Giffen, Todd Michael (29 yrs [3/13/1985]) Sex.M Salem Hospital, 890 Oak ST. SE Salem, OR 97301 503-561-5200

MRN:2110284 CSN:2904263

Procedure Notes Procedures filed by Ghalili, Kamran, MD at 10/08/08 1228

Author: Ghalili, Kamran, MD Service: (none) Author Physician Type:

Filed: 10/08/08 1228 Note 09/22/08 1246 Trans ID: D439787 Time:

Trans Available Status: Procedure Orders: 1. HOLTER MONITOR [13554779] ordered by liAvin, Rosamund, MD at 09/18/08 0955

DATE OF STUDY: PATIENT NAME: Giffen, Todd Michael PATIENT AGE: 23 PATIENT LOCATION: CARL REFERRING PHYSICIAN: REFERRING PHYSICIAN: Rosamund Irwin, M.D. TYPE OF STUDY: HOLTER MONITOR INDICATIONS: Palpitations. FINDINGS: 1. Underlying rhythm is normal sinus rhythm. Average rate was 106 beats per minute.

Sinus tachycardia. Minimum rate was 76 beats per minute at 1044 hours. Maximal rate was 160 beats per minute at 1656 hours.

2. No ventricular premature beats noted. 3. No significant ectopic beat noted. No obvious supraventricular tachycardia noted. IMPRESSION: Essentially during this Holter monitor recording patient is mostly in sinus tachycardia. No evidence of supraventricular or ventricular tachycardia noted.

S I G N E D B Y K a m r a n G h a l i l i , M . D . 1 0 / 0 8 / 2 0 0 8 1 2 : 2 9 P

K a i s e r # ( I f A p p l i c a b l e ) :

cc: Kamran Ghalili, M.D. Rosamund Irwin, M.D.

Consul t Notes No notes of this type exist for this admission. Page 1 of 8

Giffen, Todd Michael (29 yrs [3/13/1985]) Sex:M Salem Hospital, 890 Oak ST. SE Salem, OR 97301 503-561-5200

MRN:2110284 CSN:2904263

Consul t Notes (cont inued)

Initial Assessment Notes No notes of this type exist for this admission.

H&P Summary Notes No notes of this type exist for this admission.

Discharge Summary Notes No notes of this type exist for this admission.

ER RECORDS ED Arrival Information

Patient not seen in ED

Diagnosis None

ED Disposition None

ED Notes No notes of this type exist for this admission.

Clinical Lab Results Lab Results

No matching results found Radiology Results Radiology Results

No matching results found

Radiology Results HOLTER MONITOR [13554779] Resulted: 09/26/08 1253, Result Status: Final

result Ordering Provider:

Transcription Irwin, Rosamund, MD 09/18/08 0955 Order Status: Completed

ID C^te and Time Author Cardiac Lab-Stress Tests D439787 9/22/2008 12:46 PM Ghalili, Kamran, MD

Document Text Page 2 of

Giffen, Todd Michael (29 yrs [3/13/1985]) Sex:M Salem Hospital, 890 Oak ST. SE Salem, OR 97301 503-561-5200

MRN:2110284 CSN:2904263

Radiology Results (cont inued) HOLTER MONITOR [13554779] (continued) Resulted: 09/26/08 1253, Result Status: Final

result

DATE OF STUDY: PATIENT NAME: PATIENT AGE:

Giffen, Todd Michael 23

PATIENT LOCATION: CARL REFERRING PHYSICIAN: REFERRING PHYSICIAN: Rosamund Irwin, M.D. TYPE OF STUDY: HOLTER MONITOR INDICATIONS: Palpitations. FINDINGS: 1. Underlying rhythm is normal sinus rhythm. Average rate was 106 beats per minute.

Sinus tachycardia. Minimum rate was 76 beats per minute at 1044 hours. Maximal rate was 160 beats per minute at 1656 hours.

2. No ventricular premature beats noted. 3. No significant ectopic beat noted. No obvious supraventricular tachycardia noted. IMPRESSION: Essentially during this Holter monitor recording patient is mostly in sinus tachycardia. No evidence of supraventricular or ventricular tachycardia noted.

S I G N E D B Y K a m r a n G h a l i l i , M . D . 1 0 / 0 8 / 2 0 0 8 1 2 : 2 9 P

K a i s e r # ( I f A p p l i c a b l e ) :

cc: Kamran Ghalili, M.D. Rosamund Irwin, M.D.

ECHOCARDIOGRAPH [13554737] Resulted: 09/18/08 1544, Result Status: Final result

Ordering Unlisted, Provider, PA 09/18/08 0915 Order Status: Completed Provider: Resulting Lab: SALEM ECHO LAB

Specimen [XECHO-62258]

09/18/08 0915

Narrative: Ordered by Rosamund Irwin MD Page 3 of 8

Giffen, Todd Michael (29 yrs [3/13/1985]) Sex:M Salem Hospital, 890 Oak ST. SE Salem, OR 97301 503-561-5200

Radiology Results (cont inued) ECHOCARDIOGRAPH [13554737] (continued)

MRN:2110284 CSN:2904263

Resulted: 09/18/08 1544, Result Status: Final result

Component Value Flag INTERPRETATION SUMMARY

Result:

PATIENT HEIGHT Result:

PATIENT WEIGHT BSA LEFT VENTRICLE

Result:

RIGHT VENTRICLE Result:

ATRIA Result:

MITRAL VALVE Result:

TRICUSPID VALVE Result:

AORTIC VALVE Result:

PULMONIC VALVE Result:

PERICARDIUM/PLEURAL Result:

I n t e r p r e t a t i o n S u m m a r y A t w o - d i m e n s i o n a l t r a n s t h o r a c i c e c h o c a r d i o g r a m w i t h M-m o d e a n d D o p p l e r w a s p e r f o r m e d . T h i s w a s e s s e n t i a l l y a n o r m a l s t u d y . T h e r e i s r n i l d t r i c u s p i d r e g u r g i t a t i o n . 74 in 179 lbs 2.1 m L e f t V e n t r i c l e T h e l e f t v e n t r i c l e i s n o r m a l i n s i z e . T h e r e i s n o r m a l l e f t v e n t r i c u l a r w a l l t h i c k n e s s . E j e c t i o n F r a c t i o n = 5 5 - 6 0 % .

P v i g h t V e n t r i c l e

T h e r i g h t v e n t r i c l e i s n o r m a l s i z e .

A t r i a T h e l e f t a t r i a l s i z e i s n o r m a l . R i g h t a t r i a l s i z e i s n o r m a l . T h e J V C i s n o r m a l i n s i z e a n d c o l l a p s e s w i t h i n s p i r a t i o n . M i t r a l V a l v e T h e m i t r a l v a l v e l e a f l e t s a p p e a r n o r m a l . T h e r e i s n o e v i d e n c e o f s t e n o s i s , f l u t t e r i n g , o r p r o l a p s e .

T h e r e i s n o m i t r a l r e g u r g i t a t i o n n o t e d .

T r i c u s p i d V a l v e T h e t r i c u s p i d v a l v e i s n o t w e l l v i s u a l i z e d , b u t i s g r o s s l y n o r m a l .

T h e r e i s m r l d t r i c u s p i d r e g u r g i t a t i o n .

A o r t i c V a l v e T h e a o r t i c v a l v e i s t r i l e a f l e t . T h e a o r t i c v a l v e o p e n s w e l l . M o a o r t i c r e g u r g i t a t i o n i s p r e s e n t . P u l m o n i c V a l v e T h e p u l m o n i c , v a l v e i s n o t w e l l s e e n , b u t i s g r o s s l y n o r m a l . T h e r e i s n o p u l m o n i c v a l v u l a r r e g u r g i t a t i o n . P e r i c a r d i u m. / P 1 e u r a 1 T h e r e i s n o p e r i c a r d i a l e f f u s i o n .

Page 4 of 8

Giffen, Todd Michael (29 yrs [3/13/1985]) Sex:M Salem Hospital, 890 Oak ST. SE Salem, OR 97301 503-561-5200

Radiology Results (cont inued) ECHOCARDIOGRAPH [13554737] (continued)

MRN:2110284 CSN:2904263

Resulted: 09/18/08 1544, Result Status: Final result MMODE 2D MEASUREMENTS &

CALCULATIONS Result:

RVDD IVSD IVSS LVIDD LVIDS LVPWD LVPWS EF (EST.) MV EXCURSION MV E-F SLOPE AO ROOT DIAM ACS LA DIMENSION LVLS AP4 DOPPLER MEASUREMENTS & CALCULATIONS MVV2 MAX MV MAXPG MV V2 MEAN MV MEAN PG MV V2 VTI AO V2 MAX AO MAX PG AO V2 MEAN AO MEAN PG AO V2 VTI TV V2 MAX TV MAX PG TV V2 MEAN TV MEAN PG PA V2 MAX PA MAX PG PA V2 MEAN PA MEAN PG PA V2 VTI TR MAX VEL TR MAX PG RVSP RAP SYSTOLE INTERPRETING PHYSICIAN

Result:

MMode 2D Measurements & Calculations

3.0 cm 0.89 cm 1.2 cm 4.9 cm 3.5 cm 0.93 cm 1.6 cm 56 % 2.5 cm 20 cm/sec 2.8 cm 1.8 cm 2.9 cm 6.2 cm Doppler Measurements & Calculations 67 cm/sec 1.8 mmHg 45 cm/sec 0.90 mmHg 12 cm 93 cm/sec 3.5 mmHg 63 cm/sec 1.8 mmHg 15 cm 89 cm/sec 3.2 mmHg 45 cm/sec 0.95 mmHg 69 cm/sec 1.9 mmHg 51 cm/sec 1.2 mmHg 18 cm 221 cm/sec 20 mmHg 25 mmHg 5.0 mmHg I n t e r p r e t i n g P h y s i c i a n : J a m e s W a s e n m i l l e r , e l e c t r o n i c a l l y s i g n e d o n 0 9 - 1 8 - 2 0 0 8 1 5 : 4 4 : 3 7

Procedure Notes No notes of this type exist for this admission.

Page 5 of 8

Giffen, Todd Michael (29 yrs [3/13/1985]) Sex:M Salem Hospital, 890 Oak ST. SE Salem, OR 97301 503-561-5200

MRN:2110284 CSN:6308673

Consul t Notes No notes of this type exist for this admission.

Initial Assessment Notes No notes of this type exist for this admission.

H&P Summary Notes No notes of this type exist for this admission.

Discharge Summary Notes No notes of this type exist for this admission.

ER RECORDS ED Arrival Information

Patient not seen in ED

Diagnoses .DysjDhagia , ^ sogha^eaM^ /sn^^ Obstruction esophagus

ED Disposition None

ED Notes No notes of this type exist for this admission.

Clinical Lab Results Lab Results

No matching results found Radiology Results XR ESOPHAGUS [34991251] Resulted: 05/19/11 1619, Result Status: Final

result Resultedby: Farthing. David G., MD Performed: 05/19/11 1602 - 05/19/11 1602 Resulting Lab: EPIC RADIANT Specimen: 05/19/11 Narrative: ESOPHAGRAM

(Fluoroscopy time: 0 min. 36 sec. Room: 1)

HISTORY: Dysphagia. FINDINGS: With the oral ingestion of contrast, the esophagus was examined. There is normal antegrade peristalsis. There is suggestion of a minimal sliding-type hiatal hernia. No reflux was elicited. 13 mm

Page 6 of 8

Giffen, Todd Michael (29 yrs [3/13/1985]) Sex:M Salem Hospital, 890 Oak ST. SE Salem, OR 97301 503-561-5200

MRN:2110284 CSN:6308673

Radiology Results (cont inued) XR ESOPHAGUS [34991251] (continued) Resulted: 05/19/11 1619, Result Status: Final

result

Impression:

pressed barium tablet passes normally down the esophagus. The fluoroscopic procedure was performed by Kevin Hutchins, RPA under direct supervision. IMPRESSION: Suggestion of a potential minimal sliding-type hiatal hernia but no reflux was seen. No other abnormalities are identified. Reading Dr.: Farthing, M.D., David G This report has been electronically signed by: Farthing, M.D., David G

XR ESOPHAGUS [34991251] Resulted: 05/19/11 1618, Result Status: Preliminary result

Resultedby: Farthing, David G., MD Performed: Resulting Lab: EPIC RADIANT Specimen: Narrative: ESOPHAGRAM

(Fluoroscopy time: 0 min. 36 sec. Room: 1) HISTORY: Dysphagia. FINDINGS: With the oral ingestion of contrast, the esophagus was examined. There is normal antegrade peristalsis. There is suggestion of a minimal sliding-type hiatal hernia. No reflux was elicited. 13 mm pressed barium tablet passes normally down the esophagus.

Impression: IMPRESSION: Suggestion of a potential minimal slidmg-type hiatal hernia but no reflux was seen. No other abnormalities are identified. Reading Dr.: Farthing, M.D., David G

05/19/11 1602 - 05/19/11 1602 05/19/11

XR ESOPHAGUS [34991251] Resulted: 05/19/11 1615, Result Status: In process

Resulted by: Resulting Lab:

Farthing, David G., EPIC RADIANT

I D Performed: Specimen:

05/19/11 1602 -05/19/11 1602 05/19/11

XR ESOPHAGUS [34991251] Result Status: In process Resulted by: Specimen:

Farthing, David G., MD 05/19/11 Performed: 05/19/11 1602 - 05/19/11 1602

Testing Performed By Lab - Abbreviation Name Director Address Valid Date Range 5 4 - Unknown EPIC RADIANT Unknown Unknown 03/11/09 1553 - Present

Radiology Results XR ESOPHAGUS [34991251] Resulted: 05/19/11 1619, Result Status: Final

result Order Status: Performed: Specimen: [4374057] Narrative:

Completed 05/19/11 1602 - 05/19/11 1602 05/19/11 ESOPHAGRAM (Fluoroscopy time: 0 min. 36 sec. Room: 1

Resulted by: Farthing, David G., MD Resulting Lab: EPIC RADIANT

HISTORY: Dysphagia.

Page 7 of 8

Giffen, Todd Michael (29 yrs [3/13/1985]) Sex:M MRN:2110284 CSN:6308673 Salem Hospital, 890 Oak ST. SE Salem, OR 97301 503-561 -5200

Radiology Results (cont inued) XR ESOPHAGUS [34991251] (continued) Resulted: 05/19/11 1619, Result Status: Final

result FINDINGS: With the oral ingestion of contrast, the esophagus was examined. There is normal antegrade peristalsis. There is suggestion of a minimal sliding-type hiatal hernia. No reflux was elicited. 13 mm pressed barium tablet passes normally down the esophagus. The fluoroscopic procedure was performed by Kevin Hutchins, RPA under direct supervision.

Impression: IMPRESSION: Suggestion of a potential minimal sliding-type hiatal hernia but no reflux was seen. No other abnormalities are identified. Reading Dr.: Farthing, M.D., David G This report has been electronically signed by: Farthing, M.D., David G

Page 8 of 8