Document 2jGDXY2VgyOJgb499wXMN0N37

milton j donovan uOHN H madden ,,r COWARE J BARRY GORDO' H WENTWORTH jAMES i- 'OUPTELOT'E CHARLES - BERGIN jR . 1CTQR ROSENBERG RONALD C KIDD JEFFREY W ROBEPTS jEffrev l McCormick UAMES M RABBIT' .AMES F MARTIN ROBERT 0 CUNNINGHAM jCHN C SiKORSKI NANCY FRANKEL PEL.ETIER Robinson Donovan Madden & Barry ATTORNEYS AT LAW ; 50C MAIN STREET SUITE 14CC ROST OFFICE BOX 15609 SPRINGFIELD MASSACHUSETTS 011' 5 ;ai3) 732 2301 FAX (413) 785-4658 PC f t- - A.; v 'u -ul ,,::-o ^AiJl d 11NBEFG ~ENP> :^OPSE' "PEDEPGA - VcCA = ~^ .AMES 0 S MORION NEVA i KAu^MAN ICgGljAS f 3 0 v E a MINCF.AMES k BODL'Pt~f KIMBERL'" DAviS C=Eap ANNE SWIA^Ek MICHAEl ' _01--tN W L.AKE .Onathan p PICE ^CMANS ROBINSON ,5SA^9',3 _AV*PENCE M S'NC^AiP '9A2 ^986 Julv 11, 1990 Josepn Rendini, Esq. Morrison Mahoney & Miller 250 Sumner Street .Boston, MA 02210 Sharon Burger, Esq. Nutter McLennan & Fish 1 International Place Boston, MA 02110 Re: John Warren Dear Attorneys Rendini & Burger: Enclosed for your review please find copies of the medical records which we recently received from Dr. Flatow. KAM/sw Encs. Very truly yours, y/ /R Keith A. Minoff UCC 082136 Date Pr--ble2i5 (No. ana FINDINGS Dsrrioilon) //J7~/^>A J/'T- u-r Cir Number ^' ~x bare ' a 7 / 'r A)AJ~/ )i!r,,1 Ay ,Mna A7 rtrrt ' A. 'oaJ yAA W M mv LiOl/1rtx;* ~r (AkO^- . - ______________________________________________ __________________ ^Cr,au4 V --------- i A ? / A C a A . /[/tAAj-.-.yi* J.A f-Jut. A____ ! Alfa rLWPihi __________ li- l</'A .lull- AA~>aA 'a, C A f ,`S^/ __ /t'iMk 1 ^ :'sl--------- _ ^ li'Sfat It S'! v cliJjJ J- /*/!*. /IfjjjKjL AAAjr-U.fJl____ i 1A ./lMi/CAU' . 'aAj'& v C i lA j&r-r-'tsA1________ AAAM'ALLI___ CJJ_--------- -- ------------J - ;--------------------------------- 7------ ?--- r-c-- ' J ,. A`k _ ./L`" / f'Axiav ' (!)//. uMvv. (?) iJ crfJcA U k (a--------- ^ 'sJ Wjd} A- '.'y/V Aj. "ly aa J O Ik/J/A-, ~ /' "... // '"i a/ua /y/,^ /My /// rC'Ai'/)iAAA 1 /?> /, r- A Alt n J Vr w' A-'-; k 9 Aj>[jJ-rxQ " ,'V/y_LA_ ( fTA/i/y A/f'cj'iiA cjArr lhu!/l fJcM-oJjJ.C ( VJa AACCl.v C/JiAAji f /V/Ay 0- n /A'/a'; yA // y y k-J iU{u i U /Jl. r.'/J a ArAAAA',(\ yZ/UcAA "7 1 / / frrA | A> u< .*< /VAl/i ^ ' fi.' ^ A? r/rd. ivsJ/H y: !" J' .Ay"a/, x y A 'AfadUtj-. . j V i / ' j! `j i r/*iAxU /A/". */ e 4 '/cal /-Av | y//Ah A- // (^A. ' /tv UCCUCUf i\j JaoJJ '-'// jj fj^ r I r ______________ j_______ /A / AgA: - /__ ' A1 `OM'-f I*-} < |/ ___________ --_._I .. . ta j ______________________________________; i>yy _ r, / ^ a j * -Ar- . '^-;ycA A- ^ //r/A ' Ay?;yi //V ^ / OA^tlKAiIfjA Jty <C^7;/ U/A/^/, /cJn^ !J) ! It. V AW^'V/A' /'.V// AlAy /'-V . fl/ASL-AAfAACC + ii Xc .^,,/v^//' ///AV MJJ/kin A / A^CUi'C/ 1 /rA (/ 1 1 ( t` yZ7 t'jj/11 7/ - y^ //w/y" /HMs/jMi J ;hi`A- <A- V '^W (i/ /*/>y i ' ijo-'y PRIVILEGED AND */- "CONFIDENTIAL MATERIAL " u^C 082137 SUBJECT TO PROTECTIVE ORDER" UCC 082138 Patient Name Date Peebles's (No- and Description] ftndinhs Number 111 Pa*e !' m /A^idt _. Ojr+dujij . - - ---- .------------------------------------------ ----------- -...... 7T' A-W i ) A) /*%> /D fV i^ v i Cstsc'Y' Til /< ~ -y ~t- - 0W Af /,s .O/n'^.CtY / / .!> i i\ *- ;r,jr,> ----------------- -- _ \7^i { i,\ A' u "o--, ' ' d i y *%/* tj tl ^ ........................ J <Jw A/X i fl( , , ,.A- ) 3v^-'VV ^ - /'X /(i.r JLub '- fX# C ^Jr X~. /t filial L y~Hs Q-c'\/y 't'l'Tite X<a^ . (iA,*Y i J {/JlfP f'iiJ-i 'a/7"cJc 1 P, (J !( 6tA ^ ^ ftV(r,tj Jj P/'Ai c\ jJ.TlO rJff)lA/<n ( /A.CLti'i' _____________ TlvAt/i___ ^___ chti. T\ 1 ! A 9J/. _ sy ^ ~i -? __________________ yty? ty-tj'.r ri .: i-yy ~r ~ * v / - /--------- /--------------- :--------____ S f?y___ ^... /fasc*-'__ A ! '/U 7/ ev>?r y\, .V\ i PRIVILEGED AND "CONIFinFKITIAI MATEDIAI SUBJECT TO PROTFCTIVF ORDER" /, TL .r?JUi J L.-11 Us^yit /\ha ih c,!dhi l)J .P-.iiJ- 'n -... ....... --D cA_-sJjjJLs^cL '-W Ov^iT A y+i~f C-- .XAAX ... ^ y^wIt ------------------ ?/V/A (O /ij.'Ob e,^_/ N- Po&,fsevi ------------------------------------------------------------------- ----------------------------------------- UCC 082139 Patient Name_____________---------------------------------------------- "-- Date Number___________ Problems (No. and FINDINGS i nn'l ( cnh iert - Pa?e. Clvlh <i J -w/ i 3<r ,r?MM,0 , Q/Un) rj limn'idt t UUAJ - .. t`kAi c4 / y *- Jir- } fj/up' /h SfrtfMLM.---------------------------------------------- 7'oMCcw__________________________ ;<s4 t tkjdljiD----------------- ----------------------- -----------------------------------CAc---------- h/ fit Mil1 ^ j n{?M---------------------------------------------- -- \ ___________ _I ------------------------------------- T*V.^____/A 6/ y\A. A.syi) H-?SJ--------------------------------------------------------- i . ... _ iUUA^ tlJUuu-u Vi krttr , _ (ejAi An A./W 'jJ.M i___/I/(.i.' jLi--jjA1____________________________________ __________________________ k' __/A'1A' '* -J w <> K P %' At Pi_________________________________________________________________________________________________ ! Q UJ O ztw 1 ------ ^ <X La -V,1 rX.ZA'S * Aj?- Q jJq; --------------------------- ------------------ 0 A/J_________ flulp -rSA^SAii_________________ _______ _ $< Q III b- O ry _ >dZ"J H1" n -- 9o oI w >'? frN rJUi\u- \AU /Mha 1' / < , ____________________________ u --------- LAAJ.------ ___________________ AJ.rh rf Llua, '^ U*t( / [ Afj/uu ! j)Tl c P /V ^ o! - F 'Vt`/ Am4 . ,, An<- 9/? r/^7 l+A'V^.e. /7-t I/ f/ (Lt'w? /fv ^ t L t/ j , v-c-tj-c /"v^-t ^ / / .' /j r *- -> v .- ( "" '-----------*1"------------ ------- :----- ------ 0t / ~ rfCiM / /lAALfd -iJc /tVi* /3 J - ---------------- 2^2z: / L/ ^ />f >y 't'-J-LAS . .-. t'.'-s r ^ ' r /." /(/7 i'//j 0l/ lA-LJ^n ^ 'A/4 'h : r ' l \, t~-J * /- V ^ I f- f' -------------- ________________________ ______________________________ _ ^ 7^:^a . , J_.l' :"T' ...fJ.' ----------------------------.. c.,PA^Ci.Aj;i\ A/< ^ ,,,........ UCC 082140 V/; Patient Name Date ~i _i ly/.*--?'' Number. Problems (No. and findings 1Q-JbDescription) (S^iectiveand^b^ect^ivyee)______ ^ . , utr/'dy Z^FLg' P&- T 1^l,)v3 Icfu/h.-------------3) y UwCr hl'trJ. u 'J\` ftfi. d6y,r. J'Jl'w cub-1/V lift_____ &J lc-Wf Xl'M t' MiZ. tL' jWj //'-til/ . P 6 W/ 'J tir'd . fU'T.'-f h.s(,jL JtiM 1 (f~)__ [jell uZ~JJ0/L . ij>r..y-\K (ly- /? y Pa?e r -' ` i ,/ fL______.______ .. .._ -i .aA' JJjt ^p U V'J h+J /d V - ^ / ^ r^~y^) I___!-i/hr Ji- <jVLf*____ cZtv^ j__/yy Jzl i'v--{u(.ns?i^ /.ill. d----------------- , A\S^r JTj.'*, ------ $vO -/ PRIVILEGED AND "CONFIDENTIAL MATERIAL SUBJECT TO PROTECTIVE ORDER" ___X n,%\A* XXv/11 y-^ ^ k J />r^. __ U'f'r-fW' raxieriL Date Problems (No. and Description) ' FINDINGS X' Number -------------- _. JJU /V X AT' - i- yv.,* Pare "V/ PRIVILEGED AND "CONFIDENTIAL MATERIAL SUBJECTTOPK- --- \/ c/ if-i*. c] .* i\* U> L ______ ' , f X" C / ,1 / UPfJT / Xi.:(.rG bf? kj Lb\!b ~bbb/Lbh/^b. HU^hci'b^-- ' ", / Xv inbbyyyby- uur/mi, rbaibbr ,>2 w AA nb /i 1 ------------/-X--X------- -------------X- -t------V- -J' -J-J Aih----'I.r~tj^y-------y-\- . J /T~1 ,\ry "/ X .O' '' UvsTH V m. /\A "1 ' i', - ,v w, /! ' ./ --.'/Xf: , '.Jrr 't ' . ' * :i 7 _________, '.-: <>-.//' ._ i _ 1 \A > ' ;<' '< * -- / ic C (' X . '* _ ___ ! /* ' ^ ' '/-'V1 v ''jH)l,u' J ' f) ,r\ lix X. [{ 1 \ V l" 1 ! r r.b'' *v3' "V v\ 'si'' \ i A-- N- P'AoCtRriv 1/ ` ' ^ 1 ^_ " ^"''X/ ^ ' , ^] L/`l > , f ' ' /"*~-z~') (` tj , . IV*. (/ b. ' ' > \ Xx /l~\b\ jy / /____________ _________________________________________________________ ___________ . (/.X* /. . ' b'f 0 i n LA>~ -* ~ /1A? A 'fjjW I* J `J l A -a /IX/ /A ^ > V /f/t/ v:/tA<i_ , ? Jtiijj - -- 1 J .4.'/!/'tt^/> b :tuA /-< (' " AX'/ /}iA,f* I ( i W i' r-.kUj ' r,xx! X- u "' (V 1 ''/( ^o ' ` ^ f .^/--yr --/,- --- ---------------------^-------- 7TT 'V.-X --X-------^---u----7r------- ---^\3/,------ - M'T / A-f '" UCC 082142 -b^. I ' 1* / / / -7 -a, ^ "7 2 (1 /t,Y '' { 7 ( "Tj. V1 ST 4. r S.. '- 4-c^. Um. ' ^ S r^a/I , /-^ //. <? /-^- ^ Krai u. ------ JUi^L.. -. ' ix%i Qy / p, iz 4*c-Tv^ b si A i /L^, y~T^///z.y// / (_' ^ --r o //A rAvA/yL S/Alin i< ^'v/t/L A/jJjjA --------cJLL&r<Y 0 1 f\u.AJ 3&jL--.Acf J^mjI'jJ - /i/V rM l\r^A CiP.ih fej/Lvty* Vhb li/Ar-j pit jju - Uavm - /V an.sjJui kJA/bTij^M* * ___ :M.i y ~N- P^(A<^i: ,/^f-_____ pJM/^ JBL ^1 i_ Vk -fw- /^/Ha- -" D h^_ UCC 082143 Patient. Name ^ '^v V *'/ Date Pccbl-effls (No. and F'INDINCS Descr'DtiorT \zhK 7 gpr 7-- / ' /3b" (fa . / . j. v /3 A - Number Pace --'/ , . 1 1 ,A,t/ 1 - ' / O'- ' 7 O *7/> -3 ' ! v '3 C ? sc:- L~ O' --' ' j- "" - 0- y, ^3 ... , . . ^ /v - - J- ` fr U)r/*>t/Z3 Jfcj\ Pfjn' A_ w ________ A A__________ /7__ O/O/O - (AJiSSf? 3 laaaIIa.- fa, ifa!fain. \t ' /T^ Uy. ofam ,v. - -yfaiMjaUii A fh 6 i /itr.,1 lifa 0/0 3.33 /ssj 3Y4 fainuMiLi !'j 4* - /K> -//a Luf&fa/A,; v3 n(y ( ft> c<si ^ rlc, .A | ^ privileged ANn j Aft '*% ^ ___________________________ SUBJPrr ^IAL MA 1 (/ SUBJECTTO PROTECTIVE oQQ --_______________________________________________________ ///' 3, 30 '; ; O 33 ^ o hMtu o i^LuUk yj AK ff\\Z cA r 7 v L\jJ^Ah Am/ 73 ------------------------------ 3' _ ifafifaii "> O ^ ,3-. yVv>\.it-4.. ' -3^\. 3 ' f 33,.., r _ "iJ h '/y3 ` a , _ -7 <L, fa' ^ /iv~ \ / s'? /fy /' UCC 082144 Patient. Name^ (A Date Number Pecbleas (No. and FINDINGS Descriptionj (Subjective and Objective)* 4 Jr/ V MTPCF _ Pape, a///Hud l^~uA:d /2-l3 C .VI Afk Jjs/.l , / ' \ 'jsi h*' . -i n c^alL. \^rf y cJy'^v---- / -*' (A-r/t ftcKJ ( (oL Jd__ (IjZJL (V / v (V/m j-UJjso; * (T)y a(W. -4 'O JU /a- ~t(. r ( // /y^f- kj <A-d if'-^d/1 t-4/ffjjy j y ~<'H< / fjASJs'1_______ __ /av>0 y>... ',,v?/ / A (//L. rr'Arn-' ? k jrj, is /'. ,A -M J- -v v. n.'A.. :{-y iIf ` Am a /AM-_________ rMA. /'A^ / ilM UaALK JIAa /mm'-___________ J-V( "V./ /. A/. --J III <> 0 H QmO <Z <t yh ,,gS_iOa: :o; !3g ?Eu) - z "> o" 9g 7^7^" A./ t/ /y^P. A//v ' //r/y ./ /\s> /9am m/aaa a.m/ // /' . / T" / <A/'r~ ^a4'T-a- jfL * A*/ f* / j i { 'le ,-/y/v4/.--A ,;o;a y>p U t:r/ir /; v/^a, aa /4'/. / > w-. t '`yA O/m ` r^TT drvclwj v-^/v4y/ ,y#U. Jd A.A 1 //V A'' y/tA /AnU`.v-t^ /A/T1 AAj- " 1 , A - />,//,1 /. a A V '/-'A 82 Patient's Name. Institution _ EASTERN COOPERATIVE ONCOLOGY GROUP-STA ^ARO FLOW SHEET Lzm____ Ujix. "4C Hosp. or Soc, Sec. Nv. Protocol Number___ pr __ . oS 8? oS at u< X at h uJ OX 2K -^_V VI 1H/1- ]. Date io> ^ Imo./day) 2. Initials )y |'Vifli>A' RECORD ACTUAL DOSE: IF MODIFIED OR NOT GIVEN, EXPLAIN 3. Rx 1 (dose/day) 4. Rx 2 (dose/day) S. Rx 3 (dose/day) 6. Rx 4 (dose/day) 3EJL dju JllK. 7. Rx J (dose/day) SPECIFY AMOUNT; GIVE DETAILS 8. Antibiotics/Analgencs 9, Radiation (rads/day) 10. Transfusions (units) 11. 12. PERFORMANCE STATUS* -h 13. Weight (kg) 14. Temperature CIRCLE REACTIONS DUE TO PROTOCOL THERAPY 15. Anemia 16. Hemorrhage 1 7. Infection 18. GU 19. Hepatic 20 Nausea A Vomiting 21 Other Gl 22. Pulmonary 23 Cardiac 24. Neuroloeic-PN 25. Neurologlc-CNS 26 Skin 27. Allergy 28. Fever 29. Pain 30. Other (specify) REFER TO PROTOCOL FOR TEST SCHEDULES 31.HG8(m )) 32. HCT (%) 6` J-L 33 WBC (x 1000) 34. Neutrophyls (%) 1 > 5 v 35. Lymphs (%) 36. Platelets (x 1000) 37 P.etic (%) 38. SUN (mg %) 39. Serum Creatinine (mg %) 40. Aik Ptase (units) 41. Bilirubin (mg %) 42. SGOT (units) 43. SGPT (units) 44. LDH (units) 45. Uric Acid (mg %) 46. Total Protein (|m %) 47. Albumin (gm %) 48 Abnormal Protein (|m %) 49. Calcium (mi %) 50. Phosphorus (mj%) 51. 52. PPD Int (mm) 53. Mumps (mm) 54. Varidase (dose A mm) 55. Dermatophytin 0 (1 100) (mmI 56 Other: REMARKS (R,. R2. R3, etc*) fi PRIVILEGED AND "CONFIDENTIAL MATERIAL SUBJECT TO PROTECTIVE ORDER" UCC 082146 t Measure at 48 hours induration as the mean of two diameters measured at ri|ht an|les in mm. rtroMAwet status kiy 0-Mereul activity i - IreeiHi he en*4ann 1-1* kvA < SOVvt l-laM>UltlSm a-101 ratHnt status at 0 Nwt ar Netmat t-MIM 1-Meearau l-Se-tv 4-Lift- T kruyiMni B2 Patient's NameInstitution____ ^EASTERN COOPERATIVE ONCOLOGY GROUP-ST/ 'OARD FLOW SHEET Jl/1A/V\ & Pj__________________ri Hosp. or Soc. Sec. N. Protocol Number Page--__ loS 8| o5 eg 1. Date tq%'7 ImnJrtiyl 2. Initials miW CLwia~ ,(/tu .ixL \U1 .Si RECORD ACTUAL DOSE; IF MODIFIED OR NOT G'lVEN. EXPLAIN u 3. Rx 1 (dose/day) fYlTX 4. Rx 2 (dose/day) f -f 5. Rx 3 (dose/day) 6. Rx 4 (dose/day) 7. Rx 5 (dose/day) 3<fc ?>*\ 'J \ L .. >0*i4 X ll/itw REMARKS (R,.R2.R3.4ic.| ^/ vy cL ^ ' }\jJ X at OX b^ 5 c< s^ -- 6 m 3 m >-- < at i1 z53 r< SPECIFY AMOUNT; GIVE DETAILS 8. Antibiotics/Analgesics 9. Radiation (rads/day) v 10. Transfusions (units) 11. 12. PERFORMANCE STATUS* 1 3. Weight (kg) ft* ) 14. Temperature CIRCLE REACTIONS DUE TO PROTOCOL THERAPY IS. Anemia 16, Hemorrhage 1 7. Infection 18. GU 1 9. Hepatic 20. Nausea A Vomiting 21 Other Gl 22. Pulmonary 23. Cardiac 24. Neurologic--PN 25. Neurologic--CNS 26 Skin 27. Allergy 28. Fever 29. Pain 30. Other (specify) REFER TO PROTOCOL FOR TEST SCHEDULES 31. HGB (gm )| 32. HCT (*) 10-c, 7.4 3-1. ? 33 WBC (x 1000) Kv* 34. Neutrophyli {%) I6.r tier sL/->l 3_i < > > c < O < A) 7^ ^ 1/3 v* ' 35. Lymphs (%) 36. Platelets (x 1000) 37. P.etic (%) 38. BUN (mg %) 39 Serum Creatinine (mg %) 40. Aik. Ptase (units) 41 Bilirubin (mg %) 42. SGOT (units) 43. SGPT (units) 44 LDH (units) 45. Uric Acid (mg %) 46. Total Protein (gm %) 47. Albumin (gm %) 48 Abnormal Protein (gm %) 49. Calcium (mg %) 50. Phosphorus (mg %) 51 52. PPD Int (mm) 5 3. Mumps (mm) 54. Varidase (dose A mm) 55. Dermatophytm 0(1:100) (mm) 56. Other: XL 1 V>" /, i'l PRIVILEGED AND ^CONFIDENTIAL MATERIAL ' 3JECT TO PROTECTIVE ORDER" UCC 082147 1 Mtasurt it 4S hours induration as the mcan of two diameters measured at right angles in mm* KEY 0>*H*riul utMty 1 -typmn kw wMiwy 0 Nim or Normil 1-M04 . at 1-In ta4 > SP e Mete 4-tOOftMM l-Sewe B2 Patient s Name. Institution-------- EASTERN COOPERATIVE ONCOLOGY GROUP-STANDARD FLOW SHEET r. S.VV- i ___________________ Hosp. or Soc. Sec. N(____________ ___ ,_______________________ __________________ Protocol Number______________________________ Page. of_ Ilf J, Oat* 19U__(mo./dav) /v/u m~i*W "h' mM7 /'// ..-dURLL 2. Initials u7 RECORD ACTUAL DOSE; IF MODIFIED OR NOT GIVEN, EXPLAIN 3, R* 1 (dose/dav) /Vk; S<4 v m REMARKS (Rt. R3. Rj.etc.) ~jj ce 1J 5 5< 4. Rx 2 (dose/dav) S. Rx 3 (dose/day) .L 6. Rx 4 (dose/day) .... O' / *J x 13k 7. Rx J (dose/day) SPECIFY AMOUNT, GIVE DETAILS *L 8. Antibiotics/Analgesics X OZ 4. Radiation (rads/day) 10 Transfusions (units) ijily 11. 5D 5*js < I^ 12. PERFORMANCE status* 1 3 Weight (kg) 1 4. Temperature CIRCLE REACTIONS OUE TOPROTOCOL THERAPY 15. Anemia 16 Hemorrnage 1 7. Infection 18. GU 6 19 H--pa<ic 20 Nausea A Vomiting o 21 Other G! t-- < QC o r 22. Pulmonary 23 Cardiac 24 Neurologic-PN 25. Neurologic-CNS 26 Skin 27. Allergy 28 Fever 29. Pain 30. Other Ispecify) REFER TO PROTOCOL FOR TEST SCHEDULES 31. HGB (gm %)| 6.7 if 7 ,-/ 32 HCT (%) 33 WBC (x 1000) 1 i. i l.f- f'/ il (Ah /O 34. Neutrophyls {%) 35. Lymphs (%) Ar. . 36. Platelets (x 1000) 3^3 w 37 P.etic (%) 3wj 38. BUN (mg %) < > 39. Serum Creatinine (mg %) > 40. Aik Ptase (units) o 41. Bilirubin (mj %) < u. 42 SGOT (units) o 43. SGPT (units) < 44. LDH (units) 45. Uric Acid (mg %) iH 0 u PRIVILEGED AND "CONFIDENTIAL MATERIAL SUBJECT TO PROTECTIVE ORDER" 46. Total Prottin (|m %) 47. Albumin (gm %) 48 Abnormal Protein (gm %) UCC 082148 49 Calcium (mg 50. Phosphorus (mg W) i. "e.r7* H- _ *- 51 52. PPD Int (mm) 53. Mumps (mm) 54. Vandase (dose A mm) 55. Dermatophyun 0 (r 100) (mm) 56 Other. t Measure at 48 houn induration as the mean of two diameters measured at right angles in mm. ftTOtMAMCt STATUS KtV 0 'Htrmtf Kllvlty 2-t **f AUCNT status ** m HvhwI I -MU4 4-l 4-Li(*-tWut4MA| --------- B2 Patient's Name. Institution------- EA^TfcRN COOPERATIVE ONCOLOGY GROUP-STANDARD FLOW SHEET __ tLA' _______ __ Hosp. or Soc, Sec. N ^Protocol Number__ Pageof ]. Date I4f~l fmo./davl TTT'W IbTTm lJ/0- REMARKS (R,. Rj. R3,etc.) OTHER ini "5 2. Initials RECORD ACTUAL DOSE; IF MODIFIED OR NOT GIVEN, EXPLAIN 3. Rx 1 (dose/day) /xAml* sr 4. Rx 2 (dose/day) OiT i c. 13 sv 5. Rx 3 (dose/day) 6. Rx 4 (dose/day) 7. Rx 5 (dose/day) SPECIFY AMOUNT; GIVE DETAILS 8. Antibiotics/Analgesics 1 4. Radiation (rads/day) to Transfusions (units) " 1 --i K STATUS THERAPY PATIENT 12. PERFORMANCE STATUS* j 1 3. Weight (kg) j IV 1 4. Temperature I H CIRCLE REACTIONS DUE TO PROTOCOL THERAPY 15. Anemia 16 Hemorrhage 1 7. Infection 18. GU o t4m39 19 Htpalic 20. Nausea A Vomiting 0 teA 21 Other Gl m 22. Pulmonary I 3 < 1 o h 23 Cardiac 24 Neurologic-PN 2S. Neurologic-CNS 26 Skin 27, Allergy 28. Fever 29. Pam 30, Other (specify) REFER TO PROTOCOL FOR TEST SCHEDULES 31. HGB <gm )) 32. HCT (%) 33 WBC (x 1000) 34. Neutrpphyls (%) 35. Lymphs (%) 36. Platelets (x 1000) UJ 37. P.etic (%) 38. BUN (mg %) < > 39 Serum Creatinine (mg %) > 40. Aik. Ptase (units) o 41. Bilirubin (mg 3k) < 42. SGOT (units) o 43. SGPT (units) < 44 LDH (units) 45. Uric Acid (mg %) 46, Total Protein (gm %) 47. Albumin (gm %) ' 48 Abnormal Protein (gm %) 49 Calcium (mg %) IH.') /v r i1 13 Mil i.Q M,' 3.7 5^3 .................. ..... 50. Phosphorus (mg 16) 1 F .. * *P*- " vs P- - 51 52. PPD Int (mm) 53. Mump* (mm) 54. Varidase (dose A mm) 55. Deimatophytin 0 (1 100) (mml 56 Other: j 7-v^ p;.r tf./ 33 privileged and " S ORDER" UCC 082149 t Measure at 48 hours induration as the mean of two diameters measured at right angles in mm. S-Narwl WMtT km l-u eae<SMf aw J-U. M > SOB H h fATUNT status ct 1 -MU4 l-UMuau )-kw 4<llfTIV4liiun| -L*'h<----------------------