Initial Assessments - Nurse Kelli M - 05/15/2025 7:31 AM CDTFormatting of this note might be different from the original.CM Initial Assessment Interview NoteInformation Obtained From: Patient(05/14/25 1630)Admission Source: Non Health Care Facility Point of OriginImpression: Patient admitted for robotic liver resection s/p colorectal cancer and hepatic metastasis. Patient lives at home with his significant other, Kimberly and is IADL’s at baseline.Plan Includes: Patient anticipated discharge home when medically stable. Patient may have home health care needs pending PT/OT recs. Patient does not have a preference for a home health agency and a list of agencies can/will be provided if needed. Patient has family for home support and transportation. Case Management will continue to follow for anticipated discharge needs. Additional Information: Role of CM explained to patient. CM verified address, phone number, insurance and emergency contact from facesheet with patient/family. Primary Source of Transportation: KimberlyDoes the patient need discharge transport arranged?: No(05/14/25 1630)Health Insurance Coverage: MolinaPrescription Coverage: yesPharmacy:Walmart Pharmacy 1071 - Wood River, IL - 610 WESLEY DRIVE610 WESLEY DRIVEWood River IL 62095Phone: 618-259-0293 Fax: 618-259-8757Primary Care Provider: Kelsey Beard, NPSuthan, Nanthini, MDPrior to Admission:Functional Status: Independent with ADLsPrimary Caregiver: SelfSupport System: Spouse/Significant OtherHome Care Services: NoOutpatient Services: NoDurable Medical Equipment: NoneLiving Arrangements: Spouse/significant otherType of Residence: Private residenceSteps in home?: Yes, Outside of home, Yes, Inside homeNumber of steps inside: 10 stepsNumber of steps outside: 4 stepsMedication management: Independent(05/14/25 1630)SDOH:Transportation:Financial Resource:Housing:Utilities:Social Connections:Food Insecurity:Behavioral Health Services:Behavioral Health Services: No(05/14/25 1630)Anticipated Level of Care:Anticipated discharge level of care: Private residencePt/Family agrees with Anticipated Level of Care: Yes(05/14/25 1630)Patient expects to be Discharged to:Private residence, (05/14/25 1630)Patient’s Identified Problem/GoalProblem: Ensure acute medical needs are met and that patient has a safe discharge plan.Goal: Secure a discharge plan that patient/family are agreeable with and ensure patient has continuum of care.Case management will follow for discharge planning and send referrals as needed. Kelli Marie Macomber, RNElectronically signed by Nurse Kelli M at 05/15/2025 7:37 AM CDTPlan of Care - Nurse Caden C - 05/14/2025 9:34 PM CDTFormatting of this note might be different from the original.Goals: monitor I&Os, monitor vital signs, pain management, foley catheter discontinued, fall preventionSummary: Problem: Discharge PlanningGoal: Understanding discharge needs will improveOutcome: ProgressingProblem: ActivityGoal: Risk for activity intolerance and fatigue will decreaseOutcome: ProgressingGoal: Ability to tolerate increased activity will improveOutcome: ProgressingGoal: Ability to avoid complications of mobility impairment will improveOutcome: ProgressingProblem: Communication ImpairmentGoal: Ability to express needs and understand communicationOutcome: ProgressingProblem: General Patient EducationGoal: Knowledge of disease process, condition or treatment will be improvedOutcome: ProgressingProblem: Health BehaviorGoal: Ability to state signs and symptoms to report to health care provider will improveOutcome: ProgressingGoal: Ability to identify and alter actions that are detrimental to health will improveOutcome: ProgressingGoal: Ability to identify and utilize available resources and services will improveOutcome: ProgressingGoal: Compliance with prescribed regimen will improveOutcome: ProgressingProblem: Physical RegulationGoal: Will remain free from infectionOutcome: ProgressingGoal: Ability to maintain clinical measurements within normal limits will improveOutcome: ProgressingGoal: Ability to maintain body temperature in the normal range will improveOutcome: ProgressingProblem: SafetyGoal: Free from injury or harmOutcome: ProgressingGoal: Ability to maintain safety and efficiency with swallowing without signs of aspiration will improveOutcome: ProgressingElectronically signed by Nurse Caden C at 05/14/2025 9:36 PM CDTPlan of Care - Nurse Amber T - 05/14/2025 3:34 PM CDTFormatting of this note might be different from the original.Goals: Monitor vital signs, intake and output, pain management, comfort, admission questionsSummary: Problem: Discharge PlanningGoal: Understanding discharge needs will improveOutcome: ProgressingElectronically signed by Nurse Amber T at 05/14/2025 3:35 PM CDTBrief Op Note - William Chapman, MD - 05/14/2025 1:08 PM CDTFormatting of this note is different from the original.Operative Progress NoteSurgical Team: Surgeons and Role: * Chapman, William Cavanaugh, MD - PrimaryAnesthesiologist: Zoller, Jonathan Kramer, MDAnesthesia Resident: Lewis, Bradley Mitchell, DOCirculator: St. Pierre, Grace Marguerite, RNScrub: Sullivan, Ryan W., STRNFA: Scherer, Meranda Della, RNFLOAT: Berlage, Julia Newman, RN; Boehmer, Natalie Nicole, RNDATE OF SURGERY :5/14/2025Preoperative

Diagnosis: Pre-op Diagnosis * Metastatic colon cancer to liver (HCC) [C18.9, C78.7]Postoperative

Diagnosis: Post-op Diagnosis * Metastatic colon cancer to liver (HCC) [C18.9, C78.7]Procedure(s):Procedure(s) (LRB):XI LIVER RESECTION - LAPAROSCOPIC ROBOTIC ASSISTED, TAP Block (N/A)Operative Findings:Single nodule in segment 2Estimated Blood Loss:No blood loss documented.Intraoperative Fluids:600 mls crystalloidSpecimens:ID Type Source Tests Collected by Time A : Segment 2 Excision Tissue Liver, Partial Resection SURGICAL PATHOLOGY Chapman, William Cavanaugh, MD 5/14/2025 1401 Implants:Nothing was implanted during the procedureBlood/Blood Products Transfused:noneComplications:NoneCondition on Discharge from the operating room was stableWilliam Cavanaugh Chapman, MDDate: 5/14/2025 Time: 2:03 PMElectronically signed by William Chapman, MD at 05/14/2025 2:04 PM CDTOp Note - William Chapman, MD - 05/14/2025 12:00 AM CDTFormatting of this note might be different from the original.PREOPERATIVE DIAGNOSISMetastatic colorectal cancer to the liver.POSTOPERATIVE DIAGNOSISMetastatic colorectal cancer to the liver.PROCEDURERobotic segment 2 liver resection.SURGEONWilliam Chapman, MD.1ST ASSISTANTJessica Foster, MD.2ND ASSISTANTMeranda Scherer, RNFA.I was present during the operative procedure from the time of incision until the time of closure and immediately available for all remaining portions of the procedure. The patient was given Ancef within 30 minutes of the skin incision and written for less than 24 hours postoperative antibiotics. Sequential compression device stockings were placed on lower extremities for DVT prophylaxis.INDICATIONS FOR OPERATIONThis patient is a 49-year-old man who previously had a colorectal cancer and developed hepatic metastases. His primary tumor was resected after initiation of chemotherapy and his 3 hepatic metastases have essentially disappeared with exception of a segment 2 site which is 7 mm in size. He and his medical oncology team wished to have this resected to make him NED. He is brought to the operating room at this time for planned segment 2 liver resection.OPERATIVE FINDINGSThe patient had a small nodule easily available in segment 2 near the left hemidiaphragm. This was resected circumferentially and no other metastatic sites were identified.OPERATIVE PROCEDUREAfter placing the patient on the operating table in supine position, general endotracheal anesthesia was induced. Monitoring lines were placed by anesthesia. Initially, a Veress needle was used to gain access to the peritoneal cavity, which was insufflated with CO2. Initially, a 5 mm trocar was placed in the left upper quadrant with a forward viewing laparoscope in the trocar for direct visualization. The abdomen was entered without difficulty. The underlying bowel were examined and there was no evidence of bowel injury. At this point, 4 additional 8 mm trocars were placed for robotic resection. The robot was docked and attention was directed at the planned liver resection. The falciform ligament was ligated and divided with the LigaSure device. The left lateral segment was then mobilized by dividing the left triangular ligament under direct visualization. The left lower segment was elevated and a punctate metastatic site identified in segment 2. At this point, a nonanatomic circumferential resection was performed using combination of electrocautery circumferentially. After complete removal of the specimen the liver parenchyma was inspected. There was no evidence of bile leakage and the resection sites appeared watertight. The liver resection was placed in an EndoCatch bag and exited through the umbilical site. The trocars were removed and the robot was undocked. The skin incisions of the previously placed trocars were then closed using 4-0 Dexon subcuticular suture. Dermabond was placed. Patient was awakened, extubated, and taken to the recovery room in stable condition. Final sponge and instrument counts correct x2.ESTIMATED BLOOD LOSSMinimal.IV FLUIDS1400 mL crystalloid.SPECIMENSSegment 2 liver resection.CONDITION ON DISCHARGEStable.Job ID/Internal Job ID: 018311/1061817811Electronically signed by William Chapman, MD at 05/15/2025 5:06 PM CDTdocumented in this encounter