/09 1426 Filed: Note Time: *PHYSICIAN: FACULTY
Scan on: 12/23/2009 2:26 PM by: Robert Michael Tamurian, MD [195644588] - OR / PROCEDURE DOCUMENTATION Progress Notes filed by Robert Michael Tamurian, MD at 12/23/09 1427 Author: Robert Michael Service: (none) Author Tamurian, MD Type: 12/23/09 1427 12/23/09 1426 Filed: Note Time:
*PHYSICIAN: FACULTY
Scan on: 12/23/2009 2:26 PM by: Robert Michael Tamurian, MD [195644588] - PHYSICIANS ORDERS Procedures filed by Robert Michael Tamurian, MD at 12/23/09 1427 Author: Robert Michael Service: (none) Author Tamurian, MD Type: 12/23/09 1426 12/23/09 1427 Filed: Note Time:
*PHYSICIAN: FACULTY
Scan on: 12/23/2009 2:26 PM by: Robert Michael Tamurian, MD [195644588] - PRE-OPERATIVE CHECKLIST Progress Notes filed by Robert Michael Tamurian, MD at 12/23/09 1427 Author: Robert Michael Service: (none) Author Tamurian, MD Type: 12/23/09 1426 12/23/09 1427 Filed: Note Time:
*PHYSICIAN: FACULTY
Scan on: 12/23/2009 2:26 PM by: Robert Michael Tamurian, MD [195644588] - PATIENT PROPERTY RECORD Progress Notes filed by Robert Michael Tamurian, MD at 12/23/09 1427 Author: Robert Michael Service: (none) Author Tamurian, MD Type: 12/23/09 1427 12/23/09 1426 Filed: Note Time:
*PHYSICIAN: FACULTY
Scan on: 12/23/2009 2:26 PM by: Robert Michael Tamurian, MD [195644588] - PATIENT EDUCATION RECORD Progress Notes filed by Robert Michael Tamurian, MD at 12/23/09 1427 Service: (none) Author Author: Robert Michael Tamurian, MD Type: 12/23/09 1427 12/23/09 1426 Filed: Note Time:
*PHYSICIAN: FACULTY
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Progress Notes Hi Dr Baquero and TeriIts about time for another refill on Methadone. I know its early , but this is due to the horrible weather we have had, and due to the hip replacement I had on December 15h, 2009!!!!!!! YYEEEAAAHHH!!! They tried to move it back to the end of March, but when I said No way , they offered Dec 15th, and I took it. The surgeon totally underestimated the amount of pain meds the procedure would require, even though we had discussed it extensively before the procedure. Other than that everything was A-OK, I;m getting around quite well with the walker, but Im still spending most of my time in bed. Anyway, if I could get a refill on Thursday the 24th, or Monday the 28th, that would be great, I figured yall would be out on of those weeks anyhow,,, Regards, /> Mark Amundsen Transcription Type Unstructured to Doctor Preliminary
Document Text Hi Dr Baquero and Teri-
ID RH21752035
Its about time for another refill on Methadone. I know its early , but this is due to the horrible weather we have had, and due to the hip replacement I had on December 15h, 2009!!!!!!! YYEEEAAAHHH!!! They tried to move it back to the end of March, but when I said No way , they offered Dec 15th, and I took it. The surgeon totally underestimated the amount of pain meds the procedure would require, even though we had discussed it extensively before the procedure. Other than that everything was A-OK, I;m getting around quite well with the walker, but Im still spending most of my time in bed. Anyway, if I could get a refill on Thursday the 24th, or Monday the 28th, that would be great, I figured yall would be out on of those weeks anyhow,,, Regards, /> Mark Amundsen
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because
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but I'm getting around pretty good with it. The wound seems to be healing nicely, and hopefully I'll gt the staples out on the next visit. Next milestone - skiing in 2011 !! Mark Amundsen />P.S. Please call or shoot me an email when the prescription is ready, would you? Thanks! Transcription Type Unstructured to Doctor
Document Text Hi Dr Baquero and TeriJust a quick reminder - I need a refill on my Methadone today. I shot an email off last week, but with Christmas and all, I thought I'd send a reminder. The hip replacement is going pretty well - I can't walk without the walker yet, but I'm getting around pretty good with it. The wound seems to be healing nicely, and hopefully I'll gt the staples out on the next visit. Next milestone - skiing in 2011 !! Mark Amundsen />P.S. Please call or shoot me an email when the prescription is ready, would you? Thanks! Display only: Transcription (RH21776782) on 12/28/2009 5:15 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes filed by Joanna Baginski, MD at 12/27/09 0556 Author: Joanna Baginski, Service: (none) MD 12/27/09 0556 12/27/09 0555 Filed: Note Time: Author Type: *PHYSICIAN: FACULTY
Scan on: 12/27/2009 5:55 AM by: Joanna Baginski, MD [101052744] - CONSENT TO OPERATION
Progress Notes filed by Joanna Baginski, MD at 12/27/09 0542 Author: Joanna Baginski, Service: (none) MD 12/27/09 0541 12/27/09 0542 Filed: Note Time:
Author Type:
*PHYSICIAN: FACULTY
Scan on: 12/27/2009 5:41 AM by: Joanna Baginski, MD [101052744] - PATIENT EDUCATION RECORD
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Anesthetic Plan: Offered spinal, pt not a good candidate 2/2 chronic back pain issues, would prefer GA. GETA. PIV.
Sampaguita (Sam) Tafoya, MD Resident Physician, PGY-3 Department of Anesthesiology and Pain Medicine
Electronically signed by Norma Jean Klein, MD at 1/11/2010 12:33 PM Revision history: > 01/11/10 1233 H&P addendum by Norma Jean Klein, MD 12/15/09 1147 H&P signed by Sampaguita Tafoya, MD 12/15/09 0835 H&P shared by Sampaguita Tafoya, MD Progress Notes
This patient was seen, evaluated, and care plan was developed with the resident on day of service, 1/4/2010. I agree with the assessment and plan as outlined in the resident's note. Report electronically signed by: Robert M. Tamurian, MD Physician ID # 10884, Pager 3059 Attending Physician Assistant Professor Chief, Orthopaedic Oncology Service Deparment of Orthopaedic Surgery University of California, Davis Health System
Electronically signed byRobert Michael Tamurian, MD on 1/5/2010 1:23 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Visit Notes JAIME C LEE Mon Jan 4, 2010 12:44 PM Patient roomed,Vital signs taken, allergies verified, screened for pain. Jaime C Lee, MA
Electronically signed by JAIME C LEE at Mon Jan 4, 2010 12:44 PM
Progress Notes signed by Phat Giang, MD at 12/29/09 1401 Author: Phat Giang, MD Service: (none) Filed: 12/29/09 1401 Note Time: 12/15/09 1605
Author Type:
*PHYSICIAN: FACULTY
ANESTHESIOLOGY OPERATIVE NOTE Date: 12/15/2009 Time: 1605 Date of Service (Patient contact): 12/15/2009
Procedure: ORIF left humerus Anesthesia: General Estimated Blood Loss: 600 Intravenous Fluids: Crystalloid 2000 ml and Hetastarch 1000 ml
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phone or email. I will be out pf meds on Saturday the 20th, so I would hope to get the script on Friday the 19th... Thanks! />Mark Amundsen Display only: Transcription (RH22955516) on 2/17/2010 7:17 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes
Chief Complaint Patient presents with Fatigue
Subjective: Mark Amundsen is a 50yr year old male who is here for the following reason: Feeling fatigued. Not depressed but more like a generalized fatigue for some time. Status post hip surgery. Pain is 2/3 out of 10. Interested in backing off his methadone. Sleep is normal. Gets very little sun. No GI symptoms. No melena. Was anemic after the surgery. No fever or chills or upper respiratory illness symptoms. Also describes itchy skin on the lower extremities for a few weeks. No rash. Review of Systems: Constitutional: fatigue. CV: negative. Resp: negative. GI: negative.
Patient Active Problem List Diagnoses BACKACHE NOS TESTICULAR HYPOFUNC NEC BRACHIAL NEURITIS NOS ADVANCED OSTEOARTHRITIS OF THE LEFT HIP DEPRESSIVE DISORDER CHRONIC PAIN MEDICATION AGREEMENT C. Difficile Diarrhea Anemia Orthopedic Aftercare for Joint Replacement
Code 724.5 257.2 723.4 726.5 311 719.45 008.45AL 285.9Y V54.81B
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Current outpatient prescriptions prior to encounter Medication Sig Dispense Methadone (DOLOPHINE) 10 Take 13 Tabs by mouth every 390 Tab mg PO Tablet day. Hydrocodone 10 Take 1 Tab by mouth every 4 100 Tab mg/Acetaminophen 325 mg to 6 hours if needed for pain. (NORCO) 10-325 mg PO For breakthrough pain. ** Do Tablet not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. Fluoxetine (PROZAC) 40 mg Take 1 Cap by mouth every PO capsule day. Carisoprodol (SOMA) 350 mg Take 2 Tabs by mouth every PO Tablet day at bedtime.
Refill 0 0
BP 114/80 | Temp(Src) 36.3 C (97.3 F) (Tympanic) | Wt 95.255 kg (210 lb) OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Eyes: conjunctivae and corneas clear. PERRL, EOM's intact. sclerae normal. Nose: normal. Mouth: normal. Neck: Neck supple. No adenopathy, thyroid symmetric, normal size. Heart: normal rate and regular rhythm, no murmurs, clicks, or gallops. Lungs: clear to auscultation. Extremities: no cyanosis, clubbing, or edema. Skin: Dry scaly lamellar skin on lower extremities. ASSESSMENT: 780.79 Fatigue (primary encounter diagnosis) Comment: non-specific. Suspect anemia vs vitamin D deficiency vs hypogonadism. Less likely mood related. Plan: CBC AUTO + REFLEX MANUAL DIFF, COMPREHENSIVE METABOLIC PANEL, LIPID PANEL WITH DLDL REFLEX, PSA SCREEN, TSH WITH FREE T4 REFLEX, URINALYSIS-COMPLETE, VITAMIN D, 25 HYDROXY, TESTOSTERONE,BIOAVAILABLE, FERRITIN 726.5 ADVANCED OSTEOARTHRITIS OF THE LEFT HIP Comment: status post surgery. Recovering well. Plan: 719.45 CHRONIC PAIN MEDICATION AGREEMENT Comment: discussed gradual reduction of methadone Plan: decrease by 5mg weekly. Risks and benefits discussed in detail. V77.99 Screen-Endoc/Nut/Met NEC Comment: Plan: PSA SCREEN 757.1X Ichthyosis Comment: Discussed treament of dry skin or Ichthyosis vulgaris. Discussed the importance of lotions to maintain the skin barrier and avoidance of frequent washing. Discussed how environmental factors can affect skin dryness as well as the importance of avoiding scratching.
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Plan: AmLactin PLAN: See Orders. Discussed care and warning signs with Mark and all questions and concerns were fully answered. He will call or followup in the office if any problems arise. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his/her medical care. No guarantees were made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit.
Electronically signed byVictor Henrique Baquero, MD on 2/4/2010 12:57 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Visit Notes CLARE JENNINGS, MA Thu Feb 4, 2010 8:43 AM Vital signs taken, allergies verified, screened for pain, pharmacy verified, and verified immunization status. Clare Jennings, MA Electronically signed by CLARE JENNINGS, MA at Thu Feb 4, 2010 8:43 AM Progress Notes PATIENT: AMUNDSEN, MARK LOCATION: ORTHO MR #: 8081369 SEX: M AGE: 50 DATE OF SERVICE: 01/04/2010 DOB: 09/23/1959 ORTHOPAEDICS CLINIC NOTE SURGERY PERFORMED: Left total hip arthroplasty on 12/15/09. SUBJECTIVE: Mr. Amundsen is doing well. He has been home. He is slowly increasing his mobility and his gait. He uses a front-wheel walker at home and a single-point cane when he is out and about. He denies any shortness of breath, fevers, chills, or drainage from the wound. He does endorse mild fatigue and of ntoe, he was readmitted postoperatively for anemia and a transfusion. OBJECTIVE: On exam today his thigh and leg are soft without evidence of DVT. His incision is completely healed without drainage or erythema and he has intact quad and ankle dorsiflxion and ankle plantar flexion muscles intact. ASSESSMENT: Two weeks after left total hip arthroplasty. PLAN: We will remove his staples in clinic today. We will have the patient follow up in two months' time at which point, we will repeat the radiographs of the AP pelvis and lateral to left hip. He is to gradually continue to increase his activity. He is part of the Arixtra Trial as his DVT prophylaxis. The patient was seen and evaluated with Dr. Tamurian.
THIS WAS ELECTRONICALLY SIGNED - 01/14/2010 3:12 PM PST BY: RESIDENT DEPARTMENT OF ORTHOPAEDIC SURGERY
TYLER NATHE, MD
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THIS WAS ELECTRONICALLY SIGNED - 01/22/2010 12:10 PM PST BY: TN:dja(usa141) D: 01/04/2010 06:16 PM T: 01/05/2010 03:50 AM C#: 4852196
ROBERT TAMURIAN, MD
Electronically signed byTyler J Nathe, MD on 1/14/2010 3:12 PM Electronically signed byTyler J Nathe, MD on 1/14/2010 3:12 PM Electronically signed byRobert Michael Tamurian, MD on 1/22/2010 12:10 PM Links Previous Version Transcription Type Orthopaedics Clinic Note (2721) Electronically Signed Document Text PATIENT: AMUNDSEN, MARK LOCATION: ORTHO MR #: 8081369 SEX: M AGE: 50 DATE OF SERVICE: 01/04/2010 DOB: 09/23/1959 ORTHOPAEDICS CLINIC NOTE SURGERY PERFORMED: Left total hip arthroplasty on 12/15/09. ID 10977090 Date and Time 1/4/2010 6:16 PM Author Tyler J Nathe, MD
SUBJECTIVE: Mr. Amundsen is doing well. He has been home. He is slowly increasing his mobility and his gait. He uses a front-wheel walker at home and a single-point cane when he is out and about. He denies any shortness of breath, fevers, chills, or drainage from the wound. He does endorse mild fatigue and of ntoe, he was readmitted postoperatively for anemia and a transfusion. OBJECTIVE: On exam today his thigh and leg are soft without evidence of DVT. His incision is completely healed without drainage or erythema and he has intact quad and ankle dorsiflxion and ankle plantar flexion muscles intact. ASSESSMENT: Two weeks after left total hip arthroplasty.
PLAN: We will remove his staples in clinic today. We will have the patient follow up in two months' time at which point, we will repeat the radiographs of the AP pelvis and lateral to left hip. He is to gradually continue to increase his activity. He is part of the Arixtra Trial as his DVT prophylaxis. The patient was seen and evaluated with Dr. Tamurian.
THIS WAS ELECTRONICALLY SIGNED - 01/14/2010 3:12 PM PST BY: TYLER NATHE, MD
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RESIDENT DEPARTMENT OF ORTHOPAEDIC SURGERY
THIS WAS ELECTRONICALLY SIGNED - 01/22/2010 12:10 PM PST BY: ROBERT TAMURIAN, MD
TN:dja(usa141) D: 01/04/2010 06:16 PM T: 01/05/2010 03:50 AM C#: 4852196
Display only: Transcription (10977090) on 1/4/2010 6:16 PM by Tyler J Nathe, MD Document history: Transcription (10977090) on 1/4/2010 6:16 PM by Tyler J Nathe, MD
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi Dr BaqueroJust a small reminder anout the refill I requested. Please notify me via email or phone when it is ready... /> Thanks! Mark Amundsen Transcription Type Unstructured to Doctor
Document Text Hi Dr BaqueroJust a small reminder anout the refill I requested. Please notify me via email or phone when it is ready... /> Thanks! Mark Amundsen Display only: Transcription (RH22401517) on 1/22/2010 8:02 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Left message that Rx is at the front desk

Electronically signed byClare Jennings, MA on 1/20/2010 2:05 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because
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Please contact. Request follow up with me to discuss medications. Triplicate written. Please notify patient.
From: Amundsen,Mark Sent: 01/20/2010 7:37 AM Hi Dr Baquero, Well, it's that time again. I will be out of Methadone on Saturday, so I'm hoping I can pick up a refill script on Friday. The pain from the hip is mostly gone, except for the incision itself., and some lingering sciatica I am still left with some lower back pain, but I'm hoping it will work itself out when everything settles down in my body. Thanks again for everything Mark AMundsen
Electronically signed byClare Jennings, MA on 1/20/2010 9:30 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi Dr Baquero, Well, it's that time again. I will be out of Methadone on Saturday, so I'm hoping I can pick up a refill script on Friday. The pain from the hip is mostly gone, except for the incision itself., and some lingering sciatica I am still left with some lower back pain, but I'm hoping it will work itself out when everything settles down in my body. Thanks again for everything Mark AMundsen Transcription Type Unstructured to Doctor Preliminary
Document Text Hi Dr Baquero,
ID RH22341514
Well, it's that time again. I will be out of Methadone on Saturday, so I'm hoping I can pick up a refill script on Friday. The pain from the hip is mostly gone, except for the incision itself., and some lingering sciatica I am still left with some lower back pain, but I'm hoping it will work itself out when everything settles down in my body. Thanks again for everything Mark AMundsen
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ID RH22955971
Document Text Also, an update on general condition. I started taking vitamin D supplements even before I got the blood test results - about 9 days or so now. I am starting to feel better, with more energy, and I think I'm sleeping more soundly now too. I don't know if poor sleep is a vitamin D deficiency symptom, but I'm feeling better. I should be starting back to work next week... Thanks again! Mark Amundsen Display only: Transcription (RH22955971) on 2/17/2010 7:27 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi Dr Baquero and TeriI am due for a refill on Methadone. As discussed on my previous visit , we will begin to reduce the amount of Methadone per day to titrate off the Methadone. I would like to get a prescription for 340 units of 10mg Methadone, versus the normal 390. This will allow titrating of 12 per day for 15 days, and 11 per day for 15 days, more or less. Please let me know when the script is ready via phone or email. I will be out pf meds on Saturday the 20th, so I would hope to get the script on Friday the 19th... Thanks! />Mark Amundsen Transcription Type Unstructured to Doctor
Document Text Hi Dr Baquero and TeriI am due for a refill on Methadone. As discussed on my previous visit , we will begin to reduce the amount of Methadone per day to titrate off the Methadone. I would like to get a prescription for 340 units of 10mg Methadone, versus the normal 390. This will allow titrating of 12 per day for 15 days, and 11 per day for 15 days, more or less. Please let me know when the script is ready via
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methadone #60 tabs written by Dr. Applebaum. Call Dr. Baquero on Monday for further medication.
Patient notified.
Electronically signed byStephanie L Esparza, LVN on 2/19/2010 4:49 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Pt given Dr.Applebaum's msg and will p/u rx today

Electronically signed byJasvir K Bhele on 2/19/2010 3:45 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
I am comfortable writing for methadone 10mg at maximum of 2 tablets 4 times a day # 60. Patient can pick up this prescription and then follow up with Victor Baquero,MD for additional medication. Please notify patient. JApplebaum,MD
Electronically signed byJeffrey Alan Applebaum, MD on 2/19/2010 2:57 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Pt calling in to check on RH msg.He needs to p/u med today

Electronically signed byJasvir K Bhele on 2/19/2010 1:21 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Also, an update on general condition. I started taking vitamin D supplements even before I got the blood test results - about 9 days or so now. I am starting to feel better, with more energy, and I think I'm sleeping more soundly now too. I don't know if poor sleep is a vitamin D deficiency symptom, but I'm feeling better. I should be starting back to work next week... Thanks again! Mark Amundsen
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Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi Dr Baquero and TeriI'm due another refill on methadone. I received one last week while y'all were gone, but since the doctor wasn't my normal doctor, he only gave me a five day supply. I'll be out again on Wednesday (tomorrow), so I could really use a refill by Wednesday at your earliest convenience. Please let me know via email or phone when the script is ready. Thanks for everything...
/>Mark Amundsen

Preliminary
ID RH23109143
Document Text Hi Dr Baquero and TeriI'm due another refill on methadone. I received one last week while y'all were gone, but since the doctor wasn't my normal doctor, he only gave me a five day supply. I'll be out again on Wednesday (tomorrow), so I could really use a refill by Wednesday at your earliest convenience. Please let me know via email or phone when the script is ready. Thanks for everything... />Mark Amundsen
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Visit Notes MELINDA EHLERS Mon Feb 22, 2010 2:55 PM Pt roomed, vitals taken, pain scale 2/10, pt reports having pain in Lt hip. Medications, allergies, and pharmacy reviewed by Melinda Ehlers, LVN Electronically signed by MELINDA EHLERS at Mon Feb 22, 2010 2:55 PM Progress Notes methadone #60 tabs written by Dr. Applebaum. Call Dr. Baquero on Monday for further medication. Links Previous Version Transcription Type Unstructured to Doctor Preliminary
Document Text ID RH23010187 Date and Time 2/19/2010 5:26 PM
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Physician ID # 10884, Pager 3059 Attending Physician Assistant Professor Chief, Orthopaedic Oncology Service Deparment of Orthopaedic Surgery University of California, Davis Health System
Electronically signed byRobert Michael Tamurian, MD on 3/1/2010 8:48 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Left message that RX is at front desk and also for patient to return call
Electronically signed byClare Jennings, MA on 2/25/2010 8:52 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Triplicate written. Please notify patient. Please ask him how many of the methadone he is taking right now. We had talked about tapering down by 5mg-10mg weekly when we last met.
Patient is checking on status of refill message from yesterday, patient states Dr Applebaum wrote a prescription for meds on Feb 19 but states this rx lasted for 5 days. Please advise
Electronically signed byDeborah L Hughes on 2/24/2010 4:08 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Hi Dr Baquero and TeriI'm due another refill on methadone. I received one last week while y'all were gone, but since the doctor wasn't my normal doctor, he only gave me a five day supply. I'll be out again on Wednesday (tomorrow), so I could really use a refill by Wednesday at your earliest convenience. Please let me know via email or phone when the script is ready. Thanks for everything... Mark Amundsen
Electronically signed byClare Jennings, MA on 2/24/2010 10:37 AM
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I've been having some issues with pain in the other hip - it usually lasts 1-2 days , then goes away. I might want to keep some Norco on hand for these times... Display only: Transcription (RH24294299) on 4/14/2010 1:04 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Patient informed that RX is at front desk


From: Amundsen,Mark Sent: 03/17/2010 3:26 PM Hi Dr BaqueroIt's time for another refill on Methadone, since the last refill was for 3 weeks worth. I will be out on Saturday or Sunday. I have planned on reducing this month's supply to 300 10MG tablets. Please let me know when the refill is ready, either by telephone or email. Thanks in advance.. Mark Amundsen
Electronically signed byClare Jennings, MA on 3/17/2010 3:28 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi Dr BaqueroIt's time for another refill on Methadone, since the last refill was for 3 weeks worth. I will be out on Saturday or Sunday. I have planned on reducing this month's supply to 300 10MG tablets. Please let me know when the refill is ready, either by telephone or email.
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Thanks in advance.. Mark Amundsen Transcription Type Unstructured to Doctor

Preliminary
ID RH23628056
Document Text Hi Dr BaqueroIt's time for another refill on Methadone, since the last refill was for 3 weeks worth. I will be out on Saturday or Sunday. I have planned on reducing this month's supply to 300 10MG tablets. Please let me know when the refill is ready, either by telephone or email. Thanks in advance.. Mark Amundsen
Mark Amundsen Returns today s/p Right THA on 12/15/2009, doing well. Progressing with physical therapy. Utilized arixtra for dvt prophylaxis. Pain controlled on oral medication. No change in medical history since last visit. BP 133/80 | Pulse 73 | Temp(Src) 36.7 C (98.1 F) (Tympanic) | Resp 18 | Ht 1.854 m (6' 1") | Wt 97.977 kg (216 lb) AAOx3, No Acute distress, normal affect and disposition The wound is well healed without signs of infection, no erythema, tenderness or discharge. Leg Lengths Equal Lower extremities reveal no signs of deep venous thrombosis; calves and thighs are soft without swelling, induration or tenderness, Homan's sign is negative. Positive trendelenburg gait, stable with lateral support. Radiographs reveal excellent component positioning without change or signs of loosening. No evidence for hardware failure. A/P Doing well s/p Right THA. Continue aggressive home physical therapy per THA protocol and will advance activity level. Return to clinic in 4 months with Patient will need a standing AP Pelvis, AP/Lateral Right Hip, TO INCLUDE THE ENTIRE PROSTHESIS, PRIOR TO NEXT APPOINTMENT Refilled oral analgesics. Patient instructed to return to clinic for signs and or symptoms of infection or dvt. Electronically signed by: Robert M. Tamurian, MD
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From: Amundsen,Mark Sent: 04/14/2010 1:04 PM Hi Dr Baquero and TeriIt's time for another refill on Methadone. I will be out on Friday, 16 April 2010, so I'm hoping to pick up a new prescription on Friday, since I'm off work that day. Please let me know when the new prescription is ready, either by email or phone. This month, the prescription should be reduced to 250 10mg tablets. I've been having some issues with pain in the other hip - it usually lasts 1-2 days , then goes away. I might want to keep some Norco on hand for these times...
Electronically signed byClare Jennings, MA on 4/14/2010 1:22 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes Hi Dr Baquero and TeriIt's time for another refill on Methadone. I will be out on Friday, 16 April 2010, so I'm hoping to pick up a new prescription on Friday, since I'm off work that day. Please let me know when the new prescription is ready, either by email or phone. This month, the prescription should be reduced to 250 10mg tablets. I've been having some issues with pain in the other hip - it usually lasts 1-2 days , then goes away. I might want to keep some Norco on hand for these times... Transcription Type Unstructured to Doctor
Document Text Hi Dr Baquero and TeriIt's time for another refill on Methadone. I will be out on Friday, 16 April 2010, so I'm hoping to pick up a new prescription on Friday, since I'm off work that day. Please let me know when the new prescription is ready, either by email or phone. This month, the prescription should be reduced to 250 10mg tablets.
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Progress Notes it's ready to pick up Links Previous Version Transcription Type Unstructured to Doctor Preliminary
Document Text it's ready to pick up Display only: Transcription (RH19016036) on 5/24/2010 2:06 PM Document history: Transcription (RH19016036) on 5/24/2010 2:06 PM
ID RH19016036
Left message that RX is at front desk


Electronically signed byVictor Henrique Baquero, MD on 5/12/2010 8:53 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes UC Davis Health System recently introduced MyChart, an enhanced Web-based system that allows you to view portions of your medical record and communicate with your doctors office any time. MyChart will replace MD Online (also known as RelayHealth) as your personal electronic portal to your UC Davis primary care clinic. We encourage you to transition to MyChart as soon as possible in order to benefit from the expanded features. MyChart allows you to: Send and receive secure non-urgent messages with your UC Davis doctor's office Request or cancel an appointment with your primary care doctor View and print your lab or other test results />View portions of your medical records and history See preventative care recommendations View a family members record and message a doctor on their behalf MyChart is NOT to be
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used for urgent needs. For medical emergencies, please dial 911. /> How Do I Sign Up? 1.) In your Internet browser, go to https://mychart.ucdavis.edu 2.) Click on the Sign Up with Activation Code Now link in the Sign In box. You will see the New Member Sign Up page. 3.) Enter your 15 digit MyChart Activation Code exactly as it appears below. You will not need to use this code after youve completed the sign-up process. If you do not sign up before the expiration date, you must request a new code. MyChart Activation Code: XJN6D-PVZXT-VSGP3 Expires: 6/4/10 02:24 PM /> 4.) Enter the first seven digits of your Medical Record Number, Date of Birth and click Submit. You will be taken to the next sign-up page. 5.) Create a MyChart ID. This will be your MyChart login ID and cannot be changed, so think of one that is secure and easy to remember. 6.) Create a MyChart password. You can change your password at any time. 7.) Enter your Password Reset Question and Answer. This can be used at a later time if you forget your password. 8.) Enter your e-mail address. You will receive e-mail notification when new information is available in MyChart. 9.) Click Sign Up. You can now view your medical record. Please do not reply to this message. For assistance please contact mychart.support@ucdmc.ucdavis.edu. Transcription Type Provider Initiated Preliminary Document Text UC Davis Health System recently introduced MyChart, an enhanced Web-based system that allows you to view portions of your medical record and communicate with your doctors office any time. MyChart will replace MD Online (also known as RelayHealth) as your personal electronic portal to your UC Davis primary care clinic. We encourage you to transition to MyChart as soon as possible in order to benefit from the expanded features. MyChart allows you to: Send and receive secure non-urgent messages with your UC Davis doctor's office Request or cancel an appointment with your primary care doctor View and print your lab or other test results />View portions of your medical records and history See ID RH24432132 Date and Time 4/20/2010 2:25 PM
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preventative care recommendations View a family members record and message a doctor on their behalf MyChart is NOT to be used for urgent needs. For medical emergencies, please dial 911. /> How Do I Sign Up? 1.) In your Internet browser, go to https://mychart.ucdavis.edu 2.) Click on the Sign Up with Activation Code Now link in the Sign In box. You will see the New Member Sign Up page. 3.) Enter your 15 digit MyChart Activation Code exactly as it appears below. You will not need to use this code after youve completed the sign-up process. If you do not sign up before the expiration date, you must request a new code. MyChart Activation Code: XJN6D-PVZXT-VSGP3 Expires: 6/4/10 02:24 PM /> 4.) Enter the first seven digits of your Medical Record Number, Date of Birth and click Submit. You will be taken to the next sign-up page. 5.) Create a MyChart ID. This will be your MyChart login ID and cannot be changed, so think of one that is secure and easy to remember. 6.) Create a MyChart password. You can change your password at any time. 7.) Enter your Password Reset Question and Answer. This can be used at a later time if you forget your password. 8.) Enter your e-mail address. You will receive e-mail notification when new information is available in MyChart. 9.) Click Sign Up. You can now view your medical record. Please do not reply to this message. For assistance please contact mychart.support@ucdmc.ucdavis.edu. Display only: Transcription (RH24432132) on 4/20/2010 2:25 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Left message that rx is at front desk

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Progress Notes
Mark Amundsen is a 50yr old male returns today s/p Left THA on 12/15/2009, doing well. Mark Amundsen returns to the adult reconstruction clinic at the University of California, Davis Health System for a 4 month(s) follow up visit. Mark Amundsen has resumed full activity in keeping with standard restrictions for total joint replacment patients. Pain is reported using a visual analog pain scale as 2 / 10 in his anterior left knee and they are not requiring analgesics for the operative Hip since reconstructive surgery. Medical history does not have any new diagnoses or changes since prior office visit dated 2/22/2010. ROS: A Complete review of systems was performed. Except as noted in the HPI, pertinent positives were none. All other systems were negative. BP 133/89 | Pulse 68 | Temp(Src) 36.9 C (98.4 F) (Tympanic) | Ht 1.854 m (6' 1") | Wt 103.42 kg (228 lb) AAOx3, No Acute distress, normal affect and disposition. Nonicteric sclerae, Breathing Nonlabored. Focused exam of the Left knee and hip was performed. Left knee is stable and tender to palpation at the superior pole of the patella and quad tendon The wound is well healed without signs of infection, no erythema, tenderness or discharge. Skin does not reveal any new lesions. Palpation of the regional nodal basin does not reveal any lymphadenopathy. Leg Lengths Equal Lower extremities reveal no signs of deep venous thrombosis; calves and thighs are soft without swelling, induration or tenderness, Homan's sign is negative. Motor and sensory exam reveal no deficits throughout all dermatomes of the Left lower extremity. Peripheral pulses are 2+, normal reflexes. Gait does not reveal a trendelenburg sign to the Left side. Radiographs of the Left hip were ordered an personally reviewed. Today's film reveal excellent component positioning, restoration of limb alignment and length, without change or signs of loosening. Excellent osseointegration of the stem and socket, No evidence for hardware failure. A/P Doing well s/p Left THA. Continue activities as tolerated per THA protocol and will continue antibiotic prophylaxis for invasive dental or surgical procedures per protocol. Return to clinic in 6 months. Mark Amundsen will need a standing AP Pelvis, AP/Lateral Left Hip, TO INCLUDE THE ENTIRE PROSTHESIS, PRIOR TO NEXT APPOINTMENT Regarding his left knee pain, he has evidence for some tendonitis of the quadriceps and I recommend he continue his home exercise program and use OTC NSAIDS as needed. Patient instructed to return to clinic for signs and or symptoms of infection or dvt. Electronically signed by: Robert M. Tamurian, MD Physician ID # 10884, Pager 3059 Attending Physician Assistant Professor Chief, Orthopaedic Oncology Service Deparment of Orthopaedic Surgery University of California, Davis Health System
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Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Visit Notes MELINDA EHLERS, LVN Mon Jun 21, 2010 2:02 PM Pt roomed, vitals taken, pain scale 2/10, medications, allergies, and pharmacy reviewed by Melinda Ehlers, LVN
Electronically signed by MELINDA EHLERS, LVN at Mon Jun 21, 2010 2:02 PM
Telephone Encounter

Refilled. Ready for pick up. JApplebaum,MD

Electronically signed byJeffrey Alan Applebaum, MD on 6/7/2010 1:46 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Please have the covering physician write for the methadone prescription. Thanks,
VB
Electronically signed byVictor Henrique Baquero, MD on 6/7/2010 12:50 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor H Baquero Sent: Mon Jun 7, 2010 9:22 AM Subject: Visit Follow-up Question Hi Dr Baquero and TeriI'm finally on Mychart, so we can talk on email again. It's time for another refill on Methadone. This time, the refill should be 200 units, versus 250 units. I will be out on Wednesday, so I'm hoping to pick up the refill before then. Please let me know when the refill is ready via email or telephone (916-983-2589). Thanks for all your helpMark Amundsen Electronically signed byClare Jennings, MA on 6/7/2010 9:34 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed.
002377
SUBJECTIVE: Mark Amundsen is a 50yr old male. Chief Complaint Patient presents with Foot Problem swollen R>L starded getting bad 3 days / 3 months possibly Additional chief complaint(s): Hi arched feet, dyslipidemia History: Patient has noted recent swelling of his feet. This occurs primarily over the metatarsal region. Patient has had some diffuse swelling in addition. Weight has increased and patient has strong family history of hypertension. Patient has not monitor his own blood pressure. Patient has dyslipidemia on recent lab and ongoing vitamin D deficiency but is not taking adequate supplement. Patient does not specifically watch his diet and weight continues to rise. No chest pain, shortness of breath or abdominal pain. See EMR for PMH, FH, SH: Reviewed and updated medications and allergies. History Substance Use Topics Tobacco Use: Yes -- 1.0 packs/day for 20 years Alcohol Use: Yes rare . Note the patient's smoking Review of Systems No headaches. No back or leg pains.. OBJECTIVE: BP 138/98 | Pulse 76 | Resp 18 | Wt 101.606 kg (224 lb) General exam shows he is alert and in no acute distress. : HEENT: Within normal limits except for missing front teeth Neck: supple Lungs: clear Heart: regular rhythm without murmur Abdomen: obese Extremities: dependent edema is mild. Anterior foot swelling and very high arched feet Neurologic: no focal deficits Spine: normal Skin: clear without jaundice or cyanosis. No peripheral acrocyanosis Psychiatric: patient moderately anxious. No overt depression. Data : lab, imaging, office procedures, outside records ( reviewed/discussed) Reviewed recent laboratory data including a low vitamin D level. Dyslipidemia noted. . Will need EKG ASSESSMENT: 782.3AB Dependent edema (primary encounter diagnosis) Comment: associated with hypertension Plan: TRIAMTERENE-HYDROCHLOROTHIAZIDE 37.5 MG-25 MG
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TAB Followup with PCP in the next six weeks. Will need EKG at that time 272.4CB Dyslipidemia Comment: discussed need for lab with patient, especially since patient also has apparent hypertension Plan: FENOFIBRATE NANOCRYSTALLIZED 145 MG TAB 726.5 ADVANCED OSTEOARTHRITIS OF THE LEFT HIP Comment: Plan: continue therapy 268.9G Vitamin D deficiency Comment: Plan: ERGOCALCIFEROL (VITAMIN D2) 50,000 UNIT CAP See note in After Visit Summary 401.9AH Hypertension Comment: Plan: TRIAMTERENE-HYDROCHLOROTHIAZIDE 37.5 MG-25 MG TAB, LIPID PANEL, HEPATIC FUNCTION PANEL New onset and needs associated weight loss V76.9B Screening for cancer Comment: Plan: GASTROENTEROLOGY REFERRAL Needs update : colonoscopy screening 755.67G High arch Comment: with metatarsalgia and soft tissue swelling Plan: Metatarsal arch pad suggested from super feet or Spenco, then follow up with PCP Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. Jeffrey Alan Applebaum, MD
Electronically signed byJeffrey Alan Applebaum, MD on 7/12/2010 9:58 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Patient Instructions
I have reviewed your recent lab results, and they are printed below. Your vitamin D level is very low. Please supplement with Vitamin D2 50,000 U gel caps 2 times a week for next 2 months. I have called in this medication to your pharmacy. Repeat vitamin D level in 3 months. Following the Vitamin D2 50,000 U gel caps , continue with over the counter vitamin D3 2000 IU tablets, 1 per day till further notice. Follow up with me please in next 12months. BP 138/98 initially; Maxzide 25mg daily and avoid salt Abnormal lipids, Cholesterol Triglycerides
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Tricor 1 tablet daily with dinner Lab in 1month , fasting, Then follow up with Victor Baquero,MD A laboratory test has been ordered for you. Please call (916) 985-9300 to schedule an appointment. Do not eat or drink anything but water for 12 hours prior to your test. You will receive a letter or telephone call with your results. Check BP outside of clinic occasionally
Electronically signed byJeffrey Alan Applebaum, MD on 7/12/2010 9:42 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Visit Notes Stephanie L Esparza, LVN Mon Jul 12, 2010 9:18 AM Vital signs taken, allergies verified, screened for pain, pharmacy verified. Stephanie L Esparza, LVN
Electronically signed by Stephanie L Esparza, LVN at Mon Jul 12, 2010 9:18 AM
Telephone Encounter From: AMUNDSEN,MARK To: Victor H Baquero Sent: Wed Jun 30, 2010 5:48 PM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's about time for another refill on Methadone. I will be out on Sunday, so I'm hoping to pick up a refill on Friday. Also, I'm starting to get similar pain of the left hip on the right side - I may need to stay at the current refill level (200 X 10 mg) and come in for a visit. I mentioned it to the Ortho doctor when in there, but he did not seem too worried - he looked at the right hip x rays and found them okay. Possibly need an MRI on right hip? Thanks, Mark Amundsen Electronically signed byClare Jennings, MA on 7/1/2010 7:42 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed.
002380
Mark Amundsen Electronically signed byClare Jennings, MA on 9/20/2010 8:27 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Tue Aug 24, 2010 11:29 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's time for another refill on Methadone. I am staying at 200 until re-evaluation. I will be out on Thursday, so I'm hoping to pick up the precription on Wednesday evening. Please let me know via phone or email when it is ready for pickup. Thank you for your attention in this matter... Regards, Mark Amundsen Electronically signed byClare Jennings, MA on 8/24/2010 12:21 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Patient is calling to follow up on medication refill for the following medication methadone 10 mg tablet , take three tablets twice daily. Patient will be out of medication as of this evening. Please advise when ready for pickup. Patient can be reached at 916-708-6423.
Electronically signed byBrenda J Fallon on 7/28/2010 3:48 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor H Baquero Sent: Tue Jul 27, 2010 4:31 PM Subject: Non-urgent Medical Advice Question Hi Dr Baquero and staffIt's time for another refill on Methadone. I am currently staying at 200 10 MG tablets per month until I can come in to get my right hip evaluated. It is still acting up, but intermittantly. I will be out on Friday, so I am hoping I can pick up the prescription before Thursday. Please call or email when the script is complete. Thanks for your attention in this matter... Mark Amundsen Electronically signed byClare Jennings, MA on 7/27/2010 4:53 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes
002381
Electronically signed byClare Jennings, MA on 10/18/2010 8:59 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes
LM second set of message at cell phone listed under work number and home number asking patient to call back to check on overall status and to ensure he gets seen for possible EKG if symptoms continue or any concerns; I hasked patient to call 985-9300 to respond to call.
LM at patient's home to check on current status and LM encouraging to schedule to see Dr Baquero 10/13/10 for possible EKG and check on status; patient also encouraged on message left to seek immediate attention for worsening symptoms or concerns.
Chief Complaint Patient presents with Muscle Pain in legs, yesterday was so bad, pt sts that he could barely walk, his legs felt realy weak. Fatigue
Mark Amundsen is a 51yr old male patient of Victor Henrique Baquero, MD here with 2 day history of vague symptoms consistent with generalized malaise and weakness at legs along with possible myalgia and reported tingling of left arm; patient also mentions one episode of loose stool without blood 10/11/10 and none currently; no fever/chills; no neck or chest pain; no shortness of breath; no congestion; no known sick contacts; nothing makes his symptoms better; nothing makes his symptoms worse; over the counter medications tried: none He denies a history of chills, fevers, wheezing, shortness of breath, chest pain, dizziness, nausea, vomiting and anorexia. Patient admits to smoke cigarettes. ROS: General: no fever/chills Psych: patient reports recently restarting Prozac at 20 mg and then increased to 40 due to history of possible OCD and depression
Patient Active Problem List Diagnoses BACKACHE NOS TESTICULAR HYPOFUNC NEC BRACHIAL NEURITIS NOS ADVANCED OSTEOARTHRITIS OF THE LEFT HIP DEPRESSIVE DISORDER CHRONIC PAIN MEDICATION AGREEMENT Anemia Orthopedic Aftercare for Joint Replacement Dyslipidemia Code 724.5 257.2 723.4 726.5 311 719.45 285.9Y V54.81B 272.4CB
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Vitamin D deficiency Hypertension High arch
268.9G 401.9AH 755.67G
Past Medical History Diagnosis NO SIGNIFICANT HISTORY Hypertension
Date 7/12/2010
Current outpatient prescriptions ordered prior to encounter Medication Sig Carisoprodol (SOMA) 350 mg Take 2 Tabs by mouth every Tablet day at bedtime. Ergocalciferol, Vitamin D2, Take 1 Cap by mouth. take 1 (VITAMIN D) 50,000 unit PO capsule by oral route twice Capsule weekly for next 2 months. Then lab follow up 4 weeks later. Fenofibrate (TRICOR) 145 mg Take 1 Tab by mouth every PO Tablet morning after a meal. Fluoxetine (PROZAC) 40 mg Take 1 Cap by mouth every capsule day. Hydrocodone 10 Take 1 Tab by mouth every 4 mg/Acetaminophen 325 mg to 6 hours if needed for pain. (NORCO) 10-325 mg Tablet For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. Methadone (DOLOPHINE) 10 Take 2 Tabs by mouth every mg Tablet 6 hours. Triamterene 37.5 Take 1 Tab by mouth every mg/Hydrochlorothiazide 25mg morning. (MAXZIDE-25) 37.5-25 mg PO Tablet Allergies: Allergies Allergen Morphine Fentanyl itching
Refill 1 1
11 6 0
200 Tab 30 Tab
0 3
Reactions Hives
History Social History Marital Status: Spouse Name: Number of Children: Years of Education:
WIDOWED N/A N/A N/A
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Occupational History network administrator Social History Main Topics Tobacco Use: Alcohol Use: rare Drug Use: Sexually Active: Other Topics Not on file Social History Narrative No narrative on file Family History Problem Arthritis Cancer breast and lung
Yes -- 1.0 packs/day for 20 years Yes No Not Currently Concern
Relation Mother Mother
Age of Onset
PE: BP 132/80 | Pulse 70 | Temp(Src) 36.4 C (97.6 F) (Tympanic) | Wt 98.431 kg (217 lb) | SpO2 99% General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Neck: Supple; no LAD. Heart: normal rate and regular rhythm, no murmurs, clicks, or gallops. Lungs: clear to auscultation. Abdomen: BS normal. Abdomen soft, non-tender. No masses or organomegaly. Extremities: no cyanosis, clubbing, or edema. Neuro: grossly intact. Assessment and Plan: 780.79T Malaise and fatigue (primary encounter diagnosis) Comment: x 2 days; afebrile; unclear diagnosis or etiology; possible viral illness vs further need for workup if symptoms continue Plan: patient declined C spine films and nerve conduction study for workup of tingling of left arm; patient to follow-up with PCP regarding need for EKG due to Methadone for pain mgnt and encouraged follow-up with PCP for routine care and yearly CPE 268.9G Vitamin D deficiency Comment: no current supplement Plan: supplement encouraged; to follow-up with PCP 305.1 Tobacco use disorder Comment: not ready to quit Plan: cessation encouraged 311 DEPRESSIVE DISORDER Comment: back on Prozac per patient; denies SI or HI Plan: follow-up with PCP Total encounter time including history, physical examination, and coordination of care was approximately 15 minutes of which more than 50% was spent counseling regarding assessment/diagnosis and treatment plan. No guarantees were made regarding his medical care or
002384
treatment outcome. Barriers to Learning: none. Patient verbalizes understanding of teaching and instructions. Electronically signed by: Nancy Jaeger, MD Diplomat, American Board of Family Medicine Associate physician UCDHS Primary Care Network, Folsom (916)985-9300
Electronically signed byNancy Jaeger, MD on 10/12/2010 12:06 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Patient Instructions
Call or return to clinic if symptoms worsen, fail to improve or other symptoms develop.
Electronically signed byNancy Jaeger, MD on 10/12/2010 10:05 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Visit Notes MANDY CHILSON Tue Oct 12, 2010 9:48 AM CC and vitals were taken, allergies and pharmacy verified, and screening for pain completed. Mandy Chilson, MA Electronically signed by MANDY CHILSON at Tue Oct 12, 2010 9:48 AM Progress Notes
Chief Complaint Patient presents with Foot Problem hip/ right
Subjective: Mark Amundsen is a 51yr old male who is here for the following reason: 1. Follow up. 2. Right hip bothers him most of the time. Like it did on the left hip 7 years ago. 3. Pain, swelling ont he ball of the right foot and toes. Mostly tender and at times numb on the underside of the foot after walking long distances. Felt like socks were bunching up. Started after his hip surgery. 4. requested restarting the fluoxetine. Some stressors at work. Overall doing well. Review of Systems: Constitutional: negative. CV: negative. Resp: negative. Neuro: as above otherwise negative. .
History
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Substance Use Topics Tobacco Use: Alcohol Use: rare
Patient Active Problem List Diagnoses BACKACHE NOS TESTICULAR HYPOFUNC NEC BRACHIAL NEURITIS NOS ADVANCED OSTEOARTHRITIS OF THE LEFT HIP DEPRESSIVE DISORDER CHRONIC PAIN MEDICATION AGREEMENT Anemia Orthopedic Aftercare for Joint Replacement Dyslipidemia Vitamin D deficiency Hypertension High arch Current outpatient prescriptions ordered prior to encounter Medication Sig Carisoprodol (SOMA) 350 mg Take 2 Tabs by mouth every Tablet day at bedtime. Ergocalciferol, Vitamin D2, Take 1 Cap by mouth. take 1 (VITAMIN D) 50,000 unit PO capsule by oral route twice Capsule weekly for next 2 months. Then lab follow up 4 weeks later. Fenofibrate (TRICOR) 145 mg Take 1 Tab by mouth every PO Tablet morning after a meal. Fluoxetine (PROZAC) 40 mg Take 1 Cap by mouth every capsule day. Hydrocodone 10 Take 1 Tab by mouth every 4 mg/Acetaminophen 325 mg to 6 hours if needed for pain. (NORCO) 10-325 mg Tablet For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. Methadone (DOLOPHINE) 10 Take 2 Tabs by mouth every mg Tablet 6 hours. Triamterene 37.5 Take 1 Tab by mouth every mg/Hydrochlorothiazide 25mg morning. (MAXZIDE-25) 37.5-25 mg PO Tablet
Code 724.5 257.2 723.4 726.5 311 719.45 285.9Y V54.81B 272.4CB 268.9G 401.9AH 755.67G
Dispense 100 Tab Refill 1
8 Cap
11 6 0
200 Tab 30 Tab
0 3
C (97.5 F) (Tympanic) | Wt 98.431 kg (217 lb) BP 118/80 | Pulse 70 | Temp(Src) 36.4 OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Skin: Skin color, texture, turgor normal. No rashes or lesions. Neuro: Gait normal. Reflexes normal and symmetric. Sensation and strength grossly normal. Mental Status: euthymic.
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Musculoskeletal: right foot. High arch. Limited extension to 90 degees. Not tender to palpation along foot or metatarsals. Negative squeeze test. ASSESSMENT: 726.5 ADVANCED OSTEOARTHRITIS OF THE RIGHT HIP (primary encounter diagnosis) Comment: stable. Symptoms managed with current medications. Not interested in doing a right hip replacement at this time. Risks and benefits discussed in detail. Plan: The current medical regimen is effective; continue present plan and medications. 309.9CU Adjustment reaction Comment: requested restarting the fluoxetine. Some stressors at work. Overall doing well. Plan: see orders. Resume Fluoxetine dose 20mg - advance to 40 after 1 week. 726.70A Metatarsalgia Comment: discussed superfeet orthotics, stretching the achilles complex. Remote possibility of Charcot-Marie-Tooth disease. However has no family history of this. Plan: consider podiatry referral if persisting. PLAN: See Orders. Discussed care and warning signs with Mark and all questions and concerns were fully answered. He will call or followup in the office if any problems arise. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his/her medical care. No guarantees were made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit.
Electronically signed byVictor Henrique Baquero, MD on 9/24/2010 1:27 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Visit Notes Clare Jennings, MA Fri Sep 24, 2010 9:48 AM Vital signs taken, allergies verified, screened for pain, pharmacy verified, and verified immunization status. Clare Jennings, MA Electronically signed by Clare Jennings, MA at Fri Sep 24, 2010 9:48 AM Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Mon Sep 20, 2010 8:04 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's time for another refill on Methadone. I will be out on Wednesday, so I'm hoping to pick up a script on Tuesday afternoon. I'vve got an appointment on Friday for the right hip and foot. The foot is still swelling, even after the medication. Regards,
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DC Davis Medical Group

FOLSOM FAMILY PRACTICE 251 Turnpike Drive
Folsom CA 95630 916.9859300
Dale: 10/12/2010 To: Whom this may concern From: Nancy Jaeger, MD
This is to certify that Mark Amundsen was examined on 10/1212010 and has missed 10/11110 from work; patient should return to work on 10/14/10 without restrictions when full duties may
be resumed.
Nancy Jaeger, MD
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Low levels of vitamin D are associated with fatigue, diffuse bone and joint pain, muscle weakness, increased risk of fractures, heart disease, depression and even many forms of cancer. I recommend he take 5,000iu - 10,000 of vitamin D daily - long term. In Folsom he can purchase the small 5,000iu capsules at Elliott's Natural Foods. His thyroid is also a bit low. This can make him tired and draggy. I can start him on low dose replacement. Take every morning BY ITSELF then eat about 30 minutes later. If he is interested I'll call in a script and I'll want him to check labs in 6 weeks. All other tests are normal. All organ systems are working normally.
Electronically signed byVictor Henrique Baquero, MD on 10/19/2010 12:52 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes
Chief Complaint Patient presents with Tremors follow up
Subjective: Mark Amundsen is a 51yr old male who is here for the following reason: Woke up 8 days ago and felt shaky, achy in the lower extremities - like he ran a maraqtho. Some lower arm discomfort moving proximally. Shoulders are sore. Thought he was improving and last night he felt like his legs were weak. Difficuly concentrating. Went to work today but was not feeling well. No fever or chills. One instance of diarrhea - normal now. Did go off the prozac after these symptoms started - had been on it for 2 weeks. Review of Systems: Constitutional: fatigue. CV: negative. Resp: negative. GI: negative. GU: negative. Musculoskeletal: negative. Integumentary: negative. Neuro: otherwise negative. Endo: negative.
Patient Active Problem List Diagnoses BACKACHE NOS TESTICULAR HYPOFUNC NEC BRACHIAL NEURITIS NOS ADVANCED OSTEOARTHRITIS OF THE LEFT HIP
Code 724.5 257.2 723.4 726.5
002389
DEPRESSIVE DISORDER CHRONIC PAIN MEDICATION AGREEMENT Anemia Orthopedic Aftercare for Joint Replacement Dyslipidemia Vitamin D deficiency Hypertension High arch
311 719.45 285.9Y V54.81B 272.4CB 268.9G 401.9AH 755.67G Dispense 100 Tab Refill 1
Current outpatient prescriptions ordered prior to encounter Medication Sig Carisoprodol (SOMA) 350 mg Take 2 Tabs by mouth every Tablet day at bedtime. Ergocalciferol, Vitamin D2, Take 1 Cap by mouth. take 1 (VITAMIN D) 50,000 unit PO capsule by oral route twice Capsule weekly for next 2 months. Then lab follow up 4 weeks later. Fenofibrate (TRICOR) 145 mg Take 1 Tab by mouth every PO Tablet morning after a meal. Fluoxetine (PROZAC) 40 mg Take 1 Cap by mouth every capsule day. Hydrocodone 10 Take 1 Tab by mouth every 4 mg/Acetaminophen 325 mg to 6 hours if needed for pain. (NORCO) 10-325 mg Tablet For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. Methadone (DOLOPHINE) 10 Take 2 Tabs by mouth every mg Tablet 6 hours. Triamterene 37.5 Take 1 Tab by mouth every mg/Hydrochlorothiazide 25mg morning. (MAXZIDE-25) 37.5-25 mg PO Tablet
8 Cap
30 Tab
30 Cap
11
6
100 Tab
200 Tab 30 Tab
0 3
C (98.2 F) (Tympanic) | Wt 98.431 kg (217 lb) BP 126/86 | Pulse 77 | Temp(Src) 36.8 OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Eyes: conjunctivae and corneas clear. PERRL, EOM's intact. sclerae normal. Mouth: normal. Neck: Neck supple. No adenopathy, thyroid symmetric, normal size. Heart: normal rate and regular rhythm, no murmurs, clicks, or gallops. Lungs: clear to auscultation. Abdomen: BS normal. Abdomen soft, non-tender. No masses or organomegaly. Extremities: no cyanosis, clubbing, or edema. Skin: Skin color, texture, turgor normal. No rashes or lesions. Neuro: Gait normal. Reflexes normal and symmetric. Sensation and strength grossly normal. Very faint resting tremor - barely discernable. Mental Status: Appearance/Cooperation: in no apparent distress Behavior :normal Mood (pt's report) :Mood pt's report, euthymic Affect: full and appropriate Musculoskeletal: normal
002390
ASSESSMENT: 780.79 Other malaise and fatigue (primary encounter diagnosis) Comment: non-specific. I suspect physiologic process vs subacute viral illness vs medication related. Labs requested. Discussed care and warning signs with Mark and all questions and concerns were fully answered. He will call or followup in the office if any problems arise. Will await lab results. Continue hydration. Avoid supplementation with over the counter supplements. . Plan: COMPREHENSIVE METABOLIC PANEL, VITAMIN D, 25 HYDROXY, TSH WITH FREE T4 REFLEX, CBC AUTO + REFLEX MANUAL DIFF, CREATINE KINASE PLAN: See Orders. Discussed care and warning signs with Mark and all questions and concerns were fully answered. He will call or followup in the office if any problems arise. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his/her medical care. No guarantees were made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit. Electronically signed by: Victor Baquero, MD Associate Physician Associate Medical Director UC Davis Medical Group, Folsom
Electronically signed byVictor Henrique Baquero, MD on 10/18/2010 5:14 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Visit Notes Clare Jennings, MA Mon Oct 18, 2010 2:52 PM Vital signs taken, allergies verified, screened for pain, pharmacy verified, and verified immunization status. Clare Jennings, MA
Electronically signed by Clare Jennings, MA at Mon Oct 18, 2010 2:52 PM
Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Mon Oct 18, 2010 8:51 AM Subject: Non-urgent Medical Advice Question Hi Dr baqueroIt's time for another refill on the Methadone prescription. I will be out on Wednesday, so I'm hoping I can pick up a script on Tuesday evening. The problem I came in for last week (uncontrollable shaking and fatigue) is still occurring, so I doubt it's a virus. I will be coming in soon for a consultation... Regards, Mark Amundsen
002391
Subject: Non-urgent Medical Advice Question Hi Dr. Baquero and staffI was wondering if someone could forward me the results of the blood test I took on 10-19-2010? I'd like to find out how bad the Vitamin D and Thyroid hormone levels were... Thanks in advanceMark R. Amundsen Electronically signed byClare Jennings, MA on 10/22/2010 8:07 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Patient informed of doctors message

Prescription called in. Take every morning - before meal. Recheck labs in 6 weeks. Also make sure he is takes his Vitamin D.
Electronically signed byVictor Henrique Baquero, MD on 10/20/2010 10:07 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Pt called in read him info below. Pt is interested in the prescription for the thyroide. Please call when ready. Thanks
Electronically signed byJoseph Jernigan on 10/20/2010 9:38 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Left message for patient to return call

Please contact. Let him know labs show 2 things that are off. His vitamin D levels are VERY low.
002392
Visit Notes Clare Jennings, MA Tue Nov 2, 2010 12:48 PM EKG done per doctors order Electronically signed by Clare Jennings, MA at Tue Nov 2, 2010 12:48 PM Clare Jennings, MA Tue Nov 2, 2010 12:09 PM Vital signs taken, allergies verified, screened for pain, pharmacy verified, and verified immunization status. Clare Jennings, MA Electronically signed by Clare Jennings, MA at Tue Nov 2, 2010 12:09 PM Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Wed Oct 27, 2010 6:37 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI have been on the thyroid medicine for 6 days now, and there hasn't been any improvement. The weakness in the legs has improved, I think due to the Vitamin D, but the shaking is a little worse, and the overall fatigue and confusion is still present. Do you have any other recommendations? From info on the web, it seems this medicine needs a week to work, but I thought it would have been getting better by now. Please advise - I am at home today at 916-983-2589. Electronically signed byClare Jennings, MA on 10/27/2010 8:20 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Mon Oct 25, 2010 8:00 AM Subject: Non-urgent Medical Advice Question Hi Dr Baquero and staffThe thyroid medicine seems to be working, but it's slow going. I'm planning on going back to work tomorrow (Oct 26), but my work is asking for another note from my doctor excuaing my absence. Could you please forward a note via email authorizing my return to work on 26 Oct? I will have been out from 11 October to 26 October. If email isn't possible, I could come pick it up... Thanks in advanceMark Amundsen
Electronically signed byClare Jennings, MA on 10/25/2010 9:09 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Thu Oct 21, 2010 11:06 PM
002393
Mark Amundsen Electronically signed byStephanie L Esparza, LVN on 11/12/2010 8:55 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Fri Nov 12, 2010 7:54 AM Subject: Non-urgent Medical Advice Question Is it possible I have a bad hip implant? I looked up the symptoms, and 2 out of 7 are hypothyroidism and peripheral neuropathy (which sounds like what I have), Is it possible to find out if I have one of the recalled hip implants? Thanks for any info you can provide Mark Amundsen
Electronically signed byStephanie L Esparza, LVN on 11/12/2010 8:54 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Thu Nov 4, 2010 12:05 AM Subject: Non-urgent Medical Advice Question Dr BaqueroAfter the Vitamin B12 injection, I noticed improvement of symptoms after approx 8 hours. However, further improvement was not noted, and symptoms are still apparent at 70% of original strength. Is it possible that Vitamin B12 takes additional time to absorb? Or is it possible that I need a larger dose? The only noted side effect was fairly severe headache on left side of head directly behind eye. Please advise, and report any blood test results received. Mark Amundsen Electronically signed byClare Jennings, MA on 11/4/2010 8:24 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes
Chief Complaint Patient presents with Fatigue possible thyroid prob, not doing any better
Subjective: Mark Amundsen is a 51yr old male who is here for the following reason: Follow up. Still feels weak, tired diffusely. Has mental fatigue as well. No focal symptoms. Off all supplements and medications except for his vitamin D, low dose thyroid replacement, methadone. Feels better when he takes the methadone - it increases his energy and alertness. No pain or other
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constitutional symptoms. Not able to return to work yet due to symptoms. No focal neurologic symptoms. Review of Systems: Constitutional: negative. CV: negative. Resp: negative. Neuro: fatigue otherwise normal.
Patient Active Problem List Diagnoses BACKACHE NOS TESTICULAR HYPOFUNC NEC ADVANCED OSTEOARTHRITIS OF THE LEFT HIP DEPRESSIVE DISORDER CHRONIC PAIN MEDICATION AGREEMENT Anemia Orthopedic Aftercare for Joint Replacement Dyslipidemia Vitamin D deficiency Hypertension High arch Current outpatient prescriptions ordered prior to encounter Medication Sig Carisoprodol (SOMA) 350 mg Take 2 Tabs by mouth every Tablet day at bedtime. Ergocalciferol, Vitamin D2, Take 1 Cap by mouth. take 1 (VITAMIN D) 50,000 unit PO capsule by oral route twice Capsule weekly for next 2 months. Then lab follow up 4 weeks later. Fenofibrate (TRICOR) 145 mg Take 1 Tab by mouth every PO Tablet morning after a meal. Hydrocodone 10 Take 1 Tab by mouth every 4 mg/Acetaminophen 325 mg to 6 hours if needed for pain. (NORCO) 10-325 mg Tablet For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. Levothyroxine (LEVOXYL) 50 Take 1 Tab by mouth every mcg Tablet day. take on an empty stomach Methadone (DOLOPHINE) 10 Take 2 Tabs by mouth every mg Tablet 6 hours. Triamterene 37.5 Take 1 Tab by mouth every mg/Hydrochlorothiazide 25mg morning.
Code 724.5 257.2 726.5 311 719.45 285.9Y V54.81B 272.4CB 268.9G 401.9AH 755.67G
Refill 1 1
30 Tab 100 Tab
11 0
30 Tab 200 Tab 30 Tab
3 0 3
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(MAXZIDE-25) 37.5-25 mg PO Tablet C (97.3 F) (Tympanic) | Wt 97.523 kg (215 lb) BP 130/80 | Pulse 66 | Temp(Src) 36.3 OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Eyes: conjunctivae and corneas clear. PERRL, EOM's intact. sclerae normal. Heart: normal rate and regular rhythm, no murmurs, clicks, or gallops. Lungs: clear to auscultation. Extremities: no cyanosis, clubbing, or edema. Skin: Skin color, texture, turgor normal. No rashes or lesions. Neuro: Gait normal. Reflexes normal and symmetric. Sensation normal. Midly week. No fatiguability. Mental Status: blunted. Tired apearing. Normal answers to questions. Musculoskeletal: grossly normal. DATA (reviewed with patient): EKG: normal . ASSESSMENT: 780.79L Weakness/fatigue (primary encounter diagnosis) Comment: suspect physiologic cause. Vit D and thyroid replacement have not helped much. Possibly related to methadone. Will check further labs to rule out more rare disorders. Offered B12 injection. Follow up in 1-2 weeks. Discussed care and warning signs with Mark and all questions and concerns were fully answered. He will call or followup in the office if any problems arise. Plan: VITAMIN B12, FOLATE, SED RATE WESTERGREN, ANTI-NUCLEAR AB (ANA), ACETYLCHOLINE BLOCKING AB, CYANOCOBALAMIN INJ CLINIC, POC ELECTROCARDIOGRAM WITH RHYTHM STRIP, TESTOSTERONE,BIOAVAIL MALE>17, ALBUMIN, CORTISOL PLAN: See Orders. Discussed care and warning signs with Mark and all questions and concerns were fully answered. He will call or followup in the office if any problems arise. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his/her medical care. No guarantees were made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit. Electronically signed by: Victor Baquero, MD Associate Physician Associate Medical Director UC Davis Medical Group, Folsom
Electronically signed byVictor Henrique Baquero, MD on 11/2/2010 1:50 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed.
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Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Mon Nov 15, 2010 1:42 PM Subject: Non-urgent Medical Advice Question Dr BaqueroSo how can I find out if my implant is failing? I have a feeling the metal ion/particles may be the issue with the fatigue, numbness, hypothyroidism, and peripheral neuropathy. I have request a copy of my med records - they will arrive in 10-15 days. It will confirm the model of hip implant. Is there anything we can do to make progress on this problem? I still have difficulty walking, shaking, and getting up. Regards, Mark Amundsen Electronically signed byClare Jennings, MA on 11/15/2010 4:31 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Mon Nov 15, 2010 1:37 PM Subject: Non-urgent Medical Advice Question Dr BaqueroI contacted the Ortho Dept - they provided me info on my hip implant. They could not specify the model-the manufacturer is Depuy. They only make 2 models-the ASR (recalled), and the Pinnacle. It appears I have a 58MM Pinnacle hip implant cup, with a metal bearing and a Summit stem... This system is also under investigation-see http://injury-law.freeadvice.com/defective_products/depuy-pinnacle-hip-implants-failing.htm Electronically signed byClare Jennings, MA on 11/15/2010 3:48 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Fri Nov 12, 2010 7:57 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI am also about due for a refill on Methadone. I will be out next Tuesday, so I would appreciate it if I could pick up a prescription Monday evening. I know you've been out, so I wanted to give you plenty of time to respond. Thanks !
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Telephone Encounter
Added test for cobalt.

Message copied by BAQUERO, VICTOR H on Fri Nov 19, 2010 1:23 PM -----Message from: DELEON, KELLY Created: Thu Nov 18, 2010 2:39 PM Regarding: COBALT URINE OR SERUM Hi Dr Baquero, Your pt was here today to pick up a 24 hr urine container for heavy metals and stated that we didn't have a test for Cobalt. Just an FYI, we do... Well ARUP does. If you want his urine tested for Cobalt, all you need to do is put it in as a Misc Test and we can send it off. That's where the heavy metals urine goes anyway. Please advise, thanks! Kelly DeLeon CPTII
Electronically signed byVictor Henrique Baquero, MD on 11/19/2010 1:23 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Wed Nov 17, 2010 11:38 AM Subject: Non-urgent Medical Advice Question I think the tests might be the way to go to determine whether this is the issue. However, if the tests are expensive, we may want to wait until the medical records come back to make sure I have the suspect implant. My immediate problem is insomnia. I'm not sleeping more than 45 minutes in a row. I'm reducing the vitamins for now, and picking up the Soma from the pharmacy. Mark Amundsen Electronically signed byClare Jennings, MA on 11/17/2010 2:39 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Addended by: BAQUERO, VICTOR H on: 11/17/2010 Modules accepted: Orders Chart Review Routing History
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Electronically signed byTracy D Kasik on 11/24/2010 1:36 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Ok. It's not technically urgent but I would appreciate any effort to get him in soon. Thanks.
Electronically signed byVictor Henrique Baquero, MD on 11/24/2010 11:33 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Per Sirgute at the Rheumatology clinic all urgent referrals must be a peer to peer only. Otherwise the referral will be triaged as routine at this time.
Electronically signed byTracy D Kasik on 11/24/2010 9:37 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes filed by Onbase Incoming Interface at 11/24/10 0754 Author: Onbase Incoming Service: (none) Author Interface Type: 11/24/10 0754 11/24/10 0754 Filed: Note Time: (none)
Scan on: 11/24/2010 7:54 AM by: Onbase Incoming Interface [886105] - CODING SUMMARY FORM Progress Notes filed by Onbase Incoming Interface at 11/24/10 0754 Author: Onbase Incoming Service: (none) Author Interface Type: 11/24/10 0754 11/24/10 0754 Filed: Note Time:
(none)
Scan on: 11/24/2010 7:54 AM by: Onbase Incoming Interface [886105] - CODING SUMMARY FORM Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Tue Nov 23, 2010 6:43 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroSymptoms are getting worse again. Having difficulty controlling hand movements, and shaking is worse. What should I do from here? You mentioned Rheumatology. If they could help, let's please set it up. Mark Amundsen Electronically signed byClare Jennings, MA on 11/23/2010 8:26 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed.
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It's time for another refill on methadone. I will be out on Thursday, so I am hoping to pick up the prescription on Wednesday afternoon. Also, I have changed my pharmacy to the Walgreens on East Bidwell - here's the info2595 E Bidwell St,Folsom, CA 95630 (916) 817-6533 It's got a drive through, so no walking, which has become difficult and kind of a spectacle. Please let me know when the script is readyThanks! Mark Amundsen Electronically signed byClare Jennings, MA on 12/7/2010 7:46 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Left message for patient to return call, doctor is filling out his disability and FMLA forms but needs to know the date for the last day he worked and a projected back to work date.
Patient faxed over disability and FMLA forms, they are in your in box with the business chart
Electronically signed byClare Jennings, MA on 12/2/2010 9:35 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Wed Dec 1, 2010 4:26 PM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI received the cobalt test - is that level really bad, or just sorta bad? Also, symptoms continue. I did find something alarming - I had a leaking gallon can of carburator cleaner in the garage for approx 1 month. Finally found it and moved it outside last week. Don't know if fumes entered house. Could this be an issue? Fumes very bad in garage, but could not smell indoors. Please advise future plans for diagnosis... Thanks Mark Amundsen Electronically signed byClare Jennings, MA on 12/1/2010 4:37 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Referral processed.
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Start date for his disability is 10/30/10 the end date is unknown at this time as per patient
Patient returning call from MA regarding either disability or fmla.

Electronically signed byJulie Stewart on 12/8/2010 10:30 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Left message on voice mail for Sirgute about the request for the consult.
Dr Baquero did a referral to the internal medicine clinic. Please clarify which dept you are wanting patient to be seen in? Per Sirgute at the Internal medical clinic 734-4685. Please notify her.
Electronically signed byTracy D Kasik on 12/7/2010 4:12 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter

Left message for patient to return call

Electronically signed byClare Jennings, MA on 12/7/2010 8:36 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Tue Dec 7, 2010 6:37 AM Subject: Non-urgent Medical Advice Question Hi Dr Baquero and staff-
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Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Thu Dec 30, 2010 5:39 PM Subject: Non-urgent Medical Advice Question HI Dr BaqueroI called UC Davis Med Center, and they said on the phone that y'all are closed on Thursday the 30th, and Friday the 31st. This is going to make it really hard to pick up my prescription on Friday. Is there any way someone could get it to me? I don't know if anyone goes in the building on "weekends", but I'd be happy to meet them. Thanks, Mark Amundsen Electronically signed byClare Jennings, MA on 1/3/2011 7:43 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Tue Dec 28, 2010 10:29 PM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's about time for another refill on Methadone. I'll be out on Sunday, so I'm hoping to pick up a refill on Friday. I've been using more than normal - the right hip is getting worse. It seemed to start with the poor weather, but hasn't been abating as usual. I've been taking 9 per day now - 5 in the morning, 4 at night, versus 4 and 3. I may need to up the amount prescribed. The neuropathy has not abated - I've got an appt with Rheumatology in Feb. Regards, Mark Amundsen Electronically signed byClare Jennings, MA on 12/29/2010 7:37 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Left message that forms are at the front desk

Forms completed.
Electronically signed byVictor Henrique Baquero, MD on 12/13/2010 9:12 AM Chart Review Routing History
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Sent: Thu Feb 17, 2011 11:05 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's about time for another refill- I will be out on Tuesday, but since you will be closed on Monday, I'm hoping to pick up a refill on Friday afternoon, I would have given more notice, but I just found out you will be closed. Went to Neuro today, they want a nerve conduction AND muscle test. Please let me know when to pick up the prescriptionThanks! Mark Amundsen Electronically signed byClare Jennings, MA on 2/17/2011 11:09 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Visit Notes RONALD P ROJAS Thu Feb 17, 2011 8:43 AM Patient presents with: Weakness - Rule out chronic inflammatory demyelinating polyneuropathy Consultation - Requested by Victor Henrique Baquero, MD, and Barton Lahn Wise, MD Vital signs taken, allergies verified, screened for pain, med hx taken. Ronald P Rojas
Electronically signed by RONALD P ROJAS at Thu Feb 17, 2011 8:43 AM
Telephone Encounter
Reviewed rheumatology consult. chronic inflammatory demyelinating polyneuropathy (CIDP) may be a potential diagnosis. Will refer to neurology per consult recommendation.
Electronically signed byVictor Henrique Baquero, MD on 2/4/2011 12:28 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes February 01, 2011 RE: AMUNDSEN, MARK MR#: 8081369 DOB: 09/23/1959 Date of Service: 02/01/2011 VICTOR HENRIQUE BAQUERO, MD Dear Dr. Baquero: Thank you for referring your patient Mr. Amundsen to us for consultation. Chief Complaint: Weakness of legs and arms. History of Present Illness: Mr. Amundsen is an 51-year-old gentleman with a history of osteoarthritis and chronic pain on methadone and Norco, hypertension, who is referred by his primary physician, Dr. Victor Baquero, for weakness of his legs and arms of three-month duration.
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This patient has history of osteoarthritis of the hip requiring left arthroplasty back in December 2009, and chronic right hip pain requiring high-dose methadone and Norco. In terms of his most acute symptoms of weakness, he reports development of weakness in his thigh and upper arms over a weekend in October. He said he woke up one day barely able to walk or stand up. He feels like he ran a marathon. He is no longer able to walk for more than five minutes because of weakness. As a result, he has been on disability around the same time because he no longer is able to return to work as a network administrator. Besides the weakness, he also complains of worsening left hip pain around his left arthroplastic site. He denies any joint swelling or erythema around the adjoining region. He denies any myalgia or muscle tenderness. He denies any difficulty with activities such as putting his clothes on, brushing his hair. He denies any fever or chills but feels that his temperature has not been regulated properly. He reports about 15 minutes of morning stiffness. For the last eight to nine weeks, he also noted that the anterior aspect of his right foot right underneath his right toes and near the dorsum of his foot, with burning and increasing painful sensation. He denies any sensory loss in the area. He thinks his symptoms are possibly related to some sort of neurologic involvement per his reading on line. All his symptoms feel improved but not resolved with the methadone and ethanol use on alcohol. He also thinks his worsening left hip pain might be due to the particular brand of his prosthesis he had, as there is a recall of left hip prosthesis that was similar to his but not his particular model. The patient denies any trauma or recent travel. Past Medical History: Osteoarthritis status post left arthroplasty in 2009, history of low back pain, hypertension, hypertriglyceridemia. Past Surgical History: Hernia repair in 1986, tonsillectomy in 1966, left hip replacement in 2009. Medications: Methadone 20 mg every 6 hours, 240 per month; Norco 10/325 q4-6 hours as needed, Soma 350 2 tabs q.h.s. Allergies: Morphine, fentanyl. Social History: The patient has been on disability since October because of weakness. Prior to that he used to work as a network administrator. He was married, but his wife is deceased. Now he currently lives in Folsom by himself. He reports drinking one beer per week, history of one-pack smoking for the last 30 years. He denies any illicit drug use. Family History: Mom had either lung cancer or breast cancer in 70's. She also has history of rheumatoid arthritis. Dad had stroke at 88. Both brother and sister have asthma. Review of Systems: Constitutional fatigue and weakness, headaches, muscle spasm, sensitivity. GU: Frequent urination at night. Musculoskeletal: Morning stiffness for 30 minutes, bilateral hip pain left greater than right. Extremities: Some swelling of his right foot. The rest of the 14-point review of systems is negative except for positives noted in HPI. Physical Examination: Vitals: Temp 98.2, heart rate 68, blood pressure 106/69, weight 224, 3 of 10 pain in his hips. General: Overweight, middle-aged gentleman who appears his stated age, in no acute distress walking and speaking without any difficulty. Skin: No rashes. HEENT: Eyes anicteric, EOMs full, PERRLA, oral mucosa pink and moist without exudates, tongue midline. Neck: Supple with no lymphadenopathy. Lungs: CTAB. CV: No JVDR, normal S1 and S2 without murmurs, rubs, or gallops. Abdomen: Soft, nondistended, nontender. Extremities: +2 bilateral pulses, no lower extremity edema. Musculoskeletal: No effusion in the joints of the hands, wrist, elbows, knees, ankles, and feet bilaterally. There is full range of motion in the extension and flexion of his joints. He has a full range of motion in his hands, wrists, elbows, knees, ankles, and hips. There is no synovitis throughout the exam. Neuro: Cranial nerves II through XII intact, deep tendon reflexes were tested in brachioradialis, biceps, triceps, and Achilles areas bilaterally and were 2+ throughout. DTRs were 1+ bilaterally at the patellae, but were symmetric. Motor strength was 5 out of 5 for biceps, deltoids , quadriceps, gastrocnemius, anterior tibialis, neck and grip. His gait was mildly widebased with decreased motor strength on his left side. He walks slumped over but was able to be in a neutral position when asked to extend his back. He does require holding himself up when going from a sitting position to a standup position. Mental Status: The patient appears depressed but alert and oriented x 3 and answers appropriately to questions. Laboratories from 11/02/2010 were all in the normal limits. CK 40, acetylcholine antibody was 8, ESR is 8,
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ANA is negative. BMP from 10/18/2010 was within normal limits, and CBC also within normal limits. Assessment and Plan: 51 yo man with osteoarthritis and hip replacement, now with new progressive weakness of the lower and upper extremities with mostly negative physical exam and normal CK, ESR and ANA. 1) Weakness. The patient described symptoms of weakness of a progressive nature, now involving weakness of his back, which is somewhat atypical to have. Little of his weakness is convincing for rheumatologic disease and his inflammatory markers such as ESR and ANA are all negative. The patient's presentation does not fit the picture of rheumatological diseases such as polymyositis or rheumatoid arthritis. His symptoms of 15 minutes of morning stiffness is too brief to be rheumatalgically related. His age again is fairly young to present with polymyalgia rheumatica and he has no pains that are strongly suggestive of RA by distribution or otherwise. In terms of other possible differentials, in certain cases chronic use of methadone can cause muscle breakdown leading to weakness. However, his CK from February 2010 was normal, in addition to his LFT's. However, given his methadone use, we think it is reasonable to check another CK level; we suspect the CK is again going to be normal. In addition to other explanations, his weakness we think is likely more neurological rather than rheumatological. We may consider something like chronic inflammatory demyelinating polyneuropathy (CIDP) which can present with progressive weakness. The patient also reports a component of neuropathic pain isolated to his right foot, although his physical exam did not show any gross sensory loss. It is somewhat odd to have isolated neuropathic pain in one extremity without any involvement to other extremities; CIDP can cause asymmetric sensory and modal changes. As a result, we think it is best to refer him to our Neurology colleagues to see whether further workup is necessary. We will defer workup such as nerve conduction studies to them. In the meantime, we will check another CK level and LFT's to rule out muscle involvement, however we expect the yield to be low. 2) Chronic pain. We note that the patient is on high-dose methadone for his chronic pain, but he also reports occasional drinking with his opiate. We spoke to him extensively regarding the possible interaction with this combination of opiates and alcohol. We have advised him to abstain from alcohol to minimize the side effects of the medication. I have educated/instructed the patient regarding all aspects of the above-stated plan of care. The patient acknowledges understanding of plan of care. I spent 60 minutes with this patient, more than 50 percent of which was in counseling regarding his symptoms and questions. Followup: The patient does not need to be followed-up by Rheumatology at this time as this is not likely rheumatologic in nature. He can certainly be rereferred to our Clinic if new information arises that points toward rheumatologic disease as needed or he may call prn. XIAO CAI, MD RESIDENT DEPARTMENT OF INTERNAL MEDICINE THIS WAS ELECTRONICALLY SIGNED - 02/04/2011 12:15 PM PST BY: I saw, examined, and interviewed the patient personally. I agree with the resident's note and assessment and plan which we developed together. THIS WAS ELECTRONICALLY SIGNED - 02/02/2011 5:30 PM PST BY: ATTENDING XC:cg(ucd039) D: 02/01/2011 04:57 PM T: 02/02/2011 09:48 AM C#: 5343837 BARTON WISE, MD
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Electronically signed byBarton Lahn Wise, MD on 2/2/2011 5:32 PM Electronically signed byBarton Lahn Wise, MD on 2/2/2011 5:32 PM Electronically signed byBarton Lahn Wise, MD on 2/4/2011 12:16 PM Links Previous Version Transcription Type RHEUM Referral Letter Ext (1712)
Electronically Signed ID 11900701 Date and Time 2/1/2011 4:57 PM Author Xiao Cai, MD
Document Text February 01, 2011 RE: AMUNDSEN, MARK MR#: 8081369 DOB: 09/23/1959 Date of Service: 02/01/2011
VICTOR HENRIQUE BAQUERO, MD
Dear Dr. Baquero: Thank you for referring your patient Mr. Amundsen to us for consultation. Chief Complaint: Weakness of legs and arms.
History of Present Illness: Mr. Amundsen is an 51-year-old gentleman with a history of osteoarthritis and chronic pain on methadone and Norco, hypertension, who is referred by his primary physician, Dr. Victor Baquero, for weakness of his legs and arms of three-month duration. This patient has history of osteoarthritis of the hip requiring left arthroplasty back in December 2009, and chronic right hip pain requiring high-dose methadone and Norco. In terms of his most acute symptoms of weakness, he reports development of weakness in his thigh and upper arms over a weekend in October. He said he woke up one day barely able to walk or stand up. He feels like he ran a marathon. He is no longer able to walk for more than five minutes because of weakness. As a result, he has been on disability around the same time because he no longer is able to return to work as a network administrator. Besides the weakness, he also complains of worsening left hip pain around his left arthroplastic site. He denies any joint swelling or erythema around the adjoining region. He denies any myalgia or muscle tenderness. He denies any difficulty with activities such as putting his clothes on, brushing his hair. He denies any fever or chills but feels that his temperature has not been regulated properly. He reports about 15 minutes of morning stiffness. For the last eight to nine weeks, he also noted that the anterior aspect of his right foot right underneath his right toes and near the dorsum of his foot, with burning and increasing painful sensation. He denies any sensory loss in the area. He thinks his symptoms are possibly related to some sort of neurologic involvement per his reading on line. All his symptoms
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feel improved but not resolved with the methadone and ethanol use on alcohol. He also thinks his worsening left hip pain might be due to the particular brand of his prosthesis he had, as there is a recall of left hip prosthesis that was similar to his but not his particular model. The patient denies any trauma or recent travel. Past Medical History: Osteoarthritis status post left arthroplasty in 2009, history of low back pain, hypertension, hypertriglyceridemia. Past Surgical History: Hernia repair in 1986, tonsillectomy in 1966, left hip replacement in 2009. Medications: Methadone 20 mg every 6 hours, 240 per month; Norco 10/325 q4-6 hours as needed, Soma 350 2 tabs q.h.s. Allergies: Morphine, fentanyl.
Social History: The patient has been on disability since October because of weakness. Prior to that he used to work as a network administrator. He was married, but his wife is deceased. Now he currently lives in Folsom by himself. He reports drinking one beer per week, history of one-pack smoking for the last 30 years. He denies any illicit drug use. Family History: Mom had either lung cancer or breast cancer in 70's. She also has history of rheumatoid arthritis. Dad had stroke at 88. Both brother and sister have asthma. Review of Systems: Constitutional fatigue and weakness, headaches, muscle spasm, sensitivity. GU: Frequent urination at night. Musculoskeletal: Morning stiffness for 30 minutes, bilateral hip pain left greater than right. Extremities: Some swelling of his right foot. The rest of the 14-point review of systems is negative except for positives noted in HPI. Physical Examination: Vitals: Temp 98.2, heart rate 68, blood pressure 106/69, weight 224, 3 of 10 pain in his hips. General: Overweight, middle-aged gentleman who appears his stated age, in no acute distress walking and speaking without any difficulty. Skin: No rashes. HEENT: Eyes anicteric, EOMs full, PERRLA, oral mucosa pink and moist without exudates, tongue midline. Neck: Supple with no lymphadenopathy. Lungs: CTAB. CV: No JVDR, normal S1 and S2 without murmurs, rubs, or gallops. Abdomen: Soft, nondistended, nontender. Extremities: +2 bilateral pulses, no lower extremity edema. Musculoskeletal: No effusion in the joints of the hands, wrist, elbows, knees, ankles, and feet bilaterally. There is full range of motion in the extension and flexion of his joints. He has a full range of motion in his hands, wrists, elbows, knees, ankles, and hips. There is no synovitis throughout the exam. Neuro: Cranial nerves II through XII intact, deep tendon reflexes were tested in brachioradialis, biceps, triceps, and Achilles areas bilaterally and were 2+ throughout. DTRs were 1+ bilaterally at the patellae, but were symmetric. Motor strength was 5 out of 5 for biceps, deltoids , quadriceps, gastrocnemius, anterior tibialis, neck and grip. His gait was mildly wide-based with decreased motor strength on his left side. He walks slumped over but was able to be in a neutral position when asked to extend his back. He does require holding himself up when going from a sitting position to a standup position. Mental Status: The patient appears depressed but alert and oriented x 3 and answers
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appropriately to questions. Laboratories from 11/02/2010 were all in the normal limits. CK 40, acetylcholine antibody was 8, ESR is 8, ANA is negative. BMP from 10/18/2010 was within normal limits, and CBC also within normal limits. Assessment and Plan: 51 yo man with osteoarthritis and hip replacement, now with new progressive weakness of the lower and upper extremities with mostly negative physical exam and normal CK, ESR and ANA. 1) Weakness. The patient described symptoms of weakness of a progressive nature, now involving weakness of his back, which is somewhat atypical to have. Little of his weakness is convincing for rheumatologic disease and his inflammatory markers such as ESR and ANA are all negative. The patient's presentation does not fit the picture of rheumatological diseases such as polymyositis or rheumatoid arthritis. His symptoms of 15 minutes of morning stiffness is too brief to be rheumatalgically related. His age again is fairly young to present with polymyalgia rheumatica and he has no pains that are strongly suggestive of RA by distribution or otherwise. In terms of other possible differentials, in certain cases chronic use of methadone can cause muscle breakdown leading to weakness. However, his CK from February 2010 was normal, in addition to his LFT's. However, given his methadone use, we think it is reasonable to check another CK level; we suspect the CK is again going to be normal. In addition to other explanations, his weakness we think is likely more neurological rather than rheumatological. We may consider something like chronic inflammatory demyelinating polyneuropathy (CIDP) which can present with progressive weakness. The patient also reports a component of neuropathic pain isolated to his right foot, although his physical exam did not show any gross sensory loss. It is somewhat odd to have isolated neuropathic pain in one extremity without any involvement to other extremities; CIDP can cause asymmetric sensory and modal changes. As a result, we think it is best to refer him to our Neurology colleagues to see whether further workup is necessary. We will defer workup such as nerve conduction studies to them. In the meantime, we will check another CK level and LFT's to rule out muscle involvement, however we expect the yield to be low. 2) Chronic pain. We note that the patient is on high-dose methadone for his chronic pain, but he also reports occasional drinking with his opiate. We spoke to him extensively regarding the possible interaction with this combination of opiates and alcohol. We have advised him to abstain from alcohol to minimize the side effects of the medication. I have educated/instructed the patient regarding all aspects of the above-stated plan of care. The patient acknowledges understanding of plan of care. I spent 60 minutes with this patient, more than 50 percent of which was in counseling regarding his symptoms and questions. Followup: The patient does not need to be followed-up by Rheumatology at this time as this is not likely rheumatologic in nature. He can certainly be rereferred to our Clinic if new information arises that points toward rheumatologic disease as needed or he may call prn.
002408
XIAO CAI, MD RESIDENT DEPARTMENT OF INTERNAL MEDICINE THIS WAS ELECTRONICALLY SIGNED - 02/04/2011 12:15 PM PST BY: I saw, examined, and interviewed the patient personally. I agree with the resident's note and assessment and plan which we developed together. THIS WAS ELECTRONICALLY SIGNED - 02/02/2011 5:30 PM PST BY: BARTON WISE, MD ATTENDING
XC:cg(ucd039) D: 02/01/2011 04:57 PM T: 02/02/2011 09:48 AM C#: 5343837
Display only: Transcription (11900701) on 2/1/2011 4:57 PM by Xiao Cai, MD Document history: Transcription (11900701) on 2/1/2011 4:57 PM by Xiao Cai, MD Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Visit Notes BEVERLY MERRIWEATHER Tue Feb 1, 2011 9:23 AM Vital signs taken, allergies verified, screened for pain. Preferred pharmacy verified. Medication refills needed no. The patient smokes: no . Beverly Merriweather, MA II
Electronically signed by BEVERLY MERRIWEATHER at Tue Feb 1, 2011 9:23 AM
Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Mon Jan 24, 2011 7:10 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's about time for another refill on Methadone. I will be out on Thursday, so I'm hoping to pick up a refill on Wednesday afternoon. I wanted to give y'all plenty of notice in case you were out of the office... Regards, Mark Amundsen Electronically signed byClare Jennings, MA on 1/24/2011 9:49 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed.
002409
David Chesak, M.D. (Fellow)
Nandini Bakshi, M.D. (Attending)
Electronically signed by David P Chesak, MD at 3/3/2011 4:04 PM

Author Ricardo A Maselli, MD Assoc. Orders None Status Signed Last Editor Ricardo A Maselli, MD Updated 3/4/2011 10:15 PM Created 3/4/2011 10:15 PM
Electronically signed by Ricardo A Maselli, MD at 3/4/2011 10:15 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes
UNIVERSITY OF CALIFORNIA DAVIS HEALTH SYSTEM PRIMARY CARE NETWORK - CARMICHAEL NEUROLOGY OUTPATIENT NEUROLOGY CONSULTATION PATIENT: Mark Amundsen MRN: 8081369 SEX: male AGE: 51yr DOB: 9/23/1959 DATE OF SERVICE: 2/17/2011 LOCATION: NEUCAR CHIEF COMPLAINT: Weakness Rule out chronic inflammatory demyelinating polyneuropathy Consultation Requested by Victor Henrique Baquero, MD, and Barton Lahn Wise, MD HISTORY OF PRESENT ILLNESS: Mark Amundsen is a 51yr old right-handed man seen today in neurological consultation at the request of Dr. Victor Henrique Baquero of family medicine and Dr. Barton Lahn Wise of rheumatology regarding severe weakness located mostly in the legs but also in the back over a duration of 4-5 months with associated difficulty walking. He denies associated weakness of neck muscles or weakness of face muscles or blepharoptosis or dysarthria or dysphagia or dysphonia. He reports some chronic numbness in the right forefoot but otherwise there is no associated numbness or tingling or pain. With regard to timing, the weakness is constant and nonfluctuating. He has chronic left hip problems and he had left total hip arthroplasty but he attributes his walking problem to weakness rather than his left hip problem. He is on Norco and
002410
methadone for chronic pain. Dr. Wise of rheumatology did not think he had a rheumatologic condition but did suspect chronic inflammatory demyelinating polyneuropathy. PAST MEDICAL HISTORY: ADVANCED OSTEOARTHRITIS OF THE LEFT HIP DEPRESSIVE DISORDER CHRONIC PAIN MEDICATION AGREEMENT Anemia Orthopedic Aftercare for Joint Replacement Dyslipidemia Vitamin D deficiency Hypertension MEDICATIONS: Carisoprodol (SOMA) 350 mg Tablet, Take 2 Tabs by mouth every day at bedtime. Carisoprodol (SOMA) 350 mg Tablet, Take 1 Tab by mouth 3 times daily. Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule, Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. Fenofibrate (TRICOR) 145 mg PO Tablet, Take 1 Tab by mouth every morning after a meal. Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet, For breakthrough pain. Methadone (DOLOPHINE) 10 mg Tablet, Take 2 Tabs by mouth every 6 hours. Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet, Take 1 Tab by mouth every morning. ALLERGIES: Allergies Allergen Morphine Fentanyl itching
Reactions Hives
SOCIAL HISTORY: History of cigarette smoking. Rare alcohol use. Previously worked as a network administrator. FAMILY HISTORY: Noncontributory. REVIEW OF SYSTEMS: All systems reviewed on 2/17/2011 and all systems are negative except as mentioned in the history of present illness. PHYSICAL EXAMINATION: Vital signs: BP 108/72 | Pulse 76 | Resp 16 | Ht 1.854 m (6' 1") | Wt 101.152 kg (223 lb) | BMI 29.42 kg/m2 General appearance: Patient appears well, in no acute distress. Eyes: Anicteric. Respiratory: Chest clear to auscultation. Ears, nose, mouth, and throat: Normal. Musculoskeletal: Neck supple. Normal range of joint motion. Cardiovascular: No carotid bruits. Heart sounds regular. Skin: No jaundice. Psychiatric: Normal mood and affect. Neurological: Visual fields full to confrontation. PERRL. EOMI. No spontaneous or gaze evoked nystagmus. Facial sensation intact. Facial muscle strength normal. No blepharoptosis. Hearing
002411
intact. Palate elevation normal. Sternocleidomastoid function and shoulder shrug normal. Tongue protrudes in midline. No tongue atrophy. No tongue fasciculations. DTRs 2+ and symmetric throughout. Babinski sign absent. Motor power 5/5 and symmetric in distal and proximal muscles including neck muscles. Normal motor tone. Normal muscle bulk with no muscle atrophy and no fasciculations. No pronator drift. Sensation intact to temperature, vibration, and proprioception. Romberg sign absent. Mental status normal. Gait is slow and deliberate, out of proportion to any weakness demonstrated on individual muscle testing. Limb coordination normal without dysmetria. Rapid alternating movements normal. OTHER DATA: Old records reviewed: I reviewed prior UC Davis Health System records including a rheumatology note from 02/01/2011 by Dr. Barton Lahn Wise which indicates "...The patient described symptoms of weakness of a progressive nature, now involving weakness of his back, which is somewhat atypical to have. Little of his weakness is convincing for rheumatologic disease and his inflammatory markers such as ESR and ANA are all negative. The patient's presentation does not fit the picture of rheumatological diseases such as polymyositis or rheumatoid arthritis. His symptoms of 15 minutes of morning stiffness is too brief to be rheumatalgically related. His age again is fairly young to present with polymyalgia rheumatica and he has no pains that are strongly suggestive of RA by distribution or otherwise...We may consider something like chronic inflammatory demyelinating polyneuropathy (CIDP) which can present with progressive weakness..." Laboratory results: CK normal. B12 normal (478). Folate normal. ESR normal (8). ANA negative. Electrolytes, BUN, creatinine all normal. LFTs normal. 25 hydroxy vitamin D borderline low (25.1). Fasting glucose normal (94). Acetylcholine receptor blocking antibody negative. TSH borderline elevated (3.42). Free T4 normal. Urine heavy metals negative. Radiology results: I independently visualized the following radiology studies today: Lumbar spine MRI without contrast 03/05/2004: Normal. No disc bulges. No foraminal stenosis. No central canal stenosis. IMPRESSION/PLAN: 780.79L Weakness (primary encounter diagnosis) Comment: New problem to this examiner; additional workup planned. The abnormalities he displays when walking are out of proportion to any muscle weakness demonstrated on individual muscle strength testing. His reflexes are also normal. For these reasons, on a scale of nil-low-intermediate-high, my level of suspicion of chronic inflammatory demyelinating polyneuropathy is somewhere between nil and low. I will request additional testing, as delineated below, to further exclude an organic explanation for his symptoms. Plan: EMG/NCS. ACETYLCHOLINE RECEPTOR BINDING AB. ACETYLCHOLINE RECEPTOR MODULATING AB. MUSK ANTIBODY.
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CREATINE KINASE. ALDOLASE. THYROID STIMULATING HORMONE. THYROXINE FREE (FREE T4). THYROID PEROXIDASE (TPO) AB. LEAD BLOOD. COMMENT: I explained to Mr. Amundsen the diagnosis, prognosis, treatment options, risks, benefits, and his right to choose treatment options. He verbalized a good understanding and all questions were answered to his satisfaction. I provided reassurance and directed him to contact me as needed for further information. FOLLOWUP: Return after tests.
Electronically signed byAndrew Kim Oh, MD on 2/17/2011 11:19 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Thu Feb 17, 2011 11:09 AM Subject: Non-urgent Medical Advice Question ContinuedDoctor Oh confirmed muscle weakness but said it is unlikely it is CIDP, which is good because it is much more serious than Internet says it is. He also ran additional blood tests. Left hip is getting worse pain wise. I found out cobalt test that was run (urine) was not the recommended one - recommended one is blood test. There is none in UC Davis, Should I contact Ortho? Mark Amundsen Electronically signed byClare Jennings, MA on 2/17/2011 11:10 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD
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Hi Dr BaqueroIt's about time for another methadone refill. I'll be out on Thursday, so I'm hoping to pick up a refill on Wednesday afternoon. Also, I have my neuro consult on the 24th to discuss EMG test - keeping fingers crossed. Thanks for all the support... Mark Amundsen Electronically signed byClare Jennings, MA on 3/14/2011 8:14 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Left message that forms are at front desk

Forms completed. Thank you.

Forms are in your in box with the business chart

Electronically signed byClare Jennings, MA on 3/11/2011 9:23 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Procedures
Electronically signed byRicardo A Maselli, MD on 3/4/2011 10:15 PM Procedure Notes Author David P Chesak, MD Status Signed Last Editor David P Chesak, MD Updated 3/3/2011 4:04 PM Created 3/3/2011 4:04 PM
Procedures EMG/NCS
002414
Oh
Latency Differenc e
Distance
5.5 ms 20.4 ms
4.5 mV 2.1 mV
5.5 ms 14.9 ms
80 mm 456 mm
m/s 31 m/s
Peroneal.R Fibula (head) Popliteal fossa
4.2 ms 6.6 ms
5.2 mV 5.4 mV
4.2 ms 2.4 ms
106 mm 140 mm
m/s 58 m/s
Median.R Wrist
Elbow
3.8 ms
9.0 ms
13.5 mV
13.1 mV
3.8 ms
5.2 ms
80 mm
258 mm
m/s
50 m/s
Ulnar.R Wrist Below elbow Above elbow
3.0 ms 7.2 ms 9.9 ms
9.7 mV 8.8 mV 8.5 mV
3.0 ms 4.2 ms 2.7 ms
80 mm 205 mm 120 mm
m/s 49 m/s 44 m/s
Tibial.L Ankle Popliteal fossa
5.6 ms 20.2 ms
4.9 mV 3.7 mV
5.6 ms 14.6 ms
80 mm 450 mm
m/s 31 m/s
Peroneal.L Ankle
6.1 ms
2.7 mV
Extensor digitorum
6.1 ms
80 mm
m/s
002415
Fibula (head) Popliteal fossa
16.4 ms 20.7 ms
2.7 mV 3.1 mV
brevis-Ankle Ankle-Fibula (head) Fibula (head)Popliteal fossa
10.3 ms 4.3 ms
308 mm 154 mm
30 m/s 36 m/s
Median.L Wrist
Elbow
3.8 ms
8.9 ms
11.8 mV
11.3 mV
3.8 ms
5.1 ms
80 mm
267 mm
m/s
52 m/s
F-Wave Studies

Nerve and Site
Peak Latenc y
Amplitu de
Segment
Latency Differen ce
Distan ce
NR
NR
Ankle-Lower leg
ms
mm
m/s
3.4 ms
18 uV
2.9 ms
140 mm
48 m/s
Ulnar.R Wrist
3.7 ms
7 uV
2.7 ms
140 mm
51 m/s
Sural.L Lower leg
5.1 ms
3 uV
Ankle-Lower leg
4.1 ms
140 mm
34 m/s

Insertio Spontaneous Volitional MUAPs Max Volitional Activity nal Activity Config RecruitmAmplitu Pattern Activatio InsertionFibs + Fasc Duratio Amplitu Poly al n de ent de Wave n/Effort Max. Normal NoneNone NoneIncreas Normal None Normal Normal Normal Full ed Max. Normal NoneNone None Normal Normal None Normal Normal Normal Full Normal None Rare NoneIncreas Normal Few ed Normal NoneNone None Normal Normal None Normal NoneNone None Normal Normal None Normal NoneNone None Normal Normal None Normal NoneNone None Normal Normal None Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal
Muscle Vastus medialis.L Vastus medialis.R Tibialis anterior.L Tibialis anterior.R Gastrocnemius (Medial head).L Gastrocnemius (Medial head).R Extensor hallucis
Full Full Full Full Full
Max. Max. Max. Max. Max.
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longus.L Peroneus longus.L Deltoid.L
Normal NoneNone None Normal Normal None Normal NoneNone None Normal Normal None
Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal
Full Full Full Full
Max. Max. Max. Max.
ELECTRODIAGNOSTIC FINDINGS: 1. 2. 3. 4. 5. 6. Motor nerve conduction studies of the right peroneal, bilateral median, and right ulnar nerves were normal. Motor nerve conduction studies of the bilateral tibial and left peroneal nerves showed normal distal latencies and compound muscle action potential amplitudes but mildly slowed conduction velocities bilaterally. F-wave latencies of the left median and left tibial nerves were normal while F-wave latencies of the right median and right ulnar nerves were mildly prolonged and F-wave latency of the right tibial nerve was moderately prolonged. Sensory nerve conduction study of the right sural nerve showed no response while study of the left sural nerve showed severely reduced sensory nerve action potential amplitude and mildly reduced conduction velocity. Sensory nerve conduction study of the right median and right ulnar nerves were normal. Needle EMG examination of selected proximal and distal muscles of the left upper and bilateral lower extremities was normal except for rare positive sharp waves seen a the left tibialis anterior.
CLINICAL IMPRESSION: Abnormal study. There is evidence of segmental demyelination in the bilateral lower extremities consistent with a predominantly demyelinating polyneuropathy affecting the bilateral lower extremities. There is no evidence of myopathy. David Chesak, M.D. (Fellow) Nandini Bakshi, M.D. (Attending)
Electronically signed by David P Chesak, MD at 3/3/2011 4:04 PM Author Ricardo A Maselli, MD Assoc. Orders None Status Signed Last Editor Ricardo A Maselli, MD Updated 3/4/2011 10:15 PM Created 3/4/2011 10:15 PM
Electronically signed by Ricardo A Maselli, MD at 3/4/2011 10:15 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Procedures
Oh
002417
Latency Differenc e
Distance
5.5 ms 20.4 ms
4.5 mV 2.1 mV
5.5 ms 14.9 ms
80 mm 456 mm
m/s 31 m/s
4.2 ms 6.6 ms
5.2 mV 5.4 mV
4.2 ms 2.4 ms
106 mm 140 mm
m/s 58 m/s
Median.R Wrist Elbow Ulnar.R Wrist Below elbow Above elbow
3.8 ms 9.0 ms
13.5 mV 13.1 mV
3.8 ms 5.2 ms
80 mm 258 mm
m/s 50 m/s
3.0 ms 7.2 ms 9.9 ms
9.7 mV 8.8 mV 8.5 mV
3.0 ms 4.2 ms 2.7 ms
80 mm 205 mm 120 mm
m/s 49 m/s 44 m/s
Tibial.L Ankle
5.6 ms 20.2 ms
4.9 mV 3.7 mV
Popliteal fossa
5.6 ms 14.6 ms
80 mm 450 mm
m/s 31 m/s
6.1 ms 16.4 ms 20.7 ms
2.7 mV 2.7 mV 3.1 mV
6.1 ms 10.3 ms 4.3 ms
80 mm 308 mm 154 mm
m/s 30 m/s 36 m/s
Median.L Wrist
Elbow
3.8 ms
8.9 ms
11.8 mV
11.3 mV
3.8 ms
5.1 ms
80 mm
267 mm
m/s
52 m/s
002418
F-Wave Studies

Nerve and Site
Peak Latenc y
Amplitu de
Segment
Latency Differen ce
Distan ce
Sural.R Lower leg
NR
NR
Ankle-Lower leg
ms
mm
m/s
Median.R Wrist
3.4 ms
18 uV
2.9 ms
140 mm
48 m/s
Ulnar.R Wrist
3.7 ms
7 uV
2.7 ms
140 mm
51 m/s
Sural.L Lower leg
5.1 ms
3 uV
Ankle-Lower leg
4.1 ms
140 mm
34 m/s

Insertio Spontaneous Volitional MUAPs Max Volitional Activity nal Activity Config RecruitmAmplitu Pattern Activatio InsertionFibs + Fasc Duratio Amplitu Poly al n de ent de Wave n/Effort Max. Normal NoneNone NoneIncreas Normal None Normal Normal Normal Full ed Max. Normal NoneNone None Normal Normal None Normal Normal Normal Full Normal None Rare NoneIncreas Normal Few ed Normal NoneNone None Normal Normal None Normal NoneNone None Normal Normal None Normal NoneNone None Normal Normal None Normal NoneNone None Normal Normal None Normal NoneNone None Normal Normal None Normal NoneNone None Normal Normal None Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal
Full Full Full Full Full Full Full Full Full
Max. Max. Max. Max. Max. Max. Max. Max. Max.
002419
CLINICAL IMPRESSION: Abnormal study. There is evidence of segmental demyelination in the bilateral lower extremities consistent with a predominantly demyelinating polyneuropathy affecting the bilateral lower extremities. There is no evidence of myopathy. David Chesak, M.D. (Fellow) Nandini Bakshi, M.D. (Attending)
Electronically signed byDavid P Chesak, MD on 3/3/2011 4:04 PM Procedure Notes Author David P Chesak, MD Status Signed Last Editor David P Chesak, MD Updated 3/3/2011 4:04 PM Created 3/3/2011 4:04 PM
Procedures EMG/NCS
Oh
002420
Nerve and Site
Latenc y
Amplitud e
Segment
Latency Differenc e
Distance
5.5 ms 20.4 ms
4.5 mV 2.1 mV
5.5 ms 14.9 ms
80 mm 456 mm
m/s 31 m/s
4.2 ms 6.6 ms
5.2 mV 5.4 mV
4.2 ms 2.4 ms
106 mm 140 mm
m/s 58 m/s
Median.R Wrist
Elbow
3.8 ms
9.0 ms
13.5 mV
13.1 mV
3.8 ms
5.2 ms
80 mm
258 mm
m/s
50 m/s
Ulnar.R Wrist Below elbow Above elbow
3.0 ms 7.2 ms 9.9 ms
9.7 mV 8.8 mV 8.5 mV
3.0 ms 4.2 ms 2.7 ms
80 mm 205 mm 120 mm
m/s 49 m/s 44 m/s
Tibial.L Ankle Popliteal fossa
5.6 ms 20.2 ms
4.9 mV 3.7 mV
5.6 ms 14.6 ms
80 mm 450 mm
m/s 31 m/s
6.1 ms 16.4 ms 20.7 ms
2.7 mV 2.7 mV 3.1 mV
6.1 ms 10.3 ms 4.3 ms
80 mm 308 mm 154 mm
m/s 30 m/s 36 m/s
Median.L Wrist Elbow F-Wave Studies

Nerve Tibial.R Median.R Ulnar.R Tibial.L Median.L
3.8 ms 8.9 ms
11.8 mV 11.3 mV
3.8 ms 5.1 ms
80 mm 267 mm
m/s 52 m/s
M-Latency 5.1 3.5 3.1 5.5 3.5
F-Latency 66.6 32.3 33.9 51.5 31.1

Nerve and Site
Peak Latenc y
Amplitu de
Segment
Latency Differen ce
Distan ce
002421
NR
NR
Ankle-Lower leg
ms
mm
m/s
3.4 ms
18 uV
2.9 ms
140 mm
48 m/s
Ulnar.R Wrist
3.7 ms
7 uV
2.7 ms
140 mm
51 m/s
Sural.L Lower leg
5.1 ms
3 uV
Ankle-Lower leg
4.1 ms
140 mm
34 m/s

Insertio Spontaneous Volitional MUAPs Max Volitional Activity nal Activity Config RecruitmAmplitu Pattern Activatio InsertionFibs + Fasc Duratio Amplitu Poly al n de ent de Wave n/Effort Max. Normal NoneNone NoneIncreas Normal None Normal Normal Normal Full ed Max. Normal NoneNone None Normal Normal None Normal Normal Normal Full Normal None Rare NoneIncreas Normal Few ed Normal NoneNone None Normal Normal None Normal NoneNone None Normal Normal None Normal NoneNone None Normal Normal None Normal NoneNone None Normal Normal None Normal NoneNone None Normal Normal None Normal NoneNone None Normal Normal None Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal
Full Full Full Full Full Full Full Full Full
Max. Max. Max. Max. Max. Max. Max. Max. Max.
CLINICAL IMPRESSION: Abnormal study. There is evidence of segmental demyelination in the bilateral lower extremities consistent with a predominantly demyelinating polyneuropathy affecting the bilateral lower extremities. There is no evidence of myopathy.
002422
PATIENT: Mark Amundsen MRN: 8081369 SEX: male AGE: 51yr DOB: 9/23/1959 DATE OF SERVICE: 3/24/2011 LOCATION: NEUCAR CHIEF COMPLAINT: Weakness Follow Up With Specialist HISTORY OF PRESENT ILLNESS: Mark Amundsen is a 51yr old right-handed man who returns today in neurological followup regarding severe weakness located mostly in the legs but also in the back over a duration of 45 months with associated difficulty walking. He denies associated weakness of neck muscles or weakness of face muscles or blepharoptosis or dysarthria or dysphagia or dysphonia. He reports some chronic numbness in the right forefoot but otherwise there is no associated numbness or tingling or pain. With regard to timing, the weakness is constant and nonfluctuating. He has chronic left hip problems and he had left total hip arthroplasty but he attributes his walking problem to weakness rather than his left hip problem. He is on Norco and methadone for chronic pain. Dr. Wise of rheumatology did not think he had a rheumatologic condition but did suspect chronic inflammatory demyelinating polyneuropathy. EMG in March 2011 showed evidence of segmental demyelination in the bilateral lower extremities consistent with a predominantly demyelinating polyneuropathy affecting the bilateral lower extremities with no evidence of myopathy. PAST MEDICAL HISTORY: ADVANCED OSTEOARTHRITIS OF THE LEFT HIP DEPRESSIVE DISORDER CHRONIC PAIN MEDICATION AGREEMENT Anemia Orthopedic Aftercare for Joint Replacement Dyslipidemia Vitamin D deficiency Hypertension MEDICATIONS: Carisoprodol (SOMA) 350 mg Tablet, Take 2 Tabs by mouth every day at bedtime. Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule, Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. Fenofibrate (TRICOR) 145 mg PO Tablet, Take 1 Tab by mouth every morning after a meal. Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet, Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. ** Do not exceed max daily dose of 4000 mg of Tylenol/Acetaminophen from all sources. Methadone (DOLOPHINE) 10 mg Tablet, Take 2 Tabs by mouth every 6 hours. Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet, Take 1 Tab by mouth every morning. ALLERGIES: Allergies Allergen Morphine Fentanyl
Reactions Hives
002423
itching
SOCIAL HISTORY: History of cigarette smoking. Rare alcohol use. Previously worked as a network administrator. FAMILY HISTORY: Noncontributory. REVIEW OF SYSTEMS: All systems reviewed on 3/24/2011 and all systems are negative except as mentioned in the history of present illness. PHYSICAL EXAMINATION: Vital signs: BP 126/78 | Pulse 76 | Resp 16 | Ht 1.854 m (6' 1") | Wt 101.152 kg (223 lb) | BMI 29.42 kg/m2 General appearance: Patient appears well, in no acute distress. Eyes: Anicteric. Respiratory: Chest clear to auscultation. Ears, nose, mouth, and throat: Normal. Musculoskeletal: Neck supple. Normal range of joint motion. Cardiovascular: Heart sounds regular. Skin: No jaundice. Psychiatric: Normal mood and affect. Neurological: DTRs intact. Power 5/5 throughout. Normal muscle bulk with no muscle atrophy. Gait is slow and deliberate, out of proportion to any weakness demonstrated on individual muscle testing. OTHER DATA: Laboratory results: CK normal. Aldolase normal. B12 normal (478). Folate normal. ESR normal (8). ANA negative. Electrolytes, BUN, creatinine all normal. LFTs normal. 25 hydroxy vitamin D borderline low (25.1). Fasting glucose normal (94). Acetylcholine receptor binding antibody negative. Acetylcholine receptor blocking antibody negative. Acetylcholine receptor modulating antibody negative. MuSK antibody negative. TSH elevated (3.42, 4.54). Free T4 normal. Thyroid peroxidase antibody negative. Urine heavy metals negative. Blood lead level not elevated. Radiology results: Lumbar spine MRI without contrast 03/05/2004: Normal. No disc bulges. No foraminal stenosis. No central canal stenosis. IMPRESSION/PLAN: 780.79L Weakness (primary encounter diagnosis)
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Comment: The abnormalities he displays when walking are out of proportion to any muscle weakness demonstrated on individual muscle strength testing. His reflexes are also normal. For these reasons, on a scale of nil-low-intermediate-high, my level of suspicion of chronic inflammatory demyelinating polyneuropathy is somewhere between nil and low but EMG testing showed findings consistent with polyneuropathy. Many etiologies are possible. His workup so far has not revealed an obvious cause. He may have mild hypothyroidism which could be a contributing etiology. Will need CSF analysis, MAG antibody assay, SPEP, and cryoglobulins. Plan: NEUROPATHY PANEL - MOTOR, CRYOGLOBULIN, HEPATITIS C AB SCREEN. FLUOROSCOPY UNDER 60 MINUTES WITH RADIOLOGIST for LP. CELL COUNT CSF, PROTEIN CSF, GLUCOSE CSF, LYME (B.BURGDORFERI) AB CSF, SYPHILIS TEST CSF (VDRL), MULTIPLE SCLEROSIS PANEL CSF, CULTURE CSF (INCLUDES GS). COMMENT: I explained to Mr. Amundsen the diagnosis, prognosis, treatment options, risks, benefits, and his right to choose treatment options. He verbalized a good understanding and all questions were answered to his satisfaction. I provided reassurance and directed him to contact me as needed for further information. FOLLOWUP: Return after tests.
Electronically signed byAndrew Kim Oh, MD on 3/24/2011 1:23 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Visit Notes RONALD P ROJAS Thu Mar 24, 2011 8:25 AM Patient presents with: Weakness Follow Up With Specialist Vital signs taken, allergies verified, screened for pain, med hx taken. Ronald P Rojas
Electronically signed by RONALD P ROJAS at Thu Mar 24, 2011 8:25 AM
Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Mon Mar 14, 2011 6:28 AM Subject: Non-urgent Medical Advice Question
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Regards, Mark Amundsen Electronically signed byClare Jennings, MA on 4/11/2011 7:36 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Thu Apr 7, 2011 6:52 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's about time for another Methadone refill. I won't be out until Wednesday, so I'd like to pick up the script on Tuesday the 12th. I wanted to give y'all extra time cause of the weekend. Another message on medical status after this oneRegards, Mark Amundsen Electronically signed byClare Jennings, MA on 4/7/2011 8:11 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Thu Apr 7, 2011 6:57 AM Subject: Test Result Question Hi Dr BaqueroTests have been done-the nerve conduction test showed I have some sort of demylinating disease or condition, so they're testing for the usual suspects. None have come up positive so far. Still to come-Lyme, MS, Syphilis. Still haven't managed to get cobalt blood test done by UCD. Also having spinal tap done end of month-whoopee! Regards, Mark Amundsen Electronically signed byClare Jennings, MA on 4/7/2011 8:10 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes
UNIVERSITY OF CALIFORNIA DAVIS HEALTH SYSTEM PRIMARY CARE NETWORK - CARMICHAEL NEUROLOGY NEUROLOGY CLINIC FOLLOWUP
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To: Victor Henrique Baquero, MD Sent: Tue May 3, 2011 5:09 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI have found a place to perform the cobalt serum test in Folsom (Quest Diag).All they require is a lab request for the test from a doctor. It can even be on a prescription pad.I'd like to get the hip replacement eliminated as a possible source of the demylination.If you could provide the request, I would appreciate it. Also, I'm due for a refill on methadone. I will be out on Thursday, so I'd like to pick up both requests at the same time before then. Thanks, Mark Amundsen Electronically signed byClare Jennings, MA on 5/3/2011 8:14 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes filed by Onbase Incoming Interface at 05/03/11 0721 Author: Onbase Incoming Service: (none) Author Interface Type: 05/03/11 0721 05/03/11 0721 Filed: Note Time: (none)
Scan on: 05/03/2011 7:21 AM by: Onbase Incoming Interface [886105] - CONSENT TO OPERATION
Progress Notes filed by Onbase Incoming Interface at 05/03/11 0631 Author: Onbase Incoming Service: (none) Author Interface Type: 05/03/11 0631 05/03/11 0631 Note Filed: Time:
(none)
Scan on: 05/03/2011 6:31 AM by: Onbase Incoming Interface [886105] - PATIENT EDUCATION RECORD Telephone Encounter

Electronically signed byVictor Henrique Baquero, MD on 4/11/2011 12:47 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Mon Apr 11, 2011 12:11 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI miscalculated the number of days Methadone I had left when I made my last request. I will be out on Tuesday morning - so I'm hoping to pick up a script Monday afternoon ( the 11th), rather than Tuesday afternoon (the 12th). I fyou coul, please let me know via email or phone when it is ready to pick up. Also, bilateral foot pain and burning is getting worse - I don't suppose there is something different for that?
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hip is called for to evaluate new damage. If possible, before appt on June 20th so we can discuss? Please let me know what I need to do to accomplish this if needed. Thanks! Mark A P.S. Limit on msgs is tough! Electronically signed byClare Jennings, MA on 5/23/2011 3:58 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Fri May 13, 2011 8:09 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI just wanted to check and see if the results for my Cobalt blood test have been received. The lab informed me the results would be transmitted straight to your office, and it's been over a week. Please let me know as soon as any results are received. Thanks for your assistance in this matterMark Amundsen Electronically signed byClare Jennings, MA on 5/13/2011 8:29 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter

Electronically signed byClare Jennings, MA on 5/4/2011 2:29 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Wed May 4, 2011 8:12 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI'm hoping to pick up a methadone prescription and a lab request for a cobalt blood test today. Please let me know via email or phone when these items are ready. Thanks! Mark Amundsen Electronically signed byClare Jennings, MA on 5/4/2011 8:53 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK
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Electronically signed byAndrew Kim Oh, MD on 5/24/2011 9:15 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Visit Notes RONALD P ROJAS Tue May 24, 2011 8:19 AM Patient presents with: Weakness - Polyneuropathy Follow Up With Specialist Vital signs taken, allergies verified, screened for pain, med hx taken. Ronald P Rojas Electronically signed by RONALD P ROJAS at Tue May 24, 2011 8:19 AM Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Mon May 23, 2011 3:08 PM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroHave a # of issues1. Need a refill for Methadone on Thursday May 26. I have been using 9-10 per day, versus 8 per day normal. Efficacy and duration dropping. Appt made to discuss options. Please adjust script as you see fit. 2. Breakthrough pain meds efficacy at 30%. Need to change to alternate med. If possible, provide new script on Thursday, otherwise discuss at appt. 3. Would like to get copy of cobalt test from lab. Please provide note authorizing release. Thx Mark A Electronically signed byClare Jennings, MA on 5/23/2011 4:00 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Mon May 23, 2011 3:19 PM Subject: Non-urgent Medical Advice Question Hi Dr BPain level (4-5) is up on right hip. Left hip at pain level 2 (same). Have appt made, wondering if a x-ray of right
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Attachment: Scan on 6/17/2011 6:50 AM by Onbase Incoming Interface : QUEST Display only: Transcription (OBS2837774) on 6/17/2011 6:50 AM by Onbase Incoming Interface Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Message addressed.
I have a copy of the results and will inform the patient.

Christy, Can you pull up the cobalt results and copy for Mr. Amundsen. These were outside labs - they came by some time ago. I don't see that they were scanned.
Electronically signed byVictor Henrique Baquero, MD on 5/26/2011 3:06 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Wed May 25, 2011 4:57 PM Subject: Non-urgent Medical Advice Question Hi Dr Baquero and staffI'll be in for the x-rays when I come in to pick up my scripts. I wanted to make sure y'all received my message about needing a methadone refill tomorrow, and about requesting a note I can take to the lab so I can get a copy of the cobalt report. Thanks Mark Amundsen
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He is calling for a refill of Methadone (DOLOPHINE) 10 mg Tablet. He did not call his pharmacy for a refill already. He requests call when ready to p/u. Patient also states the Norco Rx is not helping him. Can you please call in a different prescription.
Electronically signed byVeronica Arriaga on 5/26/2011 1:13 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes
UNIVERSITY OF CALIFORNIA DAVIS HEALTH SYSTEM PRIMARY CARE NETWORK - CARMICHAEL NEUROLOGY NEUROLOGY CLINIC FOLLOWUP PATIENT: Mark Amundsen MRN: 8081369 SEX: male AGE: 51yr DOB: 9/23/1959 DATE OF SERVICE: 5/24/2011 LOCATION: NEUCAR CHIEF COMPLAINT: Weakness Polyneuropathy Follow Up With Specialist HISTORY OF PRESENT ILLNESS: Mark Amundsen is a 51yr old right-handed man who returns today in neurological followup regarding severe weakness located mostly in the legs but also in the back over a duration of 78 months with associated difficulty walking. He denies associated weakness of neck muscles or weakness of face muscles or blepharoptosis or dysarthria or dysphagia or dysphonia. He reports chronic numbness in the feet with associated tingling and burning discomfort. With regard to timing, the weakness is constant and nonfluctuating. He has chronic left hip problems and he had left total hip arthroplasty but he attributes his walking problem to weakness rather than his left hip problem. He is on Norco and methadone for chronic pain. Dr. Wise of rheumatology did not think he had a rheumatologic condition but did suspect chronic inflammatory demyelinating polyneuropathy. EMG in March 2011 showed evidence of segmental demyelination in the bilateral lower extremities consistent with a predominantly demyelinating polyneuropathy affecting the bilateral lower extremities with no evidence of myopathy. CSF results were normal (CSF protein near upper limit of normal).
002431
PAST MEDICAL HISTORY: ADVANCED OSTEOARTHRITIS OF THE LEFT HIP DEPRESSIVE DISORDER CHRONIC PAIN MEDICATION AGREEMENT Anemia Orthopedic Aftercare for Joint Replacement Dyslipidemia Vitamin D deficiency Hypertension MEDICATIONS: Carisoprodol (SOMA) 350 mg Tablet, Take 2 Tabs by mouth every day at bedtime. Ergocalciferol, Vitamin D2, (VITAMIN D) 50,000 unit PO Capsule, Take 1 Cap by mouth. take 1 capsule by oral route twice weekly for next 2 months. Then lab follow up 4 weeks later. Fenofibrate (TRICOR) 145 mg PO Tablet, Take 1 Tab by mouth every morning after a meal. Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet, Take 1 Tab by mouth every 4 to 6 hours if needed for pain. For breakthrough pain. Methadone (DOLOPHINE) 10 mg Tablet, Take 2 Tabs by mouth every 6 hours. Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.5-25 mg Tablet, Take 1 Tab by mouth every morning. ALLERGIES: Allergies Allergen Morphine Fentanyl itching
Reactions Hives
SOCIAL HISTORY: History of cigarette smoking. Rare alcohol use. Previously worked as a network administrator. FAMILY HISTORY: Noncontributory. REVIEW OF SYSTEMS: All systems reviewed on 5/24/2011 and all systems are negative except as mentioned in the history of present illness. PHYSICAL EXAMINATION: Vital signs: BP 112/80 | Pulse 77 | Resp 16 | Ht 1.854 m (6' 1") | Wt 102.059 kg (225 lb) | BMI 29.69 kg/m2 General appearance: Patient appears well, in no acute distress. Eyes: Anicteric. Respiratory: Chest clear to auscultation. Ears, nose, mouth, and throat: Normal. Musculoskeletal: Neck supple. Normal range of joint motion. Cardiovascular: Heart sounds regular. Skin: No jaundice. Psychiatric: Normal mood and affect. Neurological: MSRs now hypoactive in lower extremities, a new finding. Power 5-/5 in proximal lower extremities, 5/5 elsewhere. Normal muscle bulk with no muscle atrophy. Gait is slow and he ambulates with a cane. OTHER DATA:
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Laboratory results: CK normal. Aldolase normal. B12 normal (478). Folate normal. ESR normal (8). ANA negative. Electrolytes, BUN, creatinine all normal. LFTs normal. 25 hydroxy vitamin D borderline low (25.1). Fasting glucose normal (94). Acetylcholine receptor binding antibody negative. Acetylcholine receptor blocking antibody negative. Acetylcholine receptor modulating antibody negative. MuSK antibody negative. TSH elevated (3.42, 4.54). Free T4 normal. Thyroid peroxidase antibody negative. Urine heavy metals negative. Blood lead level not elevated. Hepatitis C antibody negative. Cryoglobulin 0. Ganglioside antibodes negative. Serum protein electrophoresis normal. Serum immunofixation normal. MAG antibody negative. SGPG antibody negative. CSF protein 44. CSF glucose 55. CSF WBC 3. CSF RBC 1. CSF Lyme antibody by ELISA negative. CSF VDRL nonreactive. CSF Gram stain and culture negative. CSF IgG synthesis rate <0. CSF IgG index 0.43 (0.28 - 0.66). CSF oligoclonal bands negative. Radiology results: Lumbar spine MRI without contrast 03/05/2004: Normal. No disc bulges. No foraminal stenosis. No central canal stenosis. IMPRESSION/PLAN: 356.9AG Polyneuropathy (primary encounter diagnosis) Comment: His chief complaint is weakness but there is also distal numbness and tingling. His reflexes are now hypoactive, which is a new finding. EMG showed findings consistent with demyelinating polyneuropathy. He may have mild hypothyroidism which could be a contributing etiology but it doesn't seem like that would be the primary cause. CSF protein was within normal limits but near the upper limit of the normal range. Plan: NEUROLOGY CLINIC REFERRAL for Dr. F. Gorin or Dr. D. Richman. Question to be answered: Is this a potentially steroid-responsive neuropathy like CIDP but with a normal CSF protein?
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Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Wed Jul 13, 2011 2:18 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI'm about out of the methadone prescription. I will be out on Sunday the 17th of July, so I'd like to pick up a refill script this Friday afternoon. Thanks for your attention in this matter... Regards, Mark Amundsen Electronically signed byClare Jennings, MA on 7/13/2011 8:24 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes
Chief Complaint Patient presents with Medication Follow Up Test Results x rays
Subjective: Mark Amundsen is a 51yr old male who is here for the following reason: Follow up on pain medications, recent xray, left sided hip pain. Status post left total hip replacement. Feels pain along lateral left hip and someitimes in the posterior buttocks. This pain is constant, however worse after prolonged walking. Has pain when laying on the ipsilateral side. Symptoms are mild to moderate. Pain medications don't work as well when the pain is more pronounced. Had to increase the methaodne. Reports ongoing neurologic symptoms - seeing neurology for this. Tingling, numbness wymmetrically to the lower extremities. No new symptoms. Pending neurology work up. Abnormal NCT. Notes heat intolerance as well. Not sure what that may be due to. Needs refills of his pain medications. Review of Systems: Constitutional: negative. CV: negative. Resp: negative.
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Patient Active Problem List Diagnoses BACKACHE NOS TESTICULAR HYPOFUNC NEC ADVANCED OSTEOARTHRITIS OF THE LEFT HIP DEPRESSIVE DISORDER CHRONIC PAIN MEDICATION AGREEMENT Anemia Orthopedic Aftercare for Joint Replacement Dyslipidemia Vitamin D deficiency Hypertension High arch Preop testing Polyneuropathy Current outpatient prescriptions ordered prior to encounter Medication Sig Carisoprodol (SOMA) 350 mg Take 2 Tabs by mouth every Tablet day at bedtime. Ergocalciferol, Vitamin D2, Take 1 Cap by mouth. take 1 (VITAMIN D) 50,000 unit PO capsule by oral route twice Capsule weekly for next 2 months. Then lab follow up 4 weeks later. Fenofibrate (TRICOR) 145 mg Take 1 Tab by mouth every PO Tablet morning after a meal. Hydrocodone 10 Take 1 Tab by mouth every 4 mg/Acetaminophen 325 mg to 6 hours if needed. (NORCO) 10-325 mg Tablet Methadone (DOLOPHINE) 10 Take 2 Tabs by mouth every mg Tablet 6 hours. Triamterene 37.5 Take 1 Tab by mouth every mg/Hydrochlorothiazide 25mg morning. (MAXZIDE-25) 37.5-25 mg Tablet
Code 724.5 257.2 726.5 311 719.45 285.9Y V54.81B 272.4CB 268.9G 401.9AH 755.67G V72.84P 356.9AG Dispense 100 Tab
8 Cap
Refill 1
1
30 Tab 100 Tab 7 Tab 30 Tab
11 1 0 3
C (97.2 F) (Tympanic) | Wt 101.152 kg (223 lb) BP 118/86 | Pulse 76 | Temp(Src) 36.2 OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Skin: Skin color, texture, turgor normal. No rashes or lesions. Neuro: hypaesthesias in lower extremities. Mild weakness. Limited exam. . Mental Status: normal mentation. Euthymic. Musculoskeletal: Area over the left greater trocanther is tender to palpation. Limited range of motion of the left hip. ASSESSMENT: 726.5 ADVANCED OSTEOARTHRITIS OF THE LEFT HIP (primary encounter diagnosis) Comment: xrays reviewed. Right hip osteo arthritis. Left hip - status post hip replacement. Discussed pain medicaition, ortho follow up. Consider steroid injection for presumptive trochantheric bursitis. However will try stretches first. Handout given. Plan: ORTHOPEDIC-GENERAL REFERRAL, Methadone (DOLOPHINE) 10 mg Tablet
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356.9AG Polyneuropathy Comment: continue follow up with neurology. Provided advice on treatmet and management. Plan: 719.45 CHRONIC PAIN MEDICATION AGREEMENT Comment: Plan: Methadone (DOLOPHINE) 10 mg Tablet V54.81B Orthopedic aftercare for joint replacement Comment: as above. Plan: Methadone (DOLOPHINE) 10 mg Tablet 244.9AA Hypothyroid Comment: recheck. See HPI. Heat intolerance. No other symptoms. Plan: THYROID STIMULATING HORMONE, THYROXINE, FREE (FREE T4) PLAN: See Orders. Discussed care and warning signs with Mark and all questions and concerns were fully answered. He will call or followup in the office if any problems arise. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his/her medical care. No guarantees were made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit. Electronically signed by: Victor Baquero, MD Associate Physician Associate Medical Director UC Davis Medical Group, Folsom
Electronically signed byVictor Henrique Baquero, MD on 6/20/2011 2:22 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Visit Notes Clare Jennings, MA Mon Jun 20, 2011 8:35 AM Vital signs taken, allergies verified, screened for pain, pharmacy verified, and verified immunization status. Clare Jennings, MA
Electronically signed by Clare Jennings, MA at Mon Jun 20, 2011 8:35 AM
Progress Notes Attachment: Scan on 6/17/2011 6:50 AM by Onbase Incoming Interface : QUEST Transcription Type OUTSIDE RECORDS Electronically Signed
Document Text
Date and Time ID OBS2837774 6/17/2011 6:50 AM
Author Onbase Incoming Interface
002436
KANDIS CHEATUM Tue Aug 16, 2011 1:09 PM Vital signs taken, allergies verified, screened for pain. Pt is a new pt, no refills are needed at this time. Kandis Cheatum MA Electronically signed by KANDIS CHEATUM at Tue Aug 16, 2011 1:09 PM Visit Notes Clare Jennings, MA Tue Aug 16, 2011 9:59 AM EKG done per doctors order Electronically signed by Clare Jennings, MA at Tue Aug 16, 2011 9:59 AM Clare Jennings, MA Tue Aug 16, 2011 9:53 AM Vital signs taken, allergies verified, screened for pain, pharmacy verified, and verified immunization status. Clare Jennings, MA Electronically signed by Clare Jennings, MA at Tue Aug 16, 2011 9:53 AM Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Wed Aug 10, 2011 7:50 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroShould I make a separate appointment to see you, or will I see you on EKG day? I'm not quite sure...
Mark Amundsen
Electronically signed byClare Jennings, MA on 8/10/2011 7:57 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Tue Aug 9, 2011 6:40 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's time for another refill on methadone. Please remember that on the last office visit, we upped the dosage to 9 10mg pills per day - for a total of 270 pills per subscription. I will be out on Thorsday, so I'd like to pick up the script on Wednesday afternoon. Regards, Mark Amundsen P.S. EKG scheduled for 8-16-2010 Electronically signed byClare Jennings, MA on 8/9/2011 7:57 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed.
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Progress Notes
Subjective: Mark Amundsen is a 51yr old male who is here for the following reason: 1. On methadone for chronic bilateral hip pain. Severe osteo arthritis. Sees ortho. On methadone long term. No side effects. 2. Follow up on labs. Symptoms of fatigue, dry skin, malaise, weight gain. Review of Systems: Constitutional: negative. CV: negative. Resp: negative.
Patient Active Problem List Diagnoses BACKACHE NOS TESTICULAR HYPOFUNC NEC ADVANCED OSTEOARTHRITIS OF THE LEFT HIP DEPRESSIVE DISORDER CHRONIC PAIN MEDICATION AGREEMENT Anemia Orthopedic Aftercare for Joint Replacement Dyslipidemia Vitamin D deficiency Hypertension High arch Polyneuropathy Current outpatient prescriptions ordered prior to encounter Medication Sig Carisoprodol (SOMA) 350 mg Take 2 Tabs by mouth every Tablet day at bedtime. Ergocalciferol, Vitamin D2, Take 1 Cap by mouth. take 1 (VITAMIN D) 50,000 unit PO capsule by oral route twice weekly for next 2 months. Capsule Then lab follow up 4 weeks later. Fenofibrate (TRICOR) 145 mg Take 1 Tab by mouth every PO Tablet morning after a meal. Methadone (DOLOPHINE) 10 Take 2 Tabs by mouth every
Code 724.5 257.2 726.5 311 719.45 285.9Y V54.81B 272.4CB 268.9G 401.9AH 755.67G 356.9AG
Refill 1 1
30 Tab 7 Tab
11 0
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mg Tablet 6 hours. 9 daily. Triamterene 37.5 Take 1 Tab by mouth every mg/Hydrochlorothiazide 25mg morning. (MAXZIDE-25) 37.5-25 mg Tablet
30 Tab
BP 114/74 | Pulse 67 | Temp(Src) 36.4 C (97.6 F) (Tympanic) | Wt 103.42 kg (228 lb) OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Skin: Skin color, texture, turgor normal. No rashes or lesions. Mental Status: blunted affect normal mood. Musculoskeletal: moderate osteo arthritis of hips. Limited evaluation. Antalgic gait. ASSESSMENT: 244.9AA Hypothyroid Comment: labs and symptoms consistent with mild hypothyroid state. TRT discussed. Risks and benefits discussed in detail. Will initiate treatment. Recheck labs in 6 weeks. Plan: Levothyroxine (SYNTHROID) 75 mcg Tablet 726.5 ADVANCED OSTEOARTHRITIS OF THE LEFT HIP Comment: on methadone. EKG checked per guidelines. Normal QT interval. Requested repeat in 6 months. The current medical regimen is effective; continue present plan and medications. Plan: POC ELECTROCARDIOGRAM WITH RHYTHM STRIP 719.45 CHRONIC PAIN MEDICATION AGREEMENT Comment: as above. Plan: 726.5 Enthesopathy of hip region Comment: continue follow up with ortho. Plan: Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet PLAN: See Orders. Discussed care and warning signs with Mark and all questions and concerns were fully answered. He will call or followup in the office if any problems arise. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his/her medical care. No guarantees were made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit. Electronically signed by: Victor Baquero, MD Associate Physician Associate Medical Director UC Davis Medical Group, Folsom
Electronically signed byVictor Henrique Baquero, MD on 8/16/2011 1:22 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Visit Notes
002439
Document history: Transcription (12246657) on 9/29/2011 11:01 AM by David P Richman, MD Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Visit Notes KANDIS CHEATUM Tue Sep 27, 2011 10:05 AM Vital signs taken, allergies verified, screened for pain. Pt states that he does not need refills today.Kandis Cheatum MA I
Electronically signed by KANDIS CHEATUM at Tue Sep 27, 2011 10:05 AM
Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Fri Sep 2, 2011 8:35 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's almost time for a methadone refill. Since there is a holiday Monday, I figured I would give y'all extra time to fill it. I will be out on Wednesday, so if I could pick up a refill on Tuesday afternoon, that would be great. Still waiting on Neuro HQ for info, and hanging in there... Mark Amundsen Electronically signed byClare Jennings, MA on 9/2/2011 8:51 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes
Neurology Clinic Initial Evaluation by Dr. Richman Referring Physician: Victor Baquero 251 Turn Pike Drive Folsom, Ca 95630 (916) 985-9300 CC: Leg numbness and weakness HPI: Mr. Amundsen is a 51-year-old right-handed male with complaints of leg weakness and numbness. He recalls new onset of acute right foot swelling and numbness approximately 10 months ago. Two months later he experienced an acute onset of bilateral "leg fatigue", leg weakness, and numbness upon waking one morning. He denies any any muscle pain or preceding events including viral illness, gastroenterisit, vaccinations or falls/trauma. Since onset of symptoms, he reports minimal progression of weakness (has worsened by ~10%) and no progression of numbness. He has had difficulty walking long distances >100 yards, ascending and descending stairs and getting up from a low chair. He denies any worsening of weakness toward the end of the day, but does report worsening leg fatigue with any physical activity. He has experienced several episodes of shoulder weakness but states that this completely resolves after several days. Was not prescribed statins in the past. He denies any hand weakness or forearm muscle wasting. He reports 4 episodes of blurry vision in the past 10 months, but denies double vision, eye lid drooping, change in voice quality, difficulty chewing or swallowing solids/liquids. Muscle weakness has been accompanied by a constant numbness/pins and needles/burning sensation in his bilateral lower limbs (feet > legs). He denies any exacerbating or relieving factors with respect to leg numbness. Work-up thus far has included electrodiagnostic studies, CSF analysis (results below), anti-ACh receptor Ab (negative), Serum protein electrophoresis (negative) and urine heavy metals. He was
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recently seen by by Dr. Oh (June 2011) who requested a second opinion regarding the possible diagnosis of CIDP and treatment with steroids. In addition to seeing neurology, he has also been evaluated by Dr. Wise (rheumatology) who ruled out a rheumatologic condition (also suspected CIDP). Drs. Chesak (Fellow), Bakshi and Maselli performed electrodiagnostic studies in March of 2011 which revealed evidence of "segmental demyelination in the bilateral lower extremities consistent with a predominantly demyelinating polyneuropathy affecting the bilateral lower extremities with no evidence of myopathy." Decreased conduction velocities (30-31m/s) were noted on bilateral tibial and left peroneal motor studies. Right sural SNAP was absent, while left had diminished amplitude with conduction slowing (34m/s). Needle EMG of the bilateral lower limbs and left upper limb was essentially normal. PSHx: Tonsillectomy in 1965, inguinal hernia repair in 1986, left THA 12/15/09. PMHx: HTN, anemia, Bilateral hip osteoarthritis s/p Left THA, Hypogonadism secondary to chronic opioid use, Lumbar degenerative disc disease, Lumbar radiculitis, Obesity. Pt denies history of DM or prior treatment with chemotherapy. ALLERGIES: morphine and fentanyl cause pruritis MEDICATIONS: - Carisoprodol (SOMA) 350 mg Tablet, 2 Tabs by mouth every day at bedtime. - Hydrocodone 10 mg/Acetaminophen 325 mg (NORCO) 10-325 mg Tablet, 1 Tab by mouth every 4 to 6 hours if needed. - Methadone (DOLOPHINE) 10 mg Tablet, 2 Tabs by mouth every 6 hours. SOCIAL HISTORY: Quit smoking 20 years ago. Rare alcohol use. Previously worked as a network administrator. Currently not working. Lives alone in a 1-floor home. Family Hx: Mother: Italian/German, died at 75 cancer (breast vs. Lung) Father: Norway/Ireland, died at 83 complications of stroke Denies family history of myopathy or neuropathy.
Exam: Temp: 36.8 C (98.2 F) (08/16 1307) Temp src: Oral (08/16 1307) Pulse: 58 (08/16 1307) BP: 111/63 mmHg (08/16 1307) Resp: 16 (08/16 1307) SpO2: -Height: 1.854 m (6' 1") (08/16 1307) Weight: 103.8 kg (228 lb 13.4 oz) (08/16 1307) General: sitting on exam table in NAD, WN WD, cooperative, A&O x3 MSK: Inspection: Pes cavus bilaterally Minimal atrophy bilateral distal legs ROM: full, functional active ankle dorsiflexion bilaterally Neurologic exam: CN: visual fields intact bialterally, +red reflex, PERRLA, EOMI, no ptosis noted with sustained upward gaze, facial sensation intact, face symmetric, normal SCM and shoulder shrug strength bilaterally, Soft palate elevates symmetrically, Tongue midline (+furrow midline). Sensation: Patchy sensory loss in bilateral lower limbs to light touch and pin prick Proprioception intact + stocking glove sensory loss to ankle level bilaterally Slightly diminished vibratory sense on right to the level of mid tarsal bone, > second delay in vibratory sense bilaterally. 10 Rhomberg negative. Motor: normal tone, minimal distal lower limb atrophy.
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limb
MMT exam effort dependent: Shoulder abduction 4/5 bilat, 5/5 strength in remaining upper muscle groups. Hip flexion: pain-limited on the left (3-/5) 5/5 on the right Knee extension: 4/5 bilaterally; 5-/5 on the left 4/5 on the right EHL: 4/5 bilaterally PF: able to toe-walk 1+ brachioradialis, 2+ pronator and triceps, absent biceps Ankle DF:
Muscle stretch reflexes: bilat.
1+ quadriceps, absent triceps surae bilaterally Clonus: absent Babinski: absent (down-going bilaterally) Hoffman: absent GAIT: ambulates with SC in right hand, stiff knee gait (lack of normal knee flexion in swing phase), no foot drop, foot slap or Trendelenburg noted. Able to perform heel walking, toe walking and tandem gait. (Of note, on Dr. Richman's examination, MMT revealed 5/5 strength throughout, except pain-limited left hip flexion). LAB RESULTS: Normal: CK (45), Aldolase (5.7), B12 (478), Folate, ESR (8), BMP, LFTs, fasting glucose (94) ANA negative. 25 hydroxy vitamin D borderline low (25.1). Acetylcholine receptor binding antibody negative. Acetylcholine receptor blocking antibody negative. Acetylcholine receptor modulating antibody negative. MuSK antibody negative. *TSH elevated (3.42, 4.54). Free T4 normal. Thyroid peroxidase antibody negative. Urine heavy metals negative. Blood lead level not elevated. Hepatitis C antibody negative. Cryoglobulin 0. Ganglioside antibodes negative. Serum protein electrophoresis normal. Serum immunofixation normal. MAG antibody negative. SGPG antibody negative. CSF protein 44. CSF glucose 55. CSF WBC 3. CSF RBC 1. CSF Lyme antibody by ELISA negative. CSF VDRL nonreactive. CSF Gram stain and culture negative. CSF IgG synthesis rate <0. CSF IgG index 0.43 (0.28 - 0.66). CSF oligoclonal bands negative.
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Radiology results: Lumbar spine MRI without contrast 03/2004: Normal. No disc bulges, foraminal or central canal stenosis. Impression: 51-year-old with 10-month history of non-progressive lower limb parasthesias and subjective complaints of weakness. Clinical examination and diagnostic work-up has ruled out central causes. A bilateral polyradiculopathy is less likely due to normal needle EMG examination. Chronicity of lower limb symptoms (with subjective intermittent upper limb weakness) makes AIDP unlikely. A normal CSF protein level and lack of chronic or ongoing axonal loss changes on needle EMG places CIDP lower on the differential. Lack of consistent proximal muscle weakness on examination, the presence of sensory findings and normal needle EMG place myopathy much lower on the differential diagnosis. It is very unlikely that a combined myopathy and peripheral neuropathy co-exist. Despite pes cavus deformity and mild distal lower limb atrophy, conduction velocities on electrodiagnostic testing ranging from 30m/s-58m/s essentially ruling out demyelinating forms of hereditary motor sensory neuropathy. Recommendations: 1. Dr. Richman will review the electrodiagnostic findings from 3/2011 with Dr. Maselli and determine in repeat NCS/EMG is indicated. 2. Follow-up in 1 month to discuss possibility of repeating NCS/EMG. The patient was seen and examined with Dr. Richman and the plan was formed jointly. Bethany Lipa Neuromuscular fellow PM&R This patient was seen, evaluated, and care plan was developed with the resident (see my accompanying note). I agree with the assessment and plan as outlined in the resident's note except as noted. Report electronically signed by DAVID P RICHMAN, M.D., MD.
Electronically signed byBethany Marie Lipa, MD on 8/16/2011 7:01 PM Electronically signed byDavid P Richman, MD on 8/23/2011 8:59 AM Links Previous Version Transcription Type Neurology Referral Letter (2211) Electronically Signed
Document Text August 17, 2011 RE: AMUNDSEN, MARK MR#: 8081369 DOB: 09/23/1959 Date of Service: 08/16/2011 ID 12191415 Date and Time 8/17/2011 1:40 PM Author David P Richman, MD
VICTOR HENRIQUE BAQUERO, MD UCDMG FOLSOM Dear Dr. Baquero: Thank you very much for sending Mr. Amundsen for neurologic evaluation
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concerning lower extremity numbness and weakness. I saw the patient this afternoon with Dr. Lipa and her note of our complete evaluation is enclosed. I have taken a history from the patient, examined him and reviewed his medical records, laboratory data and images, verifying the findings of Dr. Lipa except as noted below. I have discussed the findings and plan with Dr. Lipa and the patient. Ten months ago the patient developed tingling, numbness in the soles of his feet. He is not sure exactly the rate of onset although he states he began to notice it on awakening one morning. These symptoms gradually ascended to about the level of the mid-calf and he began to have occasional difficulty walking. He thinks this is related to his weakness. There were some times when he had some mild numbness in his hands as well. He has had an extensive work up for neuropathy showing mildly decreased motor conduction velocities in the tibial and peroneal nerves on one side and the absence of sural snap. Needle EMG of the lower limbs and upper limbs are normal. Previous examinations have observed normal motor function except for hip flexion and extension which was on the order of 4-5 minus. The patient's work up has included a CSF protein normal (upper limit), gangliocyte antibodies, serum immunofixation, mag antibodies have all been normal. My examination today reveals inconsistent sensory examination involving light touch and pin sensation. Vibration sensation is normal. Motor exam is completely normal with quite variable effort but maximum power is normal except for 5- hip flexion on the left. Impression: 1) Gait disorder with sensory symptoms. The patient's disability seems to be somewhat out of proportion to the findings on his exam and on his electrodiagnostic studies. Most of his disability appears to relate to his bilateral hip disease (with relatively recent left hip replacement and severe arthritis in the right hip). 2) There is possibly a mild sensory greater than motor neuropathy, the etiology of which has not been identified. It is very unlikely that we are dealing with chronic inflammatory demyelinating polyneuropathy. Disposition: I will review the electrodiagnostic studies with Dr. Maselli and develop a plan for further work up after that. The patient is to call in a few days and return here in two months. Thanks again for referring this most pleasant gentleman. Sincerely,
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DPR:lmw(usa288) D: 08/17/2011 01:40 PM T: 08/18/2011 07:43 AM C#: 5449824 cc: ANDREW K OH, MD UCDMG Display only: Transcription (12191415) on 8/17/2011 1:40 PM by David P Richman, MD
Document history: Transcription (12191415) on 8/17/2011 1:40 PM by David P Richman, MD
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes August 17, 2011 RE: AMUNDSEN, MARK MR#: 8081369 DOB: 09/23/1959 Date of Service: 08/16/2011 VICTOR HENRIQUE BAQUERO, MD UCDMG FOLSOM Dear Dr. Baquero: Thank you very much for sending Mr. Amundsen for neurologic evaluation concerning lower extremity numbness and weakness. I saw the patient this afternoon with Dr. Lipa and her note of our complete evaluation is enclosed. I have taken a history from the patient, examined him and reviewed his medical records, laboratory data and images, verifying the findings of Dr. Lipa except as noted below. I have discussed the findings and plan with Dr. Lipa and the patient. Ten months ago the patient developed tingling, numbness in the soles of his feet. He is not sure exactly the rate of onset although he states he began to notice it on awakening one morning. These symptoms gradually ascended to about the level of the mid-calf and he began to have occasional difficulty walking. He thinks this is related to his weakness. There were some times when he had some mild numbness in his hands as well. He has had an extensive work up for neuropathy showing mildly decreased motor conduction velocities in the tibial and peroneal nerves on one side and the absence of sural snap. Needle EMG of the lower limbs and upper limbs are normal. Previous examinations have observed normal motor function except for hip flexion and extension which was on the order of 4-5 minus. The patient's work up has included a CSF protein normal (upper limit), gangliocyte antibodies, serum immunofixation, mag antibodies have all been normal. My examination today reveals inconsistent sensory examination involving light touch and pin sensation. Vibration sensation is normal. Motor exam is completely normal with quite variable effort but maximum power is normal except for 5- hip flexion on the left. Impression: 1) Gait disorder with sensory symptoms. The patient's disability seems to be somewhat out of proportion to the findings on his exam and on his electrodiagnostic studies. Most of his disability appears to relate to his bilateral hip disease (with relatively recent left hip replacement and severe arthritis in the right hip). 2) There is possibly a mild sensory greater than motor neuropathy, the etiology of which has not been
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identified. It is very unlikely that we are dealing with chronic inflammatory demyelinating polyneuropathy. Disposition: I will review the electrodiagnostic studies with Dr. Maselli and develop a plan for further work up after that. The patient is to call in a few days and return here in two months. Thanks again for referring this most pleasant gentleman. Sincerely,
DPR:lmw(usa288) D: 08/17/2011 01:40 PM T: 08/18/2011 07:43 AM C#: 5449824 cc: ANDREW K OH, MD UCDMG Electronically signed byDavid P Richman, MD on 8/22/2011 7:47 PM Links Previous Version Transcription Type Neurology Referral Letter (2211)
ID 12191415
Document Text August 17, 2011 RE: AMUNDSEN, MARK MR#: 8081369 DOB: 09/23/1959 Date of Service: 08/16/2011
VICTOR HENRIQUE BAQUERO, MD UCDMG FOLSOM Dear Dr. Baquero: Thank you very much for sending Mr. Amundsen for neurologic evaluation concerning lower extremity numbness and weakness. I saw the patient this afternoon with Dr. Lipa and her note of our complete evaluation
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is enclosed. I have taken a history from the patient, examined him and reviewed his medical records, laboratory data and images, verifying the findings of Dr. Lipa except as noted below. I have discussed the findings and plan with Dr. Lipa and the patient. Ten months ago the patient developed tingling, numbness in the soles of his feet. He is not sure exactly the rate of onset although he states he began to notice it on awakening one morning. These symptoms gradually ascended to about the level of the mid-calf and he began to have occasional difficulty walking. He thinks this is related to his weakness. There were some times when he had some mild numbness in his hands as well. He has had an extensive work up for neuropathy showing mildly decreased motor conduction velocities in the tibial and peroneal nerves on one side and the absence of sural snap. Needle EMG of the lower limbs and upper limbs are normal. Previous examinations have observed normal motor function except for hip flexion and extension which was on the order of 4-5 minus. The patient's work up has included a CSF protein normal (upper limit), gangliocyte antibodies, serum immunofixation, mag antibodies have all been normal. My examination today reveals inconsistent sensory examination involving light touch and pin sensation. Vibration sensation is normal. Motor exam is completely normal with quite variable effort but maximum power is normal except for 5- hip flexion on the left. Impression: 1) Gait disorder with sensory symptoms. The patient's disability seems to be somewhat out of proportion to the findings on his exam and on his electrodiagnostic studies. Most of his disability appears to relate to his bilateral hip disease (with relatively recent left hip replacement and severe arthritis in the right hip). 2) There is possibly a mild sensory greater than motor neuropathy, the etiology of which has not been identified. It is very unlikely that we are dealing with chronic inflammatory demyelinating polyneuropathy. Disposition: I will review the electrodiagnostic studies with Dr. Maselli and develop a plan for further work up after that. The patient is to call in a few days and return here in two months. Thanks again for referring this most pleasant gentleman. Sincerely,
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DPR:lmw(usa288) D: 08/17/2011 01:40 PM T: 08/18/2011 07:43 AM C#: 5449824 cc: ANDREW K OH, MD UCDMG
Display only: Transcription (12191415) on 8/17/2011 1:40 PM by David P Richman, MD Document history: Transcription (12191415) on 8/17/2011 1:40 PM by David P Richman, MD
From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Fri Aug 19, 2011 5:23 AM Subject: Visit Follow-up Question Hi Dr BaqueroI have been to see the head of Neurology to see about getting steriod therapy going to alleviate my symptoms. As far as I knew, all the new doctor was supposed to do was to make a decision on the viability of steriod therapy in my case. Unforunately, he has evidently decided to start from the beginning of the case, including communicating with the technician who performed the EMG, and perhaps retesting some of the blood tests. He requested that I make another appointment on Sept 27 to re-discuss my case. Unfortunately, I cannot wait any more for answers in this matter. I am currently 2 months behind on my mortgage, and state disability ended on May 30. I am applying for social security disability, but am told it may take from 3 months to 2 years to be approved. The only chance I have to save my house is to go back to work. I am inquiring if it would be possible to test steriod efficacy without approval from Neurology. While I realize that approval from Neuro would be optimal, I do not feel I can wait any longer without trying to alleviate my symptoms, and get back to productivity. Please let me know what you think about this proposal. Regards, Mark Amundsen
Electronically signed byStephanie L Esparza, LVN on 8/19/2011 8:39 AM Electronically signed byStephanie L Esparza, LVN on 8/19/2011 8:39 AM Links Previous Version Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed.
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Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes September 29, 2011 RE: AMUNDSEN, MARK MR#: 8081369 DOB: 09/23/1959 Date of Service: 09/27/2011 VICTOR HENRIQUE BAQUERO, MD UCDMG FOLSOM Dear Dr. Baquero: I saw Mr. Amundsen in followup of his length-dependent neuropathy. I reviewed his electrodiagnostic studies with Dr. Maselli, and it seems clear that he has very mild motor-sensory mixed neuropathy. The patient tells me that since his visit, he has continued to have significant difficulty with walking. He tells me that, in fact, he knows that he has severe left hip disease (he has previously had a right hip replacement). He continues to have some 5/10 burning dysesthesias in the forefoot bilaterally on the plantar surfaces to about the MP joints. Review of systems reveals no fever, no cough, no rash. Past medical history reveals that he continues on treatment for his chronic pain syndrome. Physical examination today reveals blood pressure of 102/68, pulse 68 and regular, respirations 16, temperature 97.9, weight 100.4 kg, and height 6 feet 1 inch. The patient appears well and in no distress. The pain on passive movement of his hips is unchanged. There are no orbitocranial bruits. Spine is unremarkable. Chest is clear. Abdomen is negative. There is no lymphadenopathy. Neurologic examination reveals normal mental status (30/30). Cranial nerve exam reveals normal visual fields and fundi, PERRLA at 4 mm. Extraocular movements are full without nystagmus. Facial sensation and facial motor function are normal, and the lower cranial nerves are normal. Motor exam reveals normal bulk, tone, and strength throughout with some occasional give-way weakness. Sensation reveals decreased pin and light touch sensation to about the ankles bilaterally. Vibration sensation is absent in the right toes and normal in the left toes, normal at the ankles. Finger-to-nose and heel-knee-shin testing is normal. The patient's gait is very labored and antalgic appearing. Deep tendon reflexes are 2+ throughout, except for absent ankle jerks, and plantar responses are flexor. Impression: 1) Severe gait disorder - this is secondary to his arthritis, especially in his hips. 2) Mild sensory greater than motor demyelinating and axonal neuropathy - question etiology. There are no laboratory data to support the diagnosis of chronic, inflammatory, demyelinating polyneuropathy. Disposition: 1) No further workup is indicated at this time. I will be glad to see him if you and Dr. Oh feel that his neurologic symptoms are worsening. With kindest regards. Sincerely,
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DPR:vns(trs239) D: 09/29/2011 11:01 AM T: 10/01/2011 08:00 AM C#: 5469240 cc: ANDREW K OH, MD Electronically signed byDavid P Richman, MD on 10/2/2011 9:17 PM Links Previous Version Transcription Type Neurology Referral Letter (2211)
ID 12246657
VICTOR HENRIQUE BAQUERO, MD UCDMG FOLSOM Dear Dr. Baquero: I saw Mr. Amundsen in followup of his length-dependent neuropathy. I reviewed his electrodiagnostic studies with Dr. Maselli, and it seems clear that he has very mild motor-sensory mixed neuropathy. The patient tells me that since his visit, he has continued to have significant difficulty with walking. He tells me that, in fact, he knows that he has severe left hip disease (he has previously had a right hip replacement). He continues to have some 5/10 burning dysesthesias in the forefoot bilaterally on the plantar surfaces to about the MP joints. Review of systems reveals no fever, no cough, no rash. Past medical history reveals that he continues on treatment for his chronic pain syndrome. Physical examination today reveals blood pressure of 102/68, pulse 68 and regular, respirations 16, temperature 97.9, weight 100.4 kg, and height 6 feet 1 inch. The patient appears well and in no distress. The pain on passive movement of his hips is unchanged. There are no orbitocranial bruits. Spine is unremarkable. Chest is clear. Abdomen is negative. There is no lymphadenopathy.
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Neurologic examination reveals normal mental status (30/30). Cranial nerve exam reveals normal visual fields and fundi, PERRLA at 4 mm. Extraocular movements are full without nystagmus. Facial sensation and facial motor function are normal, and the lower cranial nerves are normal. Motor exam reveals normal bulk, tone, and strength throughout with some occasional give-way weakness. Sensation reveals decreased pin and light touch sensation to about the ankles bilaterally. Vibration sensation is absent in the right toes and normal in the left toes, normal at the ankles. Finger-to-nose and heel-knee-shin testing is normal. The patient's gait is very labored and antalgic appearing. Deep tendon reflexes are 2+ throughout, except for absent ankle jerks, and plantar responses are flexor. Impression: 1) Severe gait disorder - this is secondary to his arthritis, especially in his hips. 2) Mild sensory greater than motor demyelinating and axonal neuropathy - question etiology. There are no laboratory data to support the diagnosis of chronic, inflammatory, demyelinating polyneuropathy. Disposition: 1) No further workup is indicated at this time. I will be glad to see him if you and Dr. Oh feel that his neurologic symptoms are worsening. With kindest regards. Sincerely,
DPR:vns(trs239) D: 09/29/2011 11:01 AM T: 10/01/2011 08:00 AM C#: 5469240 cc: ANDREW K OH, MD
Display only: Transcription (12246657) on 9/29/2011 11:01 AM by David P Richman, MD Document history: Transcription (12246657) on 9/29/2011 11:01 AM by David P Richman, MD
Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed.
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Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Thu Sep 29, 2011 3:17 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI am due for a refill on Methadone. The methadone ran out early due to the short prescription of 240 issued last month. Please recall that at last appointment, the prescription was increased to 9 per day/270 per month. Sorry about the short notice - I will be out on Friday night, so I'd like to pick it up Friday afternoon. Thanks, Mark Amundsen Electronically signed byClare Jennings, MA on 9/29/2011 8:43 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes
See dictated letter.

Electronically signed byDavid P Richman, MD on 9/27/2011 10:44 AM Transcription Type Neurology Referral Letter (2211)
ID 12246657
VICTOR HENRIQUE BAQUERO, MD UCDMG FOLSOM Dear Dr. Baquero: I saw Mr. Amundsen in followup of his length-dependent neuropathy. I reviewed his electrodiagnostic studies with Dr. Maselli, and it seems clear that he has very mild motor-sensory mixed neuropathy. The patient tells me that since his visit, he has continued to have significant difficulty with walking. He tells me that, in fact, he knows that he has severe left hip disease (he has previously had a right hip replacement). He continues to have some 5/10 burning dysesthesias in the forefoot bilaterally on the plantar surfaces to about the MP joints. Review of systems reveals no fever, no cough, no rash. Past medical history reveals that he continues on treatment for his chronic pain syndrome. Physical examination today reveals blood pressure of 102/68, pulse 68
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and regular, respirations 16, temperature 97.9, weight 100.4 kg, and height 6 feet 1 inch. The patient appears well and in no distress. The pain on passive movement of his hips is unchanged. There are no orbitocranial bruits. Spine is unremarkable. Chest is clear. Abdomen is negative. There is no lymphadenopathy. Neurologic examination reveals normal mental status (30/30). Cranial nerve exam reveals normal visual fields and fundi, PERRLA at 4 mm. Extraocular movements are full without nystagmus. Facial sensation and facial motor function are normal, and the lower cranial nerves are normal. Motor exam reveals normal bulk, tone, and strength throughout with some occasional give-way weakness. Sensation reveals decreased pin and light touch sensation to about the ankles bilaterally. Vibration sensation is absent in the right toes and normal in the left toes, normal at the ankles. Finger-to-nose and heel-knee-shin testing is normal. The patient's gait is very labored and antalgic appearing. Deep tendon reflexes are 2+ throughout, except for absent ankle jerks, and plantar responses are flexor. Impression: 1) Severe gait disorder - this is secondary to his arthritis, especially in his hips. 2) Mild sensory greater than motor demyelinating and axonal neuropathy - question etiology. There are no laboratory data to support the diagnosis of chronic, inflammatory, demyelinating polyneuropathy. Disposition: 1) No further workup is indicated at this time. I will be glad to see him if you and Dr. Oh feel that his neurologic symptoms are worsening. With kindest regards. Sincerely,
DPR:vns(trs239) D: 09/29/2011 11:01 AM T: 10/01/2011 08:00 AM C#: 5469240 cc: ANDREW K OH, MD Display only: Transcription (12246657) on 9/29/2011 11:01 AM by David P Richman, MD
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Sorry Dr BaqueroOne more thing - the epidermoid cyst on my shoulder blew up this weekend-worked it all weekend and got all the contents out, including cyst material. The infection has subsided, and seems healed. Should I be on antibiotics due to my hip replacement? Later on, I should probably get it removed - I know it can't be removed while infected.
Mark Amundsen
Electronically signed byClare Jennings, MA on 10/10/2011 8:03 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Mon Oct 10, 2011 7:33 AM Subject: Non-urgent Medical Advice Question Dr. B Brief summary of rebuttal - cannot believe hip damage could cause numbness, pain, and burning in feet, lack of reflex/sharp pain responses (legs and arms), fatigue/weakness in arms/back, and fatigue/weakness in legs mainfesting in a single night. Previous hip issues displayed slowly increasing pain and other symptoms, which took years to become intolerable. All current symptoms match DP diagnosis exactly - including blood/CS fluid tests. Mark Amundsen Electronically signed byClare Jennings, MA on 10/10/2011 7:34 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Fri Oct 7, 2011 5:59 AM Subject: Non-urgent Medical Advice Question Hi Dr Baquero and staffI wanted to doublecheck the status of the disability, FMLA, and disabled placard paperwork I faxed in last week for your review and completion. I just wanted to make sure it was received, and possibly get an estimate on completion? Thanks for your attention in this matterMark Amundsen Electronically signed byClare Jennings, MA on 10/7/2011 7:30 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Forms are in your in box with the business chart

Electronically signed byClare Jennings, MA on 10/4/2011 9:32 AM
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From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Wed Oct 26, 2011 7:50 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroSymptoms got worse last night - shaking's back, and walking more difficult. Is there any way I can try the steroids to evaluate their effectiveness? I feel like there is no other recourse. I understand prednesone is the standard treatment, but you may have more accurate info. BTW, my pharmacy is now Walgreens... Mark Amundsen Electronically signed byClare Jennings, MA on 10/26/2011 8:58 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Tue Oct 25, 2011 8:23 AM Subject: Non-urgent Medical Advice Question Hi Dr Baquero and staffIt's time for another refill on my Methadone prescription. I will be out on Friday morning, so if I can pick it up on Thursday afternoon, that would be great. Please remember that the current prescription is for 270 10 mg tablets. Thanks for your attention in this matterMark Amundsen Electronically signed byClare Jennings, MA on 10/25/2011 9:00 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Left message that forms are at the front desk

Form completed.
Electronically signed byVictor Henrique Baquero, MD on 10/10/2011 5:57 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Mon Oct 10, 2011 7:45 AM Subject: Non-urgent Medical Advice Question
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separate message on Prednesone. Thanks!

Mark Amundsen
Electronically signed byClare Jennings, MA on 11/15/2011 8:13 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Addended by: BAQUERO, VICTOR H on: 11/9/2011 Modules accepted: Orders Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Fri Nov 4, 2011 8:09 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI ran out of the Thyroxine, and forgot to get it refilled. I'll put in for a refill today, if I can find the number. I also wanted to let you know- Walgreens would not fill the entire Methadone script.. They said it could only be a months worth, and the script was written for 2 every 6 hours/8 per day. Cont Electronically signed byClare Jennings, MA on 11/4/2011 8:37 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Fri Nov 4, 2011 8:14 AM Subject: Non-urgent Medical Advice Question Dr BCould you put a note in the chart for the Methadone prescription for 270 10mg tablets / 3 every 8 hours - 9 per day. That way I don't think they could screw it up anymore. Next's months will probably be early, since they shorted me. They promised to inform you. Please let me know if I'm good to go for the steroids... Mark Amundsen Electronically signed byClare Jennings, MA on 11/4/2011 8:36 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
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Monday afternoon, that would be appreciated. Refill should be for 270 10mg tablets/9 tablets per day/ 3 tablets every 8 hours. This should ensure compliance by Pharmacist. Back to gimpy/"normal" due to stoppage of Prednesone. All side effects have ceased. Meds working again. Unable to tell whether increased energy was due to repair or steroids. Mark Amundsen Electronically signed byClare Jennings, MA on 12/8/2011 7:40 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Tue Nov 22, 2011 8:03 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroJust about out of Prednesone - wondering where I go from here. Improvement noted under meds, but decreased along with dosage. High dosage caused many side effects, including exaggerated OCD symptoms and sleeplessness. Please advise what to do next. Thanks! Mark Amundsen Electronically signed byClare Jennings, MA on 11/22/2011 8:17 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Tue Nov 15, 2011 12:56 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroHave restarted Levo and taken Prednesone for 5 days. Pred seems to be helping, but I know it will rev u up on high dose. Food intake normal. Output less/slower than normal. Many side effects - upset stomach, more energy, and all other medications seem to be less or ineffective, including Methadone and Ibuprofen. Pain level up. Meds effect seemed to lessen with reduced dosage-keeping fingers crossed. Mark A. Electronically signed byClare Jennings, MA on 11/15/2011 8:15 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Tue Nov 15, 2011 12:45 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's about time for another refill on Methadone. Last refill was short due to Pharmacist/Insurance. Refill should be for 270 10mg tablets/9 tablets per day/ 3 tablets every 8 hours. This should ensure compliance by Pharmacist. I will be out on Friday, so would like to pick up prescription on Thursday afternoon. I will send
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To: Andrew Kim Oh, MD Sent: Fri Dec 30, 2011 9:42 AM Subject: Non-urgent Medical Advice Question Hi Dr OhI'm still here, and still disabled. I wanted to check with you to find out if I have any other options in regards to treatment of my condition. Neuro downtown was not a satisfactory conclusion IMO, and I'd like to know if there are any options I can explore to help control my illness. Regards, Mark Amundsen Electronically signed byVictor Henrique Baquero, MD on 1/9/2012 6:30 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Fri Dec 30, 2011 9:37 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI wanted to check and make sure I'll be able to get a refill next week - I'll be out on Thursday, and I know everyone takes vacation this time of yearAlso, big question - where do I go from here with my illness - any suggestions? I'll also recheck with Neuro, but I'd like to know if anything else can be done. Thanks for all your help in this matterMark Amundsen Electronically signed byClare Jennings, MA on 1/3/2012 8:09 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
ON CALL NOTE: In 12/20/11 spoke with CVS Pharmacy who was requesting clarification on methadone prescription. Pharmacist stated that the mg was not stated on prescription. Reviewed prior prescriptions. Gave verbal okay to fill dose same as prior, which is methadone 10mg take 3 tablets by mouth every 8 hours. 9 daily.
Electronically signed byKimberly Davis Williams on 12/11/2011 12:44 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor Henrique Baquero, MD Sent: Thu Dec 8, 2011 5:24 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's about time for another refill on methadone. I will be out next Tuesday, so if I could pick up the script on
002458
Patient picked up prescription/known

Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor Baquero, MD Sent: Fri Feb 17, 2012 8:40 AM Subject: Non-urgent Medical Advice Question Hi Dr Baquero and staffIt's almost time for another refill on methadone - I will be out next Wednesday, so if I could pick up a refill on Tuesday afternoon, I would be grateful. I wanted to send this in early in case you were out next week. Thanks! Mark Amundsen Electronically signed byClare Jennings, MA on 2/17/2012 9:18 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Left message for Mr. Amundsen to return call. Prescription ready for pick-up.
Electronically signed byTeresa Finer on 1/26/2012 11:22 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK To: Victor Baquero, MD Sent: Wed Jan 25, 2012 5:26 AM Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's about time for another refill on methadone. I will be out on Sunday night or Monday morning, so I'm hoping to pick up a script on Friday afternoon. Evetything's about the same - minor variations in weakness and pain, but nothing to get worked up over. Right hip's cysts seem to be growing - every once in a while, they double me over, but all in all not too bad. Feet seem to be getting worse - left foot has just about caught up with right foot. Mark Amundsen Electronically signed byYelena Tsvirinko on 1/25/2012 8:54 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: AMUNDSEN,MARK
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Pt. Filled out a Medical Release Form to get paperwork done in July 2010. Electronically signed byGloria J Newton on 3/15/2012 4:20 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter See patient message. Requesting records. Electronically signed byVictor Baquero, MD on 3/14/2012 8:20 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Triplicate written. Please notify patient. Electronically signed byVictor Baquero, MD on 3/14/2012 8:15 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: Mark Amundsen To: Victor Baquero, MD Sent: 3/13/2012 6:08 PM PDT Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's about time for another refill on Methadone. I will be out Sunday morning (the 18th), so I'd like to pick up a prescription Saturday. Therefore, I would like to pick up the script on Friday the 16th. Please let me know when this is available... Thanks in advanceMark Amundsen Electronically signed byClare Jennings, MA on 3/14/2012 7:47 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: Mark Amundsen To: Victor Baquero, MD Sent: 3/13/2012 6:12 PM PDT Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI have another request-I would like to get a copy of the pprwrk for a visit to your office around July 2010 for a right foot ailment (swelling/burning/pain). It may help me in attaining disability retirement. Is that something that can be printed there? Could I get a copy when picking up my prescription? Thanks for any infoMark Amundsen Electronically signed byClare Jennings, MA on 3/14/2012 7:47 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because
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Electronically signed byGloria J Newton on 4/11/2012 2:44 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: Mark Amundsen To: Victor Baquero, MD Sent: 4/11/2012 11:42 AM PDT Subject: Non-urgent Medical Advice Question Hi Clare and Dr BaqueroJust wanted to check and see if you received my message about a methadone refill. I will be out tomorrow morning, so I'm hoping to pick one up this afternoon. Thanks for your attention in this matterMark Amundsen
Electronically signed byClare Jennings, MA on 4/11/2012 11:51 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: Mark Amundsen To: Victor Baquero, MD Sent: 4/10/2012 7:19 AM PDT Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's time for another refill on Methadone. I will be out Thursday, so I'm hoping to pick up a refill Wednesday afternoon. Things about the same-pain level average, but tiredness and exhaustion levels up. Maybe when the sun shines, I'll be a little better. Regards, Mark Amundsen Electronically signed byYelena Tsvirinko on 4/10/2012 8:08 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Pt. Picked up prescription and showed I.D. Gloria J Newton
002461

Electronically signed byVictor Baquero, MD on 5/30/2012 9:32 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: Mark Amundsen To: Victor Baquero, MD Sent: 5/29/2012 12:09 PM PDT Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's about time for another Methadone refill. I will be out Saturday morning, so I would like to pick up a refill script on Friday the 1st of June. Thank you for your attention in this matterMark Amundsen Electronically signed byClare Jennings, MA on 5/29/2012 12:40 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter

Electronically signed byGloria J Newton on 5/7/2012 4:25 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: Mark Amundsen To: Victor Baquero, MD Sent: 5/3/2012 9:44 AM PDT Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's about time for another refill on Methadone. I will be out next Wednesday early, so I'd like to pick up a script for refill on Tuesday May 8th. I'm selling my house, but trying to stay in Folsom. Looking for a nice condo, easier to take care of. Happen to know of any? Thanks for all your help in this matterMark Amundsen
002462
Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: Mark Amundsen To: Victor Baquero, MD Sent: 7/17/2012 12:48 PM PDT Subject: Non-urgent Medical Advice Question Hi Dr Baquero-It's time for another refill on Methadone. I will be out on Saturday, so I'd like to pick up a script on Friday afternoon. I also submitted refill requests for Soma and hydrocodone through Walgreens. Thank you for your attention in this matter-Mark Amundsen Electronically signed byClare Jennings, MA on 7/17/2012 1:27 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Pt came in picked up prescription.

Electronically signed byJoseph Jernigan on 6/25/2012 4:29 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter

Electronically signed byVictor Baquero, MD on 6/25/2012 9:15 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: Mark Amundsen To: Victor Baquero, MD Sent: 6/25/2012 8:46 AM PDT Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's time for another refill on Methadone. I will be out on Wednesday morning, so I'm hoping to pick up a script on Tuesday. Sorry for the short notice, but I didn't notice I was getting so low until this weekend. Thank you for your attention in this matterMark Amundsen Electronically signed byClare Jennings, MA on 6/25/2012 9:01 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Pt picked up prescription
Electronically signed byJoseph Jernigan on 5/30/2012 4:15 PM
002463
Electronically signed byMichele Melendez on 9/4/2012 8:14 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Patient picked up paperwork, CDL verified.

Electronically signed byJulie Stewart on 8/10/2012 2:57 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: Mark Amundsen To: Victor Baquero, MD Sent: 8/8/2012 3:24 PM PDT Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI have a pharmaceutical issue. Although I know this isn't recommended, I've been having to up my methadone dose significantly in the last week, due to a number of people and organizations flaking on helping me move out of the house. I will probably be out on Sunday or Monday if I continue, which I don't really have a choice. I am hoping to get a refill on Methdone Friday. This issue will not, repeat NOT, manifest itself again. On another note, please let me know if you need any household goods - I've got WAYYY too much...particularly a washer dryer, and pool table Mark Electronically signed byClare Jennings, MA on 8/8/2012 4:01 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Patient picked up written rx, verified id with CDL

Electronically signed byJulie Stewart on 7/19/2012 4:47 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Patient informed that RX is at the front desk


Electronically signed byVictor Baquero, MD on 7/19/2012 1:01 PM Chart Review Routing History
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Tuesday afternoon (Oct 2). I wanted to give you a couple of days advance notice. I figured out the wrist pain issue - it was a task I recently started performing, and have since stopped. I think combined with the cane use, it was too much for my wrists...
Mark Amundsen
Patient picked up prescription. Verified ID by CA DL

Electronically signed byCaroline Garcia on 9/6/2012 3:32 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: Mark Amundsen To: Victor Baquero, MD Sent: 9/6/2012 2:20 AM PDT Subject: Non-urgent Medical Advice Question Hi Dr BaqueroI just wanted to send a quick reminder about the need for a new methadone prescription. I will be out Friday morning (tomorrow), so I'd like to pick up a new script Thursday (today). Also, I forgot to tell you - I have moved 2 houses up the street (2025 Tarbolton Cir), and am now at 916-983-4484 - perhaps y'all left a message about the refill at the old number. Thank you for your attention in this matterMark Amundsen Electronically signed byMichele Melendez on 9/6/2012 10:07 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: Mark Amundsen To: Victor Baquero, MD Sent: 9/4/2012 6:41 AM PDT Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's time for another refill on Methadone. I will be out on Friday, so I'd like to pick up a refill on Thirsday afternoon. I need to come in for a consult. I'm having severe pains in my wrists, of all locations. Hoping there might be something that can be done. I have been using them as little as possible, but they're pretty damn important... Regards, Mark Amundsen
002465
Hi Dr BaqueroIt's about time for another refill on the Methadone prescription. As I will be going to Reno to visit my brother this weekend, I would like to pick up a script Thursday afternoon to be filled on Friday, so I can leave first thing. Also, if you could write a short note letting the pharmacy know the circumstances, they shouldn't have to call about an early refill. As an aside, arthritis is really bad, in many areas. Both hands, right knee, right ankle, back, and usual places. Could be progression? Should I come in? Recommendations? Mark Amundsen Electronically signed byClare Jennings, MA on 10/23/2012 8:57 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Pharmacy informed
Okay to refill early.

Fax from pharmacy stating that patient is asking for a early fill on his Methadone. He is six days early he said he has moved and had to use a little more, please advise. Pharmacy is Walgreens, phone 916-817-6533
Pt. Picked up prescription and showed I.D.

Electronically signed byGloria J Newton on 9/28/2012 5:04 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: Mark Amundsen To: Victor Baquero, MD Sent: 9/28/2012 9:54 AM PDT Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's time for another Methadone refill. I will be out on Wednesday, so I would like to pick up a script on
002466
Symptoms: Patient feels his Methadone is not effective anymore. It has been decreasing in the last couple weeks. He wonders if he can get an appt with Dr. Baquero or can the medicine be increased. He also sent a my chart message. Homecare and/or Medications given: none Advice: Consult MD Pain: no Pain location and 1-10: na Disposition: Consult with MD-can this be handled over the phone or can I use spots this week? Is 15 min ok? Per: patient verbalizes agreement to plan. Agrees to callback with any increase in symptoms/concerns or questions.
Sheri Barr RN PCN Triage
Electronically signed bySheri L Barr, RN on 11/19/2012 11:37 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: Mark Amundsen To: Victor Baquero, MD Sent: 11/19/2012 12:10 AM PST Subject: Non-urgent Medical Advice Question Hi Dr BaqueroIt's about time for another refill on Methadone. I will be out early Friday morning, but since I am assuming you will be closed Thursday and Friday, I'm hoping I can pick up a refill prescription on Wednesday. I'll have to check to make sure y'all are there this week. Methadone is not working very well. Seems to be working only 21-22 hrs versus normal 24. Would like to increase dosage - should I come in to discuss? Thanks, Mark Amundsen Electronically signed byClare Jennings, MA on 11/19/2012 8:57 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Patient picked up prescription. known

Electronically signed byDannel Cameron on 10/25/2012 11:00 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: Mark Amundsen To: Victor Baquero, MD Sent: 10/23/2012 8:10 AM PDT Subject: Non-urgent Medical Advice Question
002467
From: Mark Amundsen To: Victor Baquero, MD Sent: 12/13/2012 2:09 PM PST Subject: Non-urgent Medical Advice Question Hi Dr BaqueroJust wanted to make sure my message about a refill on methadone got through. Also, I wanted to check and see what you thought about trying one of the treatments for the neuropathy - I doubt the pain clinic will handle that, but maybe so. The two drugs I was recommended were Gabapentin and Pregabalin - they seem to work well for the other person I know who has neuropathy... Mark Amundsen Electronically signed byClare Jennings, MA on 12/13/2012 4:01 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter Addended by: JENNINGS, CLARE on: 12/11/2012 03:54 PM Modules accepted: Orders Electronically signed byClare Jennings, MA on 12/11/2012 3:54 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: Mark Amundsen To: Victor Baquero, MD Sent: 12/6/2012 8:08 AM PST Subject: Non-urgent Medical Advice Question Hi Dr BaqueroHaving another failure of pain meds to control pain. Worst pain in lower back (new, 2 days), with elevated pain in normal areas (hips, knees, ankles,feet).Took laxative this morning to make sure back pain isn't constipation. Titrating methadone works somewhat, but not much. Don't know what to do - hoping for suggestions. Awaiting your recommendations... Regards, Mark Amundsen P.S. What does increased metabolism suggest? (from thyroid blood test) Electronically signed byClare Jennings, MA on 12/6/2012 8:10 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes
Subjective: Mark Amundsen is a 53yr old male who is here for the following reason: 1. reports the variable efficacy with methadone which in the past had worked very well. Currently it appears to work sometimes and not others. It also does not seem to last as 002468
long. He has noted that when he takes the methadone with food it does not work as well. 2. He is more active and eating better than before. However has lost weight over the past few months without trying. Reports no melena or bowel symptoms. Has not had a colonoscopy. Denies any constitutional symptoms. 3. ongoing neuropathy in the lower legs. Bothersome particularly at night with pain. Inquires about other treatment options. Review of Systems: Constitutional: negative. CV: negative. Resp: negative.
Patient Active Problem List Diagnoses Unspecified backache Other testicular hypofunction ADVANCED OSTEOARTHRITIS OF THE LEFT HIP DEPRESSIVE DISORDER CHRONIC PAIN MEDICATION AGREEMENT Anemia Orthopedic aftercare for joint replacement Dyslipidemia Vitamin D deficiency Hypertension High arch Polyneuropathy Current Outpatient Prescriptions on File Prior to Visit Medication Sig Carisoprodol (SOMA) 350 Take 2 tablets by mouth mg Tablet every day at bedtime. Carisoprodol (SOMA) 350 Take 2 tablets by mouth mg Tablet every day at bedtime. Ergocalciferol, Vitamin D2, Take 1 Cap by mouth. take (VITAMIN D) 50,000 unit 1 capsule by oral route PO Capsule twice weekly for next 2 months. Then lab follow up 4 weeks later. Fenofibrate (TRICOR) 145 Take 1 Tab by mouth every mg PO Tablet morning after a meal. Hydrocodone 10 Take 1 tablet by mouth Dispense 60 tablet Refill 0
60 tablet 8 Cap
0 1
30 Tab 100 tablet
11 0 002469
COPY - Protected Health Information - 02/20/2013 13:09:16-MR0137
Page 9 of 100
mg/Acetaminophen 325 mg (NORCO 10) 10-325 mg per tablet Methadone (DOLOPHINE) 10 mg Tablet Triamterene 37.5 mg/Hydrochlorothiazide 25mg (MAXZIDE-25) 37.525 mg Tablet
every 4 to 6 hours if needed for pain. Take 3 tablets by mouth 270 tablet every 8 hours. 9 daily. Take 1 Tab by mouth every 30 Tab morning. 0 3
BP 112/76 | Pulse 70 | Temp(Src) 36.2 C (97.2 F) (Tympanic) | Wt 95.255 kg (210 lb) OBJECTIVE: General Appearance: healthy, alert, no distress, pleasant affect, cooperative. Heart: normal rate and regular rhythm, no murmurs, clicks, or gallops. Lungs: clear to auscultation. Skin: Skin color, texture, turgor normal. No rashes or lesions. Mental Status: euthymic. Musculoskeletal: stable. Limited exam of the hip. Has pain in the right and left hip and gait is normal to antalgic. ASSESSMENT: 726.5 ADVANCED OSTEOARTHRITIS OF THE LEFT HIP (primary encounter diagnosis) Comment: Recommended followup with orthopedics. He continues to have symptoms in both hips although he had replacement hip surgery several years back. Plan: V76.51 Special screening for malignant neoplasms, colon Comment: Risks and benefits discussed in detail in terms of screening colonoscopy. Patient agreed to proceed with screening colonoscopy. Plan: GASTROENTEROLOGY REFERRAL V70.0 Routine general medical examination at a health care facility Comment: return to clinic for complete physical examination. Plan: TSH WITH FREE T4 REFLEX, COMPREHENSIVE METABOLIC PANEL, CBC AUTO + REFLEX MANUAL DIFF, PSA SCREEN 780.79 Other malaise and fatigue Comment: Nonspecific constitutional symptoms. Labs ordered. Plan: HOMOCYSTEINE 783.21 Weight loss Comment: see HPI. Unsure if it is related to changes in diet and activity or something physiologic. Plan: TSH WITH FREE T4 REFLEX, COMPREHENSIVE METABOLIC PANEL, CBC AUTO + REFLEX MANUAL DIFF 356.9 Polyneuropathy Comment: Discussed various treatment options as well as exploring further labs. Plan: Consider gabapentin. 002470
PLAN: See Orders. Discussed care and warning signs with Mark and all questions and concerns were fully answered. He will call or followup in the office if any problems arise. Barriers to Learning assessed: none. Patient verbalizes understanding of teaching and instructions. The patient and/or caregiver was educated regarding his/her medical care. No guarantees were made regarding his medical care or treatment outcome. I reviewed past medical, family/social and medication history during the visit. Electronically signed by: Victor Baquero, MD Associate Physician Associate Medical Director UC Davis Medical Group, Folsom
Electronically signed byVictor Baquero, MD on 11/20/2012 6:28 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Visit Notes Clare Jennings, MA Tue Nov 20, 2012 10:32 AM Vital signs taken, allergies verified, screened for pain, pharmacy verified, and verified immunization status. Clare Jennings, MA Electronically signed by Clare Jennings, MA at Tue Nov 20, 2012 10:32 AM Telephone Encounter
Appt made.
Electronically signed bySheri L Barr, RN on 11/19/2012 12:31 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Request appointment please

Mark Amundsen is a 53yr old male 3 patient identifiers used. Per: patient Reason for Call: Medication problem 002471
Telephone Encounter
LVM for patient to return call for smoking cessation options

Electronically signed byCari Shulkin, RN on 1/11/2013 1:37 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter
Spoke to pt, scheduled for the health education class, Achieving a healthy wt on 4/17. Pt would like a call back in early March to schedule for the Chronic Pain class. Best, Derika Faamausili Community Health Program Representative Center for Chronic Disease Care Management and Education UC Davis Health System 916-734-2907 http://www.chronicdisease.ucdavis.edu
Electronically signed byDerika Faamausili on 1/8/2013 2:59 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Progress Notes
Received message without any documentation. Please verify

Electronically signed byVictor Baquero, MD on 1/7/2013 12:21 PM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because communication record creation was suppressed. Telephone Encounter From: Mark Amundsen To: Victor Baquero, MD Sent: 1/6/2013 9:45 PM PST Subject: Non-urgent Medical Advice Question Hi Dr Baquero and ChristyI was going to get my methadone prescription refilled this weekend, but the Walgreen's pharmacy (916-8176533) informed me that they were not called to confirm the early refill. Could y'all be sure to call them Monday morning to authorize the early refill? I've been told the authorization has already been made, just the phone call needs to be completed. If you could email me via Mychart when the call has been made, I would appreciate it... Regards, Mark Amundsen Electronically signed byClare Jennings, MA on 1/7/2013 8:51 AM Chart Review Routing History Routing history could not be found for this note. This is because the note has never been routed or because
002472
,",C
DAVIS MEDICAL
P:t:~~~t
Date of Birth:
-------------
I have read the information regarding the diseases and the vaccines listed below. I have had a chance to ask questions that WerElanswered to my satisfaction. I believe that I understand the benefits! and risks of the vaccines cited. and ask that the vacctnets) listed below be given to myself or my child n~med above. Patient I Parent Signature:
Vaccine
Vaccine
Route & Site given
Initials of
Vaccine Administrator
Parent initials
VACCINE IPV 1 IPV 2 IPV 3 IPV4 IPV5

DTaP/DT
Date given
manufacture
lot#
1
i
I
I
DTaP I DT 2
DTaP/DT3 DTaP/DT4
I ,
I
I i I
DTaP-HIS4
DTaP/DT5
I
i
Td Sooster PREVNAR 1 PREVNAR2 PREVNAR3 PREVNAR4 HepS - HIS 1 HepS - HIS 2 HepS - HIS 3 HepS 1 HepS 2 HepS 3 Varicella 1 Varicella 2
-
i I ,I
I
I ,I I I
I .
I
I,
I
MMR1 MMR2
PPD /Tine 1 Pneumovax
.~
I r
I ,
1
I
I Vaccine Manufacturer Table M = Merck L = Lederte SK&B PM AP=Aventis Pasteur Kline Beecham
Signature of Vaccine Administrator
Initials
= Smith
C = Connaught
Pasteur Meneulc
_1
--_--------------------(6/01 )
IMMUNIZATION RECORD
002473
UC DAVIS
MEDICAL GROUP PATIENT REGISTRATION
PATIENT NAME
1J/1()/cQS(J\./
LAST
FIRST
INITIAL
DATE
114;(K
CITY
STATE
I(
ZIP ZIP
C) -/ J: ..2CX:D_
MAILING
ADDRESS
PHONE
STREET
:2()/7 /7J ;e&Jc.7(KJ

PLACE OF BIRTH
ADDRESS'
CITY
STATE
CI
;:OL.-So/f
C/O
D FEMALE
DATE OF BIRTH
I MOTHEA S MAIDEN NAME
q-~J
REFERRING PATIENTS
')9
PHYSICIAN.
/J;V~hIfIH/ CIl
S/fL.-CJccI
)sJ.MAlE IS~
I MAAITAL STATUS MARRIED 0 SINGLE DDIVDRCED DWIDOWED
,a
9 sc
~AIVEAS
L1C NO. STATE I SOCIAL SECUAITY NO
LlC;779/s 7
")</9-.<>s--o?bZ
T N 78;Z6;y., ,/"/0'
CITY RESPONSIBLE
EMPLOYER
OCCUPATION
C01'/"
STATE
/l;C1<I/J/CA'-'
ZIP
PHONE'
C()L{5U&A~
EXT.
ADDRESS
If OS &/1 u.6
NAME OF PERSON
Of
OCCUPATION
!4/JI(;e
RESPONSIBLE EMPLOYER'S
;e
FOR PAYMENT
OF THIS BILL
/.J 1-1UI'-KJJ(V
/3Zk;\//~L
CITY
STATE
:z !\/72{f2@A/W
ADDRESS'
PARTY'S
EMPLOYER:
C.o,Uk~
EXT
ZIP
PHONE
f20Y2/l'4J'
NAME.
0>
RELATIONSHIP TO PATIENT'
PERSON TO CONTACT IN CASE OF AN EMERGENCY ;e;JCNr!l

ADDRESS:
;YLIS"C
CIlY STATE
S/()USe
ZIP
;20/7
HOME PHONE
77J il-tfOL7O'J C/
/C
9/~-9g,]-;2SR
I
G9
~ORK PHONE
9/6-7;9-035<1
I ~RE YOU ALLERGIC

gj YES 0
NO
9,670
TO ANY MEDICATION? / d)l'"'eoF&.J IF YES, PLEASE LIST:
INSURANCE INFORMATION
PRIMARY INSURANCE
&u[;
SUBSCRIBER S NAME
SNI&t:/ 1'7(('Jl
CITY
~OPAYMENT AMOUNT
DEDUCTIBLE AMOUNT
RA::h'~
ADDRESS.
I
0/2
OOB
7-I-S~'
:1 0
SELF
(::RJ
SPOUSE STATE
110 NUMBER.I~S S 1/
CHILD
::'-SS 0(" - () '!

ZIP
GROUP
NUMBER
;:;1::)17 77J,e$mAJ
SECONDARYINSUAANCE
!=Or--SOM
Va
PHONE'
9S""'::;70
CQPAYMENT
9/b - 'j 8:J-::J ss
SUBSCRIBER
ADDRESS'
CITY
10
AMOUNT.
DEDUCTIBLE AMOUNT
SELF
SPOUSE
ID NUMBER: CHilD ZIP
GROUP NUMBER
STATE
PHONE
ASSIGNMENT OF BENEFITS-CONSENT FOR TREATMENT-RELEASE OF INFORMATION

I hereby assign all medical and/or surgical benefits to which I am entitled, including Medicare, private insurance, and any other plan, to UC Davis Medical Group. This assignment will remain in effect until revoked by me in wrttmq. A photocopy of thiS assignment is to be considered as valid as an original. I understand that I am tinancrally responsible for all charges whether or not paid by said insurance. I hereby authorize said assignee to release all information necessary to secure the payment. I hereby authorize the UC Davis Medical Group to perform any medical treatment as deemed necessary. Signed: ~~#UC?~ Date:
9-/.7-.2co-::l...
002474
71463-377 (8/97)
,-e
UNIVERSITY OF CALIFORNIA DAVIS HEALTH SYSTEM Date printed: 12-18-02 OUTPATIENT RADIOLOGY REQUEST Admit Date: 12-09-02 Exam #: 80A-122002 MRN: 8081369 Name: AMUNDSEN,MARK Station: UCDMGFO Extension: Room/Bed: Hosp. Serv: ANC Sex: M DOB: 09-23-59 Exam date: 12-20-02 Acct# 039462515121 Sponsor Code: P
Reason
/7'10
12:02
Date Ordered: Time Ordered: Per Date: Per Time: Tech: ,Hosp.Ord#:
persistant Admitting
for
exam:
It sided 15 radiculopathy
Dx:
Ordering Information Entered by: TAYLOR,JUDY Ordering Dr: BAQUERO,VICTOR HENRI QUE PI#08l39 Pager: Ext:9169859300 Attending Dr: BAQUERO,VICTOR HENRIQUE PI#08l39 Pager: Ext:9l69859300 Send report to:
Comment:
~ST COMPLETE "'C~ntrast Administration Contrast: Type/Amount/Route: Preliminary Notes
UC Davis Health System ~081369 Ord: 80 UCDMGFO AMUNDSEN,MARK 09-23-59 80-122002 Account #: 039462515121 UC-DavisHealtnS-y-s-t-e-m---------'8081369 Ord: 80 UCDMGFO AMUNDSEN, MARK M 09-23-59 80-122002 Account #: 039462515121 '--. . -- -- - - - - - Patient Status Information Priority: Life Support: Mobility: Isolation: Oxygen Required: Allergy to Iodine: Interpreter: N Language: ENGLISH Female Patients Only Date LMP: Pregnant: reast Feeding: Technologist/Film Information Views # Films
1
0-
1015-
2025-
30354045-
50556065-
Fllm Information Radiology Exam(s) MR LSPINE
72148
72148
7075-
80A-122002
1/, III 1/1"" III 1/ 1/

Report Information -------
.0.59095100-
Preliminary
Contacted: Pager#: Date: Time:

-------
002475
Appointment
Sex Male

DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work) Provider Joseph Clark Watson, MD
Department Neurosurgery Clinic Acc
Encounter-Level Documents: There are no encounter-level documents. Insurance Information Acct Number 039462515022 Future Appointments Date & Time 4/17/2013 5:00 PM Financial Class P Provider Achieving A Healthy Weight Department Chronic Disease Management Folsom Center None
Appointment
Department
Encounter-Level Documents: There are no encounter-level documents. Insurance Information Acct Number 039462515022 Future Appointments Date & Time 4/17/2013 5:00 PM
Financial Class P Provider Achieving A Healthy Weight Department Chronic Disease Management Folsom Center None
002476
Appointment
Sex Male

DOB 9/23/1959
Appointment
Department
002477
REFERRAL RECORO

71431-040
UNIT NUMBER: 8081369 PATIENT NAME: AMUNDSEN ,MARK DATE OF BIRTH: 23SEP59 CLINIC CODE: UCDPMC TRANSACTION DATEi 18APR03 CONSULTING DR/CLINIC DR. GAGAN MAHAJAN UCDPMC
APPT DATE
22APR03
APPT T IME: 1230
REFERRING PHYSICIAN BAQUERO, VICTOR H
REF ERRED FOR N/P LUMBO-STENTOR
002478
UNIVERSITY OF'CALIFORNIA HEALTH SYSTEM
DAVIS
ACKNOWLEDGEMENT OF RECEIPT: NOTICE OF PRIVACY PRACTICES

The UC Davis Health System Notice .of Privacy Practices provides information about how we may use and disclose protected health information about you. In addition to the copy we are providing you, copies of the current notice are available by accessing our Web site at http://web.ucdmc.ucdavis.edu/compliance/ and may be obtained throughout UC Davis Health System.' . I acknowledge that I have received the Notice of Privacy Practices .
~~ of Patient or Patient's Representative
~ature
~ _ M /Jr<K
r< !W'?()NOS"(fIV
Print Name
Interpreter (if applicable)
-------------------------------------------------------------------------------------------Written Acknowledgement Not Obtained

and reason it was not obtained.
Please document your efforts to obtain acknowledgment Practices Given Practices Given -
o Notice of Privacy o Notice of Privacy
Patient Unable to Sign Patient Declined to Sign Awaiting Signature _ _
o Notice
I~'
of Prj~acy Practices Mailed to Patient -
.0 Other Reason Patient Did Not Sign
c1.'QuoM ~tJto&J
Signature of UC Davis Health System Representative . Print Name Department
. ioooo}~i3iii3i.'.<.:,ACKNOWLEDGEMENT OF RECEIPT:'NOTICE
OF PRIVACY PRACTICES~.:~;r6:i/o3785
002479
Appointment
Sex Male

DOB 9/23/1959
Phone 916-509-0158 (Home) 916-983-4484 (Work) Department
6/4/2003 3:02 AM
Appointment
5/21/2003 1:52 AM
002480
Appointment
Sex Male

DOB 9/23/1959
Department
Encounter-Level Documents: There are no encounter-level documents. Insurance Information Acct Number 039462515071 1 Payor B/C Patient Insurance ID INT549250762 Group Number 38068
Plan B/C B/S OUT OF STATE
Financial Class P
Plan Number B10
Plan Address PO BOX 1505/ITS DEPT RED BLUFF, CA 96080-1505
Plan Phone 800-622-0632
2
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Center None
002481
Management Folsom
Appointment
Sex Male

DOB 9/23/1959
Encounter-Level Documents: There are no encounter-level documents. Insurance Information Acct Number 039462515071 1 Payor B/C Patient Insurance ID INT549250762 Group Number 38068
Plan B/C B/S OUT OF STATE
Financial Class P
Plan Number B10
Plan Address PO BOX 1505/ITS DEPT RED BLUFF, CA 96080-1505
Plan Phone 800-622-0632
2
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Center None
002482
Sex Male
DOB 9/23/1959
Appointment
Sex Male

DOB 9/23/1959
Department
Encounter-Level Documents: There are no encounter-level documents. Insurance Information Acct Number 079406336077 Other Appointments Today Date & Time 7/22/2003 2:30 PM
Financial Class P
Department Fol Fam Prac/Int Med Center None
Center None
002483
Provider Gagan Mahajan, MD
Center None
Center None
Appointment
Sex Male

DOB 9/23/1959
Plan UCD/B/S HMO
Financial Class P
Plan Number B72
Plan Phone 916-734-0739
Center None
Appointment
Patient Information
002484

Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Center None
Appointment
Department
Provider
Department
Center
002485
Patient 1nformation REQUEST DATA: TerminalID Number: UCDFFPOI Provider II) Number: UCD9980CA Patient's name: MARK AMUNDSEN Patient's DOB: 0912311959 Services From: 10/02/2003 Insurance Company:
l~~J~
Page I of I
RESPONSE MESSAGE:
BSCA Pian Code: HMO SPOTCHECK Audit No.: 2003100200224305 PCP: VICTOR BAQUERO MED GRP: IPAOl50EP UC DAVIS HEALTH SYSTEM 2315 STOCKTON BLVD SACRAMENTO, CA 95817
PLAN: 230 PRODUCT CODE: 0005 (S/O 00 00 00 10 11)20A8
h\\ps:/ /spotcheck.com/newscfspotcheck/eligsubmit.phtml?userid=ucdffp
1&userpwd=ffp 1...
002486 10/2/2003
'.
_.
USE PATIENT PLATE
UNIVERSITY OF CALIFORNIA HEALTH SYSTEM
DAVIS
TERMS-AND CONDITIONS OF SERVICE 7. FINANCIAL AGREEMENT: I agree to pay The Regents of the University of California for professional, hospital' and clinic services, including UCDHS physician services, in accordance with the regular rates and terms of UCDHS. "also agree to pay for other. professional services provided by other physicians at UCDHS. When this agreement is signed by my spouse, parent or a financial guarantor, my spouse, parent or financial guarantor shall be jointly and individually liable with me -!9r payment, [ncludinq all collection fees (attorney's fees, costs and collection expenses), in addition to any other amounts due. Unpaid accounts referred to outside agencies .for, collection bear interest at-the then current legal rate.. . _ ' 8. ASSIGNMENT OF BENEFITS (INCLUDING MEDICARE BENEFITS): I authorize and direct the payment to UCDHS of any insurance benefits includinq hospltal insurance and unemployment compensation disability benefits otherwise payable to or on my behalf for UCDHS services, including emergency services, at a rate not to exceed UCDHS' actual charges. I understand that I am financially responsible for charges not paid pursuant to this agreement. I further certify that the information given in applying for payment under the Medicare or Medi-Cal programs is correct. I further agree that any credit balance resulting from payment of insurance or other sources maybe applied to any other account owed to UCDHS by me .: 9. ADVANCE DIRECTIVES: I have an advance directive for health care (e.g., power of Attorney for Health I have provided UCDHS with a current copy of my advance directive If "No", I understand it. is my .r,esponsibility to provide. UCDHS a current directive. If I want to express my health care wishes, I understand I should care provider. . . " Care) 0 Yes 0 No . 0 Yes. 0 No copy of my advance speak with my health . 0 No
10:' PATIENT RIGHTS NOTICE:

I would like UCDHS to provide my next of kin or agent with the Patients Rights Notice 0 Yes
I haveread, agreed to and received a copy of this "Terms and Conditions' of Service."
~~~
Signature of Patient
or
S -~Ig-n-a-tu-re-o~f ~P-a-tle-n-t'-s-R~e-p-r-e-se-n-t-at-iv-e------
Relationship of Representative .to Patient .
...
Signature of Interpreter (if applicable) .
..
Date aligning
Signature of Witness ...,(required if patient unable to sign)
'\~ ;~-~~
. '...
, 71463-257(6/03)
TERMS AND CONDITIONS OF SERVICE
002487
Page 2 of 2
Th~ uC'Davis Health System (UCDHS) is part of the University of California and is comprised' of the UCDHS Medical Center, its hospital-based clinics, t~~ Primary Care Network clinics, the UCDHS Davis Medical Group, and the UCDHS School of Medicine. " 2. MEDICAL CONSENT: I consent-to any medical treatments. or procedures (except for complex procedures which require special consent), X-ray" examinations, drawing blood for tests, medications, injections, taking of medical photographs, videotaping, laboratory procedures, and hospital services rendered, to .rne under, the general .and-spectal instructions of th,e at!ending physicians, or other physicians of UCDHSassisting in jny care. I also consent to my admissjon to lJCDHS Medical Center if this is-deemed necessary-tor. my care. All of the terms and, conditions of this agreement shall,also apply to such admission., .. ' , I ' 3; RELEASE OF INFORMATION: UCDHS wnlobtaln my written authorization to releaseintorrnation aboutmy 'medical treatment, except in those circumstances when UCDHS is perrriitted or r~quired . by law to release information (see UCDHS' Notice of Privacy Practices for. a description of the specific circumstances under which UCDHS may relel3.se, this information). For example, UCDHS may release a copy 'of my patient record to insurance companies, health care service plans, governmental ageriCies, workers' compensation. carriers, or other entities which may be liable for all or any portion of UCDHS' charges. :'" . '.' " 4.. TEACHING, RESEARCH AND HEAL THCARE INSTITUTION: The University of' California, 'including UCDHS, is a teaching,- research and healthcare institution, I understand that residents, interns, medical students, students of ancillary, health care professions (e.g., nursing, x-ray, .rehabilitation therapy), post-graduate fellows, and other trainees may observe, examine, treat and participate at the request and under the supervision of the attending physician in my care as part of the University's medical education program's, I understand that my health information' may be used ' .and shared with researchers who, engage in research: related -to my treatment health 'condition, or medicalor physical status. I further understand t~at the University of California, includinq UCDHS, may use' my' medical inforrnation ' and specimens for' teaching, study and researcn purposes, including the development of potentially commercially useful products. Any use of these materials and information by UCDHS or other institutions will be in accordance with state and federal law, including all laws and .regulations governing confidentiality of patient recorcs. ' .',' .. . , ' -,.
.,
CUCCHS:,
.TEa
AND CONDITIONS OF SERVICtI '."
'
5. PERSONAL VALUABLES: UCDHS maintains fireproof safes for-the safekeeping of money-and valuables. UCDHS shall not be liable for the loss of or damage to any money, jewelry, glasses, dentures, furs or other articles of u~usual value and shall not be habletor lo~s,. or da~age.li? any personal property, unless deposited In UCDHS' sate.or locked storeroom>,'. ,~;-,,' , " ... ""':.~' .:
. :"1 .;~ " "'"; '". .} -: I
J_.'"
'.
'
,'6, USE AND DISCLOSURE OF MEDICAL INFORMATION: The State of California Information Practices Act requires UCDHS to provide the followinq information to individuals who supply information about themselves: As a patient of UCDHS, you will be asked to submit information about yourself, such as your address any phone number, Social Security number insurance information, medical history 'and treatment, an'd'other personal ihforrnatlon. The principal purpose for requesting this information is to ensure accurate identification, continuity of medical care, and , payment for such care. University policy and California' and federal law and regulations authorize the maintenance ~~ this infor~ation.- F~r'riishin~ ,all informati~n requested is mandatory unless, othe~lse noted. Failure to provide such ,Informatlo'n may affect your medical care and/or insurance benefits and coverage. The information you provide may be disclosed to.others as described in our Notice of Priva?y Practices. You have the right to review your medical inform~tion and the right to request restriction of access to your medical information, as described in the Notice of Privacy Practices.. .
-'.'
"
'
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:~.
"
7,1463-257(6/03)
.
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TERMS AND CONDITIONS OF SERVICE ",

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002488
Sex Male
DOB 9/23/1959
11/7/2003 4:20 PM
Center None
Orders Only
Patient Information

Date 10/3/2003 Provider Victor Baquero, MD Department Fol Fam Prac/Int Med

PSA SCREEN (581770) TSH (SENSITIVE) (581771) URINALYSIS-COMPLETE (582705)
Ordered On 10/3/2003 10/3/2003 10/3/2003
002489
PH0010
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Center None
Appointment
11/18/2003 12:02 PM
Financial Class P
Center None
Appointment
002490
UCD/B/S HMO
B72
PO BOX 179001 SACRAMENTO, CA 95817-9001
916-734-0739
916-734-0739
Center None
Orders Only
Patient Information

Date 12/1/2003 Provider Victor Baquero, MD Department Fol Fam Prac/Int Med

HIP BIL, 2 VW EA + PELVIS PCN (1065124) Ordered On 12/1/2003
Encounter Closed By
Appointment
Department
Encounter-Level Documents: There are no encounter-level documents. Insurance Information Acct Number 079636570123 1 Payor UCD Patient Insurance ID XEHJ00044785 Financial Class P
002491
There are no encounter-level documents. Insurance Information Acct Number 039690810013 1 Payor UCD Patient Insurance ID XEHJ00044785 Group Number PH0010 Plan UCD/B/S HMO Plan Number B72 Plan Address PO BOX 179001 SACRAMENTO, CA 95817-9001 Plan Phone 916-734-0739 PreAuth Phone 916-734-0739 Financial Class P
Center None
Appointment
Department
Plan
Plan Number
Plan Address
Plan Phone
PreAuth Phone
002492
02/20/2013
MRN: 8081369, Patient Last, First: AMUNDSEN,
r~K
01,15,13 PM
Page 1 of
UNIVERSITY OF CALIFORNIA OAVIS MEDICAL CENTER, SACRAMENTO, CALIFORNIA
-,
01 OS
n.
1. I hereby authorize and such assistants as may be selected y him! er including residents. fellows, interns, medical students and other appropriately licensed staff under hlsJher supervtsion, to treat or diagnose the condition or conditions which I understand to be: _
~f<4i!,uf~eW
t8.
.. -.
2. The roce re(s) necessary to treat such condition has been explained to me by and I understand the procedure(s) to be (this description should incl de the s and side of the procedure. the approach, halVest site, blood transfusion, etc.):
F5&J-~t'JA-
.v(R~
U:k
3. I have been informed that there are significant risks, such as severe loss of blood, blood clots, infection, cardiac arrest, and other untoward consequences, that are Involved in the performance of any surgical procedure that can lead to death or permanent or temporary disability or complete or partial disability. I have been made aware of certain risks and consequences that are associated with the procedure(s) described in paragraph 2. These include but are not limited to: .,"
tv
pv-
dAfL-n
I am aware that the practice of me ine and surgery is not an exact science, and I acknowledge that no guarantees or assurances have been made to me concerning the results of the chosen operation or procedure(s). 4. The medically acceptable slternstlve(s) in"treating such condition(s) has been explained to me and I understand it to be: _~,=O?~.~~~ ,L>7~D~ _ 5. I have been made aware of risks and described in paragraph 4. These are: associated with the alternative(s)
6. TRANSFUSION (strike out if not applicable): I understand that unless a medical emergenc) exists, or it Is determined to be medically inadvisable, my doctor will have informed me if there Is a reasonable possibility that a transfusion of blood or blood components may be necessary I understand that I may refuse blood or blood components. I understand that refusing transfuslom that are recommended by my doctors may result in life threatening consequences to me. 7. TRANSFUSION RISKS AND ALTERNATIVES (strike out If not applicable): I have been made aware of certain risks and consequences that are associated with transfusion. Including bu not limited to transmission of infeclious diseases. fever and transfusion reaction. I understanc that the medically acceptable alternatives to transfusion are _
r patlent's legal representatives initials
Physician's initials
r---;Iv'
002493
01:15:13
PM
Page 2
UNIVERSITY OF CAUFORNIA DAVIS MEDICAL CENTER,

SACRAMENTO, CAUFORNIA
8. I recognize that, during the COurse of the operation or procedure, unforeseen conditions may necessitate other procedure(s), which are in addition to, or different from those set forth in paragraph 2. I understand that It may be difficult or impractical to obtain my consent for those procedures. I therefore authorize and request that the above-named physician, hislher assistant, or hislher designees perform such procedures as are in the exercise of professional judgment necessary and desirable, including, but not limited to, procedures involving surgery. The authority granted under this paragraph 8 shall extend to treating all conditions that require urgent treatment and are not known to the surgeon at the time the operation or procedure is commenced. 9. I consent to the administration of such anesthetics as may be considered necessary or advisable. I have been advised that there are certain risks associated with anesthetics which may include allergic reactions and/or drug intolerances, cardiac arrest and brain damage. 10.1 authorize the hospital pathologist, at his or her discretion, to retain, preserve, use, or dispose of any tissues, organ or medical devices that may be removed during the operation or procedure. I understand that such tissue or organs may be used for research. 11.1 understand that I have the right to refuse this operation(s) or procedure(s). I further understand that the explanations which I have received may not be exhaustive and allinclusive and that other mora remote risks may be involved. However, the information that i have received Is sufficient for me to consent to the operation or procedure described above. I have had full opportunity to ask questions concerning my condition, the authorized operation or procedure, the alternatives, and the risks and consequences associated with It. Questions I have asked. concerning the operation or procedure have been answered to my satisfaction. 12.1 understand the above consent, acknowledge that all blanks requiring Insertion were completed before I signed and wish to proceed with the operation or procedure described a ove. .nIl
O~
.()'-t""
RELATIONSHIP OF REPRESENTATIVE (If appl' Ie) PROVIDER TRANSLATOR (if applicable) Changes to above Information~: _
TO PATIENT . ~ PI Number
---------------
Date and time
PATIENT OR PATIENT'S LEGAL REPRESENTATIVE PHYSICIAN/PROVIDER
002494
",
TERM~ AND CONDITIONS OF SERVI\
MEDICAL CONSENT. The care of the pallent IS under the control of the attending physicians, and t,he undersigned consents to routine medical treatment (rnedcaflons, j,njectl~ drawing blood tor tests, routine tests perorrned during pregnancy related treatment Including a cervical cUlture,. VORL ~creen, and a toxcolcqy screen for cocaine, opiates < amphetamines, etc.) and X-ray exarrunanone, taking of me~lc?-1 p,hotographs, laboratory procedures and hospital services rendered the patient under the general.and spe instructions of the attending physcans, or other poyscens assisting In the care of the patent . . . .. . 2. FINANCIAL AGREEMENT The patient In consideration of the services to be rendered, shall pay the Regents of th 8Unl~erslty of ClallfornlatoforhoslPI~ s~~ces.' Includln gPedrofess~~ services of hospital-based physicians, In accordance With the regular rates and terms of the UCD ~edlcal Center. -r: h e patient shall a so pay r pro essone services r~n d er as I by the UCD Protessonal Billing GrOUp/DaVIS Medical Assocates (~ereinafter referred to as UCD PBG/DMA) If jhls agreement IS executed by a spouse or a fi~anclal guarantor, spouse or tnancal guarantor shall be JOintly and severally liable ~Ith the patient Should accounts be referred to an attorney for collect on, reasonabl;:' attorney s fees and coiled expenses shall be payable, In amnion to other amounts due Unpaid accounts referred to outside aqences tor colecnon bear ~terest at !he rat~.?110"lo per year or !he maximum r permitted by law from the date of referral , . ,. For Inpatients the "Terms and Conditions ot Service" IS In effect from the POint of signing until all charges Incurred dunng the stay covered by that Terms and, C?ndltiO~S of SeNI agreement ha~e been discharged For Emergency and Acute Care Patients (Pediatric and Adult) the "Terms and Conditions of Service" IS In effect from the point of slgmng until all experr Incurred dunng that visit are discharged, For Cjruc and Anallary Service outpatients, the ''Terms and Conditions of Service" IS In effect for one year as long as there are outstanding char] for service rendered dumq that year, whichever is longer 3, CONSENT TO CONTACT EMPLOYER: The patient Specifically authorizes UCDMC Hospital and CliniCS/UCD PBGlDMA to contact hlslher eml?,Ioyer, by any lawful means that rr be required, In the collection of the patient's pnyslcran'hospta debt. UCDMC Hospital and Clinics/UCD PBG/DMA Will request only Information that IS necessary to collect cayrnem the patient's hospitaL/physICian bill . . , . , " 4. RELEASE OF INFORMATION: The patient or legal representative authorizes UCDMC Hospital and ClinlCS/UCD PBGlDMA to furnish Information from me pauent's medical !eCOI 10 the folloWing: a) the refemng phyacen for purposes 01 contrumq care; b) the patient's health care Insurance earner for purposes of reimbursement of hospnal and professional fees, c) any third party which may be liable for all or part of the patent's hospital and physican charges. , d) Seeside two for "Pnvacy Notice." _ . _ 5 TEACHING AND RESEARCH INSTITUTION: The Umversrty of Calllorrua, InclUding UCDMC Hospital and Olncs IS a teaching and research Institution. Under the supervrson the attending physcan, persons who are residents, interns, medical students and postgraduate fellows may participate In the .care of a patient as a part of the medical education progr, of the lnsthunon. The Information or specunerus) obtained from the patent dUring an exarrmanon, treatment or procedure, Indudlng laboratory or surgical procedures, may be used research, which mayor may noI be related to the patient's treatment or common. Specimen means and incudes, wnhout urrutauon, any organ, tissue. bone or other bodry part, a bodily fluids ot any kind. The patient has no property or ownersho interest In such specrrerus) or information and has no nght or entnlernent.in any research or research product us or denved from such specimen(s) 6 INPATIENT NURSING: UCDMC HOSPItaland Cleucs provdes nursing care accordnq to need as determined by the nurse and physcan. If the patient desires a Special or "private-de nurse, it is the responsibhty of the patent or hiSlher representanve to arrange for the service and pay the fees directly to the speoal or "private-duty" nurse UCDMC shall In no way responsible for failure to provide same and IS hereby released from lIabllrty arising from the fact that the patient IS not provided With such acdmonal care 7. PERSONAL VALUABLES: The UCDMC l-lospltal and Ctrucs maintains a fireproof safe, and In accordance wrth Calforrua CiVil Code Section 1860, Will not be liable for mont .jewell)', glasses, dentures, documents or other artides of unusual value and small co-pass unless placed therein. '+ 8 ELECTRICAL EQUIPMENT' California Heallh and Safety RegulatIOns prohibit the use of any line-operated electncal equipment which IS not aulhonzed by the Uraversny of Canon and UCDMC Hospital and ClinICS These regulations speotcajy Include line-operated shavers, hair dryers. raoos, and televeon appliances Your ~;i9nature on this document u'dcat you are aware of and Will abide by these requlanons. 9. CONSENT TO FOLLOW-UP The patent consents to the UCD Me9Ica1 Center retemng appropnate information on the patient's medical concmon to community heaith aqenoes the purpose of helping the patient, when appropnate, wrth beneflcal follow-up and counseling at home. The patient will not be oblqated to accept such care or counseling. If the pane does not agree to "Consent to Follow-up." please mnal here: _
c
P-u-rs-u-an-t-to-th-e-U-n,-Io-rm-A-n-a-to-m-,ca-I-G-ft-Act--, I-W-'-sh-to-pa-rt-,o-pat-e-j-n-th-e-o-r-g-an-d-on-o-r-p-rog-ra-m--O-Y-ES"--O--N() .
INSURANCE ASSIGNMENTS The patent, the patent's representative, or where nenner the patient nor the patient's representative IS the insurance subscr.ber, said nsorarcesutscnter (herein collecbvely called It "assignor") hereby assigns to The Regents of the University of Cattorrua and authonzes payment dlrE!Cfjyto It, of all bosptal Insurance benefits and Unemployment Compensation Dlsebu (UCD) benefits otherwise payable to the assignor, The assignor hereby agrees that UC Davrs" Medical Center may receipt for any such payments thereby discharging the Insurer's ot gabon to the extent of such payment . To the extent lhat fees for protessronal services rendered to the patient are payable to the UCD PBGlDMA, the assiqnor hereby assigns to the UCD PBG/DMA and authonzr payment to them of all Insurance benefrts for professional fees otherwise payable to the assignor but not to exceed the amount of such fees for professional services to the patient Tl assignor hereby agrees that the UCD PBGlDMA may receipt for any such payrnents.jhereby discharging Insurer's obligation to the extent of such payments ' . I It IS further agreed that any credit balance resulting from payment of Insurance of other sources may be applied to 'any other account owed UCDMC or UCD PBG/DMA by t~ Insured . . MEDICARE ASSIGNMENTS '
'. ,
'
I request that payment of autbonzed Medicare benefits be made either to me or On my behalf to UCDMC Hospital and Cllnics/UCD PBGlDMA for any servces furnished me by t~ UCDMC Hosprtal and ChnicslUCD PBGlDMA. I aumonze any holder of medea' information about me to release to the l-leahh Care Financing Administration and rts aqents'eny mtorrnatc needed to cetermre these benefits or the benefits payable to related' services .' I I understand my signature requests that payments be made and authonze release of medical information necessary to pay the claim. JF OTHER HEALTH INSURANCE is indicated Item 9 of the HCFA 1500 form or elsewhere on other approved claim forms or electronically submitted claims, my signature authorizes releasnq of the information to the Insurer or agenc . shown.. '. - In Medicare asaqned cases, UCDMC Hosprtal and _Cllnics/UCD PBGlDMA agrees to accept the charge determination of the Medcare earner as the full charge, and the nanent responsole only.for the dedU~fble, oolnsu~ance and noncovered services Coinsurance and the deductible are based upon the charge determination of the Mecncare earner.
I I
,
Eac,h?,f the unders,gt:'ed ~Ifies .that helS,hehas read, accepted, and received a copy of the "Terms and Cond~ions of Service" and the "Privac NotIce and ISthe,patIent, or ISdU!~authonzed on behaij of the pati~nt to execute such an agreement. The patient, the patient's representative or t~ ns~rance subscnber, further certlfies that helshehas read the 'Insurance Assignments", and n applicable, the "Medicare Assignments" an 'Kalser/ hampus AssIgnments", and agrees to them. '
~~-
OR';"
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Rela-~ollSnlp 01 RfiPi'Eisenlal!'Je
'==~=~===~_________,__~ ,F)
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Subscnber (It omer than
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pa\l~""'I"
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to p~
Insurance
'9na
rtn
fling
Time01sl9nll19
EPTIONAL o PATIENT 2. 0 PATIENT must sign
SIGNATURE IS A MINOR: IS LEGALLY as "Patient's
REQUIREMENTS ARE REFERENCED BELOW. Please hed< lhe _ate box(es) " , ' The parent or guardian must sign as "Patient's Representabve" unless the patient IS legally allowed to 'consent to medical care. INCOMPETENT TO SIGN' The court approved guardian or conservator, or the attomey in fact under a Durable Power of Attorney for Health Care Representative". _. ,
.3,,0 PATIENT IS UNABLE TO READ ENGliSH' A translator, shall read the form.to patient. The translator shall sign and indicate language used above. 4. 0 ~ATIENT IS PHYSIC~L~ Y INCAPABLE OF SIG~ING, ,The patient should give verbal consent, witnessed by a University Employee The spouse or next of kin should sign as Patient's Representatrve In witness of the patient s hawlg gwen verbal consent. The WItness shall sign above and complete the fol!owing: ThH patient gives hlSiher verbal cofls,:nt butrs physically incapable of signing because: --' 71463-257 (9197)
UNIVERSITY OF CALIFORNIA, OAVIS .MEDICAl CENTER, SACRAMENTO
002495
'\
UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER, SACRAMENTO PRIVACY NOTICE - FINANCIAL AND MEDICAL RECORDS
The State of California. Information Practices Act of 1977 (effective viduals.who supp~ information about 1hernselves.
JU~1,1978)
.
requires unlver;i~
,
'1
hospitals to provide th,Holiowing
information tojnili.

I
'
. . , ., . The principal ~rpo~~ 10r req~~ting the information 'i~ to ;nsure ~cCurateidentfficat\on and continuity 01 ~ical care, and payment therefore, from ..:mate~er source. University policy, California Administrativecode Trtle 22, DMsion 5, 'Ucensino and Cel1Jlication of HeaJ1hFacilitJes and Referral AQencies, and federal staMes authorize our maintenance of this Information. .,
Furnishing all i~fo~ation -requested is mandatory uniess othelWise noted. Failure to provide such inforination may affect your medical care and/or insurance benefits and coverage. This information may be provided to your referring physician or other health care professionals invoived 'In your- medical Care; othe.rs to the extent required ir connection with collection of acoounts or a claim for aid, insuranoe, or medical assistanoe to which you may be entitied; University facuity and students for research and educational purposes; and may be released as provided by state and federal 'i?W.The privacy of your records WIll be safeguarded. ' '. .. " '," .... "
, ,
Indivk:luals have the nght to review their own records in acoordance with the Imormation Practices Act and University policy. Information on these potoes may be ,cibtained tJ;Ieinformation. . from the officials responsible for maintaining . ..
Your medical record is maintained by:
.: Your patient billing information is maintained by:
Medicai Record Department UCD Medical Center Phone: (916) 734-5205
,.
Patient Financial SelVices UCD Medical Center Phone:" (916j}34I!:iOO . ,

'..t;
As a patient you have a right to restrict 1he release of information .about"yourself to the public (including the news media). Prior consent to release basic information (name, city of residence, address, sex and .age, reason for'admission, general nature.ot injurtes, general condition) is not requred, BaSIC mtorrnanon will be released upon request unlil and unless you specjfically wilhdraw consent, by completing and signing 'A Request Withhold Public Release of Information' form, . '.
To
If you are a psychiairic patent or a drug or alcohol abuse pstient, state and federallaw reg;"ate the type and amount of information that can be released, .Details of these restrictions are outlined in UCDMC HospitafPolicy aild Procedure Mailual'Section #2381 'Release of Patient'ldentiliaole MedicallnformatiQn (General Patient) _ .
. t,, ,'0 ,
PATIENT NOTICE, SOCIAL SECURITY NIIMBER
;ursuan~t? th~. F';'leral_Privacy Act of 1974you are her?!>y notified thaI discJosureof ycutsodal security number is mandatory. It is used to verify your Identity In the medical eate and payment systems. Disclosure of the social security number is required pursuant to Reguiation 4 Secticn 404 1256 Code ' of Federal Regulations, under Section 218, Title 11 of the Social Security Act,"as amended": . ,'. , , I _ ~' . ....
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002496
808 13 b9 "
A/I\JN8S01
,liAR/(
39-462515006
~
" ,)
G9/2l/~~
OS 119
9Ji-'8J-2~a9
i:l AO'U[ R O. VI (T 0 /10 " UC [IAVIS HEALTH SYSTEPJ I; ,, ;:; L V S " I ( L 0 - \J CDC A P TERMS AND CONDITIONS OF SERVICE AND PRIVACY NOTICE 1:;'1[,:; ,PC", fO' "01'\,' , 1 MEDICAL CONSENT: The care of the patrel;t is under the control of the attending physician. The patient or the patient's representative consents
t~ any medical treatments or procedures (except for tnvastve procedures which require special consent), x-ray exarrunatlons, drawmq blood for tests medications, injections. faking of medical photographs, laboratory proc~durt:s, and ~~spi~al services rendered the patient, unde.r the general and spe cia! instructions of the attending phystcian or other physicians of the Universityof California pavls Health Systef!l (UCDHS) assisting In the care of the patient The patient or the patient's representative also consents to the admission of the patient to UCDHS If this IS deemed necessary for the care 0 the patient. All the terms and conditions of this agreement shall also apply to such admission. 2. TEACHING INSTITUTION: The University of California, Including UCDHS, IS a teaching institution. The patient or the pat~~nt'~ representative under stands that residents, interns, medical students, students of ancillary health car.e professions (l.e., n~r~lng, x-ray, reha~llItatlon .therapy) and post graduate fellows may examine, treat and participate in the overall care of the patient, under the supervision of the attending physlcran. as part of the medical education program of the institution. 3. RESEARCH INSTITUTION: The University of California, including UCDHS, IS a research Institution. The patient or the patient's ~epresentatlve under, stands that any data or specimen(s) obtained during any examination, treatment, or procedures, Including any laboratory or surgical procedure, of the patient may be used in research which mayor may not be related to the patient's treatment or conomon Specimen. means and Includes, without Ilmltat!on any organ, tissue, bone or other bodily part, and bodily fluids of any kind. The patient or. the patient's representative further understands that the pauen has no property or ownership Interest In such specimen(s) and no right or entitlement In any research or research product, usrnq or derived from the specrmerns). 4. INPATIENT RECORDS: The patient or the patient's representative understands that some part of the patient's confidential medrca! information rna) be maintained at the patient's bedside during his/her stay. Hospital staff will make every effort to ensure that this information will not be reviewed b) unauthorized parties. . 5. INPATIENT NURSING: UCOHS provides nursing care according to need as determined by the nurse and physician. If the pati~nt desires a specia or "private-duty" nurse, It is the responsrbllity of the patient or his/her representative to arrange for the service and pay the fees directly to the spe~la or "private-duty" nurse. UCDHS shall in no way be responsible for failure to provide the special or "private-duty" nurse and is hereby released from habltlt; arising therefrom 6. PERSONAL VALUABLES: UCDHS maintains fireproof safes. and in accordance with Cahforrua Civil Code Section 1860, will not be liable for money, jewelry, glasses, dentures, documents or other articles of unusual value and small size unless placed therein, and shall not be liable for loss or damage to any personal property, unless deposited with the hospital for safekeeping 7. ELECTRICAL EQUIPMENT: UCDHS Policies and Procedures and California Health and Safety Regulations prohibit the use of any cellular or electncal equipment which IS not authorized by UCOHS, including but not limited to, cellular phones, line-operated shavers, hair dryers, radios, and televrsion appliances The patient agrees to abide by these policies and regulations. 8. FINANCIAL AGREEMENT: The patient shall pay the Regents of the Uruversrty of California for hospital and clinic services, Including professional services of physrctans, In accordance with the regular rates and terms of UCDHS. The patient shall also pay for professional services rendered as billed by the UCD Professional Billing Group (hereinafter referred to as UCO PBG). If a spouse or a financial guarantor executes this agreement, the spouse or financial guarantor shall be jointly and severally liable with the patient. Should accounts be referred to an attorney for collection, reasonable attorney's fees and collection expenses shall be payable, in addition to any other amounts due. Unpaid accounts referred to outside agencies tor conectron bear interest at the rate of 10% per year or the maximum rate permitted by law from the date of referral. 9. MEDICARE BENEFITS - Patient's Certification, Authorization to Release Information, and Payment Request: The patient or the patient's representattve certifies that information given in applymq for payment under Title XVIII of the Social Security Act is correct. The patient or the patient's representative authorizes any holder of medical or other information about him/her to release information needed for a Medicare claim to be submitted to the SOCial Security Administration or its Intermediaries or earners. The patient or the patient's representative requests that payment of authorized benefits be made on the patient's behalf to UCDHS. -
INSURANCE ASSIGNMENTS
The patient, the patient's representative, or (where neither the patient nor the patient's representativa IS the insurance subscriber) said insurance subscnber (herein collectively called the "assignor") hereby asstqns to The Regents of the University of California and authorizes payment direcny to II, ofl all hospital insurance benefits and Unemployment Compensation Disability benefits otherwise payable to the assignor. The assignor hereby agrees that UCDHS may receipt for any such payments thereby discharging the insurer's obligation to the extent of such payment.
To the extent that fees for professional services rendered 10 the patient are payable to the UCD PSG, the assignor hereby assigns to the UeD and authorizes paym~nt to them of all insurance benefits for professional fees otherwise payable to the assignor but not to exceed the amount of I such Iees for pr,ofess,lonal services to the patient. The assignor hereby agrees that the UCD PBG may receipt for any such payments, thereby diS-I charging Insurer s obligation to the extent of such payments. I It is further agreed that any credit balance or UCD PBG by the insured. resulting from payment of Insurance of other sources may be applied to any other account owed UCOHSI
PSGI
The undersigned is the patient or is dUly authorized on behalf of the patient to execute this agreement and certifies that he/she has read acc.ept~d, and recei~ed a cop~ of the "Terms. and Conditions of Service", "Privacy Notice" and Admissions Packet. The patient, th~ patient S representative or the Insurance subscrlber further certifies that he/she has read the "Insurance Assignments" and if applicable the "Medicare Assignments" and agrees to them. '. '
I
I
OR'Siii=M~fu=.~.np~,"~,,",=,~~===~--------SJgnature 01 Translator
ReiabOi1snp 01 RepresentalNe to Pallen!
IflSUrarK:e Subscnber
l.a.olQua!p
Used,
rd otfle(
than pallent)
Date Of SIgi1ing
Time
01 Signing
~XCEPTIONAL SIGNATURE REQUIREMENTS ARE REFERENCED BELOW Please check the appropriate box(es) D PATIENT IS A MINOR: The parent or guardian must sign as "Patient's Representative" unless the patient IS legally allowed to consent to medical care. D PATIENT IS LEGALLY INCOMPETENT TO SIGN: The court approved guardian or conservator, the attorney-in-fact under a Durable Power of Attorney for Health Care, or famIly member must sign as "Patient's Hepresentanve,"
PATIENT IS UNABLE TO READ ENGLISH: A translator shall orally translate this form to patient The patient must tnsn sIgn the form. The translator shall sign and mdicate language used. PATIENT IS PHYSICALLY INCAPABLE OF SIGNING' The patient should give verbal consent, witnessed by a UCDHS employee. The spouse or next of kin should srpn as "Patient's Representative" in witness of the patient having given verbal consent. The UCDHS employee witness shall also sign,
71463-257 (4100)
University of California Davis Health System
002497
PRIVACY NOTICE - FINANCIAL AND MEDICAL RECORDS
r"
~. c.:,'
I'
'The State ~f California Information Practices Act of 1977 (effective July 1, 1978) requires University hospitals to provide the following information to individuals who supply information about themselves. The principal purpose for requesting the information is to ensure accurate identification and continuity of medical care, and payment therefore, from whatever source. University policy, California Administrative Code Title 22, Division 5, LicensinQ and Certification of Health Facilities and Referral AQencies, and federal statutes authorize our maintenance of this information. Furnishing all information requested IS mandatory unless otherwise noted. Failure to provide such information may affect cal care and/or insurance benefits and coverage. This information may be provided to your referring physician or other professionals involved in your medical care; others to the extent required in connection with collection of accounts or aid, insurance, or medical assistance to which you may be entitled; University faculty and students for research and purposes; and may be released as provided by state and federal law. The privacy of your records will be safeguarded . your medihealth care a claim for educational
..
. Individuals have the right to review their own records in accordance with the Information Practices Act and University policy. Information on these policies may be obtained from the officials responsible for maintaining the information.
Your me<f1Ci3l record is maintained by;
Your patent I;>illing informationis maintained by:
Medical Records Department UCD Health System Phone: (916) 734-5?05
Patient FinanciaiServices UCD Heafth System Phone: (916) 734-9200
Patient Notice - Release of Information

As a patient you have a right to restrict the release of intormanon about yourself to the pUblic {including the news media}. Prior consent to release basic information (name, address, sex and age, reason for admission, general nature of injuries, general condition) is not required. Basic information will b13released upon request until and unless you specifically withdraw consent, by completing and signing the "Request to Withhold Public Release of Information" form. I! you are a psycniatnc patient or a drug or alcohol abuse patient, state and federal laws regulate the type and amount of information thaI can be released. Details of these restrictions are provided in UCDHS Hospital Policy and Procedure #2381 Release of Patient Identifiable Medical Information (General Patient). '
~ I
Patient Notice - Social Security Number

Pursuant fo the Federal Privacy Act of 1974, you are hereby notified that disclosure of your social security number is mandatory. If used to venty .your Identl~y In the medical care and payment systems. Disclosure of the social security number is required pursuant to Regulation 4, Section 404.1256, Code of Federal Regulations, under Section 218, TItle 11 of the Social Secunty Act as amended.
IS
I
,
U~iversiiy, 01,CalilorniQ .oa)/;S.H~alth. System . -
002498
~.
OUPATIENT
===============~=====--====------===---------------------------------------AMUNDSEN DOB: 09 ADDR: AGE: 44 MR#: 8081369 SS#: 549-25-0762 ACCT#: SEX: M 2017 TARBOLTON CIR FOLSOM CA HOME TEL: 916-983-2589 MAID N NM: NONE OTHE NM : EMPLOYER: WORK TEL: 916-337-3680 FC: P COUNTY CD:
REGISTRATIO~_
(COP_~____
UN.ITY OF CALIFORNIA ~~::~~:_:~~~~~::~~_~~~~~~
DAVIS _
79-636570016 MS: M X AID CD:
9 630
PAYOR 1 POLICY# GROUP # INS TEL AMUNDSEN,MARK SUB NAME: 09/23/1959 SEX: M SUB DOB : 549-25-0762 SUB SSN : 2017 TARBOLTON CIR SUB ADDR: FOLSOM CA \ 95630 HOME PH : 916-983-2589 HOME PH : WORK PH : 916-337-3680 WORK PH : EMPLOYER: EMPLOYER: ------------~-------------------------+------------------------------------PAYOR 3 PAYOR 4 POLICY# POLICY# : GROUP # : GROUP # : INS TEL: INS TEL : SUB SUB SUB SUB NAME: DOB : SSN : ADDR: SUB SUB SUB SUB NAME: DOB : SSN : ADDR: SEX: SUB SUB SUB SUB NAME: DOB : SSN : ADDR: SEX:
SEX:
HOME PH : WORK PH : EMPLOYER: GUARANTOR ADDRESS NAME: AMUNDSEN ,MARK 2017 TARBOLTON CIR FOLSOM CA HOME PHONE #: 916-983-2589 WORK PHONE #: 916-337-3680 SSN 549-25-0762
HOME PH : WORK PH : EMPLOYER:
--------------------------------------+-------------------------------------
95630 EMPL: CARD ISSUE DATE: VALID DATE:

-------------
---------------------------------
------------------------------
DOCUMENT
GENERATED
BY HMGJL
08:35 02/12/04
FROM LAU2,SDOPRGF1
002499
CA 95817-9001
Center None
Appointment
Sex Male

DOB 9/23/1959
Department
Plan UCD/B/S HMO
Financial Class P
Plan Number B72
Plan Phone 916-734-0739
Center None
Appointment
002500
Plan UCD/B/S HMO
Financial Class P
Plan Number B72
Plan Phone 916-734-0739
Center None
Appointment
Phone 916-509-0158 (Home) 916-983-4484 (Work) Provider Scott M Fishman, MD, MD
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
002501
"' '" :.> 03: 57 PH rS~l \.,,~'k;.20/.0I-l UC IJf]vi ~ --------_._-----------~-
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th
SY!'item
Page
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#1'J82i
{i('
T{PE
Davis Health System Referral

OF REQUEST: Referral
Phone' (916) lJo\-1181 Fax: (916) 734~118Z utter-ottrce: PRe Grange Bldg" 2nd Floor
. f<EFERRAL ACUITY: REO'D TIMEFRAME: Coordinator:

IT11"T1aSSY
ROlltlne
Specialty Contact Amadl I, Stephanie
[P-:\iTr'::-NT INf()RM~:\noN' ._ ..
Name
Address:
",,,,,~~"""~"""m"""'i'''::':''w,:,,::::,,''''''''''::':,,,,:,,,,.""::.,,,,,,.,,,, ..:.,:.:~ ':'w,,,,,,,'''''''''''''':'''''':''':':':'::,,,,,::::"::,:''''''::::::::::::::'":"""~"~l,,,~n_n''''':''''''':'':m'''''''''.,,,m':l,,,,,:m
::"",:,.""",-: :,.,,,. :.:.::..,.."..::.,::.,..": :.~: ::.,, ,,:..:,,:.,

PI# : 08139 DRIVE
Amundsen, Mark
20171AI7.BOI .... TON CI\\~ FOLSOM CA 95630
DOB: 09/23/1959 Gender', N\{)\e SSN: 549;'50762

MR#.
PCP:
VICTOR BAQUERO
PCPPhone:
PCP Address:
(916j D85-9:~OO
251 TURN PI"E FOLSOM
80813-69
CA, 95530
Language:
Contact Numbers'
Eng,I,lsh
(;j16~832G88 (Home) ~j16337368C (Work)
Guardian Name:
1-- .-.-.---.-------.~ ------. __ ._~ ~_._---~
Guardian Relatronship:
--------------~-_.---~,---~---._-_._~~_.
Guardian Phone:
,j{ICFLRI{INC I'ROVIDHU LOCATION (,"FORMATION

Provider: PIll'. VICTOR 08139 F OLSCM CA 956'30 BAQUERO
Main Office: 251 TURN PIKE DRIVE Phone: (91619859300 Fax: (916) 355-1217
Referring Site: UCD Folsom Primary Contact Blagg Bever Iy Phone: 9169859347
Fa.c: 916-608-8~Jll
:'i~ fj'-J~R R .\.I~ INfOR-~i..\i'l ()r\:--' ~- --. ""''''''''''''''''~'''''''''''''''''''''''.u"",r::""""",,::::,,...,n

Specialty Requested: ~
..~ - ----
..--.-Date:
--
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Referral
" .. ",,....,,,,,,,,,,,,..., .,,,.,,,,,,, ..,.,.. ,,.,"',,,,,,,"' ...,., .", .,,,,,.,,,, . ,

Referral Time: 0:00 am
Consultinq Site: UCD Carmwhael Ortbo
X (~~
()'? (;;) YV\}2.1.
? iJ~
d -fz> 'nsu)i',{c~YPbR;I c-fuate~.

UCD
lnsurance:
02/20/2004 BLUE SHIELD
Auth. ReqUITed'.
J~
.0,;10335
-AlL
DY1
Mtical ~e
Records: N/A~ Code:
~ Appt.Date!TIme:
i:;[J9 Code: 7242 LUMBAC30 Ctrrucat Details J Referral Notes: Date: 02/20/2004
Note'
00:00
Author: meDD
DY}trv I 01- ~
PT TO BE SEEtJ .4T CARf,1ICHAEL
peN
korrJ
*- S- \~ pt, t:lrvt
FOR CHf<ONIC LUMBAGO
002502

MR LSPINE (1867712) Ordered On 3/4/2004
Encounter Closed By
Appointment
Phone 916-509-0158 (Home) 916-983-4484 (Work) Provider Mri... Radacc
Center None
Appointment
Sex Male

DOB 9/23/1959
002503
Center None
Appointment
Sex Male

DOB 9/23/1959
3/16/2004 12:17 PM
Plan UCD/B/S HMO
Financial Class P
Plan Number B72
Plan Phone 916-734-0739
Center None
Orders Only
Patient Information

Date 3/5/2004 Provider Gary J Collins, MD Department Pain Clinic Acc
002504
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Provider James Paul Ressler, PA
Center None
Center None
Appointment
Department
Center None
002505
Plan UCD/B/S HMO
Financial Class P
Plan Number B72
Plan Phone 916-734-0739
Provider James Paul Ressler, PA
Center None
Center None
Appointment
002506
,
r
PATIENT NAME'
LAST
ADDRESS:
UC DAVIS
FIRST
re
\NITIAl DATE:
'IJR/C
MAILING
- <j -0<1
PHONE:
STATE:
ZIP
Jo/7
7}QIM<l.:1l)N . elf(
>
FOt-SOJ1
STATE:
MOTHER'S MAIDEN NAME SEX:
9>630
ZIP
~/{p-
9& s- sr
SOCIAL SECURITY NO,:
ST~E~T ADDRESS:
CITY
5tJf'l6
DATE OF BIRTH: PLACE OF, BIRTH
9-.J:J-~ ~M'HBm, ca
REFERRING
j:&!ALE o FEMALE
DRIVERS Lie. NO:, STATE
O;f
EMPLOYER
PHYSICIAN:
jJ ().
U~O
OCCUPATION: STATE ZIP PHONE: EXT:
PATIENTS
ADDRESS'
CIT'(
NAME OF PERSON
RESPONSIBLE
FOR PAYMENT
OF THIS BILL:
.. ~
RESPONSIBLE PARTY'S
EMPLOYER:
OCCUPATION:
IJ
EMPLOYER'S ADDAESS: CIT'(
STATE
ZIP
PHONE:
EXT:
PERSON TO CONTACT IN CASE OF AN EMERGENCY

NAME:
STATE
ZIP
::t(Rw ~t/Jltv.s C7
HOME PHONE:
ARE YOU ALLERGIC TO ANY MEDICATION? I)..YES 0 NO IF YES, PLEASE LIST: /
(.3u,o,('O'(7'/
=_ J
PRIMARY INSURANCE: COPAYMENT AMOUNT: DEDUCTIBLE $ GROUP NUMBERAMOUNT:
$
SUBSCRIBER'S NAME: SELF CIT'( DSPOUSE_ STATE D' CHILD ,ID NUMBER
/5.00
ZIP
5,S.1t
'">41-,;2 5-07(02
COPAYMENT $ AMOUNT:
!1 0/<; 7
PHONE:
/lJ1fLJ()t.-,
SECONDARY INSURANCE $
'flIP -: 9877'";;l S"'g'~

DEDUCTIBLE AMOUNT:
SUBSCRIBER:
o
CIT'(
SELF
SPOUSE
ADDRESS:
10 NUMBER: CHILO ZIP
GROUP
NUMBER:
STATE
PHONE:

I hereby assign all medical and/or surgical benefits to which f am entitled, including Medicare. private insurance, and any other plan, to UC Davis Medical' Group. This assignment will remain in effect until revoked by me in writing. A photocopy of this assignment is to be considered as valid as an original. Lunderstand that I am financially responsible for all charges wliether or not paid by said insurance. I hereby authorize said assignee to release all information necessary to secure the payment. I hereby authorize the UC Davis Medical Group to perform any medical treatment as deemed necessary. Signed:
71463377 (8/97)
Date:
/'-
9-0<1002507
cc: PAUL G KREIS, MD LANA WANIA-GALICIA, MD Display only: Transcription (1237596) on 4/29/2004 4:47 PM by Lana Louie Wania-Galicia Document history: Transcription (1237596) on 4/29/2004 4:47 PM by Lana Louie Wania-Galicia Encounter-Level Documents: There are no encounter-level documents. Insurance Information Acct Number 039690810047 1 Payor UCD Patient Insurance ID XEHJ00044785 Group Number PH0010 Plan UCD/B/S HMO Plan Number B72 Plan Address PO BOX 179001 SACRAMENTO, CA 95817-9001 Plan Phone 916-734-0739 PreAuth Phone 916-734-0739 Financial Class P
Center None
Appointment
Sex Male

DOB 9/23/1959
Encounter-Level Documents: There are no encounter-level documents. Insurance Information Acct Number 079636570024
002508
2025 TARBOLTON CIR FOLSOM CA 95630 Selected Appointment 5/19/2004 8:12 AM
916-509-0158 (Home) 916-983-4484 (Work) Provider Doctor Staff
Department
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Provider Jeffrey Alan Applebaum, MD
Center None
Center None
Appointment
Sex Male

DOB 9/23/1959
Department
002509
USE PAT'EN"
,!
\j,(\,
p,J-ATE
"
I'"
808 13 b'l
AHUNOSEN
II
,!
If
39-(;90810005
09/23/59
,,01/05
06139
Blut
916-983-2589 BAQU(RO, vlero 110 SHIElO-UCOCAP

peN FOlSOI1
,I1ARK
. .. 1. I hereby assistants and other condition
,i hONSENT
TO OPERATION, PROCEDURES, BLOOD TRANSFUSION AND ADMINIS~TION OF ANESTHETICS "-
authorize and such as may be selected by him/ er including residents, fellows, interns, medical students appropriately licensed staff under his/her supervision, to treat or diagnose the or conditions which I un~tand to be:, ""'i
,"C;
"
U/)'V\.~'/LV
po--c1
A~
'6"
j,'t=<
" ",
'
:,
2. The procE\cw:e(S):\ necessary to treat such condition has been explained to me' ". by Jl.\,cJUv) and I understand the procedure(s) to be (this description should include the site and side of the procedure, the approach, harvest site, blood transfusion, etc.):
'
t-P If
9 I 'ig tQ d6~
/'1U'v".g
4Ji!?f' b/ <De le-
3. I have been informed that there are significant risks, such as severe loss of blood, blood clots, infection, cardiac arrest, and other untoward consequences, that are involved in the performance, of any surgical procedure that can lead to death or permanent or temporary disability or complete or partial disability. I have been made aware of .certain risks and consequences that are associ d with the procedure(s) scribed in paragraph 2, These inclu&zbut ~~e,not limited to: ''f @ c ~ A I fA / U\...A--" \ I am aware that the practice 0 medicine and surgery is not an exact science, and I acknowledge that no guarantees or assurances have been made to me concerning the results of the chosen operation or procedure(s). 4. The medically acceptable alternative(s) me and I understand it to be: in treating such condition(s) has been explained to _ associated with the alternative(s) __
5. I have been made aware of risks and consequences described in paragraph 4. These are:
6. TRANSFUSION (strike out if not applicable): I understand that unless a medical emergency exists, or it is determined to be medically inadvisable, my doctor will have informed me if there is a reasonable possibility that a transfusion of blood or blood components may be necessary. I understand that I may refuse blood or blood components. I understand that refusing transfusions that are recommended by my doctors may result in life threatening consequences to me. 7. TRANSFUSION RISKS AND ALTERNATIVES (strike out if not applicable): I have been made aware of certain risks and consequences that are associated with transfusion, including but not limited to transmission of infectious diseases, fever and transfusion reaction. I understand that the medically acceptable alternatives to transfusion are _
Patient's or patient's legal representatives initials
MKW
~
P
Yellow _ P~tit:lnt
~
002510 MR07/03865
Page 1 of 2
1431'8114 (7/03)
CONSENT TO OPERATION, PROCEDURES, BLOOD TRANSFUSION AND ADMiNISTRATiON Or- ANESTHETICS

,"'1--: ..... _ "fl, ... ..J: ... 1 O>",,f'nrrlc::
.,
, ~, USE PATIENT rLAT~ .',~,: "
808 13 bq
AHUNOSEN
.HARK
Lf
35-69081000::
5i
UNIVERSITY
OF CALIFORNIA
DAVIS .
MEDICAL CENTER, SACRAMENTO, CALIFORNIA
0.290""
09/~3/~9
P
!
08139
BLU[
S~I[lO-UCOCAP
PCN FOLSO"
BAQUERO.
916-S83-2~a9
Icro
HO ~
4
~
---', ,"
0110';)
,..;:!
8, I recognize that, quring the course of the operation or procedure, unforeseen conditionsrWay necessitate other procedure(s), which are in addition to, or different from those set forth in paragraph 2. I understand that it may be difficult or impractical to obtain my consent for those procedures. I therefore authorize and request that the above-named physician, his/her assistant, or his/her designees perform such procedures as are in the exercise of professional judgment necessary and desirable, including, but not limited to, procedures involving surgery, The authority granted under this paragraph 8 shall extend to treating all conditions that require urgent treatment and are not known to the surgeon at the time the operation or procedure is commenced, 9. I consent to the administration of such anesthetics as may be considered necessary or advisable. I have been advised that there are certain risks associated with anesthetics which may include allergic reactions and/or drug intolerances, cardiac arrest and brain damage, , 10. I authorize the hospital pathologist, at his or her discretion, to retain, preserve, use, or dispose of any tissues, organ or medical devices that may be removed during the operation or procedure. I understand that such tissue or organs may be used for research" 11, I understand that I have the right to refuse this operation(s) or procedure(s), I further understand that the explanations which I have received may not be exhaustive and all-inclusive and that either more remote risks may be involved, However, the information that I have -received is sufficient for me to consent to the operation or procedure described above. I have had full opportunity to ask questions concerning my condition, the authorized operation or procedure, the alternatives, and the risks and consequences associated with it. Questions I have asked concerning the operation or procedure have been answered to my satisfaction. 12.\ understand the above consent, acknowledge that all blanks requiring insertion were completed before I signed and wish to proceed with the operation or procedure described above. . , Lf
"
/2-- ~/t11f (Cy;
;:?,!l1# ~~"'P0---OR PATIENTS
'
'~Time
mlENT
LEGAL REPRESENTATIVE
TRANSLATOR 'Changes to above information:.
(if applicable) _
I
Date and time PATIENT OR PATIENTS LEGAL REPRESENTATIVE
002511

Patient Instructions None Follow-up and Disposition Return in about 7 days (around 7/16/2004). Visit Disposition Disposition Return in about 7 days (around 7/16/2004).
Problem List
TESTICULAR HYPOFUNC NEC BRACHIAL NEURITIS NOS Encounter Closed By Closed By KHAMISHON, ILYA L Closed Date 07092004 Closed Time 11:29 Mark Amundsen (MRN8081369) Sex Male DOB 9/23/1959
Appointment
Department
Payor UCD Financial Class P
002512
07i20/04
07: 40
AM
ut:
Davis
[I
H Health
S System
via
VSI-FAX
Page
1 of 1 #45791
~Ie Davis Health System Referral Form

TYPE or REQUEST: RRoef~tlrnr:l REFERRAL ACUITY: "' REQ'D TIMEFRAME:
ccordtnetor:
Phone: (916)734-1181 Fax: (916)734-1183

tnter-otnce: PRe Grange Bldg., 2nd Floor
~\~\ \
@~{)oc\rWX}CI\U
v Anita
rnrnassey
Specialty
Contact.Garcia,
Contact Ph: 916-734-4818
Contact Fax. 916-734-6212
Name: Address:
Amundsen, Mark 2017 TAF<BOLTONCIR
ooa.
09/23/1959
Gender: Male SSN: 549-25-0762 MR#' 808-13-69
PCP: VICTOR BAQUERO PI# : 08139 PCP Phone: (916) 985-9300 PCP Address: 251 TURN PIKE DRIVE FOLSOM CA 95630
FOLSOML:~9::::0 Contact Numbers:
English
/3
9169S:J2589 (Home) 9163373680 (Work)
.dlan
I
Name:
Guardian Relationship:
Guardian Phone:
RI::I::t:Ki~ING l'I~O\lOEl~1 LOCATION INf<-'O-I'~-J-M-A-T-J-O-,-N------------'

Provider: VICTOR BAQUERO F'I#' 06139 Main Office: 251 TURN PIKE DRIVE FOLSOM CA 95630 Phone: (9161985-9300
-. ---------.--
Gq
~
.",di
~,...",..~~-;;~:';~,,;;:;;_;;"":"~m_;:m1"~""', ::';;::";;o;;;;-;;m1";;>;1:~"m1m:=;;;;:;::=:;;';:;:";;"'~;;;:=~;;;:;;~~"'=m:~~;;;;"~,.".,,,, . ~'" "".. "' "."
." .. ,,, .. ~,';;:;; ..... ""."."",." _-" .. -,,,-,,,-,,-,
Referring Site: UCO Folsom Primary Contact. Kasik, Tracy Phone: 916-985-9303 Fax: (916) 355-1217
Fax: 916,353-2907
l RF.fE:RRAL INFORMATION
Specialty Start Date: 071201200407:35 Specialty Requested: Spine Program Consulting Site: Spine Proqram
Referral
.....
Date:
.'.
0711612004 BLUE SHIELD E UCD Oapitated
. . .
'.'
-.
Jl'
::::::f'l::m:"::~-="::~~"l"'" ,,,,,,=:m:::.el:::"'~'-'::...-,::'l":::,~m::::":::::::=::'::::f"""'~""""..,,...":::::m::::::==:::m"""""""=:m'.:m:::,:::::mrn=::=:::m
_........ _........ ~~~;m ~_ .. ~ .. ~
~ .. _: ".. :.. "'~ .. _ .. ~~::" :
Insurance: Insurance Type:
Referral Time: 0:00 am Auth. Required: Auth. #: 41980159
Medical Records: N/A Resource Code:
Appl.oatelTime:
ICO-9 Code: 724.5 - BAC~ACHE NOS Clinical Details J Rc-ferral Notes: Date: 071191200415:23 Author: samadril Note: Per Judy l.ampe, pt to be redirected to Ortho Spine at the ACC, due to capacity at Carmichael SJA Date: 071161200400:00 Author: mcOO
~:;~W~17;~'0;;;;;;;;;;) ff-
Received '} Spine Prognm

_ U)"gent
rY~
I
_-Ruutine/
Non-op
riaged~.
Surgical _ Unllble to See
--- _
_
'on tact Patient
L ~ppointed
------
002513
Sex Male
DOB 9/23/1959
7/23/2004 11:18 AM
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Center None
Patient Information

Telephone Encounter
7/19/2004 11:17 AM
Reason for Call

Refill Request
Call Documentation
SYSTEM Signed >> CAROL A PATON Mon Jul 19, 2004 11:21 AM Encounter initiated.
002514
916-983-4484 (Work) Provider Kenten P-K Wang, DO, DO Department Spine Clinic
Provider Kenten P-K Wang, DO
Department Spine Clinic
Center None
Center None
Appointment
Sex Male

DOB 9/23/1959
8/20/2004 12:53 PM
002515
REFERRAL RECORD

71431-040
UNIT NUMBER: 8081369 PATIENT NAME: AMUNDSEN DATE OF BIRTH: 23SEP59 CLINIC CODE: SPINE TRANSACTION
,MARK
APPT DATE
31AUG04
APPT TIME: 0800
DATE: 27AUG04 CONSULTING DR/CLINIC REFERRED FOR NP L5 RADICULOPATHY
REFERRING PHYSICIAN BAQUERO, VICTOR H
DR KENTON WANG SPINE
002516
OUPATIENT
======:=========================================================~============
REGISTRATION
~.
(COPY) 44 95630 VICTOR H
PATIENT
~VE~TY OF CALIFORNIA INFORMATION RECORD ACCT#: SEX: M 79-636570081 MS: M
DAVIS
AMUNDSEN ,MARK DOB: 09/23/1959 ADDR:
AGE:
MR#: 8081369 SS#: 549~25-0762
2017 TARBOLTON erR FOLSOM CA HOME TEL: 916-983-2589 MAIDEN NM: NONE OTHER NM : PCP PI#: 08139 BAQUERO,
EMPLOYER: INTERGRAPH CORP WORK TEL: 916-337-3680 X FC: P COUNTY REF: PAYOR 2 POLICY# : GROUP # : INS TEL : SEX: CD: AID CD:
-------------'---------------------------------------------------------------
PAYOR 1 UCD/B/S HMO POLICY# : J000447850000 GROUP # : BS20MH019 INS TEL : 916-734-0739 SUB SUB SUB SUB NAME: DOB : SSN : ADDR:
AMUNDSEN,MARK SUB NAME: 09/23/1959 SEX: M SUB DOB : 549-25-0762 SUB SSN : 2017 TARBOLTON CIR SUB ADDR: FOLSOM CA 95630 HOME PH : 916-983-2589 HOME PH : WORK PH : 916-337-3680 WORK PH : EMPLOYER: INTERGRAPH CORP EMPLOYER: --------------------------------------+------------------------------------PAYOR 3 I PAYOR 4 POLICY# : POLICY# : GROUP #" : GROUP # : INS TEL: INS TEL : SUB SUB SUB SUB NAME: DOB : SSN : ADDR: SEX: SUB SUB SUB SUB NAME: DOB : SSN : ADDR:
SEX:
HOME PH : WORK PH : EMPLOYER: GUARANTOR ADDRESS NAME: AMUNDSEN ,MARK 2017 TARBOLTON CIR FOLSOM CA HOME PHONE #: 916-983-2589 WORK PHONE #: 916-337-3680 SSN 549-25-0762
--------------------------------------+-------------------------------------
95630 EMPL: INTERGRAPH CORP
-----------------------------
-----------------------------------------------
CARD ISSUE DATE: VALID DATE:
DOCUMENT
GENERATED
BY HMGCWG
08:02 09/13/04
FROM LAGF,SDOPRGF1
002517
" , 1, UCDHS: The UC Davis Health System (UCDHS) ,is" parr "Of'the. tJnil1ersity)of,:California anq IS comprised of the UCDHS Medical Center, its hospltal-based 'cli~iC:s,:: ~~' p.ririiary'-~~re~Network ., clinics, the UCDHS Davis Medical Group, and the UCDHS School of Mealclne..1 "\
III !S(;U o:fli:~~" ,. - H
,- <r . TERMS AND GONDITIONS OF SERVICE ~~.s : , ,.', ~ 1 ~ ", '

,OOb~C~>' "-"'f:: . e\I:~',
'}
2, MEDICAL CONSENT: I consent to any medical treatments or procedures (except for complex procedures which require special c~>nsent), X-ray eXi;1minations, drawing blood for tests, medications, injections, taking of medical photographs, vidsotapinq, labor~tory procedures, ~nd hospital services rendered to me under the general and special instructions of the ~tt~ndlng physicians or other physicians of UCDHS assisting in my care. I also consent to my admls~lon to UCDHS Medical Center if this is deemed necessary for my care. All of the terms and conditions of this agreement shall also apply to such admission. 3, RELEASE OF INFORMATION: UCDHS will obtain my written authorization to release information about my medical treatment, except in those circumstances when UCDHS is permitted or required by law to release information (see UCDHS' Notice of Privacy Practices for a description of the specific circumstances under which UCDHS may release this information). For example, UCDHS may release' a copy of my patient record to insurance companies, health care service plans, governmental agencies, workers' compensation carriers, or other entities which may be liable for all or any portion of UCDHS' charges." , . 4. TEACHING, RESEARCH AND HEALTHCARE INSTITUTION: The University of California, including UCDHS, is a teaching, research and healthcare institution. I understand' that residents, interns, medical students, students of ancillary health care professions (e.q. nursing, x-ray, rehabilitation therapy), post-qraquate fellows, and other trainees may observe, examine, treat and participate at the request and unoer ttie supervision of the attending physician in my care as part of the University's medical education programs. I understand that my health information may be used ". " and shared with researchers who engage in research related to my treatment, health condition, or " medical or physical status. J further understand that the University of California, including UCDHS, may use my medical information and specimens for teaching, study and research purposes" including the development of potentially commercially useful products. Any use of these materials and information by UCDHS or other institutions will be in accordance with state and federal law, including all laws and regulations governing confidentiality of patient records. LES: UCDbH . S fmainhtainl s fireproof safes for the safekeeping 01 money and .' 5. IPEbRI SONUACLDHVS A LUhAIB I be ra I e I or t e oss of or damage to any money, jewelry, glasses, va ua es. s a not dentures, furs or other articles of unusual value and shall not be liable for loss or damage to any' personal property, unless deposited in UCDHS' safe or locked storeroom: 6. USE AND DISCLOSURE OF MEDICAL INFORMATION: The State of California Information Practice~ Act requires UCDHS to provide the following information to individuals who supply information about themselves: As a patient of UCDHS, you will be asked to submit information ~bout y?urself, ~uch .as your address any phone number, Social Security number, insurance Informatlon~ medical hlstorx an~ treatment, and other personal information. The principal purpose for requesting this Information IS to ensure accurate identification, continuity of medical care, and payment for such care. University policy and"C.alifornia and federal law and regulations authorize the m~intenance o! this inforr~ation. F~rnishin~ all information requested is mandatory unless othe"':"lse noted. Failure to provide such Information may affect your medical care and/or insurance benefits and coverage..The information you provide may be disclosed to others, as described in our Notice of Pn~a?y Practices. You have the ~ight,to revie,w your medical information and the right to reque:st restriction of access to your medical Information, as described in the Notice of privacy.: Practices.
7,1~.63-257(6/03)
_ ,.J ."~
,-.<:'. ~
, .' .,,,,.
002518 'Page 1 of 2
i;.;. 80R
Q,'/.J31 ~d '31r,-'Hl3-2~8 9 USEPATIENTO~'i"J9 ri"')U(1I0. vt cr o xo

/l
;,I1UMOS eN
1~ bq ,j
If
03 2l
''i\
"AR l(
es
t:,
UNIVERSITY OF CALIFORNIA DAVll HEALTH SYSTEM
SLur
. ..-
t~
,'"
02//)(,
SHIELO-vCoet.p POI FOLSON
'3'
~]
7. FINANCIAL AGREEMENT: I agree to pay The Regents of the University of California fo professional, hospital and clinic services, including UCDHS physician services, in accordance witt the regular rates and terms of UCDHS. I also agree to pay for other professional services providec by other physicians at UCDHS. When this agreement is signed by my spouse, parent or a tinancia guarantor, my spouse, parent or financial guarantor shall be jointly and individually liable with rns for payment, including all collection fees (attorney's fees, costs and collection expenses), in additior to any other amounts due. Unpaid accounts referred to outside agencies for collection bear interes at the then current legal rate. .
'f7
8. ASSIGNMENT OF BENEFITS (INCLUDING MEDICARE BENEFITS): I authorize and direct thE payment to UCDHS of any insurance benefits including hospital insurance and unemploymen compensation disability benefits otherwise payable to or on my behalf for UCDHS .services including emergency services, at a rate not to' exceed UCDHS' actual charges. I understand that am financially responsible for charges not paid pursuant to this agreement. I further certify that the information given in applying for payment under the Medicare or Medi-Cal programs is correct. I further agree that any credit balance resulting from payment of insurance or other sources may be applied to any other account owed to UCDHS by me. '
,
9. ADVANCE DIRECTIVES: I have an advance directive for health care (e.g., Power of Attorney for Health Care) 0 Yes 0 No I have provided UCDHS with a current copy of my advance directive 0 Yes 0 No If "No", I understand it is my responsibility to provide UCDHS a current copy of my advance directive. If I want to express my health care wishes, I understand I should speak with my health care provider. \ , 10. PATIENT RIGHTS NOTICE: I would like UCDHS to provide my next of kin or agent with the Patients Rights Notice 0 Yes o No
I have read, agreed to and received a copy of this "Terms and Conditions of Service."
'l'ffi,_d~~
or
::;--Ig-n-a-tu-r-e-o-f-P-a-t-ie-n-t'-s-R-e-p-r-e-s-e-nt-a-ti-ve----
>~ L(Relationship of Representative to Patient Signature of Interpreter (if applicable) Signature of Witness (required if patient unable to sign) For office use only: o o
EXCEPTIONAL SIGNATURE REQUIREMENTS ARE REFERENCED BELOW. Please check the appropriate box(es) PATIENT IS LEGA~LY INCOMPETENT TO SIGN: The court approved guardian or conservator, the attorney-in-fact Health Care, or family member or other appropriate surrogate must sign as "Patient's Representative." under a Durable Power of Attorney The "Patient's for
,
D~
7-..20/ -OS
of Signing
PAT1~NT 15 P~YSICALLY INCAPABL~ OF 51C?NING The cetent should give verbal consent, witnessed by a UCDHS employee tative should sign In witness of the patient haVing given verbal consent. The UCDHS employee witness shall also sign
Represen-
71463-257(6/03)
TERMS AND CONDITIONS OF SERVICE'
002519
Page 2 of 2
OUPATIENT
REGISTRATION
============================================================================
AMUNDSEN ,MARK DOB: 09/2:3/1959 ADDR:
(COPY) 46
PATIENT MR#: 8081369 SS#: 549-25-0762
UN~RSITY OF CALIFORNIA INFORMATION RECORD ACCT#: SEX: M 78-080963024 MS: W X AID CD:
DAVIS
AGE:
2017 TARBOLTON CIR FOLSOM CA HOME TEL: 916-983-2589 MAIDEN NM: NONE OTHER NM : PCP PI#: 08139 BAQUERO,
95630
EMPLOYER: WORK TEL: 916-337-3680 FC: P COUNTY CD:
VICTOR
REF: PAYOR 2 POLICY# : GROUP # : INS TEL : SUB SUB SUB SUB NAME: DOB : SSN : ADDR: SEX:
AETNA-PPO/POS PAYOR 1 W142637665 POLICY# GROUP # : 620229011 INS TEL : 800-840-2925 AMUNDSEN,MARK 09/23/1959 SEX: M 549-25-0762 2017 TARBOLTON CIR FOLSO~ CA 95630 HOME PH : 916-983-2589 WORK PH : 916-337-3680 EMPLOYER: SUB SUB SUB SUB PAYOR 3 POLICY# GROUP # : INS TEL: SUB SUB SUB SUB NAME: DOB : SSN : ADDR: SEX: NAME: DOB : SSN : ADDR:
--------------------------------------+-------------------------------------
PAYOR 4 POLICY# : GROUP # : INS TEL : SUB SUB SUB SUB NAME: DOB : SSN : ADDR: SEX:
HOME PH : WORK PH : EMPLOYER: GUARANTOR ADDRESS NAME: AMUNDSEN ,l'I'.ARK 2017 TARBOLTON CIR FOLSOM CA HOME PHONE #: 916-983-2589 \WRK PHONE #: 916-337-3680 SSN 549-25-0762
--------------------------------------+-------------------------------------
95630 EMPL:
------------------------------------
----------------------------------------
CARD ISSUE DATE: VALID DATE:
DOCUMENT
GENERATED
BY HMGJS
15:33 02/08/06
FROM LAQD,SDOPRGF1
002520
Patient Information
REQUEST Terminal Provider
Insured Insured's
t
DATA: ID Number: ID Number:

s SSN: DOB:
UCDFFP03 UCD9980CA 549-25-0762 09/23/1959 02/09/2006 00002 (Aetna)

============
Page 1 of 2
Services Insurance' RESPONSE
From: Company: MESSAGE:
::========-==
Insurance Company Ins Company: AETNA INC

===========
Prov 10:
===========
Provider 680344702
~=================
Name: Add.r:
Subscriber =============-==== MARK R AMUNDSEN 2017 TI'RBOLTON CIRCLE FOLSOM, CA 95630 M 09/23/1959 W142637665 062022901100012 THE MCCLATCHY COMPANY
0620229
Gender: DOB: Mbr ID: Grp No: Qrp Nm:

Plan
Number:
Description: AETNA SELECT Plan Begin: 01/01/2006 Services on: 02/09/2006
==========
+++++++++
Eligibility
Primilry Care
Data
==========
+++++
Provider
Coverage
Type:
Prof Visit-OfficeEnrolled EP
on:
01/01/2006
Insurance TypeCode: Primary' Care Provider: VICTOR BAQUERO Phone: Coverage
(916) 985-9300 Type: Prof Visit-OfficeGateway Provider:
Facility:
Facility ID: 000000105
=======================================
Coverage
+++++++++
Type:
Prof visit-Office
--------Amount:
Coverage
Co-Payment ++++++++++++++++ In Plan Benefits ----------
$lS
Type: Prof Visit-OfficeSPEC OFF VST
https://spotcheck.com/newsc/spotcheckieligslIbmit.phtm!
2/9/2006 002521
UC DAVIS
PATIENT NAME LAST FIRST INITIAL
!J(I1(J)tOUflLl
MAILING ADDRESS. , CITY
IC
DATE.
. -)5-OG
PHONE
;)0/7 /}Jl?d(}{-!iCl/U
STREET ADDRESS CITY
DArE OF BJATH
c-e
STATE
ZIP
~OM;C)/1
I MOTHER'S
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STATE:
/5(;30
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LIe NO STATE
;}o/ 7 77Ote/SOt,;()tJ
I PLACE
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NAME
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MARl fAL STATUS
9 -;):JREFERRING PATIENT'S
S9
jt)Hllf~:/J
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o FEMALE
- ALE
PHYSICIAN.
D MARRIED
DDIVORCED
I DRiVERS
I SOCIAL
SECURITY
NO
SINGLE
,&wIDOWED
5r'?-;;2J'07Q.
OK:
EMPLOYER
I?AU?OMt2
;V/XJ
ADDRESS
CITY
STATE
ZIP
EXT
NAME OF PERSON
RESPONSIBLE
FOR PAYMENT
OF THIS BILL
MlJff/C'
RESPONSiBLE PARTY'S EMPLOYER.
iV/l
EMPLOYER'S ADDRESS: CITY
STATE
ZIP
I-"~
PHONE
EXT
P-ERSONTO CONTACT IN CASE OF AN EMERGENCY
&/VIC
ADDRESS
HOME PHONE
6
CITY STATE ZIP
RELATIONSHIP
TO PATIENT
--------~
IJV
WORK PHONE
g YES
1
ARE YOU ALLERGIC TO ANY MEDICATION?
NO
IF YES, PLEASE LIST:
SOL i"il'VR
PRIMARY INSURANCE
/H8V1'JA~
COPAYMENT AMOUNT DEDUCTJBLE AMOUNT'
I,
)
$
GROUP
MKiRk. R fiJV11 JM):.J'}v

ADDRESS. CITY
SELF
0 SPOUSE 0 CHILD
STATE
~D
IiJ I ;l<"
NUMBER.
,J(,,(,5
5L/9
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ZIP AMOUNT.
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SECONDARY
INSURANCE
/ -8[0- SS. - /5 S'S

COPAYMENT
DEDUCTIBLE AMOUNT'
$
SUBSCRIBER'
s
GROUP NUMBER
o
CITY
SELF
ADDRESS:
SPOUSE
JD NUMBER CHILD ZIP
STATE
__
PHONE
rize said assignee to release all information necessary to secure the payment.
I hereby assign all medical and/or surgical benefits to which I am entitled, including Medicare, private insurance, and any other plan, to UC Davis Medical Group. This assignment will remain in effect until revoked by me in writing. A photocopy of thrs assignment is to be considered as valid as an original. I understand that I am financrally responsible for all charges Whether or not paid by said insurance. i hereby authoI hereby authorize the UC Davis Medical Group to perform any medical treatment as deemed necessary.
_.-------
signed:~~~
71463-377 (8/97)
='===========o=============~=========='='=' 002522
----Date
b-~-IJ-O(,
.
I acknowledge that I have received the Notice of Privacy Practices,
VERSITY OF CALIFORNIA HEALTH SYSTEM
DAVIS ,
ACKNOWLEDGEMENT 'OF RECEIPT:' . NOTICE OF PRIVACY PRACTICES

The UC Davis Health System Notice of Privacy Practices provides information disclose protected health information about you, about how we may use and
In addition to the copy we are providing you, copies of the current notice are available by accessing our Web site at http://web.uc~nic,ucdavis,eduicompliance/ and may be obtained throughout UC Davis Health System.
)'-j'J-Oe;,
Signature 01 Patient or Patient's Representative
~~-~.---
Date
/1!J;ek. If
Print Name
5&..J::
Relationship to Patient
-------------------------------------------------------------------------------------------Written Acknowledgement Not Obtained

and reason it was not obtained: Please document your efforts to obtain acknowledgment
D Notice of Privacy Practices Given -
Patient Unable to Sign
D Notice of Privacy Practices Given - Patient Declined to Sign D Notice of Privacy Practices Mailed to Patient - Awaiting Signature.
tJ'Other Reason Pati~nt Did Not Sign ~ _
.'
,SiQnature of UC Davis Health System Representative
Date
Print Name
Department
002523
USE PATJENT PLATE
UNIVERSITY OF CALIFORNIA HEALTH SYSTEM
DAVIS
7. FINANCIAL AGREEMENT: I agree to pay The Regents of the University of California fo professional, hospital and clinic services, including UCDHS physician services, in accordance witt the regular rates and terms of UCDHS. I also agree to pay for other professional services provider by other physicians at UCDHS. When this agreement is signed by my spouse, parent or a financia guarantor, my spouse, parent or financial guarantor shall be jointly and individually liable with me for payment, including all collection fees (attorney's fees, costs and collection expenses), in additior to any other amounts due. Unpaid accounts referred to outside agencies for collection bear interes at the then current legal rate. 8. ASSIGNMENT OF BENEFITS (INCLUDING MEDICARE BENEFITS): I authorize and direct the payment to UCDHS of any insurance benefits including hospital insurance and unemploymen compensation disability benefits otherwise payable to or on my behalf for UCDHS services including emergency services, at a rate not to exceed UCDHS' actual charges. I understand that am financially responsible for charges not paid pursuant to this agreement. I further certify that the information given in applyipg for payment under the Medicare or Medi-Cal programs is correct. further agree that any credit balance resulting from payment of insurance or other sources may be applied to any other account owed to UCDHS by me. 9. ADVANCE DIRECTIVES: lhave an advance directive for health care (e.g., Power of Attorney for Health Care) krYes D Nc I have provided UCDHS with a current copy of my advance directive 'dYes ~Nc If "No", I understand it is my responsibility to provide UCDHS a current copy of my advance directive. If I want to express my health care wishes, I understand I should speak with my healtl care provider, 10. PATIENT RIGHTS NOTICE: I would like UCDHS to provide my next of kin or agent with the Patients Rights Notice I have read, agreed to and received a copy of this "Terms-and ~onditions DYes J&Nc
of Service."
'~p~
Signature of Patient or Signature of Patient's Representative Relationship of Representative to Patient Signature of Interpreter (if applicable) . Date of Signing
Signature of Witness (required if patient unable to sign)
For office use only:

EXCEPTIONAL
o o
SIGNATURE
REQUIREMENTS
ARE REFERENCED
BELOW
Please check the appropriate
bax(es) . under a Durable Power of Attorney for The "Patient's Represen-
PATIENT IS LEGALLY INCOMPETENT TO SIGN The court approved guardian or conservator, the attorney-in-tact Health Care, or farrnly member or other appropriate surrogate must sign as "Patient's Representative"
PATII;NT IS PHYSICA~LY INCAPABLE OF SIGNING The patient should give verbal consent, witnessed by a UCDHS employee tative should Sign In witness of the pallent haVing given verbal consent The UCDHS employee witness shall also sIgn
71463-257 (6/03)
002524
Page 2 of 2
TAs
",
~--
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,..,
.
.
.: ~ ...,.
;.:
~;
AND CO~~'IT:IONS o~~~~LI.
',1. ' UCDHS:, The.UC DavisHealth System (UGDHS) is p.a:rt6fthe University of.California and is , "comprised of theUCDHS 'Medical Center, its hospital-based Clinics, the Primary Care Network clinics, the UCDHS Davis Medical Group, andthe:UCDHS School of Medicine, .. -,.~ . ~ - ,. ,.: . . .' .. -' 2: MEDICAL 'CONSENT: 1 consent to any rnedicaltreatrnents or' procedures (except for complex , procedureswhlch-requlre special consent),' X-ray examinations, drawing blood for' tests, , medications, injections', taking of medical photographs, videotaping, laboratory procedures, and, : hospital services rendered to 'me under the 'general and special instructions of the attendinq 'physicians or other physicians of UCDHS assisting in my care: I also consent to myadmls~lon to UCDHSMedical'Center if this is deemed necessary for my care, All of the terms and conditions of this agreement shall also apply to such admission. ' , '3, RELEASE"OF INFORMATION: UCDHS will obtain my written authorization to release information about 'my medical treatment, except in those circumstances when UCDHS is permitted or required 'by law 'to' release' information (see UCDHS' Notice of Privacy Practices for a description' of the specific' circumstances under which UCDHS' may release this information). For example, UCDHS may release a copy' of my patient record to insurance companies, health care service plans, governmental agencies, worker's compensation carriers, or other entities which may be liable for all or any portion of UCDHS' charges. ' , .' , 4, TEACHING, RESEARCH AND HEALTHCARE INSTITUTioN: The University of California, including UCpHS, is a teaching, research and' healthcare institution, I understand that residents, interns,medical students,' student of ancillary 'health care professions (e.q., nursing,' x-ray, rehabilitation therapy), .post-qraduats fellows, and, other' trainees may observe, examine, treat and "participate at the request and under the supervision of the attending physician 'in my care as part of , the University's medical education programs. I understand that my health information-may be used' and shared with researchers who engage in research related to my treatment, health condition, or ' medical or physical status. I further understand that the University of California, including UCDHS, rnay .use my medical information' and specimens for teacninq, study and research purposes., 'inCiudin'g thedevelopment of- potentially' commercially useful products. Any use of these materials and information by UCDHS or other institutions will be in accordance with state and federal law, ' including all laws and regulations governing confidentiality of patient records. ,. , 5. PERSONAL VALUABLES,: UCDHS maintains fireproof safes for the safekeeping of money and valuables. UCDHS shall not be liable for the loss of or damage to any money, jewelry, glasses, dentures, furs or other articles of unusual value 'and shall not be liable for loss or damage, to any personal property, .unless deposited in UCDHS' safe or locked storeroom. ,"'; "'~
.i .: .,"" .:-;
"
6. USE AND DISCLOSURE OF MEDICAL INFORMATION: The State of California' information Practices Act requires UCDHS to provide-the folowing information to individuals who supply .lI1formatlon about themselves: As a. patient of. UCDH~, you will be asked to submit information :,~bout yourself, such ,as your address andphone' number, Social Security number, insurance 'information, medical history and treatment; and other personal information, The principal purpose for requesting this information is to ensure accurate identification, continuity of medical careand pay',mentf~r'such care. University policy and California 'and federal law and regulations authorize the m~lI1tenance of this information. Furnishing all information requested is mandatory unless otherwise noted, Failure to provide such information may affect your medical care and/or insurance benefits and coverage. The information you provide may be disclosed to others as described in our Notice of Priva~y Practices. You have the ,righ,!to 'review your medical inform~tion and the right to request restriction. of access to your medical, information, as described in the Notice of Privacy Practices. . .', " . .
71463-~57 (6/03)
TERMS A~PCONDITIONS
OF SERVICE
'Page 1 of 2 '
002525
UNIVERSITY OF CALIFORNIA DAVIS HEALTH SYSTEM RADIOLOGY REQUEST Outpatient 'Date printed: 3/10/2006 3zi:09PM
MRN: 8081369 Name: AMUNDSEN,MARK Sex: M DOB: 09/23/1959 Exam Date: 04/21/2006 Acct# 078080963024 Reason for exam: Si~lns/Symptoms: Chronic left hip pain. Admitting Dx: Pager #:916-762-2086
UC Davis Health System 8081369 UCDMGFOLSOM AMUNDSEN,MARK Sex'M 09/23/1959 Acc: 345854 Acct# 078080963024 Date: 04/21/2006
Exam #: 345854 Room/ Bed: UCDMG-FOLSOM Date ordered: 03/10/2006 Time ordered: 3:22 pm Admission Date. 2/13/2006 11:3529AIJ
UC Davis Health System 8081369 UCDMGFOLSOM AMUNDSEN,MARK Sex.M 09/23/1959 Acc: 345854 Acctll 078080963024 Date: 04/21/2006 uc Davis Health System 8081369 UCDMGFOLSOM AMUNDSEN,MARK Sex: M 09/23/1959 Acc: 345854 Acct# 078080963024 Date. 04/21/2006 UC Davis Health System 8081369 UCDMGFDLSOM AMUNDSEN,MARK Sex: M 09/23/1959 Acc: 345854 Acctll 078080963024 Date: 04/21/2006
.end
8081369 UCDMGFOLSOM AMUNDSEN,MARK Sex' M 09/23/1959 Ace: 345854 Acct# 078080963024 Date: 04/21/2006 UC Davts Health System 8081369 UCDMGFOLSOM AMUNDSEN,MARK Sex: M 09/23/1959 Acc: 345854 Acctll 078080963024 Date. 04/21/2006
UC Davis Hearth System
Orderinq Information: Scheduled By: Taylor, Judy Ordering Dr: BAQUERO, VICTOR HENRIQUE PI# 08139 Pager: nla Attending Dr: BAQUERO, VICTOR HENRIQUE PI# 08139 Pager: nla Report to:
Patient Status Information': Stat: N priority,.:,. J~t'~.~~ Mqblilty: 1t
rv
,' t~, , ..
'.J""
.'1~~'
."
Preliminary Notes:
III
345854
002526

Appointment
Orders
Sex Male
DOB 9/23/1959
Center None
Appointment
Sex Male

DOB 9/23/1959
002527

Appointment
Sex Male

DOB 9/23/1959
Account # 078199740040 Patient Demographics Address 2025 TARBOLTON CIR FOLSOM CA 95630 Selected Appointment 4/20/2007 9:26 AM Provider Xray0 Radfol Department Fol Radiology Phone 916-509-0158 (Home) 916-983-4484 (Work) E-mail Address mamundsen@sbcglobal.net
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Center None
Appointment
Sex Male

DOB 9/23/1959
002528
078080963024 1 Payor AUSHC Patient Insurance ID W142637665 Group Number 620229011 Plan AETNA PPO Plan Number A06
Plan Phone 888-632-3862
Center None
Center None
Appointment
Encounter-Level Documents: There are no encounter-level documents. Insurance Information Acct Number 078080963024 1 Payor AUSHC Patient Insurance ID W142637665 Financial Class P
002529
4/29/2008 10:52 AM
Ucd Registration
21634183
002530
1/19/2006
Appointment
Plan AETNA PPO
Financial Class P
Plan Number A06
Plan Phone 888-632-3862
Center None
002531
UNIVERSITY OF CALIFORNIA, DAVIS HEALTH SYSTEM

./
University policy, California and federal law and regulations authorize the maintenance of this information. Furnishing all information requested is mandatory unless otherwise noted. Failure to provide such information may affect your medical care and/or insurance benefits and coverage. The information you provide may be disclosed-to others, however, you have the right to review your medical information and the right to request restriction of access to your medical information, as described in the Notice of Privacy Practices. If you would like your agent under a durable power of attorney for health care or your next of kin to receive a copy of your rights and responsibilities as a patient of UCDHS (Notice of Privacy Practices & Patient Rights and Responsibilities Notice), please contact the Health Information Management Department at (916) 734-5205. 8. FINANCIAL AGREEMENT: I agree to pay The Regents of the' University of California for professional, hospital and clinic services, including UCDHS physician services, in accordance with the regular rates and terms of UCDHS. I also agree to pay for other professional services provided by other physicians at UCDHS. Should the account be referred to an attorney or collection agency for collection, I agree to be responsible for all collection fees (attorney's fees, costs and collection expenses) in addition to any other amounts due. Unpaid accounts referred to outside agencies for collection also bear interest at the then current legal rate. 9. ASSIGNMENT OF BENEFITS (INCLUDING MEDICARE BENEFITS): I authorize and direct the payment to UCDHS of any insurance benefits including hospital insurance and unemployment compensation disability benefits otherwise payable to or on my behalf for UCDHS services, including emergency services, at a rate not to exceed UCDHS' actual charges. I understand that I am financially responsible for charges not paid pursuant to this agreement. I further agree that any credit balance resulting from payment of insurance or other sources may be applied to any other account owed to UCDHS by me. I have read, agreed to and received a copy of this Terms and Conditions of Service .
~~
or
Signature of Patient's Representative Signature of Interpreter
Relationship of Representative to Patient Signature of Witness (required if patient 'unable to sign)
,X
o
9-/0
--,,;<00 ~
Date of Signing
For office use only: EXCEPTIONAL SIGNATURE REQUIREMENTS ARE REFERENCED BELOW. Please check the appropriate box(es) . PATIENT IS LEGALLY INCOMPETENT TO SIGN: The court approved guardian or conservator, the agent under an Advance Directive, or family member or other appropriate surrogate must sign as "Patient's Representative." . 0 PATIENT IS PHYSICALLY INCAPABLE OF SIGNING: The patient should give verbal consent, witnessed by a UCDHS employee. The Patient's Representative should sign in witness of the patient havlnq given verbal consent. The UCDHS employee witness shall also sign.
71463-257 (2/06)
002532 PAGE 2 OF 2
UNIVERSITY OF CALIFORNIA, HEALTH SYSTEM ..
DAVIS .
.' ,.~.
1. UCDHS: The UC Davis Health System (UCDHS) is part of the University of California and is comprised of the UCDHS Medical Center and its h<;>spital-based c1in.i~s,the Pnmary Care Network clinics, the UCDHS Medical Group, and the UC Davis School of Medicine. 2. MEDICAL CONSENT: I consent to any medical treatments or procedures, X-ray ex~minati~ns, drawing blood for tests, medications, injections, taking of medic~1 photographs, ~Ideotapmg, laboratory procedures, and hospital services (except for those which require special consent) rendered to me under the general and special instructions of the attending physicians, or other physicians of UCDHS assisting in my care. 3. ADMISSION TO THE HOSPITAL: I also consent to my admission to UCDHS Medical Center if this is deemed necessary for my, care. All of the terms and conditions of this agreement shall also apply to such admission. . 4. TEACHING, RESEARCH AND HEALTHCARE INSTITUTION: The University of California, including UCDHS, is a teaching, research and healthcare institution. I understand that medical residents, medical students, students of ancillary health care professions (e.g., nursing, x-ray, rehabilitation therapy), post-graduate fellows, and other trainees may observe, examine, treat or otherwise participate in my care at the request and under the supervision of my health care provider as part of the University's medical education programs. I understand that my health information may be used and shared with researchers who engage in research, teaching and study related to my treatment, health condition, specimens and/or medical or physical status. Additionally, as a result, potentially commercially useful products may be developed and I understand that I will have no ownership rights in those products. Any use of my medical information and/or specimens by UCDHS or other institutions will be in accordance with state and federal law, including all laws and regulations governing confidentiality of patient records. 5. RELEASE OF INFORMATION: UCDHS will obtain my written authorization to release information about my medical treatment, except in those circumstances when UCDHS is permitted or required by law to release information (see UCDHS' Notice of Privacy Practices for a qescr!p.t!o~ of the. specific. circumstances under which UCDHS may release this information). For example, UCDHS may release a copy of my patient record to other health care providers, health plans and government agencies. Additionally, I understand that if I am diagnosed with cancer, a reportable disease in California, UCDHS is required by law to report my diagnosis to the State Department of Health Services. 6. PERSONAL VALUABLES: UCDHS maintains fireproof safes for the safekeeping of money and valuables. UCDHS shall not be liable for the loss of or damage to any money, documents, jewelry, glasses, dentures, furs or other articles of unusual value and shall not be liable for loss or damage to any personal property, unless deposited in UCDHS' safe or locked storeroom. The liability for loss of any personal property deposited with UCDHS shall be no more than $500.00. ,:,"'. 7. USE AND DISCLOSURE OF MEDICAL INFORMATION: The California Information Practices Act requires UCDHS to provide the following information to individuals who supply information about themselves: As a patient of UCDHS, you will be asked to submit information about yourself, such as your address and phone number, Social Security number, insurance information, medical history and treatment, and other personal information. The principal purpose for requesting this information is to ensure accurate identification, continuity of medical' care, and payment for such care .
. ,.
I ,
I I
-I
I I
I
-I
e:I
TERMS AND CONDITIONS OF-SERVICE
PAGE 1 OF 2
002533
U 38-541463006
808-13-69-"1
--..
09/16/09
\ ~MUNDSEN ,MARK
'1
08/10
. : ,
UNIVERSITY OF CALIFORNIA HEALTll SYSTEM
DAVIS
M, 09123/1959 916-983-2589 1 . OBD9 BAClUERO. VICTO NO
\
I
"P
BLUE 5H_Ir_L_O-_U_CO_C_AP
~_J

The UC Davis Health System Notice of Privacy Practices provides information disclose protected health information about you. about how we may use a
In addition to the copy we are providing you. copies of the current notice are available by accessing our Web s at http://web.ucdmc.ucdavis.edu/compliance/ and may be obtained throughout UC Davis Health System. I acknowledge that I have received the Notice of Privacy Practices.
Print Name
Relationship to Patient
------------------------------------------------------------------------_._----------------
Written Acknowledgement
Not Obtained
and reason it was not obtained.
Please document your efforts-to obtain acknowledgment
o Notice
o Notice
o Notice
of Privacy Practices Given of Privacy Practices Given -
Patient Unable to Sign Patient Declined to Sign
of Privacy Practices Mailed to Patient - Awaiting Signature _
-0 Other Reason Patient Did Not Sign
Signature of UC Davis Health System Representative
Date
Print Name
Department
7000q-789 (3/03)
ACKNOWLEDGEMENT
OF RECEIPT: NOTICE OF PRIVACY PRACTICIES
002534
MR 03/037&
Group Number PH0010 Plan UCD/B/S HMO Plan Number B72 Plan Address PO BOX 179001 SACRAMENTO, CA 95817-9001 Plan Phone 916-734-0739 PreAuth Phone 916-734-0739
Center None
Center None
Appointment
Account # 078438665081
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
002535
Center None
Appointment
Sex Male

DOB 9/23/1959
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Center None
Center None
002536
02/20/2013
01,15,13
PM
page 1 of
UNIVERSITY OF CALIFORNIA, DAVIS HEALTH SYSTEM
1. UCDHS: The UC Davis Health System (UCDHS) is part of the University of California and is comprised of the UCDHS Medical Center and its hospital-based cllni~s, the Primary Care Network clinics, the UCDHS Medical Group, and the UC Davis School of Medicine. 2. MEDICAL CONSENT: I consent to any medical treatments or procedures, X-ray examinations, drawing blood for tests, medications, injections, taking of medical phot0l;lraphs, ~ideotaping, laboratory procedures, and hospital services (except for those which require special consent) rendered to me under the general and special instructions of the attending physicians, or other physicians of UCDHS assisting in my care. 3. ADMISSION TO THE HOSPITAL: I also consent to my admission to UCDHS Medical Center if this is deemed necessary for my care. All of the terms and conditions of this agreement shall also apply to such admission. 4. TEACHING, RESEARCH AND HEALTHCARE INSTITUTION: The University of California, including UCDHS, is a teaching, research and healthcare institution. I understand that medical residents, medical students, students of ancillary health care professions (e.g., nursing, x-ray, rehabilitation therapy), post-graduate fellows, and other trainees may observe, examine, treat or otherwise participate in my care at the request and under the supervision of my health care provider as part of the University's medical education programs. I understand that my health information may be used and shared with researchers who engage in research, teaching and study related to my treatment, heelth condition, specimens and/or medical or physical status. Additionally, as a result, potentially commercially useful products may be developed and I understand that I will have no ownership rights in those products. Any use of my medical information and/or specimens by UCDHS or other institutions will be in accordance with state and federal law, including all laws and regulations governing confidentiality of patient records. 5. RELEASE OF INFORMATION: UCDHS will obtain my written authorization to release information about my medical treatment, except in those circumstances When UCDHS is permitted or required by law to release information (see UCDHS' Notice of Privacy Practices for a description of the specifIc circumstances under which UCDHS may release this information). For example, UCDHS may release a copy of my patient record to other health care providers, health plans and government agencies. Additionally, I understand that if I am diagnosed with cancer, a reportable disease in California, UCDHS is required by law to report my diagnosis to the State Department of Health Services. 6. PERSONAL VALUABLES: UCDHS maintains fireproof safes for the satekeeping of money and valuables. UCDHS shall not be liable for the loss of or damage to any money, documents, jewelry, glasses, dentures, furs or other articles of unusual value and shall not be liable for loss or damage to any personal property, unless deposited in UCDHS' safe or locked storeroom. The liability for loss of any personal property deposited with UCDHS shall be no more than $500.00. 7. USE AND DISCLOSURE OF MEDICAL INFORMATION: The California Information Practices Act requires UCDHS to provide the following information to individuals who supply information about themselves: As a patient of UCDHS, ~ou will be asked to ~ubmit information about yourself, such as your address and phone number, SOCialSecurity nU~ber, Insurance information, medical history and treatment, and other personal Information. The principal purpose for requesting this information is to ensure accurate identification, continuity of medical care, and payment for such care.
71463-257
(2106)
PAGE 1 OF 2
002537
01:15:13
PM
Page 2
I
I
't
!t,
808 13 bCi If
A"UNOSN
UNIVERSITYOF CALIFORNIA,DAVIS HEALTHSYSTEM
10-01&806878'
~ TERMS AND CONDITIONS OF SERVICE
,llARK
AlA
Univer!!ityllpo@?/~a'ljfdrAIitt '.lan\PftlderM W91~d regulations authorize the maintenance, of this informStli1n, F.urnlshing all Information ~eqUf}fi>Wd is mandatory unless otherwise noted. Failure to provide sJC\\'inf8rmation may affect your medical care-and/or insurance bene1itsand coverage. The Information you provide may be disclosed to others, however, you have the nght to review your medical information and the right to request restriction of access to your medical information, as described in the Notice of Privacy Practices. II you would like your agent under a durable power of attorney for health care or your next of kin to receive a copy of your rights and responsibilities as a patient of UCDHS (Notice of Privacy Practices & Patient Rights and Responsibilities Notice), please contact the Health Information Management Department at (916) 7345205. 8. FINANCIAL AGREEMENT: I agree to pay The Regents of the University of California lor professional, hospital and clinic services, Including UCDHS physician services, in accordance with the regular rates and terms of UCDHS. I also agree to pay for other professional services provided by other physicians at UCDHS. Should the account be referred to an attorney or collection agency for collection, I agree to be responsible for all collection fees (attorney's fees, costs and collection expenses) in addition to any other amounts due. Unpaid accounts referred to outside agencies for collection also bear Interest at the then current legal rate. 9. ASSIGNMENT OF BENEFITS (INCLUDING MEDICARE BENEFITS): I authorize and direct the payment to UCDHS of any insurance benefits Including hospital insurance and unemployment compensation disability benefits otherwise payable to or on my behall for UCDHS services, including emergency services, at a rate not to exceed UCDHS' actual charges. I understand that I am financially responsible for charges not paid pursuant to this agreement. I further agree that any credit balance resulting from payment of insurance or other sources may be applied to any other account owed to UCDHS by me. I have read, agreed to and received a copy of this Terms and Conditions 01 Service.
-#Iwt.~
Signature of Patient Relationship of Representative to Patient Signature of Witness (required If patient unable to sign) or Signature of Patient's Representative Signature of Interpreter
/.2~" S-"t 00 ~
Date of Signing
For office use onty: EXCEPTIONAL SIGNATURE REQUIREMENTS ARE REFERENCED BELOW. Please check the appropriate box(as). Cl PATIENT IS LEGALLY INCOMPETENT TO SIGN: The court approved guardian Or conservator, the agent under an Advance Directive, or family member or other appropriate surrogate must sign as UPatient's Representative," Cl PATIENT IS PHYSICALLY INCAPABLE OF SIGNING: The patient should give verbal consent. witnessed by a UCDHS employee. The Pallent's Representative should sign in witness 01the patient having given verbal consent. I The UCDHS employee witness shall also sign.
71463-257
(2106)
002538 PAGE20F2
02/20/2013 01,15,13 PM
Page 1 0
USE PATIENT PLATE
[ 808 13 bG
I
:=~NOSCN URK 11 OS/23IlS!>S
~'r+"I~:~~UO~::"
UNIVERSITY OF CAUFORNIA DAVIS

HEALTH SYSTEM
ACKNOWLEDGEMENT OF RECEIPT: ADI1Nt>tLCR.Olif'RIVACYPRACTlCES

Practices provides in/ormation about how we may use and '
The ~Q<l.vISl\l;lealth System Notice ll/ Pri~ disclose protected heanh information about you.
In eddition to the copy we are providing you, copies of the current notice are available by accessing our Web site at hllp'/Lwww .Jcdmc ucdavis edu/compliancel and may be obtained throughout UC Davis Health System. I acknowledge that J have received the Notice of Privacy Practices.
~-?~
Signature 01 Patient or Patient's Representative
/c2-./ S-:utJfJ ~
Dete
~
Print Name
,<
/J/1lj,/L)S't!V Relationship to Patient
--------------------------------_._._----------------------.----------------.------_.------Written Acknowledgement Not Obtained
Please document your efforts to obtain acknowledgment and reason It was not obtained.
o Notice of Privacy Practices Given - Patient Unable to Sign o Notice of Privacy Practices Given - Patient Declined to Sign o Notice of Privacy Practices Mailed to Patient - Awaiting Signature
o Other Reason Patient Did Not Sign
_
Signature of UC Davis Health System Representative
Date
Print Name
Department
7DlXJO.719 t6'09)
MR03JD378S 002539
01,15,13
PM
page
USE PATII 11' S123/1959
1l0813~9 AMUNOSE~. MARK RI<A!S) AMUNDS . MARK

2150817321477 tt: 12/15118
UNIVERSI1Y OF CALIFORNIA, DAVIS MEDICAL CENTER . SACRAMENTO, CALIFORNIA
"J
I. I hereby authorize Otts). .. assistants as may be selected by himiher .. should inc1u~the'~~.lIlI~
10
CONSENT TO OPERATION, PROCEDURES, BLOOD TRANSFUSION AND ADMINISTRATION OF ANESTETICS
(At.. perform the followwg
. () 'edand anythasSociates. or . operation s or proc ure(s) ( description

IS
sile of the pro~
~$_il~tJ;\~
2. 1 understand that UCDMC is a teaching institution and that the associates or assistants involved in the operation(s) or procedure(s) may include residents, fellows, medical students or other allied healthcare professionals. 1.authorize that. s?ch associates or assistants perfonn portions of the operation(s) or procedure(s) under the direction of the physlclan(s) Identified In paragraph I, above. 3. 1 understand that Ds). .__ ~~~_ will be present during the key portions of the operation(s) or procedure(s} and at all other times will be immediately available or will ensure another qualified surgeon is immediately available. 4. The operation(s} or procedure(s) has been explained to me by _
,..-)s. I have
been informed thai there are significant risks, such as severe loss of blood, blood clots, infection, cardiac arrest, and other unloward consequences, thai are involved in the performance of any surgical procedure that can lead 10 death or permanenl or tempomry disability or complete or partial disability. 1 have been made aware of certain risks and consequences that are associated with the proced s) described in paragraph l. These include bul are notlimited to: t"Q.C! U19n. 1M e
<..,
I am aware that the practice of medicine and surgery is not an exact science, and I acknowledge that no guarantees or assurances have been made to me concerning the results of the chosen operation(s} or procedure(s).
6. The medically acceptable alternative(s) in treating such condition(s} has been explained to me and Iunderstand it and the risks and benefits to be: 7.
.J
F TRANSFUSION IS A REASONABLE POSSIBILILTY: My doctor has discussed with me that there is a reasonable possibility that a transfusion ofbJood or blood products may be necessary. Ihave received a copy of the transfusion information fonn describing my transfusion options (unless 1 have a life-threatening emergency or medical contraindications). My doctor has discussed the risks, benefits and alternatives of the transfusion of blood and blood products with me. I have also learned about the option of pre-donating my Own blood. By signing this consent form, 1 consent to the transfusion of blood or blood products, as my doctor may order, in connection with the operation(s) or procedure(s} discussed in this form,
8. 1 consent to the administration of sedation and/or anesthetics as may be considered necessary or advisable. r have been advised that there are certain risks associated with anesthetics that may include allergic reacrions and/or drug intolerances, cardiac arrest and brain damage. 9.
I recognize that, during the course of the operation or procedure, unforeseen conditions may necessitate other procedurefs), which are in addition to, or different from those set forth in paragraph I. I understand that it may be difficult or impractical to obtain my consent for those procedure(S). Itherefore authorize and request that the doctor, his/her assistant, or hislher designees perfonn such procedures as are in the exercise of professional judgment necessary and desirable, including, but not limited to, procedures involving surgery. The authority granted under this paragraph shall extend to treating all conditions that require urgent treatment and are not known to the doctor at the time the operation or procedure is commenced. .
Physician's initials
Patient's or patient's legal representatives initials

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002540
02/20/2013
MRN: R081369, Patient Last, _First: AMUNDSEN,MARK _
01,15,13
PM
page
2 of
IE PATIENT PLATE
UNIVERSITY OF CALIFORNIA, OAVIS MEDICAL CENTER SACRAMENTO, CALIFORNIA
" I authorize the pathologist, at his Orher discretion, to retain, preserve, use, or dispose of any tissues, organs, bones, bodily fluid or medical devices that may be removed during the operation(s) or procedure(s). I understand that such specimens may be used for research, as permitted by federal and stale law. I understand that.Lhave.no.property .0wnership..or-interesLin.such.specimens.ordata.derived frorn.those.specimens and no right or entitlement in any research or research product using or derived from the specimens. I understand that there may be health care iodustry representative or other visitors present, with the approval of UCDMC, during my operatlon(s) or procedure(s) for purposes of medical observation or to provide technical support. I authorize those individuals to be present. My doctor does not have any independent financial or research interest in the operationlprocedure, other than usual or customary, unless checked here.
LI
My doctor has infonned me he/she does have independent financial or research interest in this operation/procedure.
I understand that if an implantable device is used, information regarding the device and my Social Security Number may be reported to the device manufacturer, if requested, and as required by Federal law. I understand that I have the right to refuse this operation(s) or procedure(s) at anytime. I further understand that the explanations I have received may not be exhaustive and all-inclusive and that other more remote risk, may be involved. However, the information that I have received is sufficient for me to consent to the operation or procedure described above. I have had full opportunity to ask questions concerning my condition, the authorized operation(s) or procedure(s), the alternatives, and the risks and consequences associated with it. All the questions I have asked have been answered to my satisfaction.
g:~ti~~
-I
TIME
I have read and undentand with and~prOCeed

.
the above consent. [ acknowledge the risks, beneflU and alternatIves with the ~~~ed above.
,TE
PATIENT OR PATIENT'S LWAlREPRESENTATIVE
RELATIONSHIP OF REPRESENTATIVE
TO PATIENT (If applicable)
~ .TE
PHyS!ciA1'ROVIDER INTERPRETER (If applicable)
~('
O~ PI NUMBER
lfores.een circumstances require changio.8the individual pr,actitioners involved in conducting the surgery or , ange In theoperation(s) or procedure(s) listed above. Please identify: _
.TE
TIME
PATIENT OR PATIENT'S LEGAL REPRESENT ATIVE PHYSICIAN I PROVIDER
PI NUMBER
002541
Patient Name: Pt. Preferred Med. Rec. #: Account #: Proc. Date: Name:
AMUNDSEN,
MARK
Addendum Notes Main OR

Sex: Male 09/23/1959
"'DO(:i~MC
UCD
8081369 010016806878
12115/2009
oos.
Age:
Chart Copy.'
50y
Procedure(s}:
Surgeon
Arthroplasty
Hip Total
Tamurian, Robert
Primary
Preop Diagnosis
Left hip degenerative Joint disease

POstOD Diaqnosis
Same
Admission Type:
tnpanent (10)
Anesthesia
Type:
General
ASA:
Addendum
Date
1
Time Notes
12/22/2009
Addendum
1513
Note Bv
ADD'depuy
femoral head #1365-06-00
101#2998163
Holm, Cindy J RN
Signature
C rJ.) hl>c---- f!.U
Signature line for last Addendum Note Only

Date
12-12 -n~
Page 1 of 1
Pnnted'12122/2009. Note
15.14
Operating
Room Record I Addendum
MR#: 8081369
002542
2/4/2010 9:19 AM
Flabs Labfol
Fol Lab
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Center None
Appointment
Sex Male

DOB 9/23/1959
Payor UCD Financial Class P
002543
DEPRESSIVE DISORDER
5/26/2006 4/30/2008

Class: Acute C. Difficile Diarrhea 5/29/2009 12/19/2009 1/5/2010 Closed Time 10:03 Mark Amundsen (MRN8081369)

Anemia Orthopedic Aftercare for Joint Replacement Encounter Closed By Closed By ANDERSON, CYNTHIA L Closed Date 06212010
Appointment
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Provider
Department
Center
002544
Sex Male
DOB 9/23/1959
Account # 038697465037
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Plan UCD/B/S HMO
Plan Number B72
Plan Phone 916-734-0739
Center None
Orders Only
Patient Information


002545
01:15:13
PM
page 1 0
MARK
AMUNDSEN
MR 8081389 0912311969 M
'k
Amundse-n
916-983-2589
)D5530 "', MARK R AMUNDSEN

SUPPLEMENTAL CERTifiCATION
(Ullt EffftllVE
_ATE l55UED: V~/O'/~~
DATE; 10/)3.11.
IF YOU ARE STILL DISABL.ED. COMPlETE THe ClAIMANT'S CfRTIHCATION AND CONTACT YOUR DOCTOR lMME'OtATELY FOR ~OMPLrnON OF THE PHYSICIAN'S 5UPPlEMENTARY CERTIFICATE. THIS PHYSICIAN'S CERTifiCATE MUST BE SUBMITTI;O WITHIN TWENrt {2(J} DAYS OF THE DA.TE ISSUED SHOWN ABOVE OR YOU MAY lOS! AOomONAl BENEfITS.
CL\tMANT'S
CERTlnCA,l\ON
I Cllflily I"<lt I co",inul! 10 be disabled _nd incapable of doin~ my rcsular work, ~nd ,hall hayo reported ~II ",.a~c!i"Wor\r;cu' Compenulion b. onenl,; and other moni~5 recei\oed during the cl;J,imperiod 10 Ibe EmpJoymenl Deve\opmenl Oeparlml'nl.
5;,;n
YO\Ir Name
Dille SiK"~d
PHYSICIAN'S SU"'PlfMENTARY 1. Are you s~1ltroaling lhe Patient?~ 2, Whal. present CQl'l(fi\ion contirouliIS to make 1t\O Jiagno.sls (RfQUIRfOl~ leo Gode1S)IRtQUIRED): '1..:"1 C31.}. Primary __
CERTIfiCATE
2-_~I~\_"l,~\~\~\
ate 01 nell18QpainWl'ler11
_
_
AX,")
"."'10)
5eeondaty_'~2~\2~.~5_/~
3. Describe Mw thE' paeem's present condition or 11'l'1paitrnent prevenls: him 0

~" ~~ A
4.
What taclOrs or OOlTlpli?tJonS are disablng
__
Ib
6~
,_ II
"'-V-
5. Present eS1IT1,
j dale
patietlt (even if sliD under treatment) wiU be able to perlOrm hislher rQ.1lar or customary WOtk.
6. WOOd disclosure 01 this information 10 your palienl be medically Of PSYChOloaiCallydetrimental 10 the palient?
vee
~~~=r~;~AauERo~r;D.NTs
Doctor's Namc_
iN MY OPINION nULY DfSCRJ~Bt: "(HI PATI'fNT'S CONDITION AND
------------t.pri'l..l or type,
- ~
Doclor's
5i1>nalurc
----------~~-------
Spccb.tly. ir any
0.10 "5o.d
~~ili
\~ ;P>D"
Siale License
PhoneN '"
N1)mber~
3>/11/ \1
(""
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<1~&:"'-}"'Yx)
DE 2~2!1XXA Rev. , (7196)
RfTURN
THIS fORM
TO
11.1.,,1.11,11'",",11 1.1".1111,.1111,1,1( E"PLOYMENT DEVELOPMENT OEPARTMENT PO BOX 2168 STDCKTDN CA 952Dl
002546
Class: Pharmacy 240 Tab 0 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. - ORAL Class: Handwritten Rx 100 1 NORCO 10 MG-325 MG TAB Sig - Route: 1 po q 4 hrs for pain. - ORAL Class: Pharmacy Comment: This is a REFILL AUTHORIZATION for prescription number 176026
3/14/2011
4/13/2011
4/27/2009
5/27/2009

CBC AUTO + REFLEX MANUAL DIFF (66746137) Released on: 11/2/2011 11:06 AM APTT STUDIES (66746138) Released on: 11/2/2011 11:06 AM Ordered On 3/29/2011 3/29/2011
Encounter Closed By
Closed By USER, EPIC Closed Date 09262011 Closed Time 02:00
Appointment
Account # 078661756037 Patient Demographics Address 2025 TARBOLTON CIR FOLSOM CA 95630 Selected Appointment 3/24/2011 9:15 AM Provider Vflot Imfros Department Carm Lab
Phone 916-509-0158 (Home) 916-983-4484 (Work) E-mail Address mamundsen@sbcglobal.net
Plan UCD/B/S HMO
Financial Class P
Plan Number B72
Plan Phone 916-734-0739
002547
01:15:13
PM
Page 1 01
UNIVERSITY OF G:ALIFORNIA, DAVIS MEDICAL CENJER SACRAMEN~0, G:ALiFORNIA
PATIENT EDI:JCATION
L;~"~,,,,~, __,T PROCEI:JURE,INSJR~C'l'1

liDday you have had a, (circle 0 up appbihtmenl with your, physic schedule Dne,
NS, umbarPuncture.i
elo ram Results of,this exam will be discussedm afollow ollow up appointment, please contact your physician's office 10
Althougl\ side effects from this procedure are not common. you may notice the following: A :headache or nausea for 1.2 davs,after the orocedure. This is normal, and the headaches can usually be treated with Tylenol, (acetamnopnenl It is important to rest and drink lots of nuids should you develop a headache. Additionally, caffeinated drinks.canbe usefulin preventnqheadachesor treatingthem1dhce:they occur. Consult younphysician'ifyou require medications tolreatnausea 0izzinessor discomfort or weakness in.the legs,oLarms" Thesesenseuons.aswcll shouhj:only'last for 12 days. 'should theypersist beyond 2 days, nDtifyyour physclanor the;NeurDradiolDgisl. See below,fo~aeompleteflstof symptOf!lsthal should be reported, . l:Jiet YDu'may resume your-normal diet. If you.are not.on any'fluid.restrictions, you should'lorcetuids for the next 24 hours. Do not drink akoholtor the next 24 hours, Activity YDu:shDuldrest for tbe next 12 hours, AVOidstrenuous attivity of lifting'of objeCts.greaterthan 2Spounds'forthe next 24 hours, YDUmay resume your regula'r activities after 24 hours. Sitting up in a 30-45 degree angle for the next 4-6 hours will help to clear the comrast dye from your body and help prevent a headache from developi~g, Medications Unless d;rected otherwise. resume your prescroed medications, If you have concerns about resuming certain medications. please-ask your physlclan or the Neuroradrologist, Medication Comments: Procedure Site Care Adhesive'Qandages have been applied'lo,the punctureisite(s), They may havesmall,amountsDf clear or light pink drainage for '2 days, This is normal. Removeolhe bandage(s)otomorrow, You may applyloese gauze dressings over the puncure.stets) to,prevent soiling,of your clothing, Not other special care is.required,atthe punctlJle'site(sl and!you may shower orbathe when you wish, You ShDUldcall your pnys.oan or the Neuroradioiogist immediately if any of the following occur: Chills or temperature of 101 F or greater Development 01a severe h~adache not treatable.with pain medications DevelopmentDf nausea, stiff neckseizures. loss of bladder function Increased conlusion Dr irritability, diffiCUltyconcentretlnq or staying alert Headache, arm/leg pain Dr weakness that lasts beyDnd '2 days Questions about the procedure or symptoms au are-expenenonq
'.
------------------------------
f!:J703- d 71-(
N-I)
U'e,.
IV
The NeurDradioiogist can be cootacten by calli on-cal!,
(916) 734-2011, Tell'theoperatot YDUneed to contact the NeurOradiologist ,( ) ~ -. Date
d~~;;
patienloSignature~~,",;;fS.,.
1f~L
(];no~
~
LUMBAR pliNciuRE
D.,
I M~ElOGRAM
AS04S (<1111)
GENERAl POSTPROCEl:JURE INSliRUCTIONS mR:
002548
02/20/2013
01:15:13
PM
Page 1 of
USE PATIENJ PLATE
.RMUNDSIrN
1151'231191:'9
RARl31::9
~~~'~TAM~SEN. MARK ROM: 4128111
;MA~K
05001880131'1
CONSENT TOOPERATIQN, PROCEDURES, BLOOD ~NSFUSION AND ADMINiSTRATION OF ANESTETICS
I. I hereby authorize Dr(s). !1oe,\,J&IU, l:lftHU,.).'t.A!L l.frrU,/4..:J. ' and any ~sociat~s .or assistants as may be selected by himihcr to perform the following operationrs) or procedure(s) (this descrtpl1~n should include the side and site ofthe procedure): 1,,,,,1l- p""c.hllL Md C<:lll..thex-. d). r~lhd (,/",d, 2. I understand that UCDMC is a teaching institution and that the associates or assistants involved in the operation(s) or procedure(s) may include residents, fellows, medical students or other allied healthcare professionals, I authorize that such associates or assistants perform portions ofthe operation(s) or procedure(s) under the direction of the physician(s) identified in paragraph I, above. 3. ] understand that Dr(s). 130&"",1..\. \)I"llN, 'lqll. Vm.f1I'tW will be present during the key portions of the operation(s) or procedurets) and at all other times will be immediately available or will ensure another qualified surgeon is immediately available: 4. The operatioms) or procedure(s) has been explained to me by ~3R.~_. ~~~~'_:-N_'_I_~ ,.
_
5. I have been informed)that there are significant risks, such as severe loss of blood, blood clots, infection, cardiac arrest, and other untoward consequences, that are involved in the performance of any surgical procedure th~t Can lead to death or permanent or temporary disability or complete or partial disability. I have been made aware of certain risks and consequences that are associated with the procedureis) described in paragraph I. Th-eseinclude but are not limited to: hlltlln.~ .. ~nkcl\'-9l'\. lom..\ \",",\-'1 dcm~. to g;JIc;.CQ ~i:'nrfo\Lrtr1 r~J
rn,' .,rc=rlur<:-A
h,,,,cl.o.cl-..
I am aware that the practice of medicine and surgery is not an exact science, and I acknowledge that no guarantees or assurances have been made to me conceming the results of the chosen operation(s) or procedure(s). 6. The medically acceptable alternative(s) in treating such condition(s) has been explained to me and I understand it and the risks and benefits to be: ~C 6~~=!h_m~ . . I-M:~"",,-,,,,~"~.~a~ o;b~\~.~~ _ 7. IF TRANSFUSION IS A REASONABLE POSSIBILILTY: My doctor has discussed with me that there is a reasonable possibility that a transfusion of blood or blood products may be necessary. I have received a copy of the transfusion information form describing my transfusion options (unless I have a life-threatening emergency or mcdical contraindications). My doctor has discussed the risks, benefits and alternatives of the transfusion of blood and blood products with me. I have also learned about the option of pre-donating my own blood. By signing this consent form, I consent to the transfusion of blood or blood products, as my doctor may order, in connection with the operation(s) or procedure(s) discussed in this form. 8. I consent to the administration of sedation and/or anesthetics as may be considered necessary or advisable. I have been advised that there are certain risks associated with anesthetics that may include allergic reactions and/or drug intolerances, cardiac arrest and brain damage. 9. I recognize that, during the course of the operation or procedure, unforeseen conditions may necessitate other procedure(s), which are in addition to, or different from those set forth in paragraph I, I understand that it may be difficult or impractical to obtain my Consent for those procedurets). ] therefore authorize and request that the doctor, his/her assistant, or his/her designees perform such procedures as are in tbe exercise of professional judgment necessary and desirable, including, but not limited to, procedures involving surgery. The authority . granted under this paragraph shall extend to treating all conditions that require urgent treatment and are not known to the doctor at tlie time the operation or procedure is commenced. lO. I authorize the pathologist, at his or her discretion, to retain, preserve, use, or dispose of aQY tissues, organs, bones, bodiiy fluid or medical devices that may be removed during the operatiou(s) or proced~. I
71431854 (1/11) CONSENT TO OPERATION, PROCEDURES, BLOOD TRANSFUSION ~ AND ADMINISTRATION OF ANESTHETICS - PAGE 1 OF 2 ;/"
M'RfI08/0786S
002549
0212012013 MRN: 8081369, Patient Last, First: AMUNDSEN, MARK
01,15,13
PM
Page 2
USE PATIENT PL~T~
B0Rl::l~9
Msli31l~9
AMIINnC:Et>J, . Rid:i'ffi l: ~NO~[N,MAR~412B/l1
MARK
UNIVERSiTY OF CALIFORNIA, DAVIS . MEDICAL CENTER SACRAMENTO, CALIFORNIA
050019801377
RO
understan, be used for research, as permitted by federal and state law. I' understand mar 1 nave no property ownership or interest in such specimens or data derived from those specimens and no right or entitlement in any research or research product using or derived from the specimens.
II. I understand
that there may be health care industry representative or other visitors present, with the approval of UCDMC, during my operation(s) or procedurets) for purposes of medical observation or to provide technical support. I authorize those individuals to be present. other
12.
My doctor does not have any independent financial or research interest in the operation/procedure, than usual or customary, unless checked here.
D
13.
My doctor has informed me h.'iI.lfe does have independent operation/procedure. 7'\
financial or research interest in this
[understand that if an implantable device is used, information regarding the device and my Social Security Number may be reported to the device manufacturer, if requested, and as required by Federal law. [understand that [ have the right to refuse this operation(s) or procedure(s) at anytime. [further understand that the explanations I have received may not be exhaustive and all-inclusive and that other more remote risks may be involved. However, the information that I have received is sufficient for me to consent to the operation or procedure described above. I have had full opportunity to ask questions concerning my condition, the authorized operation(s) or procedure(s), the alternative" and the risks and consequences associated with it. All the question, I have asked have been answered to my satisfaction. I have read and understand the above consent. I acknowledge the risks, benefits and alternatives associated witb and wisb to proceed with the operation(s) or procedure(s) described above. t32>0
TIME
14.
15.
29 Apfl.ll-1ol\
DATE
~~~
PATIENTORPATlENTSLEGJ\LREPRiSEIVE
RELATIONSHIP or REPRESENTATIVE
2\2AAuclo1\
DATE
..---PHyS
~. PROVIDER
TO PATIENT (If applicable)
-'''OflA(Xw,,,,)
fiZZ>:
PI NUMBER
INTERPRETER (If applicable)
Unforeseen circumstances require changing the individual practitioners involved in conducting the surgery or a change in the operation(s) or procedure(s) listed above. Please identify:~. _
DATE
TIME
PATIENT OR PATIENT'S PHYSICIAN I PROVIDER
LEGAL REPRESENTATIVE
PI NUMBER
11431-154 (1/11)
CONSENT TO OPERATION, PROCEDURES, BLOOD TRANSFUSION AND ADMINISTRATION OF ANESTHETICS - PAGE 2 OF 2
002550
CA 95817-9001
Center None
Center None
Appointment
Sex Male

DOB 9/23/1959
Account # 078661756060
Encounter-Level Documents: There are no encounter-level documents. Future Appointments Date & Time 4/17/2013 5:00 PM
Provider Achieving A Healthy Weight Department Chronic Disease Management Folsom Center None
Outside Records Scan

Encounter-Level Documents - 06/17/2011: Scan on 6/17/2011 6:50 AM by Onbase Incoming Interface : QUEST
Patient Information

Telephone Encounter
6/3/2011 9:01 AM
Reason for Call
002551
P.S. EKG scheduled for 8-16-2010 Electronically signed by Clare Jennings, MA at 8/9/2011 7:57 AM Routing History 8/9/2011 7:58 AM From Clare Jennings, MA To Victor Henrique Baquero, MD Priority Routine

Disp Refills 7 Tab 0 Methadone (DOLOPHINE) 10 mg Tablet Sig - Route: Take 2 Tabs by mouth every 6 hours. 9 daily. - ORAL Class: Handwritten Rx Authorizing Provider: Victor Henrique Baquero, MD Start 8/9/2011 End 9/2/2011
Appointment
Orders
DOB 9/23/1959
002552
Class: Acute Preop testing Polyneuropathy Encounter Closed By Closed By RICHMAN, DAVID P
3/29/2011 3/29/2011
Closed Time 09:00
8/16/2011
Appointment
Account # 038697465086
Phone 916-509-0158 (Home) 916-983-4484 (Work)
Plan UCD/B/S HMO
Financial Class P
Plan Number B72
Plan Phone 916-734-0739
Center None
Patient Email
002553

UNIVERSITY OF CALIFORNIA. HEAlTH SYSTEM
01,15,1.3
PM page
1 of
. AMUNDSEN ,MARK
808136; M 09J.2$J1 Q69
DAVIS
TERMS AND CONDITIONS OF SERVICE 1.UCDHS: The UC Davis Health System (UCDHS) ;s part of the University of California and is comprised of the UCDHS Medical Center and its hospital-based clinics, the Primary Care Network clinics. the'UCDHS Medical Group, and the UC Davis School of Medicine. 2. MEDICAL CONSENT; I consent to any medical treatments or procedures, X-f'lIy examinations, draWing blood for tests, medications, injections, taking of medical photographs, videotaping, laboratory procedures. and hospital services (except for those which require spedal consent) rendered to me under the general and special instructions of the attending physicians, or other physiCians of UCDHS assisting in my care. 3. ADMISSION TO THE HOSPITAL: I aiso consent to my admission to UCDHS Medical Center if this is deemed necessary for my care. All of the tarms and conditions of this agreement shall also apply to such admission. 4. TEACHING, RESEARCH AND HEALTHCARE INSTITUTION: The University of California, inclUding UCDHS, is a teaching, research and .healthcare institution. I undersll;lnd that medical residents, medical students, students of ancillary health care professions (e.g. nursing, x-ray, rehabil~aliontherapy), posl-graduate fellows, and other trainees may observe, examine, treat or otherwise participate Inmy care at the request and under the supervision of my health care provldsr as part of the University's medical education programs. I understand that my health information may be used and shared with researchers who engage in research, teaching and study related to my treatment, health condition, specimens and/or medical or physical status. Additionally, as a result, potentially commercially usefui products may be developed and I understand that I will have no ,....... ownership rights in those products. Any use of my medical information and/or specimens by UCDHS or other Institutions will be in accordance w~h state and fuderallaw, including all laws and regulations governing. confidentiality of patient records. 5. RELEASE OF INFORMATIONr UCDHS will obtain my written authorization to release information about my medical treatment, except in those circumstances when UCDHS Is permitted or required by law to release Information (see UCDHS' NotiCe of Privacy Practices for a'desbrlptklri of the specific' circumstances under which UCDHS may release this information). For example, UCDHS may release a copy of my patient record to .. other health care providers, health plans and govemment agencies. Add~ionally,1 understand that if I am .diagnosed wnh cancer, a reportable disease in Celifomia, UCDHS Is required by law to report my diagnosis to the State Department of Health Services. 6. PERSONAL VALUABLES: UCDHS maintains fireproof safes for the safekeeping of money and valuabies. UCDHS shall not be liable for the loss of or damage to any money, documents. Jewelry, glasses, dentures, furs or other articles of unusual value and shall not be liable for loss or damage to any personal property, unless depositad in UCDHS' safe or iocked storeroom. The liability for loss of any personal property deposited with UCDHS shall be no more than $500.00. 7. USE AND DtSCLOSURE OF MEDICAL INFORMATION: The Cellfornia Information Practices Act requires UCDHS to provide the following information to individuals who supply information about themselves: As a patient of UCDHS, you will be asked to submit information abolit yourself, such as your address and phone number, Social Security number, insurance information, medical history and treatment, and other personal information. The principal purpose for requesting this information is to ensure accurate identification, continuity of medical care. and payment for such care. University policy, California and federal law and regulations authorize the maintenance of this information. Furnishing all information requestad is mandatory unless otherwise noted.. Failure to provide such information may affect your medical caraalid/or Insurance benefits and coverage. The 71463-257 (4/10) TERMS AND CONDITIONS OF.SERVICE PAGE 1 OF 2
002554
MRN:
8081369, Patient ---__ -- _.

.
02/20/2013 Last, First: AMUNDSEN, --- - MARK
01:15:13
PM
Page 2 c
AMUNDSEN,MARk'~8061009 M 09/2311969
UNIVERSllY OF CAUFORNIA,DAVIS HEALTHSYSTEM
TERMS AND CONDITIONS OF SERVICE information you provide may be disclosed to others, however, you have: the right to review your medical information and the right to request restriction of access to your medical information, as described in the Notice of Privacy Practices. If you would like your agent under a durable power of attorney for health care or your next of kin to receive a copy of your rights and responsibilities asa patient of UCDHS (Notice of Privacy Practices & Patient Rights and Responsibilities Notice), please contact the Health Information Management Department at (916) 734-5205. 8. FINANCIAL AGREEMENT: I agree to pay The Regents of the University of Callfomia for professional, hospital and clinic services, including UCDHS physician services, in accordance with the regUlar rates and terms of UCDHS. I also agree to pay for other professional services provided by other physicians at UCDHS. Should the 'account be referred to an attorney or collection agency for collection, I agree to be responsible for all collection fees (attorney's fees, costs and collection expenses) in addition to any other amounts due. Unpaid accounts referred to outside agencies for collection also bear interest at the then current legal rate. 9. ASSIGNMENT OF BENEFITS (INCLUDING MEDICARE BENEFITS): I authorize and direct the payment to UCDHS of any insurence benefits including hospital insurance and unemployment compensation disability benefits otherwise payable to or on my behalf fOr UCDHS services, including emergency services, at a rate not to exceed UCDHS'aclual charges. I understand that I am financially responsible for charges not paid pursuant to this agreement. I further agree that any credit balance resUlting from payment of Insurance or other sources may be applied to any other account owed to UCDHS by me.
__
10. NOTICE TO CONSUMERS
Medical doctors are licensed and regulated by the Medical Board of California. For information or complaints regarding medical doctors.: you may contact the Medical Board of Calitomla at (800) 6332322 and/or online at www.mbc.ca.gov.
, I have read, agreed to and received a copy of this Terms and Conditions of Service.,
Signature of Patient Relationship ot Representative to Patient Signature of Witness (requtred if patient unable to sign)
or
Signature of Patient's Representative Signature of Interpretar
S-/G-
;;20//
Date of Signing
For office use only: EXCEPTIONAL SIGNATURE REQUIREMENTS ARE REFERENCED BELOW. Please chock the appropriate box(es). CJ PATIENT IS LEGALLY INCOMPETENT TO SIGN: The court approved guardian or conservalor. the agent under an Advance Directive, orfemlly member or other appropriate surrogate must sign as Patlent's Representative.CJ PATIENT 15 PHYSICALLY INCAPABLE OF SIGNING: The patient should give verbal con nt, witnessed by a UCDHS employee. The Patient's Representative should sign In witness of the pallent.having given verbal consent. The UCDHS employee witness shall .Iso sign: '
------------------------,
71463-257 (4110)
PAGE20F
002555
Sex Male
DOB 9/23/1959
Plan UCD/B/S HMO
Financial Class P
Plan Number B72
Plan Phone 916-734-0739
Provider Flabs Labfol
Department Fol Lab
Center None
Center None
Appointment
Account # 078661756110
002556
Department Fol Lab
Financial Class P
Center None
Appointment
Sex Male

DOB 9/23/1959
002557
MRN: B081369, Patient Last, First: AMUNDSEN,
~~K UNIVERSITY OF CALIFORNIA, DAVIS HEALTH SYSTEM
DOS:Ol/0!5/13
M
20-023"13036"1 AMUNDSEN J1ARK

09/2311959
/' ---ro"'''r"l
'JC\'I-13-69
r Ie p
1. UCDHS I ne uV IJ e Health System (UCDHS) IS part of the University of California and IS compnsed of the UCDHS Medical Center and ItS hospital-based chrucs, the Pnmary Care Network chrucs, the UCDHS Medical Group, and the UC Davrs School of MediCine 2. MEDICAL CONSENT I consent to any medical treatments or procedures, X-ray examinations, draWing blood for tests, medications, InJections,taking of medical photographs, Videotaping, laboratory procedures, and hospital services (except for those which reqUire special consent) rendered to me under the general and special Instructions of the attending physiciane, or other physrcians of UCDHS assisting In my care 3. ADMISSION TO THE HOSPITAL I also consent to my adrmssron to UCDHS Medical Center If thiS ISdeemed necessary for my care All of the terms and conditions of thiS agreement shall also apply to such adrrussicn 4. TEACHING, RESEARCH AND HEALTHCARE INSTITUTION' The University of California, including UCDHS, IS a teaching, research and healthcare Institution I understand that medical residents, medical students, students of ancillary health care protessrons (e g, nursing, x-ray, rehabilitation therapy), post-graduate fellows, and other trainees may observe, examine, treat or otherwise participate In my care at the request and under the supervision of my health care provider as part of the University's medical education programs I understand that my health information may be used and shared With researchers who engage In research, teaching and study related to my treatment, health condition, specimens and/or medical or physical status Additionally, as a result, potentially commercially useful products may be developed and I understand that I Will have no ownership nghts In those products Any use of my medical Information and/or specimens by UCDHS or other Institutions Will be In accordance With state and federal law, Including all laws and regulations governing confidentiality of patient records 5. RELEASE OF INFORMATION UCDHS Will obtain my wntten authonzauon to release information about my medical treatment, except In those circumstances when UCDHS IS permitted or required by law to release information (see UCDHS' Notice of Privacy Practices for a desonpnon of the specmc circumstances under which UCDHS may release thiS Information) For example, UCDHS may release a copy of my patient record to other health care oroviders. health plans and government agencies Additionally, I understand that .f I am diagnosed With cancer, a reportable disease In California, UCDHS IS required by law to report my diagnOSIsto the State Department of H~1':I!~ Se.,,!I~S _ _ 6 PERSONAL VALUABLES UCDHS maintains fireproof safes for the safekeeping of money and valuables UCDHS shall not be liable for the loss of or damage to any money, documents, Jewelry, glasses, dentures, furs or other articles of unusual value and shall not be liable for loss or damage to any personal property, unless deposited In UCDHS' safe or locked storeroom The habihty for loss of any personal property deposited With UCDHS shall be no more than $500 00 7. USE AND DISCLOSURE OF MEDICAL INFORMATION The California Information Practices Act requires UCDHS to provide the follOWing mtormanon to indiViduals who supply Information about themselves As a patient of UCDHS, you Will be asked to submit Information about yourself, such as your address and phone number, SOCialSecurity number, Insurance information, medical history and treatment, and other personal InformalJon The prinCipal purpose for requestmg thiS Information IS to ensure accurate Identification, continuity of medical care, and payment for such care UniverSity -P1lllcy;--Callfornia-and-federal--law-and-regulatlonsauthonze-ths mamtenanoe of this information Fumlshlng all mtormanon requested IS mandatory unless otherwise noted Failure to provide such Information may affect your medical care and/or Insurance benefits and coverage The information you provide may be disclosed to others. however, you have the right to review your 71463-257 (8/12)
PAGE 1 OF 2
1111~lm~ 002558
1 7 2 0
02/20/2013 11KN: 8081369, Patient Last, First: AMUNDSEN, MARK
01:15:13
PM
Page 2 of
"'20 023"l3036"l
7
~-13--:;;;
I
rIC
UNIVERSITYOF CALIFORNIA,DAVIS HEALTHSYSTEM
"AMUNDSEN .MARK
roes
"- M
01/05/13 09/23/1f1.jg
I_
TERMS AND CONDITION!> OF SERVICE
medical Inform.atlon ana me IIyht to request restriction of access to your medical mtorrnatron, as described m the Notice-of Privacy Practices If you would like your agent under a durable power of attorney for health care or your next of kin to receive a copy Qf your rights and responsibilities as a patient of UCDHS (Notice of Privacy Practices & Patient Rights and Responsibilities Notice), please contact the Health Information Management Department at (91'6) 734-5205 8' FINANCIAL AGREEMENT I ag~ee to pay' The Regents of'the University of California for professional, hospital al\q chruc services, mcludmq UCDHS physician services, m accordance with the Charge Master In effect on the date of service I also agree to pay for other professional services provided by other phystcians at UCDHS Should the account be referred to an attorney or collection agency for collection, I agree to be responsible for all collection fees (attorney's fees, 'costs and collection expenses) m additton to any other amounts 'due Unpaid accounts referred to outside agencies for collection also bear mterest at the then current legal rate 9' ASSIGNMENT OF BENEFITS (INCqJllING MEDICAR!= BENEFITS) I autho~,ze and direct the payment to UCDHS of any insurance benefits mcludmg hospital Insurance and unemployment compensation disability benefits otherwise payable to or on my behalf for UCDHS services, Includmg emergency services, at a rate not to exceed those In the Charge Master In effect on the date of service I understand that I am fmanclally responsible for charges not paid pursuant to thiS agreement I further agree that any credit balance resultmg from payment of msurance or other sources may be applied to any other account owed to UCDHS by me
10 NOTICE TO CONSUMERS
Medical doctors are licensed and regulated by the Medical Board of California For Information or complaints regarding medical doctors, you may contact the Medical Board of California at (800) 633-2322 and/or online at www mbc ca aov Physrcren ASSistants are licensed and regulated by the Physicran ASSistant Committee For mforrnanon or complaints regarding physician assistants, you may contact the Physician ASSistant Committee at (916) 561-8780 and/or online at www pac ca gov I have read, agreed to and received a copy of thiS Terms and Condllrons of Service
~ 7 ,....
or
Slg,nature of Pallent's Representative Signatureof Interpreter
Relallonshlpof Representativeto Patient Signatureof Witness (reqUiredIf(~~e

Date of Slgnr~g
i
to'slgn)
For office use only EXCEPTIONAL SIGNATURE REQUIREMENTS ARE REFERENCED BELOW
Please check the appropnate box(es)
CJ
PATIENT IS LEGALLY INCOMPETENT TO SIGN Tha court approvad guardian or conservator. the agant under an Advance Directive, or family member or other appropriate surrogate must sign as "Patient's RepresentatIVe" The patient should glva verbal consent, witnessed by a UCDHS employee The Patient's Representative should sIgn In wItness of the patient haVing given verbal consent The UCDHS employea wrtness shall also sign . TERMS AND CONDITIONS OF SERVICE
PAGE20F2
CJ PATIENT IS PHYSICALLY INCAPABLE OF SIGNING
71463257 (8/12)
002559
01:15:13
PM
page
1 01
OOs Ol/em/I3 M 09/23/1959

\.~------
20-023<13036<1 00, 13-69 AMUNDSEN )lARK
r.c
ACKNOWLEDGEMENT OF RECIEPT. NOTICE OF PRIVACY PRACTICES The UC Davis Health System Notice of Privacy Practices provides Information about how we may use and disclose protected health Information about you In add Ilion to the copy we are providing you, copies of the current notice are available by accessing our Web SIte at http Ilwww ucdmc ucdavls edu/compllancel and may be obtained throughout UC DaVISHealth System I acknowledge that I have received the Notice of Privacy Practices
Signature of Patient or Patient's Representative
~~&v
_~Ll/rl_6_
Date
Print Name
Relatloshlp to Patient
Interpreter (If applicable)
-------------------------------------------------Wntten Acknowledgement Not Obtained Please document your efforts to obtain acknowledgment and reason It was not obtained CJ Notice of Privacy Practices Given - Patient Unable to Sign CJ Notice of Privacy Practices Given - Patient Declined to Sign CJ Notice of Privacy Practices Mailed to Patient - Awaiting Signature CJ Other Reason Patient Did Not Sign
--------------------
- Slgnature-of-bJG-gavls-l-lealthSystem.Representatlve .
gate
Print Name
70000-789 (8/12) ACKNOWLEDGEMENT OF RECEIPT NOTICE
Department
OF PRIVACY PRACTICES
002560
02/20/2013
01,15,13 PM
Page 2
AliA M 0""2311959 DllIte
AMUNDSEN OM: '2/1

SUAo:
10-016806878
808-13-694 A
,HARK
5/0g
UNiveRSITY OF CALIFORNIA DAVIS . MEDICAL CENTER, SACRAMeNTO, CALIFORNIA
OAT 1AMUAIAN .FlO;~h~ M rAUE MR;
NURSES NOTES
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.N.
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714310035
PG. 2 of 2
002561

Mark Amundsen 3-12-13 UCDavis Med CTR

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13925 Whittier Blvd. Whittier, CA 90605 Tel: (562) 696-1181 Fax: (562) 945-0663 www.arslegal.

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DEPARTMENT OF INDUSTRIAL RELATIONS DIVISION OF INDUSTRIAL ACCIDENTS

WORKERS' COMPENSATION APPEALS BOARD

SUBPOENA DUCES TECUM

State Of CA Dept Of Fish And Game

The People of the State of California Send Greetings to:

Services at 13925 Whittier Blvd., Whittier, CA 90605 (562)696-1181 Fax: (562)945-0663

properly. SEE REVERSE SIDE [SUBPOENA INVALID WlTIIOUT DECLAIlA TION]

unJeslI acc:ompanied by DOtiee (rom tbis Board D2

DIA WeAR FORM 32 (REV. 06/94)

DECLARATION FOR SUBPOENA DUCES TECUM

Services, Jrc, ... .:...-,.-., .... -,

/Eric D. Ledger, Esg.l Eric 1). Ledger, Esq.

13925 Whittier Blvd., Whittier, CA 90605 Address (562) 696-1181 Telephone

============================================================================== DECLARATION OF SERVICE STATE OF CALIFORNIA, County of 7I>-bf-~,JcJ,.r.o

Place 2315 Stockton Blvd Bldg 12 Sacramento, CA 95817

Mark Amundsen APPEALS BOARD

STREET ADDRESS: MAIUNG AOORl'SS:

OTY AND ZlP CODE:

Mark Amundsen State Of CA Dept Of Fish And Game

NOTICE TO CONSUMER OR EMPLOYEE AND OBJECTION

NOTICE TO CONSUMER OR EMPLOYEE

PLEASE TAKE NOTICE

..~~.~.'?.!?: ~~c;I.!i'.~?:! ~!,.<;I;: