•• A\~•,1 THE PERMANENTE r'"''~ MEDICAL GROUP

SRO-MAIN CAMPUS 401 BICENTENNIAL WAY SANTA ROSA CA 95403- 2149 Encounter Record

Hardeman, Edwin MRN: DOB: Sex: M Encounter date: 7/7/2008

Office Visit 7/7/2008

Visit Information

Date & Time 7/7/2008 9:00 AM

Provider Ruffner-Statzer, Susan Marie (M.D.)

Department GASTROENTEROLOGY

Encounter# 870934549

Dia noses Comments

HEPATITIS C, CHRONIC - Primary CIRRHOSIS OF LIVER

Encounter Messages No messages in this encounter

Patient Secure Message No messages in this encounter

Progress Notes

Progress Notes signed by Ruffner-Statzer, Susan Marie (M.D.) at 7/7/2008 9:19 AM Version 1 of 1

Author: Ruffner-Statzer, Susan Marie (M.D.) Service: (none) Author Type: Physician Filed: 7/7/2008 9:24 AM Creation Time: 7/7/2008 9:19 AM Status: Signed Editor: Ruffner-Statzer, Susan Marie (M.D.) (Physician)

Edwin Hardeman is a 59 Y male with +HCV, genotype 2b and cirrhosis, Biopsy not done--splenomegaly & thrombocytopenia. Treated with pegasys 180mcg weekly+ Ribavirin 4/day (800mg) starting 12/2/05-11/06. TMA negative 1/07, neg 7/07, 1/08.

No alcohol x 3 years, feels well. busy

Most recent ultrasound 0058835901/09/200810:02:44RPKX0101

Document Text

ABDOMINAL ULTRASOU D

**HISTORY**· Hepatitis C with cirrhosis. Hepatoma screen.

**FINDINGS**· There is a diffuse coarse echogenicity to the hepatic parenchyma. There is marginal ncdulariry The appearance is consistent with a cirrhotic liver No discrete hepatic lesions are identified to suggest the presence of an associated hepatoma.

Several polyps are identified within the gallbladder, the largest of which measures 9 mm in diameter No gallstones are identified.

EXHIBIT /A le> 10 I

Generated on 9/21 /18 1 1·10 AM CONFIDENTIAL HARDEMAN EDWIN KAISERSANT ARO SA 005~ - -

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.. . ... •• A'\-'•,i THE PERMANENTE ~,Wr~ MEDICAL GROUP ~ .~

SRO-MAIN CAMPUS 401 BICENTENNIAL WAY SANT A ROSA CA 95403- 2149 Encounter Record

Hardeman, Edwin MRN: DOB: Sex: M Encounter date: 7/7/2008

Progress Notes (continued) Progress Notes signed by Ruffner-Statzer, Susan Marie (M.D.) at 7/7/2008 9:19 AM (continued) Version 1 of 1

The common hepatic duct is of normal caliber. The spleen is at the upper limits of normal in size measuring 13 .2 cm in length. The remainder of the exam is unremarkable.

**IMPRESSION**: Negative examination for the presence of a hepatoma. Cirrhotic appearing liver and gallbladder polyps, as noted.

0: NAD, AF, BP 130/68 / Wt 194 lb (87,998 kg) Estimated Body mass index is 28.65 kg/(mA2) as calculated from:

Height of 5' 9" (1.753 m) as of 7/9/07 Weight of 194 lb (87.998 kg) as of this encounter

Neck: supple, no adenop/thyromeg Lungs: clear COR: RRR no murmur, S3, S4 ABD: NABS, soft, No HSM, no ascites, Skin: no jaundice, no c/c/e

ASSESSMENT: Hepatitis C- sustained viral response Cirrhosis- continue HCC surveillance Antiviral therapy: completed-neg VL by TMA at 1 year post Hypertension- well controlled, f/u PCP

Plan: Ultrasound and lab due this month -7/10/08 .

treatment

Generated on 9/21 /18 11 · 1 O AM CONFIDENTIAL HARDEMAN EDWIN KAISERSANT ARO SA 005~ - - -