Maureen Mercier, NP - 05/28/2025 9:15 AM CDTFormatting of this note is different from the original.Abdominal Transplant/HPB Post-Op Clinic NoteChief Complaint: Postoperative visit.HPI: Mr. Alexander R Towell is a 49 y.o. male with a history of metastatic colorectal cancer to the liver s/p XI LIVER RESECTION - LAPAROSCOPIC ROBOTIC ASSISTED, TAP Block on 05/14/2025 with Dr. Chapman. The postoperative course was unremarkable. Doing well today. Minimal complaints upon Ros. Feeling well. He denies abdominal pain, nausea, vomiting, constipation, diarrhea, fevers or chills. He reports a healthy appetite. Past Medical

History: has a past medical history of Anemia, Cancer (HCC), Peripheral neuropathy, Sleep apnea, and Thyroid disease.He has no past medical history of Acute respiratory failure requiring reintubation (HCC), Awareness under anesthesia, Delayed emergence from general anesthesia, Hard to intubate, Malignant hyperthermia, Motion sickness, PONV (postoperative nausea and vomiting), Postoperative delirium, or Pseudocholinesterase deficiency. Past Surgical

History: has a past surgical history that includes Colon surgery (12/30/2021); Small Bowel Resection (07/01/2024); and Thyroidectomy, partial (Right, 2022).Social

History: reports that he has never smoked. He has never used smokeless tobacco. He reports that he does not use drugs. Patient denies consuming alcoholic drinks. Allergies: No Known AllergiesFamily

History: family history includes Prostate cancer (age of onset: 69) in his father.Medications: HOME MEDICATIONS : cyanocobalamin (Vitamin B-12) 100 mcg tablet docusate sodium (COLACE) 100 mg capsule iron bisgly,ps-FA-B-C#12-succ 65 mg-65 mg -1,000 mcg (24) tablet levothyroxine (SYNTHROID) 112 mcg tablet loperamide (IMODIUM A-D) 2 mg tablet LORazepam (ATIVAN) 0.5 mg tablet multivitamin with minerals tablet omega-3 fatty acids-fish oil 300-1,000 mg capsule prochlorperazine (COMPAZINE) 10 mg tablet propranoloL (INDERAL) 20 mg tablet zolpidem (AMBIEN) 5 mg tabletVitalsBP 132/86 Pulse 93 Temp 36.4 °C (97.6 °F) Ht 182.9 cm (6’) Wt 98.7 kg (217 lb 9.6 oz) SpO2 97% BMI 29.51 kg/m² Review of Systems: Review of Systems All other systems reviewed and are negative.Physical Exam: Physical ExamConstitutional: General: He is not in acute distress. Appearance: Normal appearance. He is not ill-appearing, toxic-appearing or diaphoretic. HENT: Head: Normocephalic and atraumatic. Right Ear: External ear normal. Left Ear: External ear normal. Eyes: Conjunctiva/sclera: Conjunctivae normal. Cardiovascular: Rate and Rhythm: Normal rate. Pulses: Normal pulses. Pulmonary: Effort: Pulmonary effort is normal. No respiratory distress. Abdominal: General: Abdomen is flat. There is no distension. Palpations: Abdomen is soft. There is no mass. Tenderness: There is no abdominal tenderness. There is no guarding. Hernia: No hernia is present. Comments: Incision healing well Musculoskeletal: Comments: Independently moves extremities Skin: General: Skin is warm and dry. Coloration: Skin is not pale. Findings: No erythema or rash. Neurological: Mental Status: He is alert and oriented to person, place, and time. Psychiatric: Mood and Affect: Mood normal. Behavior: Behavior normal. Thought Content: Thought content normal. Judgment: Judgment normal. Surgical Pathology:URGICAL PATHOLOGY REPORT FINAL WITH ADDENDUM Patient Name: TOWELL, ALEXANDER R. Accession #: S25-23061 Gender: M DOB: 8/4/1975 (Age: 49) Address: 304 PICKER AVE, WOOD RIVER, IL 62095-1144 MRN: 104670153 Hospital #: 2272813559 Taken:5/14/2025 Received:5/14/2025 Accessioned:5/14/2025 Reported: 5/19/2025 Patient Type: BJH Inpatient Service: Surgery Location: BJH 0164 Physician(s): William C. Chapman, M.D. Nanthini Suthan, MD Benjamin Tan, M.D.

Diagnosis: A. Liver, segment 2, resection - Metastatic adenocarcinoma morphologically compatible with the patient’s colorectal primary. - Adenocarcinoma present at cauterized resection margin. - Perineural invasion identified. laha/5/19/2025 07:49 By this signature, I attest that the above diagnosis is based upon my personal examination of the slides(and/or other material indicated in the diagnosis). Adam L. Booth, M.D. Report Electronically Reviewed and Signed Out By Adam L. Booth, M.D. 5/19/2025 11:46:56 Diagnosis Comment Previous case (W24-7828) was reviewed and is morphologically identical to current specimen. Larry Ha, M.D.

History: Patient is a 49-year-old man with a metastatic colon cancer to the liver. Operative Procedure: Liver resection, laparoscopic robotic assisted Specimen(s) Received: A: Segment 2 excision

Gross Description: Received in formalin labeled with patient identifiers and “segment 2 excision” is a wedge shaped piece of liver parenchyma (1.5 x 1.4 x 1.2 cm). The resection margin is shaggy purple-black with extensive thermal artifact. There is an area of white pallor on the capsular surface measuring 0.7 cm in greatest dimension. The resection margin is inked black and the capsular surface is inked blue. Serial sections show a firm white nodule below the previously described area on the capsular surface measuring up to 1.0 x 1.0 x 0.8 cm. The lesion abuts the capsular surface and comes to within 0.1 cm of the closest resection margin. The specimen is submitted entirely in cassettes A1 and A 2. Jar 1 bao2/5/15/2025 10:44 PA(s): Beth Ann Obertino-Norwood, PA (ASCP)CM By this signature, I attest that the above diagnosis is based upon my personal examination of the slides(and/or other material). Addenda/Procedures Addendum Ordered:7/10/2025Status:Signed OutAddendum Complete:7/10/2025By:Samuel J. Ballentine, M.D.Addendum Signed Out:7/11/2025 Addendum Comment A request for Molecular Archived Tissue Testing was received, which is to be performed on tissue from the attached case. The report, slides and blocks for the case were retrieved from archives. The pathologist whose signature appears below reviewed the original pathology report, examined H&E slides, and selected the blocks appropriate to the specifications of the ordered molecular analysis. Materials were forwarded to Tempus where the Tempus xT test will be performed. An addendum report will be issued when the results of this molecular test are available. By this signature, I attest that the above diagnosis is based upon my personal examination of the slides(and/or other material indicated in the diagnosis). Samuel J. Ballentine, M.D.Report Electronically Reviewed and Signed Out By Samuel J. Ballentine, M.D. 7/11/2025 09:25:42 The xT 595 test was performed at Tempus, 600 West Chicago Ave, Suite 775, Chicago, IL 60654. The performance characteristics of some immunohistochemical stains, fluorescence in-situ hybridization tests and immunophenotyping by flow cytometry cited in this report (if any) were determined by the Surgical Pathology and Flow Cytometry Departments at Barnes-Jewish Hospital as part of an ongoing quality assurance program and in compliance with federally mandated regulations drawn from the Clinical Laboratory Improvement Act of 1988 (CLIA ‘88). Some of these tests rely on the use of “analyte specific reagents” and are subject to specific labeling requirements by the US Food and Drug Administration. Such diagnostic tests may only be performed in a facility that is certified by the Department of Health and Human Services as a high complexity laboratory under CLIA ‘88. The FDA has determined that such clearance or approval is not necessary. This test is used for clinical purposes. It should not be regarded as investigational or for research. Nevertheless, federal rules concerning the medical use of analyte specific reagents require that the following disclaimer be attached to the report: This test was developed and its performance characteristics determined by the Surgical Pathology and Flow Cytometry Departments of Barnes-Jewish Hospital. It has not been cleared or approved by the U. S. Food and Drug Administration. IMAGES AND SCANNED DOCUMENTS, IF INCLUDED, ONLY VIEWABLE IN PDF VERSION OF REPORT Assessment and

Plan: Mr. Towell is a 49 y.o. with a history of metastatic colorectal cancer the liver s/p XI LIVER RESECTION - LAPAROSCOPIC ROBOTIC ASSISTED, TAP Block. Presents for postoperative visit. Surgical pathology was discussed with the patient today. All of their questions were answered in detail.Continue weight lifting restrictions of <10lbs for another 4 weeks.Stay hydrated and continue to drink plenty of fluids throughout the day. Eat a well balanced diet, and continue nutrition supplement shakes as needed.As the surgical glue begins to flake off, it is ok to peel the glue off. Follow up with Dr. Tan as scheduled. Dr. Chapman to discs with oncology (Arshad and Tan).Follow-up: We will see the patient in clinic as needed. The patient knows to call the office with any questions or concerns in the interim. Maureen Mercier, NPPatient Care Team:Beard, Kelsey Michelle, NP as PCP - General (Nurse Practitioner)Arshad, Syed M., MD as Referring Physician (Hematology)Tan, Benjamin R., MD as Medical Oncologist/Hematologist (Medical Oncology)Tan, Benjamin R., MD as Medical Oncologist/Hematologist (Medical Oncology)Chapman, William Cavanaugh, MD as Consulting Physician (Transplant Surgery)Chapman, William C. Jr., MD as Consulting Physician (Colon and Rectal Surgery)Cosigned by William Chapman, MD at 08/01/2025 1:53 PM CDTElectronically signed by Maureen Mercier, NP at 08/01/2025 10:37 AM CDTElectronically signed by William Chapman, MD at 08/01/2025 1:53 PM CDTdocumented in this encounter