Initial Consult: A. Name, Age, Sex, Group Plan and Chief Complaint

INITIAL CONSULT
A. Name, Age, Sex, Group Plan and Chief Complaint

We have Anthony Ermitano 47y/M under Federal Hi, known case of Cholecystitis, Cholelithiasis.
As per Facets, patient initially presented with dyspepsia and intermittent abdominal discomfort. Patient is also noted with
elevated LFTs, GGT, Total Bilirubin and Alkaline Phosphatase. On CT Scan of the kidney done last November 2013 showed an
incidental finding of a stone noted at the gallbladder neck measuring 0.8cm. Gallbladder and CBD not dilated. There was a
request for HIDA scan by Dr. Rahmani although request was denied (criteria not met). Patient was previously advised to undergo
surgery. Persistence of abdominal pain prompted General surgery consult done with Dr. Polido and was advised to undergo
Laparoscopic Cholecystectomy possible Laparotomy.
Dx: Calculous Cholecystitis; HPN
Received request (8/19/14) for Inpatient Laparoscopic Cholecystectomy possible Laparotomy under Dr. Polido on 8/20/14 11am
at SLMC-GC.
B. History per FACETS
C. Work-Ups done On-Island include Date and Facility
(If Applicable)
D. Medical Notes on Initial Consult
C.1 History of Present Illness
C.2 Past Medical History/Family History/Social/OB History(LMP;

GP)/Medications (Current and Previous)
C.3 Physical Examination
E. Diagnosis and Requested Procedure/Test.
F. Plan of Management (For Surgery/Procedure, include date and time)
INITIAL CONSULT
We have Benedicto Agbay 57y/M under Guam Premier, known case of Aortic Valve Disorder.
As per Facets, patient presented with c/o intermittent DOB that occurs @ work or while resting @ home. Pt has not
had a Cardiology f/u this year. Pt w/ noted PMHx of atrial stenosis. ROS indicates CV w/ RRR, S2 hears, 2/6 systolic
murmur to RUSB w/o rubs/gallops. Pt recommended for TTE. Pt being referred for further eval. Patient seen by Dr.
Kuizon, ECG showed Left ventricular hypertrophy with regurgitation abnormality. 2D-Echo done showed Aortic
Stenosis, severe with effective area 0.52 cm2 with extensive aortic annular calcification, EF Simpsons 58%. Advised
to undergo corrective surgery.
Dx: Severe Aortic Stenosis
Received request for Inpatient Coronary Angiogram as pre-operative requirement for Aortic Valve Replacement. CA
under Dr. Kuizon scheduled 3/5/15 afternoon. Inpatient Aortic Valve replacement under Dr. Carino scheduled on
3/7/15 at SLMC-QC
(If Applicable)
D.1 History of Present Illness
D.2 Past Medical History/Family History/Social/OB History(LMP;
D.3 Physical Examination

Mr. Gary Guzman 35/M under Guam Premier has a known case of NSTEMI.
As per FACETS, Pt recently admitted to GMH for above Dx. Pt presenting w/ noted episode of SOB, chest tightness, diaphoresis,
dizziness, weakness w/ N&V lasting for about 30min in 11/2014. Pt presented to clinic FF day & was noted w/ elevated troponin
levels. Pt has had 3 episodes of chest tightness since 1st episode in November lasting for about 1-2min, spontaneously
resovling. Pt recommended for cardiac angiogram, EP Study +/- ablation.
Trop I (01/27/15) = 5.51, Trop I (01/26/15)= 5.65 MMB (01/26/15)= 6.0, Trop I (01/25/15)= 1.29 CK (01/25/15)= 153,CKMB(01/25/15)= 6.2
ECG (01/28/15) showed Non-Specific Intraventricular Conduction Delay.
EF=50%, Mild Infero Hypokinesis
Outpatient consult done with Dr. D Kuizon, clinical findings revealed (+)MI/CAD, Dyslipidemia, (+)HPN.
Dx: CAD, S/P MI. There is a request for CA possible PCI.
(If Applicable)
D.2 Past Medical History/Family History/Social/OB History(LMP;
A. Name, Age, Sex, Group Plan and Chief

Complaint
We have Marissa Fajardo 51y/F under Guam Premier, presenting with

microhematuria.

C. Work-Ups done On-Island include Date and
Facility
(If Applicable)
D.2 Past Medical History/Family
History/Social/OB History(LMP;
F. Plan of Management (For Surgery/Procedure,
include date and time)
As per Facets, patient was seen by Dr. Johnny Lim last 7/28/2014. Patient
presented with persistent asymptomatic microscopic hematuria, negative UTI.
Kidney and Urinary bladder UTZ done last 10/31/12 and 11/25/13 showed
normal right and left kidneys and urinary bladder with no evidence of stone,
mass or hydronephrosis. Small residual of 28cc noted post-voiding. Previous
urinalysis done showed moderate amount of blood (small to moderate to large
amount of RBCs). Urinalysis (7/17/2014) showed 6-20RBC/hpf, no malignant
cells identified on urine cytology (7/23/14), culture and sensitivity showed 10k50k orgs/mL of multiple non-predominating organisms. No note of significant
change per interval.
Follow-up consult done with Dr. Jun Dy today. CT Urogram evaluation showed
no urinary tract lithiasis, renal mass, or filling defect within the collecting
system.
Dx: Hematuria etiology unknown r/o Bladder Tumor. Received request for
Outpatient Cystopanendoscopy with poss Bladder Biopsy & RGP, scheduled on
August 18, 2014 at 7AM.
Mrs Lillian Villagomez, 52/F under Guam Premier with a
known case of OA.

(If Applicable)
As per Facets, she is approved for Ortho Consult requested by
Dr Stratton. Off-island Consult done with Dr Gaddi with notes

D.2 Past Medical History/Family History/Social/OB
History(LMP;
F. Plan of Management (For Surgery/Procedure, include
date and time)
of Knee pain, s/p TKR Right Knee 09/2013. She is using a

Cane in walking since September. According to her, because
of the pain shes experiencing, her activities are very limited.
Xray of both Knees showed Right sided knee prosthesis
placement with satisfactory alignment and no evidence of
loosening or migration, Degenerative Osteoarthrosis, Left
knee, consider left joint effusion and osteodegenerative
chages noted. Scanogram showed (-) significant leg length
discrepancy, Valgus Deformity and degenerative osteoarthrosis

left knee, and interval placement of a right knee prosthesis in
good anatomic alignment and without signs of hardware
loosening or migration. According to Dr Gaddi, Total Knee
Replacement is the best plan to do because of the bone to bone
tear. Physical Therapy, Steroid Injection, Hyaluronic Injection
wont be in effect. She is not also a candidate for conservative

Initial Consult: A. Name, Age, Sex, Group Plan and Chief Complaint

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INITIAL CONSULT

A. Name, Age, Sex, Group Plan and Chief Complaint

Dx: Calculous Cholecystitis; HPN

C.2 Past Medical History/Family History/Social/OB History(LMP;

Dx: Severe Aortic Stenosis

A. Name, Age, Sex, Group Plan and Chief Complaint

A. Name, Age, Sex, Group Plan and Chief

We have Marissa Fajardo 51y/F under Guam Premier, presenting with

B. History per FACETS

A. Name, Age, Sex, Group Plan and Chief Complaint

Mrs Lillian Villagomez, 52/F under Guam Premier with a

B. History per FACETS

known case of OA.

C. Work-Ups done On-Island include Date and Facility

As per Facets, she is approved for Ortho Consult requested by

D. Medical Notes on Initial Consult

Dr Stratton. Off-island Consult done with Dr Gaddi with notes

D.1 History of Present Illness

of Knee pain, s/p TKR Right Knee 09/2013. She is using a

discrepancy, Valgus Deformity and degenerative osteoarthrosis

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