Epic Patient API MCP Server

- id: note-1 date: 2023-12-10 type: Progress Note provider: Dr. Patricia Williams summary: Initial presentation with abdominal symptoms content: | Patient presents with 3-month history of intermittent abdominal cramping, changes in bowel habits, and occasional rectal bleeding. Patient initially attributed symptoms to hemorrhoids. Reports fatigue and unintentional 15-pound weight loss over past 4 months. Physical exam: Abdomen soft, mildly tender in left lower quadrant. Digital rectal exam reveals no palpable masses but positive for occult blood. Assessment: Concerning GI symptoms requiring workup Plan: Order colonoscopy, CBC, CMP, fecal occult blood test attachments: [] - id: note-2 date: 2024-01-15 type: Procedure Note provider: Dr. James Martinez summary: Colonoscopy findings - suspicious mass content: | Procedure: Colonoscopy with biopsy Findings: Large circumferential mass in sigmoid colon at 25cm from anal verge. Mass is ulcerated and partially obstructing. Multiple biopsies obtained. Unable to pass scope beyond mass due to significant narrowing. Impression: Highly suspicious for colorectal malignancy Recommendation: Awaiting pathology, surgical oncology consultation attachments: - id: att-1 filename: colonoscopy-pathology-2024-01.txt type: text/plain description: Pathology report confirming adenocarcinoma - id: note-3 date: 2024-02-05 type: Surgical Consultation provider: Dr. Sarah Thompson summary: Surgical oncology evaluation content: | Patient referred for evaluation of newly diagnosed sigmoid colon adenocarcinoma. Reviewed colonoscopy findings and pathology confirming moderately differentiated adenocarcinoma. Discussed need for staging CT chest/abdomen/pelvis and CEA level. Discussed treatment options including surgery, neoadjuvant therapy based on staging. Plan: Complete staging workup before determining treatment approach attachments: [] - id: note-4 date: 2024-03-22 type: Oncology Consultation provider: Dr. Michael Anderson summary: Stage IV diagnosis and treatment planning content: | New patient consultation for recently diagnosed colorectal cancer. Staging: CT imaging reveals primary sigmoid tumor with multiple hepatic metastases (largest 4.2cm in right lobe) and bilateral pulmonary nodules consistent with metastatic disease. CEA elevated at 185 ng/mL. TNM stage: T3 N2 M1b (Stage IVB). Discussed poor prognosis but potential for disease control with systemic therapy. Patient desires aggressive treatment. ECOG performance status 1. Plan: Initiate FOLFOX chemotherapy regimen. Consider targeted therapy (bevacizumab) if tolerates initial cycles well. Repeat imaging after 8-12 weeks. attachments: - id: att-2 filename: staging-ct-report-2024-03.txt type: text/plain description: CT imaging report showing metastatic disease - id: note-5 date: 2024-05-20 type: Chemotherapy Visit provider: Dr. Michael Anderson summary: Cycle 4 FOLFOX - tolerating with side effects content: | Patient here for cycle 4 of FOLFOX. Reports manageable nausea with antiemetics, some diarrhea controlled with loperamide. New complaint of tingling in fingers and toes consistent with oxaliplatin-induced neuropathy (Grade 1). Vitals stable. Labs reviewed - CBC shows improving anemia (Hgb 11.2), CEA down to 95 ng/mL from baseline 185. Assessment: Responding to therapy with acceptable toxicity Plan: Continue current regimen. May need to reduce oxaliplatin dose if neuropathy worsens. Repeat imaging scheduled for next visit. attachments: [] - id: note-6 date: 2024-07-15 type: Progress Note provider: Dr. Michael Anderson summary: Mid-treatment response assessment content: | Patient completing 6 cycles of FOLFOX. Repeat CT imaging shows partial response with reduction in hepatic lesions (largest now 2.8cm) and stable pulmonary nodules. CEA continues to trend down (now 42 ng/mL). Tolerating treatment reasonably well though cumulative neuropathy now Grade 2. Patient reports improved energy and appetite. Weight stable. Assessment: Partial response to chemotherapy Plan: Continue modified FOLFOX (reduce oxaliplatin 20% for neuropathy). Consider maintenance therapy vs. treatment break after 2 more cycles. Discuss potential for hepatic metastasectomy if continued response. attachments: - id: att-3 filename: response-ct-report-2024-07.txt type: text/plain description: Follow-up CT showing treatment response - id: att-4 filename: progression-ct-report-2024-11.txt type: text/plain description: CT showing disease progression on first-line therapy - id: att-5 filename: ascites-cytology-2024-11.txt type: text/plain description: Cytology report confirming malignant ascites - id: note-7 date: 2024-09-10 type: Progress Note provider: Dr. Michael Anderson summary: Ongoing chemotherapy and supportive care content: | Patient continues on chemotherapy. Completed 12 cycles FOLFOX. Latest imaging shows continued disease control with slight further reduction in liver metastases. Lung nodules stable. Neuropathy limiting function - difficulty with fine motor tasks and cold sensitivity. Discussed stopping oxaliplatin and continuing 5-FU/leucovorin with bevacizumab. Psychologically coping well with strong family support. Connected with support group. Plan: Transition to 5-FU/leucovorin/bevacizumab maintenance regimen. Continue symptom management. Quality of life focus. attachments: [] - id: note-8 date: 2024-10-15 type: Palliative Care Consultation provider: Dr. Rachel Martinez summary: Initial palliative care consultation content: | New consultation for symptom management and advance care planning in patient with metastatic colorectal cancer currently on active treatment. SYMPTOM ASSESSMENT: - Pain: 3/10, primarily neuropathic in hands/feet from chemotherapy - Fatigue: Moderate, ECOG 1-2 - Appetite: Improved compared to diagnosis, eating well - Sleep: Fair, occasional insomnia - Anxiety: Mild to moderate regarding prognosis GOALS OF CARE DISCUSSION: Patient expresses desire to continue active treatment as long as quality of life maintained. Priorities include time with family, maintaining independence, and avoiding severe suffering. Has adult children who are very supportive. ADVANCE DIRECTIVES: Has healthcare proxy (spouse). Discussed code status - patient prefers DNR/DNI if disease progresses to terminal phase. Completed POLST form. PSYCHOSOCIAL: Working reduced hours as financial advisor. Wife is primary support. Two adult children involved in care. Connected to cancer support group. Sees oncology social worker monthly. Plan: - Start gabapentin 300mg for neuropathic pain - Continue current antiemetic regimen - Follow with palliative care team monthly alongside oncology - Offer home hospice evaluation if disease progresses - Encourage advance care planning discussions with family attachments: [] - id: note-9 date: 2024-11-20 type: Progress Note provider: Dr. Michael Anderson summary: Treatment modification due to disease progression content: | Patient returns with concerning symptoms. Reports increased abdominal pain (5-6/10), early satiety, and 8-pound weight loss over past 6 weeks despite previous stability. Also noting increased fatigue, ECOG status declined to 2. REVIEW OF SYSTEMS: No new rectal bleeding. Bowel movements regular with colostomy management. Denies fever, night sweats. Reports mild dyspnea on exertion (new). PHYSICAL EXAM: Appears fatigued but alert. Weight 153 lbs (down from 161). Abdomen: Distended, hepatomegaly palpable 4cm below costal margin. Slight tenderness in RUQ. No rebound or guarding. Lungs: Decreased breath sounds at bases bilaterally. No peripheral edema. IMAGING REVIEW (CT 11/18/24): Progressive disease with: - Liver metastases increased in size and number (segment 7 lesion now 4.5cm) - New small-volume ascites - Lung nodules slightly increased - No new sites of metastatic disease - CEA risen to 125 ng/mL ASSESSMENT: Progressive disease after initial partial response to first-line therapy. Duration of response approximately 6 months. DISCUSSION: Reviewed imaging results and discussed second-line treatment options including FOLFIRI + bevacizumab or clinical trial enrollment. Patient wishes to try second-line therapy before considering hospice care. Plan: - Switch to FOLFIRI (irinotecan-based) + bevacizumab regimen - Start albumin supplementation - Increase pain management with scheduled oxycodone - Obtain molecular testing for RAS/BRAF status to guide future therapy - Close monitoring, repeat imaging in 6-8 weeks - Palliative care co-management for symptom control attachments: [] - id: note-10 date: 2024-12-18 type: Social Work Note provider: Janet Cooper, LCSW summary: Psychosocial support and care coordination content: | Met with patient and spouse for psychosocial assessment and support. EMOTIONAL STATUS: Patient expressing more anxiety regarding disease progression after recent scans showed growth of liver lesions. Reports feeling "disappointed and scared" after initial positive response to treatment. Spouse tearful during session. Both struggling with uncertainty about prognosis. COPING: Patient utilizing cancer support group regularly. Finds peer support helpful. Has close relationship with adult children (daughter lives locally, son out of state). Faith community has been supportive with meals and visits. PRACTICAL CONCERNS: - Financial: On short-term disability, concerned about long-term financial impact - Work: Not currently working, employer holding position for 6 months - Insurance: Good coverage through employer, minimal out-of-pocket so far - Transportation: Spouse drives to appointments, daughter helps when needed - Home care: Managing well at home currently, may need home health in future FAMILY DYNAMICS: Strong marriage. Spouse feeling burden of caregiver role but managing well. Children very involved and supportive. Family communication is open. No major conflicts. All on same page regarding treatment goals. ADVANCE CARE PLANNING: Has completed healthcare proxy, POLST, and will. Discussed preferences with family. Everyone clear on patient's wishes regarding code status and aggressive interventions in end-stage disease. Plan: - Continue individual sessions q2-4 weeks - Offered family meeting if desired - Connected to financial counseling for disability/insurance questions - Provided resources for caregiver support for spouse - Will coordinate with palliative care team regarding transitions of care attachments: []