# Private Source Manifest — RPPH Cardiology/Orthopedic Papers (2024-01-22)

Archive ID: `rpph-2024-01-22-cardiology-orthopedic-papers`

Source: six user-supplied paper photos found during old-paper review; archived privately because they contain identifiable medical data.

## Files

| File | SHA-256 |
|---|---|
| `01-medical-certificate-page1.jpg` | `23d984cfb84e1336406a3d821df0e5b5ae3e28157d0eea54444c113bec431756` |
| `02-medical-certificate-page2.jpg` | `cabe9df60d99e0dbb540d929844374d174aa7931ce7cf2412ab1639a2217c51f` |
| `03-outpatient-statement-detail.jpg` | `9bbf5845db2a899ef915b75c4167104e10e63b0bae769ea5bfc3e8283830b58e` |
| `04-radiology-pelvis-ap-view-alt.jpg` | `0463117d757bd316e2b8ffd170154b3989b22792c2a62a15cf225b6fd251df04` |
| `05-radiology-hip-rt-frog-leg.jpg` | `57b89b0533df7ff346275ba0e6bf2ad697187f6acd0eb49555abf30c215f7c3c` |
| `06-radiology-lower-extremity-doppler.jpg` | `3d1f339754d1ff6ba6673912852ba39502b560ee2998c468e95c203ad8c7e8bc` |

## Extracted medical abstraction for KB integration

- Hospital/date: Royal Phnom Penh Hospital, visit/exam/order/report dates 2024-01-22.
- Lower-extremity arterial Doppler, right leg:
  - CFA/common femoral artery: arteriosclerosis with mixed plaque causing mild stenosis, reported as 24–31%.
  - SFA and popliteal artery: normal caliber without aneurysm dilation; thin calcified plaque and soft plaque without significant stenosis.
  - Tibioperoneal trunk, ATA, PTA: normal caliber without aneurysm dilation or stenosis.
  - Resting spectral Doppler: high-resistance pattern with normal systolic velocity; RI 0.87–0.99.
  - Conclusion: arteriosclerosis of the right lower leg with mild stenosis at CFA 24–31%.
  - Medical certificate comment: incidental finding; might not explain patient symptom.
- Hip/pelvis radiology for right hip discomfort:
  - No fracture or dislocation.
  - Minimal osteoarthritis at bilateral hip joints, more pronounced right side.
  - SI joints and symphysis pubis well-maintained.
  - One pelvis AP report describes oval calcifications at bilateral gluteal insertion into greater trochanter, larger on right, suggestive of gluteal calcific tendinitis.
  - Another hip/frog-leg report says no gross pathologic soft-tissue calcification; preserve as report-version inconsistency.
  - No significant soft-tissue swelling.
- Medication/recommendation at that visit:
  - Aspirin 81 mg daily started/recommended.
  - Lipitor/atorvastatin 40 mg daily started/recommended.
  - Omeprazole 20 mg on the billing sheet; page text may read 40 mg but is less clear.
  - Follow-up in 1 week for hemo/CBC-like test, lipid profile, HbA1c, and FBS.
  - Stop smoking advised.
- Diagnosis/billing notes:
  - Medical certificate diagnosis table oddly codes `I80` phlebitis/thrombophlebitis but comments `mild PAD`; treat the free-text Doppler conclusion as the clinically relevant vascular abstraction.
  - Outpatient statement total: USD 464.90. Major line items visible: meds USD 60.90, diagnostic imaging/X-ray USD 72.00, ultrasound/Doppler USD 252.00, medical service charge USD 10.00, physician evaluation/doctor fees USD 70.00.

## Public-surface rule

Do not expose the photos or raw private path in public `/files/` artifacts. KB/report content should use the archive ID and compact medical abstraction only.