DeclarationCal. Super. - 6th Dist.October 19, 2018\OOONOtJI-PUJN-D NNNNNNNNN-‘u-Ir-Iu-nn-I-nu-Iu-a-nn-I WVQMAWNHOKOWN¢MAUJNHO Electronically Filed David S. Henshaw SBN 271226 by Superior Court of CA, HENSHAW & HENRY, PC County of Santa Clara, 1871 The Alameda on 1/1 9/2021 12:29 PM Suite 333 Reviewed By: F. Miller San Jose, CA 95126 Case #1 8CV336777 (408) 533-1075 Envelope: 5665324 (408) 583-4016 Fax Attorney for Plaintiff GUILIN LIU SUPERIOR COURT OF THE STATE OF CALIFORNIA COUNTY OF SANTA CLARA UNLIMITED JURISDICTION GUILIN LIU, ) Case No. 18CV336777 ) Plaintiff, ) DECLARATION OF DAVID S. ) HENSHAW IN SUPPORT OF vs. ) OPPOSITION TO MOTION FOR ) SUMMARY JUDGMENT, OR IN THE LING CHEN, an individual, and DOES 1-10, ) ALTERNATIVE, MOTION FOR inclusive, ) SUMMARY ADJUDICATION ) ) Date: February 2, 2021 Defendants. ) Time: 9:00 a.m. ) Deptt-a-l- 19 Peter Kirwan ) Judge: Honorable Th'arrgfiguyen-Bmett- ) ) Complaint Filed: October 19, 2018 ) I, David S. Henshaw, hereby declare as follows: 1. I am an attorney, duly licensed to practice law in the State of California. I am the attorney of record for Plaintiff GUILIN LIN in the above-captioned case. 2. I have attached the medical records provided to Dr. James G. Tappan in preparation 0f his Declaration in Support of Opposition to Motion for Summary Judgment, or in the Alternative, Motion for Summary Adj udication. Declaration of David S. Henshaw in Support of Opposition to Motion for Summary Judgment, or in the Alternative, Motion for Summary Adjudication Liu v. Chen l 3. Additionally, I provided the declarations of Scott R. Kanter and Michael Thomas Margolis, M.D., both in their entireties, with their respective exhibits, to Dr. Tappan to review for his own Declaration. 3. The medical records from Good Samaritan Hospital that my office obtained in this case are attached hereto as Exhibit "A." 4113 n 4. The medical records from the office of George Yeh are attached hereto as Exhibit I declare under penalty of perjury under the laws of the United States of America that the 10 foregoing is true and correct. Executed this 19m day of January, 2020, at San Jose, California. 12 13 14 David S. Henshaw 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Declaration of David S. I.lenshan in Support of Opposition to Motion for Summary Judgment, or in the Alternative, Motion for Summary Adjudication Liu v. Chen 2 Exhibit “A” Fa}: Server 1/19/2021 11:07:54 AM PAGE 2/002 Fa}: Server Patient: [3| fl!g¥% L.“ h H .l I Medic'alRecurdNumhersz‘fisz-hgaqqq Facility; Health Infori'n'ation Management Plume Number: ' 2425 Samaritan Dr". _ Address: San JoseJ-L‘A 95124 Cityfsme: zrp: cIERfrmcgmn a_F MEDICAL RECORDS To the best ofmy knowledge, the copied documents records and other items enclosed are true and correct copies of all original records Identified and described In the subpuena duces tecum, patient authorlzption, or court order made by or at the direction af the custodian of records. The original records were prepared In the ordinary co urse of the facility’s regularly conducted business at or near the time of the act condition, or event by persons with kn owledge of the facts recorded and the records have haen maintained In the ordinary course ofthe facility' s regularly conducted business according to ail confidentiahtyand security requirements of law This certificatinn'Is given by the custodian of recnrds instead ofthe custodian s personal appearance. We are nut aware of any omissions; however, due to the timing of th'ls request it is possible that a portion of the medlcal record may be‘ incomplete andZur prelimlnaw at thts time. The recipient of these records agrees to maintain their confidentiality and permit fu rther disclosure only as authorized by law. ' Select Only One: D The completé records consisting of pages. . a The compléte records for the time period beginningfitzal [i and endingWcunsists of g pages. D The copied records consist of pages per your request fa'r specific portions of the medica1 record. -' D The co'pled rgcords consist of -__pages..- They are inanmplete in the following: LERTIFICA'I'IDN OF NO RECORDS U A thorough search of requested information carried out under my direction and control revealed that this facility does not have the records described 1n the patient authorization ur the subpoena dunes tecum. DECL'ARATIEIN 0F cusmmm or RECORDS l, Z am the duly authorized Custodian of Records ofthe above named facility. I am familiar with de of preparation of, and have the authority to certify, the fa cilitv record. I declare under penalty of perjury under the] w oft e tate of QJMI-‘w-C‘ n" u. . CountyOman: the foregoing istrue and correct. ”16/909! Signw "ILL . Date I ***i tt$¢¥tti¥¢iiil$3fi¥ltil*‘t*tt.‘itlttfllt***#ttltfl$$$$$1ii$$¢1i¢$il¥¢$it¥$ Subscribed and sworn to me, a notary public In and for said county, tfils Dav of 20_ Notary Public My commiss1on expires: (Seal) In states where a Notary ls not required, this fa rm wilt only include signature and date ofthe medital record custodian. Good Samaritan Hospital 2425 Samaritan Drive, San Jose, California 95124 (408)559-2011 szoLS‘i‘F’i‘; b 3"?"‘fi “”7"" “Ix "gfii‘ :53? J Wt 233%? éébfifiim} "'8‘ rioéuméfi W 63% "’8" ”$3“ Accounm.M0035402 Agw Bime os/gz/lv UNIT R512?)S; 00715744 maxvgg-‘u ROOM/BED: ADM TIME: 1436 MARKET URN: M531216 CONF: VIP: 93. Typsgnap Ea ‘w‘ “éADMIT pRI/sacwggv/ PR W Iggg§g£p§(8)w%.§9 M0ya . “ fig; ‘siéko M'AA Time‘ww ' 532% w mmn LIU, GUILIN Oflmaumm. STREET: 135 CLOVER WAY Dos: 09/15/1964 ss#: xxx-xx-ssas STREET; AGE: 52 Race: ASIAN C/S/zp: Los GAmos,CA 95032 sax: F MAR STATUS: M paowau: (409)353-3532 CNTY/Rss: 43 REL: UNKNOWN LANG: ENGLISH Paonezz (403)888- 4351 CELL :_GUILIN LIU@YAHoo. com “ v‘ n fi_A . Ngoi‘xi,[ :5: 3:; Aymv n; mi . rw'wkvv' WEI, TAO 136 CLOVER WAY 136 CLOVER WAY L03 GATOS.CA 95032 LOS GATOS,CA 95032 (408)358- 3532 RELTN: SPOUSE (408)358- 3532 RELTN: SPOUSE wonx pn,(4oa)332- 6592 CELL M ‘.‘. . WORK PH: (408)332- 6592 CELL ’ ..I’=-;'.‘.. ,:.B¥fi«:nsur~- O HEPATIC FUNCTION PANEL fybaAfi/¥;€/ PROTEIN, TOTAL 6.9 ‘ . /&§ SJALBUMIN 4.2 3. g/d f) SJ GLOBULIN, TOTAL 2.7 1.9- 7 g/dL SJ A/G RATIO 1.6 1.0-2.5 ratlo SJ AST (SGOT) 14 10-35 U/L SJ BILIRUBIN, TOTAL 0.4 0.2-1.2 mg/dL SJ BILIRUBIN, DIRECT 0.1 < 0R = 0.2 mg/dL SJ BILIRUBIN, INDIRECT 0.3 , 0.2-1.2 mg/dL SJ ALT (SGPT) 13 V 6-29 U/L SJ ALKALINE PHOSPHATASE 57 33-115 U/L SJ BASIC METABOLIC PANEL SODIUM, SERUM 139 135-146 mmol/L SJ POTASSIUM, SERUM 4.0 3.5-5.3 mmol/L SJ CHLORIDE, SERUM 106 98-110 mmol/L SJ CARBON DIOXIDE (CO2) 25 19-30 mmol/L SJ UREA NITROGEN,BL00D (BUN) 13 7-25 mg/dL SJ CREATININE, SERUM 0.70 0.5o~1.1o mg/dL SJ For patients > or = 50 years of age: The upper reference limit for Creatinine is approximately 13% higher for people identified as African-American. eGFR 102 >=6o mL/min/1.73m2 SJ eGFR AFRICAN AMERICAN 118 >=6o mL/min/1.73m2 SJ GLUCOSE 92 65-99 mg/dL SJ FASTING REFERENCE INTERVAL CALCIUM, SERUM 9.1 8.6-10.2 mg/dL SJ LIPID PROFILE CHOLESTEROL, TOTAL 142 125-200 mg/dL SJ TRIGLYCERIDES 81 <150 mg/dL SJ LDL CHOLESTEROL (CALCULATED) 94 <13o mg/dL SJ DESIRABLE RANGE <100 mg/dL FOR PATIENTS WITH CHD 0R DIABETES AND <70 mg/dL FOR DIABETIC PATIENTS WITH KNOWN HEART DISEASE. CHOLESTEROL, HDL 32 L > OR = 46 mg/dL SJ non-HDL CHOLESTEROL 110 mg/dL SJ LIU,GUILIN - QH2485751 Target for non-HDL cholesterol is 30 mg/dL higher than LDL Page 1 - Continued on Page 2 Guest. (Inns! Diagnosnutha assumed logo anfl all assumed Gunstfllagnnsn'cs milks am (ha xvademavks nlOuasl Diagnoslics. O fluzfl Diagnnniu lncolnolaled. All lights Isser‘md flDZOMl-NDNSYD. filvlladm SEZK - 131571. 000043 ~ Quest 4 Diagnostics QUEST DIACNOSTICS INCOR.ORATRD COLLECTED: 05/28/14 REPORTED: 05/30/14 08:44 10:43 Quest Diagnostics Incorporated PATI NT INPOR.rl T ON LIU,GUILIN DOB: 09/15/1964 AGEr 49 GPNDER: F FAST/FNG,. Y Ipr RRPD. I'TATUS FINAL I ORDRIIINC PHYSIC AN YEH, GEORGE K Test Name In Range y'l Out~f Range CHOLESTEROL/HDL RATIO 4.4 LDI /HDL RATIO 2.94 NALE: Bt',LO'rr AVERAGE RISK: 2 AVERAGE RISK: 2.29-4.90 MODERATE RISK: 4.91-7.12 HIGH RISK: &7.13 Reference Range cholesterol target. OR = 5.0 AV.RISK 2.35-'1.12 28 Lab SJ SJ FEMALE; BELON AVERPGE RISK 2.34 AVERAGE RISK: 2.35 - 4.12 MODERATE RISK: 4.13-5.56 HIGH RISK: o5.57 TSH REFLEX TO PREE T4 TSH RFLX CBC (INCLUDES DIFF/PLTi WHITE BLOOD CELL COUNT RED BI.OOD CELL COUNT HEMOGLOBIN HEMATOCRZT MCV MCH MCHC RDW PLATELET COUNT ABSOLUTE NEUTROPHZLS ABSOLUTE LYMPHOCYTES ABSOLUTE MONOCYTES ABSOLUTE EOSINOPHILS ABSOLUTE BASOPHIL5 NEUTROPHILS LYMPHOCYTES NONOCYTES EOSINOPHILS BASOPHILS COMMENTS: Micr'ocvtosis 2+ Anisocytosis 1+ Hypochromasia 2+ Ovalocytes 1+ Polychromasia 1+ 1.85 5. 4 4.24 305 3402 1620 162 0 63 30 3 3 0 8.2 26. 8 63 19.3 30.5 20.8 162 L L L L L H 0.40-4.50 mIU/L 3.8-10.8 Thousand/uL 3.80-5.10 Milli.on/uL 11 7 - 15 5 c/dL 35.0 - 45.0 80.0-100.0 fL 27.0-33.0 pg 32.0 36.0 g/dL 11.0-15.0 140-400 Thousand/uL 1500-7800 Cells/uL 850-3900 Cells/uL 200-950 Cells/uL 15-500 Cells/uL 0-200 Cells/uL SJ SJ SJ SJ SJ SJ SJ SJ SJ SJ SJ SJ SJ SJ SJ SJ SJ SJ SJ SJ SJ HENOGLOBIN A1C IMNUNOASSAY HEMOGLOBIN Alc 5.9 H SEE BELOW According to ADA guidelines, hemoglobin Alc &7.08 represent.s optimal control in non-pregnant diabetic patients. Different metrics may apply to specific patient populations. Standards of Medical Care in Diabetes-2013. Diabetes Care. 2013;36tsll-s66 SC LIU,GUII TN - QH2485751 Page 2 - Continued on Page 3 000044 '& ~ Quest 4 Diagnostics QUEST DIAGNOSTICS I.ICORPORATBD COLLECTED: 05/25/14 REPORTED."05/30/14 05744 lgt43 Quest DtsgnostIcs Incorporated PKIIENT INFORNATION / LIU, GUILIN / DOB: 09/15/1 $ AGE: 49 GENDER: F FAS%)NG7 Y IDI REPORT status FINAL I ORDERING PHYSICIAN YEH, GEORGE K Test Name In Range Out of Range Reference Range Lab For the purpose of screentng for Che presence of diabete 5 79 ConsLstent with the absence of d3abetes 5.7-6.4g Conststent with increased rtsk for diabetes Iprediabetes) or = 6.5B Consistent with dtabetes Thts assay result is conststent wtth an increased ri sk of dIabetes. Currently, diagnosis MRAN 1'LASMA These Reference of Medical Care year in Diabetes Association. no consensus exists for use of hemoglobin A1C for of diabetes for children. GLUCOSE 133 mg/dt. Intervals are supported by the current "Standards Ln Diabetes" publtshed in January of the current Care, the Journal of the Amertcan Diabetes SC FERR1TIN 5 L 10-232 ng/mL SJ S.J PERFORMING LABORATORY INFORMATION sc Q t. D ag o t, 3736 tlo thgat BI d, 5 0 a 0 to, cA 95837 L 00 to y 0 * cr.o Alr do A *, r., MD Pho /866) 697-8378 Q D g at 0, 967 Nab y R* d. Sa 3 , OA 95733 I bo Io y 0 to Alt do A 0 , 3 , ID Phc 0 (866) 697 8378 CI,IA. 05D0665209 I,nl 05D"6088 LIU,GUILIN - OH2455751 Page 3 - Enc of Report „0,« 000045 f~, C3uOSt Pa lie n! Infurmnti en LIU, GU( LIN DOB.'9/15/1964 AGE& 50 Gender. F F,ivtinS Y Phone 408 '!583(32 Patient ID NG Specimen FN6752(SU Requis&non 6956657 CoHected Received Reponed 06/01/20)5 /09.04 PD I 06/03/20)5 /21:07 PD'f 06/08/20!5 / 10.08 PDT Chant 4 6000 I 374 MAILOO I YEH. GEORGF. K 1 FH GFORCF N(D 706 N IYIN('.HEST!IR BLUD SA&N JOSE, CA 95128. (524 Quest Diaqnostics Incorporated IRepert Status: Final )LIU, GUll L ( (5 A~ Client Infomnation 1mSpecimen lnfarinati&&ii Test Name LIP D PANEL WITH RATIOS CHO ESI', RO!u TO AL HDL CHOLESTEROL R &'YCFR DESI.DL.CHOLESZERO'7101 30 L In Range Out Of Range Reference Range ll!5-200 rag/dl, OP. = 46 mg/dL .!: 3 &sg/d!. Desirabie range &100 mg/dL for patients with CHD or. diabetes and &70 mg/dL for diabetic patients w&th known heart. disease. CHOL/HDLC i&ATIO LDL/HDI RATIO 4.8 3 Below aver ge Risk: Averag. R sk: moderate Bi Hiqh R'sk& 0&=50 (cele) 2.35-'I. ? 4.13-5.56 &5.57 UX UX NO' 'hUIE"'EBOL 114 Iargec for non-HDL cholesterol is 30 mq'. A&one& t tier. !DL ch& 'st& i'o ta ge BASIC t&ETABOLIC PANEL GLUCOSE 78 n&q/ H (cele) (5-99 irr/dh UX UX 8o'00 Noi 8 P: ICARI.E 140 4.3 108 23 9.0 eCFI& Vioh-r,!'R. AMERICAN eCFR A BICAN A!'IEBICAN BU!4/CRCATTNINE RATIO SODIJN P 0TAS 5 I 'J I '. CHLORIDE CAPBOt'IOXIDE CA'!! IUF HEt!OGLOBI!v Al &41 H HPG nii.&.G'OBI I A)C 5 6 Acccrd&.&3 to ADA gu deline&, hemoalobin Alc !.04 repre- en' opt&mal contro! in non-pregnant drabec& cpat&en'. Different met.cics may aoply to spec Fir. p .-.-.'opulatrons. stanasrds o. i~is 'real r'are in Diane&.es-2013. Diabetes Care. 2013!36:sli-s66 UREA N&TROGFN (BUN) 12 CREAT IN!N 0.80 For pat.ierts &49 years of ge, the refer.enc:r !&mi. for Creat. nine is approxirrately !34, hig e& =or penple &cl*ntitiea as African-American, Fart.ing reference interval 7 25 mt&/ IL 0 Sn-),05 mg/dr. OR = 60 m!./min/1.'!3m2 0 "- 60 a&L/a&in/1. 73 &2 & 1c) 17& - i4'rvol/L &. 5-'&, 'smn1/L 98 -li 0 mao! /& 19-30 &rn'ol/L - 10.4 mg/dL .7 I o total Hgb 0 consrslenl wrth the absence of d&auec Consistent with increased r ,k tor diat&&te& (prediabetes) Consrstent. with diabete". or.=6. 54 I'or the purpose of screening for the pres nce cf diabeces 5 7& 5.7-6.44 CI.IFNT 5 ER VICES. 866 697.8378 SPECIMEN, EN675216U v PAGE I DF 3 000046 C? 1.1(l "' Patient Infornuilion LIV, VVI LIN DGB: 09/15/1964 Gender F Patfefft ID iNG AGE: 50 Faitm Y Quest Diagnostics Incorporated Specimen lnformstioe Specimen E1N6752I6U Calle t d. 0&1/0010I5 /09:04PIYI Received: 06/0'3/2015 /2! 0/ PDI Report d. 06/08/20 I 5 / IO.GR PD'I Report Status: Final iLIV, 1('Iiii I Vii Clii.nt lnl'eriiistion Chant ¹ 6001(lt 374 'r'Ell, GE(IRUE K Test Name In Range Out. Ot'ange Ref rence Pmnga This assay result s consistent v 1th a cine inuncl risk of ciiabef.es. currently, no con ensue exist Alc for diagrosls of diabetes MEAN PLASMA GLUCOSE Htd Al'IC !UNCTION PANEL PROTEIN, 'IOTAL ir BU lift GLOBU'N A! HU!1!N/Ci OBUI,IN RATIO BTLTRUBIF1, 'I'OTAL BiLIifUBIN, D RECT BILTR!!BIN, INDIRECT ALKALIII PHOSPHATAS- ASI ALT TSH W/Ri::FLEX TO FT4 s for use ot h imoglohi r for ci ildre.. 122 7.6 5 3.1 1.5 0.6 0.1 0.5 46 12 7 2.03 nfrf/dt (cali'7 6 1 - 3 1 0/1 f1 6 - 5. I g/cIL !.9 3. 7 9/dL (cele; 1.0-2. 3 fcal (7. '? - I . ?,nt.g/dL0' 0.2 mg/dT, 0.?-1.2 m7/d (cele:3 33 130 ri/I, IO . 5 11/L 29 0/L tel 11/ I, Rel rer. Range UX U.. CBC I'!ORPI(OLOGY CBC (TN Li!DES DIFF/PLT! WHITE BLOOI! CELL COUNT R D BLOOD CE!.L COUNT HEMOGLOBIN HEMATOCRIT MCV MCH MCHC RDN PLATFiEI COUN'I MPV ABSOLUTE Fi UTROPHILS ABSOLUTF. LYA!PHOCYTES ABSOT UT .. IONG.l'TES ABSOLUTL EOSTNO Hli.S ABSOLUTE BASOFhlLS NEUIROPHILS I.YMPHOCYTES HONOCYTES EOSI"!OPHILS BASOP!I t iS FERRTTIN H PAT!TTS 8 SURFACE iNTI EN t'I/REFL CONFIRFi Anisocytosis I + Micr'ocvtosis I + Hypoc.hromasia I + Ovalocytes 1 4.9 3. t32 7 0 L 24 0 L 62.8 L 18,4 1 29.3 L 22.9 H 392 9 a 3136 1441 216 93 15 6a 0 29.4 n.n 1. 9 0.3 r = 2G Years 0. 4n ~ a ..'30 P'gr'oI f'v I',:I'g s I'ii'sf f.firn st. 1 0.26-2.i6 Sccord tr rrester 0,55-2,73 T!ii rr! I rmnoster 0.43-?. 91 IOR !AL .8 - 10.8 Tho!sand/ul, 3.'30-5. IG tirliron/ul, 11. 7 15.'& t/TI.:' O-n'3.0 80.0 - 100 0 f 27.G 33.0 Pg."'. 0 - 3o.o ci/oL I i . 0 - li. Ii I'IG-400 Ttiou tend/ut. 7.5-11.5 fL f500-7900 rails/VL 850-39170 ccl I /uL ?00 9501 cell 'uL I: -500 e!1 s/ui, 0 200 ce1ls/uL IG .232 ng/rnL UX UX Ui CLIENT SERV!CFS. 866,697.8378 SPECliMk'FE EiM675:!16U 2 smite msi I n 1 I rresrm 111). 1 PAGt:2OI 3 000047 Quest Diagnostics Incorpoieteri O(t (su Report Status.'inal LIU, (OUI li,ifiil Pditent Infornfalion LIU, G Ul L IN DOB: 09/15/196d Gender F Pet(em iD. iUO AGE: 50 Fo(nn: Y Specimen fi)formotioit Specnnen FN675211 U Collected: 06/03/20 I 5 / 09.01 P13T Receued. 06/03/2015 /21.071'DT Reponed 06/08/2015 /1008 PDT 6 liiint Aifoiiiiltion Ciiciu A 6000iP/0 FEH.GEORGE K Test Name HEPATIT S 8 SURFACE AN I I G L' 'EPATITIS B SURFACE ANTIBODY OL In Range Out Of Ruige NON REACTI(/t( REACTIVE Rsf cence Range I ION - R " A C I I '/ E I'ION - 3 it( T IVI Let) i)L PERFOR511N G SITE Ul. UL(5111 0( sit, 0 YII (10 7 A elf, I )LYD 5ACAALII 10 CA'Ul LI ul 0 »»f)0,, Ill((DD ha I c(0 II( 10 (1 (A 0)IYIM) I) UX nl 0(I Ul ( (A(l((( (1051. IASUSY 16)MA(II RY eohf) SA(lo(I' 0 I) I(0 I I, YDA. Ai I'lilt () 0 I ('l(i) il ui) ('l l'«l)illllc('ll" CONTACT HISTORY: Di TE INE CONIAC. 06/De/2015 11:06 AN DR YEH TEST NASIE ACT I OI'I TAE.IYI VER"'H f'r'LIEN1 Si'.RVICE5 866 697 8378 SPECiMEN Eim/7521611 0 0 Sw 0» .1 1 . 0 01 0 0 1( 01, 00 01 «Ail nelrci'5010 (Min! )S PACiE 3 OF 3 000048 I/y& QueSt "9' pnntnt Intnrtnition LILI, GUI LIN Dugs 09/15/19(kd AGEi SU G nd&r. F Zasuos Y Pixtnc. 408.358.3532 Patient ID. NC Iest Name LIPID PANEI WITH RATIOS CHOLESTEROL, TOTAL HDI CHOLESTEROL TRIGLZCERIDES LDL-CHOLESTEROL 06/04/2015 11:08:24 AM Spe&hneti lutormntioo Specimen. EN(i75 16U Rtquisition: 6056657 Collected: 0(volt2015 &09 04 PDT Received 06/03/2015 / 21 07 PDT I axed 06 04)2015 I I I:06 PDT In Range Oot Of Range 30 L 67 101 Report Status: Pnriial - Courtesy Cnpy +) 0(('Y. Client IniormaH&on" ryt&LLX I / (.h nt S. 60001374 'h(AI LOU I VEH. GL'ORGE K VEH OF(YR(iF MD 70(t N II&INCHLSTER BLVD SAN .IOSE, CA 95128-1524 j j Reference Range +Lab 125-200 mg/dL + UX OR = 46 mg/dL UX 150 mg/dL UX &130 mg/dL (cele) UX Desirable range 100 mg/dL for patients with CHD ar diabetes and &70 mg/dL for diabet.ic patients wtth known heart discase CHOL/HDLC RATIO LDL/HDL RATIO 4.8 3.4 Below a wragc Risk: Average Risk: hioderate Ri k. High Ri.sk: OR = 5. 0 (calrl icalc) &2.34 2.35-4.12 4.13-5 56 o5.57 NON HDL CHOLESTEROL 114 Target. for nan-HDL cholestercl is 30 mg/dL higher LDL cholesterol target. BASIC METABOLIC PANEL GLUCOSE is mg/d (cele) t.han 6 -99 mg/dL Fasting reference inter al UX UX UREA NITROGFN IBiiN) 12 CRENI'ININE 0.80 Por patients 49 years of age, the reference limit for Creatinine is aporoximately 131 higher far peopleidentifieo as African-American. 7-25 mg/dL 0.50-1.05 mg/dL eGFR NON-AFR. AMERICAN eCPR AFRICAN AMERICAN BL'N/CRHATININE RATIO SODIUM POTASSIUM CHLGRIDE CI RBON DIOXIDE CALCIUM HEPATIC FUtiCTION PANEL PROTEIN, TOTAL ALBUMIN GtOBtilIN ALBU(IIN/GLOBULIN RATIO BILIR()BIN, TOTAL BILIRUBIN, DIRECT BILIRUBIN, INDZRECT ALKALINE PHOSPSATASE AST ALT TSH W/REFLFX TO FT4 86 100 NOT APPLICABLE 140 4.3 108 23 9.0 7.6 d 5 3.1 1.5 0.6 0.1 0.5 46 12 7 2.03 OR = 60 aL/ain/1.73m2 OR = 60 mL/min/1.73m2 6-22 (cele) 135-146 mmol/L 3.5-5.3 mmol/L 98-110 mmol/L 19-30 tnmol/L 8.6-10.4 mg/dL 6.1-8.1 a/dL 3.6-5.1 g/dL 1.9-3.7 g/dL (cele) I 0-2.5 (cele) 0.2-1.2 mg/dL OR = 0.2 mg/dL 0.2-1.2 mg/dL (cele) 33-130 U/L 10-35 U/L 6-29 U/L III I U/L Reference Range UX ( LltiVT SLRViCLS: 866.()97.8378 SPECLVILN. LN675216U Q t,Q&tD s ii .itl & itdir d ii tdQ tnih ti k th t d 1 (Q tnir ii'A(.)H I OF 2 000049 I'age 2 of 2 g 06/04/2015 11I08 24 AMPg& G(uest ifcport Status: Partial - Courtesy CopyLIU, GUI I.IN Peti nt Infornistion LIU, GUI LIN DOB 09/15/1916-1 (i endor: P P i trent ID NG r(GF: 59 Dmtmf, Y 'pccinicn Information Specimen FN675216U CoHected: 06/fll/2015 /09:04 PDT Rccmvcd f)6/03/2()15 / 2 h(17 PDT faked 06/04 2015 / 11:06 PDT Pi8 en( Information 6 icnt.ti. 600013/4 EH, GEORGE K Test Name Tn Range Out Of Range Reference Range or = 20 Years 0.40-4.50 CBC MORPHOLOGY CBC (INCI.IIDES DIFF/PLTI NHITE BLOOD CELL COU'IT RED BLOOD CPLL CO(lNT HEMOGLOBIN HEMATOCRTT MCY MCH MCHC RDN PLATELET COUNT MPV ABSOLUTH N UTROPHILS ABSOLUTE LYIVPHOCYTES ABSOlrUTF, MONOCYTES ABSOLUTE EOSLNOPHILS ABSOLUTE BASOPHILS NEUTROPHILS LYNPHOCYTES MONOCYTES EOSINOPHILS BASOPHILS FERRTTTN Anisocytost- 1 + Mtcrocytosis 1 ~ . Hypochromasia 1 Ovalocytes 1 + -'. 9 3.82 7.0 L 24.0 L 62.8 L 18.4 L 29.3 L 22.9 H 392 9.4 3136 A41 216 93 15 64.0 29.4 4.4 1.9 0.3 2 L Pregnancy Ranges Fkr t triioester 0.26-2.66 second trimester. 0.55-2.73 Tntrd trimester 0.43-2.91 NORMAL 3.8-10.8 housand/uL 3.80-5.10 Million/uL 11.7-15. g/dL 1».0-45.0 80.0-100.0 IL 27.0 - 33.0 pg32.0-36.0 g/dL 11.0-15.0 140-400 Thousand/ I 7.5-11.5 fL 1500-7800 cells/uL 850-3900 cells/uL 200-950 cells/uL 15-500 cells/uL 0-200 cells/uL 10-232 ng/mL UX PEVDIVG TESTS: ! IIFA(OGLOBIN AfC IV(yil A(Pt I IF('AT IT i'I 8 51)kl ALI. ANI IUFN AV/RP 1'L CUNFH(t I PERFORVIIVG SITEI fiuIsI OIAom Ik'» A'I oii uikl'Ri 'lr uik lki ki AI AA» k ii ( A'". I'l I I A. I «Ao kfno 4 0»('I n IR I ul rl IA A o)oni CONTACT HISTORY: DATE TIME COIVTACT 06/04/2015 11.06 AN DR YEH TEST NAME ACTION TAKEN HGB VERB RB FOF CLIEIVT SERV(CES 866.697.8378 SPECLVIEN: Ei'1075216U Q ot 0 tn h \lode « t ot I .AJ il «i I 4Q to A nt' th ~ tmo k«(Q 'ts to ti. PA& 1( 201 000050 (p CIOESI Quest Diagnostics Incorporated Report Status: Final LIU, GUI LIN Patient Information LIU, GU I L IN DOB: 09/15/1964 AGE: 51 Gendei P Fasting Y Phone 408 358 3533 Patient ID iVG Specinieri I Specim n. Reqsisitiori Lsb Ref¹ Collected Received Reported EN594324L 0013710 13710 0(/25/2016 / io:04 PST Oi/26/2016 /03:15 PST 01/27/2016 / 14:13 PST g. Client Information 70 ISA n A/¹/7 Cirent ¹: 6000(374 MAILOOI H, GEORGE K H,GEORGE. MD 6 N WINCHESTER BLVD N JOSE, CA 95128-1524 Test Name LIPID .A&EL a(1TH RE: LI.X TO DIRECT CHOI.I.ST RO, TOTA HDL CHOLESTEROL TR&C-.I,TC BRIDE,S LDL- .Hol FSTEROI. In Range LDL 132 101 83 Rang~eference Range 125-200 mg/dL OR - 46 mg/dL &150 mg/dL Lab UL UL UL UI, ir hie rarge & 00 mg/dL or patients wil.h CHD or aiahc e and 0 mo/dL for diabetic patients with kr.r. r hear' sease. CHOL/HDLC RA 0 4.6 HON HIJL CHOI.E TEROL 103 Taiaet for no..-HDL cholesterol is 30 LDL cholest.erol arget. BASIC HETABOLIC PAN .L GLUCOSE 84 65-99 mg/dL F'astrng reierence interval UL UL / mg/APL (calc) UL mg/dL hrgher t.haf 19 CREJ Iisl' 0. 62 For par.rents -'e" r" of aae, tie reference limit. r Cre t n r e is aoproxima" eiy 139 higher for people raentif ied as African-American. 7-25 mg/dl. 0.50-1.05 mg/dl. eG" R NO.I-!L R. Al'IERICAN eGFR AFRICAN Ai(LRICASI BUN/CREATII IXE RATIO 5ODIUVJ POTA SIUN CHLORI E CARBO'IOXID. CALC".IIH IIEPAIIC I U.'(CTIO&f PAHLl PROTEISi, 'I'OTAI ALBU .Iil G'OBULIIJ ALBUYi N/GLOBULIN RATIO BILIRUBIFi, I'OTA,L BITIRUBIF, D RECT B LIRUilIN, INDTREC'I ALKAIINE PHO Pr!ATASE AST ALT CBC SORPV iac. CBC (IECL'IDES DIFF/PLT) WHITE BLOOD CELL COUN(T RED BLOOD CEI,L CO(JVT 104 121 NOT APPLICAB'E 139 4.8 108 23 9 I 7.3 4.3 3.0 1.4 0.5 0.1 0.4 57 12 15 Review of peripheral smear automat.ed results. Ellrptocytes I + Hypoch omasia I + Anisocytosrs 2 t 5.2 4.21 OR = 60 ml./min/1.73m2 OR .=. 60 ml'/mrn/1.73m2 6-22 (calci 135-146 mmol/L 3.5-5.3 rsmol/L 98-110 mmol/L 19-30 mmol/L 8.6-10.4 mg/dL 6.1-8.1 g/dL 3.6-5.1 g/dL 1.9-3.7 g/dL (cele& 1.0-2.5 (cele} 0.2-1.2 mg/dL OR .-. 0.2 mg/dL 0.2-1.2 mg/dL (cele} 33-130 0/L 10-35 U/L 6-29 0/L NORMAL confirms 3.8-10.8 Thousand/uL 3.80-5.10 Nillion/uL UL UL UL CLIENT SERVICES 866 697 Ki78 SPECIMEN. EN594324L (!n i l}i rl)i ", ".'",ll": « '::';«.rais i »,.:, I(}« ilii,"i u iew lii i ll riidamila I'Ua ln I md& PAGE I OF2 E n 000051 fPJ OIIES +Patient Infonostion LIU, GUI LIN DOB; 09/15/1964 AGE: 51 Gender I'J.Atm' Phoiie 408 358 3532 Pafieni TD NiG Quest Diagnostics Incorporated Specimen Information Specnnen EN594324L Requisition 00)3710 Lsb Refit: I 3710 Collected: 01/25/2016 / )0:04 PST Receiyed Dl/26/20)6 /03 (5 PST Reported Dl/27/2016 /14:(3 PST Report Status: Final LIU, G UI LIN ~ Client ¹: 6000)374 MAIL00) ( YEH, GEORGE K I VEH,GEORGE MD 706 N WINCHESTER BLVD SAiV JOSE, CA 95128-1524 Test Name LIPID PAiiEL WITH RE J.X TO DIRECT CIIOJ ESTEROL, OTA'DL CHOLESTEROL TRIGI.,".CERIDES ID!,-CHOLFSTEROI, In Range L:3 I, 132 101 83 29 L 125-200 mg/dL OR = 46 mg/dL &150 mg/dL &130 mg/dL (calcl Out Of Range Reference Range UL UL UL UL Desir.ibis range &100 vg/dL for pat.rents with CfiD or diabetes 2nd &70 mg/dL for diabetic patients with known hi.art disease. CfiOL/HDLC RATIO 4.6 NON HDL CHOLESTEROL 103 Target for noii-HD'holesterol Js 30 mg/dL highei than Lui. choice eroi target. BASIC if TABOLIC PA(i. L GLUCOS.. 84 OR = 5.0 (calc) mg/dL (calc) 65-99 ieg/dL UL UL UL Fasi:J.ng reference interval UREA Ni'fROCL'N (iiuN) i9 CREATININ 0. 62 For patieyits &49 years of age, the reference limi.t for Creatinire is approximateiy 139 higher for peopleidentified as p.fr can American. 7-25 mg/dL 0.50 - 1.05 mg/dL eGFR FOFi-Ai'R. AI,ERICAU eGFR AFRICAN AifER.ICAi'UN/CREATININE RATIO SODIU i PO'IASSIJ'N CHLO.J D CARBOIJ DIOXIJIE CALCiU&i HEPJTIC IUNCTION Piii'iEL PROTEIN, TOTAL ALBU,JI i GLOBULI"J ALBUHTN/GLOB(liiN RAI 0 BILIRUBIN, TOTAL BILIRUBIN, D RECT'ILIRUBIN, INDI ECT ALAAI 'E PkiOSPHATASE AST AT.T CB('iORJ HOLD( Y CBC (INCLUDI'5 DiFF/PfTl RNITE BLOOD CELL COLfil'ED BI,OOD CET.I. COUU i 104 121 iUOT APPLICABLE 139 4 8 108 23 9.1 7.3 4.3 3.0 1.4 0.5 0.1 0.4 57 I? 15 Review of perrphcral smear automated results. Elliotocytes I + Hypochromasia I + AnJsocytosis 2 + 5.2 4.21 OR = 60 mL/min/1. 73m2 & OR = 60 mL/min/1. 73m2 6-22 (cele) 135 - 146 mmol/L 3.5-5.3 mmol/L 98 - M 0 mmol/L 19-30 mmol/L 8,6-10.4 mg/dL 6.1 - 8.1 g/dL 3.6-5.1 g/dL 1.9 3.7 g/dL icaic) 1.0-2.5 (calc) 0.2-1.2 mg/dL & tin = 0 2 mg/dL 0.2-1.2 mg/dL (cafe) 33-130 U/L 10-35 U/L 6-29 U/L NORHAL confirms 3.8-10.8 Thousand/uL 3,80-5.10 Billion/uL UL UL UL 2 CLIPiVT SERVICES. 866 697 8378 SPECIIYIEN. EN594324L ee isa eye 3000 tORe ee 01727770 iii4000eeiie, i(i iiiiein« i yui"; eihehes nwrh«su in:Jemiie PAGE i OF2 o 0 8 a 000052 Quest Diagnostics Incorporate Report Status. Fmal LIU, GUI LINrPntieni informationLIU, GUI LIVE DOlt 09/15/19&i4 Gender F Patient ID, iVG AGE: Sl FdctinE Y Speciincn Information IF / Specmlen'N594324I. Collected 01/25/2016 / 10:04 PS'V Rccmved 01/26/2016 /03:15 PST Reponed. 01/27/2016 / 14 t3 PST I Client Information i Client d. 60001374 YEN,GEOR E K 'fest. Name PAMOGLOBIN HEMATOCRIT MCV MCH MCHC PLATYI,HI COI/¹ RIP V ABSO U'rr NE ~ TROPHILS ABSOLUTT LY.IPI:OCYTLS ABSOLUTE MONOCYTES ABSOI.U'I . LO"INOPHII.S ABSOLUTE EASOPHILS NEU'IHOPHII,S LYMP.,O .YTCS IAONOFYTES EOSI:OPHI' BASOPFIILS PERRITIN HEPATIT S B CORE AB TOTAL 1721 88 0 62.3 33.1 2.9 1.7 0.0 151 L 3 L REACTIVE eference Range 1.7-15.5 g/dL eat analysis. 5 . 0-'15. 0 0 0-100.0 Ij 7.0-33.0 pg2.0-36.0 g/di. eat analysis 1.0-15.0 40-400 Thousand/uL .5-11.5 f'L 1500-7800 cells/uL 850-3900 cells/uL 200-950 cells/uL 15-500 cells/uL 0-200 cells/uL 10 -232 ng/mL NON - REACTIVE U I. UL PERFORA11NG SlTEI lL QLEci Ol t obiltcbA(Rtblt I'1 I (Ryllctyt ~ L 0 EACRAblrc'yc CA956771657L b .'10 ALFI!EOOAEIACIONlR I IO CLIA blou44709 CLIENT SERVICES 866 697 8378 SPECIitdFN: EN594324L 6 I 0 by C *700 Audn 4 t bu27756 at 04 Ilbr PAGE2OF2 R o 000053 (Mi Quest Diagnostics Care3600 Report Status: Final LIU, GUILIN Patient lnfermation LIU, GUILIN DGB: 09/15/1964 AGE; 51 Gender: P Fasting: U Phone: 408 358.3532 Panenl ID: NG Speciinen Information Specimen. BN6829(40 Reguisitton: 7673469 Collected. 08/30/2016 / 10:00 PDT Received 08/30/2016 /23:41 PDT Reported 09/0!/20(6 / 19:35 PDT Client Information Chant ¹ 60001374 MAIL001 YEH, GEORGE K YEH,GEORGE MD 706 N WINCHESTER BLVD SAN IOSE, CA 95128-1524 Test Name LIPID PANEL WITH RA'IIOS CHOLESTEROL, TOTAL HDL CHOLESTEROL TRIGLZCERIDES LDL"CHOLESTEROL Zn Range 176 140 114 34 L 125-200 mg/dL OR = 46 mg/dL &150 mg/dL &130 mg/dL (cele) Out Of Range Reference Range UL UL UL UL Desirable range &100 mg/dL for patients with CHD or diabetes and &70 mg/dL for diabetic par.tents with known heart disease. CHOL/HDLC RA'ZIO LDL/HDL RATIO 3 Below average Risk: Average Risks Moderate Risk: High Risk: OA = 5.0 (calc) (cele) &2.34 2.35-4.12 4.13-5.56 &5,57 UL UL NON HDL CHOLESTEROL 142 Target for non-HDL cholesterol is 30 mg/dL higher LDL cholesterol target. BASIC METABOLIC PANEL GLUCOSE 80 mg/dL (cele) than 65-99 mg/dL UL UL Fasting reference interval UREA NIZROGEN (BUN) 21 CREATININE 0.76 For patients &49 years of age, the reference limit for Creatinine is approximately 134 hrgher for peopleidentifieo as African -American. 7-25 mg/dL 0.50-1.05 mg/dL eGFR NON-AFR. AMERICAN eGFR AFRICAN AMERICAN BUN/CREATZNINE RAIIO SODIUM POTASSIUM CHLORIDE CARBON DIOXIDE CALCIUM HEPATIC FU )CTION PANEL PROTEIN, IOTAL ALBUMIN GLOBULIN A HOMIN/GLOBULIN RATIO BILIRUBIN, TOTAL BILIRUBIN, DIRECT BILIRUBIN, INDIRECT ALKALINE PHOSPHATASE AST ALI TSH 91 105 NOT APPLICABLE 139 4.5 104 27 9 5 7. 5 4.5 3.0 1.5 0.4 0.1 0.3 66 18 ?3 1.03 OR = 60 mL/min/1.73m2 OR = 60 mL/min/1.73m2 6-22 (cele) 135-146 mmol/L 3 5-5 3 mmol/L 98-110 mmol/L 20-31 mmol/L 8.6-10.4 mg/dL 6.1-8.1 g/dL 3.6-5.1 g/dL 1.9-3.7 g/dL (calc) 1.0 - 2.5 (ca)c) 0.2-1.2 mg/dL OR = 0.2 mg/dL 0.2-1.2 mg/dL (cele) 33-130 0/L 10-35 0/L 6-29 U/I, mIU/L Reference Range UL UL CLIENT SERVICES: 866.697.8378 m st}'BFIIN¹(hklg¹83/8}/94 iosse PAGE 1 OF 2 Quest,Quest Diagnostics, Ihe snodst d logo s d II v snslsd Quest DI g tie marks are the trademarks of Quest Diagnostic. 000054 Wi Quest D agnostics'are360e Report Status: Final LIU, GUILIN Patient lnfarmslion LIU, GUILIN DOBt 09/15/1964 AGE: 51 Gender: F Fasting: U Patient ID: NG Specimen Information Specilnen. EN682914B Collected: 08/30/20l6 /10:00 PDT Received. 08/30/2016 /23 4l PDT Reponed: 09/01/2016 / 19.35 PDT Cli cut In formation Chant ¹: 60001374 Y N, GEORGE K f Test Name In Range Out Of Range Reference Range or = 20 Years 0.40-4.50 CBC tINCLUDES DIFF/PLT} WHITE BLOOD CELL COUNT 4.9 RED BLOOD CELL COUNT 4.95 HEMOGLOBIN 13.0 HEMATOCRIT 41.3 MCV 83.4 MCH MCHC RDW PLA1'ELET COUNT 230 MPV 8.4 ABSOLUTE NEUTROPHILS 2901 ABSOLUTE LYMPHOCYTES 1573 ABSOLUTE hlONOCYTES 255 ABSOLU1'E EOSINOPHILS 157 ABSOLUTE BASOPHILS 15 NEUTROPIIILS 59.2 LYMPHOCYTES 32.1 MONOCYTES 5.2 EOSINOPHILS 3.2 BASOPHILS 0.3 FERRITIN 16 ALPHA FETOPROTEIN, TUMOR MARKER 2.0 Reference Range: &6.1 The use of AFP as a tumor marker in females rs not. recommended. 26.3 L 31.5 L 20.3 H pregnant Pregnancy Ranges Frrst trrmester 0.26-2.66 Second trrmester 0.55-2.73 Third trimester 0.43-2.91 3.8-10.8 Thousand/uL 3.80-5.10 Millhon/uL 11.7-15.5 g/dL 35.0-45.0 80,0"100.0 I'L 27.0-33.0 pg 32.0-36.0 g/dL 11.0-15.0 140-400 Thousand/uL 7.5-11.5 fL 1500-7800 cells/uL 850-3900 cells/uL 200-950 cells/ut. 15-500 cells/uL 0-200 cells/uL 10-232 ng/mL ng/ml UL UL EN Ihrs test was performed ustng the Beckman CoulLer chemhlumrnescent method. values obt.ained from different assay methods cannot be used interchangeably. AFP levels, regardless of value, should not be Snterpreted as absolute evidence of the presence or absence of dhsease. PERFORMING SITE: EN QUEST DIAONOS'IICS WEST HILLS, 4 ol PALLBAOOK AVENUf..WEST HILLSCA 33364 3226 7 6 OD«ENRIQUETERRAEASAID, CLIA DSIX6 2327 UL QUFSTDfhohoSTICS SACRAhlEN'lo 3714 NORTNOATE BLVD SACRAMENTO CA F363 1617 L 6 «o D, l hi ROSE AKfll N D FCAP CIIA PSM6442UP CLIENT SFR3/ICES: 866.697.8378 F 4 oyfFFBWI}ftMIAX46}}24}3}ftffh toooo PAGE2OF2 Q oft,(}omtDfognostiTS,lhoossocisl dlogoondhlfoso i lodQ oint g oti 4 rkso ethel od ksofQuostDiofnoslics. 000055 (&i Quest D agnostics Cafe360e Report Statns: Final LIU, GUILIN Patient Information LIU, GUILIN DOB: 09/15/1964 AGE; 51 Gender F Fasting U Phone. 408 888 4351 Patient ID: NG Test Name Specimen Information Specimen: EN020222C Requisition; 7673468 Collected'9/03/2016 Received 09/06/2016 / 16.26 PDT Reported. 09/13/2016 /21.05 PDT In Range Out Of Range Client Information Client ¹: 60001374 MAIL001 YEH, GEORGE K YEH,GEORGE MD 706 N WINCHESTER BLVD SAN JOSE, CA 95128-1524 I( RefLfeence Range UL FECAI, OLOBIN BY IMMUNOCHEMISTRY MICRO NUMBER: TEST STATUS: SPECIMEN SOURCE: SPECIMEN QUALITY: RESULT: 61987311 PINAL INSURE (TMJ FOBT IEST CARD ADEQUATE Not Detected PERPORIUIING SITE: UL QULSTDIAONOSHCSSACRAMevro 3714NORTltOATSSLVD SACRAMSNTO C*sst34 MI7 L I «TD«M ROSSAKIN MO.FC*r CLIA SIDO444 m CLIENT SFRVICES. 866.697.8378 o Isd'5@Etid@tln@NP?IQ?42/M I os oo Quest, Q st DN¹ ostic, Ihs sssocsiod logo s d sa ssocistsd Quest Diogno tlm ks s s the Imdemsrks or Quest tN gnosilcs. PAGE 10F 1 o 000056 fbi Quest oragnosocr Patient Information LIU, GUI LIN DOB; 09/15/1964 Gender: P Phone'G Psheni ID: NG AGE: 53 Pasting: Y Care360D Specimen Information Specimen. SA819296C Requisition 9867)32 Collected: (2/07/20)7 / )(.)4 PST Received )2/Oi)/20)7 /DO:32 PST Repoiied: )2/i I/20)7 /08:25 PST Report Status: Final ( LIU, GUI LTN ) O()enl tnformaiion l I Chen( e 6000(374 MA)LOU I YEkl, GEORGE K YEII,GEORGE MD 706 N iVINCHESTER BI.VD SAN JOSE, CA 95128-1524 Test Name In LIPID PANEL WITH REFLEX TO DIRECT LDL CHOLESTEROL, TOTAL 17 HDL CHOLESTEROL TRIGLYCERIDES LDL-CHOLESIEROL Reference range; &100 Desirable range &100 mg/dL for p diabetes and &70 mg/dL for diabe known heart disease. LDL-C is now calculated using th calculation, which is a validate better accuracy than the Friedew est.imation of LDL-C. Martin SS et al. JARA. 2013/310( (ht.tp://education.QuestDiagnosti&. CHOL/HDLC RATIO NON HDL CHOLESTEROL 142 H I'or pat.vents with diabetes plus 1 major ASCVD risk factor, treating to a non - i)DL-C goal of &100 mg/dL (LDL-C of &70 mg/dL) is considered a t.herapeutic option. BASIC klETABOLIC PANEL GLUCOSE nge mg/dL (calc) 65-99 o:o/dL UREA NITROGEN (BUN) 16 CREATININE 1.17 H For pat.len s &49 years of age, the reference limit. for Creat.inine is approximately 134 higher for people identified as African-American. Fasting reference interval 7-25 mg/dL 0.5C-1.05 mg/dL eGFR NON-AFR. AMERICAN eGFR AFRICAN AMERICAN BUN/CREA1'ININE RATIO SODIUM POTASSIUM CHLORIDE CARBON DIOXIDE CALCIUM HE()OGLOBIN A1C WITH MPG HE)(OGLOBIN Alc Foi t.he pu pose of screening diabetes: 62 14 I'l0 3 103 28 10.1 53 L 5.3 for t.he presence of OR = 60 o L/min/1.73m2 OR = 60 mL/min/1.73m2 6-22 (cele) 135-146 mmol/L 3.5-5.3 mmol/L 98 - 110 mmol/L 20-31 mmol/L 8.6 - 10.4 mg/dL &5.7 4 of total Hgb UL 2 &5.74 5.7-6.4& & or =6.54 Consis ent with the absence of dtabetes Consistent wit.h increased risk for diabetes (prediabetes) Consistent with diabetes Thts assay result is cor.sistent with a decreased risk CLIENT SERVICES 866.697.8378 coot ERBCoNNNhu.got84989688 oo Quooi,QoosiD(orsooiics,ih I i di Soondoliooood iodQuoo(Diornosiico mark sr ihoindomork fQ osDi Snooiios. PAGE(OP3 000057 /&) Quest Olagnost cs Cafe360w Report Status: p)na) LIV, GVI LIN ) Padent Information i r.rv, Gvr LrN DO8t 09/15/1964 Gender: F Patient)D: NG AGE: 53 Fatting Y Test Name of diabetes. ) Specimen informat)on i Specimen: SAB)9296C Collected: 12/07/2017 / lb)4 PST Received: )2/08/20)7 /00:32 Reported: 12/I I/20)7 /: 5 Out Of Range Client Information Cltcnt d. 6000)374 YEN, GEORGE K Reference Range Lab Currently, no consensus exists regarding use of hemoglobrn Alc for dragnost.s of diabetes in children. Accordrng to American Diabe es Associatron IADA) guidelrnes, hemoglob&n Alc &7.04 represents optrnal control tn non-pregnant. dsabctic patrents. Dtfferent metrics may apply t.o specifsc patient populatrons. Standards of Nedtcal Care tn Diabetes)ADA). MEAN PLASMA GLUCOSE 111 URIC ACID d.tl Therapecttc target for gout patients: &6.0 mg/dL mg/dL (calc) 2. 5-'I . 0 mg/dL HEPATIC FUNCTION PANEL PROTEIN, TOTAL ALBO IIN GLOBULIN ALBUMIN/GLOBULIN RATIO BILIRUBIN, TOTAL BZLIRUBIN, DIRECT BILIRUBIN, INDIRECT ALKALINE PHOSPHATASE AS1'L1'SH W/REFLEX TO FT4 7.7 4.6 3,1 1.5 0.4 0.1 0.3 62 14 14 0.89 6.1 - 8.1 9/dL 3.6-5.1 g/dL 1. 9-3. 7 g/dL tcalcl 1.0-2.5 icalc) 0.2-1.2 mg/dL OR = 0.2 mg/dL 0.2-1.2 mg/dL (cele) 33-130 0/L 10 - 35 0/L 6-29 U/L mIU/L Reference Range or = 20 Years 0.40-4.50 UL CBC )INCLUDES DIFF/PLT) WHITE BLOOD CELL COUNT RED BLOOD CELL COUNT HEMOGLOBIN HEMATOCRIT MCV MCH MCHC RDW PLATELET COUNT MPV ABSOLUTE NEUTROPHILS ABSOLUTE LYMPHOCYTES ABSOLUTE MONOCYTES ABSOLt)TE EOSINOPHILS ABSOLUTE BASOPHZLS NEUTROPHILS LYMPHOCYTES YiONOCYTES EOSINOPHILS BASOPHILS 4.89 38.5 279 10,6 2627 1536 271 133 32 57.1 33 5.9 2.9 0.7 11.6 L 78.7 L 23.7 L 30.1 L 15.5 H Pregnancy Ranges First trtmester 0.26-2.66 Second trimest.er 0.55-2.73 Third trireester 0.'l3 - 2.91 3.8-10.8 Thousand/uL 3.80-5.10 Mtllion/uL 11.7 - 15.5 g/dL 35.0-45.0 80.0-100.0 27.0-33.0 pg 32.0-36.0 c)/clj 11.0-15.0 140-400 Thousand/uL 7,5-12.5 FL 1500-7800 cells/uL 850 - 3900 cells/uL 200-950 cells/uL 15-500 cells/uL 0-200 cells/uL CLIENT SERV)CES 866 697.8378 e i dvvSIIDIII64HINdfeh840396esca ct,Q tD)cgnestikethe sc cietcdt gee dell s IetedQ IDI g ct«merkcarcthct d srksetQ ctlneg I«. 8 PAGE 2 OF 3 n o 000058 (~)W} Quest Dlagnost cs Care3600 Report Status: Final LIU, GUI LIN Patient Information LIU, GUI LIN DOB(09/15/1964 AGES 53 Gender: F Fasting: Y Patient ID: NG Specimen Infornlstlon Spemmen. SA819296C Collected. 12/07/2017 / 11:14 PST Received: 12/08/2017 /00:32 PST Reported: 12/I 1/2017 /08:25 PST CHent informAdon Chent 1374 YEN, EK In Range Out Of Range YELLOW CLEAR 1.006 6.0 NEGATIVE NEGATIVE NEGATIVE NEGATIVE NEGATIVE NEGATIVE NEGATIVE NONE SEEN NONE SEEN NONE SEEN NONE SEEN NONE SEEN NO CULTURE INDICATED 13 2.2 rker Ln pregnant Test Name URINALYSIS, COMPLETE W/REFLEX TO CULTURE COLOR APPEARANCE SPECIFIC GRAVITY PH GLUCOSE BILIRUBIN KETONES OCCULT BLOOD PROTEIN NITRITE LEUKOCY'TE ESIERASE WBC RBC SOUAHOUS EPITHELIAL, CELLS BACTERIA HYALINE CAS1'EFLEXIVE URINE CULTURE FERRITIN ALPHA I'ETOPROTEIN, TUFOR NARKER Reference 'Ra .qe: &6. I The use o AFP as a tumor ma females is not recommended. Refesenc e YELLOW CLEAR 1.001 - 1.035 5.G-S.O NEGATIVE NEGATIVE NEGATIVE NEGA1'IVE NEGATIVE NEGATIVF. NEGATIVE OR = 5 /HPF OR = 2 /HPI'R = 5 /HPF NONE SEEN /HPF NONE SEEN /LPF 10-232 ng/mL ng/mL EN UL EN Thrs test was performed using tho Beckman Coulter chemiluminescent method. Values obtained frorc different assay methods cannot be used Lnterchangeably. AFP levels, recrardless of value, should not be Lnterpreted as absolute evidence of the presence or absence of dtsease. PERFORMING SITE: EN QtlEST OIAONOST(CS WEST HILls E4U( FALLEROOK APENUP WEST 1(ILLS CA 413U4 )22s I 1 I O D I TAE TOUCH(NDA Mo CLIP'SDIH(2S23 UL QUEST D(AOP(OST(CS SACRAMENTO 3714 tloRTHO TE EL D SACRAMENto CA ms34 (sir L 1 I O D«M ROSE AKI(t M 0 FCAP CLIA (lsntnn2(H D CLIENT SERVICES: 866.697.8378 Pmm Er SRIIE}66Bltt(.SPY840896Gr cs 0 * 1 l} IDi g d Alk edtl dl gttndallstm hlcd0 4(Di gassn 4 rks lk I d mark Ef0 lilt g ties. PAGF. 3 OF 3 n 000059 (& I Quest' r D)egoost)cr Care3600 Report Status: Fina) LIU, GUILI)74 Patient Information LIU, GUILIN DOE) 09/15/1964 AGE: 53 Gender: F Fasting: U Phone 408.888.4351 Pat)ent ID NG Specimen Information Specimen: SA915686C Requisition: 0884716 Collected: 12/08/2017 Received: 12/13/2017 / 12:42 PST Reponed. 12/16/2017 / 21:46 PST Cnent Information Client tt. 60001374 MAILOOI YEH. GEORGE K YEH,GEORGE MD 706 N WINCHFSTFR BLVD SAN JOSE, CA 95128-1524 COMl41ENTS: 12-9-t7 Test Name In Range Out Of Range Reference Range UL FECAL ULOBIN BY IMMUNOCHEMISTRY MICRO NUMBER: TEST STATUS: SPECIMEN SOURCE: SPECIMEN QUALITY: RESULT: 72924 121 FINAL INSURE (TMI POBT TEST CARD ADEQUATE Not Detect.ed PERFORMING SITEI Ui. OUES7DIAONOSTICSSACRANE TO )7) NOR7NO TE BLVD 7 I'R NEITO CAT)SIA )SI L b mus;n ROSE Ll, .MD PCAP CI A ED E RN CLIENT SERVICES. 866.697.8378 ps Im uv StgstdNEIHWldid)945686(dseu Quest QurslDi g ostics th ss I I dl gsaudsllsstodstsdQusstnl g timmwkssrsthslrsdsmsrksofQu (Dngussll s. PAGE I OF I 000060 PWI QuestDiagnostics'a/e360e Report Status: Final LIU, GUILIN Patient Information LIU, GUILIN DOBI 09/15/1964 AGE) 53 Gender: F Fasting: U Phone: 408.888.4351 Patient ID. NG Specimen Information Specimen: SA915686C Requisition. 0884716 Collected: 12/08/2017 Received 12/13/2017 / 12M2 PST Reported. 12/16/2017 /21M6 PST Client Information Client 40 60001374 MAIL001 YEH, GEORGE K YEH,GEORGE MD 706 N WINCIIESTER BLVD SAN JOSE, CA 95128-1524 COAIMENTS: 12-9-17 Teat Name In Range Out Of Range Reference Range UL FECAL GLOBIN BY IMMUNOCNEMISTRY MICRO NUMBER: TEST STATUS: SPECIMEN SOURCE: SPECIMEN QUALITY; RESULT; PERFORMING SITE 72924421 FINAL INSURE (TMJ FORT TEST CAAD ADEQUATE Nct Detected UL QUBST DIAOI OSTICSSACBAMSNTO I'ii ~ NOBTNOATF BLVD SACBAMSATD C sill) - s 5 S NOD koss Ass . ND.. FCAP CLI* s)DSINAT(e CLIENT SERVICES: 866.697 8378 r ~ s sr SRBtgthgstsh Sshtngogges ss. PAGE 1OF 1 Qsssi, Quest Dtsg e Il, thc smocntsd logo aad Bll sedated Qus)t Diagnostics marks s s the tn demark f Qamt Diagnestlcs. 000061 Immunizations (continued) Problem List Nofed 'I /29/2018Essential hypertension Overview Not on medications Hydronephrosls 1/29/201 0 Overview elevated blood pressure intermittent right flank pain; Labs showed decreased renal function and CT abd/pelvis on 12/1 9/17 showed right hydronephrosis-Right stent placement was attemped but was unsuccessful, therefore percutaneous nephrostomy tube (PCN) was placed on 1/9/18 E (Principal)Ureteric obstruction Ureteric obstruction - Pnmary Codes N13.5 2/2/201 8 Comments Lab, Imaqinq, and Immunization Orders Completed Blood Type Verification Red Blood Cells Red Blood Cells Hematocrit Metabolic Panel, Basic Surgical Procedure CBC Metabolic Panel, Basic Ordered On: 02/D2/2018 Ordered On: 02/02/2018 Ordered On: 02/02/2D18 Ordered On: 02/02/2018 Ordered On: 02/02/2018 Ordered On: 02/02/2018 Ordered On: 02/02/2018 Ordered On: 02/02/2018 Results Procedure Component Value Units CBC [549406297] (Abnormal) Specimen Blood from Venipuncture WBC 8.1 K/uL RBC 4.34 MIL/uL Hemoglobin 10.5 (L) g/dL Hematocrit 32.6 (L) MCV 75.1 (L) fL MCH 24.1 (L) pg MCHC 32.2 g/dL RDW 18.0 (H) Platelet 245 K/uL count Metabolic Panel, Basic [549406299) (Abnormal) Spccimon Blood from Venipuncture Sodium, 139 mm of/L Ser/Ptas Potassium, 3 6 Guiftn Liv (MR I/71366734) DOB: 09//5/f964 Date/Time Collected; 02/03/18 0559 Updated 02/03/18 0619 Collected: 02/03/18 0559 IJpdatcd 02/03/18 0706 Page 2 of 4 000062 Results (continued) Procedure Component Sar/Ptas Chloride, Ser/Ptas CO2, Ser/Plas Anion Gap Fasting Commen Value Units 107 mm of/L 25 mmel/L 7 mmol/L Date/Time Patient Fasting status not provided 101 mg/dLGlucose, Ser/Ptas Comment: Test result can be taisely de "ressed or increased il the patient is on Sulfasalazine and/cr Suifapyrid:ne drugs. Piease conlact the Chemistry section of the Clinical Laboratory for any questions Patient Fasting status not provided Reference range listed above is iiir Non-fasting paiienls Creatinine, 1.04 (H) mg/dL Ser/Ptas Comment: Measured by isotope dilution mass spectronieiry traceable method. Result can be falsely decreased in pa;ients with elevated lcvcls of N-Ace tylr yste inc (N/iC) and ivleta mi zola. BUN, 14 mg/dL Ser/Ptas Calcium, 8.8 mg/dL Ser/Piss N ilzaiive. eGFR is not reported for in-patients whose renal function may be temporarily impaired. Vital Signs BP 138/83 Ht 1.6 m (5'3") Wt 55 kg (121 Ib 4.1 oz) BMI 21.48kg/m'~il Hl None Goals None Patient Care Team Yeh, George K, MD Lo, Han Po, MD Chen, Ling Ping, MD Relationship PCP - General Specialty 'otifications Internal Medicine Urology Ob/Gyn Start Fnd I/3/18 I /3/18 I /3/18 Guilin Liu (MR ¹ 71386734) DOB G9/f5/1964 Page 3 of 4 000063 t/Wi QueSt U agnosucs Cafe360e Report Status: Final LIU, GU)LIN Pstieiitlhfotination LIU, GUILIN DOB: 09/15/1964 AGF: 53 Gender F Fscting Y Phone: 408.888.435) Patient ID: 09)5)964GL )legit)i )D. 857300(t)78483387 Specimeo Information Specimen SA360205G Requicition: 0008609 Collected: 06/23/20)8 /08:29 PDT Reccivcd: 06/26/2018 /Ol:06 PDT Rcpnrted. 06/26/20)8 /02:24 PDT Clieat Information Client li: 6000)374 iv)A)LOO) YEH, GEORGE K YEH,GFORGE MD 706 N WINCHESTER Hl VD SAN)OSE, CA 95l28-l524 COMMENTS: FASTING YES Test Name MICROALBUMIN, RANDOM URINE CREATI)INE, RANDOM URINE MZCROALBUMIN, RANDOM URINE (W/CREATININE) MICROALBUMIN t(ICROALBUMIN/CREATIt)INE RATIO, RANDOM URINE In Range iW/CREATININE) 3) 0.2 Reference Range No esr.ablished mg/dL &30 mcg/mg crea. Out Of Range Reference Range 20 - 320 mg/dL UL UL The ADA defines abnormalit.ies in albumin excre ion as follows; Category Result (mcg/mg creat inine) Normal Micros)Lumin ria Clinical albuminuria &30 30-299 OR = 300 The P,DA recommends that at least. two of three specimens collect.ed within a 3-6 month period be abnorreal before considering a patient to be withi.n a diagnostic category. LIPID PANEL WITH REFLEX TO i)IRECT LDI, CHOLESTEROL, TOI'AL 169 i(DL CHOLESTEROL 30 L TRIGLYCERIDES 155 H LDL-CHOLESTEROL 112 H Reference range: &100 Desirable rance &100 mg/dL for primary prevention; &70 mg/dL for patients with CHD or diabetic patients with & or = 2 CHD risk factors. &200 mg/dL &50 mg/dL &150 mg/dL mg/dL (cate) UL UL tlL UL LDL-C is now calcu)at.ed using the Far in-Hopkins calculation, which is a valida ed novel method providing better accuracy than the Friedewald equation in he estrmatson of LDL - C. Martin 56 et al. GAMA. 2013;310(19)i 2061-2068 (http: //education. Quest.Diagnost.ics.corn/faq/FAQ164) CHOL/HDLC RATIO 5.6 H NON HDL CHOLESTEROL 139 H For patien s with diabetes plus I malar ASCVD risk factor, r.resting to a non-HDL-c goal of &100 mg/dL (LDL-C of &70 mg/dL) is considered a therapeut.sc option. BASIC NETABOLIC PANEL GLUCOSE 91 &5.0 (cele) &130 mg/dL (cele) 65-99 mg/dL UL UL Ui, URFA NITROGEN (BUN) 20 Fasting reference interval 7-25 mg/dL CLIENT SERVICES: 866 697 8378 s.w.s sr B(sHCshcstsi ds4sk160805(5s se Q si,Q stDng seri,tk sssscist dc ge dsiisc i icdQ sinisgnssiiccm k r tk i d rks fQ stD g its. PAGE i OF 3 000064 Wi Quest Diagnostics Care360gg Report Status: Final LIV, GUJLJN Patient information LIU, GUILIN DOBi 09/15/1964 AGEt 53 Gender. F Fasting Y Phone: 408 888 435) Patient ID: 09 k 5)964GL Healih JD. 8573008)78483387 Specimen Information Specimen: SA360205G Requisition: 0008609 Collected 06/23/2018 /08:29 PDT Received'6/26/20)8 /0).06 PDT Reported: 06/26/20)8 /02.24 PDT Client Information Chant 4: 6000)374 MA)LOOI YEH, GEORGE K YEH,GFORGE MD 706 N VVJNCklESTER BLVD SAN JOSE, CA 95(28 l524 COidMENTS; FASTING.YES Test Name MICROALBUMIN, RANDOM URINE CREATININE, RANDOM URINE MICROALBU JIM, RANDOM URINE (W/CREATININE) FiICROALBUMIN i"JICROALBUMIN/CREATININE RATIO, RANDOM URINE In Range Out Of Range (N/CREATININE) 37 0.2 Reference Range Nor. established Reference Range 20-320 mg/dL mo/dL &30 mcg/mg creat Lab UL UL The ADA defines abnormalities in albumin excretion as follows: Category Result (mcg/mg creatinine) Normal &30 Microalbuminuria 30-299 Clinical albuminuria & OR =. 300 The ADA recomuends that a" least two of three specimens collected within a 3-6 month period be abnormal before considering a patient to be within a diagnostrc cateoory. LIPID PANEL WITH REFLFX TO DIRECT LDL CHOLESTEROL, TOTAL 169 HDL CHOLESTEROL 30 L TRTGLYCERIDES 155 H LDL-CHOLESTEROL 112 H Reference range: &100 Desirable range &100 mq/dL for prin:ary preveiition; &70 mg/dL for patients wit.h CHD or diabetic patients with & or = 2 CHD tisk factors. &200 mg/dL &50 mg/dL &150 mg/dL mg/dL (cele) UL UL UL UL LDL - C is row calculated using the Martin-Hopkins calculation, which is a validated novel method providing better accuracy than the Friedewald equation in the estimation of LDL-C. Martin SS et. al. JAMA. 2013)310(19)i 2061 - 2060 (http: //education.QuestDiagnost ice.con /faq/FAQ164) CHOI/HDLC RATIO 5.6 H NON HDL CHOLESTEROL 139 H For pa ient" with diabetes plus I major ASCVD risk fac or, treating to a non-HDL-C coal of &100 mg/dL (LDL-C of &70 mg/dL) is considered a t.herapeutic opt&.on. BASIC METABOLIC PANEL GLUCOSE 91 &5 0 (cele) &130 mg/dL (calc) 65-99 mg/d'L UL UL Fastino reference rnterval UREA NITROGEN (BUNl 20 7-25 mg/dL CLIENT SERVJCES: 866 697.8378 e I c by E(SH(I)tuJE(eh Sstl300205fds oc Quest,gucst Diegno tice,these oust d leg nd slices cisted Que tDiugn sn s marks th stud e kso(Quest Di gaosti PAGE ) OP 3 u o a e 000065 Wk Ouest D agnashcs Cafe360e Report Status: Final LIU, GUILIN Patient Inl'ormstlon I.IU, GUILIN DOB: 09/15/1964 AGE: 53 Gender. F Fssimg. Y Patient ID: 09(5(964GL Health (D. 8573008l78483387 Specimen Information Specimen; SA360205G Co(leered: 06/23/2018 /08:29 PDT Received: 06/26/20(8 /0(:06 PDT Reported: 06/26/20(8 /02.24 PDT Client Information Client 8: 6000(374 &YEkl, GEORGE K Test Name Tn Range Out Of anqe CREAIININE 1.07 H For patients &49 years of age, t.he referCnce li for Creatininn is approxi.mately 13h higher peopl identified as African - American. eGFR NON-AFR. AMERICAN 59 L eGFR AFRICAN AMERICAN 69 BUN/CREATININE RATIO 19 SODIUM 139 POTASSIUM 4.6 CHLORIDE 106 CARBON DIOXIDE 26 CALCIUM 9.7 HENOGLOBIN AIC NITH YPG HEMOGLOBIN Alc 5.6 I'ar the purpose of screening far t.he presence of diabet.es: Reference Range 0.50 - 1.05 rng/dL OR = 60 mL/min/1.73m2 OR = 60 mL/min/1.73m2 6-22 (calci 135-146 mmol/L 3.5-5.3 mmol/L 98-110 mrnol/L 20-31 mmol/L 8.6-10.4 mg/dL &5.7 4 of total Hgb UL &5.7 5.7 - 6.4 ar =6.54 Consistent with the ab ence of diabetes Consistent. wit.h increased risk for diabet.es (prediabetesl consisr.ent with diabetes Thss assay result is consistent with a decreased risk of diabetes. Current.ly, no consensus exists regarding use af hemoglobin Alc for diaqnosis of diabetes in children. According ta American Diabetes Association iADAI guidelines, hemoglobin Alc &7.0h represent" optim I control in non-pregnant diabetic patients. Different. metrics may apply t.o specific patient populations. St.andards of Yedical Care in Diabetes(ADA(. MEAN PLASMA GLUCOSE 122 URIC ACID 5.7 Therapeutic target for gout, pat.ients: &6.0 mg/dL mg/di (calci 2.5-7,0 mg/dL HEPATIC FUNCTION PANEL PROTEIN, TOTAL ALBUMIN GI,OBULIN ALBUMIN/GLOBULIN RATIO BILIRUBIN, TOTAL BILIRUBIN, DIRECT BILIRUBIN, INDIRECT ALKALINE PHOSPHATASE IST ALT LIPASE TSH W/REFLEX TO FT4 6.8 4.2 2.6 1.6 0.5 0.1 0.4 87 11 10 17 1,18 6.1-8.1 9/dL 3.6-5.1 g/di, 1.9-3.7 a/dL (calci 1.0 - 2.5 (cele( 0.2-1.2 n.g/dL OR 0.2 mg/dl 0.2-1.2 rcg/dL (calcl 33-130 U/L 10-35 0/L 6-29 U/L 7-60 U/L mlu/I Reference Ranqe UI. UL UL or = 20 '/ears 0.40-4.50 o CLkEiVT SERVlCES: 866 697.8378 m i ear ERE(8848% Seh860885(fees* Qnece, Qne e Di gnesdcs, ehe ss ieied (ego end eg esseci i d Q sc Dismcesncs kc e eh e demeeks ef Qn si Di g cede . PAGE20F3 n 000066 fgei Quest'm o Daonostcs Cafe3604g Report Status: I'inal LIU, GUILIN ) Specimen Information ~ Spectmen: SA360205G CoHccted 06/23/20)8 /08:29 PDT Received: 06/26/20)8 /Ol:06 PDT Reported. 06/26/20)8 /02:24 PDT Patient Information LIU, GUII,IN DOEt 09/15/1964 AGE: 53 Gender: F Fmttng: Y Pauent ID. 09!5 l964GL Health ID: 8573008l78483387 Test Name In Range Out Ot Range CREATININE 1.07 H For patients &49 years of age, the reference limit for Creatinine is approximately 134 higher for peopleidentified as African-American. 'Client Information Client g. 60001374 YEH, GEORGE K Reference Range 0.50-1.05 mg/dL Lab eGI'R NON-AFR. AMERICAN eGI'R AFRICAN AMERICAN BUN/CREATININE RATIO SODIUM POTASSIUM CHI.ORIDE CARBON DIOXIDE CALCIUM HEMOGLOBIN A1C NITH MPG HEMOGLOBIN Alc For the purpose of screening diabetes: 69 19 139 4.6 106 26 9. 7 59 L 5.6 for t.he presence of 60 mL/min/l./3m2 60 mL/min/1.73m2 (calcl l6 mnol/L .3 mmol/L 0 mmol/I, mmol/L 0.4 mg/dL OR OR 6-22 135-1 3.5-5 98-11 20-31 8.6-1 &5 7 o of to al Hgb UL &5.74 5.7-6.44 or =6.5g Consistent with the absence of diabetes Consistent with increased risk for di.abates (prediabetes) Const.stent with diabetes This assay result is consistent wit.h a decreased risk of diabetes. Currently, no consensus exists reoarding use of hemoglobir. Alc for diaonosis of diabetes in children. Accordino to American Diabe es Association (ADA) guidelines, hemoglobin Alc &7.04 represents optimal control in non-pregnant diabet.ic patients. Different me rice may apply to specific patient populations. Standards of Medical Care it. Di.abates(ADA). MEAN PLASMA GLUCOSE 122 URIC ACID 5.7 Therapeutic target for gout pat.tent.sr &6.0 mo/dL mg/dL (cele) 2.5-7.0 mg/dL UL HEPATIC FUNCTION PANEL PROTEIN, TOTAL ALBUMIN GLOBULIN ALBUMIN/GLOBULIN RAI'IO BILIRUBIN, TOTAL BILIRUBIN, DIRECT BILIRUBIN, INDIRECT ALKALINE PHOSPHATASE AST ALT LIPASE TSH ii/REFLEX TO FT) 4.2 2.6 1.6 0.5 0.1 0.'I 87 11 10 I ') 1.18 6.1-8.1 g/dL 3.6-5.1 g/dL 1.9 - 3 7 g/dL (calc) 1.0-2.5 (calc) 0.2-1.2 mg/dL OR = 0,2 mo/dL 0.2-1.2 mo/dL (calc) 33-130 U/L 10-35 0/L 6-29 U/L 7-60 U/L mIU('L Reference Range ()L UL UL or = 20 Years 0.40-4.50 CLIENT S ERV)CES: 866.697 8378 r orrmor SPHXo'AA484HEakgd&28IGgooo 0 rt,Q rDtagnottim,tkoowodat diag odoiiatoociat dQo otDmgoo&no srk r th t«de k. ofQoootD) g otirs. PAGE 2 OF 3 000067 Dmgnosncs Care360e Report Status: Final LIU, GUILIN Patient Information I.fU, GUILIN DOBI 09/15/1964 AGES 53 Gender: F Fasting: Y Patient iD: 09151964GL Health lD. 8573008178483387 Specimen lnfornlotion Specimen: SA360205G Collected: 06/23/2018 /08:29 PDT Received: 06/26/2018 / Oi:06 PDT Reported. 06/26/20i8 /02:24 PDT Client leformation Client ¹'0001374 YEH, GEORGE K Test Name In Range Out Of Range Reference Range Pregnancy Ranges First t.ris:est.er 0.26-2.66 Second trimester 0.55-2.73 Thrrd t.rrmes er 0.43-2.91 Lab CBC (INCLUDES DIE'I'/PLT) WHITE BLOOD CELL COUNT RED BLOOD CELL COUNT HEMOGLOBIN HENATOCRIT FCV NCH NCHC RDW PLATELET COUNT NPV ABSOLUTE tiEUTROPHILS ABSOLUTE LYNPHOCI'TES ABSOLUTE NONOCYTES ABSOLUTE EOSINOPHILS ABSOLUIE BASOPHILS N UTROPHILS LYNPHOCYTES NONOCYTES EOSINOPHILS BASOPHILS URINALYSIS, COMPLETE it/REPLEX TO CULTURE COLOR APPEARANCE SPECIFIC GR/VITY PH CLUCO E BILIRUBIN KETONES OCCULT BLOOD PROTEIN NITRITE LEUKOCYTE ESTERASE WBC RBC SQUAMOUS EPITHELIAL CELLS BACTERIA HY/LLINE CAST REFLEXIVE URINE CULTURE FERRITIN 4.2 4.91 12,9 40.8 83.1 14.5 192 9.9 2495 1391 122 8 59.4 33.2 4.3 2.9 0.2 26.3 L 31.6 L 181 L YELLOW CLEAR 1.006 5.5 NEGATIVE NEGATIVE NEGAIIVE NEGATIVE NEGATIVE NEGATIVE NEGATIVE NONE SEEN NONE SEEN NONE SEEN NONE SEEN NONE SEEN NO CULTURE INDICATED 13 3.8-10.8 Thousand/uL 3.80-5.10 Nillron/uL 11.7-15.5 9/dL 35.0 - 45.0 SO.G-100.0 fL 27.0 - 33.0 P'I 32.0-36.0 o/dL 11.0-15.0 140 - 400 Thotssnd/uL '/.5"12.5 IL 1500-7800 cells/uL 850-3900 cells/uL 200-950 cells/uL 15-500 cells/uL 0-200 cells/uL YELLO'W CLS:/LR 1.001-1.035 5.0-8.0 NEGATIVE NEGATIVE NEGATIVE NEGATIVE NEGATIVE NEGAIIVE NEGATIVE OR - 5 /HPF OR = 2 /HPF OR = 5 /HPF NONE SEEN /HPF NOliE SEEN /LPF 10-232 ng/mL UL UL UI, R PERFORMING SITE: UL OUES7 DIAG 'OS7ICSSACRAME lto I714tORTRGATEELTD SACRALIERTO CAWO4 llilTL h DD «M ROSE AI It,.ss D.ICA .CLIA Dsovsa Uc CLIENT SERViCES: 866.697 8378 mhlgpftfkkdSSVS SA360281tgsee. Q esl, Q sl Diagnostics, the sm elated 4 g d sg ss lated Q est Dlsgnectl s marks sre th Irsdcm Ark f 0 I ni gnmti .. I 8 g PAOF.30i'3 000068 (Wi Quest Olsgnostlcs Care360e Report Status: Final LIU, GUILIVI Patient In for lnation LIU) GUILIN DOB: 09/15/1964 AGE: 53 Gender: P Fasting: Y Patleot ID 0915 l964GL Health IDI 8573008178483387 Specimen Informatfon Specimen: SA360205G Collected: 06/23l20I 8 /08:29 PDT Received: 06/26/2018 /Cl:06 PDT Reported 06/26/2018 /02.24 PDT Client Information Client ¹: 6000i374 YEH, GEORGE K Test Name In Range Out Of Range Reference Range Fregnsncy Ranges Fire trtmester 0.26-2.66 Second trtrres er 0.55-2.73 Thtrd rrLmesr.er 0.43-2.91 CBC IINCLUDES DIFF/PLT) WHITE BLOOD CELL COUNT RED BLOOD CELL COUNT HEMOGLOBIN HEMATOCRIT MCV MCH MCHC RDW PLATELET COUNT MPV ABSOLUTE NEUTROPHILS ABSOLiiTE LYMPHOCYTES ABSOLUIE MOMOCYTES ABSOLUTE EOSINOPHILS ABSOLUTE BASOPHILS NEUTROPHILS LYMPHOCYTES MONOCYTES EOSINOPHII.S BASOPHILS URINALYSIS, COMPLETE W/REFLEX TO CtlLTURE COLOR APPEARANCE SPECIFIC GRAVITY PH GLUCOSE BILIRUBIN KETOMES OCCUI,T BLOOD PROTEIN NITRITE LEUKOCYTE ESTERASE WBC RBC SQUiu'iOUS EPITHELIAL CELLS BACTERIA HYALINE CAST REFLEXIVE URINE CtlLTURE FERRITIN PERFDRMIVG SITE: 4.2 4.91 12.9 40.8 83.1 14.5 192 9.9 2495 1394 122 8 59.4 33.2 4.3 2.9 0.2 YELLOW CLEAR 1.006 5.5 NEGATIVE NEGATIVE NEGATI'VE NEGATIVE NEGATIVE NEGATIVE NEGATIVE NONE SEEN MONE SEEN EIONE SEEN NONE SEEN NONE SEEN hiO CULTURE 13 26.3 L 31.6 L 181 L INDICATED 3.8 - 10.8 Thousand/uL 3.80 - 5.10 Ml.llson/'ui. 11.7-15.5 g/dL 35.0-45.0 80.0-100.0 IL 27.0-33.0 pg3?.0-36.0 g/dL 11.0-15.0 140-400 Thousand/uL 7,5 - 12.5 IL 1500-7800 cells/uL 850 - 3900 cells/uL 200-950 cells/uL 15-500 cells/uL C-200 cells/uL YELLON CLEAR 1.001 - 1.035 5.0-8.0 NEGATIVE NEGATIVE NEGATIVE NE ATIVE NEG/LTIVE NEGITIVE NE'.GATIVE OR = 5 /HPF OR = 2 /Hpi'R 5 /HPF NONE SEEN /HPF NONE SEEN /LPF 10-232 ng/mL UL UL UL UL UL QUEST OIAOTO 7'tCSSACRAMEA 0 77WRORltlOATCSLTO SACRAAIERTO CAmsn ml7L E «OO 'R ROSE AKU.I IO.TCAR CLIA Usollsllss CLIENT SFRVICFS: 866.697.8378 R«.c Ulsi&iCERhtB¹h.ghildttgBIOios Qocst,Q IDWL stirs,lh sescht dl E dell T A htsdQRR iDhaaosu s R kss Ih Imd ma ksstQ sslDI S tl s. PAGE 3 OP 3 000069 Miscellaneous 000070 iscel PREVENTIVE CARE% WOMEN Date of Birth 4 AGE Date sa I 1g I 2o I 2fl 22I 231 25 2$ 27 2L so ~ t 22l 22 I~ I WI 27 I g.s kL ~ I I I II7' I I I II' I + 'I I I I +- I I + 000071 Eoooo H . . _ llllliillggu _.I'llllfill. _ IIIIIIIIIIEI I . , s . am . %zmsoa ..,o I . wm<0w>_kzm>mmm ’.:‘p. cEm“o9mg .D. F 47984, M.D. Pages: 3 OISCLAIIAER: Thedoc rl(s)a cmp, y glhscommuncationca tainsmedicaoy ntendad for Ihe v. ol the ndividual or envly named above If you ere inlenr!ed res pent, yo are hereby noufed that any disclosure. copy ng Ibis iilformal o s stricdy prohibaad g you hav. recewed this infatmato ts retu Ths k you rlheauhi ~ forrnaton Tris nfomalon s ployee or agent respon ibis lo deliver I to the ion n resene. on m regording the conlonts of mmrdietefy so that we may ar ange lo secure 000072 Name PREVENTIVE MEN Date of Birth AGE 1 9 .19 20 21 23 24 25 28 27 28 29 30 31 32 33 34 37 38 39 40 41 42 43 44 45 48 47 48 49 50 51 52 53 54 55 58 57 58 9 80 Date 000073 meofmnha e H CARE E PERFORMING SITES All tests performed in San Jose unless otherwise indicated. UN)LAB LOCATIONS DC FR GH IiiIH MK OC PS RG SC SI SM 92 TZ 550 Washington St., Suite 100 Daly City, CA 94015 (650) 756.Z8'I 7 Director: David Yamaguchi, CLB 2191 Mowry Ave. Suite 5008 Fremont, CA 94538 Directors Howard I. Finkle, M D. Harold H. Brazil, M.D. 3002 Leigh Ave. Suite 100 San Jose, CA 95124 (408) 278.3658 Director. Jeffrey F Young, M D. 500 E. Calaveras Blvd. Suite 100 Milpitas, CA 95035 (408) 719-9762 Director: Juke 8, Chan M 0 16'I30 Juan Hernandez Dr. Morgan His, CA 95037 (408) 778-8425 Director. Julra S Chan, M D 227 North Jackson San Jose, CA 95116 (408) 258-0348 Director: Juha S Chan, M D. 205 South Drive Suite G Mtn. View, CA 94040 (650) 968-8852 Director David Yamaguchi, CLB 295 O'onnor Dr San Jose, CA 95128 (408) 295-0392 Director. Robeil M. Rinehart, M D 770 Welch Rd Suite 181 Palo Alto, CA 94304 (650) 3Z5-4096 Director. Jeffrey S. Young, ivi.D. 2999 Regent St, Suite 100 Berkeley CA 94705 (510) 848.8452 Director: Samuel Spivack, M 0 3714 Northgate Blvd Sacramento, CA 95834 Director; Gerald E. Simon, M.D. 212 San Jose St., Suite 100 Salinas, CA 93901 (831)424-1432 Director. Warner J Stamm, M D 2516 Samaritan Dr. Suite 8 San Jose. CA 95124 (408l 356-9154 Director: David Yamaguchx CLB 3311 Mission Dr. Sania Cruz, CA 95065 (831) 476-9364 Director Kenneth W. Westphal, M D 18408 Oxnard Street Tarzana, CA 91356 Director: Paul Wertlake, M D WK CC CP MY Nl NM PT SP UC US 110 La Casa Via Suite 220 Walnut Creek, CA 94598 (9251 930 6897 Director David Yamaguchi, CLB Coagulation Center 3023 Summit Street Oakland, CA 94609 Director: Mervyn A. Sshud, M.D. California Pamfic Medical Center 2333 Buchanan St San Francisco, CA 94115 Director: James L Benrsngton, M D. Mayo Medical Laborato:y 200 1st Street, Southwest Rochester, MN 55905 Dnector. Robert Kisabeth, M.D. Med Tox 402 W. Country Road St Paul, fvlN 55112 Director: Harry McCoy, M.D. Microbiology Reference Lab 10703 Progress Way Cypress, CA 90630 Director: Wayne Hogrefe, M.D. Guest 33606 Ortega Hwy. San Juan Capistrano, CA 92690 Director: Jerald Nelson, M.D Nahonal Medical Services 3701 Welch Road Wigow Grove, PA 19090 D. t Fi h t Midrlleliarn M D Pamiic Toxicology Laboratory 6160 Variel Ave Woodland Hills, CA 91367 Director: Olivia Stirison, M.D Specialty Laboratories 2211 Michigan Ave. Santa Monica, CA 90404 Director: James 8 Peter, M D UCD School of Medicine Dept. of tviedical Microoioiogy Tupper Hat, RM 3144 Davis, CA 95616 Director. Demosthenes Pappagienis, M D UCSF Spec Coordinators - Lab 505 Parnassus Ave. Rm L521 San Francisco, CA 94143 Director. Stephen Cohen, M.D 000074 Lifeguard September 10, 1999 George Yeh, M.D. 58 North 13 Street San Jose, CA 95112 Re: Patient: IDg: Date of Birth: Group: Rx Plan; Lamisil Guilin Liu 62480641501 09-15-1964 4852 RX510 Dear Dr. Yeh: Thank you for providing your patient's clinical information. We are pleased to inform you that reimbursement for the medication listed above has been approved. Payment has been authorized for three months for your patient. Coverage is contingent on the patient's continued eligibility with this health plan. Please be assured that Lifeguard is at alf times concerned with focusing on treatments which can improve a member's health in a manner which presents the least risk and greatest potential benefit for our member and in keeping with objective medical standards. Sincerely, LIFEGUARD, INC. Ron Salas Pharmacy Benefits Department cc: Guilin Liu 6t5 PO BOX 5506, Ses Jose, OA 95150-5506 ww wiifeaomd oom 400-943-9400 000-995.0300 &ooesioeusxltsw coos) 000075 GEORGE K. YEH, HI D INTERNAL MEDICINE TOS N. WIHCHESTEA SLVO STE A SAN JOSE, CA 95128 I aIII requesednq a physical examination, which may or may not be covered by insurance. 000076 . H, MD. N EDI ma . IN R B D. 3 5. 3 M ose. 3 m g E g ysi a l inati n, hi a a t e. omelflofl 20/6 _ Signature: GEORGE K.YEH, N.D. I am responsible for the charge of all the tests requested by me. Some test are not covered oi only partially covered by t.he insurance. Date: JAy p~'D~g 000077 . , M. . 1 si C l e. e t f l art e. ate: GEORGE K YEH, M.D. INTERNAL hlEDICINE 706 N WINCHESTER BLVD. STE. A SAN JOSE, CA 95128 I am requesting a physical examination, which may or may not be covered by insurance. Date: " I'3020ig 000078 , H, . . {N MEDI . wa H D. s_T . ose, s n ysi al e ina ti n, hi a a t b y e. Signature: ,QuzLi/rm AUG 3-0 2015 ate: GEORGE K. YEH, M.D. INTERNAL QEDICNIE TOS t4. %'NCHESTER SLVO. STK. A SAN JOSE, CA 95128 I am requestinj a physicai examination which may or may not be covered by insurance Signature: l&(07 00007g . iN fi M mCEN 706 : . Mucnesma B D 97!: ose 3 esti g ysi al in at hi a a t . ignaturelrp_&p}f wbmw WImZ 7/012. 6 9 Pathology Reports 000080 at eport p9 4 Pathology Report 4Caipath il/ledical Associates100-C Albright Way, Los Gates, CA 95032 tek (408) 886.LABS (5227)patnologists; D. Berkeley MD, B. Douglas MD, J. Gonzales MD, M. Ranchod MD, R. West MD Sex F Reference LIU29642F Troche fr. sess»re OPT 0-000928 DOEk Collected: 9/15/1964 Oi/21/2010 Received: 01/21/2010 ComPleted: 01/22/2010 Physician: Location: YU, ANDY ~ OFFICE 2101 FOREST AVE STE 106 SAN JOSE, CA 95128 DR. ANDY S. YU FOREST SURGERY CENTER SPEC: GASTRIC BIOPSY, cc: DR. ANDY S. YU GROSS: The specimen is received in formalin and is labeled "gastric biopsy'. It consists of three pieces oftissue measuring 2-3 rnm. Submitted in toto in one cassette. An Alcian yellow stain is requested. SH:mjb 01/21/2010 MICRO: The gastric biopsy showS unremarkable antral and oxyntic mucosa. There is n» chronic gastritis,mucosal ulceration or intestinal metaplasia. There are no Helicobacter pylori organisms. DIAGNOSIS: STOMACH, BIOPSY - NO ABNORMALITY MR:pfi 01/22/2010 Dr. Mahendra Ranchcd Page 1 of I OPI 0-000928 000081 RUN DATE; 07/11/16 0 PAGE 1 RUN TIME: 1408 GOOD SAMARITAN HOSPITAL 2425 Samarrtan Drive, San Jose CA 95124 DEPARTMENT OF ANATOMICAL PATHOLOGY pathologists: Rajeev Bala M.D., David Berkeley M.D., Salma Dabiri M.D., Bruce Douglas M.D. John Gonzales M.D., Mahendra Ranchod M.D. PATHOLOGY REPORT Patient Medical Age/Sex(Room/Bed'5/64 SPECIMEN¹: GO: SP: 167 003420 Collected: 07/07/16 Acct ¹: M00352770448 Doctor: Chen, Ling P MD Distribute to: Yeh,George K MD 706 N Winchester, Ste A, San Jose, CA 95128-1524 COPIES TO SELF REFERRED Chen, Ling P MD Yeh,George K MD SPEC1MEN: ENDOMETRIAL CURRETTAGE GROSS DESCRIPTION The specimen is received in formalin labeled "endometrial curst.tinge" and consists of mostly blood clot with a small amount of pale soft tissue with a total volume of 40 cc. Most of the tissue rs submitted in three cassettes. DB/ee 07/08/16 MICROSCOPIC DESCR1PTION Sections show blood clot, benrgn endometrial polyps and some shedding endometrium. There is no atypra or hyperplasia. DIAGNOSIS BENIGN ENDOMETRIAL POLYP6 WITH SHEDDING (ENDOMETRIAL CURET AGE1 DB/ee 07/11/16 Signed Original on File ) Berkeley, David H ,M.D. 07/11/16 * END OF'EPORT 000082 RUN DATE: 10/18/17 PAGE 1 RUN TIME: 1358 GOOD SAMAR1TAN HOSPITAL 2425 Samaritan Drive, San Jose CA 95124 DEPARTMENT OF ANATOMICAL PATHOLOGY pathologists: Rajeev Bala M.D., David Berkeley M.D., Salma Dabiri M.D., Bruce Douglas M.D. John Gonzales M.D., Mahendra Ranchod M.D. PATHOLOGY REPORT Patient N e: LIU, GUIL Medical Rec~071574 Age/Sex: 53/F D /64 Room/Bed: M.299-1 Distribute to: Yeh,george K MD 706 N winchester, ste A, san Jose, cA 95128-1524 sPEcIMENS: GO 1 SP 4 17 1 005073 Collected: 10/16/17 Acct 8: M00354306916 Doctor: Chen, Ling P MD COPIES TO Chen, Ling P MD Yeh,George K MD SPECIMEN: UTERUS, TUBES AND OVARIES GROSS DESCRIPTION A single specimen is received in formalin addit.ionally labeled "uterus, bilateral fallopian tubes and ovaries" and consists of an intact hysterectomy specimen with attached cervix and attached bilar.eral adnexa. The hysterectomy specimen weighs 518.8 g (post fixation) and measures 14.5 cm fram superior to inferior, 6.5 cm from cornu to cornu and up ta 6 cm in thickness. The uterus is globoid in shape, in keeping with a large int.ramural leiomyoma located at the lower aspect of the uterine fundus/lower uterine segment. The cervix is variably effaced by the lower ut.crine segment leiomyoma but shows an unrema.rkable ectocervix. The ut.erus is bivalved to reveal the aforementioned intramural leiomyoma, measuring 9.5 cm in greatest dimension, located at the lower uterine segment. The endocervx.cal canal is compressed by the large intramural leiomyoma but shows no focal lesions or polyps. Representative sections of cervix are subml.tted in cassettes A-C. The large intramural leiomyoma is serially sectioned to reveal tan-white fibrous cut surfaces without areas of cystic degeneration, hemorrhage or coagulative tumor cell necrosis. Representative sections of the large intramural leiomyoma are submitted in cassettes D-H. The uterine cavity is markedly deformed but shows a thin endometxxal lining measuring &2 mm in thickness. No polyps or masses are identified within the endometrium. Representative sections of endomyometrium are submitted in cassettes I and J. serial sectioning through the remainder of the myometrium shows occasional small intramural lexomyomas ranging in size from 0.3 to 0.5 cm in greatest dimension. Representative sections of small intramural leiomyoma and endomyometrium are submitted x.n cassette K. The right. ovary is tan-yellow, lobulat.ed and measures 3.5 x 2.5 x 1.5 cm. The ovarian capsular surface is grossly unremarkable. No focal lesions or papillary excrescences are identified. The ovary is serially sectioned to reveal a single unilocular cyst measuring 1.5 cm in greatest dimension. The CONTINUED ON NEXT PAGE ** 000083 RUN DATE: 10/18/17 PAGE 2 RUN TIME: 1358 GOOD SAMARITAN HOSPITAL 2425 Samaritan Drive, San Jose CA 95124 DEPARTMENT OF ANATOMICAL PATHOLOGY Pathologists: Rajeev Bala M.D., David Berkeley M.D., Salma Dabiri M.D., Bruce Douglas M.D. John Gonzales M.D., Mahendra Ranchod M.D. PATHOLOGY REPORT &Continued) Patient Name: IIU,GUILIN sPEcIMEN ¹: GO: SP: 171005073 GROSS DESCRIPTION internal cyst lining is smooth and shows no focal lesions or papillary excrescences. The cyst is surrounded by grossly unremarkable ovarian parenchyma along the periphery. Representative sections of cyst and ovary are submitted in cassette L. The associated fallopian tube measures 7.5 cm in length and is fimbriated at one end. The external surface is unremarkable. No adhesions or focal lesions are identified. The fallopian tube is serially sectioned and no focal lesions are identified. Representative sections including the fimbriated end are submrtted in cassette M. The left ovary is tan-yellow, lobulated and measures 3,5 x 2 x 1.5 cm. The capsular surface is grossly unremarkable. No focal le tons or papillary excrescences are identified. The ovary is serially sectioned to reveal unremarkable ovarian parenchyma No focal lesions or cysts are grossly identified. The associated fallopian tube measures 8.5 cm in length and shows an unremarkable external surface. No focal lesions or adhesions are identified. The fallopian tube is serrally sectioned and no focal leszons are identified. Representative sections of ovary are submitted in cassette N and representatrve sections of fallopian tube are submitted in cassette O. SD/ee 10/17/17 MICROSCOPIC DESCRIPTION Sections of the cervix show ectocervix and endocervix with no specific hzstopathologzc abnormality. There zs no squamous dysplasia or glandular atypia, zespectively. Sections of the e .domet rium show unre nazkable proliferatzve phase endometrium . There is no atypia, hyperplasia, or carcinoma and endometrial polyps are also not identified. Sections of the myometrium show a large intramural leiomyoma without increased cellularity, nuclear atypza, increased mitotic activity or coagulative tumor cell necrosis. sectzons of the rrght ovary show unremarkable ovarian parenchyma with a corpus luteum cyst. There is no atypia, neoplasia or malignancy. Sections of the left ovary show unremarkable ovarian parenchyma with a raze cystic follicle. There is no atypia, neoplasia or malignancy. Sections of both the right and left fallopian tubes show no specific histopathologic abnormality. There is no atypia, neoplasia or malignancy. A small paratubal cyst is noted. ** CONTINUED ON NEXT PAGE 000084 RUN DATE: 1,0/18/17 PAGE 3 RUN TIME: 1358 GOOD SAMARITAN HOSPITAL 2425 Samaritan Drrve, San Jose CA 95324 DEPARTMENT OF ANATOMICAL PATHOLOGY pathologzsts. Raj eev Bala M.D., David Berkeley M.D., Salma Dabiri M.D., Bruce Douglas M.D. John Gonzales M.D., Mahendra Ranchod M.D. PATHOLOGY REPORT I'atient Name: LIU, GUILIN (Continued) SPECIMEN 8: GO) SP(171005073 DIAGNOSIS UTERUS, RIGHT AND LEFT OVARY AND FALLOPIAN TUBE, LAPAROSCOPIC VAGINAL HYSTERECTOMY WITH BILATERAL SALPZNGO-OOPHORECTQMY CERVIX NO ABNORI'IALITY ENDOMETRIUM UNREMARKABLE PROLIFERATIVE PHASE ENDOMETR1UM MYOMETRIUM INTRAMURAL LEIOMYOMAS OVAR1', RIGHT AND LEFT OVARIES WITH FUNCTIONAL CYSTS (SEE DESCRIPTION) FALLOPIAN TUBE, RIGHT AND LEPT NO ABNORMALITY SD/ee 10/18/17 ( Signed Orrginal on File ) Dabiri,Salma ,M.D. 10/18/17 ** END OF RRPORT 000085 Progress Notes 000086 r gr ote ,Ca'/- ~ STV IES ORDERED: George K. Yeh Ltn IVledtane / Hemetn(nn ~a Tenn 13th Street San aose, I 'A 951 12 TREATMENT OUTLINE: RETURN: & J(r / t "a( "% / (g/)p// ' / /' / I I/ nmy + ay, 000087 ywséwzw . ‘ ‘ eor . e M n. ;nrernal Medici e at ob North t tr et d uose, CA 12 UTLI E: RN: Q)><\Q’W ly/yI/én/V 0_ fEFPBMQQE‘ /}D\ {O/M 7 - ”W-JM (MW M‘ WWWW ( ‘(W/wwl l. NAME ADEREEE Ca~G /T CONTINUATION 1nternal NII-~~ BEE NAAN ' E I .A Q5112l~ IMan, 7d J /I v'~~ /~4~ ~ raJ-4rh~~ nM, c/T " /EE: rt il nz i E( ~ /pl n. / * ~l 000088 TI TI D ESS 000089 SIONIWWI 'N9IvawvH3 ‘swaLSAs 113M103 0628 wuoa CONTiNUATION F&OS ZUU1 g w X.,XM ~n F QPQIIIjit X. TPIIy WI,LL IIIIIIIIIaf iiAIII!ICIIIii I ri&lllclllJiiiIIMAT~ L C Oo liv~"" '" s-CAAQ42 /6' i / in n n C7 d III II' if 'lflN /Q Jv /OII/ / /ii i i)~ x. vvug j/~ gc O M wA 000090 - .4 GEGRQEtt.vt:, intetnal tueeane i~tt, 5tt Nolui iu~itfeet abut J~~tE- lou 000091 W CONTINUATION ~mpkSRGF K.'ffH, M.Q. ) Medicine I P(e()T5 QYIll~ F()I Te(n Qrlesmr58 pic JCee Urv 'Q5& 2 ~I v r .. HJ~JL, ~~l /W 3-K0 - -I . ~~~~. p d' (7 I ~~i) a eS /E ( r.c2l 7+ S '' '/ ~. ~4~ ROS. Fever(~Chills( ) Wt loss( )-Polyurfa(~Thirst(~Fatique(~ ul I I Seizures~rotten rorno~ Vcmittineg 'I Biarrh. (~Const(on, ', --'iveriinv( nysuria( ) Llrglwoy( ) Hl.sitancy( ) Hematuria( ) Hoccuria( ) Periods( ) Last pelvic( ) Last mamma( ) neorcar.rona:on 0 c. Skip,-~P pier (~JEundipe~ Cyanosis ( ) Head, ~ PERLA(Q- Fundf( ) EHT( ) Exudate( ) Lmpph-nedel-~ waarine(=)=v'i's'Torii, P)lyroidsl ~'ses, L-)- Heart,(--d ~~ Murmurs( ~ GallopsM Abdome~ ~/~anderness( ~ Liver( )-- Spleen( ) Mass( ) ~ec al~) ~rosmare( I Iendulez( i I laces i j ~trim( n/6. N - u~ I~ 000092 nvYtobago. /6 la I I . I R~g'7~~''Q l Am~w PA~ v sr. ~URGE K."~".™.". /, q PP L '~ M g Medjg'Ige / PIIIIIcIIUIUQ) 66 "'~~ S8fl dIISa mA 9R42- 'nn. ~~ V niDAu A. '~ ~ n ,. (/ /( " ~, ~pM~~Q~Q,( ~vz'M~ Ar~ wm 000093 ~ / J' Cl( ('L.) N r mcul p"rr 0 eaosaaz,vaw.u.o g/ cp c, / d z ~ ~ 'NTERNAL MEDICINE ~~~ dpyc" W 'i0/& d'OS,'ever( c~nTTln( +-wt 1Vissi ~puiyuci«i ~ H vl eton(~ uw ezJJI~cnar W Chest cain()- Hemor tvsis(-)Paloitations(-) Hausea( ) Vomittinp(~ Diarrhea~- ConstiphtionP-)Bleedinv( ) Dysur(s~) Urgency( ) Hesitancp~wematurta( -I nocrurlai . ~jV ) Medical~~ 0: Ski~n, / Mr(cu- Polar( ~ Jaundice(M Cyanosis(~ Head, ~ PERLA( M FundtT-F zoll~ Gallops( ~ I I nwoddrm r A: ~c) 7~Ii SP dz P. &~. rt dsvm(=h On~ ( mrsiil r Itic Headache( ) Dfzzin~eea ) LAC~Seizures~ Blurred vision~ CouShP)d-Wheezind(~ SOS~ Chest pain(~ Hsmoptysie(-)Palp(tat(num(- TT i Po I da( I I ~+„I ( I+. ~ --( Medic dc'Inn. Or okl ilc~ I'acor I- I J aunclncm( I 1 yanoelmt-). L~JLJInde. ~ I oI 'I VI - -yhyroida, us'11tlps t~ Ext, (~ Edema(~- Pulses(-+ 000094 8 lUUU (A-, L iy" GATI~TN z-4B GEORGEtK=.YEK-.-MtD. NAL MEDICINE~OB FFJIF(HCHESTHR)TEVEFST~ OAF)-deca-'emgtgg- t Per(elute ~est peivrc~ ) ~emmet'--~tton~ O.'Skin C EBA. Paler(~ Jaundice(~Cyano is(~ Heart,(~ Am gM. Ot MAR IIE TH(IS "-2~ E'min T t 7."F (Ii~ -J i LrgA ) itationa( ) ) 1 C-5C ,i JP, Thyroid Heo c p~L a Hectel. oen(u artu& (n n nne ~ e ~J-CtctliH(-k-W „ t Headactu+) oizzinessat-B ~I.oc seizures~( Blurred yisinn(cough~ wheazinggg sog( ) cheat nein( ) Hemontysie( )Palo Hedications: -Reae . ~a o J Jauriolcoe uyanosra~ * s P') ()Uwy JJ) o~ n Y w~~e--(:o& ~ ~M~p.V/ rlUrlllur(( z t st to)vs\ ) ( } Proetati ' vro ( Ext, ( ) Edema( ) Pulses( ) .Hc '. i awwcoc eral Iw 000095 ADDAEEE i iu, &~i Lin IRIEE~I.,~I-;- ~R IIIII a ~e'y GEORGE K Y nenthrrtm ~~ziRIe vv+-)-.~ 1 ~~LIErxed v I E 1 nn ( I Ches~ain( Mlrmontvsis(~patottstton~ Nausea~) Vomttttnx( ) Diarrhea ~ Constipbtton( yt(leedtnB(~ Dysur(AF)) UrgencyJ ) Hesitennry n Hematurta ~Decurtate I i Perto~s ~ast petvtct i Lvsc -mamma+ -~ ttstticvctrnrs-. fl 0: SktnI~Pator(~ Jaundice~ Cyanaet~ Head, ~ PERL,A( ~ Fununt~ ~Lymp n~oe, n e Err i~~FEsdmrr(-t~ Heart,(~ Murmurs(M E/ I v:Il )vV ~ i ~EP . II Mi(Y n 6 )nnt) nc. M~b dl c) J-aLz-4aarv(-k-PRE-Ly""' d-vet(- sd)ey) LOI;( ) Seizures( ) Blurred visian( SOB)P-') Chest pain(tdT Hemantvais( )Pain(est io,sr, ) "y's BP9 Dtarr'hl'Rt ) ConsttpattnnP29 Blesdfnp~) e-LA~Iaaaaad-Pettnder Meditations I (.. Headv, ~PEHLEL-(,'vamh-nnde. IO H A ) oI 1 vr~~~~ Thyroide, (.attapst R E./3 EJJ R~eccel ~ prostare&~~dttlemb) T EE AI t Eat, () Edema( ) Pulees( ) Neet'0 '( ) u I I EEII I~ mm IXEWED. I ED III I 000096 LILA, (n{Ai M 6 K}K KKKK }I K. VEK gJ} L MEDICINE Wt%- 000097 Q U @UUMV)1 m; éfiONT'NHfiTPfiFI‘/ GEORGE . YEHLALQ. .JANmmn ‘ f/éfi’b‘g“ ' ‘ MAL EDI I Pk T . £0) Constiphti ”Bleeding“ 5 Dys ria( ) Urgency( ) Hesitan y_ ) Hematuriag ) Nocturi‘fl 1 Periods< I~ st pelv1c( I Ldst-nra ) ‘ . fl J diceffiCyanosisfi0. Skin,fl Palom aun WM“Head, PERL Fund}? ) ENH )/W Lympfi noaefg } Murmurs( ) Gallops( ) . Headachfl) Dizzinesa(~J-LOC§_k Seizureflfi’ BLurred v-Lsinnifi’CoughQJ/Wheezing-P) SOBI“) Chest pain-K) Hemoptyaifl )P_alnitationsc(_)Nauseaj/Womfitinygmiarrhen(fi/ConatipatinnP-Blnedinpé-éfi WZJVQ "55% 0' 5“”5 “b” Parork-d‘ Jaundicrrv Lyanosisw- l L c Hesdw 4i Wfi/ W) W . z H l C - p g‘ I Thyroids, L) Rectal; )' ' Exc, 9.)»- _ ' Emma.“- msem _ Neuro,F’)’ . ' I .. m I ‘ ‘_ .‘ . V I, I ~ I ’ > --------’--_'--.’ ‘ ' - - '- v r. ,. - . _ = . III - ' WE“nmcm comm; Loaommuo . (1//I (i Ff 'NIIA I ~,W GEORGE K. YEN. MD„ m me . dhvf /E l 'r IIITERNAL MEDIGINE f(C()ESTER~ Nv Ymca IM l~ef~e( m Rl „~ x~vnnew l ~ T " I ( & ux I t 1 cne( 1 chest nafn(--) Hl mor tysfs~velo1tatfor(el ) Nausea(~vomfttfnp(-) Dfsrrhea(~Constfpht ion( )Rleedfnp(~ CD IT, Dysuria (W Ur i ncyT ) Hesitancy( 1 Rema turret- / noc curfEC(P Perfods f Cess ~pe v c (~~vGalelmr(- Tl e dfut(sfuTTE-. ~DI,Skin,fff~ ValorC ) Jaundice(-)- Cyano 1o( ea A Heart,E ) ~ Nurmurs M Gsffopla~ Abdomen,(~ .nllernassl -). Lfver( p SDAGN i c~/ A A: y'FZ/P.C) I \ g Af Ub( " U~~ ~+R /mfn RR /mill T "F 3. n/i~ ( Couph( )yWheesfng( ) SOB( ) Chl.st nein( ) Hemoptvsfs( )palp(tat(one( ) nauseal ) ~nm tt DF.(~arch .R( ) Const1patfn~Y )Rleeclfne,( ) ) P rl .I ( ) loins AefAAfm( grimm I Nedf cd t fons; np - .K1op~~sun 1ce(pr uyanospm~ nor" Thyrofde~( ) ~'I ~ I/ Ext, (yP" Edema(Q Pu1ses~j rt ~L J N m 000098 N GE AOO EEE GIL re S~ )) r CU IL GEORGE K. YEN.M.O. INTERNAL MEOICINE ~CNMTEIRICVlfvrzz QIGE ROST Fever( ) Ch11(~soss t~ rI'auh~&drz(RIG~' "' . = r TIrm~ RI » d. v tnrion~ -Ceugh~ing~JII 'r Ches~to An(armor tysis( ) palo&ratio~ ittinp ( diarrhea( ) constiphr ton~ee~ritn,"' )Me~s~pe vtcl I G~P-)- I'IL u Atst n ,. C(CRI ead, hyrolrts, Heart,(~ ~, Hurmurs(~ Gal)OP(N(-)- I T u I ( Y rarer LrJ OaunIFFCCG re Lyanosls N-I n or 1 9 PR(y (t P /(~ (Olin &min 7 ( r( F ( i' „A,~=~~~ (P"~~ 7 dr' "(p& M~XW ~ use- n ~u RO-' Eauazgrd~ d(z-Loss '-1"--1st'n~dmat-(-) ~ezi()uo(~ - ---I Headache( W Ilizzi 'EGG~~COO ~eizures & ) Blurred vision( Cough(~d(heeztng( ) +OB( ) C&est pain( ) Hemontvsis( )Paloitations( ) P r( TI ( ~Z -mammo-(---.)- Hedications: Xr Thyroid, ( ) Lungs, (RRF I 7 Hurmurst u 8 I. A 0 p a 1 Rectal ~) Proats~vndut *Q~ Edemtt(') Pulses( 3 000099 REER MAR A)I 7()R s:C ~ft f 1 f-'s ~ L(i()L, (7(y(/t L1~ l/RONT)NL(/AT)/DN ~ ~ GEORGE K YEN M D )T)TERNAL MED(CINE 7 DD~NCF(ESTBFELV~E, A~~M-d()8~ESP()- fir. nm .(-)-Lf)C&~e-Lsderea~glnr~ Chest Rain( ) Hf mor tvsis( )Palo(tat(one ( ) Neuse ) Vomirerng(+ Diarrhr s ( ) Const ipbt ion( ) Bleed~ling Dysu. (ss ) 1JreencyC ) Heeiteney~e~matur a( ) Tfocturra( i )periods( ) l.ast pe~v c( i i.ast-manr Mad 1 c d c * v ./)A JL- J mo((yl gkind w Pa)or(n1 Jaundice,f cyano~a( ) Headgear PERL ( ) Fund(( T onf~ ' '« ~ .( LfeT ~Hear t, Murmurs( ) Csllope Abdomen,~( Tenflerness~ 1lverrr ~pled r~ ~n n. A '(sr(Se~ . nMyzdC- g~ r/o 'm ! f /~/a- l n 'Jgfs SP(( C)//T ~R /min RR /min T "F ~/)- p )E He&ache~ Dizziness~LCD( ) Seizures~i Hlurred vis1nn( 3 Cough( +Nheezin~OK( ) Chest nein( ) Hemontvsis( )Paloitations ( )Naiiseaf~ vom~iting~lu1arrht R( 3 conetipatinr~gleeding ~arLode ( i l a~e Lv tc/ -) I~a mamma.( )Meorcsriu ls;~a oOOZaun~(j uysnos)drt ) ~~ve(- Thyroids, (P ~Lffngs m /yn'/ R 1 () Pares J! l ) Nnd LLSSLC( T~r/ l ~arne ( l Edema (n) Pulses(n) /c/' E«CC EU m cede 000100 ./ XW 000101 /Spv y i-r I-h ~~(iu Cei Lte /„,. Qo»i~&lf&/v 'r + GEORGE K. YEH, M,O.s~~~ (NTERNAL MEO(ClNE , Ito|nm mecnrzeooneee 'deem-emg)R(t o(+ cne( ) Chest oain( ) Heraontvsis( )Palo(tat(one( ) Nausea( )~om(ttinj~(Diarrhea( ) Constipht ion( )Bl~serlfnp, Dysurl/t( r)y~rgency( ) HesftsncyyHimaturta( / nocturrei i dhcshhons-. s hy i I/+ I( t, (~) Murmurs( ) Gallops(/tbdome/i,(A'endernesgh ) tzvert / opreeni i 4 C n A F~/ m &&&J'i Y p - ./I / //'(~W 75P /(co / 'PR /miln RR min ' / Lry . ctrv (,( /~l.../J- '/W~~ h( 0 8 2()(54, I,, Heads h ) Dizzin'ass( ) 10&+ ) Re/sures( Q Blurred vis(On~ I Courh(/) Wheezing( ) SOR( ) Chest pain( ) Hemoptvsis( )Paloitations( ) I cl „Nedicgtions; (l)/( (I l x/ C ) Trv"~v ""u v 3 " ~r ~urmursi / uerropst ~) Proarate( ) / Nnrl Iee/ ) ro r ( ~rn& ( Edema( ) Pulsesg ) Neuro, ~ T/~~ ~w ~ .. Mn1/ (- e ~ " I/; m ~l co e N e»e QnP, // ((--f,(t L-Im Coma: I -,. r ~~ r r oo r r. v rr'E()R( Ã tl VESS Ae 11 ~AN 2E )~r . ~ - L C3, INTERNAI RBE()i(.'ihip'W/ 3) ngu~ -grti 4~ N W(HCHKSTER8LVD STE A //j SAM i/()68, Q//1( 88188 Ros. Fever( / chiglsI)///t~( )/polyuuuep') Thrrrati 1) tattq~u Heaoaone( r/irlssrneesiijj guin i svTxrr/ . r ~" ~ ' o ~ i+/ ~ r I +r.i m ~ r ( 1 u - I I '111 1 Irarinns( 'I o( UDI azzhaa( 'I /constipation( )Hleedinp( ) Dvsurie(/) Urgency(r7 Hesitancy( ) Hameturia( ) Nocturia( ) Periodic( ) Last pelvic( ) Last mamma( MeelcatlOne: (~E ~/rq n car s lor/( I Jeutu)ice(/) Cvenosirf( ) Head( Q PERLlA( ) Fundi( ) r ENT( ~) Exudate~ Lymph J(odor ~ Hearing( ) Vision( )Inyrolcs,/( I/ I ar 1g ('i'nrmurs( J- Gellops( ) Abdomen,( 4 Tenderness/ ) Liverr( ) SPLaert( ) Mites( )~ Rectal,( ) Prostate -) Nnculea I I Iascesl / sama« i i'"" '/ 4 ~ ~ /4~~y MCA~ ~ (/ ~u tV% ,. K /L..r CA . O/ I ' S I~ (gd(/g/m I ('-)4P" (! ///)'g I MW&a/ / '-,, /u a.h/~ W:w ~3 I Au../tr .I, 1 ~ter . V QBP / 4PR /minRR I /min T 'F ~ IKill= I / ri M~& ~aM,J I . y///Ac 4' //I 3/ I l,/ a /, r lv/g- y'g e'- -g '~ rc/~ tv~ ~' i I rulyuraair I lnlrstl ~actque( I/rl Head h ter-nr 1 ooI I mr r~ ~ .. r M ~ .. ~ ~ ~I7~ g( I Cough( 3 Hheasind( ) SO)L( ) Chest cain(~namnntvava( Nausea(~ Pomit tinp~Dierrhaa~onstips tion( ) Bleeding( ) oyaurlal, -I urgency( I Iiesltancv( ) Hamsturis( )~courts( ) '/? - /c / Medicationer 1 i r v i lriamlllr 1 @ //(/ OI agin, ~palorCpp JaundicdT ) Cyanosis( ~~PE~ I uncl~ ENT( ) Exudate(~ 1 4 e- / o'8/- - - 'Zhvroide.- (-)/ 'ungs, g/Zg v'/ r~ r ir 1 rlc Is i j nernla( )Eat (M . Er(arne( I~ 1r 1 f~ Qn/ Nacre, (~ AI ~j/r ++ i ~ r ~r/ n 000102 Exudate(~ BnP, 8 ( (--~ j -1 m (-11.: ) T I QE()RAN k'/cai Aa n '.)AEL552I5i~ .~ - i. Q., )NTERNA( MS()(C(FJF:/ ll „ ~ »4 J~ W. WIECEESTEIIELTE STE S- g- // F - pg mm)v diyga, cy DBTED f .,g ~~~ /w/ + RCS I Fever(?'hi?les )»)It~( )/Epolyuj'fa?E') Thlrrsti q»attq~u Headeyne( v lllzlrnessL»ij mLIIEL j WELcu/ I ~ d Mi L m * S ( 1 4 ' ERI IR 1 ITSTI one( o I UDIS Trhwe( ) /Cnnatiuat inn( )Hie»din»( ) DvsuriaC/) Dr~one (/5 Hesitancy( ) Hemstutia( ) Nocturia( ) per iodlr( ) Last pelvic( ) Last mammn( ) ] ~ v'edicati,one: I n. RRI peloE»I I Jaundice(/) Cvanoaisr( ) Head(»» PERL»A( ) Fundi( ) r ENT( ~) Exudata( ) Lymph EfodeI~ rnyroros,p 0 8 '" Mltrmurs( Gallops( ) ( 3 Abdomen,(») Tenderness»( ) Llverl( ) spleelt(. ) Ness( ) ~ Rectal,( ) prostate{ ) Nodules( I Lestee( r neflrce( j RXCI 1 /I'44~El I E» . r/(@C4r&~ rl(4g,gdds» E'/ t»~ I /(.- » ( -( HI~a I S (~ CvdboDmj 6-? X «3~~~ ()7rt% l~~ l /i... Zu(Jm ~ ~~r 1.It» .I, 1 WVC»~ . V QBP / v PR /min RR / /min T 'F ~ /'k/~6--- .-' /~ I» »/ '~W~m~~ .Z' i.) / ) ri " y//m (/ ~~.//('3 / / / ./,.I /v///- » /wda. ~ ' pJ~ ~ v~ +T 4 * 1 l »uzyurta YI Entrsti~attque( )/E/ H d b Mns s ~ 1 InI Ta c I .. T f '1A»//Y Cough( 3 NheeainG ) SILE( ) Chest nein(&Hsmnmt~~~E*t lw ~ I I Nausea~(FETmittinp~Disrrhea~onstipatinn( ) Bleed ink( ) Dyi»uriat I ur»»ncy( I Hesitanl.'y( ) Hwmaturia( )-Noc"; ria', . /« ? Hgdlcationel li~»'. (A ol skin, ~ PRlorCRP- JeundicdT ) cyanosis( ~ ' ~ T'r nunl«y ~und td I4/''4 / Thvroide.- (-)- d /'ungs, Nesrtv(~ Nurnero(-y -Dusk-1 epE»(-)(»'EIwn 1- i Lwnnarness(~ Liver~ Spleen++- Nasa~TE/Pw' t»l~ R I l 1 4 nero&.at I dj ts? Nauru,(~ M)/~+a . 000103 nelni«( ) I~3 /UI) l n .- o D(A"- JT-IS-( I ~ Lib), (J( I/P) lllolla ~IIR EA?Rlg .,c I'7%41K P - () INTERQALQEO(Cj28F /lit ' TEEN WINCNSSTBI SLVD STS S~r SJ(m dQSK& CA 88128 /g~z-~~&~7I' ROE( PeVerL)-Chills~Et loss( ~Polyurie(~h(rsetFatzqua~J J., / F Nesoacn~e J utzzine~Y(v) uu«J .lvzzul . & o' ~"henna~=)-888( + u-C ~ -Cter(-')~cpzaai,(-VO ) l &er(ona~' o J 'l -v mizzin~M(srrha~~on i ation(A%lead(~op~Dsuria( )Mrae~nc (~es(taney( ) Hematurier( ) Nocturia( ) Meaiesr lone,( P.i J Head, ~ PERLA/r ) Pundi( ~ ENT(r1 Exudstm(-)-l l Abdomen,~ Tende~rness ( ~ Liver+-) EpleenT ) Rectal&( ) Prostat~e ) Nodules( )~nates(~:/'uv e»v-o-n -i, t 2/)» I7 /Jab'PR /min RR /min T 'P / / / &)zM A»r-ad'-Ed J( I ~)-TNT q„~"**""" ~Cou h(+Hheezlna(XSOR(&Chest~on( ) H monrve&a&p Nausea(~~(& ting~))iarrhs~e Constipatin~leadins(~T)yy&orts( ) ursenry( ) Hesitancy~ster~() Nocturne+~ umst llnnle(rn l JMe~dong)arne l Ol ~~n, M Paler~ Jaundice~Cyanosis~ ~~4 Bl"I Exudate~ lungs, l Oaliops2-)-i&dnel8ll&~ lennerness( p Ttver(rT Rplaen( ~Mass~ l&'.SC ~ S( J neman( ) *'/ ~L- sh 000104 Nausea( ) Vomittinx( ) Cierrhaa( ) Constipation( )Bleadi~n( ) . rr"". " wTMesdede+ ~ t " .' smart nntdarn( . y murmurs( ) .. Gallops( )a nese (~ &Br{ 1st )Est. Neuro,( ) Aj Pi Pelor( ) Baundice( ) Cyanosis( ) )-+~ -( iTh e L»n((si ( ) Heart, ssct 000105 Radiology Reports 000106 adi eport ll/15/02 12;40 FAX 15102124023 BIIC ti6005 BMC BAY MOBILE CAP.E d 0 osi «ag no Famiity: Patient. Somal Security iy Date of Birth: Date. Study: Ordering Physician: Clinical History Office of George Yeh M D Liu, Gui Lin 604-62-5645 9/1 5/64 1 1/13/02 Abdominal Ultrasound Geroge Yeh, M D. Abdominal pain Abdominal Ultrasound TECHNIQUE: Porlable realhgme ultrasound is performed of the abdominal and retroperitoneal structures and multiple static images are obtained. Comparison - none FINDINGS: Gallbladder, common and intrahepatic ciliary ducts, liver, spleen, and visualized portions of the retroperitoneum are unremarkable. Pancreas is poorly visualized due to bowel gas Right kidney is unremarkable, measunng 9 5 cm in length. Left kidney measures 10.0 cm. CONCLUSION: Negative study and subopbmal visualization of the pancreas Robert J. Schier, M D Bay Mobile Care 400 30" Street, Suite 206 Oakland, CA 94609 Office {510) 272-4620 Fax {510) 272-4623 http://www.baymobilecare.corn 000107 03/10/03 Ogr 95 AH P07 via YSI-FAX Page 2 op 2 tt93915 EE COIIDIEuHty IIOSIHtnt Of LOS GatOS DIAGiVOSTIC/rIIAG/NG 8th P lla dad L G ioi,CA 91032 Phme (40818664075 VeriTied IIIftcayfh04LTIC 1MACIftfG PATIENT Rft;IPORT PATlEIYTDE/F/O RAPlllCS/ FATIEtVT NANIE 1 IUi GUII. BIRTHDATE AGFOEXALI SEX 9/15/196d 44 yr I'ATIENT TYPE 2 LIED RFC ii 000503'160 ADLHSSIOV DATF. 9M/2008 7 ISAVI ORDER/1 219103 ORDER OA'IE 9/6/200S ACtXhU 1 "1 ii 9483009 SVC LOGRA LOCATION RADIOtOOY RESULT ID i AUUF. 1DULI 202312 / 0 All listed physicians ivdl havefrmerl copies of this report. REOUEST[VG PSIYSICIAV r AD/tllTTI, /G PHYSICIAN: PHYSICIAN, )its NEW ATYEEDINt'HYSICIAN: PHYSICIAN HIS NFW EXAEI: LOG DIAG CHEST 2VW REASON: CHROVIC COUGH PilPRESSION i EXALt DATEr 9/6/2008 8.08ALI EXAM TVVO VIEW CHEST EXAM DATE: 09/06/200K 0800 HOURS CLDilCAL HISTORY. A 43-year-old. Chronic cou h COMPARISON: None. FINDINGS Frontal and lateral chest radio raphs were obtained. Thc lun markin h arc normal m appearance No effusion or pneuinothorax are msiblc 'Llediastinum and biter ar'nounal Heart size is rionnal IMPRESSION, 140 RADIOGRAPHIC CARD!OPULMOlsARY DISFASE. RADIOLOGIST: Kenneth On, Nl D. DO. 09/06/2008 12:53.03 EST MT; aa DT 09/06PUDS 13:21A2 EST JOB 568947/568947 I'U: 09/(xii200S 13 28 28 BST Distribunon 219103// DICTATEDBYr 010, KEilViFTH lvlD TkANSCRIBEU 8Yr LOGSP13 0//06/2008 10.44 VERIFIED BY: OViG, KENNETH I ID DATE: 2008/09/06 113926 00 PATIENT NAlhIEr LIU, GUILI I P Sc I of 1 000108 4/14/2009 I 28 PM CASNJ0181/003 -& 4082980119 Page 1 of 2 0~»7 I V:."~f f.f.'I'Af3fk.)fd."»4/; ' AXixK i NF1l-;f!IMf X»»ot.""„fea'f'f.".», Put.", SAMARITAN IMAGING 2581 SAMARITAN DRIVE St/lTE 100 Phone: 408-358-6881 Fax. 408-356-8785 RE& LIIJ, GIIILIN DOB September 15, 1964 MRN; 01341744 Enc 8; 569'737 Examflstet Apn113,2009 George Veh MB " 786 N. gylnchester Ave. 71 A Sao Jose, CA 95128 EXAM: ABDOMINAL ELTRASOI/ND flISTORYI Abdominal pain REPORT: /~ Py-/JIFf TECHNIQUE: Transvcrsc and sagittal images performed by transabdominal approach with evaluation of the liver, spleeo, pancreas, gallbladder, common bile duct, intrahepatic ducts, kidneys and visualmed portions of the abdominal aorta and IVC. COMPARISON: None. FINDINGS.'he pancreas is normal in appearance though the distal tail is not seen The liver is normal in size, ecbogenicity and contour. No hepatic mass or intrahepatic duct dilatation is present, The main portal vein flaw is normal. No gaflstones or gallbladder wall thickening. The common duct measurm 4 mm. The right kidney measures 9 cm. The lefl kidney measures 9 cm. The spleen measures 8-9 cm. The aorta and inferior vena cava are normal. The main portal veia flow is normal. IMPRESSION: Normal sonographic appearance of thc abdomca. Thank you for the opportunity to participate in the care of this patient. rb f t: I M S f ' ~wpd lnd d AAW Ibf I il ad lyf d fit m 'I I emn~ ip lifth tlh I AM p l,i*be b& hgwth t ydh ti d I bw py*flb t I I'IPPMibbd Ify I* Ma ,pl *hfy M I lyby lwl ~ u s eg I Mg t dll I 'Mene Iheu.g.P I Ise 'Pwwy A Mibdbylh A C il g fgM I gy' g w b,ult w eg phyudM wwphy. P IM 4U4/2on I 2ll p LIV,UUILIN ts 4477yb& P ge I F2 000109 I O'onnor hospitalM Mm N ~saa Jose, CA 99(2!t 'rel.(488)947-2992 Fax (488)947.2478 FATIEFIT NAME: LIU, GUILIN Ooe: 09/15l1964 PATIENT CLASS OUTPATIENT Imaging Services ACCTB 00083055545 MRe: ESS172 EXAM: CTABDOI/IEN Wl CONTRAST EXAM OATEITIME: 2/12/10 9:08 am ROOIWSOUROE'All. TO: REFERRING MO AEIDY YU 2101 FOREST AVE 8108 SAN JOSE, CA 95128 ~- (5(), REASON: epigastdlc pain ~5& 0(vc fx(AY 7944T(naaI 5fe)(see( (45) - TJEPJ(4 tg PAUI (knisxfce 2/xnl(egnx (e(a(eos(anx/ TECHNIQUE: 'l.5 mm collimation volume data was obtained through the abdomen with oral and intravenous contrast. ~ac Frro U wi& fxoef&'t ~f(E((o . FINDINGS: Images of the lung bases demonstrate no evidence of pleural or pericardial effusions. There is no acute consolidation P-4)( CG rK0 'fat i'(0 The liver, kidneys, adrenals, pancreas, gallbladder, and aorta are unremarkable. There is no evidence of bowel obstruction or dilatation. There is no free fluid or free air. No inflammatory changes, No mass or adenopathy seen. There is a moderate amount of stool in the colon. No slgnigcant focal bone lesions. IMPRESSION: Unremarkable CT of the abdomen. No significant focal lesions. Dictated by: VINEET SHARMA Reviewed and signed by: VINEET SHARMA M,D. 02/17/2010 16:03 **THIS REPORT HAS BEEN ELECTRONICALLY AUTHENTICATED Transcriixer. WHITE. RACHEL TranSCritaed Date 02/17/2010 15:48 CC1: CC2'IU, GUILINAccession OCH0217251 CC3: YU, ANDY Page 1 of1 000110 4/15/2011 5 25 PN CASSJOISV003 -& 4082980119 Page I of 2 SAMARITAN IMAGING 2581 SAMARITAN DR, STE 100 SAN JOSE, CA 95124 Phone: 408-358-6SSI Psxi 408-356-8785 RK: LIU, GUILIN DOB September 15, 1964 MRN: 01341744 Enc k 911765 Exam Date: April 13, 2011 Ling Ping Chen MD 2505 Smnarltan Dr Suite 107 Sau Jose, CA 95124 EXAM: ULTRASOUND PELVIS, NON-OBSTETRIC ULTRASOUND ENDOVAGTNAL HISTORYI 46 year old woman with history of menometrorrhagia. Posiuve IUD in place. REPORT: TECHNIQUE: Longitudinal and transverse sonograms through tbc pelvis were obtained transsbdominally snd endovaginally. Endovagmal exam was performed for additional anatomic detail. COMPAIUSON; None. FINDINGS: Uterus: Measures 12.2 x 4.4 x 6.7 cm on transabdominal ilnages. Tbe uterus is iu near neutral position on endovaginal exam which somewhat limits the evaluation on the endovaginal exam IUD is idcntilied without tbe endometrial cavity and appears within normal limits. On transabdominal evaluation, tbe endometrial stripe measures approximately 13 mm which is within normal limits. A 1.9 cm lefi anterior body approaching the fuedus Intmnurat uterine fibroid is seen. Another 2.1 cm utenne fibroid is seen within the posterior intramural lower uterine segment. Right ovmy: Transabdomiusl images show that tbc ovary measures 2.9 x 2.6 x 2.4 cm not weE seen on endovsginal images, and the appearance is within normal limits. Left ovary: Measures 3.6 x 3 x 2.7 cm on transabdominal images not well scen on endovaginal images. A dondnant follicle measuring appmximately 2.S cm is seen. IMPRFSSIONI l. IUD in place. 2. Intrwnural uterine fibroi ds. 3. Dominaot left ovarian follicle. rb A~ I ~ IM fwf s ~ i*pe 'lead d fd I I fowht 411 dM tyf Ih fib 'l 'd I do~ p I Ifa ~1ta I dwwy t b heeby hgwlh I ydl 'ibad t bw wpyofd ism I m gywabbd Ify b Mn ,pl ohfy i~w lylyt luh dw a g' wsl etb b Me Ib Us P 12 . 21 hy p '. 4nmol I 2 22 p 4 Mbdbyd A . c seg fsMolbwbM g w 2 MUb g phy IM %IcyLIU, UUILIN tn I lc424422 Pg I f2 000111 4/15/2011 5:25 PN CASNJOISV003 -& 4082980119 Page 2 of 2 Rz: LIU, GUILIN DOE; Sq&temher 15, 1964 MRN: 01341744 Eno gl 911765 Exam Date: April 13, 2011 Thank you for thc opportunity to pauicip ate in the care of this patient, SAMARITAN IMAGING 2581 SAMARITAN DR, STE 100 SAN JOSE, CA 95124 Phone: 408-358-6881 Fax: 408-356-8785 Ctng Plug Ceca MD 2505 Samaritan Dr Suite 107 Saa Jose, CA 95124 Michael Kuo, MD Board Certi Sod Radiologist 6/ecfroni co/iy Signed. 4/15/1 1 5 21 pm AIJ Tressmfbedl 4/15/11 3142 pm George Yeh MD * shia I' Ml dl f I cu p 'I*gMM m t'I'f I'MMM lyf d n fib 'dim I esty~ n p l.lflb lib t AM P t,t bc eby o smlb t y dc h dn h co n pyof lb I ~ I 'ypnblbem Ify h ~lb n .Pl Otl'y '' lybynlua M n lh g' ou t schon Mn Ib Ug P 15 'nmy A ndembyd A ' snl fnmnl gyhM neh IMM,Kt g pby dM og Iby. P cd.4/lsucl1 5:25p tm, oultlu (a Uml4P2) Pge2 f2 000112 6/22/2011 10:50 AN CAbNJ0167003 -& 4082980119 Page 1 of 2 I~+'Y I I,'A,LLLT; jacal)lL1I.&&t,".;I.7fb l: . ',3%( I, 1'1l:.!Ilk zh'l !A,'IEO&,"„l/& I k:;.:7, AIL', RE: LIU, GUILIN DOB: September 15, 1964 MRN 01341744 Enc ¹; 943638 Exam Date: June 21, 2011 SAMARITAN WOMRNS CENTFR 2581 SAMARITAN DR, STE 206 SAN JOSE, CA 95124 Phone: 408-358-6881 Pax: 408-358-7121 Clog Plug Ches MD 25e5 Samaritan Dr Suite 107 Ssn Jose, CA 95124 EXAM: ULTRASOUND PELVIS, NON-OBSTFTRIC ULTRASOUND ENDOVAGINAL HISTORY: Follow up ovarian cyst. REPORT: TECIINIQUE: Longitudinal sad transvmsc sonograms through the pelvis were obtained transabdominafly and codovaginafly Endovaginal exara was performed for addinoosl anatomic detail. COMPARISON: Ultrasound dated 04/13/11. FINDINGS: Uterus measures 10 x 5 x 7 cm and is hetemgeneous in echo texture. Two uterine fibroids are again identified. One is in the lefl fundus and ietramurai messuriog 2.3 x I 4 x 2 cra probably unchanged given differeaces ie scanning technique. Second fibroid is in the right posterior body measuring 2.1 x 2 x 2.4 cm and is intramural. This is probably unchanged as well. An IUD is scen within the endometrial cavity. The right ovary measures 3 x 3 x 2 cm. No right ovarian mass is seen. The leit ovary measures 2.2 x 2.2 x 1.3 cm aod demonstrates a dominant follicle measuriog 1.1 cm which is decreased in size. There is a small amount of fiuid in the cul-de-sac. Bladder is unrnnarhable. IMPRESSION: 1. Stable uterine fibroids. IUD within the endometfial cavity. 2. Normal bilateral ovanes. Dominant follicle in the lefl ovary decreased in size. ih f I ~ 2 f I wk p led 2 fd I I h II ad lyf Ih tdkhd d I my~ pl I.lfa~ td ' bd p I,b b by bhmtt I yd w kdl ho py ftb U Uyp blvd. Ify b ~a ,pk bfy ~'yby Ivh d k th 2 I m k UU b md U ns tmkIS , rmuy U Mlkdlylh h 's 2 fRhml x item R,uib mpwhy du e pby 2 kd k22ndll id ye llu, onltltl is lblliÃ2) Pd I f2 000113 6/22/2011 10 50 AM CASBJCISV003 -& 4082960119 Page 2 of 2 Va~! '::::.:,'-.K~h Y ~ VexLLL'I'k'd II()LC,"t(e;y.&i@ I:RIEL)tF.';yhLAi.~p.IClA;I'I',b,!BNI.": RZ: LIIJ, GIJILIN DOB September 15, 1964 IUD'1341744 Bnc gt 943638 Exam Date: June 21, 2011 Thank you for the opportunity to participate in the care of this patient. SAMARITAN eyOMENS CENTER 2581 SAMARITAN DR, STB 206 SANJOSB,CA 95124 Phone: 408-358-6881 Fax. 408-358-7121 Ling Plug Ches MD 2505 Samaritan Dr Suite 107 Sao Jose, CA 95124 Raymond Chyu, MD Board Cerlifled Radiologist 8/ec/ronice//y Signed: 6/22/I I 10.46 am ML Trdnscrihsdl 6/22/I I 7:57 am George Yeh MD" shet o I m ed dl f d ~1 y 'Iego d fd ' of se I mern lyf Ih fd on 'd I dly~ Ip' Ifd ee& n In asm pe I,beb by chemo I y& b,dl bo'pyeflt b I M dynmb&d. Ify I boih ,Pl ee I M I lybyt bob ~ o Ih g I eo I elbe b Md 'h Us.pm Is 11 hy n Mndbylh A c tl g fRMI I gy' oct n,tn o phy~M moby P eted SC2lmll le 5C !2U.UUItln tb tcs5y22) Pg2 f2 000114 Exam Date: 09/24/2011 Acct¹: M00346721788 AGE: 47 SEX: F P MD George K Yeh MD 706 N Winchester Blvd San Jose, CA 95128-1524 EXAMSt 001616450 DIG MAMMOGRAM SCREENING BI EXAM: GO-001616450 - DIG MAMMQGRAM DATE: Sep 24, 2011 9:54i00 AM CLIiNICAL HISTQRYi 47 year-old with no and no prior breast surgery. CQMPARISQNi September 2009, July 2008, TECHNIQUE: Digital CC'nd MLO vi.ews of reviewed with CAD. CPT: 77057 SCREENING BI family history of breast cancer March 2007. both breasts were obtained and ~ ~ er ~ I ~ ~ 4 g1 ~ ~ Jl Al FIND1NGS: The breast parenchyma is moderately dense. There is no evidence of dominant mass, architectural distortion, or clustered calcification. There is no visible skin retraction nor enlarged axillary lymph node. IMPRESSIONr No evidence of mass or ma)ignancy. RECOA(MENDATIONr Routine screening mammography. MOSA Assessment: Negative / I 11'BIRADB 1) ** Electronically Signed by M.D. I"latthew E. Paste ** ** on 09/27/2011 at. 1833 ** Reported and signed by: Matthew E. Pasta, M.D. CC: Ling P Chen MD; George K Yeh MD DICTATED DATE/TIMiE: 09/27'/2011 (1833) TRANSCRIBED DATE/TIME. 09/27/2011 (1833) TRANSCRIPTIONIST:.QRAD.VR PRINTED DATE/TINE: 09/27/2011 (1834) BATCH¹i M La ~ a h a ~ 88 V PAGE 1 George K Yeh MD Good Samantan Breast Care Center l 5400 National Avenue, Suite 200. Los Gatos, CA 95032 408 358-84l4 FAX 408 356 2740 000115 10/26/2012 9.22 AM CASNJOISV003 -& 4082980119 Page 1 of 2 I VA&.LLLY RADIOLOGY f MEDt C/hL ASSO4 1/-'hT6S, l1hjC, RE; LIT/, GTI1LIN DOB Septeniber 15, 1964 hIRN 1&134174-1 Fnc. I/ 1184292 Evmn Dater Ocirbei 24, 2012 C ge YehMD" 70/N &VmCieiter A e u 4 San Jnie,CA 9 128 1,05 CATOS 7 s IvNtitvl.pv ORIVI 310&T I t/ Piione 408-8O'I 7 hi i 1st 408.8/0-7494 EXAbf: ABDONIPIA2.1ILTRASOUND HISTORY: 0'antral abdommal pain REPORT: TECHNIQUE Transverse and sag ttal iruages perfoimed bi t a sabdoaiinsl approa h ivith evaluation ol'the liver, spleen, pancreas.. agbladder, corn on bile duct. mtrahepatic ducts. kidnm s. and vis«ulired portions of the abdormnal aorta mid IVC COIvIPARJSON Abdonnnal ultr,isound 0-1/13/09 Fbi IOINGS. Liver mcasnrcs 14 In and s no mal m sme Floe in the maui pc tal rein Is hepatopetal Tbe pancreas ts niostl obscured by boirel gas and uot itell visuahzed Gallbladde Is norm I I appears ca mitliootstonesorsludge So og aph cMa pli 's sign s eh t and tlu lmess rs normal Common bile du t is & nim IGdneys and spleen are normal iri sire Aorta ts I 2 crn Ihl'PRESS'IGNI No acnte intinslnlornmal process is seen P t crees is obsmirerl bi bovvelgas andnot iveg iisualired Thin& &au br ther it i&unit& rapsiiic pate m the care nt thi patient tin I I'Irm (Im tiara I r s*i I'00116 10/26/2012 9;22 AI4 CASISJ0269003 -& 4082980119 Page 2 of 2 I VILL@'DtOLOCZ I M~DtmL ASSO4-VZES. INt4-, RK Llli, GIIILIN BOB September 15, 1964 MRN 01341744 En 4 IIS5298 Scam Dare. Omob» 1,2012 tellln idnana, iilID 0 a d Certitied Rad t logcl Flemrnni'o//2 Siatnd IO/2012 9 19 en Ce rae Yeh IVID" 7eh 14. 59lnrheater Are. a A Saa 3 ce, CA 95128 LOS CATOS 555 K140tto.i 5 DRIVI: M.tlTI I IO Pi r ne 408-Sd(n7131 I.ac 405-St( 7494 /M7'eer'rbrd lliSO(12 733am tin, I.'trite ta, i r'rt' 000117 Exam Date: 11/20/2012 Acct(): M00348131070 AGE: 48 SEX: F P MD George K Yeh MD 706 N Winchester Blvd San Jose, CA 95128-1524 EXAMSt 001748435 DIG MAMMOGRAM SCREENING BI EXAM: GO-001748435 - DIG MAMMOGRAM SCREENING BI OPT: 77057 DATE: Nov 20, 2012 Bt45:00 AM CLINICAL H1STORY: 48 yea.r-old with no family history of breast cancer and no prior breast surgery. COMPARISON: September 2011, September 2009, July 2008. TECHNIQUE: Digital CC and MLO views of both breasts were obtained and reviewed with CAD. FINDZNGSt The breast parenchyma is composed of scattered fibroglandular densities. There is no evidence of dominant mass,architect t al distortion, or clustered calcification. There is novisible skin retraction nor enlarged axillary lymph node. IMPRESSIOltlt No evidence of mass or malignancy. RECOMMENDATIONr Routine screening mammography. MQSA Assessment: Negative / I IY (BIRADS l) ** Electronically Signed by M.D. Matthew E. Pasta ** ** on 11/21/2012 at 1338 ** Reported and signed by: Matthew E. Pasto, M.D. CC( Ling P Chen MD; George K Yeh MD DICTATED DATE/TIME: 11/21/2012 (1337) TRANSCRIBED DATE/TIME: 11/21/2012 (1338) TRANSCRIPTIONIST: QRAD.VR PRINTED DATE/TIME: 11/21/2012 (1339) BATCHBt PAGE 1 George K Yeh MD Good Samantan Breast Care Center 15400 Nattonal Avenue, Sutte 200, Loa Gatoa, CA 95032 408 358-8414 FAX 408.356-2740 000118 11/15/2013 0: 12 AM CASRJ0159003 -& 401 Pago I of I I 'vALLEY AUDIOLOGY I tv1EDtch&LAssot IATEs, lac. SAISIARITAN IAIAOING 2591 SAILIARI TAN 17R, STE I tl(& CAN IOSIL CA '&512& Phnne 4(ia &St.rgg I FaL 405-355-37R5 RE: LIU. GLIILIN DOB Septernlnr 15, 1964 NIRN 0134174.1 En II 135(54 Esne& D ite: Nni emu I &, gii I" Ceorge Veh MD ioa N. SVtncl&e&ter A& e. ¹ A San 4 &e, CA 9512¹ Ei(AAI: R-RAT CERVICAL SPINK HISTORY: Cei& ca( . pine pmn rad&atmg to nght REPORT: TEC'HNIOUE Foui i icos f72 0 nucn " C'ONIPAIUSON None FINDINGS Tl eie «mild sea ghtenm of 0 c iu al ceo&cal lordosi Venebral body lie&ghts and disc spaces are o mal I ace&a aie normal Nonual CI.2 nn&cola(&on Tlteie is no s& n&if&cant osseous neural foramn&al stenosis. IAIPRESSIOan Nonual ccr»cal spme nitb nnl&l straiglueuu& of d&e normal cer»cal lordos&s Tlmnl, i all tor d&e nppn tunin n pait&opal m ihe ea e nf ih &L¢ 9 &Ihs I lnu& h(1& 0 &rdCenit'ied R&di&l g«i Elect(cia lh &'ierird I Ill 71& 9 I I am I;I (fi r &thol Il'I lit 9(&7am Co%i'FIDENTIAL Llc,ii'IL& I (I'. » i i& tii I's I ri 000119 Exam Date: 12/19/2013 Acct(): M00349469141 AGEt 49 SEXt F P MD George K Yeh MD 706 N Winchester Blvd San Jose, CA 95128-1524 EXAMS t 001868901 DlG NAMMOGRAM SCREENING BI CPT s 77057 DIGITAL SCREENING NAMNOGRAN WITH CAD ANALYSIS 12/19/2013 4t10 PM HISTORY: 49 year-old undergoing annual screen. There is no reported family history. TECHNIQUE: Full field digital mammogram was performed with standard CC and MLO views. Image analysis was aided by iCAD software v7.2. CONPARISONr 11/20/2012. FINDINGS: The parenchyma is mild to moderately dense. No suspicious microcalcifications, focal areas of architectural distortion, or dominant mass lesions are seen. IMPRESSZONt No.mammographi c evidence for malignancy. RECOMMENDATIONt Continue annual screening mammography. According to The Breast Cancer Risk Assessment Tool from the NCI snd the information provided hy the patient, the lifetime risk (to age 90) of this patient developing invasive breast cancer is 7. 8%. As a comparison, the age and ethnici ty adjusted average risk is 6.3%. RESULT CODE: (I ) NEGATIVE FOIIOW UPr (1Y) ANNUAI, REMINDER ** Electronically Signed by M.D. Yueh-Ju Yale Chung ** ** on 12/20/2013 at 1938 ** Reported and signed byr Yueh-Ju Yale Chung, M.D. PAGE 1 George K Yeh MD (CONTINUED) Good Sarnantan Breast Care Center 15400 Nattonal Avenue, Suite 200, Los Gatos, CA 95032 408 358-8414 FAX 408.356-2740 000120 BREAST CARE CENTER GOOD SAMARITAN HOSPITAL 15400 National Ave. Suite 200 Los Gatos, CA 95032 PHONE Si (408)358-8414 FAX 8t (408)356 - 2740 Na Ph MD DO Agei 52 Sex: F Ac Loc; M.BCC Exam Date: 16/11/2016 Status: REG CLI Radiology No: Unit No: M000715744 George K Yeh MD 706 N Winchester, Ste A San Jose, CA 95128-1524 EXAMS t 002180296 DIG MAMMOGRAM SCREENING Sly CPTt 77057 DIGITAL BILATERAL SCREENING MAMMOGRAM 10/11/2016 9:10 AM CLINICAL HISTORY: 52 year-old for annual screening. Sonographicevaluation of both breasts has been requested by the patient'physician. The patient has been determined by her physician to be highrisk. No personal or family history for breast neoplasm is reported. The patient well schedule the ultrasound examination for another day. TECHNIQUE: Digit:ally acqurred standard views were obtained of bothbreasts. Images were reviewed with CAD analysis. Comparison is madeto 9/22/2015, 12/19/2013. FINDINGS: The mammary parenchyma is moderately dense. No new andsuspicious mass, architectural distortion or clusteredmicrocalcifications are identified. ~ ~ ~ \ 4 ~ ~ ii X II ~ ~ IMPRESSIONr Stable mammogram. No mammographi c evi dence for malignancy. RECOMMENDATION: Routine screening. Sonography has been reguested hythe patient's physician. The patient states she will schedule thatexamination for another day. BI-RADS CODE: Negative, l. I Y RESULT CODE: (1) NEGATIVE FOLLOW UPt (1Y) ANNUAL REMINDER PAGE 1 George K Yeh MD ( CONT lNUED) ** Electronically Signed by M.D. Cynthia J. Sigler ** ** on 10/11/2016 at 1436 ** Reported and signed by: Cynthia J. Sigler', M.D. P La ~ a ~' 81 V ~ ~ Good Samantan Breast Care Center 15400 Nalional Avenue, Suite 200,1.os Gatos, CA 95032 408.358.8414 FAX 408 356 2740 000121 GOOD SAMARITAN HOSPITAL 2425 Samaritan Drive San Jose, CA 95124 PHONE ¹: (408)559-2141 FAX ¹: (408)559-2679 52 oc: M.ED Exam Date: 06/23/2017 Status: Radiology No: Unit No: M000715744 Sex: F ER George K Yeh MD 706 N Winchester, Ste A San Jose, CA 95128-1524 (((+ 002265275 US PELVIS NON OB 002265286 US ENDOVAGINAL SCAN Exam: Transabdominal and endovaginal p vic ultrasound 6/23/2017 HISTORY: 52 year-old with vaginal bleeding. FINDINGS: Comparison is made to prior exam from 7/7/2016. The uterus measures 12.8 x 8.4 cm. There is a heterogeneous mass is seen at the lower uterine segment measuring 9.3 x 7.5 x 7.0 cm. A smaller probable fibroid near the fundus of the uterus measuring 1.4 x 0.9 cm is again seen. The endomet.rial stripe measures 5 to 6 mm. The right ovary measures 2.2 x 1.8 x 2.1 cm and is mostly cystic. The left ovary measures 2.1 x 1.0 x 2.1 cm. No significant. free fluid within th 1 IMPRESSI he lower uterine segment is again identifi 9. 3 x 7. 5 x 7. 0 cm and previously measured 7.0 x 6.6 x 5.4 cm. The endcmetrial. stripe is not abnormally thickened. ** Electronically Signed by M.D. Yueh-Ju Yale Chung ** ** on 06/23/2017 at 1605 ** Reported and signed by: Yueh-Ju Yale Chung, M.D. CC: George K Yeh MD Dictated Date/Time; 06/23/2017 (1600) Technologist: Darnall,Sheri L; SN¹ 4795 Transcribed Date/Time: 06/23/2017 (1600) Transcriptionist: PRCHUYU Orig Prrnt D/T: S: 06/23/2017 (1608) BATCH NO: N/A PAGE 1 George K Yeh MD 000122 BREAST CARE CENTER GOOD SAMARITAN HOSPITAL 15400 National Ave. Suite 200 Los Gatos, CA 95032 PHONE ¹: (408)358-8414 FAX ¹r (408) 356-2740 53 Sex: F c; M.BCC Status: REG CLI George K Yeh MD 706 N Winchester, Ste A San 0'ose, CA 95128-1524 EXAM S r 002299778 DIG MAMMOGRAM SCREENING BI CPT: 77067 DIGITAL BILATERAL SCREENING MAMMOGRAM 10/13/2017 9:00 AM CLINICAL HISTORY: 53 year-old for annual screening. The patient' physician has requested a bilateral sonography secondary to dense parenchyma. By history, this patient is high risk screening. TECHNIQUE: Digitally acquired standard views were obtarned of both breasts. Images were reviewed with CAD analysis. Comparison is made to 10/11/2016, 9/22/2015. FINDINGS: Breast density: B - scattered areas of fibroglandular density. The mammary parenchyma. is moderately dense. No new and suspicious mass, architectural distortion or clustered microcalcifications are identified. IMPRESSION: No mammographic evidence for malignancy. RECOA1MENDATIONr Routine mammographic screening. The patient has declined at the requested bilateral ultrasound exam at this time. She wants to assess insurance coverage before scheduling that exam. Ultrasound was not performed today. This patient 's calculated lifetime risk for breast cancer using the Tyrer Cuzick model is 20.2$ relative to a lifetime population riskof'0. 88. This facili ty utilizes a reminder system to ensure all patients receive reminder letters and/or direct phone calls for appointments. This includes reminders for routine screening mammograms, diagnostic mammograms and other breast imaging interventi one when appropriate. This patient will be placed in the appropriate reminder system. PAGE 1 George K Yeh MD (CONTINUED) Good Samaritan Breast Care Center 15400 National Avenue, Suite 200, Los Gatos, CA 95032 408 358 5414 FAX 408 356 2740 000123 Fax Server 9/2018 1:01:43 PM PACE 2/002 Fax Server0 at en ailon Patient Nam Liu, Guikn I stl HAR 3000066684 MRN 0001396979 Sex Female ~OB 9/15/1964 Tyre 10 Operasve Nots 3090354 Signed by Anup K Smgh, MD on 01/1 9/18 at 1301 PROCEDURE LIST: 1. Right nephrostomy tube placement fluoroscopic 2 Right nephrostogram. Date and Time I/9/2018 12 00 AM and ultrasound guidance Dictating Provider Anup K Smgh, MD MODERATE SEDATION: 30 minutes. SEDATION. IV moderate sedation under my direct supervision using fentanyl and Versed, with hemodynamic monitoring ANESTHESIA. Stan time: 01:35 p m End time. 02.08 p m RADIATION, fluoroscopy time 1.8 minules. Number of images: 2. TECHNIQUE. Following a full discussion of the risks, benefits, and alternatives, informed consent obtained. The patient then prepped and draped in normal sterile fashion Local anesthesia with 1% ifdocame solution. Moderate sedation as above Under ultrasound guidance, the right kidney was accessed through the lower pole calyx. Clear unne returned. A small amount of contrast was injected to venfy positioning. An 0 18 wire placed followed by the introducer set, the 0.35 wire, 8-French diiator, and then placement of an 8-French pigtail nephrostomy catheter placed in the right renal pelvis Antegrade nephrostomy was then performed demonstrating marked hydronephrosrs and a tortuous hydroureter to the level of the mid to lower pelvis The patient tolerated procedure well, and there were no immediate compkcations Nephrostomy tube to gravity bag drainage. Anup K Singh, M D. CC: AKS.HI Job ID: 3090354/711398 D: 01I09I2018 14:02:13 T: 01/09/2018 14:30:47 000124 i (. 5amaritoll A RadNet Imaging Center VRI Samaritan 2581 Samaritan Drive, Suite 100 San Jose, CA 95124 Phone. (408) 358-6881 Fax: (408) 356-8785 LIU, GUILIN MRN 01341744VR1 DOB 09-15-1964 Sex F Phone 4083583532 Date of Service 03-06-2018 Ordered By ) (GEORGE VEH, MD 706 N WINCHESTER AVE, STE A SAN JOSE CA, 95128 FAX (4081 298-0119 EX AMLULTRASOUND ABD0lvIEN COiNIPLETF HISTORY: Abdommal paw TECHiNIQUE Standard grayscale ima es were acquired with additional Doppler mtcrrogation u hssi appropriate. COhIPARISOiq 10/24'2012 ultrasound, CT 12/19/2017 FIXTHNGS Liver. Thc liver measures 12 2 cm. Echogenicify and echotexture are withm nnrmal limits. iNo suspicious liver lesioru arc identitied The liver surface is smooth ivfain portal vein shnws normal liepatopetal fioiv Bil~ Ducts. Intr ahepaiic and cxtrabepatic bile ducts are not dilated. The common bile duct measures 4 mm. Gallbladder'ormaL No evidence for cholelithiasis. Sonographic Iv!urphy sign is negative. Pancreas: Tbe pancreatic hmd is unranarkable. Right Kidney. S urg wally absent Lefl Kidney i%ensures 9 8 cm longitudnwgy. Corneal echogcnicity and tluclmess are within normal limits Nio echogenic stones or hydronephrosis is seen Spleen: The spleen measures 9 7 mn Aorta and Inferior Vena Cava s/isualiaed portions appear normal Ascites: None. lihIPRESSIOiN. Patient LIU, GUILIN DOB 09-15-1964 Confidential Psgsi of a 000125 A RadNet Imaging Center VRI Samaritan 2581 Samantan Dnve, Sutte 100 San Jose, CA 95124 Phone (408) 358-6881 Fax. (408) 356-8785 LIU, GUILIN MRN 01341744VRI DOB 09-15-1964 Sex F Phone 4083583532 Date ol Service 03-08-2018 Ordered By GEORGE YEH, MD 706 N WINCHESTER AVE, STE A SAN JOSE CA, 95128 FAX (408) 298-0119 EXAith ULTRASOUND ABDOMEN COSIPLETE IIISTORY. Abdominal pain TECHiVIQUE: Standard grayscale images ivvae acqub ed with additional l&oppler intervogation when appropriate, CONIPARISON: 10/24/2012 ultrasound, CT 12/19/2017 PliVDINGS: Livrr: Thc liver measures 12 2 cm Echogenicity and ohotexture src ivithin normal lunits. No suspicious liver lemons arc idmtified. Tlie hvar surface is smooth. Main portal vein shows normal hepatopetal flow Bile Ducts Intrahipatic and exlrahepstic bile ducts are not diLsted The common bile duct measures 4 mm. Gallbladder: Normal No evidence for cholclithiasis . Sonographic Murphy sign is negative Pancreas: The pancreatic head is unremarkable Right Kidney Surgically absoit. Left Kidney Measures 9 8 cm longitudinally. Cortical echogerucity and thiclmess are vvithin normal limits. No echogenic stones or hyilronephrosis is seen Spleen: The splevvr measures 9.7 cm. Aorta and Info ior Vena Cava: Vuualizcd portions appmr normal Ascites None. liVPPRESSIOrV. Confidential Patient LIU, GUILIN DOB 09-15-1964 Page r of 2 000126 I)t Radwet Imaging Center VRI Samaritan 2581 Samaritan Dnve, Suite 100 San Jose, CA 95124 Phone (408) 358-6881 Fax (408) 356-8785 !Itatus post r ight nephrcctomy. End of diagnnstrc rcp I for accessron: 13683120 Dntated 03-08-2018 10 C6 Cl ycul Dictated By: Chyu. Raymond 1V, htD Signed By Chyu, Raymond W, hlD 03-0tl-2018 I 0 46 41 Al I Patient LIU GUILIN DOB 09-15-1964 Confidential Pace 2 ci 2 000127 Special Procedures 000128 pecial r ur Andy S. Yu M.D., F.A.C.P., F,A.C.G. Medical Director. Paciyrc Gaefrucnieroiogy 2101 Forest Avenue, Ste 106 San Jose, CA 95128-1448 Teh (408) 286-3222 Fax: (408) 286-2022 0 Mail t) Fax Gastraenterology Procedure Report 0 Mail 13 Fax 0 Mail 0 Fax George Yeltr M.D. Rctbrrms Phy. ician N I 706 N. Winchester Blvd. Nnmbe Strcct S itN San Jose, CA 95128 Rcfcrnne Phy. icim N t Number Strcct Stt tee Rcfcrnna Phytl Nn e 3 K mbcr Strcct SniteN Ctty 408 298 4495 niece phone 408 298 0119 I:ax ncmbcr State Zip Code C try Oflice pitenc Fax mtmber State yip Code Offtce phm Fax mbcr sum zip cod. Nameofpatie: Liu, Guilin Procedure(s)i FG Date(s) performed: 01-21-2010 DOB: 09-15-1964 Indicatioos: epigastric pain Gross findings. {1) regular GE junction at 38 cm, (2) gastric pH 7, (3) nonerosive gastritic, and (4) normal duodenum Pathology: normal gastric mucosa Impression: nanulcer dyspepsia tvith normal sonogram and FGD Recommendations, consider abdominal CT scan for further evaluation of epigastric pain h(h Signature and date: ~44 0'lq&Sft(,F L5~ (o t'JhR(dP koR. )Ic(h (h (Jhbu I(,'(tc(&, )(I f()toND 8m((m((). 4&bc( t fL(Itb 000129 PROCEDURE NOTE FOREST SURGERY CENTER 2110 FOREST AVENUE SAN JOSE, CA 95128 (408) 297-3432 FAX (408) 298-3338 ENDOSCOPIST: PROCEDURE: SUB-PROCEDURE: INDICATION: ANDY S YU, M.D EGD. Cold biopsy. Epigastric pain. The patient is a 45-year-old Chinese female from Beijing who presents with epigastric pain. She was in usual state of health until a year ago when she started experiencing dyspepsia which she described as dull and aching sensation without association to food exacerbated on awakening in the morning and without radiations to the back. Stomach medications did not provide any relief. She was tested negative for H Pylori infection. Abdominal ultrasound one to two years ago was negative. She is scheduled for EGD today. DESCRIPTION OF PROCEDURE: EGD was performed in the Gl unit at Forest Surgery Center as an outpatient elective basis by Dr. Yu after full informed consent was obtained. She was given a total of Versed 4 mg IV, fentanyl 100 mcg IV and Zofran 4 mg IV. She was placed in the left lateral position. Oropharynx was sprayed with Cetacaine Biteblock was introduced. Upper Gl endoscope was lubricated and introduced via the biteblock into her hypopharynx, where normal vocal cords were well visualized. Under direct visualization, the scope was advanced into the esophagus. There were no ulcerations or esophagitis. Regular GE junction was noticed at 38 cm from the incisors. The scope was advanced in the stomach. Gastric pH was 7. We noticed nonerosive gastritis. The scope was advanced through the pylorus into the duodenal bulb and then to the second part of the duodenum, all which were noticed to be normal. Next, the scope was withdrawn back into the stomach. Retroflexion was performed, which showed no hiatal hernia. The scope was then straightened out. Biopsies were performed in the gastric antrum and body with specimen sent for histology. Hemostasis was observed. Finally, the scope was withdrawn from the patient. She tolerated the procedure well without immediate complications. PATIENT: LIU, GUILIN DATE OF DICTATION: 01/22/2010 ID¹: LIU-23642-F DOB: 9/15/1964 DATE OF PROCEDURE: 01/21/2010 PHYSICIAN: ANDY S. YU, NI.D. TRANSCRIBER: Bre 000130 PAGE TWO ENDOSCOPIC FINDINGS: 1. Regular GE junction at 38 cm. 2. Gastric pH 7. 3. Nonerosive gastritis. 4. Normal duodenum. IMPRESSION: 1. Nonulcer dyspepsia. RECOMMENDATIONS: 1. Reveal abdominal ultrasound results from one to two years ago. 2. Consider abdominal CT scan for further evaluation of epigastric pain. ASY/Bre DOT: 01/22/10 ANDY S. YU, M.D. Dictated, but not edited cc: Andy S. Yu, M.D. 2101 Forest Ave, Ste 106 San Jose, CA 95128 George K. Yeh, M.D. 706 North Winchester Boulevard San Jose, CA 95128 PATIENT: LIU, GUILIN DATE OF DICTATION: 01/22/2010 ID¹: LIU-23642-F DOB: 9/15/1964 DATE OF PROCEDURE: 01/21/2010 PHYSICIAN: ANDY S. YU, IIII.D. TRANSCRIBER: Bre 000131 Andy S. Yu, lul,Du F.A.C,Pu F.A.C.G. Medical Director, Pacific Gnsfroenterolngy 2101 Forest Avenue, Ste 106 San Jose, CA 95128-1448 Teh (408) 286-3222 Fax: (408) 286-2022 CI Mtu1 V Fax Gastroenterology Procedure Rcport Cl Mai! Ct Fax G Mail Cl Fax George Yeh, M.D. Refenine Phyacia S I 706 N. Winchester Blvd, Numbel Stlcct Suhctl San Jose,CA 95128 Reiem S I'hyciclan n t N tuber st a Sl Iten Refminafhyuiaa dy Number Stna Sutletl City 408 298 4495 Offlee pho c 408 298 0119 anne Zip Codi mty Ofacc phone Paa tnltnte Stale Z pCode Cit Office phone Slate Zin Code DOB: 09-15-1964Name of patient: Liu, Guilin Procedure(s): colonoscopy ASA class: 1 Date(s) perfortned: 06-24-2010 Colonoscope withdrawal time: 13 min Indications: epigastric pain Gross nndings: (1) normal teuninal ileum, (2) normal colon, aud (3) mild internal hemorrhoids Pathology; none Impression: nonulccr dyspepsia Recommeadations.'evsin pm epigastric pain; repeat colonoscopy in 5 years as colon cancer screening. Sigusture and date: ~AU( M( 000132 Outside Providers 000133 utsi r vi er From 3sli Martsnez 1.877.696.7209 Tue 3an 9 12:17:35 2~8 EST Page 1 of 4 [History and Physical] [Gullin Li l9247] [Date Printed: I/O/201 8] Page I of4 El Carnino Urology Medical Group Inc. History and Physical Patient Name Patient ID: Guilin Liu Visit Date: Provider: 3anuary 5, 2018 Frank Lai, MD Sexi Female Birthdate: September 15, 1964 Primary Care Provider: George yeh MD Referring Provider: 3oseph Chao MD Locahon: Location Address: Location Phone: Ei Cameo Urology Medical Group Inc. 2490 Hospuat Drive 5uite 210 Mountain View, 1'A 940404117 (650) 962-4662 Historv Of Present Illness The patient is a 53 year old Asian female who is sen for a second opmion regardmg her nght hydronephrosrs with hydroureter Since the last visit, the patient notes that her condition is stable The patient notes stable signs and symptoms ence the last visit She reports no addibonal tests since last visit Current uroiogrc medication no medhcations Problem S I Right hydronephrosis Work for new onset hypertension revealed right hydronephrosis. Creatinine previously was 0.6. More recently, it increased to 1.1. Patient underwent robotic converted to open hysterectomy 10/2017, Inretrospect, she may have felt intertmittent right flank soreness over the last few months but she is not sure. She denies hematuna, history of stones, known endometnosis. No previous imaging priOr to moSt reCent ultrasound and CT. Non contrast CT abdomen pelvis 12/19/2017 reviwed with patient - sever right hydronephrosls with hydroureter to the level of the distal ureter. The length oF stricture cannot not be ascertained. patient also has appointrnen to see Dr. Ben Chung at StanFord Past Medical Historv Disease Name Hydronephrosis Hypertension Date Onset Notes History and rmagrng suggests nght drstal ureteral stncture from previous hysterectomy with new onset renal insufficiency Patient liekly wilt beneFit from robotic nght ureteral reimpiant with possible psoas hitch. If she is not ready to proceed, I would recommend at least demmpression of right kidney weh nght vreterosmpy and ureteral stent. This would potentially allow us to helter define length oF strichire. If ureteral stent is not possible, nght pcN can be placed in the meanbme. Aher discussion, she defers re implant at this time, she oapts to proceed wth right retrograde pyelogram, ureteroscopy possible dilation of stncture and stent placement Past Suroicel Historv Procedure Name Hysterectomy Date Notes Medication List Name amiodi pine 5 mg oral tab(et Date Started instructions 12/11/2017 [Digital Signature Validated] 000134 From 3rli Martinez 1.677.696.7209 Tue 3sn 9 12:17r35 2~6 EST Page 2 of 4 [History and Physical] [Guilin Li 19247] ~ [Date Prlntcxt: I/8/2018] Page 2 of 4 Tylenol 325 mo oral tablet Allerav List Allergen Name NO KNOWN DRUG ALLERGIES Date Reaction Nates di Disease Name Heart Disease Relative/Age Notes / Father/ Social Historv Finding Status Engineer No alcohol use, no- tobacco use Regular Exercise Tobacco Never Start/Stop tiuantity Notes -/- -/- I2/29/2at7 - am Review of Svstems Constitutional o Admits: fever o Denies: chdls Eyes o Denies: changes in vision, double vision MENT o Denies: sore throat, headaches Cardiovascular o Denies: chest pain, irregular hea* beats, dyspnea on exertion Respiratory o Denies: shartness of breath, sleep apnea Gastrointestinal o Denies: nausea, vomiting Genitourinary o Denies: additional symptoms, except as noted in HPI Integument o Denies; rash, itching Neurologic o Denies: trngkng or numbnesN seizures Musculoskeletal o Admits: baCk pain a Denies: muscular weakness Endocrine o Denies: cold intolerance, heat intolerance, weight gain, weight lass Psychiatric o Denies: anxiety, depression Heme-Lymph o Denies: easy bleeding, lymph node enlargement or tenderness Allergic-Immunologic a Denies: frequent slnesses Vitals Date Trmc BP Posiban srte L'1R cuff size HR RR TEMP IF) wT BMI HT ko/m BSA m 02 Sat 'DigitalSignature Validated] 000135 From 3111 Marttnez 1.677.696.7209 Tue 3an 9 12117135 2]LLS EST Page 3 of 4 [History and Physical[ [Guilin Li f9247] + [Date Printed: I/8/2018] Page 3 of 4 Ot/05/2gla tn52AM 153/66 Sitting 93 - 9 99.4 l25ibs l6 5'" 22.32 1.59 01 Phvsical Examination Constitutional o Appearance: Well o Ability to Communicate: Communirates clearly Eyes o Sdera: Anictenc HENT o Head: Normocephalic Neck o Inspection and Palpation: Supple Chest o Respiratory Enure .'reathing non labored o Auscultation: Clear Cardiovascular o Heart: Heart rate is regular vdith normal rhythm. Gastrointestinal o Abdominal Exam: Solt, non-tender, non-distended without masses, No organomegaiy. o Hernias: No inguinal hernias present. Lymphatic o Groin: No lymphadenopathy present Musculoskeletal o Spine: No CVA tenderness. Spine straight. o Right Lower Extremity: No tenderness, edema or ecchymosis is present. o Left Lower Extremity: No tenderness, edema or ecchymosis is present. Skin o General Inspection: anicteric, no obvious brusing Neurologic and Psychiatric o Orientation . Onented to person, place and time Results In-Office Procedures UA UA ECU (010013 ~ Glucose, UA: Negative ~ Bilirubin, UA; Negative ~ Ketones, UA: Negabve ~ Specitic Gravity, UA. 1.020 ~ Blood, UA: Negative ~ pH UA: 6.0 ~ Protein, UA: Trace (15 mg/dL) ~ Urobillnogen, UA: 0.2 mg/dL ~ Nitrites, UA: Negative ~ Leukocytes, UA: Negative ~ WBCs/hpf, UA: 0 ~ RB(a/hpf, UA: 0 ~ Bacteria, UA: Negative ~ Epithelial Cells, UA: Absent Administrative, misceganeous and experimental MtPS Quality Measures ~ Current Medications Documented: Yes Medications Documented ~ Tobacco Cessation Counseling: Smoking cessation education ~ Influenza Vaccination NOT Given; Influenza vaccination declined [Digital Signature Validated] 000136 From ilii ilfartfnez 1.877.696.7209 Tue 3an 9 12:17:39 ~B EST Page 4 of 4 [Histofy and Physical] [Guilin Li 49247] + [Date Printed: I/8/20 I 8] Page 4 of 4 ~ Below Normal BMI FU Provided: LifeStyle education regarding diet Assessment ~ Hydronephrosis 591/N13.30 History and Imaging suggests right distal ureteral stricture from previous hysterectomy with new onset renal insufficiency. Patient liekiy will benefit from roboti«nght ureteral reimplant with possible psaas hitch. If she is not ready ta proceed, I would recommend at least decampression of nght kidney with nght ureteroscopy and ureterai stent. This would potentially aflow us to better detine length af stricture. If ureteral stent is nat possible, right PCN can be placed In the meantime. After discussion, she defers reimpiant at this bme, she aopts to proceed with right retrograde pyelogram, ureteroscopy possible dilation of stricture and stent placement ~ CKD (chronic kidney disease) stage 2, GFR 60-89 ml/min 585.2/N18.2 Likely due to ureteral stricture. Plan Instructions o Time spent with counsebng andfor coordination of care was 40 minutes Disposition o Return Visit Request in/on I week+/- 2 days (42335). Electronically Signed by: Frank Lai, MD -Author on 3anuary 6, 2018 11i18:49 AM [Digital Signature Validated] 000137 Fax Server 9/2018 f:59:27 PM PAGE 2/Og Fax Server Patfeoufaformation .-~ Pahenl Na HAR Liu, Guilm 3000066684 nsullsbsxeetio K Slnah, MD at 1/9/2018 1:49 PM MRN 0001396979 Sex Female DOB 9/15/1964 Author Type: Physician Status Signed Author AnuP K Smgh, MD Service: Imervenlional Radiology Filed I/9/2018 1.53 PM Creation Time I/9/2018 I 49 PM Fditcr: Anup K Sings, IvlD (Physiean) Consult Orders 1. Inpasenl Consult lo Interventional Radiology [31826457] ordered by Anup K Singh, MD al 01/09/I 8 1237 INTERVENTIONAL CONSULT NOTE Historv of Present lllnesss The patient is a 53 y.o. female who presents with prior hysterectomy in 10/17 hydroureter, s/p unsuccessful r retrograde ureteral stenl earlier today Patient placement and r nephrostogram No abdominal pain, fever, etc. r hydro nephrosis and referred for nephrostomy tube Review of Systems 12 pt ros negative Past Surgical History: p ixt surri: ",i Bhx civ: 'cuir' HYSTERECTOMY 10/2017 Allergies: Patient has no known allergies. Medications: ~ caFAZolin in dextrose (ANCEF) pie mix IVPB I a ~ fentaNYL PF (SUBLIMAZE) iniectian 50 mcg I g IntraVenous 50 mcg IntraVenous alii 'm Once Every 5 min PRN Frank Lai, MD Margaret Anne Vartanian, MD 50 mcg at 01/09/I 8 1337 H YDROmorphcne (DILAUDID) inlection 0 25 ma HYDROmorphone (DILAUDID) mlecticn 0.5 ma i oh ex ol (OMNIPAQUE) 350 mg iodine/mL iniection lactated Ringer's (LR) infusion meperidine (PF) (DEMEROL) iniection 12.5 ma midazolam (VERSED) I mg/mL 0.25 IntraVenous mg 0.5 mg IntraVenous 125 IntraVenous mL/hr 12 5 IntraVenous mg Every 10 Min Margaret Anne PRN Vartanian, MD Anup K Singh, MD Continuous Every 5 min PRN PRN Margaret Anne Varlanian, MD Margaret Anne Vartaman, MD Anup K Singh, MD Every 10 Min Margaret Anne PRN Varlanian, MD 25 rnL at 01/09/I 8 1335 I mg at 01/09/I 000138 Fax Server 9/2018 1;59:27 PH PAGE 3/005 Fax Server infection 8 1338 Family History: History reviewed. No pertinent lamily history. Social History: ~ Marital status: Spouse name: ~ Number of children ~ Years of education. Married N/A N/A N/A ~ Smoking status: Smokeless tobacco: Alcohol use Drug use: Sexual activity: Never Smoker Never Used None No Not Asked None . None Physical Exam: BP 135/83 I Pulse 65 ) TemP 37.3 'C (99.2 F) I ResP 16 I Ht 160 cm (5'r) ) Wt 56 5 kg ) SpO2 98% Breastfeeding? No I BMI 22 06 kg/m'P 135/83 I Pulse 65 I Temp 373'C(992 F) ) Resp 16 ) Ht 160 cm (5'3) I Wt56 5 kg I Sp0298/o I Breastfeedingo No I BMI 22.06 kg/m'e: WDWN NAD HEENT: SCLERA ANICTERIC, NCAT NECK'UPPLE NO JVD COR: RRR LUNG CTAB ABD: SOFT NDNT EXT: NO EDEMA Laboralory Results: WBC RBC Hgb Hematocnt MCV MCH 01/08/201 8 01/08/2018 01/08/201 8 01/08/201 8 01/08/2018 01/08/201 8 4.91 122 38 A 4 50 - 11.00 Final K/uL 4.00 - 5.20 Final M/uL 12.0 - 16.0 Final g/dL 360-46 0% Final 80 0 - 100.0 Final fL 26 0 - 34.0 Final 000139 Server 1 9/2018 + i'27 Ptt PAGE 4/OQO Fax Server consults bv Anuo K slnoh, MD at 1/9/2019 1:49 pM (continuedl MCHC RDW NRBC NRBC Absolute Platelet Count Mean Platelet Volume Neutrophils Lymphocytes Monocytes Eosinophils Basophils Absolute Lymphocytes Absolute Monocytes Absolute Eosinophils ~ Absolute Basophils ~ Sodium - Potassium C blonde C02 Anion Gap Glucose, nonfasting 01/08/201 8 01/08/201 8 01/08/2018 01/08/2018 01/08/2018 01/08/2018 01/08/201 8 01/08/201 8 01/08/2018 01/08/2018 01/08/2018 01/08/2018 01/08/2018 01/08/201 8 01/08/201 8 01/08/201 8 01/08/2018 01/08/2018 01/08/2018 01/08/2018 01/08/201 8 31.8 0.0 0.00 223 9.9 53 0 39.0 1.0 3.0 00 1.16 0 09 0.00 140 104 27 116 pg 31.0 - 37.0 Final g/dL 11.5-14 5% Final 0.0-0.2/100 Final WBC 000-001 Final K/uL 150 - 450 Final K/uL 94-123 fL Final 40.0-700% Final 22.0-44.0% Final 1 0 - 11 0% Final 00-70% Final 0 0 - 4 0% Final 1 00 - 4 80 Final K/uL 0.30- 0.90 Final K/uL 0 00 - 0.50 Final K/uL 0 00 - 0.30 Final K/uL 135 - 145 Final mmol/L 3.5 - 5.0 Final mmol/L 101 - 111 Final mmol/L 22 32 Final mmof/L 3- 12 Final mmol/L 70 - 199 Final mg/dl Comment Glucose, ncn/ssiing interprets/ion. Diabetes me/eius (o f99 mg/dL and symploms ofdisbefes) BUN Creatinine Calcium Calcium, Adjusted 01/08/201 8 01/08/2018 01/08/201 8 01/08/2018 12 10 9.5 9.5 Comment. Ad/usted Caicium csfcu/sled using the fallowing (crmufs calcium, ad/usted =((4 0-/i/cumin) x 0.0)+ calcium 8- 20 mg/dL Final 0 4 - 1.0 Final mg/dL mg/dL Fmai 8.5 - 10 5 Fmat mg/dL Total Protein Albumin Bilirubin, Total Alkaline Phosphatase AST ALT (SGPT) Glom Filt Rate, Est 01/08/201 8 01/08/201 8 01/08/201 8 01/08/2018 01/08/2018 01/08/201 8 01/08/2018 7.9 4.0 0.5 70 24 25 6.0 - 8.5 g/dL Final 3.0- 5 0 g/dL Final 0.2 - 1.3 Final mg/dL 38-126 IU/L Final 15 - 41 IU/L Final 14 - 54 IU/L Final &60 mUmin Final 000140 Fax Server 1/9/2018 li59 27 PM PAGE 5/0$ Fax Server Consults bv Anuo K Sinah. MD at 1I9I2018 1:49 PM (continuedi ~ GFR, if Afr American 01/08/201 8 &60.0 ~ GFR, Interpretation 01/08/201 8 see below Commenli GFR based on Abbreviated IVIDRD Equation. MDRO equation not defmed for patients under I8 years of sge. At GFR aver 60 MDRD equation lrequentiy underestimales frue GFR. &60 mL/min Final Final Prothrombin Time 0'I /08/201 8 INR 01/08/201 8 Comment "see below for lull INR fherspeulic ranges FOR PATIENTS NOT ON ANTICOAGULANT THERAPY. The 8VR reference rangeis. C.g-l 2 FOR PA TIENTS ON ORAL ANTICOAGULANT THERAPY An INR of 5 0 or higher is assooeled wilb an unacceptably high risk ot ma/or hemorrhage, I) Standard infensrly anficoagulaticn. fcr example. chronic therapy tcr patients with a history ct D VT or pulmonary embolism but without acute or ongoing thrombosis Suggested INR = 2.0 to 3 0 2) Higher intensity anticcagulation, with INR 3 8 4.5i Recommends sons vary with clmicai senmg (reference below). Reference: Antithrombo!ic and Thromboiylic Therapy, 8th edition. ACCP Guidelines. Chest f33(6) June 2808 (suppl) 11.3 9.7 - 12 8 Final seconds 2.0 - 3.0 Final Culture Unne Bands Number of Cells Counted Absolute Neutrophils Manual Morphology Spherocytes Ovalocytes Elhptocytes 01/08/201 8 01/08/2018 01/08/201 8 01/08/20 I 8 01/08/201 8 01/08/201 8 01/08/201 8 01/08/201 8 Culture in progress; no growth to date 4.0 100 I 70 Reviewed I+ I+ I+ Prehminary 0.0 - 11.0 '/ Final Final K/uL Final Final Final Final Final Plan. R nephrostomy tube and nephrostogram R/B/A for this fully d/w patient who desires to proceed. Diagnosis; Obstructive uropathy, hydronephrosis, ureteral obstruction ANUP SINGH, MO 1/9/2018 I:49 PM 000141 Fax Server 1/9/2018 11; 44: 29 AM PAGE 2/$3 Fax Server0 P nt information Patient Name HAR MRN Liu, Guikn 3000066684 00013969/9 I Ooerstive Scoot(bv Frank Lai, MD at 1/9/201811;35 AM Sex Female DOB 9/I 5/ I 964 Author: Frank La/ MD Service Urology Fied 1/9/2018/1 I 42 AM Creation Time 1/9/2018 11:35 AM Editor Frank L/ak MD (Physician) Author Type Physiaan Status Signed UROLOLOGY SURGERY POST PROCEDURE NOTE Pre-Procedure Diagnosis: Right Hydronephrosfs, right ureteral stncture Post- Procedure Diagnosis: same Procedures performed and description: 1. right ureteroscopy 2. nght retrograde pyelogram Findings: 1 Right retrograde pyelogram showed complete obstruction About 5 cm from the ureteral orifice 2. Ureteroscopy showed completed obiiteratron of the ureteral lumen at this level Surgeon(s) and Role: 'rank Lai, MD - Primary Anesthesiologist.'Margaret Anne I/artanfan, MD a Type of Anesthesia: General Specimens sent to pathology: None Estimated Blood Loss: minimal Fluids: Crystallofd- 400 cc Drains and Tubes: Complications: none Condition at the end of procedure: stable DESCRIPTION OF PROCEDURE: The patient was brought to the operating room Site and scope of surgery were confirmed with the patient The patient's fdenaty fs confirmed General LMA anesthesia was achieved without any comphcations. Intravenous antibiotics were then given. Appropnate timeout was then performed Patient was placed in lithotomy position. Genital was prepped fn the standard fashion Cystoscopy was performed using a 21 French straight Olympus cystoscope. Urethra was narmal Bladder is normal without evidence of sutures or lesions. Cystogram did not reveal evidence af extravasation The right and left ureteral onfice was identified and is normal Right ureteral onfice was cannulated with a cone tipped catheter Right retrograde pyelogram showed complete obstruction about 5 cm from the ureteral orifice Semi-rigid ureteroscapy was performed using 8.5 French Olympus ureterascope. Ureterascopy showed completed obbteratfon of the ureteral lumen at this level. Soft probing with glide wire was also unsuccessful. 000142 Fax Server t19/2018 ll:44:29 AN PAGE 3$/3 Fax Server Full ooerallve Reooh bv Frank Lai, MD at 1lel2018 11:35 AM fcontinuedl Bladder was drained. The patient was then awakened from anesthesia and brought back to recovery in stable condition. Discussed with patient and husband previously If stent is unsuccessful, will proceed with right nephrostomy tube placement to decompress kidney and then schedule for Robotic right ureteral re-implant with possible psoas il/tch Frank Lai, M.D. cc: George Yeh Md, Joseph Choo MD 000143 From 3|II uart2¹ke 1.877.69G,7209 wed Jan 24 li:39:49 2nfs EGT Page I of 4 (Progress hfut 1 feuilin LIVI [24~ [Date Printed: I/23/2018] Pago I nf 4 El Carnino Urology lvledical Group Inc. Progress Note Patient Na Patient ID Sew Birthdate: September IS, 19G4 Primary Care Provider: George yeh MD Referring Provider: 3oseph Chao MD Visit Date; Provider: Locaftion: Location Address: Location Phone: January 17, 2018 Frank Las MD El Cammo Urology Medical Group inc. 2'l90 Hospital Drive Suite 210 Mountmn View, CA 940404117 (660) 962-4662 ~Hister I3f Present Illness The patient is a 53 year old Auan female who refivns for a srheduled follow up urologic evaluaton Hydronephrosis since the last visit, the pauent notes that her condition is stable Tfie patrent notes no addiuonaf signs or symtoms sm«e the last wst. She reports additronaf tests since last visit Current urologic medication no meditations Problem ¹ 1 Right hydronephrosis with right ureteral stnclure Work for new onset hypertension revealed right hydronephrosis. Creabnine previously was 0.6. More recently, it increased to 1.1. Patient undenvent robotic converted to open hysterectomy 10/2017. Non contrast Cl abdomen pelvis 12/19/2017 - sever nght hydronephrosfs with hydroureter to the level of the distal ureter. The length of stricture cannot not be ascertained. I/2018 - right retrograde showed complete obstrction about 5 cm from UV3. Right nephrostomy tube placed I/9/2018. INitially not much umie output from nght ludney (120 cc nght vs 890 cc le/t) Now, 1425 felt, 730 cc nght Patient reports fever and body aches today. Denies coughs, headache, or flank pain. Nephrostomy site without tenderness or erythema urine taken from voided and right PCN. Cipro given pending culture patient also has appointmen to see Dr. Ben Chunq at Stanford Past hledlcb~IHfator Disease Name Fever Hydronephros&s fiypertenslon Ureteral stricture, nght Date Onset 01/17/2018 01/17/2018 Notes Low grade fever without other foraf&zing symptoms. Check urme cuture. Start opro Due to rueteral stncture History and imaging suggests right distal ureteral stricture from prevrous hyslerectomy with new onset renal insufgcfency. Patient lickly will benefit from robotic nght ureteral reimpfant with possible psoas hitch. If she is not ready to proceed, I would recommend at least decompression oF right kidney with nght ureteroscopy and ureteral stent. This would potentially allow us to better define length of stricture. If ureteral stent is not possrbfe, nght PCN can be plated in the meantime. Alter discussion, she deters rermpfanf at this time, sha oopfs io proceed with rrght retrograde pyelogram, ureteroscopy possible dilation of stricture and stent placement Renal scan to conFirm split renal function to determme whether patient would benefit from nghureterai re-implant vs. nephrectomy [Digital Signature Vafidafedl 000144 -Fresr 3-'uart e 1.877.696.7209 Seu Ian 24 11:39:49 Z016 EST Page 2 of 4 jprngrcss Igotc jDiuilin L/uj j'2 jDatc Prmlcd I/23/20 1 S] Page 2 of 4 Past Suraica Isistor Procedure Name Date Notes Hysterectomy Medication List Name amlodioine 5 rng oral tablet Tylenol 325 mg oral tablet Date Started Instructions 12/11/2017 Allerav List Allergen Name NO KNOWN DRUG ALLERGIES Date Reaction Notes Fa milv Medical Hi~stor Disease Name Hean Disease Relative/Age Notes / Father/ Social Historv Finding Status Engineer No alcohol use, no- tobacco use Regular Exercise Tobacco Start/Stop quantity -/- -I- Flotes 12/29/2017 - am Review of Svstems Constitutional o Admits: fever o Denies: chills Eyes o Denies: changes in vision, double vision HENT 0 Denies; sore throat, headaches Cardiovascular 0 Denies: chest pain, irregular heart beats, dyspnea on exertion Respiratory o Denies: shortness of breath, sleep apnea Gastrointestinal 0 Denies: narrsea, vomiting Genitourinary o Denies: additional symptoms, except as noted in HPI Integument o Denies: rash, itching Neurologic 0 Denies: tmgling or numbness, seizures Musculoskeletal 0 Denies: back pain, muscular weakness Endocrine o Denies: cold intolerance, heat intolerance, weight gain, weight loss Psychiatric o Denies; anxiety, depression Heme-Lymph jDigrlal Signature Valxlaicd] 000145 From gt 'I uartgfke 1,877.696.7209 Wed ian 24 11:39:49 2018 EST Page 3 of 4 [Progress)fbi.'] [Guidon Liuf [Date Printed I/23/20) B] Page 3 of 4 o 0 ies: easy blee g, lymph node enlargement or tenderness Agergic-I o Penles: frequent illnesses Vitals Oste Time BP Position Site LtR Cuff Sze IIR RR TEMP (I ) WT Bl'0 kg/irg BSA in 02 Sat 01/17/2018 01.39 PM 120/83 Siftine 113 - R 1006 128101 16 3'" 2232 159 Oz Phvsical Examination Constitutional o Appearance: Well n Ability to Communicate: Cornmunicatrs clea ly Eyes o sclera: Anictenc HENT o Head: Normocephakc Neck o Inspectiori end Palpation: Supple Chest o Respiratary EHort Breathing non labored o Auscultation: Clear Cardiovascular o Heart: Heart rate is regular with normal rhythm. Gastrointestinal o Abdominal Exam; Sol't, non-tender, non-distended without masses. No organomegaly. Right PCN in palea o tiernias; No inguinal hernias present. Lymphatic o Groin: No lymphadenopathy present Musculoskeletal o Spine: No CVA tenderness. o Right Lower Extremity; No tenderness, o Left Lower Extremity: No tenderness, Skin o General tnspection: anictenc, no obvious brusing Neurologic and Psychiatric o orlentatlo»: Oriented to person, pface and erne Results In-Office Procedures UA UA ECU fa1001) ~ Glucose, UA. Negative ~ Bilirubin, UA; Negative ~ Ketones, UA; Negative ~ Specific Gravity, UA: 1.010 ~ Blood, UA: Negative m pH UA: 6.0 ~ Protein, UA: Negalive ~ Urobilinogen, UA: 0.2 mg/dL Nitrites, UA: Negative a Leukocytes, UA: Negative ~ WBCs/hpf, UA: 0 ~ RBCs/hpf, UA; 0 [Digital Signature Validated] 000146 ~-Fioam~t 1 I net 1.877.696.7209 ireri San 24 11:39;49 2018 EST Page 4 of 4 [PrngressNo [Guilin Lfu] [24. [Date Printed:1/23/201 8] Page 4 of 4 ~ Bactei'ia, A: Negative ~ Eprt ' Cells, UA: Absent Assessment ~ Hydronephrosis S91/N13.30 Due ta rueteral stncture ~ Ureterai stricture, nght 593.3/N13.5 Renal scan to confirm split renal function to determine whether patient would benefit From righureteral re-implant vs. nephrectamy ~ Fever 780.60/R50.9 Low grade fever without other lacakring symptoms. Check urnie cuture. Start cipra ~PI a Instructions o Time spent with counseling and/or caordinatron of care was 25 minutes Disposition o Return Visit Request in/on 2 weeks r./- 2 days (42744). Electronically Signed by: Frank Lab MD -Author on Sanuary 17, 2018 03 06 27 PM [Digital Signature ValidatedJ 000147 6 24/2018 10:26:12 AH PAGE 3/ 06 Fax Server Q',~hioI S EilAkMd HEALTH CARE uno oiicoioov Sianlord lteatth Care 876 Blake Wiinur Onve Palo Allo CA 84305 Phone 650-488-6000 Fax 650.723-0765 Be[OV/, PIO05O f5 id the PrOr/roah nets flem '.9uilin Ln/6 Vmxit Vnfh Benfanuri Inheh Cliurig Mf) in UixO ()N(1OLOGY af Slant'oi 0 I leattti Care on .i srir&kry '.!ri, 2018 ShOuld VOu liar'0 SnV edditiOriai neenS rt garding thia Or Ofiler patier (S yOu haVif refer ed (O Sfantcrd, PIOBSC COntaCt the S/an!Oid Rekiririg Ph/Srrem R tkaurce rdmitrxr at (8681 f42 t811, Referririg physrcim» /nay access infoirnstion about ihe care provrded to tiieir patients el Slanford Hospifei and Clrnics immg PRISM, e secure web-based porta/ Vrsrf hiypi//prism.sfsnfordmed/c/ne.oro foi details and lo spp/y for a uaer ScCoirni STANFORD UROLOGIC ONCOLOGY CONSULT I/24/2018 Primary Doctor: Yeh, George K Referring MD: Lo, Han Po, MD tlrolog ical Surgeons of Nortl em Calif 75 N Bascom Ave 210 San Jose, CA 95128 REASON FOR YISIT: hydronephrosis HISTORY OF PRESENT ILLNESS: The patient is a 59 YO female with hydronephrosis. Shc underwent total abdominal hysterectomy on 10/2017 She subsequently had elevated blood pressure intermittent right flank pain Sew Cardiology and started amlodipine 5 mg and got a sel of labs Labs showed decreased renal function Further workup with CT scan on 12/19/17 revealed large nght hydronephrosis, s/p unsuccessful R retrograde ureleral stent followed by nephrostomy on I/9/18 Presents today lor lreatmenl options PAST MEDICAL HISTORY Past igedical Ihstory: Diagnri»s ~ Hydronephrosis Hypertension lpatn PAST SURGICAL HISTORY Past Surgical Hlslm,: P 0 nrlir". HX TOTAL VAG HYSTERECTOMY (OVARIES STATUS UNKNOWN/NO CE) NEPHROSTOMY TUBE i.afcr" litt Unto 10/201 7 01/09/201 8 MEDICATIONS'o current outpatient prescnptions 000148 SMC Fax Server 106 1/24/2018 10:26 12 AM PAGE 4/006 Fax Server0 ALLERGIES.'llergies not on hte FAMILY HISTORY: Noncontnbutory SOCIAL HISTORY: Social ieisioly "r.ial i.listen/ Mantel status Spouse name. ~ Number of children. ~ Years of education Married N/A N/A N/A Ocmipalicr;el i49,!ory ~ SQA Engineer ,'le: Hll t. rv Melrl Topics Smoking status: ~ Smokeless tobacco: ~ Alcohol use ~ Drug use Sexual activily Other;:pius ~ Exercise wa//cng dady Scr ie'l Hl,.trit r N" rrauiei ~ No narrative on file Here today with tiusband Never Smoker Never Used No No Not on hie Ccli "I:I Yes REVIEW OF SYSTEMS: The patient filled out a ts point system review which was filed in the chart GENERAI 'o weight loss or constitutional complaints. HEENT: There ls no dysphasia or nose or throat problems. CARDIOVASCULAR SYSTEM no current chest pain, shortness of breath, rapid heart beat. PULMONARY SYSTEIVI. no cough or hemoptysis or shortness of breath Gi SYSTEM Negative for pephc ulcer disease or hepatitis No bowel complaints. GU SYSTEM, as per HPI HEME SYSTEM'o bleeding or clotting problems NEURO SYSTEM. Negative for stroke or seizures PSYCH SYSTEM'o history of depression MUSCULOSKELETAL SYSTEM No significant inluries. No bone or loint Pam ENDOCRINE SYSTEM Negative for diabetes or thyroid problems. No hot flashes or Gwl lv OOS 9lisli991 si hlhrh llhhrih ca * 3 000149 slic Fax server 106 Q/23/2018 10:26 12 All PAGE 5/006 Fax Server excessive thnst BP: Pulse: Resp Temp: 1empSrc Sp02. Weight Height: PHYSICAL EXAM; The patient appears well. ECOG PS. VITALS: Fil d Vitals. i'I I/2&i/ I 6 rlsgil 135/80 73 20 36 6 'C (97 9 'Fi Oral 99% 56 7 kg (125 Ibi 1. 6 m (5'") LUNGS Clear to auscultation HEENT: No neck mass or adenopalhy HEART: Regular rate and rhythm ABDOMFN well healed Pfannenstiel, no hepatospienomegaly, no masses, no hernias EXT no edema no masses or tenderness DATA: Creatinine: 10/13/17: 0.8 1/10/18: 1 0 IMAGING; 12/19/17 CT AP I Right megaureler measunng up lo 1 8 crn diameter with tortuosity and tapering distally lust proximal lo the bladder associated with marked pelviecaliectasis but partrcularly pelviectasis No distal ureteral stone, stone at the ureterovesical function or obvious extnnsic mass ureter Presenting m an adult, megaureter is often secondary to a dista! obstruchon bul can occasionally be secondary to vesicoureteral reflux as well as nonrefluxing unobstructed primary megaureter. Patient with pnor pelvic surgery, there could be scarring in the region of the rcsulung in obstruction 2 No nephrolithiasis or left hydronephrosis. No left rnegaureter. ASSESSMENT: 53 Y female s/p total abdominal hysterectomy on 10/201/ willi postop hypertension Worked up with labs that shov/ed decreased renal function Subsequent CT revealed large nght hydronephrosis, s/p unsuccessful R retrograde ureterai stent followed by nephrostomy on I/9/18. Presents today for treatment ophons Recommend further evaluation of renal function wnh Mag3 Patient othe wise healthy and good surgical candidate PLAN; - Mag3 scheduled at El Camino to evaluate kidney function Owi is OOS 3/islisai 3'xxivrd i rex rrr car ~ 4 000150 From 3ill Martinez 1.877.696.7209 Thu Feb 1 18;49r29 20ia EST Page 1 of 4 [Progross Note] [Ouilin Liu] [249+ + [Date Printed:2/l/2018] Page 1 of 4 El Camino Urology Medical Group Inc. Progress Note Patient Name: Patient ID: sex: airthdater Primary Care Provider: George Yeh MD Referring Provider: 3oseph Chao MD Visit Date: Provider: Location: Location Address: Location Phone: January 31, 2018 Frank Lai, MD El Cammo Urology Medical Group Inc. 2490 Hospital Drive Suite 210 Mountain View, CA 940404117 (650) 962-4662 History Of Present Illness The pabent is a 53 year old Asian female who returns fora scheduled follow up urologic evaluaton ilydronephrosis. since the fast visit, the patient notes that har condiuon is stabfe. The patient notes no additronal signs or symtoms since the fast visit She reports additional tests swee last visit Current urologic medhration: no medfuftfons problem 8 1 Right hydronephrosis with right ureteral stricture Work for new onset hypertension revealed right hydronephrosis. Creatinine previously was 0.6. More recently, it increased to 1.1. Patient underwent robotfc converted to open hysterectomy 10/2017. Non contrast CT abdomen pelvis 12/19/2017 - sever right hydronephrosis with hydroureter to the level of the distal ureter. The length of stncture cannot not be ascertained. 1/2018 - nght retrograde showed complete obstrction about 5 cm from UVJ. Right nephrostomy tube placed I/O/2018. INmaliy not much urnfe output from nght kidney (120 cc nght vs 890 cc left) Now, 1425 left, 730 cc right Renal scan 3 week after palcement of nephrostomy tube showed 86'/a function leh, 14'/a Function right, Creatinine 1.1 eGFR 58, estimated egfr right 5-7 Past Fdedical itistorv Disease Name Fever Hydronephrosis Flypartension Ureteral stncture, right Date Onset 01/17/2018 01/17/2018 notes Low grade fever without other focaffzmg symptoms. Check urnre cuture. Start cipro Due to ureteral stricture Dua to rueteral stricture History and imaging suggests right distal ureteral stricture horn previous hysterectomy with new onset renal fnsuffiaency. Pabent fiekfy will benefit from robotics right uretaral raimplant with posable psoas hitch. If she is not ready to proceed, I would recommend at least decompression of right kidney with nght urete roscopy and ureteral stent. This would potentially allow us to better define length of stncture. If ureteral stant rs not possible, nght PCN can be placed in the meantime. Alter discussion, she defers raimplant at this bme, she oopts to proceed with nght retrograde pyelogram, ureteroscopy possible dilation oF stncture and stent placement ureterai stncture with poor renal fundton.Will reFer to nephrology to dacuss risks and bene/its of right nephrectomy vs repair of urataral stnctura Renal scan to confirm split renal function to determine whether patient would benegt from righuretarai ra.rmplanl vs. nephrectomy [Digital Signature Validated] 000151 From 3111 Martinez 1.877.696.7209 Thu Feb 1 18:49:29 2018 EST Page 2 of 4 [Progress Note) [Guifin Liu] [249 [Dale Printed:2/1/2018) Page 2 of 4 Past Suf'oical Nistorv Procedure Name Hysterectomy Date Notes Medication List Name amlodIpine 5 mg oral tablet Tylenol 325 mg oral tablet Date Started Instructions 12/11/2017 Allerev List Allergen Name NO KNOWN DRUG ALLERGiES Date Reaction Notes Familv Medical Historv Disease Name Heart Disease Relative/Age Notes Father/ / Social Historv Finding Status Engineer No elmhoi use, no- tobecm use Regular Exercise Tobacco Start/Stop Quantity Notes -/- -/- 12/29/2017 am Review of Svstems Constitutional o Admits: fever o Denies: chills Eyes 0 Denies: changes in vision, double visIOn HENT o Denies: sore throat, headaches Cardiovascular o Denies: chest pain, irregular heart beats, dyspnea on exertIon Respiratory o Denies: shortness of breath, sleep apnea Gastrointestinal o Denies: nausea, vomiting Genltoudnaly o Denise: additional symptoms, except as noted in Hpi Integument o Denies: rash, itching Neurologic o Denies: tingbng or numbness, seizures Musculoskeletal o Denies: back pain, muscular weakness Endocrine o Denies: cold intolerance, heat intolerance, wefght gain, wefght loss Psychiatric [Digifal Signature Validafed] 000152 From 3111 Martinez 1.877.696.7209 Thu Feb 1 18:49:29 2018 EST Page 3 of 4 [Progress Note] [Guilin Liu] [249 [()ate Printed:2/1/20)8] Page 3 of 4o Denies; anxiety, depression Heme-Lymph o Denies: easy bleeding, lymph node cniargcmcnt or tenderness Allergic-Immunologic o Denies: frequent illnesses Vitals Dare Ttn10 Bi'll BP Position Site LIR Cuff Size HR RR TEMP (F) WT HT kg/mz BSA mz 02 Sat 01/31/2010 07:22 PM 138/00 5 tung 91- R 98.5 124105 8OZ 5'" 22 05 1 58 Phvsical Examination Corwtitutionel o Appearance: Well o Ability to Communicate: Commumcates clearly Eyes o Sclera: Anicteric HENT o Head: NOrmOCePhakC Neck o Inspection and palpation: Supple Chest o Respiratory Effort 'Breathing non labored o Auscultation: Clear Cardiovascular o Hen*: lleart rate is regular with normal rhythm. Gastrointestinal o Abdominal Exam: Soft, non-tender, non-distended without masses. No organomegaly. RIght PCN m palce 0 ttemias: No ingumal hernias present. Lymphatic o Groin: No lymphadenopathy present Musculoskeletal 0 Spine: No CVA tenderness. o Right Lower Extremity: No tenderness, 0 Lait Lower Extremity: No tenderness, Skin 0 General Inspection 'anicteric, no obvious brusing Neurologic and Psychiatric o Orientation: Onented to person, piece and hme Results in-Otnce Procedures UA UA ECU (81001) ~ Glucose, UA: Negative ~ Bikrubin, UA. Negatwe ~ Ketones, UA: Negative ~ Specific Gravity, UA: 1.025 ~ Blood, UA: Trace ~ pH UA; 6.0 ~ Protein, UA: Negative ~ Urobilinogen, UA: 0.2 mg/dt ~ Nitrites, UA; Negative ~ Leukocytes, UA. Negative [Digztal Signature I/ahdated] 000153 From li11 Martinez 1.877.696.7209 Thu Feb 1 18:49:29 20~8 EST Page 4 of 4 (Progress Note] [Ouilin Liu] [249 Q [Date Printed:2/I/2018] Page 4 of 4 Administrative, miscellaneous and experimental Mrps Quality Measures ~ Current Medications Documented: Yes Medlcations Documented ~ InFluenza Vaccination NOT Given. Influenza vaccinabon declined ~ Abave Normal BMI FU Provided. Lifestyle education regarding diet Assessment ~ Hydronephrosis 591/N13.30 Due to ureteral stricture ~ Ureteral stricture, right 593.3/N13.5 ureteral stncture with poor renal funciton.Will refer to nephraiogy to discuss risks and benefits of right nephrectamy vs. repair of ureteral stricture. ~ CKD (chronic kidney disease) stage 3, GFR 30-59 ml/min 585.3/N18.3 Does not appear to have much recovered function in the dight kdieny despite neprhastomy tube. Estiber eGFR in the right kdieny 5- 7 cc/min Plan Instructions o Information on medicaiton and health conditions speciFic to the patient discussed. Medline Pius link to patient ta access the information Disposition o Return Visit Request in/on I month 4/- 2 days (43314). Elecnonically signed by: Frank Lai, MD -Author on )anuary 31, 2018 03:18i08 PM [Digital Signature Vahdsted] 000152] Liu, Guiiin (MR 4 71385734) Discharge Summaries by Chan, Lao Chanc, MD at 2I3I2013 11:05 A )induration, nor drainacLe and was otherwise unremarkable. Page 2 oi 4 NA K CL CC|2 BUN CR CA LabsCBC:;Electrotvtes. IRerent Labs !Recwnt Labs 02I02I18 02I03I18 ,'0170559 RC6 -. 105* il"ICT 34.4'2.6'PLT .. 245 02I02i I 8 101 142 4. 'I 110'4 17 1.04'8 YcjiT3I18 0559 139 3,5 107 25 'la 'I.04'.8 Dischsr e Medications :Current Discharge Medlcabnan List :sTART tsklnn these medications Ddtails ..':::... lacetamtnophen {TYLENOL) take 1-2 Tabs by mouth every 6 hours as needed ,500 mg tablet Qfy: 100 Tab, Rafilfs' ',docusate (COLACE) 250 mg lake 1 Cap by mouth 2 times a day as needed 'capsule '(constipation) Qfy.'0 Cap, Refillsr 0 ,gabapentin (NEUROI4TIN} take 1 Cap by mouth 3 times a day ,'30tl mg capsule Qly. 45 Csp, Refills. 0 'polyethylene glycal {INIRALA)I) 17 gram packet itraMADot (ULTRAIN) 50 mg .tablet take 1 Packet by mouth daily as needed (constipation) Qfy. 30 Packet, Refills 0 take 1 Tsb by mouth every 6 hours as needed Qly: 20 Tab, Raiflls: 0 IAddific 1Qrder C 5 0 'Discharge Proced nel Instru ommenrs arge Instructions fallowing ey removal) PIET; Vau can resume your regular diet title enccurage you to eat well-balanced and nutritious meals. Please be sure you are drinking plenty of fluids to stay hydrated..You shauld avoid red meat or splay foods until bowel movements normalize to avoid constipation or bloating. PHYSICAL ACTIVITY; 000155 SHC Fax Server 106 Qt/7/2018 11:51 07 AH PAGE 3/006 Fax Server cX uuut rm STANFORD UROLOGIC ONCOLOGY CONSULT 11/7/2018 Primary Doctor. Yeh, Georae K Referring MD: Yeh, George K. MD 706 N Winchester Blvd San Jose, CA 95128 REASON FOR VISIT, hydronephrosis HISTORY OF PRESENT ILLNESS: 1 he patient is a 5A YO female with chronic kidney disease stage IIIA, hydronephrosis s/p total abdominal hysterectomy on 10/2017. unsuccessful R retrograde ureteral stent toliowed by nephrastomy an I/9/18, robatic right simple nephrectamy on 2/2/18 Presents today far post-op follow Up She bnngs a set of labs showing creaunine 1.2 twas 1.0 after surgery) and UA with trace blood arid no RBCs She complains of dull back pmn, mostly on the left side over her remaining kidney This pain began a few months ago She docs nol have a history of kidney stones No hematuna No UTls No FH of kidney cancer Mmor occasional stomach cramps No blood m the stool She dnnks 6 8 cups of water per day Her pnmary physioan is George Yeh in San Jose. She does have some new urinary symptoms These have existed for Ihe past year or so She has na uui but does have some sui. 3 children born via vaginal birth Has had 2 UTls She voids every 2 hours dunng the day PAST MEDICAL HISTORY " " 1'u: i mr) Ii Hni V: ');* I!4 e H/0 I ypertension Due to obs/ruchon of the right kir/ney, resolved iwth decampression of ihe kidney, naf on medica/ therapy Hydronephrosis Obstrudion of nghl ureter PONV (postoperative nausea and vomilingi Utenne fibratd With menorrhagia. s/p hysterectomy Lstemlit/ I'.!mc 1985 2/2/2018 01/09/2018 2/2/2018 PAST SURGICAL HISTORY: APPENDECTOMY Open ~ NEPHRECTOMY PARTIAL ROBOTIC ASSISTED LAPAROSCOPIC; WITH OR WITHOUT CYSTOSCOPY AND URETERAL CATHETER OR STENT PLACEMENT Performed by Chung Ben/amin Inbeh, MD al STANFORD HOSPITAL MAIN OR NEPHROSTOMY TUBE ROBQTIC RIGHT SIMPLE NFPHRECTOMY Right Performed by Chung, Beniamin Inbeh, MD at STANFORD HOSPITAI MAIN OR avi Lv OOS viislivui sirv'4 u iiev th cx 3 000156 SHG Fax Server 106 1/7/2016 tt:51:07 AN PAGE 4/006 Fax Server TOTAL ABDOMINAL HYSTERECTOIVIY Lap converted to open I 0/2017 MEDICATIONS No cun ant outpatient prescnptions on file ALLERGIES: No Known Allergies FAMILY HISTORY Noncontnbulory SOCIAL HISTORY. 41 " "I'antel status Spouse name. . Number of children: Years of education Marned N/A N/A N/A SQA Engineer So//ware Oua/ily Ana/ylics Stanford Smoking status Smokeless tobacco Alcohol use Drug use. Sexual acuvity. Never Smoker Never Used No No Not on file Exermse walking dar/y I.rr Ii,! I'i Yes I ~ l va I No narrative on file Here today with husband Works at Stanford In IT REVIEW OF SYSTEMS: The patient filled out a 14 point system review which was filed in the chart GENERAL No weight loss or constitukonal complaints HEENT: There is no dysphasia or nose or throat problems CARDIOVASCULAR SYSTEM no current chest pain. shortness of breath, rapid heart beat. PULMONARY SYSTFM no cough or hemoptysis or shortness of breath Gl SYSTEM. Negative for peptic ulcer disease or hepatitis No bowel complaints GU SYSTEM as per HPI HEME SYSTEM: No bleeding or clotting proillems NFURO SYSTEM Negative for stroke or seizures oos vrl irsi, I Sisal d ne Ih I:a e 4 000157 SHC Fax Server 106 11/7/2016 ll:51;07 AH pAGE 5/006 Fax Server PSYCI-I SYSTEM No history of depression MUSCULOSKELETAL SYSTEM No signiftcant inlunes. No bone or feint pam.ENDOCRINE SYSTEM. Negative for diabetes or fhyrotd problems. No hot flashes or excessive thirst PHYSICAL EXAM: The patient appears well ECOG PS VITALS' il 0 i'lI'tlv'P. Pulse Resp Temp: Sp02 Vyetght Height: I 35/7 7 70 17 36 4 'C l97 6 'F) 100% 57 5 kg (f26 ib 12 2 oz) I 6 m (5'.99") LUNGS Clear to auscultation HEENT: No neck mass or adenopathy HEART. Regular rate and rhythm BACK No Cl/AT ABDOMEN weil healed Pfannenstiel, no hepatospienomegaly no masses, no herniasEXT. no edema, no masses or tenderness DATA: Crealinine: 10/13/17: 0.8 1/10/18: 1.0 IMAGING: 04/12/1 8 CT AP 1. Post nght nephrectomy Smelt ovoid complex collection rn the nght nephrectomy bed favorsrepresent postoperative seroma Superrmposed infection cannot be excluded by imaging aloneCorrelate with cirnical symptoms of infechon.2 No evidence of abnormal fiikng defect in the left coliecung system No hydronephrosrs or unnarycaicificattons 12/19/17 CT AP I Right megaureter measunng up to 1 8 cm diameter with tortuosity and tapenng distally lust proximal to the bladder assocrafed with marked peivrecalrectasts bul particularly pefvrectasrs No distal ureteralstone. stone ai the ureierovesical tunction or obvious extnnsic mass ureter Presenlrng m an adult,rnegaureler is often secondary tc a distal obstruction but can occasionally be secondary lovesicoureteral reflux as well as nonref foxing unobstructed pnmaiy megaureter Patient with pnor pelvicsurgery, there could be scarnng in Ihe region of the resultmg in obstrucbon2 No nephrofithiasis or left hydronephrosis No left megaureter PATHOLOGY: 02/2/2018 Pathology A KIDNEY, RIGHT, NEPHRECTOMY CHRONIC PYELONEPHRITIS (SEE COMMENTIARTERIOSCLFROSIS, SEVERE PEI VIC FAT NECROSIS Oat tv coil alisllahl St a'a d Health Ca a 5 000158 SHG Fax Server 106 lll7/2018 ll;51;07 AM PAGE0 6/OOB Fax Sexver Ci-IRONIC REFLUX coMMENT. Histologic secuons demonstrate a dilated ureter and pelvic calyceal system with broad bands of chronic inflammation extending trom the cortex to the medulla and associated with pan- interstilial fibrosis Glomeruk are widely spared and Tamm-I lorsfail protein casfs are pienuful withm the distal tubules. These histologrc fmdmgs are consistent with chronic pyelonephntis and reflux nephropalhy Additionally, artenoles demonstrate a severely thickened wali surrounded by fibrosis, concernrng for a hypertensive state Gram stain, GMS, FITE and AFB additionally were negauve Cknical correlation is recommended ASSESSMENT: 54 Y female s/p robotic simple nephrectomy 2/2/2018 for non functional nght kidney She is s/p total abdominal hysterectomy on 10/2017 She was found Io have elevated creatinine and underwent failed attempted right retrograde ureteral stentmg This was followed by nephrostomy on I/9,'18 MAG3 scan demonstrated only 12% residual right kidney function Her new nse in crealinine to 1.2 is modest and could be due to lab vanance PLAN: . BMP loday, will lu by phone - rlc pm Lee W. White. MD, PhD PGY-2 Urology 11/07/18 10 53 AM Pager: 27 185 Teachind Phvsician Attestation I was present and directly participated dunng ihe history and physical examination with the resident/fellow I saw and exammed Ihe patient and discussed management with the resident f reviewed I'ne i esident s note and agree with the documented findings and plan of care, with the addition and/or exception of the items documented below History Physical Examination Findings Impression and Plan Agree with above Beniamm Inbeh Chung. MD oos srisiissi lee recess Ce e 6 000159 580 Fax server 108 1/30/2018 3. 51: 43 pN pAGE 3/007 Fax Server STANFORD HOSPITAL AND CLINICS DIVISION OF NEPHROLOGY NEW PATIENT VISIT K Phone 408.298 4495 Inbeh, MD Date o Patien Patien DOB Prima Refer r Urology Clinic 875 Blake Wilbur Dr MC 6560 Stanford. CA 94305 Reason for Referral: elevated creat/nine Dea. Colleagues, I had the pleasure of seeing Gusin Liu in the Adult Nephrology cimic at stanford University Medical center The patient was seen al the request of Beniamin Inbeh Chung for evaluation of elevated creaumne She is unaccompanied today Please allow me to review her history foi our records Guihn Liu is a 54 Y year. old female with history of solitary kidney due to urinary obstruction who presents for evaluation of elevated creatimne I am the thrrd nephrologet that she has seen for this condition. Sho has a iiistoiy of utenne fibroids and underwent hysterectomy and saipingopherectomy on 10/16/17. which was unfortunately compkcated by ureleral iniury that was not detected at the time She presented a month later with HTN and elevated creaanine, had CT scan 12/19/17 that showed severe rrgtit hydronephrosis and hydroureter Was lound to have complete ureteral obstruction and had R PCN placed with minimal UOP. Lasix scan 1/2018 showed nonfunctional kidney. She saw Dr Lin in 2/2018 who recommended nephreclomy over ureteral reimpiantation She had nght nephrectomy by Dr Chung on 2/2/18 Has been concerned about her kidney function, saw Dr Ting in 10/2018 for a second opinion who recommended monitonng for HTN She had labs later in October that stiowed her creatimne went up shghtly so was concerned and presents today for another opinion The patient reports basckne creahnme of -0 7 mg/dL Her creatinine was I 0 I 1 in 1/2018, pnor to ncphrectomy Smce her surgery. SHC creatinine has ranged from 0 99-1 04 She has outside labs from 10/25/I 8 that showed crealmine of I 20; she recalls fasting lor these results Since then. her creatinine was checked 11.'7/18 at SHC and was 1 03 Her last UAs from 10!2018, 4/2018, and 2/2018 were bland, no protein or blood She monitors home BPs which are mostly &120/Bgs, although intermrltently has higher values she does not take NSAIDs or herbal supplements She has no history of kidney stones or infecuon. Reports normal UOP. No dysuna, urgency, fiequency, gross hernaturia. or incomplete bladder emp!ymg She does have nocturra x2-3 REVIEW OF SYSTEMS Posilives as per HPI oos elevisf, I ee evJ ries Ie Ce e 000160 SHC Fax Server 108 1+0/2018 3:51:48 PM PAGE 4/007 Fax Server 0 Review ol Systems Constitulianal. Negative for chats and fever IIENT Negative for sore throat Eyes. Negative Respiratory Negative for cough and shortness of breath Cardiovascular: Negative for chest pain and leg swelling Gaslromtestmal Negative for nausea and vomiting Genitounnary. Negative for dysuna, frequency hematuria and urgency Nocturia x2-3 Musculoskeletai: Positive for:, i Skin Negative for itching and rash Neurological Negative for dizziness and headaches Endo/Heme/Allergies: Does not bruise/bleed easily PsychratrrC/Behavioral The patient does not have insomnra PAST MEDICAL HISTORY I Fibroids s/p TAH/BSO 10/2017 c/b R ureteral mjury 2 Obstructive nephropathy s/p R nephrectomy 3 Elevated BP without diagnosis of HTN PAST SURGICAL HISTORY APPENDECTOMY Open NEPHRECTOMY PARTIAL ROBOTIC ASSISTED LAPAROSCOPIC, WITH OR WITHOUT CYSTOSCOPY AND URETERAL CATHETER OR STENT PLACEMENT Perfarmed by Chang, Benfamin Inbeh, MD af STANFORD HOSPITAL MAIN OR NEPHROSTOMY TUBE ROI3OTIC RIGHT SIMPLE NEPHRECTOMY Right Performed by Chang Benfamm Inbeh, MD at STANFORD HOSPITAL MA/A/ OR TOTAL ABDOMINAL HYSTERECTOMY Lap converfed ra open 1985 2/2/2018 01/09/2018 2/2/2018 10/2017 ALLERGIES'a Known Allergies MEDICATIONS No outpatient prescriptions have been marked as taking for Ihe 11/30/18 encounter IOffice 1/rsrtj with Yu, Margaret Katie MD. No NSAIDs SOCIAL HISTORY No tobacco. Etoh Marned. Iwes willi husband and kids (23 yo, 20 yo and 13 yo) Works at Stanford IT. FAMILY HISTORY No FHx of CKD PHYSICAL EXAM: oas olio'idio S:owo dii oto Coo o 000161 Visit Vitals BP Pulse Temp Ht Wl 8MI 136/74 (Pauenl site Left Arm, Patient Posioon sming) 69 36 4 'C I97 5 'F) fOral) I 6 m )5'2 99") 59 I kg (130 Ib 4 7 oz) 23 09 kg/m'en well appeanng. reeling comfortably NAD HEENT. PERRL, sclera aniclenc, OP cfear. MMM Neck supple, no LAN ol thyroid abnormahty Pulm CTAB, normal WOB CVS: RRR. no m/r/g Gl soft NT/ND Extrem no c/c/e, normal musde bulk/lone Neuro AAO x4, normal speech Psych normal affect, normal interaction Skin no rashes or bruising LABORATORY DATA rewewed and notable lor. ,:1 .I4II).II it '13' nr I!. "Iig la I li1 ' I,n Colorless Clear I 004 Negative eul i u OOS alla'leiil eaeiuiu lice lu C e 1 No results foi tnput(s) AIC in the last 87600 tlOurs 'Ii. lirmuu 'LICOL XUCLAR XSPG XUKET I elle 04/03/201 8 04/03/201 8 04/03/2018 04/03/201 8 000162 SHC Fax Server 10S l 30/2018 3 51 49 PN PAGE 6/007 Fax Server XUBLOOD XUPH XUPROT XNITRITE XLEUKEST XURBC XUWBC Negative 55 Negative Negative Negative 0-3 0-2 04/03/2018 04/03/2018 04/03/20 1 8 04/03/2018 04/03/2018 04/03/201 8 04/03/2018 No results foi input(s) GALS, ALCRU, UA( BCR, UPROTTOT, UPROTCR, UCR m the last 87600 hours Outside Labs 10/25/18 WI3C 4 7 Hgb 13 8, platelels 194 Na 141, K 4 5, Ci 106, bicarb 30, BUN 21, Cr I 20. Ca 9 9, albumin 4 4 UA negalive for protein, tiace blood, no RBCs STUDIES: 4/12/18 CT A/P Kidneys and ureteis Post nght nephrectomy Ovoid hypodensity with mild peripheral enhancement measunng 3 6 x 0 8 cm f302/107) in the surgical bed is favored to represent a postoperatwe seroma No other suspicious soft tissue nodule is seen I M P R E 66 I0N I Post iight nephractomy. Small ovoid complex collection in the right nephrectomy bed favors ropresent postoperative seroma Superimposed mfaction cannot be excluded by imaging alone Correlate with clinical symptoms ot infection. 2 No evidence ot abnormal filling defect in the left collecting system No hydronephrosis or urinary calcifications IMPRESSION Findings are consistent with global nght renal dysfunction with abnormal perfusion, extraction. and excretion The lett kidney is normal Split renal function ia 86% for the left kidney and 14% far the nght kidney DIAGNOSIS.'levated serum creatinine 2 CKD /chronic kidney disease). stage li R79.89 N18 2 ASSESSMENT: In summary. Guilin Liu is a 54 Y year.old female with history of surgical sohtary kidney who presenls for evaluatron of elevated creatviine. i hi 5 oas siihiisse Wee 5 5 ii iih ce 5 5 000163 SHC Fax Server 108 1+0/2018 3 51:49 PM PAGE 7/007 Fax Server 0 I Elevated creatinme. Pt had mildly elevated creatimne 10/2018 that may be due to fasung status or may represent her new basehne range Her last creatinine has improved to I 03 2 CKD stage 2 due to solitary kidney. Discussed that her kidney function is still very good, in fact has some hyperfiltration She does not have tradihonal nsk factors for CKD and her nsk of progression to ESRD is very low Recommend rrionitonng BP, avaidanco of nephrotoxins and adequate hydration Can follow Bi'vlP every 6-12 months Check UA. UACR annually. 3 Elevated BP without diagnosis of HTN Patient will continue to monitor home BPs 4. DieL No strong dietary recommendations at this level of CKD No need to restnct K or phos Would avoid high protein diet aim fai moderate protem intake f0 8.1 g/kg/day) Consider low sodium diet if she has high BP Drrnk la thirst. RECDMMENDATIDNS: I No further diagnostic testing is recommended at this time. 2 Monitor home BPs 3 Avaid nephrOtaxinS 4 Moderate protein restriction Can consider low sodium diet i( found to have high blood pressure 5 Can monitor BMP every 6 12 months Check UA. UACR annually I will plan to see the patient back in chnic PRN 1hank you for allowing me to take perl in the care of this patient. II you have any questions or concerns, please do not hesitate to contact me. Margaret K. Yu, MD, MS Clinical Assistanl Professor Division of Nephrology BOSWELL CI INICS KIDNEY CLINIC 300 Pasteur Drrve All Ambulatory Care Clime I Stanford CA 94305 Tei 650-723-6961 F'x 650 725-8418 Pagei 23099 ah I u oas silhiivse h here v nee ih cere 7 000164 Insurance 000165 O 00 U O 4a CA N 4s 00D Cll o Q) CI C) C& CD CD W 33 X X 0 CUn-zz O N O CO O Cb WO N D 00O O -0 A lTl Q m n I CD g) (D tl 0 r N O 00 D 4 z 0 CI C Z m Zl O b l u e J 4 ” 2 B t u e S h i e l d o f C a I i f o ' m I a 5 2 0 S T A N F O R D U N I V E R S I T Y ? H Q D / / S u b s c r i b e r G r o u p # W 0 0 5 1 ' 4 2 8 / / G U I L I N L I U E f f e c t i v e 0 1 / 0 1 / 2 0 1 6 C o v e r a g e F A M I L Y | D # S X D Q O 4 5 2 4 8 0 5 P l a n P P O R x B l N 6 0 0 4 2 8 R X P C N 0 2 9 6 0 0 0 0 A m , G M L M ( " w a 9 ~ / - f ' é y P P O 0 0 0 1 6 6