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Home My WebLink About00-04783 - ~ "~. '" ",_f' .-~ _'''' '_". ~--,y-_"",,~~.~>,. ._,^',~~",_~__, ", ~"" , , . ALLSTATE INSURANCE COMPANY, Plaintiff v. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. NO. CO - 4""~ ~~~, ~ JOSEPH ALDINGER, JAKE ULRICH, BRANDI MILLER, GLENN SHOLLY and WILLIAM McCLOSKEY, Defendants CIVIL ACTION - AT EQUITY JURY TRIAL DEMANDED NOTICE YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this Complaint and Notice are served, by entering a written appearance personally or by attorney and filing in writing with the Court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the Court without further notice for any money claimed in the Complaint or for any other claim or relief requested by the Plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. o CUMBERLANDG_Q!JN'l'Y BAR ASSOCIATION 2 LIBERTY AVElI1UE CARLISLE PA 17013 (717) 249 3166 or 1 800 990 9108 ''''. _~_,._ , ,_ . .".~ . _,,_, __ ,~,_,. _", _ _.__cn. ^-> , ~__,~ n_, '.. _ ._'._ , -"".'-;':;".1 ALLSTATE INSURANCE COMPANY, Plaintiff v. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. NO. JOSEPH ALDINGER, JAKE ULRICH, BRANDI MILLER, GLENN SHOLLY and WILLIAM McCLOSKEY, Defendants CIVIL ACTION - AT EQUITY JURY TRIAL DEMANDED NOTICIA Le han demandado a usted en la corte. Si usted quiere defenderse de estas demandas expuestas en las paginas siguientes, usted tiene viente (20) dias de plazo al partir de la fecha de la demanda y la notificacion. Usted Debe presentar una apariencia escrita 0 en persona 0 por abogado y archivar en la corte en forma escrita sus defensas 0 sus objeciones alas demandas en contra de su persona. Sea avisado que si usted no se defiende, la corte tomara medidas y puede entrar una orden contra usted sin previa a visa 0 notificacion, y por cualquier queja 0 alivio que es pedido en la peticion de demanda. Usted puede perder dinero 0 sus propiedades 0 otros derechos importantes para usted. LLEVE ESTA DEMANDA A UN ABODAGO INMEDIATAMENTE. SI NO TIENE ABOGADO 0 SI NO TIENE EL DINERO SUFICIENTE DE PAGAR TAL SERVICIO, VAYA EN PERSONA 0 LLAME POR TELEFONO A LA OFICINA CUYA DIRECCION SE ENCUENTRA ESCRITA ABAJO PARA AVERIGUAR DONDE SE PUEDE CONSEGUIR ASISTENCIA LEGAL. UNTY LAWYER REF' 213 STREET 1 2 -~, , --," ~--~ '-.c_. ", ",C_y ~- " "_"__ ~'__~,";~_'_," __', ;'< -~'~- H,,/~~,',j - ALLSTATE INSURANCE COMPANY, Plaintiff v. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. NO. tHJ.'-{-7f3 E'jt<./fy UCfl".. JOSEPH ALDINGER, JAKE ULRICH, BRANDI MILLER, GLENN SHOLLY and WILLIAM McCLOSKEY, Defendants CIVIL ACTION - AT EQUITY JURY TRIAL DEMANDED COMPLAINT IN EQUITY AND NOW, comes Allstate Insurance Company, by and through its attorneys, NEALON & GOVER, P.C., and requests that this Honorable Court exercise its equitable powers to accept interpleader of Allstate Insurance Company's liability limits under its insureds' automobile liability insurance policy for the following reasons: 1. Allstate Insurance Company is a corporation that maintains a local claims office at 6345 Flank Drive, Suite 1000, Harrisburg, Pennsylvania, and is authorized to conduct business in the Commonwealth of Pennsylvania. 2. Joseph Aldinger is an adult individual who resides at 3 South Street, Enola, Pennsylvania 17025. 3. Jake Ulrich is an adult individual who resides at 101 Pepper Avenue, Enola, Pennsylvania 17025. 4. Brandi Miller is an adult individual who resides at 330 Fourth Street, West Fairview, Pennsylvania 17025. 5. Glenn Sholly is an adult individual who resides at 105 East Columbia Street, Enola, Pennsylvania 17025. ... CH~_ _ _ ",' . "'<,>' ",,_ .. ro" , .. ''''-~'. """[ 6. William McCloskey is an adult individual who resides at 371 Watts Drive, Duncsnnon, Pennsylvania 17020. 7. Robert Gill is an adult individual who resides at 95 Salem Church Road, Mechanicsburg, Pennsylvania 17055. 8. Brenda Moore is an adult individual who resides at 97 Salem Church Road, Mechanicsburg, Pennsylvania 17055. 9. As of September 26, 1998, and at all times relevant hereto, Brenda Moore was the policyholder of an automobile liability policy, Policy No. 69812263201\03, issued by Petitioner, Allstate Insurance Company. 10. The above-referenced policy provides liability coverage for personal injury in the amount of $25,000 per person and $50,000 per occurrence. A true and correct copy of Ms. Moore's policy Declaration sheet is attached hereto and incorporated herein by reference as Exhibit "A." 11. On or about September 26, 1998, Robert Gill was the operator of a 1989 Isuzu Trooper owned by Brenda Moore and covered by the insurance policy referenced above, when it was involved in a one-car motor vehicle accident. 12. At the time of the accident, each of the individuals named as defendants in this Petition were passengers in that vehicle. 13. The accident occurred on Humer Street near its intersection with Lafayette Street, East Pennsboro Township, Cumberland County, Pennsylvania. 14. At the aforesaid time and place, Mr. Gill was operating the Moore vehicle in a northbound direction when he lost control of the vehicle, crossed into the 2 ~ - - ,.-<-~- " "-~_ '~_, ." '8-'.~," '~'"""".'" -,- ,"- --,"~ ---_.-^'"' '>".Ch~",'c-_~,"", ---, '^ - '-0' - '" "'_"'~_"'" .,~ j southbound lane resulting in the vehicle doing an undetermined combination of rolling and flipping before coming to rest on its driver's side facing in a southbound direction in a yard on the west side of the roadway. 15. As a result of the accident, various injuries were sustained or are believed to be sustained by the above-named defendants. 16. It is believed and averred that Defendant McCloskey is represented by David Rosenberg, Esquire, with respect to a personal injury claim against Mr. Gill. 17. It is believed that the remaining defendants are unrepresented by counsel. 18. Allstate Insurance Company believes that some or all of the named defendants may wish to make claims against Mr. Gill and/or Ms. Moore, which would be covered by the liability insurance policy referenced above. 19. Plaintiff, Allstate Insurance Company, believes and therefore avers that the combined policy limits of $50,000 are or may be insufficient to fully compensate all defendants or their respective claims. 20. In light of the number of claimants and potential claimants as well as the anticipated value of those claims based on the known severity of the various injuries, Allstate Insurance Company desires to interplead its liability limits into the Court of Common Pleas of Cumberland County for distribution amongst all claimants as the Court deems appropriate. 21. This Court has equitable power to accept interpleader of these funds. See Shellhammer v. Gray, 359 Pa. Super. 499, 519 A.2d 426 (1996). The Court also has 3 -' '_do"~ - _''',' ~",,., ",.,,--_,,'_,", -,.,,'.,'" ,_VO <.>' ~'-<,"'-"",'.,~,d~'-~""';-"-~"_'_el,""_..',,,., -,~ ,-_;""""O/,~'-,>'.i;,,,:,,,,~,~~_.__.',,~,.,"_~_-;b" ,'-'"" P_''-, "-':';';;-'>"1 power to direct the Prothonotary to place the money into a financial institution with interest accruing to the benefit of al,l claimants. 22. Plaintiff is unable to determine the fair and proper distribution of the policy limits of the various claimants. 23. Plaintiff has no other means of fairly distributing the funds while protecting itself against claims for the expense of litigation, delay damages and/or claims of bad faith refusal to settle. 24. The said sum of $50,000 will not be reduced by the payment of any attorneys' fees for the preparation of this Complaint or the processing of it. WHEREFORE, Plaintiff, Allstate Insurance Company, respectfully requests that this Honorable Court direct the Prothonotary to accept payment of the $50,000 liability limit to be placed in an interest-bearing account until the Court orders distribution of the principal and all accrued interest to the claimants as deemed appropriate. Respectfully submitted, NEALON & GOVER BY~ Christop er J. Knight, Esquire Attorney 1.0. #80058 301 Market Street, 9th Floor P.O. Box 865 Harrisburg, PA 17108-0865 (717) 232-9900 4 ill,: VERIFICATION I, Patricia Hoffman, hereby certify that I am an authorized agent for Allstate Insurance Company, and that the averments contained in the attached Petition are true and correct to the best of my knowledge, information or belief. To the extent that any of the averments of the Petition are based on an understanding or application of law, I have relied on counsel in making this Verification. I understand that I am subject to the penalties of 18 Pa.C.S.A. ~4904 relating to unsworn falsification to authorities for any false statements knowingly made herein. D~~MkO~ i Patricia Hoffma, !aim Representative Allstate Insurance Company -, ~ -=- -^ " _. .... Allstate. You're in good hands. October 8, 1999 Claim #: 1553220664 B19 Insured: Brenda Moore Date of Loss: 09-26-1998 , '- ~O~t We have received your request for a policy declaration sheet. The original is computer generated and no duplicate is kept. In fact, there is no physical policy file. Brenda Moore is insured with Allstate Insurance under policy number 698122632 with liability limits of $25,000 per person and $50,000 per occurrence. Attached is a copy of a computer printout that confirms the above. Sincerely, Mike 8m uk, Front Line Performance Leader , Subscribed and sworn to before me th,is C:\ \:I 2*' Dayof (~~\<;:ll.)., i9--I.1 I tfv-Jl Notarial Seal ~. ,no 'c:. Slabonik, NOT:wy Public Lower ''''.xton Twp., Dauphin County My Commission Expires Feb. 26, 2001 ~l;-nber. Pennsylvania Assoclatlon of Notaries . 52-1 . (:())fPy !;c~~~;j:ir~r{~~!t;r:1: I~~ ,~;:>~~220{;b';; ~.€~~~* "~L_Nl!M: 698122632 ~_USSDT: :'RINT DATE: 10/08/1999 ~NSUF~E~D: BRENDA MOORE POt.ICY DATA f)RINT *tfft , F'(.;GE :,.C}c: ~ 5~5() 09/26/t998 EFFDT: 97/03/i998 PR!N'I' 'rIMj~:-i0:08 AM \lf~}TICEDT : (,?';.:o/~~:a/i 9'~)!:; ~DR: 95 SAI..EM CHURC!-l RD CITY: MEC~!ANICSBURG ~T: p~ lIF" 1705528.56 4GME PHONE-; 717--691--6664 WOF~K PHONE: 000--000--0000 LINE: i9 AU1"C)--INDEMN!'fV ~;GENT: .J j(r:.L.l~.!::Y ~: SON INC PHONE: 7'1"?--'737.-'6~}:3E,~ CJ!:":1:CIN1'.:.1L. ''f'!1:: ''::(( ~ARRATIVE: if** ADllITIONAL. COVERAGE STIC:KER PR3:NT PEF~ DE~SK BM() i'** VEHICL.E YR: 89 MAKE: ISUZlJ VIM: ~}ACCH58E0K7~08475 TYPE: 10 S"fANDARD lPTION(S): FULL TCIRT POL.ICY SCODES: 91 AGE >::'or~H: {~IUi 3W?~_;~ For':':i'<1: j-::1U i 90f,:),w"'3 FnF;~r'i: 1~1 I1l2:5"'? FOl~ri: U i i (.I'!/7 FGRH: Uii<.}"?6 J~ECL.t-lSS IF ref-iT IDN ~fE)':.1~:;~'-'FUTUF~E 'l'CtJi'~G D!:;~IVEF: i,UTG POLICY PENNSYL\}:~lN I:~ J-;UTDFiO:B ILl:: j:-:i""iEf~lDJ~:TDF:Y Ej\-l:!)C!:;~S.'f::j"'lENT AMENDATORY EMDORSEMENT DSC;L.ARA'Y'IONSJID CARD DECl_ARATIONS/AMENI)ED DEC^ CLf:.~IN ~"'~UM: 1 ::;=;~):~::1~~),!j64 ')!::p:')(' POLICY D:~,:T~t: ;:'PIf',!T .};...i:.Y: I::' "::,, r:,(:. . .....".. r', ~~D...EISTEF;:: Bi S) LOG: i 550 POl..MUM: 698122632 L.OSSDT: 09/26/1998 EFFD'f: 07/03/1992 NOTICED"i': 09/28/1999 CClVEH{;GEll._ I r-i I T ~.:.' DESCHIF'T!:Cr'~ :E{Ol)ILY IN..JUr;;:y PF~DPEf(TY n:~1~'1~:~GE MEDICAL PAYMEN'rS FUNEHAL B[r'~[FIT '- STAC](ABLE UNINSl}!~SD MOTORIST STACKABl.E llNDERINSllRED MOTORIST INCOME DISABIL.ITY CF'~~NABLE AA 25.000/50.000 y CD'Il I:l''=!T~~ :(;)7/r:\:?~/';:'t:f i{;7/(:,13/S>a 07,/()3/'-;:';:~ 1:::7 /~):~~/9H 07,/\~):3/';:)S BB 2:}, Hf;}"f; CC ::;, 000 y G~': 2. :>-0H SS 25,000/50,000 Sll 25.000/50,000 V~:) y '"( y 07/f:3/9'3 l)7/~):?;/9S y " N N "- '" '" ~~~ . ','r '''--'_'~''_ " ., ,,' .'~,"'" ',,,'",^' '. ~"".' .~ '''~'''''''--''-' -', - ~'J,,~ " , JUL II 6 ZO~ \ " ALLSTATE INSURANCE COMPANY, Plaintiff v. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. NO. 06- Lj7J3 ~'L ~4-y '-r~ JOSEPH ALDINGER, JAKE ULRICH, BRANDI MILLER, GLENN SHOLLY and WILLIAM McCLOSKEY, Defendants CIVIL ACTION - AT EQUITY JURY TRIAL DEMANDED RULE AND NOW, this ~ay of , 2000, a Rule is hereby issued upon Joseph Aldinger, Jake Ulrich, Brandi Miller, Glenn Sholly and William McCloskey, defendants in the above-captioned matter, to Show Cause why Petitioner, Allstate Insurance Company, should not be permitted to pay its policy limits of $50,000 into Couli pending resolution of the various claims against Robert Gill and/or Brenda " Moore. Rule returnable lliays from service thereof, J. DISTRIBUTION: / / Christopher J. Knight, Esquire, (NEALON & GOVER, P.C.), 301 Market Street. 9th Floor, Harrisburg, PA 17108. , I"d ~ ~ ^-~. d " "".," ,~~-". .". .. . ''''~ ., "-.~ '-' ~" ,-' . -~,~ ~, ~ -- ~ . ._~< ., v, C) (;J D- c ~;~~ -o-'(~ ,Y\ \.-'<-, ~ :;2;.;-'; %s:~... U) _. 8'-' LC" ~ ' ?;? Ir) .-'::;::"--...-. ~ )7~ :2 '- 'c;; \ ...- t" ",4,"_~,.1_ ,... ."..,..,.... -0 ':l:~' ~~ -,,^ --\.3 H }f . ...n -'f-", ';'..-"\ , ,~..' '--:-."i--) -':,>~\-\ (.f;}~ "J'p. ,-"- :,,:> .' o ,0 ,T_"'" _~ . .... -. , _ _ < ~,- ='"'' '0""_ __,;:,_, -,C"ed-C-,-C'.,-_', "' '-"':'~' 'c,,',",- ~_,.." ~><, (,__~"".,,,,.Jc:"~~';':,_, .'"',-"",-,,,,_. ALLSTATE INSURANCE COMPANY, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. v. NO. 66 - ~7RJ ~kd1 JOSEPH ALDINGER, JAKE ULRICH, BRANDI MILLER, GLENN SHOLLY and WILLIAM McCLOSKEY, Defendants CIVIL ACTION - AT EQUITY JURY TRIAL DEMANDED PETITION AND NOW, comes Plaintiff, Allstate Insurance Company, by and through its attorneys, NEALON & GOVER, P.C., and requests that this Honorable Court issue an Rule upon the Defendants in the above-captioned matter, to show cause, if any, why Plaintiff should not be permitted to pay its applicable policy limits of $50,000 in to Court pending the resolution of the various claims against Robert Gill and/or Brenda Moore and in support thereof avers as follows: 1. Concurrent with the filing of this Petition and Rule, Petitioner/Plaintiff, Allstate Insurance Company ("Allstate") filed a Complaint in Equity against the Defendants, Claimants for personal injuries arising from a car accident involving Allstate's insureds, occurring on September 26,1998. 2. The Complaint requests that this Honorable Court accept interpleader of Allstate's policy limits of $50,000 to be held by the Prothonotary in an -,,<=- - ~ , ,-,~ ," .. ,^-""", , ,'-~ -,^ ;". ',"-,'- "'.',-;,.,"'Jo~:-'::'-'~-'" --~_ .:."~""__'",,",,,,,'_,- -~-,,,,'}0-" ';;'-;,U-' '^' '-i interest-bearing account pending resolution of the various claims of the Defendants pursuant to Shellhammer v. Gray, 359 Pa. Super. 499, 519 A.2d 426 (1996). A true and correct copy of the aforementioned Complaint in Equity is attached hereto and incorporated herein as Exhibit "A." WHEREFORE, Petitioner/Plaintiff, Allstate Insurance Company, respectfully requests that this Honorable Court issue a Rule upon the Defendants to Show Cause why it should not be permitted to pay its policy limits of $50,000 to the Prothonotary, to be held in an interest-bearing account pending resolution of the various claims of the Defendants. Respectfully submitted, NEALON & GOVER BY~ Christop er J. Knight, Esquire Attorney I.D. #80058 301 Market Street, 9th Floor P.O. Box 865 Harrisburg, PA 17108-0865 (717) 232-9900 =<,' ., -, ALLSTATE INSURANCE COMPANY, Plaintiff v. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. NO. JOSEPH ALDINGER, JAKE ULRICH, BRANDI MILLER, GLENN SHOLLY and WILLIAM McCLOSKEY, Defendants CIVIL ACTION - AT EQUITY JURY TRIAL DEMANDED COMPLAINT IN EQUITY AND NOW, comes Allstate Insurance Company, by and through its attorneys, NEALON & GOVER, P.C., and requests that this Honorable Court exercise its equitable powers to accept interpleader of Allstate Insurance Company's liability limits under its insureds' automobile liability insurance policy for the following reasons: 1. Allstate Insurance Company is a corporation that maintains a local claims office at 6345 Flank Drive, Suite 1000, Harrisburg, Pennsylvania, and is authorized to conduct business in the Commonwealth of Pennsylvania. 2. Joseph Aldinger is an adult individual who resides at 3 South Street, Enola, Pennsylvania 17025. 3. Jake Ulrich is an adult individual who resides at 101 Pepper Avenue, . Enola, Pennsylvania 17025. 4. Brandi Miller is an adult individual who residesat 330 Fourth Street, West Fairview, Pennsylvania 17025. 5. Glenn Sholly is an adult individual who resides at 105 East Columbia Street, Enola, Pennsylvania 17025. ;,c'- P: 6. William McCloskey is an adult individual who resides at 371 Watts Drive, Duncannon, Pennsylvania 17020. 7. Robert Gill is an adult individual who resides at 95 Salem Church Road, Mechanicsburg, Pennsylvania 17055. 8. Brenda Moore is an adult individual who resides at 97 Salem Church Road, Mechanicsburg, Pennsylvania 17055. 9. As of September 26, 1998, and at all times relevant hereto, Brenda Moore was the policyholder of an automobile liability policy, Policy No. 69812263201\03, issued by Petitioner, Allstate Insurance Company. 10. The above-referenced policy provides liability coverage for personal injury in the amount of $25,000 per person and $50,000 per occurrence. A true and correct . copy of Ms. Moore's policy Declaration sheet is attached hereto and incorporated herein by reference as Exhibit "A." 11. On or about September 26, 1998, Robert Gill was the operator of a 1989 Isuzu Trooper owned by Brenda Moore and covered by the insurance policy referenced above, when it was involved in a one-car motor vehicle accident. 12. At the time of the accident, each oHhe individuals named as defendants in this Petition were passengers in that vehicle. 13. The accident occurred on Humer Street near its intersection with Lafayette Street, East Pennsboro Township, Cumberland County, Pennsylvania. 14. At the aforesaid time and place, Mr. Gill was operating the Moore vehicle in a northbound direction when he lost control of the vehicle, crossed into the 2 southbound lane resulting in the vehicle doing an undetermined combination of rolling and flipping before coming to rest on its driver's side facing in a southbound direction in a yard on the west side of the roadway, 15. As a result of the accident, various injuries were sustained or are believed to be sustained by the above-named defendants. 16, It is believed and averred that Defendant McCloskey is represented by David Rosenberg, Esquire, with respect to a personal injury claim against Mr. Gill. 17. It is believed that the remaining defendants are unrepresented by counsel. 18. Allstate Insurance Company believes that some or all of the named defendants may wish to make claims against Mr. Gill and/or Ms. Moore, which would be covered by the liability insurance policy referenced above, 19. Plaintiff, Allstate Insurance Company, believes and therefore avers that the combined policy limits of $50,000 are or may be insufficient to fully compensate all defendants or their respective claims. 20. In light of the number of claimants and potential claimants as well as the anticipated value of those claims based on the known severity of the various injuries, Allstate Insurance Company desires to interplead its liability limits into the Court of Common Pleas of Cumberland County for distribution amongst all claimants as the Court deems appropriate. 21, This Court has equitable power to accept interpleader of these funds. See Shellhammerv. Gray, 359 Pa, Super. 499, 519 A.2d 426 (1996). The Court also has 3 ,c;.~_ ~" "'~'jl,; power to direct the Prothonotary to place the money into a financial institution with interest accruing to the benefit of all claimants. 22. Plaintiff is unable to determine the fair and proper distribution of the policy limits of the various claimants. 23. Plaintiff has no other means of fairly distributing the funds while protecting itself against claims for the expense of litigation, delay damages and/or claims of bad faith refusal to settle. 24. The said sum of $50,000 will not be reduced by the payment of any attorneys' fees for the preparation of this Complaint or the processing of it. WHEREFORE, Plaintiff, Allstate Insurance Company, respectfully requests that this Honorable Court direct the Prothonotary to accept payment of the $50,000 Iiabili!y limit to be placed in an interest-bearing account until the Court orders 'distribution of the principal and all accrued interest to the claimants as deemed appropriate. Respectfully submitted, NEALON & GOVER BY~ ' Chnstop er J. Knight, EsqUire Attorney ID. #80058 301 Market Street, 9th Floor P.O. Box 865 Harrisburg, PA 17108-0865 (717) 232-9900 4 .-<li-- ,~ " ~' ;''- VERIFICATION I, Patricia Hoffman, hereby certify that I am an authorized agent for Allstate Insurance Company, and that the averments contained in the attached Petition are true and correct to the best 01 my knowledge, information or belie!. To the extent that any of the averments of the Petition are based on an understanding or application of law, I have relied on counsel in making this Verification. I understand that I am subject to the penalties of 18 Pa,C.SA 94904 relating \0 unsworn falsification to authorities for any false statements knowingly made herein. i , -1 D~ ~~o~ ! Patricia Hoffma, laim Representative Allstate Insurance Company , . _ -, _ __J__--_ _ ',- -_ ,~- > ~,- ,_, -"'_',-,~" - .';'.- -"_.i-" -',",-.1 -, ';"". --<._<,'",'n, ____ ,,;' n",_,';':__""__"'';; -,,',~__ ~~_ .' ",~,".'" .'~;T-''''" ,':'" ""->'"-~"",,,,.~,=i~;~;--,__;.:_ ,,_ __ :," ;;. _,'. .., ALLSTATE INSURANCE COMPANY, : IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA v. : NO. 00-4783 JOSEPH ALDINGER, JAKE ULRICH, : CIVIL ACTION . AT EQUITY BRANDI MILLER, GLENN SHOLLY and WILLIAM McCLOSKEY, Defendants : JURY TRIAL DEMANDED PRAECIPE FOR ENTRY OF APPEARANCE TO THE PROTHONOTARY: Please enter my appearance on behalf of the Defendant, William McCloskey, with regard to the above-captioned case. Respectfully submitted, HANDLER, HENNING & ROSENBERG Dated: ~ /:;:2- / ()b I I By: David H osenberg, Esquire Attorn 1.0. # 20569 319 arket Street P.O. Box 1177 Harrisburg, PA 17108 (717)238-2000 Attorney for Defendant --~ " , ,''''- '~~'<'.- '"'" --."" -- .-,_,;_",,",",_ ""_ "'" ",,~ ~o' ",C <-.: __'''- .__;~;,-,<' d"'--~~>-"6 ',--! ~ ALLSTATE INSURANCE COMPANY, Plaintiff : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA v. : NO. 00-4783 JOSEPH ALDINGER, JAKE ULRICH, BRANDI MILLER, GLENN SHOLLY and WILLIAM McCLOSKEY, Defendants : CIVIL ACTION - AT EQUITY : JURY TRIAL DEMANDED CERTIFICATE OF SERVICE I, Nancy L Bistline, an employee of the law firm of HANDLER, HENNING & ROSENBIERG, hereby certify that on this day I am serving a copy of the foregoing Complaint upon the persons(s) and in the manner indicated below, which service satisfies the requirements of the Pennsylvania Rules of Civil Procedure, by depositing a copy of same in the United States mail, first-class postage prepaid as follows: Christopher J. Knight, Esquire NEALON & GOVER 2411 North Front Street Harrisburg, PA 17110 Robin J. Marzella, Esquire MARZELLA & ASSOCIATES 3515 North Front Street Harrisburg, PA 17110 HANDLER, HENNING & ROSENBERG Dated: cy ( ;;.;;;./ CV ( , B~~ Nancy L stline, Secretary ""'., ~;.,- - ."'~ " L,_.__ -r-- c';"- ~_,J~ ' I,. .,>' '-'..:' .,;~;;,;, ~~ . ,," -", ". ',.m.. 0 CJ (:J C Cl --n ~ ,.f) __~1 -00) J'Tl lTln: -0 .. - 2:::1) -;f"r--- N fj)""" U , -<:> [of; r:,--' , '<~. -T! ?c' ) r's Zc " >c: :~ n', :'OJ r.:- '1'> ~} -<. (P ~ ,- >~ ,-"> ":;....'-]-,,,-'.-<-, , 'r " \. -,. -',;,-'"'. ,",. ,'~' ~" -. "'-'e"-" --"--;~:t:,,'-:,~\i,_:,:_,~'~ ' ::-~kl 'SEP 2 5 20~r 'Y ALLSTATE INSURANCE COMPANY, Plaintiff v. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. NO. 00- ~~P.J G~.t I~ JOSEPH ALDINGER, JAKE ULRICH, BRANDI MILLER, GLENN SHOLLY and WILLIAM McCLOSKEY, Defendants CIVIL ACTION - AT EQUITY JURY TRIAL DEMANDED ORDER AND NOW, this -z.,jday of ~, 2000, it is hereby Ordered and Decreed that the Plaintiff, Allstate Insurance Company, it permitted to pay its interpleaded funds of $50,000 to the Prothonotary of Cumberland County and that the Prothonotary is further directed to hold such funds upon payment in an interest-bearing account pending further order of distribution by the Court. BY T~>k:{1U... ;1~' ,/ /' "r' ,/ , J. ^)~ ~ \.-00 q-:lUl R~~ Distribut~on: Mr. Joseph Aldinger, 3 South Street, Enola, PA 17025 Ms. Brandi Miler, 330 4th Street, Enola, PA 17025 Mr. Jake Ulrich, 101 Pepper Avenue, Enola, PA 17025 Mr. Glenn Sholly, 105 East Columbia Street, Enola, PA 17025 Mr. William McCloskey, clo David Rosenberg, Esquire, HANDLER, HENNING & ROSENBERG, 1300 Linglestown Road, P.O. Box 1177, Harrisburg, PA 17110 1-- -"--' ~.! .., "._" ,'~ l-!"_'''1'O';~-'''t~e__,"_;~:r:, . 'C"i:~\Cf: ("::,'"; :;,,~",:)r,.J;c~\\O~~.flHY fir ~<:p ?C viJ ~,.r.. I....) Q'., , . I" \ rl 4' ~ CUM8ERU\NO COUi'lTY PENNSYLVANiA ,"~l"...,..,",~_." ' t:l';iJIJli11 ,~ ~ , ~ - ,---- -, , """.-.' ,", --c .. '. ''''"~'''_'_ -,",'0 "<"~ ,'-;'-"_--,;;L~f_, '/":_i'..-';".-:~" '-<-,,:';;<,0_. _.-""" - ~_,_.. j~'';o..;,i-'_;;:_:'J'i-~\'''~ . ALLSTATE INSURANCE COMPANY, Plaintiff v. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. NO. OC)- .I.n 1>.3 ~,():L T~ JOSEPH ALDINGER, JAKE ULRICH, BRANDI MILLER, GLENN SHOLLY and WILLIAM McCLOSKEY, Defendants CIVIL ACTION - AT EQUITY JURY TRIAL DEMANDED MOTION TO MAKE RULE ABSOLUTE AND NOW, comes Plaintiff, Allstate Insurance Company, by and through its attorneys, Nealon & Gover, P.C., and requests that this Honorable Court issue an Order allowing Plaintiff to pay its interpleaded funds of $50,000 to the Prothonotary of Cumberland County to be held in an interest-bearing account pending distribution by the Court of s;:i(d principal and any accrued interest and it support thereof avers as follows: ,l',., 1. This Honorable Court issued a Rule dated July 12, 2000, upon the Defendants in the"above-captioned matter to show cause why Plaintiff, Allstate Insurance Company, should not be permitted to pay its policy limits of $50,000 into Court pending resolution of the various claims against Robert Gill and/or Brenda Moore. The Rule was returnable 15 days from service thereof. A true and correct copy of said Rule is attached hereto and incorporated herein as Exhibit "A." 2. Said Rule was served upon all Defendants at their last known address by letter dated July 19, 2000. A true and correct copy of said letter is attached hereto and incorporated herein as Exhibit "B." o' ''',-,- , -,..",'-,,-,,- ",--',- 'h'> "" .,_.~-" '... ,0;',,"-, 0' ,i<..,,,- ,,',,~-'r,' ~-, -. ;-,-~..-_";,.",-,;_; i,~;'";.;J;;, ,-~;'",,;';"> ' '" ";,",,,:~~ji 3. More than 15 days have now passed with no response being filed or being indicated by any of the Defendants. WHEREFORE, Plaintiff, Allstate Insurance Company, respectfully requests that this Honorable Court enter an Order allowing it to pay its interpleaded funds to the Prothonotary of Cumberland County to be held in an interest-bearing account pending an Order of Distribution of the principal and any accrued interest to any appropriate Defendants by the Court. Respectfully submitted, By: Christopher J. Kni t, Esquire Attorney 1.0. #800 8 301 Market Street, 9th Floor P.O. Box 865 Harrisburg, PA 17108-0865 (717) 232-9900 ". JUl 0 6 2~ ALLSTATE INSURANCE COMPANY, Plaintiff v. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. NO. C>G - f!E-~1 J~ CIVIL ACTION - AT EQUITY JOSEPH ALDINGER, JAKE ULRICH, BRANDI MILLER, GLENN SHOLLY and WILLIAM McCLOSKEY, Defendants JURY TRIAL DEMANDED RULE AND NOW, this /)~ day of ~ ' 2000, a Rule is hereby issued upon Joseph Aldinger, Jake Ulrich, Brandi Miller, Glenn Sholly and William McCloskey, defendants in the above-captioned matter, to Show Cause why Petitioner, Allstate Insurance Company, should not be permitted to pay its policy limits of $50,000 into Court pending resolution of the various claims against Robert Gill and/or Brenda Moore. Rule returnable /S' days from service thereof. BY THE COURT: /$/ ~ ;3~ J. DISTRIBUTION: Christopher J. KniQht, Esquire, (NEALON & GOVER, P.C.), 301 Market Street, 9th Floor, Harrisburg. PA 17108. TRUE COPY FROM RECORD In TGstimN'IY wr.e,eof, I tl1'.re unto ~t my twld and Ul<l s<;~l oj said C ' at ea.i!~, Pi. Thi rF- day of .'l1J;J-<) ,,,M -~ ~ ., <'" '..' '81tiil,e. · "~er {rrORNEYS T LAW r~-' 301 MARKET STREET' 9m FLOOR P.O. BOX 865 HARRISBURG, PA 17108 (717) 232-9900 FAX, (717) 236-9119 July 19, 2000 JAMES G. NEALON, ill MATIHEW R. GOVER BRIAN W. PERRY DAVID J. FREED CHRISTOPHER J. KNIGHt Mr. Joseph Aldinger 3 South Street Enola, PA 17025 Mr. Jake Ulrich 101 Pepper Avenue Enola, PA 17025 Ms. Brandi Miller 330 4th Street Enola, PA 17025 Mr. Glenn Sholly 105 E. Columbia Street Enola, PA 17025 William McCloskey clo David Rosenberg, Esquire Handler, Henning & Rosenberg 319 Market Street P.O. Box 1177 Harrisburg, PA 17108 RE: Allstate Insurance Company v. Aldinger, Ulrich, Miller, Sholly and McCloskey Cumberland County Docket No. 00 - Equity Term To All Defendants: Enclosed for service upon each of you is a copy of a Rule issued by the Cumberland County Court requiring that you come forward within fifteen days of the date of this letter with any objections to Allstate paying its policy limits of $50,000 into Court pending resolution of the various claims arising from the car accident of September 26, 1998. Very truly yours, Christopher J. Knight NEALON & GOVER CJKldlf Enclosures cc: Patti Hoffman (w/o enclosures) Claim No. 1553220664 B19 - ,:.. . CERTIFICATE OF SERVICE AND NOW, this 18th day of September, 2000, I hereby certify that I have served the foregoing Motion to Make Rule Absolute on the following by depositing a true and correct copy of same in the United States mails, first-class, postage prepaid, addressed to: Mr. James Aldinger 3 South Street Enola, PA 17025 Mr. Jake Ulrich 101 Pepper Avenue Enola, PA 17025 Ms. Brandi Miller 330 4th Street Enola, PA 17025 Mr. Glenn Sholly 105 East Columbia Street Enola, PA 17025 William McCloskey c/o David Rosenberg, Esquire HANDLER, HENNING & ROSENBERG 1300 Linglestown Road P.O. Box 1177 Harrisburg, PA 17108 r J. Knight, Esquire ALLSTATE INSURANCE COMPANY, Plaintiff v. JOSEPH ALDINGER, JAKE ULRICH, BRANDI MILLER, GLENN SHOLLY and WILLIAM McCLOSKEY, Defendants I'; ~ IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. NO. 00-4783 CIVIL ACTION. AT EQUITY JURY TRIAL DEMANDED PRAECIPE TO THE PROTHONOTARY: Please reinstate the Complaint in the above-captioned matter. A true and correct copy of the Complaint which was previously filed in this matter is attached hereto and incorporated herewith as Exhibit "A" Respectfully submitted, NEALON & GOVER BY~~ Christop er J. Knight, Esquire Attorney J.D. #80058 2411 North Front Street Harrisburg, PA 17110 (717) 232-9900 ",~ 'M,"-" "~, ,; , <'. ALLSTATE INSURANCE COMPANY, Plaintiff v. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. NO. 00-4783 JOSEPH ALDINGER, JAKE ULRICH, BRANDI MILLER, GLENN SHOLLY and WILLIAM McCLOSKEY, Defendants CIVIL ACTiON - AT EQUITY JURY TRIAL DEMANDED NOTICE YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this Complaint and Notice are served, by entering a written appearance personally or by attorney and filing in writing with the Court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the Court without further notice for any money claimed in the Complaint or for any other claim or relief requested by the Plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. LAWYER REFERRAL SERVICE CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVENUE CARLISLE, PA 17013 717-249-3166 , ,~~ ~ ALLSTATE INSURANCE COMPANY, Plaintiff v. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. NO. 00-4783 JOSEPH ALDINGER, JAKE ULRICH, BRANDI MILLER, GLENN SHOLLY and WILLIAM McCLOSKEY, Defendants CIVIL ACTION - AT EQUITY JURY TRIAL DEMANDED NOTICIA Le han demandado a usted en la corte. Si usted quiere defenderse de estas demandas expuestas en las paginas siguientes, usted tiene viente (20) dias de plazo al partir de la fecha de la demanda y la notiftcacion. Usted Debe presentar una apariencia escrita 0 en persona 0 por abogado y archivar en la corte en forma escrita sus defensas 0 sus objeciones alas demandas en contra de su persona. Sea avisado que si usted no se defiende, la corte tomara medidas y puede entrar una orden contra usted sin previa a vi so 0 notificacion, y por cualquier queja 0 alivio que es pedido en la peticion de demanda. Usted puede perder dinero 0 sus propiedades 0 otros derechos importantes para usted. LLEVE ESTA DEMANDA A UN ABODAGO INMEDIATAMENTE. SI NO TIENE ABOGADO 0 SI NO TIENE EL DINERO SUFICIENTE DE PAGAR TAL SERVICIO, VAYA EN PERSONA 0 LLAME POR TELEFONO A LA OFICINA CUYA DIRECCION SE ENCUENTRA ESCRITA ABAJO PARA AVERIGUAR DONDE SE PUEDE CONSEGUIR ASISTENCIA LEGAL. DAUPHIN COUNTY LAWYER REFERRAL SERVICE 213 NORTH FRONT STREET HARRISBURG, PA 17101 717 -232-7536 2 :.lli~ , - J _ ,,:, ,'. ~ ""',} . ""d''''A~''''1 ALLSTATE INSURANCE COMPANY, Plaintiff v. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. NO. 00-4783 JOSEPH ALDINGER, JAKE ULRICH, BRANDI MILLER, GLENN SHOLLY and WILLIAM McCLOSKEY, Defendants CIVIL ACTION - AT EQUITY JURY TRIAL DEMANDED COMPLAINT IN EQUITY AND NOW, comes Allstate Insurance Company, by and through its attorneys, NEALON & GOVER, P.C., and requests that this Honorable Court exercise its equitable powers to accept interpleader of Allstate Insurance Company's liability limits under its insureds' automobile liability insurance policy for the following reasons: 1. Allstate Insurance Company is a corporation that maintains a local claims office at 6345 Flank Drive, Suite 1000, Harrisburg, Pennsylvania, and is authorized to conduct business in the Commonwealth of Pennsylvania. 2. Joseph Aldinger is an adult individual who resides at 3 South Street, Enola, Pennsylvania 17025. 3. Jake Ulrich is an adult individual who resides at 101 Pepper Avenue, Enola, Pennsylvania 17025. 4. Brandi Miller is an adult individual who resides at 330 Fourth Street, West Fairview, Pennsylvania 17025. 5. Glenn Sholly is an adult indiVidual who resides at 105 East Columbia Street, Enola, Pennsylvania 17025. 3 6. William McCloskey is an adult individual who resides at 371 Watts Drive, Duncannon, Pennsylvania 17020. 7. Robert Gill is an adult individual who resides at 95 Salem Church Road, Mechanicsburg, Pennsylvania 17055. 8. Brenda Moore is an adult individual who resides at 97 Salem Church Road, Mechanicsburg, Pennsylvania 17055. 9. As of September 26, 1998, and at all times relevant hereto, Brenda Moore was the policyholder of an automobile liability policy, Policy No. 69812263201\03, issued by Petitioner, Allstate Insurance Company. 10. The above-referenced policy provides liability coverage for personal injury in the amount of $25,000 per person and $50,000 per occurrence. A true and correct copy of Ms. Moore's policy Declaration sheet is attached hereto and incorporated herein by reference as Exhibit "A" 11. On or about September 26, 1998, Robert Gill was the operator of a 1989 Isuzu Trooper owned by Brenda Moore and covered by the insurance policy referenced above, when it was involved in a one-car motor vehicle accident. 12. At the time of the accident, each of the individuals named as defendants in this Petition were passengers in that vehicle. 13. The accident occurred on Humer Street near its intersection with Lafayette Street, East Pennsboro Township, Cumberland County, Pennsylvania. 14. At the aforesaid lime and place, Mr. Gill was operating the Moore vehicle in a northbound direction when he lost control of the vehicle, crossed into the 4 . " ~ ~ "'---W', southbound lane resulting in the vehicle doing an undetermined combination of rolling and flipping before coming to rest on its driver's side facing in a southbound direction in a yard on the west side of the roadway. 15. As a result of the accident, various injuries were sustained or are believed to be sustained by the above-named defendants. 16. It is believed and averred that Defendant McCloskey is represented by David Rosenberg, Esquire, with respect to a personal injury claim against Mr. Gill. 17. It is believed that the remaining defendants are unrepresented by counsel. 18. Allstate Insurance Company believes that some or all of the named defendants may wish to make claims against Mr. Gill and/or Ms. Moore, which would be covered by the liability insurance policy referenced above. 19. Plaintiff, Allstate Insurance Company, believes and therefore avers that the combined policy limits of $50,000 are or may be insufficient to fully compensate all defendants or their respective claims. 20. In light of the number of claimants and potential claimants as well as the anticipated value of those claims based on the known severity of the various injuries, Allstate Insurance Company desires to interplead its liability limits into the Court of Common Pleas of Cumberland County for distribution amongst all claimants as the Court deems appropriate. 21. This Court has equitable power to accept interpleader of these funds. See Shellhammer v. Gray, 359 Pa. Super. 499,519 A.2d 426 (1996). The Court also has 5 ~. '" , '" ,-'"j- power to direct the Prothonotary to place the money into a financial institution with interest accruing to the benefit of all claimants. 22. Plaintiff is unable to determine the fair and proper distribution of the policy limits ofthe various claimants. 23. Plaintiff has no other means of fairly distributing the funds while protecting itself against claims for the expense of litigation, delay damages and/or claims of bad faith refusal to settle. 24. The said sum of $50,000 will not be reduced by the payment of any attorneys' fees for the preparation of this Complaint or the processing of it. WHEREFORE, Plaintiff, Allstate Insurance Company, respectfully requests that this Honorable Court direct the Prothonotary to accept payment of the $50,000 liability limit to be placed in an interest-bearing account until the Court orders distribution of the principal and all accrued interest to the claimants as deemed appropriate. Respectfully submitted, NEALON & GOVER ~ S' Christ pher J. Knight, Esquire Attorney I.D. #80058 2411 North Front Street Harrisburg, PA 17110 (717) 232-9900 6 J.l:.i.;~... " _M~W' '~"-~I\i~~~" O'~" ,.Ji'_'~~~~_ ""-- ~>"li",- - .~ . ~ .., "iI' () C ? ( . (= -';..-'" :=j -" i Ii ill II d ji ;, r i' I ~I 11 '1' ,I II "1 j'i .1.'1' I I' i, !I , ,""" ',,-, ,'"<, "-.' ::::) :--) '--.-1 >,3 C.: ; ~ 'I ;::-J - ~ (:'::.i :..'] _-:---C'\ ::-~~ ?') t:;:TI :;:.! :iI -< .", (n -"I <_,-~ ",I " ' < -- ~, c ' . . , : -'~ - ;'u: ,,~-, gh~<~,,;'_~~~l;..--, - J ,<::~' " ~ ..., , o -. 0", C ALLSTATE INSURANCE COMPANY, Plaintiff v. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. NO. 00-4783 JOSEPH ALDINGER, JAKE ULRICH, BRANDI MILLER, GLENN SHOLLY and WILLIAM McCLOSKEY, Defendants CIVIL ACTION - AT EQUITY JURY TRIAL DEMANDED ACCEPTANCE OF SERVICE I accept service of the Complaint in Equity on behalf of William McCloskey and certify that I am authorized to do so. /7 By: J, #/~ David H. osenberg, Esquire Attorne 1.0. #20569 HAND ER, HENNING & ROSENBERG 1300 Linglestown Road PO Box 1177 Harrisburg, PA 17108-1177 (717) 238-2000 ___0 .., ~o , "" -;,-~- " ~,,-' V ..,\- -" ;",' , ~ c-- ,_,'",'_,-, ',-:',':.-,,;:__; .-," ::~j ,..... ... ~ , ALLSTATE INSURANCE COMPANY, Plaintiff v. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. NO. 00-4783 JOSEPH ALDINGER, JAKE ULRICH, BRANDI MILLER, GLENN SHOLLY and WILLIAM McCLOSKEY, Defendants CIVIL ACTION. AT EQUITY JURY TRIAL DEMANDED ACCEPTANCE OF SERVICE I accept service of the Complaint in Equity on behalf of Jacob Ulrich and certify that I am authorized to do so. rzella, Esquire ttomey I. . #66856 R. J. MARZELLA & ASSOCIATES, P.C. 3513 North Front Street Harrisburg,PA 17110 (717) 234-7828 ~ :~V.L /-J:il.bJ.' ,~~ ....:' . , '. ~. -'.litill!lilji(f" - ~' , , - ,"\1, T>.", ,~'- ,. t-_I../ i!;( "". '.../' ~,/ ,.h. r:jJ p~lf:n ',~,\~ I ~~~~ ":\ ooi nE.t \), -'1 \~jI " ~ ~ -, .,. --;";'<' ,jf~~.". .. ,<'.- ~-~ >-. i,L" . ." .., ~"_~'.,",.'h.. . ' ,... '" .... .. . -'llil 'I i I . "I""""'" , ",' ~. , , ~- -,"-" '" , SHERIFF'S RETURN - REGULAR CASE NO: 2000-04783 P G.~o COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND ALLSTATE INSURANCE COMPANY VS ALDINGER JOSEPH ET AL KENNETH GOSSERT , Sheriff or Deputy Sheriff of Cumberland County,Pennsylvania, who being duly sworn according to law, says, the within COMPLAINT - EQUITY was served upon MILLER BRANDI the DEFENDANT , at 0017:50 HOURS, on the 1st day of December, 2000 at 330 FOURTH STREET WEST FAIRVIEW, PA 17025 ANGIE MILLER (ADULT SISTER) by handing to a true and attested copy of COMPLAINT - EQUITY together with REINSTATED WITH NOTICE and at the same time directing Her attention to the contents thereof. Sheriff's Costs: Docketing Service Affidavit Surcharge 6.00 .00 .00 10.00 .00 16.00 So Answers: ~~n-.-'~~! R. Thomas Kline 01/08/2001 NEALON & GOVER Sworn and Subscribed to before By: ~~ ~ i/Dep ty; 's rif., mq.{::~ ~a: of AD 1 ~ , C1 fiut;;, _ ~ P othonotary , "C,~' "',."'."~, -~^ "~, ~- "I~djj;j,l.l..-I" ~J SHERIFF'S RETURN - REGULAR CASE NO: 2000-04783 P COMMONWEALTR OF PENNSYLVANIA: COUNTY OF CUMBERLAND ALLSTATE INSURANCE COMPANY VS ALDINGER JOSEPH ET AL CPL. TIMOTHY REITZ , Sheriff or Deputy Sheriff of Cumberland County, Pennsylvania, who being duly sworn according to law, says, the within COMPLAINT - EQUITY was served upon ALDINGER JOSEPH the DEFENDANT , at 0018:49 HOURS, on the 7th day of December, 2001 at 209 1ST ST ENOLA, PA 17025 by handing to JOSEPH ADLINGER a true and attested copy of COMPLAINT - EQUITY together with REINSTATED WITH NOTICE and at the same time directing His attention to the contents thereof. Sheriff's Costs: Docketing Service Affidavit Surcharge 6.00 9.30 .00 10.00 .00 25.30 ~~:~~~~f R. Thomas Kline 01/08/2001 NEALON & GOVER Sworn and Subscribed to before -~~ By: rJ- ~ . D uty Sh~r' f me this .:i3.Ml day of ~<. "'<7 c20v1 A.D. q't:' , (;1 )'i"Jt,,)) ~ P othonotary ". SHERIFF'S RETURN - NOT FOUND CASE NO: 2000-04783 P COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ALLSTATE INSURANCE COMPANY VS ALDINGER JOSEPH ET AL R. Thomas Kline ,Sheriff or Deputy Sheriff, who being duly sworn according to law, says, that he made a diligent search and inquiry for the within named defendant, DEFENDANT SHOLLY GLENN but was unable to locate Him in his bailiwick. He therefore returns the COMPLAINT - EQUITY REINSTATED WITH NOTICE , NOT FOUND , as to the within named DEFENDANT , SHOLLY GLENN DEFENDANT MOVED, LEFT NO FORWARDING, DID NOT RECEIVE~ ALTERNATE ADDRESS INFORMATION FROM ATTORNEY PRIOR TO EXPIRATION DATE OP; 12/27/00 Sheriff's Costs: Docketing Service Not Found Return Surcharge 18.00 9.30 5.00 10.00 .00 42.30 So ana~~~ R~S Kline Sheriff of Cumberland County NEALON & GOVER 01/08/2001 Sworn and subscribed to before me this ~:3.uR day of C)"''" 7 ,;2{ytJI A . D . {J~f-< a tkJP.. - , ~/ py t onotary ~~-- - "'"" "'..i! ,. ,.-' ALLSTATE INSURANCE COMPANY, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. v. NO. 00 -/.t7~' Q~,~ ^'7-~ JOSEPH ALDINGER, JAKE ULRICH, BRANDI MILLER, GLENN SHOLLY and WILLIAM McCLOSKEY, Defendants CIVIL ACTION - AT EQUITY JURY TRIAL DEMANDED NOTICE YOU HAVE BEEN SUED IN COURT. if you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this Complaint and Notice are served, by entering a written appearance personally or by attorney and filing in writing with the Court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the Court without further notice for any money claimed in the'Complaint or for any other claim or relief requested by the Plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFiCE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. DAUPHIN COUNTY LAWYER REFERRAL SERVICE 213 NORTH FRONT STREET HARRISBURG, PA 17101 717-232-7536 () Cl C <:::) :s:: <-. ~~ ~ Z:c (f,).E': ~c5 ~o TRUE COpy FROM RECORD :>2 In TestlmOOywharllOf. f here Uf/W Silt my haoo ~ ~." ~'1 "'.:~. .1i~!:t:z ' a .~ 0- ,. ~-,~ . ~/.). ,t;)~ ..' . cnotafy I , U3- () ~;'.-1 ::::i i';'1:"n ~";,: 1;q .~~ (~i~ :g??, ~ c- 53 .c- -< "" :J!:: ------ .. ~ 's;<il '" - <", . <~ :' " " ALLSTATE INSURANCE COMPANY, Plaintiff v. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. NO. JOSEPH ALDINGER, JAKE ULRICH, BRANDI MILLER, GLENN SHOLLY and WILLIAM McCLOSKEY, Defendants CIVIL ACTION. AT EQUITY JURY TRIAL DEMANDED NOTICIA Le han demand ado a usted en la corte. Si usted quiere defenderse de estas demand as expuestas en las paginas siguientes, usted tiene viente (20) dias de plazo al partir de la fecha de la demanda y la notificacion. Usted Debe presentar una apariencia escrita 0 en persona 0 por abogado y archivar en la corte en forma escrita sus defensas 0 sus objeciones alas demandas en contra de su persona. Sea avisado que si usted no se defiende, la c;orte tomara medidas y puede entrar una orden contra usted sin previa a vi so 0 notificacion, y por cualquier queja 0 alivio que es pedido en la peticion de demanda. Usted puede perder dinero 0 sus propiedades 0 otros derechos importantes para usted. LLEVE ESTA DEMANDA A UN ABODAGO INMEDIATAMENTE. SI NO T1ENE ABOGADO 0 SI NO TIENE EL DINERO SUFICIENTE DE PAGAR TAL SERVICIO, VAYA EN PERSONA 0 LLAME POR TELEFONO A LA OFICINA CUYA DIRECCION SE ENCUENTRA ESCRITA ABAJO PARA AVE'RIGUAR DONDE SE PUEDE CONSEGUIR ASISTENCIA LEGAL. DAUPHIN COUNTY LAWYER REFERRAL SERVICE 213 NORTH FRONT STREET HARRISBURG, PA 17101 717-232-75.36 2 . "~- " " > -, - ~ " ALLSTATE INSURANCE COMPANY, Plaintiff v. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. NO. JOSEPH ALDINGER, JAKE ULRICIH, BRANDI MILLER, GLENN SHOLLY and WILLIAM McCLOSKEY, Defendants CIVIL ACTION . AT EQUITY JURY TRIAL DEMANDED COMIPLAINT IN EQUITY AND NOW, comes Allstate Insurance Company, by and through its attorneys, NEALON & GOVER, P.C., and requests that this Honorable Court exercise its equitable powers to accept interpleader of Allstate Insurance Company's liability limits under its insureds' automobile liability insurance policy for the following reasons: 1. Allstate Insurance Company is a corporation that maintains a local claims office at 6345 Flank Drive, Suite 1000, Harrisburg, Pennsylvania" and is authorized to conduct business in the Commonwealth of Pennsylvania. 2. Joseph Aldinger is an adult individual who resides at 3 South Street, Enola, Pennsylvania 17025. 3. Jake Ulrich is an adult individual who resides at 101 Pepper Avenue, . Enola, Pennsylvania 17025. 4. Brandi Miller is an adult individual who resides at 330 Fourth Street, West . Fairview, Pennsylvania 17025. 5. Glenn Sholly is an adult individual who resides at 105 East Columbia Street, Enola, Pennsylvania 17025. f__-~ - ., ,,' ~, ~ "-'- , ;1-'1/_ " 6. William McCloskey is an adult individual who resides at 371 Watts Drive, Duncannon, Pennsylvania 17020. 7. Robert Gill is an adult individual who resides at 95 Salem Church Road , Mechanicsburg, Pennsylvania 17055. 8. Brenda Moore is an adult individual who resides at 97 Salem Church Road, Mechanicsburg, Pennsylvania 17055. 9. As of September 26,1998, and at all times relevant hereto, Brenda Moore was the policyholder of an automobile liability policy, Policy No. 69812263201\03, issued by Petitioner, Allstate Insurance Company. 10. The above-referenced policy provides liability coverage for personal injury in the amount of $25,000 per person and $50,000 per occurrence. A true and correct 'copy of Ms. Moore's policy Declaration sheet is attached hereto and incorporated herein by reference as Exhibit "A." 11. On or about September 26, 1998, Robert Gill was the operator of a 1989 Isuzu Trooper owned by Brenda Moore and covered by the insurance policy referenced above, when it was involved in a one-car motor vehicle accident. 12. At the time of the accident, each oHhe individuals named as defendants in this Petition were passengers in that vehicle. 13. The accident occurred on Humer Street near its intersection with Lafayette Street, East Pennsboro Township, Cumberland County, Pennsylvania. 14. At the aforesaid time and place, Mr. Gill was operating the Moore vehicle in a northQound direction when he .lost control of the vehicle, crossed into the 2 - , ~ '~, fcj southbound lane resulting in the vehicle doing an undetermined combination of rolling and flipping before coming to rest on its driver's side facing in a southbound direction in a yard on the west side of the roadway. 15. As a result of the accident, various injuries were sustained or are believed to be sustained by the above-named defendants. 16. It is believed and averred that Defendant McCloskey is represented by David Rosenberg, Esquire, with respect to a personal injury claim against Mr. Gill. 17. It is believed that the remaining defendants are unrepresented by counsel. 18. Allstate Insurance Company believes that some or all of the named defendants may wish to make claims against Mr. Gill and/or Ms. Moore, which would be covered by the liability insurance policy referenced above, 19. Plaintiff, Allstate Insurance Company, believes and therefore avers that the combined policy limits of $50,000 are or may be insufficient to fully compensate all defendants or their respective claims. 20. In light of the number of claimants and potential claimants as well as the anticipated value of those claims based on the known severity of the various injuries, Allstate Insurance Company desires to interplead its liability limits into the Court of Common Pleas of Cumberland County for distribution amongst all claimants as the Court deems appropriate. 21. This Court has equitable power to accept interpleader of these funds. See Shellhammer v. Gray, 359 Pa. Super. 499, 519 A,2d 426 (1996). The Court also has 3 .....~ ~ ,--',-","', -, ~ , .. l' , , " power to direct the Prothonotary to place the money into a financial institution with interest accruing to the benefit of all claimants. 22. Plaintiff is unable to determine the fair and proper distribution of the policy limits of the various claimants. 23. Plaintiff has no other means of fairly distributing the funds while protecting itself against claims for the expense of litigation, delay damages and/or claims of bad faith refusal to settle. 24. The said sum of $50,000 will not be reduced by the payment of any attorneys' fees for the preparation of this Complaint or the processing of it. WHEREFORE, Plaintiff, Allstate Insurance Company, respectfully requests that this Honorable Court direct the Prothonotary to accept payment of the $50,000 Iiabili~y limit to be placed in an interest-bearing account until the Court orders . distribution of the principal and all accrued interest to the claimants as deemed appropriate. Respectfully submitted, NEALON & GOVER BY~ . Christop er J. Knight, Esquire Attorney I.D, #80058 301 Market Street, 9th Floor P.O. Box 865 Harrisburg, PA 17108-0865 (717) 232-9900 4 ~,'" ~~~ -- ~ " - . "'""'" ., VERIFICATION I, Patricia Hoffman, hereby certify that I am an authorized agent for Allstate Insurance Company, and that the averments contained in the attached Petition are true and correct to the best of my knowledge, information or belief. To the extent that any of the averments of the Petition are based on an understanding or application of law, f have relied an counsel in making this Verification, I understand that I am subject to the penalties of 18 Pa. .C,SA ~4904 relating to unsworn falsification to authorities for any false statemenls knowingly made herein. -, l j PatricIa Hoffma, lalm Representative Allstate Insurance Company , , ! . '. - - ~.. . .. October 8, 1999 Claim #: 1553220664 B19 Insured: Brenda Moore Date of loss: 09.26.1998 " . ~ - ",,;:, ":,j _ _ '^"" , ., Allstate;, You're in good hands. c~~~ We have received your request for a policy declaration sheet. The original is computer generated and no duplicate is kept. In fact, there is no physical policy file, Brenda Moore is insured with Allstate Insurance under policy number 698122632 with liability limits of $25,000 per person and $50,000 per occurrence, Attached is a copy of a computer printout that confirms the above, Sincerely, Mike 8m uk, Front Line Performance leader Subscribed and sworn to before me this 0. C\ 3*' Dayof (~~~ ~ 19---1..1 t~~ Notarial Seal p, 'M '". Slabonik, N01sry Public Lowe'r" "xton Twp" Dauphin County MV oommlsslon Expires Feb. 26, 2001 M-.mber. Pennsylvania Association of Notaries 52.1 . . . ". rt:(())fP'If 1.~:'~::::'.i. N.Pr-i; ~ :5:;;~~::~2{;}~':b.'~ ,~~.ft* ~-:'DLICY D(~TA PF~):N'r ~::H',~ <i.)...}U,~ TE:!::~, B 19 ~-:'AGE :".i:}C ~ ~ :5~)'Z) "0t.NlJM: 698122632 ~_USSDT: '09/26/i998 EFFDT: 07/03/i998 ~~OTICEn1': 09/28/1998 :'r;~INT I:'l":'iTE: i \~/03./i s>,,;)';} PI::~T.r.rr Tt1"'H='-: - i 0: Ot3 {..'!y~ ~NSUF~ED: BR~~NDA MOORE ~DR: 95 SAI..EM C!-lLJRC!-1 RD CITY: MEC\-!ANICSBURG ~T: p~ ZIP- 1705528b6 '!OME P~iONE: "117-691--6664 WOF~K PHONE: 000--000--0000 t.INE: ~9 AU1"[)--INDEMN!'fV ~GENT: ...J KELl.EY & SON INC PHONE: 717-.,737-,6030 ORJ:GINAL YR: Q7 ~ARRATIVE: *** ADDI1"IONAL. (:OVE~RAGE STICKER P~~INT PER DESK BHO **!E \/l::HICL.E ';'F~: t$9 j"'i;~)K!:.: ISU:ZU VIi"!: ..JACCH~5~~EOiC79(1~~47::~ T'J'PE: '1 () ,S'T;~'lN:()I~)F~D ~'!PT!ON(S): FUL.L. TORT F'DLICY SCDDES ~ S~'1 ;~G~::: RECLI.;~S'SI.FIC1~)TION YE,~:~~'-'FUTURE YOUt':.!G D!~~I\{Ej::: ;;:'OF~ri: fIlii ~:J7~-2 ~~UTG POLICY FORM: AUi900-3 PENNSYL,VANIA AlJTOMOBILE AMENDATORY ENDORS~MEN1' FnR~'i: ALU2:)7 A~iEND:f~TOHY EriDClESEt.iE:HT FOi;:N: U1 i!.:).!,S) FOt\~'i: U'i i f:)7c'., DECl.ARA"YrONS/ID C;ARD DECLARAT]:ONS/AME~NDED DECft CLI~":I~1 HUrt: i ::;::;:32j~~),~~,~).i} 3{,.:~:.)1:' F'OLICY D:~JT~: j::'i:;:J:l\j'T ';.::Jl:~if; l:,,~,!.:.t:' ::' ~~n~lUSTEF~: Bi9 LOG: i ~):H) POLNUM: 698122632 LOSSDT: 09/26/1998 EFFD'l'. 07j03/~998 NO"l'rCED'T: 09/28/1999 CClV[F~{~GE/LIr-iITS DESCF~IPTI(j~,~ C:t;':~Nf.IBLE cuv D;~T':;: AA 25.000/50,000 BODIL,Y INJlJRY v 07/03/98 BD 25.000 PROPER1'Y DAMAGE CC 5,000 MEDlr:AL F'AYMEN"'S CF:- 2. ~H}H FUNEHAL. BENEFIT SS 25,000/50,000 S'Y"AC)(ABLE UNINSURSD MO"J'ORIST Sll 25.000/50.000 ~. STACKABl.E lJNDERINSljRED MOTORIST VW INCOME DISABIL.ITY .,{ ooor/(.)3/9H 0'[1 /()~)/S)~;,:' y y r:}7 /0:~)/9E~ v I (:)"(../ !~:!; / ';' ~3 0-;1 /(.)~;/S-'t1 f)7/()3/~~S , ' ;;; ~ c. w "' , . .....- . . ",-~_~:_~1f! __ ,jl!I:lT......,.,,,"",,, (~ frl.'ril ,s:".~ ~ liVil. "~1'~"'I _i!'~~_:CW!!_IRi!W'1'-!if'~~!I>fi!",jf.~~'-I1f!~!Illl!!~~",)I!l~ImI;;'W'1%'r;;!j1;jI'jI,@1'fI<- -, ,~ .~-~ ~ .. ' " . - _.",! ^_, ,:-,.,d;;~0i;. '; - " , , ALLSTAtrE INSURANCE COMPANY, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. v. NO. . 00-4783 JOSEPH ALDINGER, JAKE ULRICH, BRANDI MILLER, GLENN SHOLLY and WILLIAM McCLOSKEY, Defendants CIVIL ACTION - AT EQUITY JURY TRIAL DEMANDED PRAECIPE TO THE PROTHONOTARY: Please reinstate the Complaint in the with regard to the above-captioned matter. Respectfully submitted, NEALON & GOVER, P,C, BY.~ Christoph r J, Knight!, Esquire I.D,#:80058 2411 North Front Street Harrisburg, PA 17110 (717) 232-9900 '". "," , ,~ -......- ". "'- ..~~ ..k., SHERIFF'S RETURN - REGULAR CASE NO: 2000-04783 P fr COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND ALLSTATE INSURANCE COMPANY VS ALDINGER JOSEPH ET AL DAWN KELL , Sheriff or Deputy Sheriff of Cumberland County,Pennsylvania, who being duly sworn according to law, says, the within COMPLAINT - EQUITY was served upon SHOLLY GLENN the DEFENDANT , at 0016:57 HOURS, on the 4th day of April at 105 EAST CUMBERLAND ROAD , 2001 ENOLA, PA 17025 by handing to GLENN SHOLLY JR a true and attested copy of COMPLAINT - EQUITY together with REINSTATED and at the same time directing His attention to the contents thereof. Sheriff's Costs: Docketing Service Affidavit Surcharge 18,00 9,30 ,00 10,00 .00 37,30 So Answers: ~. ~~ R. Thomas Kline 04/05/2001 NEALON & GOVER me this /0 tf- , day of By: ~~ Deputy Sheriff ~ Sworn and Subscribed to before (l,,:Jl 2M I A, D . /Ja: () L A": - L IIg...... /~ P 0 honotary I~ ," -' ~~".. '~', .,. ~; S-"., , -~. ^ ^_. -., ALLSTATE INSURANCE COMPANY, PLAINTIFF v. 0"::"' .<.",.' '~'-"'" :..' ._' ,~..,',~ ._._ ,", .- _ .".'.' ;;';;: ,,: ,~ i, .. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. NO. . 00-4783 JOSEPH ALDINGER, JAKE ULRICH, BRANDI MILLER, GLENN SHOLLY AND : WILLIAM MCCLOSKEY, DEFENDANTS TO THE PROTHONOTARY: CIVIL ACTION - AT EQUITY JURY TRIAL DEMANDED PRAECIPE Please reinstate the Complaint in the above-captioned matter, Date: 03/22/01 Respectfully submitted, NEALON & GOVER, P,C, BY:~ Christop er J, Knight, Esquire LD, #: 80058 2411 North Front Street Harrisburg, PA 17110 (717) 232-9900 '~":^' - " . .-.,,' . ~. , ,,',' .~ y-;) , , CERTIFICATE OF SERVICE AND NOW, this 22nd day of March, 2001, I hereby certify that I have served the foregoing Praecipe to Reinstate the Complaint on the following by depositing a true and correct copy of same in the United States mails, first-class, postage prepaid, addressed to: David H, Rosenberg, Esquire HANDLER, HENNING & ROSENBERG 1300 Linglestown Road Harrisburg,PA 17110 Attorney for Defendant, William McCloskey Robin J, Marzella, Esquire R. J. MARZELLA & ASSOCIATES, P.C. 3513 North Front Street Harrisburg, P A 1711 0 Attorney for Jacob Ulrich Joseph Aldinger 3 South Street Enola, P A 17025 Brandi Miller 330 4th Street Enola, P A 17025 ~~ Christopher1, Knight, Esquire ,> --" '-_''_,___"o~ -~_..~,,-,,_'-'- ", __<_~ "~.d -~ '. ":'::'.,,-:,"-"<,-;,'.,.., -',: -'~ ALLSTATE INSURANCE COMPANY, PLAINTIFF V. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. NO. 00-4783 JOSEPH ALDINGER, JAKE ULRICH, BRANDI MILLER, GLENN SHOLLY AND WILLIAM MCCLOSKEY, DEFENDANTS CIVIL ACTION - AT EQUITY JURY TRIAL DEMANDED PRAECIPE TO THE PROTHONOTARY: Pursuant to the Order of this Honorable Court attached hereto, please accept the draft enclosed herewith payable to the Prothonotary of Cumberland County in the amount of $50,000.00 and hold such funds in an interest-bearing account pending further order of distribution by the Court. Respectfully submitted, NEALON & GOVER, P.C. Date: 'Z.! 2 f! () L By: (J/f'A__~ ~i~:;~ Knight, Esquire Attorney I.D. No. 80058 2411 North Front Street Harrisburg, PA 17110 Attorney for Plaintiff (717) 232-9900 -- , " -, ~ -- , . 'SEP 2 5 2800f \; \ ALLSTATE INSURANCE COMPANY, Plaintiff v, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA, NO. 00- iI"1PJ G~Lt l~ JOSEPH ALDINGER, JAKE ULRICH, BRANDI MILLER, GLENN SHOLLY and WILLIAM McCLOSKEY, Defendants CIVIL ACTION - AT EQUITY JURY TRIAL DEMANDED ORDER AND NOW, this ~ (11,,1 day of ~, 2000, it is hereby Ordered and Decreed that the Plaintiff, Allstate Insurance Company, it permitted to pay its interpleaded funds of $50,000 to the Prothonotary of Cumberland County and that the Prothonotary is further directed to hold such funds upon payment in an interest-bearing account pending further order of distribution by the Court. BY ~~5 GOO;/'/ J. )~~ t~ ,-DO o..-:11.P R~!) Distribution: Mr. Joseph Aldinger, 3 South Street, Enola, PA 17025 Ms. Brandi Miler, 330 4th Street, Enola, PA 17025 Mr. Jake Ulrich, 101 Pepper Avenue, Enola, PA 17025 Mr. Glenn Sholly, 105 East Columbia Street, Enola, PA 17025 Mr. William McCloskey, clo David Rosenberg, Esquire, HANDLER, HENNING & ROSENBERG, 1300 Linglestown Road, P.O. Box 1177, Harrisburg, PA 17110 _ _"c-_ ,_ "~ '. - _....,".~'-. -,- -- " ';,-_'" u' ,"'c.. ~~c"''';L'' '~_,,_% f~'<< '_ '0 _,;_~, CERTIFICATE OF SERVICE AND NOW, this 21st day of February, 2002, I hereby certify that I have served the foregoing Praecipe on the following by depositing a true and correct copy of same in the United States mail, first-class, postage prepaid, addressed to: David H. Rosenberg, Esquire HANDLER, HENNING & ROSENBERG 1300 Linglestown Road Harrisburg, PA 17110 Attorney for Defendant, William McCloskey Robin J. Marzella, Esquire R. J. MARZELLA & ASSOCIATES, P.C. 3513 North Front Street Harrisburg, PA 17110 Attorney for Jacob Ulrich Joseph Aldinger 3 South Street Enola, PA 17025 Brandi Miller 330 4th Street Enola, PA 17025 Glenn Sholly 105 East Columbia St. Enola, PA 17025 ~~ .- - "< ~ ~-. .do ALLLSTATE INSURANCE COMPANY, PLAINTIFF IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. V. NO. 00-4783 JOSEPH ALDINGER, JAKE ULRICH, BRANDI MILLER, GLENN SHOLLY AND: WILLIAM MCCLOSKEY, DEFENDANTS CIVIL ACTION - AT EQUITY JURY TRIAL DEMANDED PRAECIPE FOR ENTRY OF APPEARANCE TO THE PROTHONOTARY: Please note the Entry of Appearal}ce of the undersigned on behalf of Defendant, Glenn Sholly, in the above-captioned matter, Respectfully submitted: 0n~ ~ . ~ ~ David J. Foster, quire I.D, No, 23151 COSTOPOULOS, FOSTER & FIELDS 831 Market Street P,O, Box 222 Lemoyne, PA 17043-0222 Phone: (717) 761-2121 Dated: April 10. 2002 ~ " ~ ~ ~. . .' " . ,,".',-e- CERTIFICATE OF SERVICE AND NOW, this 10'h day of April, 2002, I, David J, Foster, Esquire, hereby certify that I have served the foregoing Praecipe For Entry Of Appearance on the following by depositing a true and correct copy of same in the United States mail, first class, postage prepaid, and addressed as follows: David H, Rosenberg, Esquire HANDLER, HENNING & ROSENBERG 1300 Linglestown Road Harrisburg, P A 17110 Attorney for Defendant, William McCloskey Robin J, Marzella, Esquire R,J, MARZELLA & ASSOCIATES, P.c. 3513 North Front Street Harrisburg, PA 17110 Attorney for Defendant, Jacob Ulrich Christopher J, Knight, Esquire NEALON & GOVER 2411 North Front Street Harrisburg, PA 17110 Attorney for Plaintiff, Allstate Insurance Company Joseph Aldinger 3 South Street Enola, PA 17025 Brandi Miller 330 4th Street Enola, PA 17025 \Yl ~~ By: ~v.. David J, Fost ,Esquire '-"--Ll'-.-'lIllilUl!ii:m~U~!iWiil~~Jlj-!l<II;;i~ifi~JJilK~~ ~~ -~ - a~w;- "~~"". Ji4 0 0 0 c: I'V <- -n Uf":" ". ~,=-::i [!lfi': '"'0 Z:t:j ::>::> _":~n r- Zij:- ~S8 (f:L " 1'--' -<2- :~~~~ ~C:'1 -"0 ~C """'"c ;:'"5:D -.;""" c=c) ;:;;'CJ >e.:: N (5rn 2" ;;:;! ~ Ul :n -< f ~ -, --., -. ,__ j'--, , 'w~""'<_:/'o';/"'" ,-".-"~,,, 'V.';' "'~"-',,-~-_f, q',' ~_,__". ,_'.___ ",o,,'h',-'- .' ""j , " , . . . ALLSTATE INSURANCE COMPANY, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYL VANIA v. NO. 00-4783 JOSEPH ALDINGER, JAKE ULRICH, BRANDI MILLER, GLENN SHOLLY and WILLIAM McCLOSKEY, Defendants CIVIL ACTION - AT EQUITY RULE AND NOW, this t S- day of ~\. , , 2002, a Rule is hereby issued upon Joseph Aldinger, Jake Ulrich, Brandi Miller and Glenn Sholly, Defendants in the above captioned matter, to come forward with proof of their claim or be forever barred in sharing the interpleaded funds paid to the Prothonotary of Cumberland County on February 25, 2002 by Plaintiff, Allstate Insurance Company, and to Show Cause why Defendant, William McCloskey, should not be permitted to be paid the policy limits of $25,000.00 from Plaintiffs interpleaded funds. Rule returnable "50 days fi'om service thereof. ~~ R)\3 /-;-0 '.1fCinJI eR. I l~e1JAJ i ^!3 q. Rosenberf t5Ro-Jd\ -f\\\\ \e ~ eteJ0" 0~o)lr ~e.~~ ~\~\fI~f~ ~ . \- ~\\stop'neR.. :], \ ~\.s\ ;'n\ ~ j . -{1\o..R 'l.e \ 0.. BY THE COURT> .' J. - , I'll "O-O":FfI'c nr.: .\'<'\Ir-....~"" ,I, 1Vl.. VI' ""- "'~"rl-',.'\'^'7'^oy '-(- J ':i,.Jl.f!ji\'V'If11J 02 APR 15 Al'll0: 40 CUMBE8i.,AiVD COUN7Y . PENNS)ILVAN/A' ~. " _c_". )~~~~L: . ,--~-,'''_~'~ "t," "< '-", , ~.. "~~'"""""~-, ", !r_,_'" , , ~1!lI!.,:_,,~ " .' ,'_ ,_ '_ _~_"' __ _"_' :r', ,'n, .-~_ '_~_,-_,'_ ___,} ,,~__"_ __ "'.,. ,,;,'_" " .' , ""',!'" -"''''--''-,, . ,~~,~ ,:'1..", -- ~' " , " ALLSTATE INSURANCE COMPANY, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYL VANIA v. NO. 00-4783 Equity Term JOSEPH ALDINGER, JAKE ULRICH, BRANDI MILLER, GLENN SHOLJL Y and WILLIAM McCLOSKEY, Defendants CIVIL ACTION - AT EQUITY PETITION AND NOW, comes Defendant, William McCloskey, by and through his attorneys, HANDLER, HENNING & ROSENBERG, by David H Rosenberg, and requests that this Honorable Court issue a Rule upon the Defendants in the above captioned matter, requiring all defendants to come forward with proof of their claims or be forever barred in sharing the interpleaded funds of $50,000.00 paid to the Prothontary of Cumberland County on February 25, 2002 by Plaintiff, Allstate Insurance Company, and to show cause, if any, why Defendant, William McCloskey, should not be permitted to be paid his policy limits of $25,000.00 from Plaintiffs interpleaded funds and in support thereof avers as follows: 1. Plaintiff, Allstate Insurance Company, initiated this action by filing a Complaint in Equity, requesting, inter alia, that the court accept an interpleader of Allstate's policy limits of $50,000.00, against Defendants, who are Claimants for personal injuries arising from a motor vehicle accident involving Plaintiffs insured, Robert Gill, which occurred on or about September 25, 1998. 2. As a result ofthis motor vehicle accident, Defendant, William McCloskey, suffered severe injuries including but not limited to torn ligaments in his left shoulder, a ..-~.,,"' - - - ". .," " -~-,-, ,-. ~.. - . : '", .'0 ",.'__,,' "j~t ",-",,,:, ,.~,. -.':>6,",,-~"-'i' ""~ herniated disc at L5-S1, and an accessory navicular of his left ankle, Attached hereto and marked Exhibit "A" are some of Defendant McCloskey's pertinent medical records. 3. On October 12, 1999, Defendant, William McCloskey through his counsel, David H Rosenberg, made a claim with Plaintiff against its insured seeking policy limits of $25,000.00 for the severity of William McCloskey's injuries. A copy of the aforementioned correspondence is attached hereto and incorporated herein as Exhibit "B." 4. On July 12,2000 a Rule was issued upon Defendants to Show Cause why Plaintiff, Allstate Insurance Company, should not be permitted to pay its policy limits of $50,000,00 into Court. This Rule was served on Defendants by letter at their last known address on July 19, 2000. 5. David H Rosenberg, Esquire, filed an Entry of Appearance for Defendant, William McCloskey, on September 22, 2000. 6. On September 25,2000 the Court entered an Order allowing, Plaintiff, Allstate Insurance Company, to pay its interpleaded funds to the Prothontary of Cumberland County. 7. On October 10,2000, a Writ of Summons was filed by William McCloskey against tortfeasor, Robert Gill. 8. On February 25,2002, Plaintiff, Allstate Insurance Company, paid its $50,000.00 in interpleaded funds to the Prothonotary of Cumberland County. , ~~ - ^ . -,. ' ." ",,"' 'h.,_ '~-. .,,__.,:;;, ,,'-- ,- '- '-.', "0 _,-, ,,~__~, e" -'-c. -,-' ,~-.'- i WHEREFORE, Defendant, William McCloskey, respectfully requests that this Honorable Court issue a Rule upon the Defendants requiring all defendants to come forward with , proof oftneir claims or be forever barred in sharing the interpleaded funds of $50,000.00 and Show Cause why Defendant, William McCloskey, should not be paid his policy limits of $25,000.00. Respectfully Submitted, HANDLER, HENNING & ROSENBERG Date 'ff!/rJ ^' By Attorney for Defendant ~ -, ADM, DATE: 09/26/98 C(' Motor vehicle accIdent. EF! Seventeen year old whIte male here with hIs motber following a motor vehIcle accident. He was ambulatory to the Emergency Department, Tbe pahent Was m.volved In I motor vehicle accldent'several bours before admiSSion. He IS re.lfy not sure 'When. We have '""" '.)? 4 olhe. people Crom this accIdent here 10 tbe Emergeocy Department. The patient was a front seat ,;;!:LDJ",:?;Jr, unr:~tramed, man buzu Trooper. The drIVer was drinking and swerved to mIss another vehicle, h'JI '00' 11rol of hi. vehIcle and It rolled several times, I have gotten thl5 hl5tory Crom other people. The patIent h,,,,,o',[ '",noot remember the accident. The pat.ent beheves he was ejected Crom the vehicle, He says tbls ,'':'"':-f.::<l:w:,: he .;tates he remembers the car swervlDl:" and tbe next thing he remembers be was on the pavement .::;: of the vehicle and then he ran home, He denies any alcohollol.ake tOOlght. He complalos of pam .10 hIS 1 ~H ro.ot Mnd ankle arta, left postenor .pelv1t: ram areal left shoulder area, posterior aod supenor and tbe c'.:Clpilol orea of the scalp, Minimal neck discomfort at tbe present tIme, He also has mId back pam, lIe ctenle. shortness of breath, PMH Unremarkable, Last tel.anus sbot .. unkoown, MEDICATIONS None. ALCERGIES No known aUell'gles, PHYSICAL EXAMINATION 'litol :>igm "",""",od On .unes'a DOtes. COH!.1ITUTIONAL: Alert, aOX10U5, appears uocomCortable POSItIve odor or alcobol on tbe breath, HEAD: AbrasioD and moderate swelling on the occlpilal area somewhat 10 the left SIde, EYES: Coolunellva wllhout dl5charge Dr I01eelloo, LIds withoulleSloos, PERRL. l!'J'j'7: Ears: TympaOlc membraoes Wllhout perforatlOo, lD)e.lioo, or bulglDg, iVlcuth: LIps, teeth, and gums normal, 'hr~.l; Oropharyox WIthout lesions or exudate. A.nray patent. NGse: Naslll mUCosa normal :)muses: No sinus tenderness. NECK: Some lDu5Cular tenderness. No vertebral SpInE tenderness. Range of mohon IS near normal. BACK: He has mId to lower T-spinc vertebral splDe tenderness. There 15 no lumbar area tenderness. LUNGS; Normal respiratory effort. Breath sounds equal, No rales, rhoochl, or wheezes, Page 1 HOLY SPlRIT HOSPITAL Cllmp Hill, PA J70ll NAME: MCCLOSKEY, WILLIAM MR#: ].13877 ROOM #: ECU DR,: Luley, ~GENCY ROOM UPORr o. ;';"""=""~;:' .- - '- .-"Ji" ~:; 464r ADM. DATE: 09/26/98 The pallent was .Iined out to me by Dr, Luley with lD.tructlons to chcck the x-rays, suture laceratIOn and get. ,o,,&.cal consolt. DIAGNOSTIC TESTS: X-ray. of the cervIcal opine were negative, X-ray, of the len foot and ankle a. read by tbe radiologist was that there was aeCt5Sary tarsonavicular bone not an acute fracture However,OD my physical examination, tbe pabent 15 tender oyer that area, 50 1 think contrary to what the radIologISt .aid, I am concerned that .t might bc a fracture, The wound on the left forearm was approximately 1 S em, I eleaned.t WIth Betadme .crub, prepped .t WIth Bctadme, Infiltrated with 2% Lldocame, draped It, reprepped.t wIth Beladine and .utured It WIth ,Ix #4/0 nylon ,utures, I consolted Dr. Froelich for further evaluatIon and management, DIAGNOSIS: 1. Laceration, left forearm, 2, MultIple contusIOns and abrasion" HR/Jf 0: 09/26/1998 T: 09/26/1998 8900 Page 1 HOLY SPIRIT HOSPITAL Camp Hill, PA I7(JII NAME: MCCLOSKEY, WILLIAM MR#: 343877 ROOM#:ER DR.: RudnIck EMERGENCY ROOM HPORT ~' -. - ..... ~- "~~ InltIBIl-Bb & X-Ray Orders: Labs / lJrlfHI Spec/mena I I A....m'nop...n (I ESR [ 1 AlCohol ( ) Glucose I J AmyLaslIlllpase I] HCGS ( IAPTT ( Il.Jvo' I 1 Blood Cultures Proll)e ( JC~ \Lyt.. I IC~MB IPlP I ICPRO lRonol I ICRPt "'''''. I J DIgoxin J Qomldlne I I Dllantln J SallCylal8 RlKllolc>gy ( ] Abd/Obftr Senlls I IAn'" R L I )Cl8.vlCle A L ( ] ClW Spine L.ateral [ J ClM'V SPinEl Routine ( IC"''' RIn I PM I TPA I lElbow R L I ] Facl.1 ( JFemur R L ( I F"lI'" R L 11- R L [ ) Fof'$8rm R L I IHond R L ( !H'i' R L I !H"m&lUll R L I lKn.. R L [ lomer I Serum Acetone 1 Theophylline 1 Thyroid Prohl. J Tex Screen )TPAlaba l Type & Crou --* of unll. I Typo & Sc>oon IU/A )UnneC&S ) Workman's Comp Drug Screen ) Other IKUB ILlS 5",,,,, ] Mandible )Nual )0"", R L ) Pelvla ) Pyelog,"m 'VP JAlba R L 1 Shoulder A L )5""11 ]St.rnum IT/Sp..... )Tab/FIb R L IToe_R L }Wnst R L TlrnRlt":RTllnl ^,.. :k" , ~, Time Seen: Card/sc ( ] Monitor ( I EKG pagod.' ( J02 '..IMln ( J 02 S8Mallon Raap/rarory ( J "00'11 paQ6d et [ J PMk Flows Before/Aller R..-p Tx [ ]R..spratcryTx Medicatlons/IV's/ Additional Orders Time DaleITlInellnl IV: NSSI D5WI LRI D6I.45NSI D5.9NS Infuse at ccJhour, { ] ObtaIn old records, Special ProcedUreIl, Utb'aoul'd I AtOdomen ] OlJplex:Doppl&l' ] GlIflbhadder I IPoI~' Cultures ) Bttta Stl'ep AG I Culture )Cl!IOMCal lClllllomyd.a lGCCultu... I CT Scan 01 ] Va Scan 1 Other BIlling Classlrlcation { ]LtfV8ll [ IFoUQ'IOiuP I }""""" I ) Cas. , [ 1,-"",'11I ( ILewllV I I'-"""V Holy Spirit Hospital Camp HlII, PA Emergency Care Unit Physician Order Sheet 206-ECU REV IW6 JD BR,MO CHART COPY TII""III>I'r.;:!T/lm )SpLrlumC&S ]SkJoIC&S ]SlOoIO&P )SkJoIC Ortfl=11. lWoundC&S ]....CC1dlilnt 1_" ) MedICal Non-Emergency Initials: Initials: InItials: Initials: Signature: Signature' Signature: Signature' RN AN RN RN MDlDO Signature: Dale: !/i,c;/i6;. h:rJ;{ ;u,~ ~ ~CClOSrrT ,wllllAH I~I r CClHBIl lYr [CU [ 'll PA 17025 (1/1'/10'1 732-5534 21 ,-~~-'lb9 [o.QOUr r ",/~1 '"'- ~~-" ~ -I-.~ ,. ~" ~ ~ Iii -,,~,,~~-_.- - .--. --. ge~ Log-In Time Triage Time Time to Exam Room Pi"cc~"1r.fGr7t~~~';"~m;j~'-'( J Home [ 1 Industry ( ) Recreallon : !nfDm'l;u~!(:;l \,l;;ti;:lmt:f.lI1''Om~8tl.nt _FamltylS 0 , E){ll~-':''";>J S.'.'~h':::l~~ Trlaged to radiology for Dc1onn!f)' Yes I No Skin Temp Warm I Cool 'lIto., ~:::~1"" r-:,-:x I Cyunotlcl Mottled Palin ("'0) J !m;)n:~r:t~J'::n -'-.:' ~-". fmii:q:; j'" ..._....cr_. I 1 :~lJbJl>C1JV&~ \ r: I ~. j-'.'.-.--" ~,;::~ 10-. " " '!:::-c-,j ~",,J;.L~-r_ '_" f\).t,~",,~.=,-.....h . or Record. _EMTlParamedlc 01....1 Pul... Present I Absent Paruthea&8 PrelOilnl! Ab&ent Dea""oban 'lfJcu [ ] EDF nmo S. nature Last Tetanu& VI5UUl-ACUtty BlPJ Pulse Ox ' Temp Pul.... Allergies/ReactIons' latex. Vas -<I o LMP OS .. ,'1':;;", );;p.t;J i'r""'~:T:\;,jt 1/1. 'ut DnIOoseIFre uen Last Dose Medlcatlon/Dose/Fr uenc Lest Dose Are there advance dlrectlV9s? copy avculable? P".~l M~dlcaVSurglcal History: UP. ~rovemen1ln cardiac oulpul demonslrated by lnlproved v s and dlagnosbc lesls Oecrease or relle1 of dlscomlort _ Improwmetll In flUid \/01 demonstrated by decrea!le In symptoms of flUid vol ImbaJlIfI08 - lmprO\led gas exch&ng& demonstrated by Improved oxygenatlon and vnal sIgns Decrease I symploms IndGllng 1n19Ct1on or polentl8llor In~ctIon 1m edge de trated by vertJaflUitlOn I return dlKTlOl\stratlon Assessment completed a Data obtained by: AdmiSSion Called 1 AdrYllSSlo"; [I k9r~'~r;. ( 1 Old Records Sent A&port Called A mrtted to ~ ~t(.t z..o Hrs Transferred 10 D.spos.non I J Home { ] AMA I J OR at I ] Salosladory 1 ] Imp' DIscharged , J I 1 DIscharge Instrucllons Discharge R N by R,N, MA by rQueat at Holy Spirit Hospital Camp Hili, PA ECU Nursing Assessment CHART COPY ~ ;L , ,- ') ",\ f} 3 K R H 38 77 E , I K ,""lCSHT ,\tllLll [CO I"'; [ COL~"81. lH %5 I 'L t P l 170 1113/1q317H-!l!lH ~\,-"1-Hbq [0 ~qouP 201 ECU S1117 Qt1 RIIW JO Me BR t '""-~"l' ...~.~ -.......,.....,.. . .=~ ~ ~ - --,~; HOLY SPIRIT HOSPITAL CAMP HILL, PENNSYLVANIA 17011 EMERGENCY AND OBSERVATION RECORD PATIENT CARE NOTES --,< FORM HO ,.. l2It5) l :lS;)i~O"3 IlR 'H3877 E "CCLOSK(! .WllLIA~ ,,; l'il ( COLUll81A H( rcu [ ~ll ~l 17Q25 OIlI}/lq~1 HZ-SSH . ZI~-q3-31&q [0 "QOUr , , , ~ Cl/2~/q~ " ~ c ,,,~ ~- . ~. " . ORTHOPAEDIC SURGEONS'OF CENTRAL PA, LTD, MCCLOSKEY JR,WILLIAM J 371 WATTS DRIVE DUNCANNON,PA 17020 ACCOUNT # CHART # SS # 84901 31093 216983169 October 13, 1999 J, Stephen Snoke, D.O, 1800 Carlisle Road Camp Hill, PA 17011 RE: William J, McCloskey, Jr, Dear Dr. Snoke: .\ I saw your patient william McCloskey in follow-up in my office today, October 13, 1999. The patient was last seen on January 26, 1999 when he was scheduled for an MRI of his lumbar spine, He missed two follow-up appointments, He returns today with pain to his back and right hip with increased activities, He apparently has noted increased pain when attempting to lift or do heavy labor type work. He attempted to find a job in this job market but was unable to perform this work. '._~' :':~ "'if' ,'. On exam, he has back flexion to approximately 750 with pulling pain to his right buttock and right posterior thigh, He has negative sitting root signs. He has a slightly positive straight leg raising sign at 75-800 with right buttock and posterior thigh pain, His patellar and Achilles reflexes are normal reactive, He has no extensor toe weakness nor apparent sensory changes. . .~I ,'" ,!.' The patient did have the MRI performed which I ordered, This was completed on February 8, 1999, This shows a mild right posterolateral disc protrusion at L5-S1 adjacent to the right Sl nerve root. DX: Prominent bulging disc at L5-S1 on the right , ,;, :, This would certainly account for his persistent back pain, particularly when he attempts to increase his activities, He will be scheduled for ten sessions of physical therapy for his lumbar spine. He was also prescribed Naprelan 500 mg bid as an anti-inflammatory medication, We are going to see him.in six weeks in follow-up. With his young age, if he .continues to have pain without response to the therapy, he would be a candidate for a lumbar epidural injection. Sincerely, Thomas H. Malin, M~:!j '~?, 7.\\\\'\ lJN~"Z/~N'" . , ., ~N8rITU '8tANa ,;. /' / orION'! . -:.t ~~. ' :,;~,\~?" "If l' ".'~j\i, -;f-.~/' -/.,.;', ~h:r" '~ri;\ Y'>i -v .,/~;~ i":';~: )!J;~ THM/vjc (dictated, not read) TK-FAX sent to J. Stephen Snoke, D,O. ( i MISSED \ APPOINTMENT \ ON 13\ l~\bD ,I.: . ~~ " I" , -- . " ORTHOPAEDIC SURGEONS OF CENTRAL PA, LTD, MCCLOSKEY JR,WILLIAM J 178 WYOMING AVENUE ENOLA,PA 17025 ACCOUNT # CHART # SS # 84901 31093 216983169 07/07/2000 HARRISBURG OFFICE EXAMINATION (Rubbo, Ernest R, MD) SUBJECTIVE: William is here for evaluation of lower back pain, He has had this problem since October when he was seen by Dr. Malin.. An MRI evaluation was obtained at that time which showed a herniated disc at L5-S1, adjacent to the right S1 nerve root. However, the patient complains more of pain in his lower back, A trial of physical therapy was recommended, but the patient states that because of work constraints as well as care of his child, he has been unable to do therapy, He has essentially been living with the pain but is here for evaluation of pain in his lower back, He was suppose to see Dr. Malin two days from now but states he is having increasing pain and discomfort in his lower back and walks in a bent over fashion because of his pain, He denies any type of bowel or bladder dysfunction or any type of radicular symptomatology, PHYSICAL EXAMINATION: He has marked paraspinal muscle spasm in his lower lumbar area, He has intact reflexes to his knee jerks and ankle jerks. No motor sensory deficits were noted to his lower extremities. There was no active clonus noted or any type of hyper-reflexia, IMPRESSION: HNP L5-S1. PLAN: I have explained to the patient that I feel it is important that he consider a trial of physical therapy 3 times a week over the next 4 weeks. I have also given him a muscle relaxant in the form of Soma 350 mg four times a day and Vioxx 50 mg as an anti-inflammatory agent, I have also given him a booklet on the care of his back for him to read and instructed him on certain exercises for him to do. He may follow-up with Dr. Malin, who he was suppose to see, and proceed accordingly, However, I have told him it is very important to consider a conservative trial of physical therapy since he appears to want a quick fix for his problem. I have told him that these things do not go away without being taken care of, If physical therapy does not give him much improvement, one might consider a trial of epidural steroids. (transcribed 07/11/00 gb) r; ') 'l.1J1J\ jf\1\ "" , ...,) ~ ., -\d -"~ '..... .:, '..J'>'~ - , ,', - " }II' ~ #A ORTHOPAEDIC SURGEONS OF CENTRAL PA, LTD, MCCLOSKEY JR,WILLIAM J . 178 WYOMING AVENUE ENOLA,PA 17025 ACCOUNT # CHART # SS # 84901 31093 216983169 July 21, 2000 CAMP HILL OFFICE This patient was seen by Dr. Rubbo on 7/7/00, 2 days before I saw him, because of increased pain, The patient apparently has had increased back and right leg pain. He was seen by Dr, Rubbo and sent to PT, He has had difficulty with transportation getting to PT. He lives 2 miles from Wormleysburg Health South. He did not complete the PT that I outlined to him when I saw him on 10/13/99, The patient now has leg pain right> left, weakness and walks with a limp, He was prescribed Soma and Vioxx by Dr. Rubbo. PE: He has bilateral sitting root signs at approx, 350_450, His patellar reflexes are present bilaterally at +3 out of +5, His Achilles reflexes are present bilaterally at +2 out of +5, He has no extensor toe weakness, His straight leg raising signs are positive on the right at approx, 350 and positive on the left at approx. 350-450. DX: HNP L5-S1 PL: The patient must continue the therapy. He must make arrangements for transportation. I recommended a Medrol Dosepak and Tylenol with Codeine for his pain, He will be unable to work during this period of time. We shall see him in 4 weeks in flu. Thomas H, Malin, M,D, THM/lms T: 07/29/00 ( MISSED ONA~Th~T;QT 'L'\:,'\:,\ \ c~ '2J ~~~. .,Y _.~':/'l:S.,j >~ \: ,"- PATIENT . UNDERSTANDS . INSTRUCTIONS ,;, i':. " ':":,'."-" .. ":c' ",' . ~" February 8, 1999 RE: MCCLOSKEY, WILLIAM 371 Watts Drive Duncannon, PA 17020 AGE: 18 SS#: 216-98-3169 STUDY: MRI of the lumbar spine REFERRING PHYSICIAN: Thomas Malin, M.D. CLINICAL HISTORY: Low back pain MRI PULSE SEQUENCES: 1) T2, T1 sagittal 2) T1, GE oblique axial COMMENTS: The study was obtained with the 1.5 Tesla strength magnet and compared with an AP lumbar spine film dated 1/14/98. The lumbar spine shows normal anterior posterior alignment and marrow signal intensity is also normal. There is mild dehydration at the L5-S1 disc with the remainder of the lumbar discs showing normal hydration. The conus medullaris is normal ending at the thoracolumbar junction and there is no evidence of an intrathecal lumbosacral mass. parasagittal images though the neural foramina show no demonstrable pars defect and there is no stenosis or neural compression identified. Mild disc protrusion on the right is noted inferiorly in the neural foramen. Angle axial images through the neural foramina show a broad based right posterolateral and lateral disc protrusion without compression seen on the thecal sac. The disc is adjacent to and possibly compressing the proximal aspect of the right S1 nerv& root. No left sided compression is seen and the L5 nerve root exits through the foramen without suggested compression. Facet joints are normal in appearance. L4-5, L3-4, L2-3 and L1-2 interspaces show no evidence of focal disc protrusion. Mild disc bulging is noted and most apparent at L2-3. Only minimal impression occurs on the thecal sac and there is no focal nerve root compression suggested. CONCLUSION: Lumbar spine MRI scan shows a mild right posterolateral and lateral disc protrusion at the right S1 nerve root. _ ^(f) -CONTINUED- ~ "<'- .?-\ pl"l1 11\:'.'. \", C} ...;,';: fJ.J 2001 L5-S1 adjacent to .~ i. ~ --" ,~ -.." .', , ... RE: William J McCloskey JR October 14, 1998 page 2 .. _ -"~i "0",;'. with abduction because that is when he brings his acromial process against the clavicle_where he sustained his contusion, I will limit his gym activities and he is to do no overhead activities during this period of time, We will see him in two months for a final visit, Overall he should do very well, Sincerely, THM/vjc c: J, Stephen Snoke, D.Q, Malin, M,D, OCT 3 0 1998 RECEIVEo REC:;::l'1!~l'" ..,...- ,,~.....~ OCT 2 6 1998 Susqueilanna Sl.li.f;~cns ~;~ l "_.~~~u ' " -J Orthopaedic Su~g~ons of Central Rnnsylvarii~, i;D. October 14, 1998 Thomas H. Malin, M.D., F.A.C.S. Susquehanna Surgeons 532 North Front Street Wormleysburg, PA 17043 RE: William J, McCloskey, Jr, OCT 3 0 1998 RECEIVED John S. Rychak, M.D, Willian> J. Polacheck, JrO', M.D. Dear Doctors: I saw your patient william McCloskey in my office on October 14, 1998, This 17-year-old White male has had pain to his left shoulder secondary to an automobile accident which occurred on September 15, 1998, He apparently was a passenger in the front seat and not wearing his seatbelt when the accident occurred, He had numbness and pain to his left ankle, His left shoulder is his main source of difficulty today. He cannot abduct and flex without pain to the superior aspect of his AC joint, He has had no paresthesias to his fingers, He feels his grip is slightly decreased on the left as compared to the right. He cannot sleep on his left side. The patient also identified symptoms of low back pain without pain to his posterior thighs or legs, without paresthesias, tingling or numbness, Balint Balog, M.D. Craig W. Fultz, MD, Ernest R. Rubbo. M.D. Robert J. Maurer, M.D. Speciafidng in Hand &: Upper Extremity - Retired - Ch(Jmpe C Pool, M.D. Willard H. Lm'e. ,H.D. Sa1/luel J. Ammo. M.D. . Total Joint Replacement . Fracture Care . Hand & Foot Surgery His past medical history and review of systems were reviewed and are essentially negative, . SpOIlS Injuries Examination of his left shoulder reveals he has pain over his AC joint with slight pain with compression of his AC joint, There is a slight suggestion of some prominence, but no stepoff, He has pain to abduction at 900 and pain with flexion of 90-950 of his AC joint, His bicipital and tricipital reflexes are normal reactive, His power of grip is equal, . Arthroscopic Surgery . Workers' Camp Injuries . Bone & Joint Surgery . Back Surgery WE<;T SHORE OFFICES 99 November Drive C.mp Hill. PA 17011 717.761-8644 Fax 717-761-6860 HARRISBURG OFFICE 2800 Green St HlUTisburg. PA 17110 717-234-5976 Fax 717-234-2137 He had multiple x-rays which have all been reviewed, X-rays of his left clavicle and AC joints demonstrated no change in position of the clavicle with or without weights to substantiate an AC separation, Lumbosacral spine films were taken today, AP and lateral, which show there are no compression fractures or avulsion fragments, nor decreased disc space at any level, 5 Willow Mill Park Rd. Mectmnicsburg, PA 17055 717-691.0808 Fax 717-691-0557 HERSHEY OFFICE 32 Northeast Dr.. Suite 20t Hershey, PA 11033 717-533-2348 Fax 717-533-4490 This patient has a contusion of his AC joint without frank separation, This should do well with time, This can take up to 6-8 weeks, He will have pain RECEIVED - Providing Quality Orthopaedic Care to Central PennsYlv~'ct2 6 1998 SusqU.2;li2.:lnz.. t.:w:~.!;..;cns --~. " . ~.!"" ORTHOPAEDIC SURGEONS OF CENTRAL PA, LTD, MCCLOSKEY JR,WILLIAM J 371 WATTS DRIVE DUNCANNON,PA 17020 ACCOUNT # CHART # SS # 84901 31093 216983169 January 26, 1999 CAMP HILL OFFICE XR: LUMBAR SPINE (2V) , PELVIS (lV) This patient returns returns with back pain with flexion, He has pain with standing to his low back for what appears to be a major portion of his activities, He gets relief with laying flat or almost flat, Previous x-rays of his LS spine done in 10/98 showed no gross bony abnormalities, He has no complaints in regards to his thoracic spine, his clavicle or his AC joint, PE: His back flexion here is to 750-800 with pulling pain to his low back in the area of L5-S1, He has lateral bending which is full and extension which is full, He has slight pulling pain to his right back with sitting root signs at 450-500, His straight leg raising signs are slightly positive for back pain at 750-800. His patellar and Achilles reflexes are normal reactive, He has no extensor toe weakness or apparent sensory changes, XR: He had a left and right oblique completed, These show no evidence of spondylolysis or spondylolisthesis, DX: PL: Because of his persistent pain since 10/98, we are going to schedule him for an MRI of his LS spine from L2 to Sl to r/o a bulging disc or any nerve root or cord compression in the face of his increasing disability, We shall see him in 2 weeks to evaluate that study. He was advised to use Nuprin or Advil, 2 tablets 2-3 times per day for his pain during this time, Thomas H, Malin, M,D, THM/lms RTO: 2 weeks ~ ':> \~~~ ~t.'?> ...- ~'6.u'Go' .. PATIENT UNDERSTANDS INSTRUCTIONS .-- "," <:l ~"~" " February 8, 1999 RE: MCCLOSKEY, WILLIAM Page 2 Elsewhere there is mild disc bulging present without other areas of focal protrusion. Thank you for referring this patient to us. Sincerely, p' 1'4~~ ~Kraus, M.D. RK/lag . 1\~' 0" L\l\}'\ j~..,\\ '" " \?~i"~~2,(~ ~~'~-:~ .~_: ;:.-') .- U'. -"-- ,-~.- ';;--: . ''f5'{\?J; SUSQUEHANNA SURGEONS LTO. '532 NORTH FRONT STREET. WORMlEYSBURG. PA 17043 PHONE (717) 761-4141 FAX (717) 761-14,6 October 5, 1998 , J, Stephen Snoke, D,Q, 1800 Carlisle Road Camp Hill, PA 17011 Re: William McClosky Dear Steve: I saw young William McClosky in our office on 10-05-98. As you know, he is a 17 year- old that was recently involved in a motor vehicle accident and hospitalized at Holy Spirit Hospital. He comes in for a recheck status post his accident, The patient is doing reasonably well. He states that he is very sore and his major complaints involve the left shoulder, his mid-back and his left ankle, His appetite has been good, his bowels are moving normally and he is otherwise having no particular problems. On examination today, his head, ears, eyes, nose and throat were within normal limits. His chest was clear, his abdomen was soft with normal bowel sounds, There are no masses or tenderness noted, On examination of his ankle, he had minimal swelling and really no tenderness except a small amount laterally, On examination of his shoulder, he did have some tenderness and swelling along the AC joint, It was somewhat difficult to tell, but it seemed as thought he AC joint was disrupted slightly, He did have reasonably good range of motion of the arm, His other complaint was of back pain and he had some tenderness along the paraspinal muscles in the mid-back. On review of his X-rays, he had a normal left shoulder as well as a left ankle X-ray, He was noted on the thoracic spine at approximately T-7 to have wedge compression deformity which they felt was probably old in nature, GEORGE B. fARIES. JR.. MD KENNETH W. GRAF. MO MICHAELJ. PAGE. MD RONALD G. BARSANTI. MD ANGELA M. SOTO-HAMLlN. MD JOSEPH P. ESPOSITO. MD ROLANDO A. CASAL. MD A. DAVID FROEHLICH, MD ANASTASI US O. PETER. MD LISA K. TORP, MD GENElW. SURG<RY MINiMAllY INVASrv'E SURGERY COLON-l1ECTAl SURGERY BREAST SURGERY ONCOlOOICAl SURGERY VASCULAR SURGERY lASER SURG<RY .~- ~.~ ", - ~ . -" Octooer 5, 1998 William McClosky Page 2 I have discharged him from our care, but I mentioned that he should se.e the orthopedist who saw him in the hospital. I am unsure as to who that is, but we are,planning to look that up for him and call and obtain an appointment. My major concern is about a possible AC separation of the left shoulder, as well as the back pain he is experiencing in view of the X-ray showing what they though was an old wedge defect in the spine, Thank you very much for allowing us to participate in this gentleman's care, I remain, Sincere s, MJP/epg - .- - "-~ ., ,"- ;-" ~ ..- Of~"Ot'1\.EDIC SURGEONS OF CENTRA - L., LTD. MCCLOSKEY JR,WILLIAM J 151 E COLUMBIA AV ENOLA, PA 17025 ACCOUNT # 84623 CHART # 983217 SS # 216983169 9/25/98 ADMITTED HOLY SPIRIT HOSPITAL 9/26/98 SEEN IN CONSULTATION (DR. MAURER) HISTORY/CHIEF COMPLAINT: 17 YO white male passenger unrestrained in automobile accident that occurred 9/25/98. He had left shoulder and elbow contusion, left ankle injury and multiple abrasions to all extremities, No loss of consciousness; no apparent thoraco-abdominal or pelvic trauma. He has no significant back pain, PHYSICAL EXAMINATION: His neck is supple, nontender and he had mild tenderness over the A-C joint on the left; none on the right. There is no ecchymosis or crepitus. Glenohumeral joint motion was normal. No elbow tenderness or deformity. Pain in the area of the left hip, No ecchymosis or deformity, He had no significant pain with push/pull test of the hip or rotation and he has normal range of motion, Knee exam was normal; no tenderness or swelling, He had tenderness over the lateral aspect of the left ankle, minimal swelling, no ecchymosis, no instability or crepitus. Neurovascular exam of all extremities was normal. Xrays were reviewed. There is no evidence of neck or back injury and there was accessory navicular noted in the left ankle with no evidence of fracture or significant soft tissue injury. IMPRESSION: Multiple trauma, PLAN: p.r.n. AUTO Ice, elevation and analgesics, (transcribed 9/29/98 /rah) Follow-up in the office NO;; Ou 1'1~ 7990 C4:'/1f: ~l:) . ~" ..... - "". - 4. ",:... ' -- . ' 1~8{'~} ;1 ~ ~/o Ill'SULTAn,. REPORt / r r c/~ ~ /J- ~Jb( <- ) 7 (v:;) .(>-0 o-=' .? ~ . . J"~ .,k"._h ./ ~~ /- if'( r--~~- . c ~ jJt,.~~,0/~~ rd~~. ~@J{k--i':; w/~%~ flU oz/r~:f8~ ~ ;M We.- IV<> .~. -. V/~ ~"J,J,"~n~. r^-. W y~ ~ _I"""'P' t!h- /V- ~,~ S Y ~ fi.-....-. / . r9 J1 L- j~+'I-~ if rJc.' ~..w =--<.~ Ju' ~~ J ~-:l--;.joJwdF aP'l' :;J JVV .>-<-r-4i <D--'t .-P~ ~~ {h . :",. - p.r 0 (j;/!:.j; ~ >r-.. .e..-L-v ..., ~ .- {;) ),~ 1."-"/1 A-- jj) At d-- u~ ~Jor-~~~~~ ~U/ ~,/ -I ~ _~ kf". ...&.J~1 ~ro/' /I}o E'.-~'b<. ~ t..P- ,-<- JZ.'"--t.r~ ;;<J- t/~ )( ~ . ;"'" ,;;~ -Y< ""- ,,&~ '<7 /i/~?'7-?!(.-~;t;:?:J~,:!;j -vvi Dro"",, ",rn ~'" YJ7 I ~ o CONSULT ONLY ~.~ REPORT ' .n. ,..., REOUESTED ' ~ ',"GARDING OR~ (l 10"""'OfCO""'''''-.., ~ ~t- "" '" '" '11<ol~ O,"EGTEDT:\'r ~' 1\0\- k~ld\4 L..n 1}- (' ~~I,~'t~ H~:~,~:.~R~,~~~VA'" @ 1~.rS :~ I ' ~R JO~77 , I ' I. L I'M \, , ',u""~ Hf 4040Z '. I ,11i'/i4 n ,Pl 17U; lllll/l)AI 1,-~~34 II ~ I -CCL(!,r; ~~, 17 SU5wuEHAII. ., , .. .1(-~a-31i.' "- ~ . HANOLER HENNING& ~ C'W"':''''- TTll W"':' 01 r-. I\.U~C'.t.l.'DDnU --~------- - '\TTORNry, I' '," ;~. I, \ t J P.! :...!-.;', 319 Market Street, P.O. Box 1177 Harrisburg, PA 171 08 (717)238.2000 . (717)233-3029 Fax October 12, 1999 . , 'LESLIE B. HANDLER W. SCOTT HENNING .. DAVID H ROSENBERG "'CAROLYN M. ANNER .... MATTHEW S. CROSBY JAMES R. CARROLL .... GREGORY M. FEATHER 'Reliredl199B) .'Also Admilted 10 Fl Bar "'licensed RN in PA and NY ....Also Admilled 10 NJ Bar SAMUEL HANDLER (1922.70) Rosenberg@hhrlaw.com James G. Nealon, III, Esquire NEALON & GOVER 301 Market Street - 9th Floor Harrisburg, PA 17108-0865 RE: William J. McCloskey v, Allstate Insurance Company Dear Mr. Nealon: I spoke with Patti Hoffman concerning the above-referenced case and she advised me that she has recently assigned this case to you. Apparently, there are several claimants and some of those are not represented by counsel. As indicated above, I represent Mr. William McCloskey in this case and it is my understanding that the policy limits in this case are $25,000/50,000. Mr. McCloskey sustained serious injury and his claim would certainly be worth $25,000, however, I am not sure of the value of claims for the others involved. Would you please contact me and advise me what information you will need, if any, from me to assist you in moving this matter forward. I look forward to hearing from you. Very truly yours, HANDLER, HENNING& ROSENBERG By: DHRlnlb cc: William J. McCloskey ,_.='"U~_ - ~" -,- "~ ALLSTATE INSURANCE COMPANY, : IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYL VANIA v. : NO. 00-4783 Equity Term JOSEPH ALDINGER, JAKE ULRICH, BRANDI MILLER, GLENN SHOLLY : CIVIL ACTION - AT EQUITY and WILLIAM McCLOSKEY, Defendants CERTIFICATE OF SERVICE On this 4th day of April, 2002, I hereby certify that a true and correct copy of Defendants Joseph Aldinger, Jake Ulrich, Brandi Miller, Glenn Sholly and William McCloskey's Rule and Petition was served upon the following by depositing in U.S. Mail; Robin 1. Marzella, Esq. RJ. MARZELLA & ASSOCIATES, PC 3513 N. Front Street Harrisburg, P A 17110 Attorney for Jacob Ulrich Joseph Aldinger 3 South Street Enola, PA 17025 Brandi Miller 330 Fourth Street Enola, P A 17025 Glenn Sholly 105 East Columbia St. Enola, PA 17025 Christopher 1. Knight, Esquire NEALON & GOVER 2411 North Front Street Harrisburg, P A 1711 0 Respectfully submitted, HANDLER, HENNING & ROSENBERG Date: (J L(-(),<] -OJ. By: IJ David H Rose I.D. # 20569 1300 Lingle town Road P.O. Box 60337 Harrisburg, P A 17106 (717) 238-2000 Attorneys for Defendants ~ -~ M~~6'liiIi!~;il~obl~"'\lbJ'WI\l,"W;l';~"'!J~~'W-"l"~.'IE",,",,-&1!W'~Jiiij'1. ~,~ __~..w"";"",,,,,,,,~~~ ~.."'"IiiftB~""~ - ... -~' () C ;;> u{~f' 2?~Ii z (f)~ A"~"" ~"6 :)>. '",0 ""'n $.c z :;! .~ ;'-.) . o N l:~ " ::..? I co o "11 ::;:1 i'i'?;J1 ~7h1 ?~'? .=-~O -;L:":fj ~d(") c.:;;"n ~ "" -< -''J :2; . ~ .~- --~- " . ".'. ,-., . . " ,- - ';'"'-~ R, J. MARZELLA & ASSOCIATES, p,c. BY: RobinJ, Marzella, Esquire Pennsylvania Supreme Court I.D, No, 66856 3513 North Front Street Harrisburg, PA 17110 Telephone: (717) 234.7828 Facsimile: (717\ 234-6883 Attorneys for Defendant, Jake Ulrich IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - EQUITY ALLSTATE INSURANCE COMPANY, DOCKET NO, 00-4783 Equity Term Plaintiff v, JOSEPH ALDINGER, JAKE ULRICH, BRANDI MILLER, GLENN SHOLLY, and WILLIAM McCLOSKEY, Defendants : JURY TRIAL DEMANDED ORDER AND NOW, this day of , 2002 is it hereby ORDERED that a status conference is scheduled to take place on , 2002 at All parties alleging entitlement to a claim for damages in the above-captioned matter are ORDERED to attend, j. ~ L- _ ,.j ,"'-- ___ ,.~"",o'. <-',.',._ _ , .,..- "-.' ,-'<- " , .. R,J, MARZELLA & ASSOCIATES, p,c. BY: Robin J. Marzella, Esquire Pennsylvania Supreme Court 1.0. No, 66856 3513 North Front Street Harrisburg, PA 17110 Telephone: (717) 234.7828 Facsimile: 1717\ 234.6883 Attorneys for Defendant, Jake Ulrich IN THE COURT OF COMMON PLEAS OF CUMBERlAND COUNTY, PENNSYLVANIA CIVIL ACTION - EQUITY ALLSTATE INSURANCE COMPANY, DOCKET NO, 00-4783 Equity Term Plaintiff v, JOSEPH ALDINGER, JAKE ULRICH, BRANDI MILLER, GLENN SHOLLY, and WILLIAM McCLOSKEY, Defendants : JURY TRIAL DEMANDED JAKE ULRICH'S RESPONSE TO DEFENDANT McCLOSKEY'S PETITION AND NOW COMES, Defendant jake Ulrich, by and through his attorneys, R.]. Marzella & Associates, P ,c. by way of filing this responsive pleading: 1. Admitted, 2. Defendant McCloskey's medical records speak for themselves. Defendant Ulrich alleges that his injuries are, at a minimum, as severe as Defendant McCloskey's injuries. To date, there are three parties of record who have retained counsel to represent their interests, Defendants McCloskey and Ulrich are the only two who have I . "c_ - " , . " "'"~,,,,,,-> '0""",,;--,,-,, ~ made a claim supported with proof of damages, As such, Defendant Ulrich is entitled to the remaining $25,000,00 in damages, 3, Admitted, 4. Admitted. 5, Admitted. 6, Admitted, 7. Admitted, 8, Admitted. WHEREFORE, Defendant, Jake Ulrich, respectfully requests this Honorable Court order the dispersement of $25,000.00 to compensate Jake Ulrich at the time of compensating Defendant McCloskey, In the alternative, Defendant Ulrich requests. in the interest of justice, this Honorable Court order a status conference prior to the dispersement of any and all funds to ensure a fair and equitable distribution, R, J. Marzella & Associates, p,c. Dated: rvkj 10 , 2002 II II ," ~ . - ~ - , ,. ," ~ o ,_, ~ _.,;_ ~ '. , ...-~, , ,,~ j-~-~' "'-'-" CERTIFICATE OF SERVICE I, Lisa R. Rhoads, HEREBY CERTIFY that a true and correct copy of the foregoing document for Defendant, Jake Ulrich was served upon counsel of record this 11th day of~. 2002, by depositing said copy in the United States Mail at Harrisburg, Pennsylvania, postage prepaid, First Class delivery, and addressed as follows: Christopher J, Knight, Esquire NEALON & GOVER 2411 North Front Street Harrisburg, PA 17110 David H, Rosenberg, Esquire HANDLER, HENNING & ROSENBERG 1300 Linglestown Road Harrisburg, PAl 7111 _.. I - ~,,-.-- c_ _ ---; ~..:i>'_- '-,'--'.'. '. ,~ >-"'--'! . 1 " . R.]. MARZELLA & ASSOCIATES, P,C. BY: Robin]. Marzella, Esquire Pennsylvania Supreme Court 1.0, No, 66856 3513 North Front Street Harrisburg, PA 17110 Telephone: (717) 234.7828 Facsimile: (717\ 234.6883 Attorneys for Defendant, Jake Ulrich IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CML ACTION - EQUITY ALLSTATE INSURANCE COMPANY, : DOCKET NO, 00.4783 Equity Term Plaintiff v. JOSEPH ALDINGER, JAKE ULRICH, BRANDI MILLER, GLENN SHOLLY, and WILLIAM McCLOSKEY, Defendants : JURY TRIAL DEMANDED RULE AND NOW, this "2- \. day o~ ' 2002, a Rule is hereby issued upon any and all parties to show cause why DefendantJake Ulrich is not entitled to be awarded $25,000,qo at the time Defendant McCloskey is awarded $25,000.00, Rule returnable ~ days from service thereof, fiap-llD L .5 'J.9.-t:J~ R ~~ \<\o.Rl.e.\ \0- I!"~: ?-?S~N 'oe.'y .;t\, 1<n\3\"\ J. ~= >- ~ \-_. l2J(:~ ~? t~) ,! ~- t..:" fT~l _..J u: J IL () 1IIii~" . LO (.: 7' :~) '''''1<( L,_ 7 ':""') :'? :'~:J:3 :~i9 'r~ -:7 l~uUJ ~f~t')- :3 o ro ~ ('-.I ~ , ... '~, ~ ",~. Z 0J <::) liIiI'" ili![u~~~dl '"" ~ ~1~'~'h& ~'WIlIiliIIliM~ '"'~ ~"-....~ . \ . - , , , -,;, -" ,~, ','__ ~",,' -01 ",' ,~" "=-~-. ( ,~ , R,J, MARZELlA & ASSOCIATES, p,c. BY: Robin J. Marzella, Esquire Pennsylvania Supreme Court \.D, No, 66856 3513 North Front Street Harrisburg, PA 17110 Telephone: (717) 234.7828 Facsimile: /717\ 234.6883 Attorneys for Defendant, Jake Ulrich IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - EQUITY ALLSTATE INSURANCE COMPANY, DOCKET NO, 00-4783 Equity Term Plaintiff v, JOSEPH ALDINGER, JAKE ULRICH, BRANDI MILLER, GLENN SHOLLY, and WILLIAM McCLOSKEY, Defendants : JURY TRIAL DEMANDED PETITION ON BEHALF OF JAKE ULRICH AND NOW COMES, Defendant Jake Ulrich, by and through his attorneys, R,]. Marzella & Associates, p,c. by way of filing this Petition requesting compensatory damages in the amount of $25,000,00: 1. On or about September 26, 1998, Jake Ulrich was an eighteen year-old young man involved in a motor vehicle accident as a passenger. 2, Jake was seated in the backseat of a 1989 (suzu Trooper, driven by Robert Gill. __L____ - .1' t__ ,'c _,~ _ ,- ,^':"--, > ( 'f' 3, At approximately 11 :OOpm, on September 26, 1998, Robert Gill was driving around a curve on Humer Street, Cumberland County, at an excessively high rate of speed. 4, As a result, the vehicle flipped and rolled-over an undetermined number oftimes, 5, As a direct and proximate result of this accident, Jake presented to the Emergency Room of Holy Spirit Hospital and was diagnosed with a "sawtooth" fracture ofthe mid to distal shaft of the right clavicle, a possible A-Cjoint separation of the right shoulder, as well as a right scapular abrasion, (See Holy Spirit Hospital Records attached hereto as Exhibit "A"). 6, In addition, Jake's treating physician at Holy Spirit Hospital indicated that he may also have suffered a closed-head injury: therefore, upon discharge, Jake was given "head injury precaution" instructions and ordered to follow-up with the Orthopedic Institute of Pennsylvania for treatment of a shoulder and clavicle injury. 7, As instructed, Jake presented to the Orthopedic Institute of Pennsylvania and commenced treatment with Dr. Hallock, (See OIP Records attached hereto as Exhibit "E"), 8. Dr. Hallock confirmed that Jake suffered from a displaced clavicle fracture and ordered that)ake remain in a figure.of-eight immobilizer and not move his right arm for the next four weeks, 9, Approximately one month later, Dr. Hallock ordered shoulder exercises to rehabilitate Jake's right arm, - ~-. ,-,;",,;;:-~ 'I~";-' " '_n____ ,~--- "~.' - '. --'.;--. ~" ',Co -'k:,: i j . , ( " 10, Approximately one month after the exercises were prescribed, Dr. Hallock discharged jake from his care, but not without ordering a final x-ray that revealed jake's right arm had been "mildly shortened" as a result ofthe fracture, 11, During the rehabilitation time, jake Ulrich lost two months of work due to the injury. 12, jake was employed by Giant Food Stores earning approximately $300.00 per week, As evidenced by the attached employment record, he was unable to work during the months of October and November 1998; therefore, jake incurred $2,400,00 in lost wages as a direct and proximate result of his injuries, (See Employment Record attached hereto as Exhibit "C"), 13, On or about, September 22,2000, R,j. Marzella & Associates, p,c. filed a Writ of Summons on behalf of jake Ulrich to recover damages, 14, Thereafter, on or about September 25, 2000, this Honorable Court ordered All-State Insurance Company (the driver's insurance carrier) to pay its policy limits of $50,000 into escrow held by the Prothonotary of Cumberland County pending further order of distribution, J - - ,. ~'" - ,~ j '( , , WHEREFORE, Defendant, jake Ulrich, respectfully requests this Honorable Court issue a Rule upon Defendants to Show Cause as to why jake Ulrich is not entitled to $25,000,00 to be dispersed at the time of Defendant McCloskey's damage distribution, R, J. Marzella & Associates, p,c. By: rsar,jr., ir Attorney Identification No. 86072 Dated: rth ( (0, 2002 II II -- " '_""L; ,.-1,. ., ~- . - ') , .{ Exhibit "A" - ~ co, , - ~ ,,~ 111='0 trA~ 09/]6/1'8....---. " 00' 13 ....... ,.,Qj y t;~1I ~ ,,0$P1- AI..?'" .AMI' HIl,., ~~.~~I,.V~ L1 C::l>1t!Kl\I!IIit<lCV Fl:.\RM , .' " "..,. -. 1 2t'123'31 2- I':R 'If ~715~, " NAI'Il:-1 ADlJW'$:ii' ,-i.l'< :"(1)1'1 rr:1 i"M1-'1.C')V::'R: ADDil.:$S' t .1l.J~{(,." C.UMI'lb.l'< f: t"ATlF'NT itllFOf<~TJ_ON , ,,-' l!fA_~"-""'" _ 7. If-NOl.A l~f-.;' .M:.. . ' ."...; .; ". H3 SeX: M ~I$; 'S . . 1 '. . ,. .... nCCiJPATfOtli' ICAMP HIL~ IPA~;QIJ CA7hQUC-GQOD SkFPHE'kD AMlilJ fl:i.'*P. " lJI.tH CJo; ..J~ C' .- 1 0 1 ~FPf'\- R AlIF O~/OJJlgeO AGt!: GIAN1 ~OOD STOHF~ NAME. AtJTll-le-S$1 .;Mt-~NCY u.,_..~ ~'h , I"IAAY AIIIi'< ) 01 }-'t-. '~PF.k AV>- ~ONTACT IN~O~~Tr.~ .. JIIQMli R"'L TO PH M "1, '!!!'\.,M._ Ie-NOlA JPA/I10?5 MK., 71Z-~~Z7~ NAM~: AO[)!-(...5S' I RF.l.. TO pn I I WClIiIK PH .' PH :jf;;: AOMa~, 1 tIO<I+S A r fl\1l) UHI '80018 Rf+l-K OR; AD/'Irr ox. GOMl '(..f.I J I~TI MVA Al"ill Elt.n iN ,WI CUM"'It::N r; CAse: lNF~ATlON. l-Jl ~ H'CG ~F-; F.Cl ,....r liJ'll TVt.'f, I I'" ~. <:l.,IUidJ..l..., .\ HOS,'~) ~'iI FIl\l~.J~- ~Sl T' "'~\~~ \/lSn tOL-Il\llC li,':0Il1i' ECU RQW_,.. 1CD-9 OXI ~ Blo<T IN BY: BW:OThi:f\; ACClm-:lIlt lfJolt-Ot</'lATID\!!. {JAili!.l'i,IME: 09nM98 :13:00 AQ; iNn# 'r. ' ...JaB ~T....D= ~ lIt-:ftCl-lll'"" !Ollll l-Il-$Tr~INF'l) I"ASi&lI"r-IGI-H I.~TIQNJ~ , >-'I.AN OI'JN~"~ !NFOI<l'llI\'U~"",:L ,lACOII \J1.l'UCn ....r RJI- Ta..~ S ~..' 19~-~Jiff7... lOt I-'t-p~ AYI- ;r./IlOt.A J'Pij(.~1* il'J-f..".. 7.J.l-~"'~ Co!AIIl'{ F(~P SNflE$ CONTACT ~I . ~ I II pH.', INSU~ I.":i')~A710N I.: !"OR 1"000IC'I . .~ ~ . RF:.L PI: Vi"Y CARD ;:>~T I AllTh" ~!IIiiiIIF~ 1 f; Y ,\, q I ~~ ~='~ e.etb I t~crs ~~ hlAl'll:t ATlJJKH,~ I '~I"""l.CYH:H ADn~t SSI 11'l&~J- co ~!lllER i'\l:l1 AlJTO 7~l"' 1/0 UI H ..I..l' ,.)IIl(.OCl C !N":iUH.AOOR~l>'3l .' ;N'3UH. AD[\lo(l:~SI ~l J I~~H. ADDRI::.S~' 4 .. I NhlJH. AlmRI:: ',.$1 .. q.3sq.. . 2Cf2;qo , OMM" NISI I MO-OO'4l Hrn"E p ~ dA'> NO 21'10 .NS ,'OfNi:;) AUTO If.if. ~ AI/AlL" .. .' 1"1'1-. ,,'Ni I\lA"l11 rl',~11 ~ Q . I li.=II HV I ul..K1CH ,....~oa C ,\-.__- 1-"*1 , 1;:5233:1,..: /'lfUtl 17'5825 ":"'HlJE:. ~DnE:O svl____..&_J.:..~.tlATil_ ___ I::.NO or: DOCl.'MIi!.I\oT I . .. ""' ... ~ fd:'i.1e,:~ ~ . . , . ~ ....- - ....... .... --. , . , " CONIIIlN'J' 1'0 ~"I. ..........- . l""relly~....~lIDIy$pintHfll!ll!al......,lIIId~ "'","I .. :t.ot~-, ~___.......... ~. .....I@l..........:iIJIid......... l~. '.. ....... ...~.,~..r~.'..I.':I.:.' ~.CiOl~......J,. '...~~\O -.' Ilj:),.hl.- "'-':'it. "'. It.: .'l t.I-","" -~c>r~QI~t'fIJ:<n~..,_IIO'. , ~wlU..~IIpOtJ""1inlDq<<....I.!..an~~ ~~~1Clil'~~.~Jllr..", ~1~~mf~~lIIltl~~. . RIllaII.f1"~.".\Il~"" to. ....'_. _. ,Jlll!IID. ' ~pm..' ~~... ........,""'....~.... . I w...IOI"__ lIIIl'..._....~,... ~ ":~. .~.tllII......... alld_D1I~tbiI.~~. ~lIIId,......,.._...__IID4_......._'h ,,'ljlli"_itwtItwnab<>f IJVUry or..... dellda Gd ~ GIlt ~,par_ hta beeo mw '" n>>..1I> IIIe HIlIdU ofDy _............ ~~ in tIlIIlIoopItllI I~ 1IIII\l' of""':~..lIIe~<lf1lo1ybitHn.pntl_IOI~......-ofdle..... b\1l1llllbet...lr~COIl!>""." wlloloa,v~,IIHn.'... ~die.pn.vdeo...~ofui1.~.t"".. D.~fIdfiWs. . fur................ of~ FIirtIMt,r..... '.I!di.' SlIIIId..aflllldlina; Il<>spIW lIIId . illIo &spnal-1iI!Ii\!II ~ " ... In_gwho, UDICllUIllri80Il requ ~, _ pIIliIqpllleior""" \0 p/taIIDldurini my care ..pan ot tboor' ' ." .....~ plC1llm and olO~1 -.. mlJllilnrinJ /11 palioIn e.... _ 1Ilai>!No "'""" lOt edui:aUomd purpoaes dio I. sly , '\ 7 , "1 '-. , " - Co v lIdar1ol111up Date L -', I L To PoIint 1- Holy s,.,.HoipUal to "'......to heoIlh......... __S), 1iIoJr I'qIRlIIllIIIIIlIIId.-n,lIIId any ~ IIIIIIth cen: provuIon, >llllhdlllgnosbClIIId~I8I~~( lIIIl'blfo..-......lOh~fIJt~arlllldl'oi~-pf~ ' .. may "" """'-Y Ioi'tlIetlo ~'llOiiiiSl'___., '" ~...,.,..... fut health <are ..rv.... pnrvidod dUn.. ' ~ .... fut ~ ~ A jli!oIDel1ili. or cirI10n copy of 1Ius autbon.aboD ,hall lie ~.. "'bYe alid VIllll.. tho 1lfIIIUI TIlo 1IIJdao.ped .....audoonzio t.fodIaano, when apphCable, 1<1 _ to _ l11SUr1lll<O camer, IljlOn requell. llleG1l:lIIlIlfomlalaoll DCli>dIe<I to IIIIb JIll)'1lIllDI """n thai cIalm I ullder_ and _. thai ~...r,of any ~~ ~ b: my phYSICIan dImJla 1he course of IllY sursery/procedure may be provided WIIh my Illetm ~ ""'VvV WelWlllilled "" Fedonll1.aw ~ S~\_(V ~=p INSURANCE ASSIGNMENT I alllbDrize ~ duooIly to roo of all boaDtlIa~ ullIIer my _ pol..... I uado.~ 1 am telIpOllOllaIo to 1he ~ for all oIIatges IlOt tIIiI ot'lllis..... plIlIIdl Re'--.p ~ To Pmant TO . .. PA OP S TO l'ROVIDBas, PHYSICIANS AND l'ATIIlNT I........ ~of AaliIaI_ ModlI:ue '. to 1110 or onm:y bobalffor illY........ f\InusbIid... by 0"" Holy SpIt\t IlOf!l!IlIiI UI . 1"'ll~ _ IIlIlIllar8e aoy IlnIder oflllOCllcollllld DI!lor Ulfo_ 8l>out mo, \rJ re/ouCd to MOdIWe aud ItS.........., loibmloildn ""'"""" to tboae benoIta fut relaled ........ DATE SIONATURE HOSPITAL BIlHEFITSIPART AJIIl'P DATE CAL 'A DATa L :Ai My""",""", cortdiea thai I ""'.."'" a ........ or_ fto;m Hi>IY Spa H\1spaIIllllld Dr OIl the cIaIe b*I boIow IIIIlIIetIIaIaI thill ~for 1bla _ or IIoalWIIIlllo....P<dliIIII_Sllle1inids, _1llai 8If'J lilIIe....... _. ordoeumonls, or-.".,""'"": of 1IllIfAlna1_ 1>0 protICltUllld \lIIUr _~. hdonl_ SIIIe ~ I have n:ad .... agree W1lh die lIiIcWe _ DATE, 1AlJilll1.T $lQNA1'UJQI, Tlus .. to conIfy tholl, , a ...- lit lIal)r Spml Heapdal. ... ........ 1he ho.,.w ...- 1he lIdvIce of Dr _ 1he .........H_ I bay. _ Joiomlod of 1he rak lavolved lIIId bInl>y ~ 1he pb)'$IC'UI ao4 1he 1IoapalIl 6-om all ~ Illd l8pIllIIbdrty :JlONATlJRll WITNIlSS. N 1'0 P 11ENT E. PORM~ Dacr: (.. 'itw- ~ CONSBN'l' FOIl TIlIlA'TMENTIREU!.ASE OF lNFOllMll1fON INSURANCE A.SSIGNMENT .~_... .. , .' I" ,ll.tO' t ,', ,\,.~t~ ut 1''' ., f L' 7SZ-t7't5 , " '/1""~7 to GROIIP , ,b - ,,>Z "'1\ . . ,., JAiC. : I~l >I"~ 'ill ,- l7U1S HOLY SPIIlfl' HOSPITAL, CAMP BIlLL, PA ~--- CHART COPY MEDUC ~8n (11115) - . '" " ) , "~ d'_'_ " " ADM. DATE: 119/16/98 CC MVA. HP I This is an lll-year-old restrained passenler who was In the back seat of a ear that rolled over. The patJent ambulaUd hatH after thil ""ot and .... brought.n by blS brother after he was eomplamillll of rilbt sholllder pam, The patient denied dnnking aleohol to the nnrse but wben I eonfronted him I .melled aleollol on bls brutlland be did state be had two beers today. He deDles loss of 00_'" He did have blood on his hanlls ....t be states t....t tbat was not Ins, It wa. his fr.end's. MEDICATIONS None. PMH None. ALLERGIES None. ROS Conltitlltlonal: No ..e'8llt Iou, weillbt lIalll, fever, or ebllls, Eyes: No v",on Jo.., eye pal., double v........ paueoma, or eataraets. ENT: No vision loss, earaohe, dIZZIness, nOBebleeds, sinus trouble, or sore tbroot. Cardlovaseulllr: No elleat pam, palpitations, ....lbnll of feet, or beart murmur. Respiratory: No eougb, sputam produetlon, wheezi.., or eoaghiBlI up blood. Gastrolntestmal: No nau..... vom,ting, dlarrbea, constipatIOn, abdomiDal pain, or reelal bleedmg. Gen.tourinary: No blood In orine, palnfol Dnnatlnn, or frequent urinatIOn. Museuloskeletal. Complains of ngbt sboulder pain, PlfIYSICAL EXAMINATION VIlId Sipf ,~ril.wW" ...-'........ T_p 97.... pBIae... ._~L 111...16, lIIood p" J .to 12ll'62. CONS'll'lTUTIONAL: In general, th.. IS an lll-year-old male who appears to be .n no acute dutross. He does smell of aloobol. He IS eooperative and plellSllllt. EYJ:S: WIthout nystagmus, OtherwISe normal. ENT: Ears. Tympanao membranea witbout perforation, lDJeetillll, or bulgmll- Without bemotympanum Moutb: Lips, teeth, and gums normal. Throat: Orop....ryn. WIthout .....ons or esodate. AIrway patent. Nose: Nasal mUeDsa normal. Smu.... No SInus tenderness. NECK: Witbout midline teuderaess to palpation. He bad foil ranee of motion. LUNGS: Normal respiratory effort. Breath sonnd. equal. No rales, rboRell!, or wheezes. CARDIAC: Regular rate and rhythm w.thoul murmurs, o<:topy, rubs, or gallops. No pedal edema. Page 1 HOLY SPIlllT HOSPITAL CIlInp HIli, PA 17011 NAME. ULRICH, JACOB MR#: 175825 ROOM #: ECU DR.: Rowndo, EItIDOitNCY /lOOM. ~T . .- ~- ... -"-" ~. , - " GIIADDOUN: Soft, non-lender, normal bowel.onn"', no 81...... No hepntospleno81egaly. SKIN, Wllh abn'lon noted to the nabt lateral allJllltt of the sholllder over tbe repon of the seapula. He had dimlnushed .honlder range of motion obo"e the bea'" He hod elovleulor sweillag IUId lendel1leS5 noled over the antenor aspect or the clavlde "' well a. toademess with palpation over the anterlOr aspoet of tlte .hOlllder. He bod Intad exillary median, radial llnd ulnar motor aDd ....auon to the right upper extrelDity, DIAGNOSTIC PLAN: Tb,. is an lS-year-old male who omells of llleohol and presents 10 lb. EmergODcy Departmenlstatus poot MV A eomplamlDg of rlllht shonlder pain. On ellam, he bd probable .vidence of a clavIcle fraetore I will he obtainill& rIght ."wlder ud clavicle IiIm. and aI80 C-.p1ne IiIms beea... he does smell of alcoboL I bv. also ord.red a blood akolloll...e'. W. WIll be hydrallnll hIm with oormal sa6ne solunon and observIng bim I. the Em.rgency Department until sober and be doing a repeat and serial exam.. C-spme lIImo Were obtaIned altltaugb the patIent had na camplalnh of neel< paIn beeause of tbe aloollal on board, DIAGNOSTIC RESULTS: Serum alcahall...el 0.15. C-spllle films showed na san tllS"" _RIIlIl' no bony abnormabties and no malallgnment. Shoulder x-ray. and elavlc:le film. showed a rIgbt daneJe fracture. MEDICAL DECISION MAKING: ThIS IS .0 lS-year-old male wba presents to the Emergenty Department .melbng af alcabol and Involved In an MV A. On physIcal exam, be IS complalninll of sboulder paIn and had evldeo.., of a elavlcl. fradure tbat WlIS eanflrmed by x-rllY, Neck films were o"laln"" evOD tbough the patient waSD't compla.nmg of neck pain. because of akOOal on board. Tbe patient was bydrated WIth normal saboe solullan and reevaluated when his blood oleohollevel was les. than tOO. Upon repeat exam x 1, the first of wbleh was done after he returned from x-ray ....d the .econd or wIlleh was done wben h.. bloDd aleoholl..v..1 was I... tban 100, he Just cant,uDed to CDmpJaIn of claVIcle pam and he ...d swelling noted m that area add on repeal exam of the deck he had no m.dl1l1e tenderness to palpabon, He had fnll neck ranI!" of motIOn. He had full neurovascular IOtegrlty in both upper extremities I reel the pabeot's symptoms today are secondary to a claVIcle lracture. He WIll be diseharged to the care 01 hIS bratber. He will have bead injUry precautIons DIAGNOSIS: 1) Rl&l1t ClaVICle lraetlll'<l, statu. post MV A. 1) Alcoholllltox",atJon, 3) Rtiht scapular abraSIOn. DISCIlIARGE INSTRUCfIONS: I) Follow up with OIP nellt week for follow up. 1) RetUrD WIth any sbould.. pam, neck pain ar beHy pa.n. 3) lee tn the cla"lele 10 mlnntes ...ery 2 baurs for the next 1 days. 4) Clavlele strap at all time. neept bedtime, S) Head injury preeantJons. Page 2 HOLY SPl1llT HOSPITAL C""'P Hili, 1'A 171111 NAME: ULRICH, JACOB MJlJI: 175835 ROOM #: ECU DR.: RotDlUlo, ~GiiNcYMJOM .uollT . ~ ~ " NRlln 0: 091Z6I1998 T: 091Z6I1998 886S HOLY SP1ll1T HOSPITAL Camp Hiff, PA f7011 EMUGBNCY ROOJIllBPOllT . Page 3 NAME: ULRICH, JACOB MRtk 175825 ROOM#: EClJ DR . Rotmrdo, ~ Noelle Rotondo, D.O. - " ~ - -. ~~ l.~" .Jtlljf~. 09/26/98 _.)LY SJ'IRI~ BOSPn'AL. C.AIIP Bn.x.. . 17011 PAQII 1 ll1lJI '.l'DIB . 0121 tlIIPJ.It........ O. r.aaoJI&S'OllY Mml:tCDIII S'1'd..wmmr S.P. SIQIaJlOIS ..l)" l):tRBC'1'OR LOC&'1':EOII _t 11t.lU<lK...l'NXlB e *Iftlj, 111M AlIt_ DIr. aD~ ~t, <l0<f.01*3JU llIIaLtt, 17SS:Ui ...... we tdlCIl.""", Il;:U IlOC'1' .... U/:261" ~. Spec #. 0926 LOO156S ColI, 09/2619:~Statu8' COMP Req # 00952774 Reed, 09/26/98- 6 Sub Dr' EO GROuP Ordered JU,CO C01lll\\E!nta, ROOM 7 '1'ell.t 'ReII.11lt i'lliaa ~ ~ SDIlIl l\LOOIIQL I Q.j,1I I H O.04~O,OO ~ COLLIi'C'l'BD BY S ~-=.IW BY l\IR GAISKI 2o/f-t<:> l'So' 130 Ito >/00 01,;;,0 C;l~...:> 0"300 l:7<-1m ....-...-.~ ~ - -"'--~-~ ....-~.~--.....---- - --_I ..... . .~ ~ - '=' " , CH""ae NUR.Se moo HAMe , , DEPARTMENT OF RADJm.OGY HOU SPIRJT HOSPITAL -r:: II IJ PRELIMINARY X-RAY 1NT8I_ RET ATION -M.G~~ ~(^ 5J.17AGE I~ g~~ ' C1.~ - RADIOLOGIST FINDINGS. LOCATION EC .k - , , ': G '\h \ - Oste - iii ... ~e'5uttSf"" .- I; Ii I, I f> " I,: DATE CD/HOUSE PHYSICIAN FINDINGS' S~ CP (jCW\~ le.- ~ ~c1.- ,h (\G\O\~~ A- ~~?sfJt fl--~ ~ ~ , i~ I: I,' ED/HOUSE PHYSICIAN RADIOLOGIST ~~ FORM :-n AAOIEC ED CHART COPY -.. ----_..------- ------ -.........' .- .. ~ ~ -.--,.--' 'iF - . ~ - . " IDLY SPDl'1' lIlIPIDL ~ W ~ .. Dlnlllhe;rAC DfAImIG CMIP BILL. PllliJ>.!lboVAllIA 17011 (n.1) 16)..26041 PAfiEMfl ULRIaI. JAaIB C .. 175825 sac SIlCI 192-66-5277 0Ill) t8. 1 ED GlQJP, PI nPEl E ADl'I DIl'l't 09/26/1998 12113M LOCATION ECll DICfA'IUII Dd'E1 9/26/98 to.34M 'lIWlB 'brx...OII mIlE 09/2611998 10158A11 AIIUVa. DIlft:t JIC8> IlEllYICE. ECU EXAlUtIA'l'IOIh CERVICAL SPINE (5v) COlIlEN1'llt l..8teral awi_r's, oblique. AP and odontoid pnljectillllll do not show ~ fracture or Mleli9lllN\.l of the cervical vertebra or facet jOintll. I do not see 6iISC space nanowtng or bJ....'tIO(ll!.lC degenerative changes. There lI1"e no cervical ribs. 'ftle at.lantoaxla1 IIrtlculatlon ill sYlBetrical. CONa..USIONI NorII8l cervical spine. T"~"'n ~\,l-1 , wad by ~M.D.ID.o. DIC'tA'11J) B1't DATE OF I!:XAlh ~ II.D.~dg C!9126/1998 ~------- - - - .- ,~O"'~ - " - -. L. o~ - , HtU 8>I8I'l' BDlPIW. .M'l11lHI <S' ~ JIll) DUGlIOH1c I1WmIG CAlC> aUo, PllIUII..'1AlUA 17011 (71"1)163--2600 PA'l'IaIl'. utRIaI, JAfDI C .. 175825 sac ., 192-66-5277 ORD 1Jt. I ED GROUP. P'l' T!FI: 1 E ADII DAft 09126/1998 12,UM LOCATIC* ECU D1ClAT.tClIt DMEI 9/26198 10,3_ m.WtmMICIf DMZ 09i26/1998 lllQOM 1IIlIUVAt. IJIm:I IIOIP IIR'IlCEI E:CII &:XAIIDlAt'Iaf1 RIGHT SRO'lI( -OER (3v I COIfIlDITS I There 1s a fracture of the eld to dllJta1 ellaf't of the d\lht clavide. 'nle AC joint eppe~1I "idened as well. 'l1w sIloo1dft joint, ~rus and e'~.ep..la ,,~ to be intBct 8S do the subjacent ribs. CONa..USXOJb Mo.tlllll right IIbouJ.der but there is fncture of the .id to distal sMft of the right clavicle and there _y be At joint separation. DXC'l'A'JED ID'I DIlTE (If' ElrM 1 ~.~ 09/26/1998 ~::~I;;:,~dl ~~_ 1!-MJUO 0 1I.o./dg ~----_..-...- -- -- ------------- ----- ,-, ~._' w,,1b ,: j =..... 'r! - -. ~, ,- -, " IIlX.t &PlIII!' lIOQ>IftL llfJI....u...ft CF IIAIJIeLOG.J III) MJl.RllI8'l'lC IlIAGING CMP IIU.L, I'IlIB'!I.VNI1A 17011 (71'7~ __J-2600 Pr.'nDl'l'1 tIUl%QI, JACOB C lib 175825 SOC SEeI 192-66-5277 ORD DR.. ED GROOP f Pi' 'nPE1 E AIIII ~. 09/26/1998 12.13A1l LOCA'lICft ECU DICI'M"ICIf OIlS. 9/261'J8 10.35A11 'l'Il'1MaI&n..GI OIl. 09/26/1998 I1t02A1l AIlRIVllt. ra21h HOiIP ~a:1 ECU EIMIIIATllQlh RIGHT aAVIaE (2v) COIttli1fTlh 'ltlere it an oblique -NWtootb- fracture of the .id to distal shaft of the right clavicle. 'ftHIre i. only.InIMl ~1"" offset of the distal frllllllnt and there i5 no slgnif1CSlt 8IllIUlation or overriding. CONa.USloth Fracture of the !lid to dIstal shaft of the right clavicle as described above. r '/Pwad~:~ =--lM 0 , DlcrA1m IlY I DIl.M OF EXAlh ct~ It.D./d9 09/26/1998 - ~ ~ ~-, .-""... ..,,,,,,- -- -. " MISCELLAN:EOUS o Telephone Messages o Telephone Orders o Other o PhysIcian's Advice o PharmacylRX Flecallll$ ,... .. i:''\P ...' . -.-~I, ".t.-- .~'i.:.. ,eP98 II MON HR - -92 A~ . )~ , I I I I I I~' !::: Ii'" I, : I' 'I I t fI. ' I' )1 .- '~V~Ji/\'--'~r~~~'-iy/\/~/~I- ? Nlee- Nt) F . ~ INGS mmHq 1 i:,-:' ~..:. ~iJ. rft'"7 :11;' ]11," ~ r I , ':~;;'~.I.r1.' J~l !~"'~.1;~ '~~~.1 I " ~2':';.''''V ,,:;# r "I""'. I' . t., fJ, . ,1_;. .. ...'!1..... " ',,:~ , ' 1;;'.,/'.1; ,,,,,,,"t:' ,", "'iTf. riJ ;,.,.. 'f.;~,.V! ~/I'J' ~ t"~ i' . d;';~, ,-J", "'~ ,;u;". ~~ "~:;i ,~1'{':1>;. " i', ..J ~,. ., i~. "~''''l,. ~ ;.... . r~'" ,'. t'~ t'J"J~lf~1 ... (.~ ,.1) ). l~'... 'fl' . l',..- ~~~. J., .. ~1,,J '.-z " ,'.".,....,,'t' .""":.J~:r:t. ~t'J .t w j 'L . r.v. ~ ~1J~ ..; '.~'~ ,;,J" - - ""i/~"i5~t ~ J~.. J. f4"~~.t . (I ,,,"), 'Ji~:ll "; "~I"'. ,"J' ~r >: . ~,.", ".' " .' ~I, :AJ " * / I!'. J ~"lJlJ~~ I: !. ~.;/j1"'''' ~ .'r, ~". "1."0"'_' 'J - hi , : 'fir p~(,' ,.~,..., .'.: ,. . .' , . ~ j , I, 1 I, r II) II pl..n4 tilt. lfta'Rlm 1I'J "tn. arrow.. PoaIU... _rt......1O lop "'" ... guIdo 1111II, IDHnC 11I1 _rt _ ~I' 11Io ..po.... I hill.. Th. adh..lve II prestJul.-,enslt,vfI De .~r... to "". tH repgrt Dnr tb. two adhnlve .,... Pr... IIghtfy t" flttlch tempof'lU'lty Pteu f"mly ID atYch I_fafy MId p__y , '7 , - J ':. II ~ "!" ,', :- I ' ,~f, r- (0' I' \vt _::>\~Je ,~L,~"'"'\I\~,::~ ,J~,~,,~~ ~ - ----- ~ ~ - --~-- "'tl> .. .. .. .. .. .. .. .............. . " '. InlllallaIIA ~Ordln: I..I1I>>IUlllwS~.. IJ~""",,"n {]_ ~ IIGI- I J~_ I IHC<lB r J APTT I J liver I I_Culturo8 Prelile { ] cae ]Lyt.. I 1 CIQ,IB ]I'TP I I CPRO I Renol I J CRP1 Profile I ]O~n ]QuNdno I ] DRnIln I BoIlcytOlO ~ I I~r Sones I IAnkle A L ()d'~ ~ L f )' C... 81>"'" La\O'" \Xeorv._- I ] Chell A.. I Pon I TPA { JEIOOw A L [I- I I...... A L I ] Plnger A L ( lFoot A L IIForoorm A L I IHIInd A L I jH1p A L I I Humonlo A L I IKnoe A L 110llIer I Sen.m_ J ThoophyiIlno I ~rotd Proll. I TOI< Bc,.... I TI'A Lalla I 1\'1'0 & C_-J 01 ..... 11\'",,&- lU/A lUnneC&S lWaokmon"CompCIIIII_' ]0""" IKUS 1 US SpIno IMondIbIo JNo"'" 10... A L ] PoIwI I Pyologlam IVP [ 1- A L p<t_ ~ L I ISkull I ISlomum I ]TlSpIne I ]T1bIFob A L 1)T00 A L I JWlIot A L "1'1nwLICRTllnt o~ ~, ~ ri.t"\,_ ==, TI_Seen: CMIItJt: I lMonI..r I I El<<lpoged It I ]02 LM. [ I 02 _..... -1jI/IatcIty I I AB<l'. ~agod ot I J POak _ _roIAlletAoep r. I ]A_....ryTl< ll'allh,.'ona I IV'al AddItIonal Oldtq Time !,DIIW1'_ ~. .. ,:lIN8 at~ur. 0blIdn old ..-nla. fII*:-' ""-., WiD: _. 1- 10__ I~' lPelvlc ~dltuwa ] eota S1raP I>G I Cu""", I CeMCaI I CIliomydla ] GCCu""," ICT Scan'" I va Scan J Olhet SIIHng cta..llIcetI!ln: I I~l ( lFoIIow~ I 1'9'11 I I Case I ivK-11II r I LowlIV I ]ImeIV TlR'fItICRTIlnI llipublmC&B ISlcolC&8 I_O&P I 5tool C iJlfflclle ]WoundC&S ~ 11-1 I ] M_1t N..,-Emergency Inlt"'''': Inltlala: InitIlIl.: Inlllala: SIgnlltu..: S\fInIdu": S1gnatu..: Slgn.tu..: fiN AM RN AN S1gn8Cu..: Dete: ~ MDlDO Holy SpIrit HoepIteI Ollmp Hili, PA Smel'gtlncy C_ Unit Pl1yelclan Order Sheet 206-EOU REV 8198 JO SA Me CHART COPY '. , 1 ') '~" '::!.., 1;:: "It I', I r', . J I ~ 0 8 '; r I 'f ."f? HE f l ~ 175825 E ( '-II " I' \ . .f ~ I.. 1 J 1 He \ \ '). ~ 1.1. ECIl I'l 17025 73(- 2 7'15 {" GROUP M~I I I --~- ~ -- ~- .- - -~.._--_.....~- " bate: 7~"",,"'~ Name: u.. D ~ Age: FMD of:Anwal . [ ] r', .' . J $LS [~dical mmand CHlEfCOMPLAlHT: INiffAttFllAGE: ~ -I '"'. '- Log-In Tune' <:> Triage Time . rome to Exam Aopnl 10 ,/ <a /0 P_lnjury _.,rod, [ J Home [ ] IndUSlry RecreatIOn I 1 0Iher /nfomllllon_nllClfrOm __nl_FamllylSO _Raco,do -EMTlParemed'c ~ Ti~ __IV "'ol.a""n TrIogl1C1 to _logy far Deformity Yes I No Skin T.mp Warm I Cool 01.' P\ll8M Present I Absent ~tlnBtIon [] ECU [ ] eOF Skin COlor Pmk I Cyal101lC I Motlled P8m (1~10) P..lllheaia Present I Ab&ent Time Inltruntl:gn ..re Temp: AeaplretlOl15: SIP: · ~ Pul'" Ox. : AI/ergl /_0_" ^ ~~~ LaotTetanuo _ Acuity OD LMP OS WeIght _OC8lo/eotJlnOle (If pertlnontl OU _a Subjec:tl :i- , o I II- PrehOOpltol Treatmonl Last Past MedlcallSul'lIlcal History: ~,/ ~ Dolle Has pabent had e>:paoure to meeoles, chlCl<enpox or Ta In pa.' mORIn' _ Are In.... adva..... <lI''''''''''.' ,. copy _, NlJHIND;DI~ ~ureoul9 _ cartll8C Output. alteratIOn m _Impl'tlwment In cardiac outpuI demonstrated by Improved vs ;Q1d dla.gnostlC I.8st5 -""Comfort alter'aMn In _ Oecl'9ase or rabet of dJecomfort Auld VQlume, alterabcnln ---c.../mprOYGmllnlln fftlll:1 vol demonstrated by decrease In symplom& of fh.lIQ vol Imbalance Il11plllred 98' eJtchangt _ Impl'O'led ga8 excharige demon&ttated by ImPf')YBd OXVQBnabon and vl1a1 SIgns Potenllar/AC!UallnfacllOl1 _ Decr&iitse In symptoms tndICa!1rt9 InfaQllon or poten1JaI tor lmeCIJon .' Knowledge Oeficlt ImpJOYl3d knOwledge demonBtrat8d by verbab;auonJ relurn demonstration AsseSllment compleled Data obtallllld by: .... by R.N M.A AdmlSSlOn Called Report Called OlSpOO ] Discharge [ ] AdmlnJon [ l Observation Adrmtted to at A OR charge InstrucllOns H<>ly Spirit Hospital Camp Hili, PA EeU Nursing ,~ssessment 201 ECU 5/97 8th AeII JO MO BR >( i' ~ ~ . f L' '/1-1 --')')1 ':' Joe ) ">/11 , , CHART COPY by J ur (tv pj 17fl5 n2~lH5 l e ao JP J!q ,- . "....;: '. 411 J J .ant. Vllal Signs Mcnrtor PhYSICian Assessment 02 SaturatIOn Lung Assessmen1 V,suol Acuity ~ EKG Labs PCXRIPort c.spmo Sont to Rsd,ology Returnod from RadIology Prue......... RespIratory Treatment leo Faley Insertion NG InlSertlon Wound Care SohntlOCUSllnolCrutc/1es -.-. Pam Scale (0.101 Lsval of Consciousness SldsJ'81ls Intake & Output Patient E<:iucatlon Info Other -- - -, R- -, TltIW: ..~.. '- ~ ^VlI(" .......... . ~ . . ..;'" ': ,'0, ,:"" ",_, ,_ ..,. '" . ',-' . ~ , JA..oI.A 4oIl-o .~+ ~ 4If-o .....- ~.J IJ/,- T~~~.,....,..........., ,d..,...."...,'.,. ~.....,' .,..' ,......,... '. 11111.: , r'\ . ~ I 'G;;' ...... " ,- , ' -: ,~!, ~ , " .c- ~ ,I - : -- ", ,y ...!!/...,.,R C .~ ' .. J .A... "') '" ...,... . ,.. AAJf" A..I ~_ ~ /' . __ ~ . ' /.~. ~." f' c)A:' / L. "--./'_ I '" IV Therapy D 0 Imlral SIgn lnilral Slgnalure Initial SIgnal Imtlsl Slgnaturo Calhon.. Rale Control Sit. Allie Condltlon All. Co"dlllon Cod.. o-No Inflamnon 1.Edema a.PSIn 4.HardnM$ 5-Warmth Rat. Co""" 1-AVI 2.stalM_ ... ~...~. 2A.Erythems 2B.Ecchym.... . ~ - - '"1 - ':- ..~ CO : . \ r 1158 Holy Spirit HOSPital Camp HIli, PA Emergency Patlet'll OOQumenlallon \ c I ECU ~ : 1702 S -\2-21'5 , ' " ~ ,~( . II .., '" J CHART COPY 205 ecu RsVlsed 5IlIB JD. al'l, MD 'r 1I EMERGENCY CARE UNIT (717) 763-2316 - . "" rb$ t:'...an:"'IIti&J lUlU tre.urnent V(IU ltotW R..c.C IVi'd III lhl. EmeT[..'(.tJ\.J' C8e Unll (OCU) hllW: been ~ ()ft 4tl: atrerge~) ~.t only."as~:e Mll.enddd to ~ a ~rute" tar" (JI" an dli:n1 to proVIde 1.~1ete ma:hcaJ <<ore If YOU dt:velop ne.... ~bIetw. Qf <.;..\(nphl.ut("J(\"~l 'J~pb.~~ ~ ~ Unn rou.oW THb \NSTRUCl10NS CHP.CXED BE.U1W ~ .~ t In'ormatJon ,heehl contain Importlnlln~".uoa. to tW.1UW and ... ( ) ConJUnctlVlbs . ~) F.,,~d Fever ( ) l.aceratlon () GOPO () Au (J Ned< Sua," ( ) Corneal abraslorulorslgn boCJy ( ) Fr&c:JIure ( J ND&Bbleed ( ) Croup/bronchllrS ( ) HllJadache ( ) 0tCl& MGclla ( ) Crotch walking ~.ad Il1Iury , ) Pedlatnc Heiild InjuIY ( l 018rmea and VomltlnglP9d Vomrbllg ( 1 Hyperter1Slon ( ) Pedraina URI ( ) Drug/AlcohOl abuM/adl!lcllOl1 ( llmmumzatlonlTetanus { I PIDND ( l Febrile Convulsion ( ) KlCln.y Stonea / . All8h MEDICATIONS ( )Coll1>nUOpmonI__a..ll8pl FAlIflLy IIDtTlU:INI11lll. . 1(717) 763-242<< .iltJilt. ~.u'__ ; s.- _ . -~ " DISCHARGE INSTRUCFIONS ( Padant InIorm_n ( ) AbdomlnaJ paIn ()Alcohol reaction {}Allelg\C r&aet1Orl ( )As1~ma ( ) SlICk pain ( ) Bnes-Hurna(\lMlm8lJln$8CI {)Bum ( l Chesl Pam WOUND CARE ( l May gently waah over wound U\ 2~ haws with ~ and water Ol' parmada 00 not soak In wiler ( ) Change cllWSll'l9 _tImes dally Redress wtth B8:Cttl'8Cln/NeospoM and stems dreSSIng ( ) l<eep wound clean, dty, covered ( ) Tete.nus/t1lpthena Booster glV-6n SPRAINS, STRAINS, IlAUlSES, FRACTURES l) .ilevate the IOJurad pan for_days to reduce swelhng ~pply IC8 packs I~muttently for ...z;.days to reduce sweUW'lg . { } Ace wrap. fOf ~ tor _days i4 Wear'" I a" bm.a untj follOW-up lf~ to:! btift- C''1hCif ) For actIVity as needed ( ) Use sllOQ tar SUPPOR i ) U&e crut<:hes. () A8 needed. welgnt beating as tolerated ( ) At all bmos NO WEll3HT BEARING NECKIIIACK { } Wear c&NlCaI collar fer support 10' _days ( ) Rest, avoid bending, hftJng, strenIJOU8 actMty for _ days ( ) Awly mOJat hll8l for mlnut.. _s daJiy bElglnnll'lg In hours ADDITIONAL INSTRUCllONB ( ) Oft worklschool from ( ) ughl Duly unlll RntnctlOO6 ( ) No gym/aports unbi ( ) F~low Instl"lJdlons on Workmen's Compensatlon Form ( J W$&r eye patch far hours ( ) tf nose bleed recuts, ,nnch l\06e fKmly tOf 5 minutes contrnuously, ratum If bleeding not oontrolled I ) The prB$C1'1bttd an.tbtOtlc may re4UCB '\he ef(ecbll&ness af medlC8hon you are cummtJy taJcU1g Check package 1Mtrut:tl<1M or consult lMlt\ PMr'maoat ( } The Inlerpretabot'l of your X Aays are preliminary reading YOU!" films wI\! be I"@vtewedby a radlolcg18t '(OU -or youf physician will be contacted If 1here IS a. change In the diagnosIs to lU'11~0~ ~ \l. ~;~ =6> C~~i~~ :<'~I il/W) ~~~~~~~O~fl~~db-p ~ t-WlAl..{ tlb-... ~ ~ HOLY SPIlUT HOSPITAL ( )S8Izure \ } Sora ll"oat ( ) Sprllns and Strall'l$ {)1'hreIl\eneclMlSCllmage ( ) Toothache I ) URI and Colds ( l UTI and PyelGnephnbS { lO1her ( ) U.. _I (I~) or Ty\6noI os n_ tor pam ,..... aceorrJ/ng to package InstrudlOl'\e for ags, wetght I ) Us& ltIe folloWIng meOlClnas accoldlng \Q package mSfructJOO8 , ? 3 ( ) The ,D.fJOWing roedJcines ma)' ~U88 drowmess DO NOT DRIVE OR OPERATE MACHINERY WHILE TAKING FOLLOW..uP ThIS IS our recommQndabDn for foDow-up If your lMUrllnCa (HMO) _. a llb'l"lO\8I\ relelral jor spoc\'~ ""naUltalioa, IT IS YOUR RESPONSIBILITY TO OBTAIN THE ~CeSSARYAPPAOVAL ~) Follow-up wl1ti ( ) R.tum \Q nospllal r"1r'O ( ) FllIll'ly Doctor V'l. { ( ) Wor1<N.' . L ,a ~'&-\ \~~.l days tor 9') Follow-up I ) Suture ...._ ( ) Call as soon as posSIble for appollttment ( ) PJck up. your X~R8Y. from the Radiology Departmen1 pntlr to your fo/tow-up appointment Call 763-2896 to hay. films ready t ) See yoU( phystaan or Spec.lakst H net Imprwed In E days )>( Return 10 ECU If you feel )'QUr CondlbOl'l..1S worsenl especIally If ( ) Your bk)Od preS8Ure was elevated Please ve It rechecked by your phYSICIan ( ) Test results have been gJV8n to you TBke them WIth you to the follow-up B;Jpomtrnent rostresulillgMln DCSC DCPRO DEKG DX.RAYCOPY o flf;NAL PRO 0 RECORDS Copy CHART 0 GLUC ...J l-Pll1lENT VERBAUZES UNDERSTANDING I honJby .....MYdadge rocaopt ollllosO rnatrud.... and understand them I understand that I have had emergency lrOll1mont ~ wlltall may be .....aoct boforo all of my J1'I8dtcaj problems are known or treated I will arrange fOr foIlow.up care a!. , have been m~n&cted :......-- SlGNATUM >~ --~'~-r "p ent Ot ~Ie Petscln V'd1J...l -- )\...."""1,/, ,'...<' //_- ./ I,.-,....~ SIGNATURE Pl1ySICl8ll lOot. <- MDIOO N....RN {~ 1J1l.<G. "''''''''1'\ HOLY SPIRIT HOSPITAL EMllRGENCY CARE UNIT SOO NORTH 1lS1' STKEE'f CAMP HILL, PA 17011-1.188 (717) 763.:1316 ( ) Vamlba AbrahlUn. M D 038840l ( ) RobeJ1 Hymek DO OS 004400-1. ( ) Thonw.\ AIdt.1llS. M D OI707"5'E { J Rll.bard Luley. M 0 029960-E ( ) SaI..dtQre Alfano, M 0 02SS02E ( } PflJlhp M.lgum M D OIS06,-c ( ) R~me'lh Arord, M D 016727E t ) L.1wrell(,t,. Paul M D 0l9524-1 ( ) Glen Daug)ltry, D 0 OSOO6'776E ( ) Prolllk PrucaPICI, M D 003643-F I ) Jon Dubm DO 0,> Q06991L ( ) Huw.clro Rudn1_k~ M D 040~62'l OAT[ . _.~. n ~ ~~ ( ) Ranj""" ~hlum.l M D 03126S-E ( J Od.vtd Spuall~r. M D 023502 E ( 1 AJ.m Teph'l M D 0,001 R--E t ) E1.une ThdUner M D O'lIj7101-L nDOWtd Zunmennan M D ~636-E ,. .." H~' ~I ~.b.....- \ , nVl:ll\' ","1oJU11'U ...."'........, ......"OIO:OU \, ,GLGUUl:l'VtfI"__ U\IUO\IIlI' 'I:I'V"" SPRAINS, STRAINS, BRUISES, FRACTURES ~e.t~e InJuted part for_days to redYce swelling yn."pIy \CO """"" IntemI!\lS1I\\y lor ...iO,.ays 10 """'"" ._ { ) ACOl wrap for ~rt for _da,. J4 Woor .. _ 1113 Om.. unOlfollow-up J('/I1O.>t t:l ~_ ~ } "'" acoVlly .. naadad . ( } Use aim; for sUJlIlort { ) Use crutchas () "" neaded, weight baenn; os _d ( ) Al all 0",.. NO WEIGHT BIOARING N!CKlBACK ( ) Wear ceivlCBl collar for support tor _Days ( ) Rest, alfOld bendIng, IlI'tIng, atrenuoua actIYJIy for _ days { ) Apply "",'s! ha.. for mtnutss ..... dally beginning m hcuts ADDITIONAL INSTRUCTIONS ( ) Off worklachool frorn to ( ) lJghl Duly un", RestnctlDllS I l No gymJsporIS un", ( ) Follow Ill$Iruchons on Wort;men 5 Compensalion Form ( ) Wear eye patch for hours ( ) It nose btElad recut&, ptt1cl'\ nose {uml.y 10r 5 minuteS contlnLlblJSly, retum If b1eechng nat controlled ( IT". p__ onr.1>JOttc may _Ihe _ness at mechcatlon you lire currenti)' taktng Check packag~ Jrlstrucbons or eonsu1t with PharmaCIst ( ) The InterptBtabon of your X-Rays 9.1'$ prellrl'llnary rtifldll1g Your hJms wllf be reVl9Wed by a radiOlOgIst You or yoor pnyslOlSn WII\ be _ ~ 1here I. . chango m Ill, dfagM916 tua"l~~ ~~~ C'1K:r.t' (p ~ :@C~~~] -t7/NtJ . fr+; kg~~)~~~~"~~f> ~.u.l {~~, 1J1l.( C. ...-h00f' ""~ ^,,' ;j .....-"...\~.nl\J.._.._..-....... :;lI -t"""--Il'- instructions 1 2 3 ( ) The follOWUlg mecllcmes may causa drOWSln855 DO NOT DfIIVE OR OPERATE MAOHINERY WHILE TAKING FOUOW-uP ThIS 18 our recommandabOn for follow-up If your msuranoe (HMO) requires a phyBtCfan referral for specialty consulta""". IT IS YOUR RESPONSlBlLITY TO OBTAIN THE ~JCFSSARY APPAOVAL ~) Fc!ow-up wl1h ( I IWtum to '-"'" orr' ( ) F....1y Doctor ~ L ()Wor1<N" In ~t 'MiQ doy. fer 0 Faltow-up ( ) Suture removal ( 1 Call as SOM os posSible tor appomb'l19nt ( ) PIcl< up yo'" X.f!ays from !he IWd,oIogy DspaJ1mon' or"" 10 Y(l\.lf follow-up appom1mem Call 763-2696 tD have Mms reody ( ) See your phytlCIl!ln or speclahst If not Improved m / days )>( Return to ECU II Y'?u feel your condttlOn IS worsen"f1l'__ d... \ _",ally, QII'l V"'t'w<M;~ ~)I.W rl;,/' ( ) Your blood Plllssure was ~evated F'lease ve n 1\!C1 J'fl1-1l rechecked by your phy&lcl8l1 -b,..[ 'f ~,.., ( ) T BS1 results have been gwen to you Taite them wrth you to 1h9 follow-up appomtment Testl8SUlts gIVe>1 :lCBO OCPRO OEKG OX,RAY COf'y OE\El!lAL PRO 0 RECORDS COPY CHAFlT 0 GLUe ( ~ VERBALIZES UNDERSTANDING "I henlby acknowledge receipt of these Instructtons and understand 1hem I understand tha1 I have had emergency 1realJnent 2!l!:t and that I may be retea&ed before all of my mechcal problems are 'mown or 1reated I will arrange for tonow.up care as I h~ve been~tecl , 'l-' SIGNATURE~' --~ ' ent or Respo Ie. Person -- , '; '/>.'~ J / -./ '" /,,;..--- ...., ,; 10atb SIGNATURE ~Ys:tclan ~v , MDIDONurseRN HOLY SPDlIT HOSPITAL EMERGENCY CARE UNIT S\l3 NOR.TH 21ST STIllF.ET CAMP HILL, fA 17911-1188 (717) 763-1316 I ) Vanlth.. Abrahollll, M 0 O~8840l ( ) Roher!: Hynu.k no OS 00440(M , ) Thorn.. Aldo.. M 0 0l7075E , '1\1elwd LuI,y.M 0 029960-E { ) Salvatore AlfMo. M 0 02SS02F C ) PbIUlP M.tglllfC M DOl 'i063-F { ~ R.meltb Arora M 0 OHi727F ( ) LDwren~ Pilld M D 019~24-L ( ) Glen D.l.ughtty DO OS006176h ( ) Fr~k ProcOPIO, M D 00164l-E { ) JOB Dubm, 0 0 OS 00699 JL '\. } Howard Rudmck. M 0 040862-1. , PATE 6 / SIGNATURE ( ) RllIlldrlA Sh.lf'lIl:a. M 0 03126S-E { > De.vld Spurner, M D 023502-E l ~ Alan Te-phlo.- M 0 0300l8-E ( ) Elame ThaUner. M D OS7301-L ) Davld Zlmmerman M D 00'i616-E DEA#. REFILL TIMES IN ORDBR FOR A BRAND NAMB PRoOVC'TTO BE DlSPE'~fD THE PRESC'RlBBR MUST HAND WRITE "BRAND NECES"iARY OR 'BRAND JIofEDICA[ I Y NECEsSARY IN TflE::. ~ACE BELOW o LABEL CSUBSTmlTlON PeI<Ml~~IBLF 178(41981 ~ ECU fA ) 7025 '111 71Z-2795 1 ! [:, GROUP UI I ;J:;-)l~ 1;:; MR ;'l ~ Ie', ,J A C 0 8 C 1)1 ~~PPfq AVE f ',ll t. , 1/ )?l1 q ?,' 112- ,1,-';(17 U,'IC~ .JAC if 175825 E " ,..-., OJ.. , r." ;& ~." - h - _ ,_' [_ ." ., , '",";:';,,'. - _~j " Exhibit "8" ..~ r~ _ -..... ~ ........., , ~=~ ~. ~~'i;t~-2j ,. ORTHOPEDIC INSTITUTE OF PENNSYLVANIA \ " (717) 761-5530 Patient: Jacob C, Ulrich DOB: 08/02/80 SSN: 000 00 0000 Chart #: 14814628 Page # 3 ----~------------------------------------------------------------------------- 11/24/1998 RICHARD H. HALLOCK MD !.EVEL TWO RbDIOLOGY RESULTS RIGHT CLAVICLE X-RAY: X-rays show his clavicle fracture has healed. There is some overlapping and some mild shortening. -CONTINUED- ] IMPRESSION: SEE ABOVE STUDY. RIlH/ram 12/01/B98 RICHARD H, HALLOCK MD REQUEST FOR RECORDS office notes copied, billed by HCC and mailed to ALLST~TE PROPERTY CASUALTY CLAIM SERVICE ORGANIZATION. elb ~ II : ~ :~ 1 I I I .1 I " ; :~ Ij i~ \~ ., . . ~~~ " ORTHOPEDIC INSTITUTE OF PENNSYLVANIA (717) 761-5530 " , Patient: Jacob C. Ulrich DOB: 08/02/80 SSN: 000 00 0000 Chart #: 14814628 Page # 2 10/27/1998 RICHARD H, HALLOCK MD LEVEL TWO DIAGNOSTIC TESTS: X-rays of his right clavicle show it is healing excellently. There is excellent callus formation. -CONTINUED- DIAGNOSIS: Healing fracture right clavicle. PLAN: a lot prior He will begin Phase I shoulder exercises. He is unable to work doing of lifting. He will be seen in four weeks for recheck with re-x-ray to returning to work. RHH/jal CC, Cathleen Sangi11o, M.D. RADIOLOGY RESULTS RIGHT CLAVICLE, X-rays of his right clavicle show it is healing excellently. There is excellent callus formation. IMPRESSION, See above study. RHH/jal 11/24/1998 RICHARD H, HALLOCK MD LEVEL TWO Trindle Road Office CHIEF COMPLAINT, He is two months post fracture right clavicle. He still has some soreness there. Overall he1s doing well. REVIEW OF SYSTEMS: The patientts review of systems, past medical history, family history and social history have been re-evaluated and reviewed. PHYSICAL EXAM: Exam today reveals that he has nearly a full active overhead range of motion. He has minimal sensitivity around the fracture site. Neurovascular status of his arm is intact. He has a negative impingement sign in his shoulder. He has no instability in the shoulder. DIAGNOSTIC TESTS, X-rays show his clavicle fracture has healed. some overlapping and some mild shortening. There is DIAGNOSIS: Fracture right clavicle. .' ! PLAN: He will resume activity as tolerated. He will be seen in the office prn. " .~ ~. I I RHH/ram cc, Cathleen Sangillo, M.D. , , .; .~ .~ ~ -1 1~ ., .~ ~",...,-- l_lo<il!'>>Ji'i.&'!?",~ .!J -~-"". .H1lrl'J! R ~L a~ --~-- ~_&l._ ~ -,. "~" ~ ,~ ^ -~..... ^4"~'1j)! ORTHOPEDIC INSTITUTE OF PENNSYLVANIA . (717) 761-5530 Patient: DOB: Jacob C, Ulrich 08/02/80 SSN: 000 00 0000 Chart #: 14814628 Page # 1 ------------------------------------------------------ 9/29/1998 RICHARD H. HALLOCK Me LEVEL TWO Trindle Road Office I had the pleasure of seeing JACOB ULRICH in my Trindle Road Office on September 29, 1998 for evaluation of his right shoulder. CHIEF COMPLAINT: Right shoulder pain. HISTORY OF COMPLAINT, He is a very pleasant 18-year-old young man who came in for evaluation of his right shoulder. He was the passenger in a speeding car that flipped and he injured his collar bone. He was sitting in the back seat, unrestrained by a seat belt. REVIEW OF SYSTEMS, Review of systems, past medical history, family history and social history have been recorded and reviewed. PHYSICAL EXAM, Exam today reveals he has some tenderness over the right midshaft clavicle. Skin is intact. Neurovascular status of his right upper extremity is intact. He has no significant pain reproduced with rotational movements of his shoulder. DIAGNOSTIC TESTS, X-rays of his shoulder were reviewed. They demonstrate a minimally displaced and non-angulated fracture of the midshaft of the clavicle. DIAGNOSIS, Fracture, midshaft of right clavicle. PLAN: At this point he is going to remain in the figure-of-eight immobilizer. He was also given an arm sling for extra support. He will be seen in four weeks for recheck with x-ray. RHH/kir LTR-DR HALLOCK-CORRESPONDENCE (Ref) SANGILLO, M.D., CATHLEEN 10/27/1998 RICHARD H. HALLOCK MD LEVEL TWO Trindle Road Office CHIEF COMPLAINT: He is four weeks post fracture of his right midshaft clavicle. His shoulder is ~eeling much better. REVIEW OF SYSTEMS: The patient's review of systems, past medical history, family history and social history have been re-evaluated and reviewed. PHYSICAL EXAM: Exam today reveals minimal tenderness in his shoulder. still has a palpable lump from his overriding clavicle. Neurovascular of his. right arm, is intact. Range of_ motion of his shoulder is nearly He status full. ------------------------------------------------------ ~15 ~..~. IU.tlOX .J!:!t '" i ,-~ . ".~"""""'~ ..., " -llllIllilIlllIIliIi.,I.-,'- I; -~I"u.L. "_.. ,...........i,I..J..'L...: . ~~~~--ilIiiiIillI~h <' -I.~j~~~,",,~--,-~"" ~JC~--<';. y~~~.:.a_~~.;ra .~,&H; OR'IHb J;N~'J-~ ~ v . ,_~~.g,~ ~_r ~!"\c....' f ,...;.... Wf< .~ ,. 4~('~\n 'JaIPoAI1~' ~ . . ~...~~ 7-1)- . E.C't:,':' MIll l'tIallll ~~.~i~ ..~1> q~J.s II' pO~'~"\5aiC') . "R..J 8 .....J1l..Ml/llJIlSlIlbll -S . - ~i ~oU. .~:; ~~ ~ (' Q..rll~_OII .1lIII., ~~ .B"":Se' - I'JQB Il- 5.5:), w~ 1imptcIyI~ 10-..- ~ ~+ {;J)(ted7cJn.3 . . . PIlltMr DOl W" "v.v~ , .~. ~ \' I .4 , ~~,~ t. {'.~ M~r'" '1'1~""" .. " '. ~ ! .g 1\1 @ .' llmpla)8r ',' IpcIIIII! Emp., Cllid (lIoI\GGI) ClOB _ W;t , , ~pllft'lIllll PIrty r CIIlJll . MIrJIItiIICIllIr Canlltlt ~ Injqlll. "f' =J~pl'('~ \ A.... '1-,' WalllRI/IIEII' ' ~~t~;~ ~~ ~ ~t* Dillll at ~ fbt IIfIPel1lll J"llt 1rIlll/f . _UfWI~1lIY ~ '~t, S-!v-k Fev-rn SCOIIdeJV .\<e4~L '\tI" ~ Addl'Hll if: Atldl'll' , . QrD\IIl t Pa(:y-' 3iS'JO'6'u-IJO~ ' autllctller'l NITII' Addml GlllllP' Pallcy' 011; ;q ~ Lf~ g [), q UJ 8ubll:Tllltl'l Name:...I!b r~ . ~ Alldnll. fllJl\llVlDr~ C D.Jh l 0 QxI Add~. ~'I ~.ratr!nl1'C1r. AlIII/1lll& (lOOt, , , , ...._re: It4mMyllr'r~D.t.' . NahW }f)~ 1'~ .m --~-I -_~ 3_ . .~ . ._"~~-". ,:-.-.. -- - --~~. ~... , ,~ ~ ^' " - - ~, ~ j . , MEDICATION RECORD NA>JE LAST FIRST MIDDLE DOC'l'OR OF PATIEN'l' ClW<T N1lMBEl< U\nch Joco b L Hcdlo~J- )Y'i!1/0 MEDICATIONS PIllUlMACY AND AMr. BEFILLS DAn DOCTOR . PHONE NUMBER DISP. COSIGiN' Vf~Od / h h 30 ) %,9/7'2- K ))/1 I I , I I I I I I I . . I I , - . I I -' .JI . HEALTHIDSTORY ~~ ~ , 11Ie follo~g is very important to us in ta.king care of your health. Please take time to completely and accurately fill out all of this information. Please also make sure you update this information as changes occur. Patient's Name jOe' p,,\\ U\ n'r lri Medications You Are Taking Name Amount Frequencv ,-, .. Are you ta.kingdietmedlcation?; No~Ye& .. .-. ',' -,-';',---,','" . -. " :-:;- :., ':"'_-.'-"-";:';'~:-,~ . -, Allergies (Drug!>' and()then'AJJ:~~~t.., . . "'.';:" ,-- Penicillin ~. y~ ;:c.reacti~ ". . Local Anesthetic Nc;:--.-..y";', .... _;;";;tib:ri'c (xylocaine, novocaine) Other Allergies Hospitalizations (List serious illness- and injuries or operations and .pproximate year,) Year H ollPital _____~__-J....-.,,-_~~...,M"'" Chart Number B ~! y /..s; UPDATE Past Medical History Have you or members afyaur family ever been told that you have: 'fJ?- rfNrc f(y;).'l-{i7>Je A 1-;)l(-rPNE You Family Describe Anemia [ ] [ ] Asthma [ ] [ ] Abnormal Bleeding [ ] [ ] Blood clots! phlebitis [ ] [ ] Cancer/tumor [ ] [ ] ...',> , ~'_.-' Diabetes [ ] [ ] ."..- Drogeabuse' [ ] [ ] c; ~~~~/ psoriasis [ ] [ ] .C' Epilepsy I, seizures [ ] [ ] "';, .;0,'--';.. ~7'-, :0:,~ ~;~ _: '~', ;:.. '.:ReartCon&tion [ ] [ ] ,"-' High or: low blood pressure [ ] [ ] Liver; diseased hepatitis' / 'yellow jaundice LJ [ ] Kianey / bladder problems [ ] [ ] Lung disease [ ] [ ] Prostate problems [ ] [ ] Stroke [ ] [ ] Thyroid disease [ ] [ ] Tuberculosis [ ] [ ] Ulcer in stomach / duodenum [ ] [ ] Osteoporosis [ ] [ ] Arthritis . [ ] [ ] Other bone / joint disease [ ] [ ] Any nervous system disease [ ] [ ] Your Social History Do you smoke? Do you drink alcohol? Do you uSe street drugs? No Y~ Amount!O-I( a"d~ ~Y~ Amount I', fTl~ _ No::::"" Yes_Amount Continued on back of page.......... ~.,-""-",,,- ~ -"'''''''''''- ;u ,. ~~ ^ ".~ DlJril\g the past year, have you had: , , 1 heartburn or indigestion? .........................,..................................,...... 2 bowel movements: that were bloody or tarry?..,.................................. 3 any recent change in your bowel habits?....,......................,.....,.......... 4 frequent urination during the day or night?.......................................... 5 any recent loss of control of your bladder?..........,...............,..,........... 6 burning with urinatiort?,.,............,............,..,........,....,......,................ 7 difficulty starting your urination?..........,........................,..,..,..,........... 8 excessive urination?............ ..........,....... ................ .....,............. ....... 9 excessive thirst?..................................... ............. ......,........:... .......... 10 shortness of breath or wheezing?...............................................,...... 11 chronic cough?................................................................................ 12 chest pain with activity?..............,........,;,........................,..,.....,........ 13 racing heart or palpitations?....,..,.................,..........,.......................... 14 swollen feet or ankles?....,................................................................. 15 frequent headaches? ......................,...........................,..................... 16 difficulty hearing? ................,................,............,......,....,....,............ 17 dental or other mouth problems? ..,........,.......................................,.... 18 frequent nose bleeds?...............,....,....,..,....,........,......,..................... 19 easy bruising?.......................,.............................."..,...........,..,......... 20 skin rashes?................ ........ ....,...... ........... ...... ....... ..........,.....,......... 21 aching muscles or joints?.........,....,....,....................,...............,.......... 22 swollen joints? ...,.........,........ ....... ,.,...... ...............,............................ 23 cold hands / feet?................,.......,.........,...........................,...........,.. 24 gangrene?...........,.... ........... ........,.. ........,....... .......... .......... .............. 25 loss of consciousness?....................,.....................,.............,............. 26 recent nurnbness in anns or legs? ...........,..,..............,....................,.., 27 chronic fatigue?............................, ......,.............. ....:.. ............... ........ 28 uncontrolled bleeding? ......................................,..........,..................... 29 weight loss?..,.............., ........................ ....... ......... .......................... 30 weight gain? ..........,..,...........~...................,..........,........,..............,.... 31 heat / cold intolerance?..,..,....,......,.....,....,....,..,.........,...................... The above information is true and correct to the best of my belief. P..~..gnaturefLc 1f.44 ""~- ___ _=..*1!!1_ ;, .~ i>-~4t~j Jll!isrl1ll1~ '__""'f<!~_ N~ Yes_ No~ Yes No~ Yes No-+ Yes - N~ Yes - No~ Yes_ No~ Yes - No~ Yes No"'" Yes_ No~ Yes - No "\ Yes_ No . "" Yes_ N~ Yes NO~ - Yes_ No Yes NoI Yes - No "'- Yes - NO+ Yes_ :~"- Yes_ Yes No\ Yes_ No~ Yes_ No~ Yes_ No~ Yes_ N~ Yes_ No~ Yes_ No~ Yes - No"'" Yes - No"- Yes - No~ Yes - No~ Yes - Date i-71-f( !e..~ ~ ._-- .,,-- ~ V";'C_.;"j -~""""""" " . ~ ORTHOPEDIC INSTITUTE OF PENNSYLVANIA (717) 761-5530 Patient: Jacob C, Ulrich DOB: 08/02/80 SSN: 000 00 0000 Chart #: 14814628 Page # 2 ",,",-, ------------------------------------------------------------------------------ 11/24/1998 RICHARD H, HALLOCK MD RADIOLOGY RESULTS RIGHT CLAVICLE X-RAY: X-rays show his clavicle fracture has healed. There is some overlapping and some mild shortening. IMPRESSION: SEE ABOVE STUDY. RHH/ram I?A~aj ~ ""~ _~~~-"~4~;; ". ~ - " . . ~~ - -<". -'l; '~i ORTHOPEDIC INSTITUTE OF PENNSYLVANIA . ~ . (717) 761-5530 Patient: Jacob C, Ulrich DOB: 08/02/80 SSN: 000 00 0000 Chart #: 14814628 Page # 2 ------------------------------------------------------------------------------ 10/27/1998 RICHARD H. HALLOCK MD RADIOLOGY RESULTS RIGHT CLAVICLE: X-rays of his right clavicle show it is healing excellently. There is excellent callus formation. IMPRESSION: See above study. RHH/jal j~ 1I~f'-1rJ. B41251 ~ _ ~'J'_r.~1I!...~_".____~ ~-I!l!!I<I'f' ._~..(>;:.~~,_ I~ ~'''',~...~" ~~'"; ,~ ~.:.~""-",'(,~""'-=:"'_~ " .,-',- ~- .'~ - -', C' - . ,. . . Exhibit "e" -,-,. , ,; _',c ""'"'-"'_,,,:,_ I' \i " i'- I' i' ii,' i, I I Ii li I,. i i I !~: I:' I~ , i "~ -..~~- ~ - COMPA~Y GT GIANT FOOD STOR S NAME: ULRIC~, ~~COB C SSAN: 192-6&~5lV7 .- ~- " , ~~ SALARY WAGE/PAYMENT H STORY REP EMPLOYEE NUMBER: 0192665277 PR805STD REQUEST START PAYMENT DATE: 08-01-1998 RECON PERlOO PAYMENT NUMBER END DATE OATE HEO 00390068, 08-22-1998 ()B-28--l998 001 063 00398833 08-29-1998 1)9-04-1998 001 021 00401607 09-05-1998 o 4 042 10 09-19- 00433953 09-26-1998 00542851 12-19-1998 COMPANY GT GIANT FOOD STORES NAME: ULRICH, JACOB C SSAN: 192-66-5271 REeDN NUMB ER PERIOD END DATE 00542851 12-19-1998 00552402 12-26-1998 00561B38 01--Q2-191lJ9 00 0 01- 1999 00 98 3 01- -1999 00616 3 02- 3 1999 Q9-11-1998 - - 99 9- 10-02-1998 12-24-1998 PAYMENT DATE 12-24-1998 12-31-1998 01-08-1999 o - 2 1 99 2 0 1999 2 9-1999 001 2 063 o 041 043 o 2 063 o 021 063 001 010 21 o 010 020 021 001 020 AMOUNT HOURS -------- 204.75 35,00 1.50 .00 234.00 40.00 70.53 8.00 o . 3 4 .00 234.00 40.00 74.9 0 4.00 :00 317.35 49.00 190. 3 3 0 43.88 7:50 4.44 .50 , 2 :00 .25 246.32 48.00 4. 40.00 68.33 7.75 4.00 ,00 187.20 32.00 8.00 8.00 1 . 4 2.00 259.74 ~o.oo 228:48 .00 38.50 1:46 :25 68.34 7.75 .4 0 213.53 36.50 20.48 3, 0 0398833 CK 0 00407607 CHECK TOYAL 00416335 CHECK TOTAL 00433953 CHECK TotAL 00524142 CHECK TOTAL 08 C 0 SALARY HAGE/PAYMENT HISTORV REPT EMPLOYEE NUMBER: 0192665277 PR805STD RE UEST START PAVMENT DATE: 08-01-1998 HED 021 063 001 010 001 04 010 020 10 020 1 010 020 o 3 010 020 00 010 020 063 010 AMOUNT HOURS 30.95 2,25 3.50 ,DO 184.28 7.75 2 .3 179.89 .0 214.14 31.50 7,75 4 .00 30.75 ,00 40.75 8.00 46.80 209.83 130: 16 8.00 8.00 42.50 22:25 ,00 29.25 176.11 2. 4 ,25 1.46 3.38 306.47 .00 5.00 34.25 9. ,25 .25 .00 48.00 ,7 45.34 234.44- 19 .9 6.50 38.03 .7 254.56 7.7 7.75 46.50 3 . 0 6.50 6.50 .00 43.00 3.00 8.00 o 2 0 0 00561838 CHECK TOTAL 00571074 CHECK TOTAL 00580262 CHECK TOTAL 00589299 CHECK TOTAL 00598323 CHECK TOTAL 00607212 CHECK TOTAL 00616053 CHECK TOTAL ~ '," "~"-"""''''[l.riildl\ii.~;' ~~ ~ . P~GE 1 TIME: 19:40:56 DATE: 02-11-2002 REQUEST END PAYMENT DATE: 04-30-2001 , - ",,,, PAGE 2 TIME: 19:40:56 DATE: 02-11-2002 RE UEST END PAYMENT OATE: 04-30-2001 - L. ,. I ~- ~ , '. . ' CERTIFICATE OF SERVICE I, Lisa R. Rhoads, HEREBY CERTIFY that a true and correct copy of the foregoing document for Defendant, Jake Ulrich was served upon counsel of record this 13th day of MllJ', 2002, by depositing said copy in the United States Mail at Harrisburg, Pennsylvania, postage prepaid, First Class delivery, and addressed as follows: Christopher J, Knight, Esquire NEALON & GOVER 2411 North Front Street Harrisburg, P A 17110 David H, Rosenberg, Esquire HANDLER, HENNING & ROSENBERG 1300 Linglestown Road Harrisburg, PAl 7111 R. f~a & Associates, P.C. B'~~ Lisa R. a s, ecretary to Charles W, Marsar, Jr. . ~-_...'" ., u .~..... - , ~O;^h t~ " '. _ '"-\."1!, , , .. , - -, > ALLSTATE INSURANCE COMPANY, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYlVANIA v. NO. 00-4783 EQUITY TERM JOSEPH ALDINGER, JAKE ULRICH, BRANDI MILLER, GLENN SHOllY and WILLIAM McCLOSKEY, Defendants CIVIL ACTION - AT EQUITY RESPONSE OF DEFENDANT GLENN SHOlLY TO THE PETITION OF DEFENDANT WILLIAM McClOSKEY AND TO THE RULE ISSUED BY THE COURT AND NOW, comes Defendant, Glenn Sholly, by and through his attorneys, COSTOPOULOS, FOSTER & FiElDS, and respectfully avers in response to the Petition of Defendant, William McCloskey, as follows: 1, Admitted, 2, After reasonable investigation, Defendant, Glenn Sholly, does not have sufficient information with which to form a belief as to the truth or falsity of this averment, and so averment is therefore denied, and proof thereof is demanded, 3, Admitted, 4, Admitted, 5, Admitted, 6. Admitted, 7, Admitted, 8, Admitted, ~" , " UJ .~d..'~",. , " _-.;....l( I~ I . , '< NEW MA ITER 9. Defendant, Glenn Sholly, presently an adult, born on April 5, 1983, was also seriously injured in the motor vehicle accident involving the Plaintiff's insured, Robert Gill, occurring on or about September 25, 1998, 10, Upon receipt of the Instant Petition by mail, Defendant Glenn Sholly, first retained the services of undersigned counsel, David J, Foster, who entered his appearance in this matter on April 1 0, 2002. Prior to this, Glenn Sholly has been unrepresented in this case. 11, At the time of the accident of September 25, 1998, Glenn Sholly was a minor and did not become an adult, sui juris, until his eighteenth birthday, which was on April 5, 2001, 12, Also on Apri I 10, 2002, undersigned counsel sent out requests to various medical providers for records pertaining to the injuries that Defendant, Glenn Sholly, suffered ill the automobile accident of September 25, 1998, 13, On April29, 2002, Defense counsel received a copy of the Rule issued by Judge Bayley in this matter on April 15, 2002; the Certificate of Service attached to the Rule indicated that it was mailed directly to the Defendant, Glenn Sholly, on April 22, 2002 by depositing it in the United States mail; however, the Certificate of Service incorrectly states Defendant Glenn Sholly's address as 105 East Columbia Street, Enola, PA, when in fact his correct address is 105 East Cumberland Road, Enola, PA, __ - - " '" ~ "c'" .- c ~- ";-"L: .. - , , - 14, As of the date of this response, undersigned counsel has received medical records pertaining to Defendant Glenn Sholly's injuries from Good Hope Family Physicians (his family doctors), the Holy Spirit Hospital Emergency Room records, and the Hershey Medical Center, Excerpts of these records are attached hereto and marked Exhibits 1, 2 and 3 respectively, 15, We are still awaiting receipt of records of Guidance Associates of Pennsylvania, where Defendant, Glenn Sholly, received treatment and counseling for injuries resulting from the accident of September 25, 1998, 16, As a result of the accident of September 25, 1998, Defendant, Glenn Sholly, suffered serious injuries to his head and scalp (requidng plastic reconstructive surgery) and back, Since then, through his family physicians, and through Guidance Associates of Pennsylvania, he has received care for anger management, depression, and loss of impulse control which have been directly attributed to the accident of September 25, 1998, His back injuries have been treated by Orthopedic Surgeons of Central PA, Ltd" whose records have not yet been received, These injuries are serious and permanent and have significantly impacted Defendant Glenn Sholly's life, lifestyle, and future, 17', It is respectfully submitted that, of all the Defendants who were injured in the car accident of September 25, 1998, that the most seriously injured was Defendant, Glenn Sholly, and that he is entitled to policy limits of $25,000,00 under the Allstate Insurance Company policy covering Plaintiff's insured, Robert Gill. r. ", ==, ""-'.. '~', , I _~'._ , ~ T I 1 _ I ( VERIFICATION I verify that the statements made in the foregoing document are true and correct. I understand that false statements herein are made subject to the penalties of I8 Pa, C,S, Section 4904, relating to unsworn falsification to authorities. MfIJ)/IJL f ~ Jt- Dated: .-!; -;~ I - Od-.. ... -.1k-u: , . ..... .t- I.. '- , (~ ' ( CERTIFICATE OF SERVICE I, Tiffany M, Miller, a secretary for the law offices of Costopoulos, Foster & Fields, hereby certify that I have served a true and correct copy of the foregOing document on the individual{sl listed below by depositing the same in the United States mail, first-class, postage prepaid, from Lemoyne, Pennsylvania, addressed as follows: Robin j. Marzella, Esquire R,j, MARZELLA & ASSOCIATES, PC 3513 North Front Street Harrisburg, PA 17110 Attorney for Jacob Ulrich David H, Rosenberg, Esquire HANDLER, HENNING & ROSENBERG 1300 Linglestown Road P,O, Box 60337 Harrisburg, PA 17106 Attorney for William McCloskey Christopher j, Knight, Esquire NEALON & GOVER 2411 North Front Street Harrisburg, PA 17110 Attorney for Plaintiff Joseph Aldinger 3 South Street Enola, PA 17025 Brandi Miller 330 Fourth Street Enola, PA 17025 Dated: May 22, 2002 ,'C ~ , ~= , J. "lL;i'l- - "^",,~" ~-""""iltl~,j i IO~ \:IUUU nul''' nU<lu - CTlUII:I- r-A. 1 TU':::! (717) 732-8877. FAX (717) 732-9241 0) NAME: 61er,n 5,,01ly 0('. ,~ PAGE NO. . ( I ~ .- 'j DATE: I 11ME: ~AM /(1: rJ!J 0 PM :Hl PHONE -132- ();7?,(fb o CALL BA~K' bNlY IF PRo.slEM PHARMACY: PHONE: ~~~~ ~~~L- ~ &-I'1.Cjq e lI~jYI.... L\"" b-. t'<? 14 ..; JClcl~ G' Heme ~~O hcuJt {l+ lIllTYY\ &uJ ~ ~ ;;1, sW f~re.u "'- ~,oS'\..-.s ~ ~~ ~.('JC~, %)~ Glenn is here for problems with anger. Apparently Glenn was in a very serious MVA in 9/98. At that time he was a passenger in a car driven by a drunk driver. Apparently there were several people injured. GLenn 'had a severe laceration of his scalp, hospitalized for several days in lCU, apparently at one point they were concerned that he might not sUIVive. However, aside fran bleeding to the scalp, there were no other head injuries or other bodily inj uries . Since that time man notes that Glenn has been very angry. Glenn reports punching walls when he I S angry, denies any urge to punch people. Denies any suicidal thoughts. He does note sane tearfulness, denies any problems with concentration. Reports sleeping well but having trouble with feeling tired. His appetite has been good. Denies use of alcohol, tobacco or other dIugs. He denies being in a sexual relationship. He refuses to go to counseling. 0: Glenn has his head down most of the time in the room, maintains poor eye contact. At one point mom is talking about family hx of alcoholism in father and Glenn began to cry. His answers to me are very short. Toward the end, however, he did maintain better eye contact. A: 1) Depression. ':; EXHIBIT It -L- ~ . 97 ~ <_ c ,.} ~';J , r \ ,~ ,- r' \ . , . , NAME C-~ 5~~~ BIRTH DATE, <-{ /5 J f') 55' ";:0 CJ .. (" L\_ C,) ). 0 (" I ALLERGIES, -l'V K D 1\ .. .. ... : . . , . .. . . . .. V' ~MOKER O()\~i ^ (j:' ') "if<;!: ,,-,~QtY, t-\1( I-\A-..H;\P/r-f1 t'\\JA ~C. '. (S c ~ ~ L,( It.... fu.b~ V I IN Will: GYN; PCP: ..... r A j , l..ti'\ c__ . DATE DATE DATE / J. I) LV G ACTIVE PROBLEMS GHFP FORM#11 (5/98) ..".-_...--.---.-----,-.-_.._~ \- .,'"",-~, " ~""'*"" ""~~~~..... '"',~ - ~~ . '-':,Ce'; , . . . , , '. MEDICATION LISTING Pt. Name (1\ <:,11[\ 5hOllj Date iol'1({ "/q~, j"k" 'I~IDI ~~ Dose ;:: ~'-"" G /y3~~ '/0',\(;0 -= ~~Z 3bl? UfR y ~"<" " \\\-rl s ~:/ JD Dale 1f:J/(1 Dose OlD UfR BQ'>t"J., ~ '0'-1'\ Te'V~ Date JD1f'" Dose T" t% .~".., R-<Y'O't\ ~ ~ UfR , , Date ~IIJIOI 4'1111,~ Ntv~m Dose 4tl.,J .' UfR :)11 ~i3 Date Dose UfR Date Dose UfR Date Dose UfR Date Dose UfR Date Dose UfR Date Dose UfR Date Dose UfR MEDICATION LISTING - _' _c -'~ - " ~'. ,-"::'; '~'I .'0' " -", . , ADM. DATE: 09/26/98 c.( Motor v.hicl. accld.nt. ir,'! S.venteen year old whIte lIlale here wIth hIS mother following a molor vehIcle accident. J!e was ambulatory to th. Emergency Department, The pahe"twas Involved In . motor vehu:le accident "veral bours before admiSSion. He I' really not sure when. '-W't'!bave" ,:',"" : '), 4 ,>1her people', from thl. ac.,dent here In tb. Emergency Department. Tbe patient was a fr,ont seat ;;~-.<;,):;'.:.J.r} u:u'.::.stratned,.m an Isuzu Trooper. Tht driver was drinking and swe.n"ed to mISS aRother :Yehlcl~, ' Mt :0 ,lro1 ofhb vehltle,and It roll.d ",v.ra! limeS, I have gotten tillS hIStory rrom oth.r people. Th. pallent '.1>11:0'.1 ':.'noot r.member the a..,denl The patient beh.ves h. was ejected from the vehicle, H. say. tbls ~.~C-.~:j'Z~ lit .tates he remembers the car swervlPl:" and tbe next thing he remembers lIle was On the. pavement ,:.: oj lhe v.hlcl. and Wen h. ran ham., He deDlcs any alcohol Intake tORlght. He .omplalns or paIR In hIS ~~;t foct Mnd ankle- an~t lert pOJtcnor ,pelVIC rim area, left shoulder area, postenor and supenor and the c',:c'p;tol or.a or the scalp. Minimal ncck discomfort at the preseDt lime, He al:lo has mid back pain, lie denIes shortness oJ breath. Pl\offi Unremarlulbl.. Last tetanus .hotls unknown. MEDICATIONS None. ALl,ERGIES No known allergies, PHYSICAL EXAMINATION Vi.t~l 3igm rniarc:d on aunc:s'. DOtes.. ,:OiiSTITUTIONAL: Alcrt, anXIOUS, appear> un.omlortable POSlt,ve odor of alcohol on th. breath, HEAD: Abrasion aDd moderate swelhng on the occ'pital ar.a somewhat to the I.ft "d., .- !':YES: ConjunctIva Without dIScharge or mJecllon, L,ds "ilboutles,ons, PERRL. F.NIf': Ears: Tympanic membranes Wlthout perforation, Injection, or bulgmg. i'/1outh: LipS, teeth, aDd gum-s normaL ;bnal: Oropharynx without lesions or exudate, AlrwaJ' pat.nt. !'I.{r,se: Nasal mucosa normaL .imuses: No slnu3 tenderness. NECK: Some muscular te.nderness. No vertebral spJne tenderness. Range of motion l5 near normal. llACK: H. bas m,d to low.r T-spinc vertebral spm. t.nd.rn.... Ther. IS no lumbar area tenderness. LUNGS: Normal respIratory effort. Breath sounds eqoal. No ral.s, rhonelll, or wheezes. Page 1 HOLY SP/RlT HOSPITAL Camp Hill, PA 17011 NAME: MCCLOSKEY, WILLlAM MR#: U3877 ROOM #: ECU DR,: Luley, ~GENCY ROOM REl'OKT z EXHIBIT " ! ~ " <5 z w ~ , ~ .........~ ~~,..... " ,. ." "',Y"~-,,: ,~ I I 1 "- 16{J- ADM. DATE: 09/26/98 ' ne pol.enl w.. .fined oullo me by Dr, Lufey wllb IDslmchons 10 check the x-rays, .ulure I.C.,..llOn .nd get a surgical consult DIAGNOsnC TESTS: X-ray. of Ih. cervlcal.piDe were negahn, X-rays 01 tbe len foot aDd ankle as read b)' the radiologist was that there WaS acc:cssary tarsonavicular bone not an acute fracture HoWeVler,OD m)' physical exammatioD, the pahent IS tender oyer that area, so I1bmk contrary to what the radlologlSl said, I am cODeerned Ihalll mIght be a lnoclure, Tbe wound on the lelt forearm wa. approximalely I 5 em, I cleaned 'I Wllh Betadme scrub, prepped It Wllh Iktadme, Infiltrated with 2% Lldoeam., draped It, reprepped.t Wllb Betadine and sUlured .t wIth six 114/0 nyloD sutures. I consulted Dr. Froelich for further evaJuatJOD aDd management. DIAGNOSIS: 1. Laceration, left forearm. 2. Multiple eontuslolIS and abrasions. HRtJI D: 09/26/1998 T: 09/26/1998 8900 Page 1 HOLY SPIRIT HOSPITAL Camp Hill. PA /70ll NAME: MCCLOSKEY, WILL/AM MR': Jn877 ROOM': ER DR.: Rudnick EMERGENCY ROOM ZEPORT ~' ~-, ,,~,<"~~ Initial Lab & X-Ray, Orders: lain / Urine SplfC!m!'i1. 1 ) AcetalTl'nophen 'I IES" 1 Serum AcekX1e I ),Ak:ohol I 1 Glueou J ThlloOph)'lhne 1 I Am)'iaselllpas.a I jHCGS ] Thyrotd Prot.lll I JAPTT I )LJver ) Tax SetHn I J Blood CullUf815 Prehle JTPALabI I ICee 1418s 'Type & Cton--* 01 units I ICK'-'B I P7l' I Typo & Sc<een I ICPRO lRon.aJ ]UlA I lCRP1 p,,,,... ]UnneC&S I 1 Olgoxln ) OuIl1Id1ne 1 WOfkmll.n's Comp Drug Screen 1 )0118l11ln ) Saheytal. ) Other P...rlf,..f^""v . .------a~ I ) AbdI0b4tr Senls I IKUB I IAn'" R l I I LIS Spine I )C~vltl. A l I JMandlble I J Carv Spine LeWal 1 )Na.N1 I J C~ Sj)lrHl RoUtIne I )Otblt " l 1 I Ches1 RIn I Po" I TPA 1 ) Pelvla 1 JElbcw A l 1 I Pyelogram IVP I ) Facial I JRlb8 " l I ) Femur A l I ) &louldor " L I )Fl'lger A l I ) Skull I I Fool " L I )S:'rrr..lm I ) Forearrn A l I li/Splf'le I I Hand A l I JTIb/Flb R L I jH" R l I )Toe_R L I ) HumenJ8 R l I ]Wnlt R L I I.... R L 1 ] Other n"'Afl.RTllnf Special P~u"",. Utl:ruound I Abeloman l Duplex Doppler ) Gallbkidder ) FelY1c Culturws ) Beta Srrep AG I Culture ]COMCttoI ) Chlamydl4 IGCCui'.ure- Ic:rSeanol )VQScan JOUler T1MI','CRTJ1n1 )SputumC&S jSloolC& S jSlOoIO&P ) $k)oI C DIff.:.. )WoundC&S Billing CISl>SlIlcaUon I IL_' 1 IFollowup I 1........11 [ )c.../ I ) L....I III 1 IL....IIY 1 I.......IY ] Ac:aden{ I "-"'<oJ I MedlC8l Noo-Emergpnc;y Holy SpirIt Hospital Camp Hili, PA Emergency Care Unlt Phyalclan Order Sheet 206-EClJ REV &IX JO BA....O CHART COPY . -" ~<.iJ~~~! ,. 'J 'i Time Seen: Cardiac R".plr.tory ( I "00'1 po.oed II ( J Pwk Flows BeforafAfl.( R-p TJ: ( )R"'pil1l.loryTx I Monitor I EKG paQ&d" ]02 l/t,M ) 02 Saturallon Madicatlonal IV's I Additional Orders Time . Date/Time/lnl IV: NSSI DSWI LRI D5I.4SNSiDS,9NS Infuse at cc/hour, ) Obtain old records. Inlllals: Initials: Initials: Initials: Signature: Signature' Signature: Signature' RN AN RN RN "'DIDO Signature: Date: IJ,c;,~6;.h:t:,( ;vj/;~ ~CClosrrY .WlllIAH I~I r COl'HBIA AY[ feU [ 'LA PA 17025 (1/1'/10'1 732-553' 2! ,.n-,I!,q [O.qour r I jI )/ ~ '\ "'-- '"" ~~ ,~~ ,>~ ~ , <-':"", ~ ~ ~ -- ... , , , , ( fo:;;;':'~~=~'--~~ -- \ . I . ~~-\\l'\"" \ \ -.Ll-- ,N:urJ: .(\S&.' l-) \ \ ;\ ~ge 'j "'~,,-:n \" - 4 ' }.1t ~;::; ,,;i;:;:~ '~:,noul"o' I ) BLS I ] ~ [ I Med,cal ''''~~ ;:1:~;. ' .1 C f;, MPLAINT: ,'rirH1'lt,\l_ Ti1li\G~;., I"UI:- "<"'1[1:5:_\ t~::.- ~-~:~'.~_. ' I' ~~",~-~:~!,i';.;>( ;:~~::.~_.~~r=!-d ( J Home ['J Industry ( J Recreation .n':""I'i.".H"'~') ....!..~!"l:-d :rom~atl.nt _FamtlylS 0 . E~;;':-t7:::Y ;:.'.' :!1.1:;~ Tnage-d to radiology for I C::fum:!?'f Yes/No Sklnicmp Warm/Cool i J:U/1 f:.::~ r- f.); I Cy'lll"'.otIC I Monied Pllln (HQ) I I !.'";:.)r.'~,.~!,~.; _.__ _. 1~"~"'-"~-'):{ .~~~~1~=- . I I . 1 Sl]Ql~t'/~~:~ r..'---.-....: ~ ":,,, f!~.:~b.,,:.c::--.::~I=' _ ; O..~~~:i~..:Il!_P....:b: ' ,'::;;..'';j::~;..j \i~:;;:.:,~t Log-In TIme Tnage Time Time to Exam Room "---= C- _EMTlParamedlc o,stll PUIMA Preaentl Absent ParNlhe.... Pnnlnl J Abaent Deallnebon ){J'pCU ( ] EDF' 11mB ~ SI nature BJPJ Last TeIBOIJ& Vlsusl,.Acurty LMP OS .. . --..-'.-'....-.-.. ; Last Dose MedlcatlonlDose/Freauenc Last Dose P"..;t Mc;;!,caV$urglcal HIstory: Are the,e advance dlredlYes? copy available? up'ECTFO OlJTcnLlF~ ~rov-em&n1 In Cllf08C QulplSl demonstl81ed by Improved v:. and d1agnostJc tesls Oocrea.se or 1'81181 cllbcomtort _lmprOVUm9lll In fluid vol demonstnltBd by ~.a5C In SY"'Plorns of llutd vel rmbalance Improved gas 8ItChange demon&1raled by amp~d oxygenallOn and vrtBl 6:1gns Decrllase I symplcms. lnl.1ecailng mlacton 01 potermallor In&ecbon 1m edge de trall1d by vetbal1U11OR I nlurn dMK)l'tStratlon Assessment completed a Data obtained bY': AdtnlSSlon Called ] AdrTllSSlO'1{IJ..9r~lp9' [ ] Old Aeconis Sent R&port CaJled A mrtt&d to ~tl/ "Z-O Hrs Transfefred lo D'spoSlnon I J Ho",. I ] AMA I ] OR at I ) Sallsfactory I J Impr d ] Cn""'" [ ) Otscharged I I ( ) DIscharge Instructions Discharge R N by R,N, MA by rgueat at Holy Spirit Hospital Camp Hili, PA ECU Nursing Assessment CHART copy -t ~l. , 1-' ".\1)3 ~R 343&77 E .:"lCSH 1 .1I11.11H I'.i [ COl:.J~Bll HE 170t;CU I . I Pl t 1'~)/lq31 7H-SSH ~lv,")-llbq [0 ~Qour 201 fCU 5197 6lt1 A"" JO MO BR ,- - , ~ - ,~^~, fl I I " ~, ~ S~A.TURE .- I HOLY SPIRIT HOSPITAL CAMP HILL, PENNSYLVANIA 17011 EMERGENCY AND OBSERVATION RECORD PATIENT CARE NOTES ....(, FORM HO 1PO (2J~S) l:lS:J1403 U 343877 E ~CClOSnl .\llllH'I .. 15\ r COlUUll AVr Eeu t r'l A P l 1 7025 OII\}/lq~1 nZ-55H Zl~-q~-Jlbq [0 ~~our , ) i . , C1/Z1/q". ,"'-~ . , o-.-.~W' .-. ~ oi_.' - 'e-'_'~__ . 4. , , . , "-' ORTHOPAEDIC SURGEONS'OF CENTRAL PA, LTD, MCCLOSKEY JR,WILLIAM J 371 WATTS DRIVE DUNCANNON,PA 17020 ACCOUNT # CHART # SS # 84,901 31093, 216983169 October 13, 1999 J. Stephen Snoke, D,O. 1800 Carlisle Road Camp Hill, PA 17011 RE: William J, McCloskey, Jr, " Dear Dr, Snoke: " I saw your patient William McCloskey in follow-up in my office today, October 13, 1999. The patient was last seen on January 26, 1999 when he was scheduled for an MRI of his lumbar spine, He missed two follow~up appointments, He returns today with pain to his back and right hip with increased activities, He apparently has noted increased pain when attempting to lift or do heavy labor type work, He attempted to find a job in this job market but was unable to perform this work. ')~~ _.' . ~' On exam, he has back flexion to approximately 75' with pulling pain to his right buttock and right posterior thigh, He has negative sitting root signs. He has a slightly positive straight leg raising sign at 75-800 with right buttock and posterior thigh pain, His patellar and Achilles reflexes are normal reactive, He has no extensor toe weakness nor apparent sensory changes, . .k The patient did have the MRI performed which I ordered, This was completed on February 8, 1999. This shows a mild right posterolateral disc protrusion at L5-S1 adjacent to the right 81 nerve root. DX: Prominent bulging disc at L5-S1 on the right '; ~ This would certainly account for his persistent back pain, particularly when he attempts to increase his activities, He will be scheduled for ten sessions of physical therapy for his lumbar spine, He was also prescribed Naprelan 500 mg bid as an anti-inflammatory medication. We are going to see him.in six weeks in follow-up. With his young age, if he ,continues to have pain without response to the therapy, he would be a candidate for a lumbar epidural injection. Sincerely, 'I\~\ '~~ ?'UG'\ UNtt;rll:Nr M,n. INSrpRS'rA.,,... ,", 'llJ,C';',"Yc.)8, ',,;.,: ' .' 'IONS ';:~~~1 ..:_~,'- ;I~ . >,;;::X '.I';~.'1- ....t~.:.. ;,,;!it "" :j~~ ,,:,;'f.'l . :....,~ .';:Mr.:-r "~"':';.I\'"",'\l:, . ~7:~ .. ,~',.... '; .::';"P' ~ " ',.,~,'J" ~ . '~1.(l,7 ..... THMivjc (dictated, not read) TK-FAX sent to J. Stephen Snoke, D.O. Thomas H. Malin, ... ," ! I MISSED \ APPOINTMENT \ ON 13\ l~\l)i) " ., ";.i;J~ii;t{!;WiB':',..'," ,~_. - ". -~ -''-"' ~ ~ . 'I ,t 'f'- ORTHOPAEDIC SURGEONS OF CENTRAL PA, LTD, MCCLOSKEY JR,WILLIAM J 178 WYOMING AVENUE ENOLA,PA 17025 ACCOUNT # CHART # S8 # 84901 31093 216983169 07/07/2000 HARRISBURG OFFICE EXAMINATION (Rubbo, Ernest R, MD) SUBJECTIVE: William is here for evaluation of lower back pain. He has had this problem since October when he was seen by Dr, Malin. An MRI evaluation was obtained at that time which showed a herniated disc at L5-S1, adjacent to the right Sl nerve root, However, the patient complains more of pain in his lower back, A trial of physical therapy was recommended, but the patient states that because of work constraints as well as care of his child, he has been unable to do therapy. He has essentially been living with the pain but is here for evaluation of pain in his lower back, He was suppose to see Dr. Malin two days from now but states he is having increasing pain and discomfort in his lower back and walks in a bent over fashion because of his pain, He denies any type of bowel or bladder dysfunction or any type of radicular symptomatology, PHYSICAL EXAMINATION: He has marked paraspinal muscle spasm in his lower lumbar area, He has intact reflexes to his knee jerks and ankle j e,rks, No motor sensory deficits were noted to his lower extremities, There was no active clonus noted or any typ.~ of hyper-reflexia. IMPRESSION: HNP L5-S1, PLAN: I have explained to the patient that I feel it is important that he consider a trial of physical therapy 3 times a week over the next 4 weeks. I have also given him a muscle relaxant in the form of Soma 350 mg four times a day and Vioxx 50 mg as an anti-inflammatory agent. I have also given him a booklet on the care of his back for him to read and instructed him on certain exercises for him to do, He may follow-up with Dr, Malin, who he was suppose to see, and proceed accordingly, However, I have told him it is very important to consider a conservative trial of physical therapy since he appears to want a quick fix for his problem. I have told him that these things do not go away without being taken care of. If physical therapy does not give him much improvement, one might consider a trial of epidural steroids, (transcribed 07/11/00 gb) n" 7.1:l\)\ j~:C\ '" " ,~ --~ .' . . J'" ~. -' ,i~ :~_ :.... j fIA r , . , , ORTHOPAEDIC SURGEONS OF CENTRAL PA, LTD. MCCLOSKEY JR,WILLIAM J 178 WYOMING AVENUE ENOLA,PA ,17025 ACCOUNT # CHART # SS # 84901 31093 216983169 July 21, 2000 CAMP HILL OFFICE This patient was seen by Dr. Rubbo on 7/7/00, 2 days before I, , saw him, because of increased pain, The patient apparently has' had increased back and right leg pain. He was seen by Dr, RUbbo and sent to PT. He has had difficulty with transportation getting to PT, He lives 2 miles from Wormleysburg Health South. He did not complete the PT that I outlined to him when I saw him on 10/13/99, The patient now has leg pain right> left, weakness and walks with a limp, He was prescribed Soma and Vioxx by Dr, Rubbo. PE: He has bilateral sitting root signs at approx, 35"-45", His patellar reflexes are present bilaterally at +3 out of +5, His Achilles reflexes are present bilaterally at +2 out of +5, He has no extensor toe weakness, His straight leg raising signs are positive on the right at approx. 35" and positive on the left at approx, 35"_45", DX: HNP L5-S1 PL: The patient must continue the therapy, He must make arrangements for transportation. I recommended a Medrol Dosepak and Tylenol with Codeine for his pain. He will be unable to work during this period of time. We shall see him in 4 weeks in flu, Thomas H, Malin, M.D, THM/lms T: 07/29/00 ---~----~. MISSED l ONA~~;rroT "L'\l'\:,\ \; '1 ~ p ~~,\\ , ,.. ,) -.-: -: -.~./ .~j\...-".'" ",,,- PATIENT , UNDERSTANDS ,INSTRUCTIONS " , " . ":- :"':~;' ~.'-. .:;.. .." ..,,'. ""~-~ ., ~- .. --~i"",",d'-k.::,i , " _~-.J- --~ , ~~ . ~ -'- - JIll. . 1m '11....1: ... Fe:Qruary 8, 1999 4.. ~d>A ~q~ ,Y i 'V ',' r~ r".: I: I .;;:-1:; 'I.fl1 <r{f:~'~~4{ /JJ lr;rn ~'~'-'~J10 ",'" (,",,"f L I. 3 f..r{J. . ' ~'~~<(;~~ " ~ ,Iv-I.:..) i , o. , -..-. - V ~ (f1J~HrJf"\',L"C ';';;'(;l:',i'~rOJ;. .:. ._..1.nA!~ F~~Q;~{!~~.__l~~ RE: MCCLOSKEY, WILLIAM 371 Watts Drive Duncannon, PA 17020 AGE: 18 5S#1 216-98-3169 STUDY: MRI of the lumbar spine REFERRING PHYSICIAN: Thomas Malin, M,O. CLINICAL HISTORY: Low back pain MRI PULSE SEQUENCES: 1) T2, Tl sagittal 2) T1, GE oblique axial COMMENTS: The study was obtained with the 1.5 Tesla strength magnet and compared with an AP lumbar spine film dated 1/14/98. The lumbar spine shows normal anterior posterior alignment and marrow signal intensity is also normal. There is mild dehydration at the L5-S1 disc with the remainder of the lumbar discs showing normal hydration. The conus medullaris is normal ending at the thoracolumbar junction and there is no evidence of an intrathecal lumbosacral mass. parasagittal images though the neural foramina show no demonstrable pars defect and there is no stenosis or neural compression identified. Mild disc protrusion on the right is noted inferiorly in the neural foramen. Angle axial images through the neural foramina show a broad based right posterolateral and lateral disc protrusion without compression seen on the thecal sac. The disc is adjacent to and possibly compressing the proximal aspect of the right S1. nerve root. No left sided compression is seen and the L5 nerve root exits through the foramen without suggested compression. Facet joints are normal in appearance. L4-5, L3-4, L2-3 and Ll-2 interspaces show no evidence of focal disc protrusion. Mild disc bulging is noted and most apparent at L2-3. Only minimal impression occurs on the thecal sac and there is no focal nerve root compression suggested. CONCLUSION: Lumbar spine MRI scan shows a mild right posterolateral and lateral disc protrusion at the right Sl nerve root. ^([) -CONTINUED- ~ "<- ~\ r/"l1 L5-S1 adjacent to ,-~P:"l~.;~~ Z001 ,-- , .. RE: William J McCloskey JR October 14, 1998 Page 2 ,1,,' ., '. " with abduction because that is when he brings his acromial process against the clavicle. where he sustained his contusion. I will limit his gym activities and he is to do no overhead activities during this period of time, We will see him in two months for a final visit, Overall he should'd6 very well. ' Sincerely, ) THM/vjc c: J, Stephen Snoke, D,Q, (/pAJl[) Malin, M.D, OCT 3 0 1998 RECEIVED RECi=l"Vt::T' ....-- "'"..~~ OCT 2 6 1998 Su::;que;1:?n~5 S:':i'CSCI1S ~ .~=~ .'r.lililliOO < "~; , ,- ~,,~~~--I , ','v,,:;~ I' Orthopaedic Surgeons of Centrall1nnsylvania, '~TD. October 14, 1998 Thomas H. Malin, M.D.. EA.C.S. Susquehanna Surgeons 532 North Front Street Wormleysburg, PA 17043 OCT 3 0 1998 RECEIVED John S. Rychak. M.D. RE: William J. McCloskey, Jr. William J. Polacl1eck, Jr., M.D. Dear Doctors: I saw your patient william McCloskey in my office on October 14, 1998. This 17-year-old White male has had pain to his left shoulder secondary to an automobile accident which occurred on September IS, 1998. He apparently was a passenger in the front seat and not wearing his seatbelt when the accident occurred. He had numbness and pain to his left ankle. His left shoulder is his main source of difficulty today. He cannot abduct and flex without pain to the superior aspect of his AC joint. He has had no paresthesias to his fingers. He feels his grip is slightly decreased on the left as compared to the right. He cannot sleep on his left side. The patient also identified symptoms of low back. pain without pain to his posterior thighs or legs, without paresthesias, tingling or numbness. Balint Balog. M.D. Craig W. Fultz. M.D. Ernest R. Rubbo. M.D. Robert J. Maurer. M.D. Spt!dalbng i/l Hand & Upper Errremiry - Rc!lin.tf - CJWItlI't! C. Putll. ,\4.0. Wiffard H. Lol"/.'. .\1.D. Sdl1fUl!/ J. All/usn, A/.D. . Tot:1IJoim Replacement . Frocture C:ue . Hand & Foot Surgery His past medical history and review of systems were reviewed and are essentially negative. . Sports Injuries Examination of his left shoulder reveals he has pain over his AC joint with slight pain with compression of his AC joint. There is a slight suggestion of some prominence, but no stepoff. He has pain to abduction at 900 and pain with flexion of 90-950 of his AC joint. His bicipital and tricipital reflexes are normal reactive. His power of grip is equal. . Arthroscopic SlJrgery . Workers' Camp Injuries . Bone & Joint Surgery . Back Surgery WEST SHORE OFFICES 99 November Drive Comp Hill. PA 170 II 717.761.8644 Fax 717.761.6860 HARRISBURG OFFICE 2800 Green St. Harrisburg, PA 17110 717.234.5976 Fax 717-234~2137 He had multiple x-rays which have all been reviewed. X-rays of his left clavicle and AC joints demonstrated no change in position of the clavicle with or without weights to substantiate an AC separation. Lumbosacral spine films were taken today, AP and lateral, which show there are no compression fractures or avulsion fragments, nor decreased disc space at any level. 5 Willow Mill Pork Rd. Mechanicsburg. PA 17055 717.691.0808 Fox 717.691-<)557 HERSHEY OFFICE 32 Northe:m Dr.. Suite 201 H.:rshev. PA 17033 717-533-2348 Fax 717.533.4490 This patient has a contusion of his AC joint without frank separation. This should do well with time. This can take up to 6-8 weeks. He will have pain R,..~-".~.... .-~ -.....~ f .".~ 7 L.o;.,.l'~~ ~ ).w... - Providing Qualiry Orrhopaedic Care to Central Pennsylvfjt:!2 6 1998 SUsqt.:s1":2:1n:. t.w:J\..=cns ,"-~~-~ ~-~~ . - , _.~ c, ,._ _ _' _~ I. t t c , ORTHOPAEDIC SURGEONS OF CENTRAL PA, LTD. MCCLOSKEY JR,WILLIAM J 371 WATTS DRIVE DUNCANNON,PA 17020 ACCOUNT # CHART # SS # 84901 31093 216983169 January 26, 1999 CAMP HILL OFFICE XR: LUMBAR SPINE (2V), PELVIS (lV) This patient returns returns with back pain with flexion. He has pain with standing to his low back for what appears to be.' a major portion of his activities. He gets relief with laying flat or almost flat. Previous x-rays of his LS spine done in 10/98 showed no gross bony abnormalities. He has no complaints in regards to his thoracic spine, his clavicle or his AC joint. PE: His back flexion here is to 750-800 with pulling pain to his low back in the area of L5-S1. He has lateral bending which is full and extension which is full. He has slight pulling pain to his right back with sitting root signs at 450-500. His straight leg raising signs are slightly positive for back pain at 750-800. His patellar and Achilles reflexes are normal reactive. He has no extensor toe weakness or apparent sensory changes. XR: He had a left and right oblique completed. These show no evidence of spondylolysis or spondylolisthesis. OX; PL: Because of his persistent pain since 10/98, we are going to schedule him for an MRI of his LS spine from L2 to Sl to r/o a bulging disc or any nerve root or cord compression in the face of his increasing disability. We shall see him in 2 weeks to evaluate that study. He was advised to use Nuprin or Advil, 2 tablets 2-3 times per day for his pain during this time. Thomas H. Malin, M.D. THM/lms RTO: 2 weeks \) ~ ,~~fj ~~'?J -- v,..\ " f\~ PATIENT UNDERSTANDS INSTRUCTIONS ,=~'~~~- 1M '" .. February 8, 1999 RE: MCCLOSKEY, WILLIAM Page 2 .... b" ...., '\'" ~~ ~~A.. >ql- ... /.0~.~~...~......~.. q~- <<-'<'!?o0' , //-w.:: . '. V ~Qvc,'?>'::; "/.J ...~ ~(j~ !O"ol;o'l-~"'~ tor; ~'d~(j{>,\ "" ~,'\ '\ , . Elsewhere there is mild disc bulging present without other areas of focal protrusion. Thank you for referring this patient to us. sincerely, #~&~ P.Z./lag , 1\" " () 'Z.()\l'\ J..Jl " " -r.-;,"': ~.:-';' ~-") 'c~~;....j'- ~h,""-.G. --,,_ _~! , , ~ " ~- - . ~ ~ - ,-',c;, "_.[: .. ''{;;Y\ ?f SUSQUEHANNA SURGEONS LTC!. , . '532 NORTH FRONT STREET, WORMLEYSBURG, PA 17043 PHONE (717) 761-4141 FAX (717) 761.14,; October 5, 1998 J. Stephen Snoke, D.O. 1800 Carlisle Road Camp Hill, PA 17011 Re: William McClosky Dear Steve: I saw young William McClosky in our office on 10-05-98. As you know, he is a 17 year- old that was recently involved in a motor vehicle accident and hospitalized at Holy Spirit Hospital. He comes in for a recheck starus post his accident. The patient is doing reasonably well. He states that he is very sore and his major complaints involve the left shoulder, his mid-back and. his left ankle. His appetite has been good, his bowels are moving normally and he is otherwise having no particular problems. On examination today, his head, ears, eyes, nose and throat were within normal limits. His chest was clear, his abdomen was soft with normal bowel sounds. There are no masses or tenderness noted. On examination of his ankle, he had minimal swelling and really no tenderness except a small amount laterally. On examination of his shoulder, he did have some tenderness and swelling along the AC joint. It was somewhat difficult to tell, but it seemed as thought he AC joint was disrupted slightly. He did have reasonably good range of motion of the arm. His other complaint was of back pain and he had some tenderness along the paraspinal muscles in the mid-back. On review of his X-rays, he had a normal left shoulder as well as a left ankle X-ray. He was noted on the thoracic spine at approximately T-7 to have wedge compression deformity which they felt was probably old in narure. GEORGE 8. FARIES, JR., MD KENNETH W. GRAF, MD MICHAELJ. PAGE, MD RONALD G. BARSANTI, MD ANGELA M. SOTO.HAMLlN. MD JOSEPH P. ESPOSITO, MD ROLANDO A. CASAL. MD A. DAVID FROEHLICH, MD ANASTASIUS O. PETER, MD LISA K. TORP, MD GEIIER.'l. SURGERY MINIMAlLY INVASIVE SURGeRY COLCJN.REGTAL SURGERY BREAST SURGERY ONCCl.CGK:AL SURG~qy VASCUlAR SURGERY lASER SURGSqy ~.- ~,1IliiiilIlII - . , . .' Octooer 5, 1998 William McClosky Page 2 I have discharged him from our care, but I mentioned that he should se.e the orthopedist who saw him in the hospital. I am unsure as to who that is, but we are,planning to look that up for him and call and obtain an appointment. My major concern is about a po.ssible AC separation of the left shoulder, as well as the back pain he is experiencing in~iew of the X-ray showing what they though was an old wedge defect in the spine. Thank you very much for allowing us to participate in this gentleman's care. I remain, s, MJPfepg. ,,~ .;,-<- 0;> "ili;('" ~_. .~~ ~~ - ~~... I ,~ ". " - OP~"0t'/\EDIC SURGEONS OF CENTRJI- L., LTD. , . , . MCCLOSKEY JR,WILLIAM J 151 E COLUMBIA AV ENOLA, PA 17025 ACCOUNT # 84623 CHART # 983217 SS # 216983169 9/25/98 ADMITTED HOLY SPIRIT HOSPITAL 9/26/98 SEEN IN CONSULTATION (DR. MAURER) HISTORY/CHIEF COMPLAINT: 17 YO white male passenger unres.trained in automobile accident that occurred 9/25/98. He.' had left shoulder and elbow contusion, left ankle injury and. . multiple abrasions to all extremities. No loss of . consciousness; no apparent thoraco-abdominal or pelvic trauma. He has no significant back pain. PHYSICAL EXAMINATION: His neck is supple, nontender and he had mild tenderness over the A-C joint on the left; none on the right. There is no ecchymosis or crepitus. Glenohumeral joint motion was normal. No elbow tenderness or deformity. Pain in the area of the left hip. No ecchymosis or deformity. He had no significant pain with push/pull test of the hip or rotation and he has normal range of motion. Knee exam was normal; no tenderness or swelling. He had tenderness over the lateral aspect of the left ankle, minimal swelling, no ecchymosis, no instability or crepitus. Neurovascular exam of all extremities was normal. Xrays were reviewed. There is no evidence of neck or back injury and there was accessory navicular noted in the left ankle with no evidence of fracture or significant soft tissue injury. IMPRESSION: Multiple trauma. PLAN: p.r.n. AUTO Ice, elevation and analgesics. (transcribed 9/29/98 /rah) Follow-up in the office " NO' va ~I$ . G 1998 Ct:1v i::1.J 1 ~ - ,::;,. "_;~ , , "~ ~. ~ '~~ ~-""'- 1".i -- , l~" 11o."#4} , . , , . . 11 ~ '? ClINSUlTAnON REPORT I rr~ c/~ ~ /J- ) ~~ ~ 7 y-2! '0-> 0--" f' ,.. P'_ . I . AL- _ A./ ~~......e/ ~ /r77 r-~tii---.-d~ - ~~ ~ A~~~~~rJ~~ ~@J{J~---7~ w/~%~. ,zv#r~fi<h- ~ JU Li;;C-, /Va -~.' y/'~ ~o.J/P..~ -('Y""-" "-. r^--- W ,V~ ~ -/IM~ lV- ~,0-...0r-- ,; Y l--y< ~,/ ' GJ J1 c.j~+-f-~ uJ-% v-&7~=.-L;d ?" ~ ~ :::.J) ~ --:~,/ "~w-dJV J,t:;J. !VV .Y<-"f/'0c-1fi ~t fl'~- Q. <4-~ Ih ' "". - IV' 0 (l;/;;";I1 ~ h.' ~vv .~ -- 19d;~ 4~,iY A--- jj) L- G d--- uF: w.JO r~ ~~ 'O--<-pf~ -- i0 ~C/,/ -f ~ ,~ V ...&)~" ~Jy, /1-'. <,,--~',,- .# t,.;..e- T"-- .s2.-'-'...t-r ~/J ;-;u- (/~ x~. ~u ~~-yc~ ~'<-7 /i/~?7 .~0~:;zJ~:);j 7/~ o W~"" '''''~" YJZ-r / ~ o CONSULT ONLY ~.- REPORT REQUESITD . ~ "GARDING OR ~ 'ON"V"' 0' co. _ C~ J) t- ."''''''' _ D..r[ ,. '" 1.1<IE. DI'EC1EDT~ 'N'\r1.' l\ol-l~ h.n 1}- (' ---vvu j "p.~%@~ r....( Plol . . nR 30.77 . I " I. L 1& M . \, , ~Cl""~ \y( ~C4 OZ .. I , I J;" I; c n . / I I 7C l; I III lfl 'AI J ,-~~.~ · $ I '[CL(~r[l ~~I 17 SU5wuEHAIRl " , ., .1I-1e-lI11 '"'='= iiW, ,'''"'<J .' '~ -~ ...w_ ." itiIfllWl,. _"C; '04'- ~ ~ '-.."I ..".,"""""" cb;~iiiii.II{SERVE SuiIe 0 17lee_d P.O.8ox3Ot7 .,.. l' -. PA 19356 PH:61~ 1~2922 FfV('61~7 , . , , Recordex Acquisition Corp., dba SOURCECORP HEAL THSERVE has been retain~ by the Medical Record Department of Milton S. Hershey Medical Center to fulfill requests for copies of medical records. Enclosed are the reproduced medical documents spedficallyauthorlzed by the patient or hiS/her legal represenl1ltive. We wish to emphasize that the increasing demands for patient data pose a rtslng threat to the ronfidentlality of the patient's medical Infonnatlon. . SOtJRCECORP "HEAL THSERVE strives to I1lke every opportunity to safeguard the patients' right to privacy as outlined in the AHA's Patient Bill of Rights. Spedfically, all patients hqve:the right "to expect that all communications and records pertaining to their care will be treated as confidential by the hospital aAd any other party entitied to review certain Infonnation In such records." As one such party, we ask that all information transmitted herewith be treatEd with utmost respect and the dignity such personal medical Infonnation warrants. Please be advised of the following state and federal disclosure statements governing medical records In Pennsylvania: ~1S~tlOO,'&3S'~~d~;ixi m~fiOO\'reO:ii:dS"~:IlY.fI$@l:tOnfidei\&iiiY-'rules: "''''2'tl:.jilD ....,j..2i'i.'lTi';". .'..",'..,.".. ....!bit.... ,'....~.. "a;;'" . ..' tOlUief-ai;.;.,~.. "';;;;;,' 'U.'!r'''ro.~fi.!~' f'(~'~"~;:"~'~~}~'~'~"":~6i!~'~~'~":'~~;~!:':~: ib!~Or.as&~~~4~'dR~~ ;~i:.i ....; "..': ;-.": ." ~.: -"~~~/\:.:;::' ThiSjnfOl'riiatiol1'lias been disclOsed to yOu frOinstate fecOOisvihoSe COllfickintliliitY.iS piOtected J>V.state statute. 'State regulai:lon$ liinit yOur light to make any further>diSdosu~of this Info.rmcitIon without prior ai_ofthePerSoo to whom It pertains.'. ..... , 'This: InfOrmatlOo ,baS 'beeIL(llsdosed to:. YQU' from~recoi:dS ~ by:fl~!I~ Ia~, t~~rila.:~w:~bit$.:~:;fr<ioj.~Jdi\{J:anY..~:i1~re of #I~)~~\un~. ,fi/rthei"dlsdOsurels expressty~. WUie~ ~ofU:te~.~.~:It~I!lS' cor Is a~ bY. tne,<;:OnfidentiaIlty'.Q( the HlV~ InfOnfiati~. 'A<;tP . ~ QeRefal 'atrthoiizatlon 'f9r t1le release ofinediGil oi'Qther InfOrmatkin Is not suffideIlt fOr this purpose. .' Based upon guidelines provided by the Amertcan Health Information Managel}'lent Association, the records should be destroyed alter the stated need has been fulfilled. We thank you for your cooperation in maintaining the patient's right to pOVacy. Each medical record has been carefully reviewed to assure that proper disclosure goes only to the authorized Requestor. If you have any questions, please do not hesitate to contact us at 1-800-525-2922 and one of our Customer ServIce Representatives will be happy to asslst you. " EXHIBIT ~ ! 3 " <:\ 0\ ~ :cl~_"",,,,' ".&/liI<-' ~I . ~~... l. ..>~ ..~;: . f 9 -<I tl9' .5 L./. ,'", Lc LIFE LION PREHOSPITAL TRANSPORT NOTE PATIENT NAME: SHOLLY, Glenn PATIENT NUMBER: 360516 SEX: M SS #: DATE OF SERVICE: 09/25/98 DATE OF BIRTH: FLIGHT # 98-1717 . DISPATCH INFORMATION: Dispatched to Cumberland County to assist Medic 81 and BLS at the scene of single vehicle motor vehicle accident. SOURCE OF INFORMATION: Paramedic and patient. HISTORY: The patient ,was a back seat passenger of a vehicle that swerved off the road and went down an embankment and rolled over. The patient climbed out of the vehicle and was walking around at the time of initial contact with BLS and ALS. The patient claims he was wearing a seat belt and unbuckled it prior extricating the vehicle. Prior medical history is negative for any medical or surgical interventions. No known allergies. . TREATMENT PRIOR TO ARRIVAL: The patient immobilized and stabilized on long board with C-collar and CID device, oxygen via nonrebreather 10 litters 100%, two IVs established, 16 gauge in the right hand remaining right antecubital to LR at KVO rate. No medications . received. The patient has a bandage on his head. PHYSICAL EXAMINATION: The patient outside of the ambulance, quick assessment shows patient is alert and oriented to name, date of birth, age, and location, remembers recent events, pupils are equal and reactive, facies intact. The patient has large avulsion laceration on head with oozing of blood, dressing onto avulsion. CV - pulses are present in the upper and lower extremities, skin is warm and dry, capillary refill is brisk" to IV lines are established. Pulmonary - breath sounds are clear bilaterally with equal chest expansion, no shortness of breath, respirations even and nonlabored, trachea is'midline. GI/GU - abdomen is soft, nontender. Skeletal - upper and lower extremities remarkable, negative to any pain on palpation. Patient denies any pain on palpation of chest, abdomen, or pelvis. LABORATORIES/X-RAYS: TREATMENT/PROGRESS: The patient told of disposition at University Hospital, secured in primary position. This is first patient of a Page 1 of 2 "--'6!11_ I --~ ~ ~~". _'~'m"- ,,-~~- }.i 1~ .,-~,~-_._- ~, . CfC/ ~or34 PATIENT NAME: SHOLLY, Glenn PATIENT NUMBER: 360516 two patient transport. Medical command given update in flight to university Hospital. TIME BP P R Cardiac 0, Other Monitor Sat 0020 170/64 82 14 normal sinus 100%- rhythm 0026 154/70 88 14 normal sinus 98% No rhythm change from baseline IMPRESSION: Blunt trauma with avulsion to scalp. . DISPOSITION: team leader, included long was 150 ce. The patient moved to trauma room 2 with no valuables left with patient. The EMS board, CID device, and C-collar. Total report given to equipment fluids infused nICTATED BY: f. Michael Dubin, RN(~9' Jeffrey arledge, M.D. MD/smt D: 09/26/98 T: 09/28/98 08:35 . Page 2 of 2 PENNSTATE ) ~)" CoUegeQfMedicine ~_ University Hospital. Children's Hospital ~ The Milton $, Hershey Medical Center . " '.3bOSlb r~~~J!i;' ED TRAUMA/RESUSCITATION FLOW SI-IEET TIME PT ARRIVED TIME RESPDNSE STAT PAGED wrf2:j AGE SE PRE-HOSPITAL ~MB/MEOIC # '~~~/'----""'" HELICOPTER ( ~__...!-- ON.SCENE .L INTERHOSP LOG_ YES_ # MIN NO ENTRAPPED YES # MIN NO SELF EXTRICATED YES NO G-COLLAR GIDITOWEL ROLL LONG SOARD/KED SPLINT UNKNOWN SEDATED , PARALYTIC AGENT _ M~STTROUSERS _ABD _RL /LL ~~ ~R --' 8M OF INJURY AR ~R EJECTED _ WINDSHIELD DAMAGE SPO ANEQUS RATE _ PICKUP SENGER 1FT BROKEN FRONT _MIN MASK UMlt ~ Mfl! _ TRUCK _ FRONT _ ROLLOVER SPIDERED BACK _ MOO _ 02 CANNULA UMIN_ . VAN ~ BACK NONE X _ BROADSIDEO HEAVY _ ASSISTED RATE_ ~ UNKNOWN UNKNOWN STWHEEl BENT _ R L BVM RATE_ MOTORCYCLE BICYCLE _ ATV HELMET NONE UNKNOWN _ _ AIRWAY (ORAUNASAL) BED OF PICKUP _ OIVING _ FAll FT GSW _ CAUMM INDUST Al SPORT _ ETT (OR~UNASAL) SIZE _ CR1CQTHYROIDOTOMY BURN OROWNING _ FARM STABBING PEDESTRIAN T R TR~CH SIZE .' ~f't\J16J~ESOSCITAT(ON " Cs/~ri~Ao/J?' :n ',' $GtlWCtllVlA$CAlE' . 'yo S onlaneOllS Opening To voice Response To '0 , None 1 Best Oriented Verbal Confused 4 , Response 1M fa riatewords 3 3 lncom rehen Ihl sounds 2 , None I 1 B." 0'. command Motor Localiles aln S 5 Response Withdraws ain 4 4 Flexion 0 3 3 E:ctension ;, , None Total Apply this score to GCS GCS portion 01 TralJrna Score '8EVI$ED'TflAUMASCOflE GlASGOW 13 -15 COMA 9-12 SCALE (GGS) 6.8 (TotalPolnts 4-5 fromallOve) 3 Systolic Blood Pressure . >89mmH 76-89mmH 5Q.75mmH 1-49mmH NOPlJlse Respiratory to-29lmln. Rate > 29fmin. 6-9/mln. 1.5/mln. None Tolal Revised Trauma Score ALLERGIES PRIMARY $0 V.EY PER PHYSICIAN CHEST RESP B 0 BREATH SOUNOS V-1! T SOUNDS YES NO PRESENT _ _ PRESEN PAIN v.::: ABSENT _._ /MUFFLEO YES NO CLE~R (/-'J WHERE ;;:---/ DIMINISHED _ CREPITUv:-_ . YES NO CHF..t SYMMETRIC~L WHERE J YES NO .:dOO'REIIJIITlES MO EMENT SENSATION P lSES LA L d,:" .-- ...,'.'i':".." Scores , 1 o Region Wound Type PMH MEDS PARADOXIC:/.::AL MOTION YES NO N SOFT RIGID DISTENDED GUARDING BOWF1AlUNDS ~S- NO OECREASED P VIS STABLE UNSTABLE OPEN WOUNO BLOOO AT MEATUS VHalSlgns (Adott) , 1 3 2 VHaISigns 1 (Pediatric) Neurological Exam Weight 2 Peds Only 1 Vehicle Eft'" AS , 1 o INJURY ECK AYPATE~ YES NO JVD YES TRAoREA MIDLINE ~YES NO 1. OPEN FRACTURE HCo-t(J,l{lSl$ 2. AMPUTATION A-I.BR:sON GUNSHOT WOUlllCi c-co<<'"'.:5!OIl 4.EFQRMITY L~TIOII TAB WOUND SW-S1h9lJNG 6. BUAIl P-Pt.U...S:: 7. PAIN ~?J~~ 8 RASl-i T_T~8';!3S 9. CLOSE fRACTURE S-SE.,,<,:J,-:',!J'I .:~Wi~: ''''. . '",ADUI:TJP ,J)lA,TRU; 1 Oistal Limbs or Only Minor Ope Wound SBP> 100 and HR<100; RA10-25 ~11ISJ:D1JiAUMAINDEX . 3 5 Chester Spine Only 3 Bum,OpenFx. Open Tronk Wound SBP<80or Pulse > 150; RR>3Sor<1D SBP<50or Pulsl!> 150; RR>35or<10 Only Responds to Pain 6 Head,Abdomenor , eAreasolnju funk, Mulliple Blont Injuries No Pulse or Brealh andHR < 120; RR1D.25 Agitated,Drowsy, UncooperaUve 20-30 kg Oeath 01 Assoc. Occupant No Pulse or Breath Unresponsive .I .:' , I' I;, :1' e ~'': ." 1 ;re {. 10-20kll Delormrtt:=.30. 55-65 Years Old .::10 kg Rollover/EjectIon or Fall > 2D" 66-80 Years Old T-bonellalerallmpact . 1/lctim'sSlde Over BO Years Old Total " 1 of-- , , "1:r( MR 690 4/96 Original - Medical Record Yellow - Trauma Service Pink - ED ED TRAUMA/RESUSCITATION FLOW SHEET ...J.....:..:, .,. , ~~ ;, ! ','I ;,/ " ., , TI,' ;: ;, .;;, ; , , it i :1 '1 , " , l 1 ~a!!-!!~Ae;tJYB ,'~1lilE.~Jio,~!G~4t\Y~IiQ'N:;J? ~{.r""~~;~k'~(l~,l;~'IGtiI:s.~~ti''';~:;Y;; B' '" Brisk '. F = Fixed Time Pupil Pupil.. , iDl1 Time Warm S = Sluggish D = Dilated Size Rea1 MotO{CIUC~Y~U! ~ ~~ca~rdiac 1M 02 . 9 Lnes N = Nonreactive ~ , S L ~RA R L m;BP 1'J;I~S~ J I B.H. J~ ..."... "" I/,-'~ k-" I >'T 17. Ll.. 'Ai 1\, IJ 17<, ..,- If!: (J7.. l' PUPILS MM / " '1'" ~ ~', ~', ;: ~: . WWI ' . ~ ~~ " R.~Umr R'j92.1.o.. . ,:~ ',111<:-1 ?; i" '" \/ lAaS 1 CW'IO' f\ECOf\~ I~. /.- it90t..-r ~" AJ3GIARTHLB TIME BACK, ~ " ,:c;,i'MEDICATiqNS , ' 'v \V.j CBGlPLTCT TIM" DRUG DOSE I~UTE INIT~ LYTESlRENAL ""\ I "Yc '/ GLUCOSE (J 7/, )" f) (<; ().fll ~ W ') -KU2f PTIPTT AMY~_ I tJ'')L '51~1I fI CK/M - "\ t (rrL ::ts-rL " ,......-r&C U _ ~EGrkCY )()--v ()y {9.{ o~^ ~ (, ETOH(MEDICAl) 'J/)" ,A {,,1 rf. "\.. J1 A ( UR DRUG SCREEN 'I ,'~ ..... ~ LEGAl URINE DRUG / {)(.L. II 75 /i'D A"/'\, "" l LEGAl BLOOD ET9(i I / " I I OTHER I( ~ (, r SITE I ~~~~~~~ptll 9~~~1 J\ N ITO RINARF/";;"",,,,.i;:f,',')'" FOLEY YE In NQ HEME:Y+' SIZE ''/ V FR \ po, BLOOD AT MEATUS. A '/AJ ~J INSERTED BY III! I<Y\A : I/'{ ~ -- ' ,~,\10,ilil,,,,)E','GA ",' TESTII)ij\~'i'""A'j ~ RECTAL lJlnE _ HEME + ( . TONE,{J GOOD ~ o DECREASE o ABSE PROSTATE NO AL \ DONE BY DR 0 ~1'iX!i,);JVG _ N/G (ORAUNASA[-, (' \ SIZE _ FR '- J INSERTED BY _ PERITONEAL LAVAGE , DONE BY DR RETURN 0 CLEAR 0 PINK o GROSS BLOOD AMOUNT INFUSED CC AMOUNT RETURNED_ CC FLUID TO LAB YES NO i'~;~i(!'i"+,';1:AIlDIOJUORACIC~.Cij~;,;;,':t~.,, _ RCT SIZE FR CVP R L _ LCT SIZE FR A"lINE _ R THORACOTOMY CUTOOWN _ l TKORACOTOMY BY: _ TOTALS.." _ PERICARDlOCENTESIS DONE BY DR 12 LEAD EKG YES NO ~~~~("?;~~4iit'~NEUROlOGIC~~0";'::~:~<JiS;!?:~f~~-- TIME ICP BOLT INITIAL READING HALO DONE BY DR . ';',)(~RAY Time /. ~ C-Soine Lateral AlP ~ mrs elvis _ Cystogram ilE~~emities Cranial Abdomen Chest -Olher == Angiogram :~~~~_', ~"_ ;:::~~;i:jt'f~~{fil~:~~rl{::tt:~r~i1;f~~~Bi:~rf~~~QXR-,'~~:-:r~:t::tj.- '.-,':~, ::::<:,~:,:> -'-; ';j;,~:-::~t::;~.- ..~.~;-,'; ,::_~.'~ ,; IV # TIME /J SOL'N ITE ,AMT. LEVEll ) '{ .r , /CUe:.. ;.J -..< /1 (I ,'-;"1T.! /,)/",'1. ,<-- I, r I r "I J-,L..J Y Il.lL 71 V), '"v1 ~ . j {J11/1 /, i v . tOTALS',~~ " ... fi (\'1\ , '-Ii! I '.~' .'" '''"''".' ~~~~~~1j~~&i[llijili~%~~lmJtQ9.Q~~Bg'B'i:2t~::]ri~t;~t~$~fit~~:!~~~~,.;:f5~t~~1t~~1I~(1 PRODUCT UNIT# LEVELl TIME SITE AMT. INF. INIT. _' :':"iji}j;'t~~~:~,l:~~~~f~ "t-~~: ';:-';";.- ..<,., -,-"- :;,. :('-';"":~:'J!,- ',' :~-I{t~~i,~~~~!~i~~;ji~tfi~$.I~!~~f~1~riQuTPuf:~--)~;~~:~-;Y(ii~~'~j,:~:"~:A~.;";;~jj~~.-'~::; URiNE LCT TOTALS NG RCT EMESIS 1,\ .-... //\ '),J-IIJ -4.U YI ... , "L'(,/I/l-c . . ~ , NURSE'S NOTES IS ~1 0 W!M- ;CJJa.:IIJ ()~A ~ ~ j ~~ \'Or,+ ~)0nY-;;;d-C. _.iv)l':r bAIlA ..PY' 0 lJ/. C r: AI --J. ~ /1.! >f../Ai?J 0 /I OY j fAfh / ()9'J-Inr/.. >CJYak",j)JA A Jt()rf ;:r-0l,h1'Jv1.. r1 JA (}//lA /I)/i"Jhft.da+. ( aL.-/l f~ l (' jp, v1 a, AJ'Y\..lAA tJJ..J - (l J() A ()nli/C'Y rn A.l ~p .I./l<jj...p f Al '0''/'/ ~ (fV1 J1 A ~ ?!to ,8Yv\, L ( & A',/\0/!..d d9fOA P(/7:tf(j 0 c:: ",lYl. " Ifl .r :A '-!7CJ U/ .L/r) J ",.A I< ~ Ai) ---- I m~ r>yr ( ) d f) Cd Ai/7 / ) \/~J lL j'JY:>'hCrJ)~ 1 V'S f't+~2.- ,-+0 'L~(}, f0'd,~ ~AA~, ------' J2._ G, j../lA//;02. vJ () ~ cB -:/C,a,.tn ~ fA) J.i I /3n. 5d 0' <9- c.)J-. A \1L7tvrv I -,... J !J~ Il/\ (\ II A Ah\ ) 11/11 jj v ~~ (AA1o,liP --< 1- -IJ^~/I^'!A"- (, 'oA/\'r./llh/iYli/;,flM'jl----/'th/l # \ j,,\.A..-tdl/!:fJ(; orfl .N!1),^( ~() -f\:;r 7.J{) nh1$uFi':iJij ,-;;/1, 1A1yO( -- IAl (] A (VI rUMo jJ cI - f)()-q' IY V ') /.--;7:, neE/! ~ (1/ rV\ (( ( rlP: '77'1 /V:-- ~)f)SS- ,/ L M A-t 11 '" 10/1 ^ J &/) '-- V I(U /II\- cr ^ if'! ~ I 0 :) r$ lAt.. A II () +- li\ /\ I \V fA If./ ~ ..- ff /1.J d.;,.., /) \( '" fL.ll/V1fi r rmLdY ~'Y l/k-tA 0/\/1 'N 0.. (0, ..( f1;;l L.{/Y\A '.PIt ) \~0\i - -:I..-~I ir-t... k!1'Orl'-- ~a JA< )) kJ1 dA AA~ 1]L.U~ K~ '1' C, -r'}{\ 0, c;-l fi/lM /\J:v1 ~d5 (\~.-f ./J ~~~ Yc j( /7:J- C6-~..- n Jir...(, ( ) /I) '-'~ /)11 /(': rrf;;'o~n'[~, 1'1/1 Jl ff.. IL) '\--IM1 111'laJ Cv ~ ~ " ,\ ~ ,..\ J ,/ ,/ '\.\ '. I Support Nurse: <=' '-1 . rol.... I", to I.. Documenting NU~ e: I \.I I ' /~ : fiii\ijBE\1ll\tiQtI$~;;l$:i~"ii:ii;1;;(Jt~f:i;_\qfQtt'filIf:ld:tiJ1N'Sj.yif~1Ft ~f~\;li':~..fff~'";"':\;tiM~~~,,ii\~$;titpAG ;;;!@liflB., ED.' BVM = Bag Valve Mast LCT = LellChestTube NS = Normal Strength EDDR 11 ('}"" (' AI-"I A ET = Endotracheal Tube RCT = RightChestTube W = Weakness TRSURG\ ""'. '- ~. L V LP'--V ABD = Abdomen PH = Pre.hospital FP = Flaccid Paralysis PGY 4 ) RL = Right Leg LOC = Level of Consciousness R = Rigid PGY 2 LL = Lell Leg PMH = Past Medical History DCB = Decerebrate Posturing PGY 1 RA = Right Arm BH = Bair Hugger OCT = Decorticate Posture PEDS LA = Lell Arm PEDS ~~~~~~fo;~1 ['A/ Jm ,/ ~ ~ 6~C TIMEORNOTIAED ttY7l (.' ORREADY (//')V TO,oR/'l d.n ..L ANESTHESIA FAMILY NOTIFIED @ ',dL I lR>' II i'5.ITn ^ "h\ '-'- o^ n /\ NEUROSURG RELATIONSHIP ~ ~ "j(), ,.0 ...! /\ IJ ORTHO CoSPINE CLEARED 0 ~I ?O NO ~Y DR. X.RAY C-COlLAR ON 0 YES P ASPEN 0 NO -: L CT VALUABLES 0 W/PATlENT 0 SAFE 0 ONE W/FAMll>>1)O. I n", VA RT o EXPIRED CORONER NOTIFIED@ -I::f CHAPLAIN MATERIAL EVIDENCETO POLICE 0 YES 0 NO CONSULT OFFICER BADGEi CONSULT CONSULT TRANSFERRED TO VIA ;;,:;".~, ~~'!.HIiI.""""'--~ --, ,""""",,_Ilii..w ~. J"'-IW ' ,=-, . - - l,'-~,~ e <. .",) ." ~I~-~' ~~ - - , - ~-...""',~~- --ll"-. "- -~ ~M'.1",il .- - -I ..IL --............,...,...-..-:...."" """"1.0'1....-10"":1.. The Minon S. Hershey -- H al, th S te Medical Center ,~e ysm _ -' .... "- -'" '/'" "':", '~'.', r , 3bOSlb TRA UHA [Hrp " J60SU i . v nVA~,'iLt" VV ,/\ Dt ;J',fj., TIME.... -, "OG S NOT P 0 1NPtT'7'\'T ( JS.,.. Om"~( I NAME. TITL T5lt 7~ )/ (~' on.{f Jr1 ~ VI J) 1/R;r1 /\~ (~1- -<:;.j~A '7 WJ fl", J"r-?~7i ,.-. ()j dio, y, 'n, Il''--- 'flJ ./1/ .0 PI , ' L<- UJ'-hV\M \..C '\ 00 rb +-0 C; -C ~ a In ) L -:..L.. '" _ '} rJ(1./i'h ( , r~ A A.J2. QArL1 J 0 j J::::t, 1,1 J~ 11)/,\ ~ --:!\IT () ,,:..pC" 7f VI: ') (JfA tn. /:7J ~ . o( ~ ot LD '. '/\..1~ \ ~A r \. uA: ~Cc ~ ~ c::;,'=~.. a ~ J/V-.-t"- .'-' 1; ct I r ~)Y'\,fA. U), () L) -- ,^ / lU---t I /11 0-, ,~/1l1L 7f(1)1{J!...~~Y7v\.()7[7SIlM~l,l[ ~ /1./7 '~;:~ v I ~ Dj', J A,^ -hJ f6. n a rl 'fA \IT }J~ h -C-, ~Jn i:ru ~r:!'2 N; Q Ii: I ''''l ~ - / l <ii'I-fL ( rfrli '"1 P;-" <--)I (A( P III m()(.J2J~.~ \f.J.. A r II... ()~.. ~ r-- ( ill lOAA ,1/1 --li- I flr.1. It "ui' -/. - 'r L.- \ 11 (, 0 011 V tD 1 {,]z1J:xx2. . r I /,J,,--W / L;., (J], ) / /II, I -1 dr, , ~ ,r\V, ;;-j..,-~, r p ~ '/j-rffiVfo rtfl J-r)TG ?l-t: 't/ISll, jn ....1--. , . (), '^ J~ :;" '1'0g AA.t:7/J ., ArrJ(~ ~ I /or 7' c; .~ A ~ A ,;.,:7l TZ: ~,m.N V L ~ 11./r)..J II -V f.....r;J.; r\//~"'-'7 //'N 'TI)(J'J.h O^ ,TA 01 .~ 't-" ). PI 1,A.A..i ' V; ~ J\ I A ();" c...::: Afv\. ( ? ro..,.. A ' fIJ / 1 ''''1 Jroi -\-! , \l ~ - / /I C) /\ "2c ,",I:Q o.<::n fi.\f! ~ ~ ~/' /I 1'\ I A' n --ra J I~ A '--Iff1 () A J nl A }-J(' ./1 7, . I' ~( .f 0 A....l-I\ rY-if I) A -( ,('{(] f Aoo dO"ffll; if b.:).rDU\ ."'- 0... iJ/1/1/ r I " () rl IA'h '-<,- (5~rL 'JIJ! (l I 0 r;-P;f)A1)'" i /I, n 1 Ie:; ( ff'- ,\ (()(j (. (J 'liA /7r r ~ Ii A III A A A 0 I f:7 '" /\ ^ __~./ fI t)2/c;-vf rc 121170 ',h 1f?/a.J (JA'nJP7d)/ I kL7! .' \.; , , , , , " \!' ( I ~-c ~~~^E~O~T i' n \ 0 . H-., l. / (;(j !A-r, ). ~:;) , MR 6-2 (1191) -(\ / / / /h PROGRESS REPORY ( J I' / J! r/'W LY f ~~} -~ ,,- Co~' -"~'-""'"'-"UlpJ;ill_~..~..UI.i,I~~ ~~ L "~ . 'ij'.lM liIiIlillili' "< ~ ,," ~- " - ~-~~ ,- --"""';t~ n:'I"lI"l0IAIC . "" ' .:, 'peMil10n S. Hershey Medical Center Lb ~ ~ f'lSI b -- - U ...i." , ",~""",,,,,,' ',":"?'-",- ' . --, " " 1;_,1 , TRAUMA RESUSCITATION ORDERS TilAUIf~ 360516 rM~'i '1!l 00 00 :1,' :,; Dat~', : ';J:Tim:e c'i rde 11' Ow ,ed ( (,!! ,'-~ \VI ""\\V \ "vv , .~;'::'?.:) " " ! ;.-;L~;) "- ~ '\ ell) rlJ\ MR 691 4196 , " ORDE~~Date and Sign All Entries) Signature of Physkian / Circle Orders Desired /\t or"N.ur~Attendingt(!)'prder Oxygen: Yese {No } Airway: Yes,f,iQ Intubate: Yes! No J'. \ \ "'" \ fLUID RESUSQmlrr ON: " \ <...../ \ _' - /...., \ \ \ " "t f'o.. \ Ringers Lactate, ffesJ/ Nm IAJ I 0 y., L-' I.J.. U\:0 '\ '\ \ \ \ \Y Normal Sali""" V1iir -No ) "-LI"- '\ \ 'j..':, '-.J , fFP: Yes (NO) BloOcf: Packed cells Yes No J \ / 1 ~ '\ ""X-RAYS ../'" _ -= ./' \ 1\ , C.Spine: Lateral--""AP/ OdontoicV"Swimmers r\ \ Chest /" Extremities: " 1\ ~" \ Pelvis: / .....-t-..." '-.... \ CTScans: ./ / \ \ (,\ y Cranial /Abdominal/ \ - C/ Chest Neck Other: ^ 'l ~ ./ ABG / CBC & Diff / Platelet Count ./' AmylaselLFT ./'LyteslRenal "'---protimelPTT / Medical Blood ETOH .......-Glucose ~ Legal Blood ETOH CK/MB .....-- UA "7 "~e "- Urine Drug Screen ./'" / T & C x 3 Units Type & Screen \ ./ PeritonE;lal Lavage Fluid LAB: , ' \ \ '\ \ '~\ ~ Ii\ \ l) 'I----' \'.. I~, \ \ I, \' '\ :/\ '\ f'--/ I\...J '" MEDICATIONS: Tetanus Toxoid: Tetanus Immune Globuli~: ANTIBIOTIcS: { { " / "'" \ \ / \ \ \ \1\11 -"^ \ ~/} Y \ \IV'-..Y OTHER.:MJ:DICA IONS: ^ /, / \JJI'IN ^UC\/ I7J//J(j(!.}LI'Ii-Al r,-ifi'uA 3~ 'I ,--; ~n~ ) GENERAL: "\ \ /"\ '-" Cardiac Mohltan -Yes ~ Follv=< Yes No NG Tube ~ -NO) Rest s 't.Io ) EKG: Yes\. No ~ \ '-..:::/ ChestTube: R: Yes \No L: Yesl No J Cervical Collar Yes INcn Aspen ~ No \,J _ \V ~ /J-Au./ 0 ~= V M,D. Signature: / '/ I ~ ./ -- J ate::::;;;o' ~ "1 ~ ~ II\~- "- \ " 1'\'\ I ......, (\ \\ Y \. '11\ 'v / h TRAUMA RESUSCITATION ORDERS Original - Medical Record Yellow - Trauma Service Pink - ED ,~-, ~-'"'~=-IiI'~ -"~,., ~". ~-,~--~' ; Jl........_ ~ '" ._ ~ _1 ~ ~~ . -. - -U-------~-U.O-. . ~ He~th System . ' me Millon ~. Hersney Medical Center t 3bOS16 , , , , TRAtlH/. 360516 E I>fE R 00 ac 00 "C' , TRAUMA TEAM SIGN-IN SHEET -- DATE TRAUMA NUMBER E.D.! MEDICAL COMMAND M.D. TRAUMA STANDBY: Paged at Hrs. Trauma Response Stat: Paged at Hrs. TRANSFER CARE OF THE ABOVE PATIENT TO THE TRAUMA TEAM AT . HOURS. TEAM MEMBER NAME TIME,OF ARRIVAL Trauma Attending Trauma Team Leader Senior Surge ffrauma Resid~nt. , Junior Surge ffrauma Re$id~nt Junior Surgeryffrauma Resident E.D. Resuscitation Nurse 1 E.D. Resuscitation Nurse 2 Anesthesia Attending Anesthesia Resident Neurosurgery Resident Orthopaedics Resident Pe4iatric ChielResident Pediatric Junior Resident Re$piratory Therapy Technician Radiographer Radiologist EDEMT Chaplain C.T. Technician Trauma Coordinator/Resource Specialist OR Nurse/T echnician EmergencY Medicine Resident .../ c , :L :). ~ CONSULTING SERVICES SERVICE M.D. NAME TIME OF CONSULT TIME OF ARRIVAL , Original copy - Medical Records Pink copy. Emergency Dept. Yellow. Trauma Services MR 414 Rev. 2/97 TRAUMA TEAM SIGN-IN SHEET , liiiiiil rcnuouu.c ~n5111gCl ) ~ l;Iealth System - The Milton S. Hershe)' Medical Center .,JUU-J.L.U U!:._U I 'liOi;:J'T ~ !N$-. N1ME SHOLLY, RboM Nrl. 1 2 1 - 0 8 PHvSICI~ t L l :..: "" . ""-",, Gl~",~, f. SEX C , J . ~ '." < / "\Q' '" . \. v" , 0 , ..,,, 0 'O"TE odlt"'fH1 Pll, R .. i:6f5J INSTRUCTIONS: 1. IN CASE OF NARCOTICS.ADD NARCOTIC UCENSE NUMBER TO SIGNATURE. ALSO INDICATE' DURATION OF ORDER, DOSE AND INTERVAL. . 2. STOPPING OF AN ORDER.WRITE AS A NEW ORDER. DAlE & TIME PRESCRIBED lllEATMENT, MEDlCAnON AND DIET -I r/J .:b DATE 11ME&JNmAl. ":,",'. "'''''''-1 c 'Yv,~t/ ,'.\'.','."'1 .1 - -. - ------- .------.0-- ,. ,Health System , The Milton S. Hershey Medical Center ?,' NO. < , ~ NA"", n. lb 8~' q RO~~:;> CO . PHy!iltllilll Y. Cl E', '" q If 8 <;:f~'t " DlITE OF BIRTH ^ INSTRUCTIONS: 1. IN CASE OF NARCOTICS.ADD NARCOTIC liCENSE NUMBER TO SIGNATURE. ALSO INDICATE DURATION OF ORDER, DOSE AND INTERVAL. 2. STOPPING OF AN OIilDER.WRITE AS A NEW ORDER. TIME PRESCRIBED TREATMENT, MEDlCAllON AND DIET DA; 11ME&lNmAL .<,')j PROVISIONAL DISCHARGE ORDER I PLAN 'TO D E TOMORROW. . PENDING: cu/. , r. ,.0::",) - . Inpatient stay. "Ulnlll"Q~ _'""1 r~Illl':)I.aU~ \J~lslIlg~r ". 'fIealth System The Milton S. Hershey Medical Center ~ NO. """'l! (""1 r- T f r"'l ..... NAME ::: ." ",; ':.; ~ ':) ~\ ~ h g g.lf Q,B 3.y. ROOM N6.H 0 l L Y. G l [ f~.... !: DATE OF SlRTt: PHYSIC,AN' 2 , . C 8 0 t/ ~ S /198:; . . MIS A j INSTRUCTIONS: 1. IN CASE OF NARCOTICS-ADD NARCOTIC LICENSE NUMBER TO SIGNATURE. ALSO INDICATE DURATION OF ORDER, DOSE AND INTERVAL. . 2. STOPPING OF AN ORDER-WRITE AS A NEW ORDER. PRESC lMENr, MEDICATION AND DIET DATE T1ME&lNlTIAL ,~O\d. PI \f\", LG.AA,Je:Ji ('Y1e..~ -CI it (Z47J C - ('(}a c- ~ .1 tf&-1 .. '.,.:C[ -[ _"-1 .L CllU':>U1U:; Ut::~:SJ.l~~C~ ". ,f{ealth System The. Mitton S. Hershey Medical Center ~ NO. -Sr'!""'l OJ~_O nUQq-' ~ ~AME;:;'l 0':;1.0 OC..1 i Iq~".{.6.*.:)l.t ~ooM~OLL Y. eLE '.'. , DATEOFBI"1)-I iPHYSlc7A~ 2 1 - G 8 O. ;' ., 5/1 9 e J . . M n INSTRUCTIONS: 1. IN CASE OF NARCOTICS.ADD NARCOTIC LICENSE NUMBER TO SIGNATURE. ALSO INDICATE DURATION OF ORDER, DOSE AND INTERVAL. 2. STOPPING OF AN ORDER-WRITE AS A NEW ORDER. DATE & 11ME PRESCRIBED TREATMENT, MEDICATION AND DIET DATE TIME & INmAL '\. o o \1} ----- -. ~~..---.. ~,C>- ,,:.,::,.-1 PENNSrATE . (...u....."....M....id..., II,n...Jl)Ilk"!'il"I'Chiklr>:""I"""'",1 Th<M;I"..~.lk"""'yM,"'i",I('._.,. MEDICATION ORDER CLARIFICATION PATIENT # D51lo ROOM # C'J ilal-(S NURSE: ATIACH THIS FORM UNDER THE LAST ENTRY OF THE DOCTOR'S ORDER FORM ~ l'enn:State Uelsmger ". 'Health System The Milton S. Hershey Medical Center ~-', -;,/,' ->~~;,'~:::::~~.\f:~~fI{~:\~~< . ),":, ' NOo 1(....., """"16 l. ':;OU:J I, J SJ;;X f ~ .. NAME ROOM NO. TR A UIf A 360516 "">,,imi6F!lIRiH' o 0 :;'~;'-...~;(~;- INSTRUCTIONS: 1. IN CASE OF NARCOTICS.ADD NARCOTIC LICENSE NUMBER TO SIGNATURE. ALSO INDICATE DURATION OF ORDER, DOSE AND INTERVAL. 2. STOPPING OF AN ORDER.WRITE AS A NEW ORDER. -I J ~ ~: a lV.' 1/2 II 0 c.d ~ < \It\ \V C:i( Z 0 -I PRESCRIBED TREATMENT, MEDICATION AND DIET c.. ~ ~ "- , \/~: -, ,:;,':-'\',1 ~ G?f.c,"'l~ 'Z. e.. , ~V"<; G:,l'2'" ~~ Jfi-o ~ -I DA: T1Mf &lNmAL '^-1 rMk:? O'?LfJ -..,.-';:C"":.' '"~. ~~ rt;'11110U1\'v'-..l\...-.1.;:)1.1.1.5'-'1. '.',Hea1th System . . ':. . The Milton S. Hershey Medical Center " , f 3b OS lb 'I ., TRAUMA HISTORY AND PHYSICAL EXAMINATION TnA UHI, 3605i 6- fMeq 00 00 00 - ~C:' r'1'') ~ 1 // ("'j 'I: \ I ! :~\.~ J.^ I. , . i \ (/ i!~ '\' l I \ ti ) t~\~ \ \, . , i , Time: Ty}l~ olTrauma IStMVC Belted? o Pedestrian 0 MCC o Fall 0 Burn o GSW 0 Stab ,!'ieid,llesuscitation Airway: Field Vitals: P: 'gt.j ImmDbi/izaliDn:c...-~ Field Notes: ti'5l~lI1a:~istotv," , R.O.S. Amnesia? 0 Yes 'pnll1aij! ~~rvey " " Airway: Ci!I Patent 0 Obstructed Intubated: 0 OT 0 NT 0 Trach Breathing: S] Breath Sounds: - Circulation: P: l{i) BP: tSzpg RR: '20 Disability: I,!?J.Alert 0 Vocal 0 Painful Exposure: Vxvo.P \~ Procedures: 0 NG~Tube Urinary Catheter D A'line: D CVP{s): Chest tube: 0 right 0 left ""..- PSH: DapL: t~~~#d,~~~rv~c:'2nd\>1 s:Temp: ,HEENT: Head: 1M "La<... Ears: TM's: B Face: Maxilla: Jilt Nose: l€/J} q, Mil Mouth: le,o'-~ '<V<' Necle Tenderness: ^.rr Chest Wall: Tenderness: (;6 lungs: Gr It- =' Last Meal: last Telanus: u." J:.,v. '" ""- RR:..zc...02 Sat wr P: lI1>....-sP: Eyes: ~ Battle's: Mandible: :rn.r Dentilia: :i:'V\- Dentures: "_ Crepitus: Crepitus: (5 Trachea Ml: lj-e...o Crepitus: Heart: Abdomen: Distention: Rectal: Tone: >'If..- Pelvis: Stable: BS: Heme: e> Tenderness: Tenderness: Prostate: Vascular Exam: Radial Right/Left +{-t' Resl nl Signature " ^- COPYRIGHT, 1999 PSGHS MA 611 Aev.3198 Femoral -'<{-t- DP -+(-t' PT -tIt' TRAUMA HISTORY AND PHYSICAL EXAMINATION DYes 0 No o Assauit o Electrical o Other o Airbag IV's: 2.. BP: IBt Fluid: LEGEND: L -laceration Cfx -closed fracture ObC-open fracture Ab -abrasIon C -contusIon RR: IS Orlg . Chart Copy. Treuma Services It I, TRAUMA HISTORY AND PHYSICAL EXAMINATION . , , ;$~~(j"(!ary$uiV~y{corii.j"" .." Extremity Exam , :;;~ ~".~~ .~;'rffi{ ~~, ~~ ~~ ~ ':' .",'.. ,":~""- ':.'::.."...", , ,-,}-:,,:,-,:. -', :~~qr:olUglc\IJl:xaI1!C' " Cranial Nerves: Motor: ,.',' ~ ',.;'": C1-7 Sensory: Pinprick Proprioception DTR's ~ t~ A t~ L 1~5 ~ :S':~r-I'" \, \?,.s m;() Pelvis: S<h Extremities: .j(g!i!!!:i',;; Attenll'lna SlvnatutelDatelrlms Mil 611 Rav.3/98 '\~ i . ;\ ! :1 I '.\\ : , ' \ ~\' \tl' l( ",:1 'II, \~\ lfj LEGEND: L -laceration Cfx-c1osed fracture Ofx~open fracture Ab -abrasion C -contusion - <.! I , iii \ i' , ,I ~I ~-, ij \;::: (~ ,j ;ii ~ Glasgow Coma ScalelPeds Eye Opening '-None 2-0pen to Pain .l..- Open to CommandNoice WSpontaneous Verbal Response 1- None 2 ~ Incomprehensible/Moans to Pain 3 - Inappropriate I Cries to Pain 5-.;: Confused I Consolable (]I Alert I Oriented I Interacts Motor Response 1 ~ None 2. Decerebrate 3-Decorticate 4-Withl::lraws -Local1zesPaln Obeys Total: Tro onin: Myoglobin: CPK: Amylase: ICa: Trauma Score Resp. Rate SBP 0.0 0.0 1.1'9 1.0.49 2.,36 2-50.69 .25.35 -1.70.90 10.24 Id) >90 GCS 0.3,4 1.5-7 2.8.10 A1H3 W14.15 Total: VIA: Drug Screen: ETOH: BHCG: :p TRAU A HISTORY AND PHYSICAL EXAMINATION Orlg . ChM Copy. Trauma Services : ; i I !,.. . . . . "_.''-IL.. ::' ':J ,~~ ~-, 1',) 8;:J'-)q S'-lg(~ -= t,' 7 ~ College of Medicine IIIIIEJ Un~versity Hospital- Children's Hospital ......,. Thl Mitton S~ Hershey Medical Center , S ''I(iL L y GL 7 1 Z 1 .::;s v" ) .1.198 , " ;' J. D J L L ,', Pt , K " ~; f 1 ~ ... ., ~ , ADMISSION NURSING ASSESSMENT - ::!^!~;AD1~~l~t:L~~~~~jNAM~:=EREN~ OUTPATIENT DE7lJA _ Oci:{oli.'110 I Jfi I JIIO ADMITTING DIAGNOSIS/CHIEF COMPlAINT / PRESENTING SYMPTOMS HEIGHT NAME WElGHr=' ::;: ~ LAST TAKEN U) iil", Oz 130 ~~ Co a w " I- Z W 0: 0: " o ;< I MEDS BROUGIfT FROM HOME: NO o YES-SENT HOME o YES-SENT TO PHARMACY FOR VERIFICATION PATIENT/FAMILY CONCERNS. QUESTIONS 0 NONE YES, EXPLAIN SPECIAL EOUIPMENT NEEDS ~ NONE 0 YES, EXPLAIN, RECENT EXPOSURES; DCHICKEN POX 0 MEASLES OTHER: MR 470 Rev. 9/93 White - Chert Yellow - Pharmacy -0, E!: ~ ~. 'i? rr1 '" ~ ~CI f;:;~~%~ :!~ ~~~}:: '2 ~ , , " ?j ~ 'PAIN FI\US NEURD ..;a ii':::....s;:::>.Q ;;:: Z m z m, 1:.5:a;.~ ') '" " =--e.- -fll.D ~ .. ~ z !S.~:.~ :< !l! " d~; :y ~~~ '{;1 "'0 " ,)>; ~ ~ j;i 0000031 '" ',," "-l ~ ~.~ z <> .....~g - Z ;l~ rr1' '" =' :;.~=- .l:' ~ ,,'" :lI .~ ~.~. ~ ~. 0 z:om ~ a c: ~o z I ooooo~ ~ :!:.. :0 _.g. en :::;'Q ~'T\C/)(J)"'O _ 0 (') 8 O::mc: Z ::S::I:o /' ~5~~~ G') l'/.IO == ~ . ~ 0 ill ~~~gm ~ ::r::~~ 0 Ul ~!!Co z Gi ~S!ZZ~ lil ::::l(j)~ UJ ::r"ni ~~~Qg m <!". ~ Ul "'8. Ul ;;::0._. " <z~--z ~ 8:95. ~ m ~o 0 ill z" m, Q ",~t'tI " ~ ~t5 z -;<: 0 o o~ -I (')0 c z z m ~ ~ m &1~ 0'0 0- ~!!C g ~ oel < 0 ~ o :::IE < o ~~ '9':Jlo~cp~~ ~ Z .g~~grfc:: .e ~~s~ Ei ~ - ...- ;1! z ~ 0 0 z m 0 , ~ <::> '" "'-, DISCHARGE PlANNING PSYCH/SDCIAL 0'" ~c ~~ m~ "m 8~ oZl om 3~ ~6i !i! Om ~g !;1; !<i!; ~~ ~~ q 1;;::; o ~ m '" !l! ~ ?; ~~~I "Oil "':1: (j) ~~~~~ ~ ;'i~2l,,~ '" ;!:Il:!:l;;s ~ ~i!~Fi3 iil !:(i!~c:lZ z .,,~mm:?:: -I m::I:;::6;~ !:J r-ozhi~ rlI :i!~""IJ-IC/) 0 ~w~g~ ::: s;:om~~ g <2:! m, m mQ -nm z [;!< g(g ~ 2J~ CI):D m ~~ ~Q :r ;;I> g~ g ."li!! )>o::!i! zm ~iR ~ ~ om ~ Q ~ /' '" '" m c 0 ~ ~ 1; m g ~ 1'I1,,00~ ,.), < -z~m ~-< 0 -<~ at ~ ~.~ 1: m::!"{T: XZ~(1) ~~:gffi z-l:>m .. :: -i 0 ~mm ~2~ omO ~~;H ~~~ oCl'l5 m m g m c :g o "l ~ ~ il c m m o\~ SKIN 'tl'ij~;;! oom8 fil ell c: ~ '~ r;;i 8 ~ > -< ~! ~ ~ ftJ.....~,~ o 5 ~ ~ 15::::l ~"\m :;:~Jj'"" filg1ii m :II!J' ~:;; m ~ ~ ~ ~ OJ ffi G) ~ ~~~J!!P:g -< m :;::::.-.-:i!! ~ m C := !:1J -,--:ti ::I: ~ -I o:::j -< C :I: y:j ~ - g ~ ~ Cii (n 0 r::! Q) ~ en -l '-l 00 -l .0 Q (") m:D - 00 ~ om m ~ >! ~ 3 ~ m.-I o 0 ~ ~$~: id8]P~ g ::0 ,. ~ '" g -i rn ;:: ;'? ,,"J\~I!~_[jk~MlKJiI~~"""'illj_rIIlilil~ PENNSTATE ~ '. College of Medicine _ Ul1iversity Hospital' Children's Hospital .... The Milton S. Hershey Medical Center -"~ ~ ,,"'",- - '-~." ~" ,I ...., r- , , -"\ -~ <..-' ' ,) :~) ~:J!..;C- C..! G q -:" I () . ,-i " r , H':-LLY. 71?1 -'.:" C I, r ~. \, ~: l1 / " 5/ 1 Ct?, :- . . t,': Pi. ;; 1-< 'j :-1 i'1 1 ~ J , I ;_ l, ~ . F!~DIATRIC PATIENT HEALTH-CARE PROFILE liVelcom~ to the Children's Hospital. To aid us in planning your child's individual needs, please help us wiih the following IOformalion. You may use the back of the sheet if necessary. Yes No o IlZI Has your child been hospitalized before? Explain: Most recent surgery: What is your child's understanding of this illness and/or hosptalization? >- Il: o I- !a :I: Yes o o o z o i= it I- ~ Z o oa DC! DC! DC! DO DC! DC! Feed with: Yes No 8 ~ glW o ~ o C! Cl z :> ::; ~ <C c ... o III W i= :> i= o <C C!~ UI z a: w o z o o Yes No O'IZI o IiZl o ~ olC! O~C! ..J <I: () o en Yes I;? MR 290 Rev 8/94 No ~ [2J Food allergies? If yes, explain: Weight loss/gain in the past month? If yes, explain: Trouble chewing or swallowing (gagging, spitting up, tiring during feeds, trouble breathing)? If yes, explain: Any problem with the following: nausea, vomiting, diarrhea, poor appetite? If yes, explain Jar baby, food Table food Tube feeding Commercial formula Breast feed Feeds self C! bottle <Special texture? Favorite food/drink? <If yes, what type? Amount: oz/day Special dilution/additives Schedule: (how much/how often/night feed?) cal/oz C!cu Day C! C! C! spoon ~ht C! C! other How often does child have BM? Last B Uses diapers Training pants Uses toilet on own Trouble with urine or BM? If yes, explain: Does your child have any special sleep routine? Explain: Did you bring a favorite toy/security object with your child? Explain: Special Home Equipment and/or Nursing Agency Any equipment or special needs? (e.g., monitor, oxygen therapy, orthopedic assists) Name of agency Name of agency Phone # Phone # Does your child have special fears? Explain: Do you have any special requests for this hospital stay? Explain: Do you have family concerns that may affect you and your child during this hospitalization? Explain: Will your child need help with maintaining school work while hospitalized? Explain: Would you like a nurse to arrange for a chaplain to visit? Father I2Jln sho/ (l( <:).t<.. Mother Guardian/significant other: No C! Alternate name and number if unable to reach parent(s}/guardian: 7,~a- IcraG relation Does your child have brothers/sisters? PATIEN "-. ~ " ..- --'n.;,IliIDM~"~~ - ~' Il ~i"".' _.i..ll --. ~.....".~ .""'- -"- ~.^ ~: _....1 .cvlIl1l..JlaU;; U\Jl~lllO"'l ".' Health System ' The Milton S. Hershey Medical Center . f3b0516 > > > . PROGRESS REPORT TRA.UKA 3605!{," ' r ' DATE TIME PROGESS NOTES o INPATIENT o OUTPATIENT NAME - TITLE vtlllLJ rtJ UJ C- 01;. 2.-( ~ ? f? WUa .~ VI- fl if c...r M-J <P /.Pl.u...J ~ !vis V(....!MM1' !-- /~ ..,1 -.-;.-...--,f '-...::.:-." w PROGRESS REPORT MR f-2 1'10'1 ~o"'_^' ''''.Jj-~"",.,,,~~_." ._~ "....I:II'!II1 ~"""'uil.......~,""" j~~~ ~"~~" ~, - " ""-~, ~"~~ . "' .ti'~~ ~ Yenn~tate Uelsmger . .~. I1ealth System PROGRESS REPORT The Milton S. Hershey ,.,edical<;enter i ", J'~:' C/e.-...- '~~ T :~ :J ~:. 3 b 0 5 M .' . . ~"ql~F~~ 4/'~OI DatefTime PROGRESS NOTES: (Include Name, Title) 2!J t4- rU V --) 0. / ~~o PI It () u.... ' MR 6 Rev. 2/95 PROGRESS REPORT -- ,. . ~~'.",...._ ~ '~ .L" '" ~" ~ . - ~ - ~- ~ '~'S, PROGRESS REPORT ,. , , . , PROGRESS NOTES: (Include Name, Title) \.)~ q. €)~~O MR 6 Rev. 2/95 PROGRESS REPORT ~t- ~ "- ~ """O~,_" _ "~,__~; ~.'."~.. " = ~ '. 1"'""","..-- "1II1llJll!"~ ~ J -~~,_ ,-'..~- . .~o --, ; ~ PennState Geisinger "~' Health System The Milton S. Hershey 'lIedical venter v [, ' "-::- C _I - ~:;-_l~, ,I '_ '. . it. " ., ---.. , c PROGRESS REPORT 2' ( 1 : Q C- > ~'PAIf ~','J//>fb; ct~ -~. I"~,(' ~1 MR 6 Rev. 2/95 PROGRESS REPORT _1' ...-..- "' " ~~ , , " ~~ ",",', " ,PROGR~SS REpORT , , DatefTime q-~l-'if t,:;d""'" ' " i!PROGRESS NOTES: (Include Name, Title) II p 'i /<.5. lIyF- vs S L.--o ; J - 3' Cc n'. . ~ e~ ,-~ Olc f'u ~c~ M<o MR 6 Rev. 2/95 PROGRESS REPORT ;,u::JiIIlllU.Jl\L -~ 1 Ualr:3;lr~ "~~ - '~,~~I.!J,j".J"J.:J~ I '11-..w,."J,."JL~_<. 'L ~ ~,~i"". -.r<=~=.~, '"~ ~ ~~ - - '-~b~~I~~~~~~~I~'" -, '""~ ~~"" , '~- ~ Penn~tate Gelsmger . ,~. Health 'System The Milton S. Hershey ~edical genter i., , "' ,- , , :.... J -~' __ i.. ,J 2 ::: :_j C C\ ~ :j C " , PROGRESS REPORT ~H~:LLY. 71/1~0~' OIL L ~ ': , GL I,:' ,,' ~ / 1 4 I-~ j . . P l I L i-< H DatefTime ! PROGRESS ~OTES: (Im:lude Name, Title) , MR 6 Rev. 2/95 PROGRESS REPORT o ...""~-''''c'"~'''_ i~,<i__I~ ~.~..... , . " ,~~ " ~ > "- '~ h4IL"ro:-"~_ "'""li,IIl;ljjll) ~, .' :>.'..Ii -;;' ~_ ~~Jt'enn:state uelsmger "~' :Health System The Milton S. Hershey Medical Center , ' ::-! f'"""\ ,- 1 1 .......-)1.. C IC '; :::~ (~::: ~+ ~,1-' ~; L L Y . " , / 1 - ' eLf' . PROGRESS REPORT , ~', : : L ,. ) / 1 r; f. ~ . P l : '_ "t' \. , .) Z 6 1 ~ //;;M ! " 'I,,', ': PROGHEpS ~mESi: (Include Name, Title) ~ tV DatelTirne , MR 6 Rev. 2/95 PROGRESS REPORT - .~ "~: DDJIliIIl!iIiIi1J;r_ "-;;--:Ji(!j '. , , CONSENT UPON ADMISSION TO'HOSr'TA'j ~/C~Sl4 TAfENJ''l3lf ~ SHOLLY. Gl(~~ ( ~ "21-08 04l0~/t98)..M PATIENTNUMBER 4DMlSSldfW.lC5. PE T f R w I, (or'~ on behalf of ()../ ho/l, knowing that I, (he/she) am (is) suffering from a condition requiring hospital care, do hereby voluntarily consent to such hospitaare encompassing routine diagnostic procedures and medical treatment by the medical staff of University Hospital, The Milton S. Her. shey Medical Center, their assistants, or their designees as necessary in their judgement. I am aware that the practice of medicine and surgery is not an exact science, and I acknowledge that no guarantees have been made to me as to the result of treatments or examinations in the hospital. For the purpose of advancing medical knowledge I con. sent to the admittance of medical students and other observers in accordance with ordinary practices of this medical facility. This form has been fully explained to me. I certify that I understand its contents and have agreed to these provisions. ", l t PA TIENT NAME WITNESS PATIENT'S SIGNATURE Patient is unable to consent because he/she is: ~ minor o undergoing emergency treatment o other, describe ~~~ ti: SEST RELA IVE OR LEGAL GUARDIAN SIGNA TURE .p.~~r RELA TIONSHIP HOSPITAL MEDICAL RECORD RELEASE AUTHORIZATION/PERSONAL EFFECTS The Milton S. Hershey Medical Center may disclose information about me and the treatment for which I am being admitted, in. cluding copies of my medical records, to (1) my health insurance company, (2) my employer, (3) any person or firm which conducts reviews of my treatment at the University Hospital, The Milton S. Hershey Medical Center on behalf of my health insurance company or my employer, and (4) the peer review organization designated by the appropriate governmental bodies to review hospital utillza. ~on under the Medicare program. This information will be used by these parties to determine the medical necessity of the medical and hospital services I will be receiving, and to promote timefy and appropriate discharge from the hospital. The information may also be used to get all or part of my hospital bill paid. I have read this consent and understand it fully. I have had the opportunity to ask any questions relating to this consent, and any questions I had, have been answered to my satisfaction. Safety deposit boxes arl' maintained in the Hospital Financial Management Office for the safekeeping of patient's valuable per- sonal effects. Patients are urged to avail themselves of this facility as the Hospital does not assume responsibility for any valuables. The undersigned accepts the full responsibility lor any personal effects taken to the hospital room, including but not limited to such things as money. dentures, eye glasses, contact lenses, hearing aids. radios, and television sets. ~ ~(]JY)dth WITNESS PA~.IENT/.I/ i/// q/~Ci.lq2 \/_~~ ./ft.ARENT OR GUARDIAN PA TIENT RESPONSIBILITY AGREEMENT I. the undersigned, do hereby acknowledge and accept financial responsibility for the payment of all charges For services rendered to ~ 0 II I, the undersigned, do hereby acknowledge and understand that all charges not covered by ins rance will be payable in full prior to or upon date of and time of discharge. I, the undersigned, authorize the hospital to make a credit investigation if necessary. I hereby assign and authorize payment directly to The Milton S. Hershey Medical Center Hospital, Pennsylvania State University. Shouid the account become delinquent, and should it become necessary for the account to be referred to an attorney or collec. t. n gency ~ r c lectio or . he undersigned shall pay the reasonable attorney's fees or collection expense. S' ed Date 9/tU..e./CfR itness Date q /OLU.. / q J1 DATE DATE All persons will be accepted for admission without regard to race, color, creed, religion, national origin or sex. ,;....._0 L-I!"'!'''"< . -"""-~"o~~.~. o"_~I"=", iL "~ ~I",,~,. -.;j'"t~' >.-~~ ~~...,~,,-~~"'.~'"*"~-~~ ,'''if~~ ~ - Iii! '-,.;;J:. .Iii).. PeulflState Geisinger ..... Health System The Milton S. Hershey Ml'dical Center \J1X.-<- 1'N---u- ~ ?~(') S/& SPECIAL CONS;ENT FOR OPERATION OR OTHER PFlOCEPORE Condition For Which Treatment is Proposed: Sc.aJ.p ~;. ~ nAJ~;..,v. 1. I hereby authorize my physician, Dr. ~ , and/or such other staff physicians or resident physicians as my physician may designate, to perform upon mE! (or the patient identified above) the foil wing oper 'on or roce re: . n this consent form, this operation or procedure is referred to as the "procedure". 2. My physician has discussed with me the items that are briefly summarized below: (1) The nature and purpose <<;lUhe proposed procedure: ~ ~. . (2) The risks of the r pos d_procedure, inclu ing the risk that this treatment may not accomplish the desired purpo e: (3) The feasible alternative treatments: ~ (4) What may happen if the proposed procedure is not undertaken: ~ 3. I am aware that, in addition to the risks specifically described above, there are other risks that are present with resprct to any surgical procedure, such as severe loss of blood, infection. cardiac arrest, and blood clots lodging in the lungs, any of which may require additional corrective surgery or result in death. 4. I understand that during the course of this procedure, unforeseen conditions may arise which could require the nature of the procedure to be altered, or that another operation or procedure be performed. I therefore authorize my physician, or other physicians designated by my physician, to provide such medical treatment, or perform such operation or procedures as the necessary and desirable in the exercise of professional judgement. 5. I am aware that the practice of medicine and surgery is not an exact science, and I acknowledge that no guarantees have been made to me concerning the results of the proposed procedure. MR 21 Rev. Page 1 of 2 12/96 SPECIAL CONSENT. FOR OPERATION OR OTHER PROCEDURE .t -'" ... ~~, - """ ~~. -'~~~ ~ .' ~ ~" '. SPECIAL CONSENT FOR OPERATION OR , . OTHER PROCEDURE 6. I understand that, during the course of my operation, it may be necessary for me to receive blood transfusions or blood components. I authorize my physician to administer these to me if it is determined to be necessary for my care and treatment. I understand that an adverse outcome from a blood transfusion may sometimes occur even though the best available practices have been followed. 7. I acknowledge that the information I have received, as summarized on this form, is sufficient for me to consent to and authorize the procedure described above. I have had the opportunity to ask questions concerning my condition, and about the procedure, alternatives and risks, and all questions have been answered to my satisfaction. 8. I impose the following Iimitation(s) regarding my treatment (if none, so state): ~ 9. I authorize the staff of The Milton S. Hershey Medical Center to preseve for scientific or teaching purposes any tissues or parts which may be removed in the course of this procedure, and to dispose of them. 10. I authorize The Milton S. Hershey Medical Center to permit other persons to observe the procedure with the understanding that such observation is for the purpose of advancing medical knowledge. I authorize The Milton S. Hershey Medical Center to obtain photographic or other pictorial representations of the procedure, and to use such representations for scientific or teaching purposes. 11. I certify that all blanks requiring insertion of information were completed before I signed this consent form. P< ~JIIA (Patient's Signature/Date) (or signature of person consenting on behaK of the patient) / / ) Dr. for the procedure. CJtI11 f? provided the information summarized above and obtained the consent /Jt1t:;J / ? -,;;.r; -~ ature/Date) I CONSENT TO THE ADMINISTRATION OF ANESTHESIA, RECOGNIZING THE RISKS THEREOF, POSSIBLE ALTERNATIVES, AND SPECIAL PROCEDURES INCLUDING THOSE DESCIBED ABOVE. I REALIZE THAT PROCEDURES DIFFERENT DR IN ADDITION TO THOSE DISCUSSED MAY HAVE TO BE USED DURING THE ANESTHETIC. I HAVE HAD THE OPPORTUNITY TO ASK QUESTIONS WHICH HAVE BEEN ANSWERED TO MY SATISFACTION. Witness Patient (or parenVguardian) [For elective procedures, this consent is valid for up to 60 days from the date of p~tient's signature, unless there is significant change in the patient's condition or consent is revoked by the patient.] MR 21 Rev. Page 2 of 2 12/96 SPECIAL CONSENT FOR OPERATION OR OTHER PROCEDURE . ~ -,.~' . illi'lhj'''IIl~r~i . -~. Lob" ~i,....." ~, "' .~~-, 'GlIiliil ' -l'_~,,,,, '~'" ~, ~'L!Ii W~1M . ""~~':::'-"~1; ---",,~ ,",J._.LI.J.~""" '-"-.J.~.J."''''6-.J. . Hl;l!lth System . . -' ~I!! -0' ..z !'len, Zlll ~a:::: ~" OlO H .. WOl "Z 0:0 <li US:!' OlO i5~ ,> ..U wZ Uw ~ij Ww ..< L ~ 0_ !i~ ~f ~~ 8!i WO 0- 0: o T Milton S. Hersh M, ieal Center lOI~j "I ~i-~~:~ L Y . . C l , ' 1<;'[, " t,. , --" I,)". " 2 (. 1 ) ~ OAYOF OISCHARGE FORM .. i'/1ysician HMCResident a ~"" 'tI-rwJ . ti.. Name/Dosage/Route/Freqt.lerx:y Name/Dosage/Route/F~ ~ (It, tnh 11/ tV t>i I fl .e4 ~ Nu~Cam Aide/Homemaker PhysicaIThempy :"..1 a...,/ RespiratoryThempy Qoo.Jpll1iooaI Thempy $peechiThelapy SociaISeMoes Nu1ritionaI Care HospiceCam a...- J ~ z Mi.w.f-. On At ~~:~E~ ~' At am/pm am/pm On nderstand this Wlitten statement regarding my discharge instructions "'" R.N. Yellow-PatIent Fandcopy-FacUltyI Agency Qate ~~~ 1/ Timed/lo am / pm M.D. Qate DAY OF DISCHARGE FORM "-~- v' ~ --;j',-,,;,; , ' '::,'lI" " PennState Geisinger Health System Health Information Services M.C. HU24 P.O. Box 850 Hershey, PA 17033.0850 DISCHARGE SUMMARY PATIENT NAME: SHOLLY, Glenn PATIENT NUMBER:3i>9EH + LOCATION: q"%Q3 SEX: 'T DATE ADMITTED: 09/26/98 DATE DISCHARGED: 09/27/98 DATE OF BIRTH: ADMISSION DIAGNOSIS: Motor vehicle accident with multiple trauma. DISCHARGE DIAGNOSIS: Scalp laceration. OPERATIONS OR PROCEDURES: Debridement and repair of scalp laceration. BRIEF HISTORY: The patient is a 15-year-old white male who was involved in a motor vehicle accident on 9/26/98. He was a belted rear seat passenger. He reportedly had no loss of consciousness, and he was not amnestic to the event. His GCS on arrival was 15. The patient was found to have sustained a scalp laceration on the left side of his head, extending from the frontal to the occipital region. A plastic surgery consult was obtained, and he was taken to the operating room for debridement and repair of the laceration. The procedure was done without complications, and the patient tolerated the procedure well. A CAT scan of his head and abdomen were essentially negative. Imaging studies of his chest, pelvis, and C-spine were ,all negative. The patient's postoperative course was uneventful. The patient remained afebrile with stable vital signs throughout his hospital course. He was ambulating, eating, and voiding without problems prior to discharge. A JP drain was removed on postoperative day #1. He was subsequently discharged to home in stable condition. DISCHARGE MEDICATIONS: 1. Keflex 500 mg p.o. q.i.d. 2. Tylenol p.r.n. 3. Bacitracin ointment to wound twice daily. DISCHARGE INSTRUCTIONS: Diet: The parents and the patient were significant problems or changes. Regular. Activity: As tolerated. instructed to call for any Page 1 of 2 leU,. 1tT111''' - ...."""~~""""""" ~ "~ ~.", '-\,1 -\ . '\ ~ . . :PATIENT NAME: SHOLLY, Glenn PATIENT NUMBER: 360516 FOLLOW-UP APPOINTMENTS: clinic to see Dr. Hauck be removed. The patient is to return to plastic surgery in one week. At this time his sutures will DICTATING MD: Foong-Yen Lim, M.D. FYL/ean T: 10/02/98 15:54 ATTENDING MD: Peter W. Dillon, D: c: WP Clerk Randy M. Hauck, M.D. GOOD HOPE 1830 GOOD ENOLA PA FAMILY PHYSICIANS HOPE ROAD 17025 \ Page 2 of 2 -- ~ " ,l~ '" ~ ~ " JjW '~ ~-, ,-';' 't," -~~ '., .. Health Information Services M.C. HU24 P.O. Box 850 Hershey, PA 17033.0850 pennState Geisinger Health System OPERATIVE REPORT PATIENT NAME: SHOLLY, Glenn PATIENT NUMBER: 948934 DATE OF BIRTH: LOCATION: DATE OF SERVICE: 09/26/98 SEX: M SURGEON(S): Randy M. Hauck, M.D. ASSISTANT(S): Linda A. Camp, M.D. PREOPERATIVE DIAGNOSIS: 20-cm scalp laceration on the left scalp from the upper forehead posterior to the occipital region. POSTOPERATIVE DIAGNOSIS: Same. OPERATION PERFORMED: Debridement and repair of large scalp laceration with placement of closed suction drainage. ANESTHESIA: General endotracheal. ESTIMATED BLOOD LOSS: Approximately 50 cc. TOLERATION: The patient tolerated the procedure well. INDICATIONS: Mr. Sholly is a young man who had been involved in an MVA. He came in as a trauma patient and was evaluated in the trauma bay for significant scalp laceration. The patient had emergent suturing placed to secure bleeding of the scalp and pressure dressing was placed in the emergency department. Due to the significant nature of the laceration as well as a degloving of the left side of the calvarium, the patient was taken to surgery for surgical repair of this wound. OPERATION: The patient was brought to the operating room and placed on the table in the' supine position. General anesthesia was induced. The patient was prepped and draped in a standard head fashion. After shaving the head, he was prepped with Betadine. Debridement of the edges of the scalp wound was performed to make a smooth edge along the incision. After copious irrigation with Cystex irrigator, ~-inch Jackson-Pratt drain was brought out posteriorly in the hair line. The deep layer of the galea was closed with 3-0 Vicry1 running suture. The drain was on top of the galea. The subcutaneous tissues were brought together with 3-0 Vicry1 interrupted sutures. The skin of the scalp was closed with staples. The skin of the forehead was closed with 6-0 Ethilon interrupted sutures. The drain was sutured in with a 3-0 nylon stitch, secured Page 1 of 2 OCT,. .. H~ ~ _H ~,_ ;..1;- ?, " - .~ ~,,' -l,b, - PATIENT NAME: SHOLLY, Glenn PATIENT NUMBER: 948934 in place, and found to be adequate functioning with bulb s~ction. Sterile dressing was applied. The patient was awakened,and extubated in the operating room and taken to recovery in stable condition. DICTATING MD: Linda A. Camp, M.D. LA c: /fv> 1./ T: 10/26/98 07:50 ~ Page 2 of 2 :~iOi;>>jl~ill~~l!IUIIill'oMiIiIll!Ii"ill,jj'~~ JI......... ~ .""."", '" ~ " '~, '"' '~''"'lr ~~~ ,-.~.' " -bflJJ" '_:.' "c, , , PENNiSTA TE College of' Medicine . Univ~r~ity Ho~pital . Children's Hospital The Milton S.: Hers~ey Medical Center 360516 SHOLLEY, GLENN 04/05/83 HAUCK, RANDY M Delay Codes atlent'ln ime: ,02:27 , urge"n Start ime: 02:41 urge,y End DATE O.R. 09/26/98 05 Add.on [ Y ] Level: Instrument Count: Sponge Count: Needle Count: SERVICE PLASTIC RE ONSTRUCTIVE SURGERY Patient Type: INPT FTE: 20 [ N] (C)orrect [ C] (C)orrect [ CI (C)orrect (I)ncorrect (I) ncorrect (I) ncorrect (N)/A (N)/A (N)/A Anes. Start Time: 02:27 Incision T,ime Time: 02:58 Patient Exit Time: 03 Pre.Op. Diag SCALP LACERATIONiWITH PARTIAL AVULSION Operation REPAIR OF SCALP LACERATION ,,'~ost.Op Diag, SAME AS PRE.OP DI,!>.NOSIS Attending Surgeon HAUCK,RANDY Assistant CAMP,lINDA Assistant CODE Wound C:;1~s$ification 3 Scrub:LYNCH, DAN Relief Name: Time In: Obi Scrub: Out: ... ssistant Circulator: WEBB, JODIE Relief Name: Time In: Dbl Circulator: Out: Attending Anesthesiologist PEDENKO,ALEXANDER Assistant ZAWATSKI, PHIL Post.o~~nation PIc.-lI .es. Tech. X'ray N Anes. Type Specimen: Fluoro N GENERAL ANESTHESIA NONE Perfusionist Prosthesis. Implants. Grafts: Type NONE Post Anesthesia Care Unit Time In: Time Out: Total: Description Lot No.: Serial No: Size: Mfg. Bacitracin 50,000 units in 3000cc NaCI for antibiotic irrigation MR 219 REV 8/90 Signed By: OPERATING ROOM RECORD ~' -~, -~'~ -,~~ .~~ . " =~ ,= -" ..,,~ ,,-u _'; ~, .PennState Geisinger .... Health System i The Milton S. HershliY Medical Center --, ,_ rl L 1 1 :::.' -)U~'.L Q ?-<;r:~}'-i '1~(5'-1:.,',- SHOLLY. 7121 <8 OILLC,~.. GL r . . ;:, ,j .' ~ ~) :' 1 9 B ) . . ~~ P t ] r. k V' J !~ 1 ' " , INTRAVENOUS THERAPY RECORD ~ Dqf:J(" DATE DATE DATE DATE ORDER # TYPE OF SOLUTION DATE MEDICATION ADDED HAa\~ HOUAIAATE HOURjRATE HOUA!AATE H.OUAI RATE RATE ql~b DS l/z t\ls oj I LOet./ 0 . AM 0'j':' - - - -- - - - - - - f-- - - PM AM - 1-- - - - - - - - - - - I- - - - PM AM - 1-- - r - -- - - - - - - -- - - PM AM - I- - - r - -- - - - - - - -- - - PM AM - ~- - r - - - - - - - - - -- - - PM AM - 1-- -. ~ - - - - - - - - - -- - - PM AM - 1-- -. - -- - - - - - - -- - - PM AM - f-- - - - - - - - - - - 1-- - - PM AM - -- - - - -- - - - - - - f-- - - PM AM - -- - - - -- - - - - - - f-- - - PM AM - -- - - - -- - - - - - - -- - - PM AM - -- - - - -- - - - - - - -- - - PM IV SITE CHECKED EVERY AM - -- -. - -- - - - - - - -- - - SHIFT AND PRN PM IV DRESSING CHANGED AM - -- - - -- - - - - - - - - - - EVERY DAY PM IV TUBING CHANGED AM f- -- - - - -- - - - - - - - - - - EVERY OTHER DAY PM INITIAL SIGNATURE INITIAL SIGNATURE INITIAL' l GNATUIjlE U. 'I J/ 11111!J1 . , NAME MR 230 4/82 INTRAVENOUS THERAPY RECORD ,i,~"~~}'Pe.mlState Geisinger "II" .. " -, :"".. ' Health SJ~;tmn ' ". --...... '"',-.',,,0._0;',,1--':-'1.':'-" . ,. - '.~.-. 3bOSlb ,',:,--~... ""i".i'_-.'., lRAIIU;:st051', EliEll 00 00 c,~ "" <If Ioll'<:~ .1,'01 ANESTHESIA RECORD I .._tt_ 9/ PAGE_.................OF.,.._.._ IIad1iml.---....:.. CMBnuous~ nlllMfer 11) ktdl&lon ~. CM~ ArICl!rt!~ PaNen'l ~~~ .~net~logld Cai'li~fllI. SUrg000 Tnloo1t/fto CentEl'Kla ~_ .__ _ _ _ __ O~f)'r O;3r ?..211. ......":".. OI~IJ4B-[..I<- ----~u<~.....-u'lli': <:, ""1"f-'- Oper41tilN~rl'!.t ~ Rt!'mt9:.f~~7... -~~:.L:~~~.1PA'.<H~~..;"' :2 ., ~,.~t\ ~...T~j ~-~:m_:: ' .,,/'(f 1:;~'2- .. .. ~I~ l~:. L1?i~j:-rl:.:~:~:. p~;:~~="" -~~"i'"~"J'f~~;~~'I;~;;~;;.~~.~"F~O. 5Pc;----'-.-.-.-.-!.-.8~.-F;[-. -P,'-'~ii'i' i'liM::JP' "T,',mp' ~j,l ::1 (Wa ~j ~=:n:tubaUrJ" F,I ::rliN TYPE VOUJME f1; 0 1U [.1 tlY~lSi11l1 (J Hem!- bktc.k LR _~__'__'_'." ___.'1' _ . ___ [] 1~ltlUol1 tj Morneon:;d Can!. __._.-----!.. ...................._ 1.,.... P Antlhl.,Itk~ _'.""'.... _ _ _ _ _..._._ _.._" ___. _. Til'oo ............_..~ ~'I) "" """ ;fJ6 'inl' PH'f 5iAT ~._ ~,._ ~~,~.ec OIl'~l,tmMr 'y.- ~,,' _.------~-------I;;<: TOTAL .tt ----..-.....(;:(: __.___CC ____,__..f.'C ~,_._____.(;l; T"'Al.. E.6J.., ~ ...t.:..: URiNE ...........___.._._ C(; V N",.,q ^ !,fl'j\\'ml'1l 200 200 tlllil5iw AllT p!IiJ(i-ioIJl'U lBC 160 ,'::1:::: :::,:::: - ::..-.:::: ,.,. 180 160 140 120 ~ ..!#:~, 140 Or~t!!. St~ 120 100 .(1.1, ,...__ BO , .",,::::r 100 80 60 40 -.r' ,!""f-':::r:- .,... ~~ r;;1..: , !~, ':..;;~(rf.H30(lir~~ AH'ENmoo ANEsnl~f.ociili,FNO~s{ ~. fo'Q<Stthr. MIESTIiESiOLOOi.. pos PEHA.nVE NOTES:' . STATUS ON PACIJ ARRIYA,l: ep_,~.,~...._ P___ ~ '1.... 'u'~' ..~, 'J n,_,,"_ R~_.~ SPO. _.___ Teln:> _.........._...... POSrtl-PEHA.1WE COURSE: SlQtlA.rURE. ----...-:J "~==:1 TIME\ DA''iE, s~Gt~ ATT'EtID1HG ..~, 'I"'" .,-"'",, """", ""'~J n . 1. Operalive permit signed and dated. 2. Old records obtained and sent to O.R. with chart. .3. Hislory a physical signed and dated. 4. Lab w k/test completed, il ordered: . Hct g~gnancy test (within 48 hrs) ,.JZrChest X.ray CJ EKG CJ Other la s (e.g., labs ordered I """,",..,,,,. -....--- UlllWfA PENNSTATE ~ ~ .5. .a. .9. .10. ..- ";"'" ~~ -"~"'.~i1\\'iIll""~~--~" College of Medicine University Hospital. Children's Hospital The Milton S. Hershey Medical Center ":.:,~~.."",~'i:"" PRE-OPERATIVE CHECKLIST I -I)'!'::,',/.. . -~, -.' '.~tJI CJ Yes ~ ( ."- J'CJNo v .' Yes CJ Negative CJ Positive Allergies: (specily) CJ Yes Complet ,II ordered: ~1:e Type & Cross done, Number of units CJ Limited Donor Protocol CJ Autologous blood availab~ --A-- CJ Type & Screen only r-:: ~ CJ Blood ID band site CJ R # Irom blood band b. Living WilVAdvanced Directives on chart c. Limited support on chart 7. a. Religio Yes CJ N Yes CJ No Not removed: CJ Wedding Band Taped CJ Hearing Aid CJ Glasses Removed, il applicable: CJ Undergarments CJ Contact Lens CJ Wig CJ Dentures CJ Hairpins CJ Prosthesis CJ Glasses CJ Heartng aide CJ Other CJ Nailpolish CJ Jewelry (especially if on operative extremity) a. NPO at b. Peds NPO: Clear liquid or breast milk until , then NPO If ordered, oper tive prep done. 11. 'Special patient devices (e.g., ostomies, pacemaker) CJ Yes CJ 0 Describe: .12. Vital signs at: TPR -3~3- f last void/diaper change: Foley in place .16. 14. List meds sent to O.R.: CJ None 4AJU10- 17, Plastic master card on chart. Patient preparation comp t ,R.N. Date Patient l.O. prior to transp Date , R.N. Patient to. prior to transport ~ CODE , Aide Date Time U I PR OPERATIVE TEACHING RECORD see other side MR.j2 rev 6/94 o PRE-OPERATIVE CHECKLIST ""-~~ ,. ;t;I,w,"--" '" -'-"""",i!liI II '_ ,~ ~~ '~ "">~~. - -..-., -4IfiI-.I- ~.PennState Geisinger ..,~. Health System Ml~~ , .. If ->=<:1:':-; The Milton S. Hershey Medical Cl:enter -: r-- \ , INTRA OPERATIVE NURSING DOCUMENTATION RECORD Pre-Op Chilcklist: Hospitall.D! Band checked Verbal Confirmation of Patient 1.0. Verbal Confirmation of Operative Procedure Pre.Op Consent Signed Allergies ,< rk.:lJ7J.-- Safety Belt on Thermal Uriit Temperature Yes No Type/Screen # Units None PATI T ASSESSMENT Level 0 :nsciousn and Behavior: _ Asleep Crying ~ ~Ie,rt,' , ^( ,/ C00,perative ~~rowsy AnXIOUS' _ Unresponsive Restless Talkative Disoriented Calm Comments: General Appearance of Skin: Good Color Skin intact Flushed ~ale _ Cyanotic Jaundiced _ Diaphoretic Comments: Rash Bruise Reddened Area Mottled Abrasion ~ Open Wound MR 370 12193 : 9r~b:'; ~ }( Date: Physicallm'pairrilents or isal:ii iiles None Obese Blind Deaf Irnmobile Joint _ Amputation Ostorny Prosthesis Language Arthritis Comments: 11. 1~"CLk ""'u"Rr~f,'fi!<'/' <r<.<,.~ r -f<'> r7R /,,,i U .. INTRA.OPERATIVECARE Position for Surgery ~ Supine ,_ Prone Lithotomy In!., I Sitting or Fowlers Georgia Prone Lateral Left Right Positional Aides: Pillows Disc Table --*-,Blanl~;;~el Montreal Lateral rolls Sha";,~ Positioner _ Sandbags Spine Frame Armboard Beanbag Olympus Armboard Chan Headrest Overhead Arm Horse Shoe Support Headrest Long Leg Stirrups Mayfield Gardner Stirrups Headrest with Skull Fracture Table Points Other Foam rinps A::~~~'> -krL~ '.fe/MC!, Skin Preparation: Pre'Op Shave: _ Clipped _ Razor ~one Prep Solution: ~ ~etadine Soap ~etadine Solution Alcohol Other Prep Completed by: y/,J(' jj., Jf!u Catheter: ~es No _ Fr. _ cc Balloon Urimeter _ Straight Drainage Other Foley Inserted by: Comments: P-I aRf:[.uJ.f-" OR (; r:;:;/,l' Mr AI<tq r INTRA OPERATIVE NURSING DOCUMENTATION RECORD (" ~ . ~~~~ . ~ " ~-Wl ' ~ ......il; ~Lll<-"""""~ ~"~ INTRA OPERATIVE NURSING DOOUMENTATION RECORD Drains: Location Size Hemovac Jackson Pratt (@ffa#M k..J-/o f7~ {- Penrose Miller Vac. Butterfly Duval Sump T-Tube Other None Used ~~ Comrnents: # Used -i- ~u~~ Time Down: Time Down: Tourniquet: _ Yes Applied by: Time Up: Time Up: Site Applied to: Electro Surgical Unit NJ.ne Used Location of Ground Pad: @ irI,-AfJ h Applied by: ':J--.p. (':r Pre.Application Skin Condi Ion: ~ Skin intact, no apparent defects _ Other / Comments: onipolar # ! ') / ~ Bipolar # S n condition after removal of ground pad: 4fL- Skin intact no apparent defects _Other Comments: / / / I' Chest Tubes"M / None Used _ Right C.- Left Fr. # Used _ Fr. _ # Used Chest Drainage Sy' tem _ Yes _ No Comments: MR 370 12/93 ~J Packing: Location: Material Used: Dry Solution Used: Other: Dressing: Location: None Used - f.wJ; ~~-'->;-. Wet None Used _ Jones Dressing Ace _Splint Cast _ Montgomery Dressing Pressure Dressing ~ Opsite _ Adap.tic _ Eye Pad 4 x4's Abd's Band-aid Collodion _ Steri.strips Xeroflo or Xeroform Fluffs Kerlix _ Kling Benzoin Tubex Gauze Webril Type ofTape Used: Cornments: 11 Cl:c.-y.e<>c-", -;;, to r . l ~ ~".... -' .l.rYf-:i" ...o,c.I r . Sponges Used: lfJA Baytec ~Laps _ Peanuts _ Cottonoids Sponge <:Qunt: ~ Correct Incorrect N~d" Count: ~ Correct Incorrect Instrument Count: Correct Incorrect Additional Comments: _ Long Tapes Tonsil None None ~one Signature & Date -d tv cfJf./lvc (Fr. = French) INTRA OPERATIVE NURSING DOCUMENTATION RECORD 9- tl.4-'5?P ;;"~~DATE V . " " 'PRE-ANESTHESIA EVALUATION" . ..., ]11~,1:CE -~~~':~I2{.~",[j;,~,~k~lS' P::81~Al ~rAT~S PRE.OP ox; '_H-+--' .' ~._, '../lA..' . ,.PROPOSE6'(jp:.-""'."""""~"....~..:.....- (,.(.{ ".{ " ,,) .j .PBEVIOUS ,SUHGEfiV; DATE OPERATION 1 .' . ":TO';'AilllCOijj"E~3f v ''':;:-5 r /"\ ,1-'" "...- AiIERGlE'&^/i(';"'"'---''' ........---., PAST MEDICAL HISTORY (10 bo completed by patient) , ...',..., ......: ,....,..CUFU'lENT.MEDIGATIONS: COMPUCATIONS....",....,.."....._..._......._._ -fT' "~~,,1!::~~~~. , ~~~..._- -""--"-"" .'~' ". ~~._-......"..._.. " IlAVr.Y''!UEY.f.!1 HAD: ' 'lES"O i::~!~:~]f~yu.;;,r-~~:-.::t~..,:~'"~,...; ...-.:....~._:.-.':'".._~:.;:."r"'-.;..:;'~.~~- .~\i(~:=:.~~ ,........;;:;:;;;::::::':V~ :t-L';'~.<4._a.~~~.tis~~__M" ... '. ".M~",. :..~~..:,.,~_'_.l_; ."~:o.i,;;::_-~~~:-....,'\- ., :'-. ,",'; '.j;:~2':;::;'I;'~})E:~' ':;~,t~~'--=~~~~.~.":.: -, - ,~'~.. ~.~;.;-f:~~~~~~...~.,~:,~; "~,~:..:~;;.,:~~i:'~o&~:~. :'~::~~::~~~,:~:~".~tr~ "~",.'.,".::~;~::~~;::.::;;..; .-\..,-,.~.,:,~.,nheuO'l.a:Ucl~I';;,.:.". ." _~. . ' ~~~ftea~f-ff4.lm:wr ~ . - ..' -- . .:$ ~",,"' 3"" tm;jUfai -twi~f in.Yttmi -.,. ',:;:."~~:--- - ,,__. ~:';~t~:-~ ';' -'''-'A.-Heart attack::<~-,,;;' --. ,...____.'..'.' "". :"'/5,;~Heart '1ai1i.1m:':'--,~~;,~;"'-;' _ __.~. ... ,..'6A",;hElSt pain, ,.:-.-,,;,::_;: . " 7. 'Shot::tne:ii-.'}.of breatt,'l ri,~..~~~~r~'t:;:;':; "'h'_ -=""",. '_' :.._':.,2._~ -r.;,;" -':,'-'-:'; _ ,-;,..,., '., .>~~__-"_:,_., o~:fE:t0C~~.j\~:..;l;~3i;::f ~i,;:,~~~S::~~~:=;:~:_:':~::?:/f~:~j.::".:~~~:~-~:;~:.':~ F. _' ~roio'l(}Stina.! ';, ..--~:? '.' ,,'-,... - , ... ~' ..:1, Hesialllis . - ,_' '" , ' " __._,_......_ ., '_;"." 2:, Uver (fu-,oooo i'.,wJ,,~....,., ',:1-; '..','C ..,-- '-':;-,:;:';:"_ --:;::.; -"". 3.'f.l"nhbhol ,'",:",.,' ,'___... ........ ,4. :,JalJl)dir.:? ..:.';:,;:.~~:~~:;:~~L~: ,-,. ;6":' '"""..........,..... -""''''''''_'' ........ 5. Dtl'fictl'lty ~tt!,;\'Wlng' . .,.- ,:'" ~....._._.__ 6. Heartbum ..., _..::.._ "7;Hi'~taJht:!fria '.-r" '"~:':"..:'.........._..' (3i, Endlxme, , _ __, , _1.: Di<l!.;l(l!.Q.'S" <, .,;~;:~ i.~;.~:.,-,,_.. .. ..:_,., _ .0....___,----.,., .., 2..'l'h)rmid dis-t.~ -, 3. prednirone /01' .ste(l:lfd ther.al'Y w.__.~ __._.._. _4, (.',(;nllr.! )'!XI 00 "lrogmnt? ,,;; l-l.' family .'Ii'&~I)~Y of AdVeroo ' , Ane_Ila<<ClI",n' . I: Other M(->(:Iica! Problems "". ,< -".--, ___"Af~ESTHE-sio'i'!)(~fSl', N011~-'~':~- '_' .. ",;...--.--.--.--. ~~~:ii__,' ..~"'l::-~.:~':'.'?~IE,;;;~":'..':"..,~' .".'~,~ ,~ l'flEMEotCA-l~(: , .--,....". -"--"-.-.-- I-EMATotOOY: ~.__~fJJl.t~f,1\:,l; (:t-l8l!S'my; , Dt,~ (~G$T X.RAY: > '", -,tr ?i '" ~ " 'fib-STOP CARE: o Short' SUW o inpatient. o I.G. U. ,-'.,',,,," ,.^ A "H~~_~_",_=-""~",,," ~iil. - U.~ ". 1f>~"' '"_" __'"~~ ~ ".... -li .'; -~-:: . S, PennState Geisinger .. Health System The Milton S. Hershey Medical Center ~~ 3(P05:/(P CONSULTATION REPORT TO~ FROM I~~ DATEfTlME OF REQUEST fWI q~~(r'7S ;)..:00 PROVISIONAL DIAGNOSES REASON FOR REQUEST ~,~/~- REQUESTING PHYSICIAN'S SIGNATURE J(URGENT o ROUTINE --- -, CONSULTING REPORT BY TEACHING PHYSICIAN (STUDENTS, RESIDENTS, USE REVERSE SIDE) PRESENTING ILLNESS (CHIEF COMPLAINT, PROBLE~ L, S- 4 L lr r HL- 9-{~ stYt L - ~ oL ~ m- R- {J1 tw'>- ~4_;. o~ -"'l ' lYv- ASSESSMENT (IMPRESSION): ~ .J 4 L, HISTORY OF PRESENT ILLNESS: . YA tfl^ V I't- -S? PHYSICAL EXAMINATION: 1? RECOMMENDATIONS (PLAN OF CARE): .-?/o{l f- ch f~- SIGNATURE OF CONSULTANT (TEACHING PHYSICIAN) MR 114/97 CONSULTATION REPORT . "~ '~-~~,. - ~~~A~."~-- ~,~ --~ '" ~ ~> " --~t - + CONSULT~TION ~EPORT DOCUMENTATION BY STUDENT, RESIDENT , OR FELLOWS P+ ~ I S' ('O M - ~A V III ~ ./-- 1'[ 11 G ~Jo' ~ 4U. r/rk UJc. ry '. P/Yl/th/ ~ ~-k' ~ - 40 fr/--- f f-- -. by~Lt-~ J., ~ c ~ \ ~.,. ,1 ~ \= l' o ~"" L+~~' ,,/ ,/ tqvh ,y.,..., ",.. "'v~ c ~~' I(J CD'o Df- r ~ rvJ-J- ff~ G) (h(~ ~, "G","" ~./. "A'^. ~ lyrV-J. ITITLr~ I DATEfTIME 9 ~ :.>-"-96 MR 114/97 CONSULTATION REPORT ~."" .- - ~J n lIiOl I '"'~ ,'. -Nlilili "--~- .., ""''''",- " PennState Geisinger Health System Radiology Services M.C. H066 P.O. Box 850 00948934 Hershey, PA 17033.0850 26A-092698 SHOLLY,GLENN 0~::!pr-83 EM,t:K , (,0' DS Date of Exam: 26-Sep-98 KYM A SALNESS MD EMERGENCY HMC, ** ***** Exam: CT ABDOMEN ENHANCED-PED Exam: CT PELVIS UNENH-PED ENHANCED CT OF THE ABDOMEN AND PELVIS CLINICAL HISTORY: Status post MVA. PROCEDURE: Routine enhanced CT of the abdomen and pelvis was obtained. COMMENTS: There are no comparison studies. The lung bases are clear. The intra-abdominal organs show no evidence of acute traumatic injury or other abnormality. There is no evidence of free fluid or adenopathy. Similarly the pelvic organs are normal without evidence of free fluid or adenopathy. The bone windows demonstrate no evidence of acute fracture. Dr. Sefczek reviewed the images and discussed the interpretation with Dr. Kramer. IMPRESSION: 1. Negative exam. JPK/bjc Dictated: JEFFREY P KRAMER, M.D. Reviewed & Signed: DONNA M. SEFCZEK, M.D. DICTATED: 26-Sep-98 TRANSCRIBED: 27-Sep-98 SIGNED: 01-0ct-98 - "~~. " ~. ~~ .' ""~ ::.H . PennState Geisinger Health System Radiology Services M,C. H066 P.O. Box 850 00948934 Hershey. PA 17033-0850 25A-092698 SHOLLY,GLENN ~~~3 Date of Exam: 26-Sep-98 KYM A SALNESS MD EMERGENCY HMC, ** ***** Exam: CT HEAD UNENHANCED-PED UNENHANCED CT OF THE BRAIN CLINICAL HISTORY: MVA. PROCEDURE: Routine unenhanced CT of the brain. COMMENTS: There are no comparison studies. The ventricles and extraaxial spaces are normal in size and shape for the patient's age. The brain parenchyma demonstrates no foci of abnormal attenuation. There is no evidence of intracranial hemorrhage or mass lesion. The bony structures are intact. The soft tissues demonstrate a very large hematoma involving the left frontotemporal area. The paranasal sinuses are clear. IMPRESSION: l. Soft tissue hematoma without evidence of brain injury. Dr. Sefczek reviewed the images and discussed the interpretation with Dr. Kramer. Dictated: JEFFREY P KRAMER, M.D. Reviewed & Signed: DONNA M. SEFCZEK, M.D. JPK/jor DICTATED: 26-Sep-98 TRANSCRIBED: 27-Sep-98 SIGNED: 01-Oct-98 ~-~~- ~ -i~~'. ~ .~ II "'''''<--'-.'. , PennState Geisinger Health System Radiology Services '2/. 0 :;J t, M.C. H066 ~ P.O. Box 850 00948934 Hershey. PA 17033.0850 68A-092698 SHOLLY,GLENN 05-Apr-83 7SAI 712108 Date of Exam: 26-Sep-98 Jf\ JY PETER W DILLON MD PEDIATRIC SURGERY HMC, Exam: OX SPINE ANY LEVEL 1 VIEW - PORT, SUPINE, AP , PORTABLE OPEN-MOUTH ODONTOID AT 1000 HOURS CLINICAL HISTORY: Motor vehicle accident. Please evaluate odontoid. COMMENTS: There is normal alignment of Cl on C2 with a normal appearing odontoid. IMPRESSION: There is no evidence of an acute injury involving the odontoid on this single portable view. Dr. Jones reviewed the images and discussed the interpretation with Dr. Briguglio. Dictated: JOHN BRIGUGLIO, M.D. Reviewed & Signed: BLAISE V. JONES, M.D. JB!lmw DICTATED: 27-Sep-98 TRANSCRIBED: 28-Sep-98 SIGNED: 29-Sep-98 ""' ,,- .. "- """''''', r - ~~ ~,~' .~_.....iIi ,. ,'.:" ~-- " PennState Geisinger Health System SectiOD ofPlasti, aDd RecoDstructive Surgery M.C_ H071 P.O. Box850 Hershey, PA 17033..()850 Administrative Office: 7[75318371 Tel 717531 4339,Fax Practice Site: 717531 8952 Tel 7175316956 Fax PLASTIC SURGERY CLINIC NOTE NA~: MSHMC#: DATE: Glenn Sholly 948934 October I, 1998 HX: Glenn is here in follow-up with a long scalp and forehead laceration which was repaired in the operating room with Dr. Camp on September 26, 1998. EXAM: He is doing quite well. His sutures were removed from his forehead. PLAN: Our plan is to see him back in another week to remove his staples in his scalp. DICTATE~ ( Randy M. u Ie, M. . Assistant Professor of Surgery Section of Plastic and Reconstructive Surgery RMH/Icb cc: Medical Records "'~ - -~""-~" . .. ~- IL ~~ ~ "-"'''--,~ _"" r'""'" , .... . PennState Geisinger Health System Section of Plastic and Reconstructive Surgery M,C. H071 P.O. Box 850 Hershey, PA 17033-0850 Administrative Office: 71.753 I 837,1 Tel 7175314339 Fax Practice Site: 7175318952 Tel 7175316956 Fax PLASTIC SURGERY CLINIC NOTE NAME: MSHMC#: DATE: Glenn Sholly 948934' October 8,1998 HX: Glenn is here status post repair of the scalp and forehead laceration by Dr. Camp on September 26, 1998. EXAM: He is doing well and the sutures were removed from the forehead, His wounds are closed well and his staples are removed. PLAN: Our plan is to see him back here on a p.r.n. basis. I explained to his mother that the scar on his forehead will become more reddened and noticeable in the next few months and then it should fad. I recommended that they follow-up in a year if they have any questions or problems at that time. Randy J. Ha Assistant Professor of Surgery Section of Plastic and Reconstructive Surgery RMHIlcb cc: Medical Records ~.d....- d ~. ~..'- " ;; ... ~ ~ ,,- "'-"-'--<::- - -,~ ,-, """"'"'.r~-'~ ,",,,,~-.~_. .-, - '" ~ ~".---~~ ~"- , PennState Geisinger Health System EMERGENCY MEDICINE CENTER P.O. BOX 850 HERSHEY, fA 17033-0850 7175318333 TEL EMERGENCY DEPARTMENT NOTE PATIENT NAME: TRAUMA 516 PATIENT NUMBER: 360516 SEX: DATE OF SERVICE: 09/26/98 DATE OF BIRTH: The patient is a 15-year-old male who was involved in a motor vehicle accident. He was the rear seated passenger, unrestrained in a roll over motor vehicle accident with a significant amount of injury. He self-extricated and was able to orient the scene. However, due to the mechanism of injury, he was slightly confused, the helicopter was called for and he was flown here as a trauma. His vital signs were a blood pressure of 150, his pulse was in the 100's, his respiratory rate was 12 and unlabored. On arrival to the trauma room, he was conscious, alert and oriented. His GCS was 15. His lungs were clear to auscultation. His airway was intact. His breathing was okay. His abdomen was soft and nontender. The extremities showed no obvious deformities. He did have abrasions and contusions about the extremities, none significant. Note, he had an extensive scalp laceration with avulsion of the scalp down to the bone from the parietal area all the way up to the temporal area with an extensive amount of bleeding. His tympanic membranes were clear. The bleeding was controlled with Raney clips. His head CT was negative. His abdominal CT was negative. He had a work up per the trauma team and he is going to be taken to the operating room for plastic surgery to fix his extensive scalp laceration. DICTATING MD: Jeffrey arledge, M.D. JO/~'~ T: 09/28/98 06:56 Page 1 of 1 PENNSTATE "".', ~ Milton S. Hershey Medical Center College of Medicine Patient: SHOLLY, GLENN E MRN: 360516 Flowsheet Print Request Last 120 Results Printed by: Shiner, Crystal L Printed on: 04/30/2002 11:14 AM ,.Wii,'r ,",",/ ,~",^,,: 1< .'''''-'''-n"' ;1"~i9a'.\. ,-09j};'6ji," >~~,;~~4h i.f~'::::::;:~~f. " "...'........,,'..,.'. "S,tt};~~~t~r(f/:,*~:'~,'" Q9:''','' '6 l:1~98,! :3,.......,.:.. fi.(!.li::::nni:;;2~\~p_" .. _., '"'-.-"':'-'",7:',',,-" -,- ';BtJN.: ./,,' '; 135 L . 0 103 25 6 8 0.6 L 169 H ,- ":'-'.,'". , ',,', ""';":,23.0 . L ,,"'; . ': :~- ; ":' 2:L 7 L 15.3 H 8.:1 L 23.2 L 2 84 L 82 34.9 28.5 23.5 H 8.2 L 23~5 L 2 86 L 82 34.9 28.7 :.! '","", ;'" "/{ (~!::"".,,! ',;,.J.,:'" " :ids,f'} ',hF "e , ,,:},;;j -",-'~ ~~~~ii'\";.~:"'"'.: . ~:;i-i.~~ "'(~';:" ..... "."'~'-":,' ,-'~-"" ':_~_~t..' 'Ii) " f~?RB~,'ii(- ~,t,(:.(~) i- amous ~ ~.i:' Crystal i ~RS:~~~: ~,. ":1 'I 'I 'I 'I 'I I "u.~~s_~_~~*(,:,-} _~ Page 1. An EqU;11 Opportunity Univ('r,~ity PENNSTA.TE ..,.~ Milton S. Hershey Medical Center College of Medicine Pa.tient: SHOLLY, GLENN E tm.N: 360S~6 Flowsheet Print Request Last 120 Results Printed by: Shiner, Crystal L Printed on: 04/30/2002 11:14 AM '1:,:';!:'r~~~~~i~~ ::};~}~~:mJj!~:, i~~l~~\~VJA~;;;:' :&~~~f~~~lf~: i~1~~\::ri;~', "~',~~~~:~1* CXJit (I-vi.. pe:Lvis XR Pelvis CT Pa.ge 2 An Equal Opportunity University PENN STATE ,..,.. ~ Milton S. Hershey Medical Center College of Medicine Patient; SHOLLY, GLENN E MRN: 360516 Flowsheet Print Request Last 120 Results 7.5 L L 21.4 . L L 2.61 L 4.33 L 82 82 35.0 34.9 28.7 28.6 Clear to Hazy Negative Negati'tre Negative 1.025 Trace e- 6.0 Negathre 0.2 ~'f~~~#i~iL f~~~;l~~:~~! ,," -1 Page 3 Printed by: Shiner, Crystal L Printed on: 04/30/2002 11:14 AM An t<ju:J1 Opportunity Univef~ity PENN STATE ,..,., "l:1 Milton S. Hershey Medical Center College of Medicine Patient: SHOLLY, GLENN E MRN: 360516 Flowsheet Print Request Last 120 Results '~"p:g:i2~6/_1~!l,8'~, ". O~J26/.199'8 ". " 09/2!51:J.9.98<< j :~~,;:.;.~,';";t5..:)$i.;:~;~~: . "." "1~\i~fiY::~~~(:;: ~"l :(1.~ :'Q~ ~"; 70.2 L 37.0 Not Available CT {e.. None detected None detected None detected None detected None detected Page 4 priAted by: Shiner, Crystal L Printed on: 04/30/2002 11:14 AM An Equal Opptlrl\lniry UniversilY f' ~~ "" ~ ~~ htt.""'m__.___l:- '. ~~ ~"""' ,..:.u,;'i:...-; PEN N STA'fE !S Milton S. Hershey Medical Center . College of Medicine Abd CT (enhanced) SHOllY, GLENN E - 360516 * Final Report * CT ABDOMEN ENHANCED-PED PATIENT DOB: 05-Apr-83 EXAM NUMBER: 26A-092698 EXAM: CT ABDOMEN ENHANCED-PED ORDERING PHYSICIAN: KYM SALNESSA Exam: CT ABDOMEN ENHANCED-PED Exam: CT PELVIS UNENH-PED ENHANCED CT OF THE ABDOMEN AND PELVIS CLINICAL HISTORY: Status post MVA. PROCEDURE: Routine enhanced CT of the abdomen and pelvis was obtained. COMMENTS: There are no comparison studies. The lung bases are clear. The intra-abdominal organs show no evidence of acute traumatic injury or other abnormality. There is no evidence of free fluid or adenopathy. Similarly the pelvic organs are normal without evidence of free fluid or adenopathy. The bone windows demonstrate no evidence of acute fracture. Dr. Sefczek reviewed the images and discussed the interpretation with Dr. Kramer. IMPRESSION: 1. Negative exam. DICTATED: JEFFREY P KRAMER, M.D. REVIEWED AND SIGNED: JEFFREY P KRAMER, M.D./DONNA M. SEFCZEK, M.D. JK/bc Printed by: Printed on: Shiner, Crystal L 04/30/2002 11 :14 AM Page 1 of 1 (End of Report) An Equal Opportunity University ~~ '-- "~~ ~J ..__..",,~__. PENNSTXTE !!5:l Milton S. Hershey Medical Center . College of Medicine Head CT (unenhanced) " SHOLLY, GLENN E - 360516 * Final Report * CT HEAD UNENHANCED-PED PATIENT DOB: 05-Apr-83 EXAM NUMBER: 25A-092698 EXAM: CT HEAD UNENHANCED-PED ORDERING PHYSICIAN: KYM SALNESSA Exam: CT HEAD UNE:NHANCED- PED UNENHANCED CT OF THE BRAIN CLINICAL HISTORY: MVA. PROCEDURE: Routine unenhanced CT of the brain. COMMENTS: There are no comparison studies. The ventricles and extraaxial spaces are normal in size and shape for the patient's age. The brain parenchyma demonstrates no foci of abnormal attenuation. There is no evidence of intracranial hemorrhage or mass lesion. The bony structures are intact. The soft tissues demonstrate a very large hematoma involving the left frontotemporal area. The paranasal sinuses are clear. IMPRESSION: 1. Soft tissue hematoma without evidence of brain injury. Dr. Sefczek reviewed the images and discussed the interpretation with Dr. Kramer. DICTATED: JEFFREY P KRAMER, M.D. REVIEWED AND SIGNED: JEFFREY P KRAMER, M.D./DONNA M. SEFCZEK, M.D. JK/jr Printed by: Printed on: Shiner, crystal L 04/30/2002 11: 14 AM Page 1 of 1 (End of Report) An Equal Opportunity University ;c~' ~, _.~~~"" - .~ ~', - .&11II01 ,~~~ -"~~~-""'~""""''''']'''''<J'';fJl=~ ~~"""""~~, PENN STATE 9 Milton S. Hershey Medical Center . College of Medicine Pelvis CT (unenhanced) SHOllY, GLENN E - 360516 * Final Report * CT PELVIS UNENH-PED PATIENT DOB: 05-Apr-83 EXAM NUMBER: 26B-092698 EXAM: CT PELVIS UNENH-PED ORDERING PHYSICIAN: KYM SALNESSA Exam: Exam: CT ABDOMEN ENHANCED-PED CT PELVIS UNENH-PED ENHANCED CT OF THE ABDOMEN AND PELVIS CLINICAL HISTORY: Status post MVA. PROCEDURE: Routine enhanced CT of the abdomen and pelvis was obtained. COMMENTS: There are no comparison studies. The lung bases are clear. The intra-abdominal organs show no evidence of acute traumatic injury or other abnormality. There is no evidence of free fluid or adenopathy. Similarly the pelvic organs are normal without evidence of free fluid or adenopathy. The bone windows demonstrate no evidence of acute fracture. Dr. Sefczek reviewed the images and discussed the interpretation with Dr. Kramer. IMPRESSION: 1. Negative exam. DICTATED: JEFFREY P KRAMER, M.D. REVIEWED AND SIGNED: JEFFREY P KRAMER, M.D./DONNA M. SEFCZEK, M.D. JK/bc Printed by: Printed on: Shiner, Crystal L 04/30/2002 11 : 14 AM Page 1 of 1 (End of Report) All Equal Opportunity University ::M.ii - ~ - ~ ~, ~ ".~...-~.. 1 ' ,. '""" tL PENN STATE !S Milton S. Hershey Medical Center . College of Medicine CXR (1-view) SHOLLY, GLENN E - 360516 * Final Report * OX CHEST 1 VIEW - AP ,SUPINE, INSP, PATIENT DOB: 05-Apr-83 EXAM NUMBER: 6A-092698 EXAM: OX CHEST 1 VIEW - AP , SUPINE, INSP, ORDERING PHYSICIAN: KYM SALNESSA Exam: Exam: Exam: DX CHEST 1 VIEW - AP , SUPINE, INSP, DX PELVIS 1-2 VIEWS - AP , SUPINE, DX C-SPINE 4-5 VIEWS - LT , LAT, XTAB, SUPINE, AP , DIAGNOSTIC C-SPINE, CHEST AND PELVIS CLINICAL HISTORY: Status post MVA. DISCUSSION: CHEST: The lungs are clear and the cardiac silhouette is within normal limits and size. The bony structures and soft tissues show no evidence of acute trauma. PELVIS: The bony structures of the pelvis are intact and the soft tissues are unremarkable. C-SPINE: The alignment of the cervical spine demonstrates an abnormal flexion of the upper cervical spine. This is due to the patient's large posterior scalp laceration and multiple towels placed under his head. There is no evidence of an acute fracture and the soft tissues are unremarkable. The odontoid view is inadequate secondary to the multiple towels placed under the patient's head. A tip shot was taken which demonstrates grossly normal alignment of the lateral masses, however, there is decreased visualization of the dens. A repeat odontoid view today is recommended. Dr. Sefczek reviewed the images and discussed the interpretation with Dr. Kramer. IMPRESSION: Printed by: Printed on: Shiner, Crystal L 04/30/2002 11 :15 AM Page 1 of 2 (Continued) An Equal Opportunity University '#H-'~ ~~ ,-[,: -"" ~____~!lI;!I_-=-- '-;;"--",,:;;: pmNSTA'TE !S Milton S. Hershey Medical Center . College of Medicine CXR (1-view) SHOllY, GLENN E - 360516 1. There is no evidence of acute trauma to the chest or pelvis. 2. The C-spine is grossly within normal limits. A repeat odontoid view and lateral are recommended once the patient's scalp is repaired. DICTATED: JEFFREY P KRAMER, M.D. REVIEWED AND SIGNED: JEFFREY P KRAMER, M.D./DONNA M. SEFCZEK, M.D. JK/bc Printed by: Printed on: Shiner, Crystal L 04/30/2002 11: 15 AM Page 2 of 2 (End of Report) An Equal Opportunity University ^ ~ ~ ~ "~".~.- , '~-=-''1ll:<.'i''''- -~~'~ . ~" PEN N STATE !$l Milton S. Hershey Medical Center .. College of Medicine Pelvis XR (1-2 views) SHOLLY, GLENN E - 360516 * Final Report * OX PELVIS 1-2 VIEWS - AP ,SUPINE, PATIENT DOB: 05-Apr-83 EXAM NUMBER: 6B-092698 EXAM: OX PELVIS 1-2 VIEWS - AP , SUPINE, ORDERING PHYSICIAN: KYM SALNESSA Exam: Exam: Exam: DX CHEST 1 VIEW - AP , SUPINE, INSP, DX PELVIS 1-2 VIEWS - AP , SUPINE, DX C-SPINE 4-5 VIEWS - LT , LAT, XTAB, SUPINE, AP , DIAGNOSTIC C-SPINE, CHEST AND PELVIS CLINICAL HISTORY: Status post MVA. DISCUSSION: CHEST: The lungs are clear and the cardiac silhouette is within normal limits and size. The bony structures and soft tissues show no evidence of acute trauma. PELVIS: The bony structures of the pelvis are intact and the soft tissues are unremarkable. C-SPINE: The alignment of the cervical spine demonstrates an abnormal flexion of the upper cervical spine. This is due to the patient's large posterior scalp laceration and multiple towels placed under his head. There is no evidence of an acute fracture and the soft tissues are unremarkable. The odontoid view is inadequate secondary to the multiple towels placed under the patient's head. A tip shot was taken which demonstrates grossly normal alignment of the lateral masses, however, there is decreased visualization of the dens. A repeat odontoid view today is recommended. Dr. Sefczek reviewed the images and discussed the interpretation with Dr. Kramer. IMPRESSION: Printed by: Printed on: Shiner, Crystal L 04/30/2002 11: 15 AM Page 1 of 2 (Continued) An Equal Opportunity University ~""'- ~~"~ - ~, - "~ IlL '''fI;'t,'P;"~ '"~~-'-~- ~ oo"'.~ ,. '!d . PENNSTAiE !!5l Milton S. Hershey Medical Center . College of Medicine Pelvis XR (1-2 views) SHOLLY, GLENN E - 360516 1. There is no evidence of acute trauma to the chest or pelvis. 2. The C-spine is grossly within normal limits. A repeat odontoid view and lateral are recommended once the patient's scalp is repaired. DICTATED: JEFFREY P KRAMER, M.D. REVIEWED AND SIGNED: JEFFREY P KRAMER, M.D./DONNA M. SEFCZEK, M.D. JK/bc Printed by: Printed on: , khiner, Crystal L 04/30/~002 11: 15 AM Page 2 of 2 (End of Report) An Equal Opportunity Univen;ity ~~~,-"~~ ~~ ~-~~ ~~~.ibaI- -...;. ~ -~ ;;, PENNSTA'rE !!5l Milton S. Hershey Medical Center ., College of Medicine C-spine XR (4-5 views) . SHOLLY, GLENN E - 360516 * Final Report * OX C-SPINE 4-5 VIEWS. LT, LAT, XTAB, SUPINE, AP, PATIENT DOB: 05-Apr-83 EXAM NUMBER: 6C-092698 EXAM: DX C-SPINE 4-5 VIEWS - LT , LAT, XTAB, SUPINE, AP , ORDERING PHYSICIAN: KYM SALNESSA Exam: Exam: Exam: OX CHEST 1 VIEW - AP , SUPINE, INSP, DX PELVIS 1-2 VIEWS - AP , SUPINE, OX C-SPINE 4-5 VIEWS - LT , LAT, XTAB, SUPINE, AP , DIAGNOSTIC C-SPINE, CHEST AND PELVIS CLINICAL HISTORY: Status post MVA. DISCUSSION: CHEST: The lungs are clear and the cardiac silhouette is within normal limits and size. The bony structures and soft tissues show no evidence of acute trauma. PELVIS: The bony structures of the pelvis are intact and the soft tissues are unremarkable. C-SPINE: The alignment of the cervical spine demonstrates an abnormal flexion of the upper cervical spine. This is due to the patient's large posterior scalp laceration and multiple towels placed under his head. There is no evidence of an acute fracture and the soft tissues are unremarkable. The odontoid view is inadequate secondary to the multiple towels placed under the patient's head. A tip shot was taken which demonstrates grossly normal alignment of the lateral masses, however, there is decreased visualization of the dens. A repeat odontoid view today is recommended. Dr. Sefczek reviewed the images and discussed the interpretation with Dr. Kramer. IMPRESSION: Printed by: Printed on: Shiner, Crystal L 04/30/2002 11 :15 AM Page 1 of 2 (Continued) An Equal Opportunity University lli ~$~' ...., , . - -~. ~-" ~ ,,;':', PE~NSTATE .~ Milton S. Hershey Medical Center College of Medicine C-spine XR (4-5 views) . SHOllY, GLENN E - 360516 1. There is no evidence of acute trauma to the chest or pelvis. 2. The C-spine is grossly within normal limits. A repeat odontoid view and lateral are recommended once the patient's scalp is repaired. DICTATED: JEFFREY P KRAMER, M.D. REVIEWED AND SIGNED: JEFFREY P KRAMER, M.D./DONNA M. SEFCZEK, M.D. JK/bc Printed by: Printed on: Shiner, Crystal L 04/30/2002 11: 15 AM Page 2 of 2 (End of Report) An Equal Opportunity University " <,- ~" -~ ,- ~'~"~--~'- . '0' _..,: , PENNSrJ\TE " 9 Milton s. Her,shey Medical Center .. College of Medicine Spine XR (1-view) SHOLLY, GLENN E - 360516 * Final Report * OX SPINE ANY LEVEL 1 VIEW - PORT, SUPINE, AP , PATIENT DOB: 05-Apr-83 EXAM NUMBER: 68A-092698 EXAM: DX SPINE ANY LEVEL 1 VIEW - PORT, SUPINE, AP , ORDERING PHYSICIAN: PETER DILLON Exam: DX SPINE ANY LEVEL 1 VIEW - PORT, SUPINE, AP , PORTABLE OPEN-MOUTH ODONTOID AT 1000 HOURS CLINICAL HISTORY: Motor vehicle accident. Please evaluate odontoid. COMMENTS: There is normal alignment of C1 on C2 with a normal appearing odontoid. IMPRESSION: There is no evidence of an acute injury involving the odontoid on this single portable view. Dr. Jones reviewed the images and discussed the interpretation with Dr. Briguglio. DICTATED: JOHN BRIGUGLIO, M.D. REVIEWED AND SIGNED: JOHN BRIGUGLIO, M.D./BLAISE V. JONES, M.D. JB!lw Printed by: Printed on: I S/1iner, Crystal L 0~/30/2002 11 : 15 AM Page 1 of 1 (End of Report) An Equal Opportunity University ~!liH1I"''''''- . ,~ di!llil . "'I_or .v ~-r . ~ -. ~ii'M1~~~Ii"r:i~:>i;'~~..Ml\:?''''''''''''''~~IMlk.llllll .. ~., .J ,~C ~wItUIII!ltj!~llIi!r"'''O~ '8iI)f; - ~1!ii!liIL'l!I! o_~iMiilillllr"'-'-~ .' . ' 0 C) 0 C r..,,} ~ ; ~ :"r;: ~".:! "'1"] l~,: :~ IT: roo"; ...~... :"1 L~ :,l.] f'<) ~ <- i',) (0 , """"->' r~t) I , " ~ !~~ <.-) .- "",'" ,..-, ;C", Z>.< ~~~~rj~ >c -..j z "'r;.. =< Ul :D .< , 0uu !~ ~ -U fiR ~ On ~~ .~ . -. ~' ".'. , , ,~--- . ," , R.]. MARZELlA & ASSOCIATES, P.c. BY: Robin]. Marzella, Esquire Pennsylvania Supreme Court J.D. No. 66856 3513 North Front Street Harrisburg, PA 17110 Telephone: (717) 234-7828 Facsimile: /717\ 234.6883 Attorneys for Defendant, Jake Ulrich IN THE COURT OF COMMON PLEAS OF CUMBERlAND COUNTY, PENNSYLVANIA CIVIL ACTION - EQUITY ALLSTATE INSURANCE COMPANY, DOCKET NO. 00.4783 Equity Term Plaintiff v. JOSEPH ALDINGER, JAKE ULRICH, BRANDl MILLER, GLENN SHOLLY, and WILLIAM McCLOSKEY, Defendants DEFENDANT JAKE ULRICH'S REPLY TO DEFENDANT GLENN SHOLLY'S NEW MATfER 9. After reasonable investigation, Responding.Defendant does not possess sufficient information to either affirm or deny the allegations set forth in this paragraph. By way of further response, it is specifically denied that 10. After reasonable investigation, Responding.Defendant does not possess sufficient information to either affirm or deny the allegations set forth in this paragraph. 11. Admitted. , j 2. After reasonable investigation, Responding-Defendant does not possess I sUfficieryt information to either affirm or deny the allegations set forth in this paragraph. "i , 13. After reasonable investigation, Responding.Defendant does not possess sufficient information to either affirm or deny the allegations set forth in this paragraph. 14. After reasonable investigation, Responding.Defendant does not possess sufficient information to either affirm or deny the allegations set forth in this paragraph. 15. After reasonable investigation, Responding.Defendant does not possess sufficieht information to either affirm or deny the allegations set forth in this paragraph. Strict proof of Moving.Defendant's treatment and counseling with Guidance Associates of Pennsylvania and causal relation to the accident at issue is demanded. 16. After reasonable investigation, Responding-Defendant does not possess sufficient information to either affirm or deny the allegations set forth in this paragraph. By way of further response, it is denied that Moving.Defendant suffered the emotional and mental damages set forth and strict proofthereof is demanded. 17. Denied. It is specifically denied that Moving.Defendant was "the most seriously injured" party claiming damages; as such, it is denied that Moving.Defendant is entitled to the policy limits of $25,000.00. 2 .-. -" ~ -, . '"'~ WHEREFORE, Defendant, Jake Ulrich, respectfully requests this Honorable Court order the dispersement of $25,000.00 to compensate Jake Ulrich at the time of compensating Defendant McCloskey. In the alternative, Defendant Ulrich requests, in the interest of justice, this Honorable Court order a status conference prior to the dispersement of any and all funds to ensure a fair and equitable distribution. By: Dated: Mav 28.2002 , o " ~ -~ .-' d_"" ;,: VERIFICATION I, Jake Ulrich do hereby swear and affirm that the facts and matters set forth in the foregoing document are true and correct to the best of my knowledge, information and belief. I understand that the statements made therein are made subject to the penalties of 18 Pa. C.S. ~ 4904 relating to unsworn falsification to authorities. Dated: ,,'5 -r\Jt( rJ d----. ~{r~ ake Ulrich - '" " - ~ ,-' -~'~"~'\- . > CERTIFICATE OF SERVICE I, Lisa R. Rhoads, HEREBY CERTIFY that a true and correct copy of the foregoing document for Defendant, Jake Ulrich was served upon counsel of record this 1lst day of May:, 2002, by depositing said copy in the United States Mail at Harrisburg, Pennsylvania, postage prepaid, First Class delivery, and addressed as follows: Christopher J. Knight, Esquire NEALON & GOVER 2411 North Front Street Harrisburg, PA 17110 David H. Rosenberg, Esquire HANDLER, HENNING & ROSENBERG 1300 Linglestown Road Harrisburg, P A 17111 "~I'>> SHERIFF'S RETURN - REGULAR CASE NO: 2000-04783 P if~'7 COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND ALLSTATE INSURANCE COMPANY VS ALDINGER JOSEPH ET AL DAWN KELL, Sheriff or Deputy Sheriff of Cumberland County,Pennsylvania, who being duly sworn according to law, says, the within COMPLAINT - EQUITY was served upon MILLER BRANDI the DEFENDANT , at 1924:00 HOURS, on the 27th day of September, 2002 at 330 FOURTH STREET ENOLA, PA 17025 by handing to BRANDI MILLER a true and attested copy of COMPLAINT - EQUITY together with and at the same time directing Her attention to the contents thereof. Sheriff's Costs: Docketing Service Affidavit Surcharge 6.00 10.35 .00 10.00 .00 26.35 So Answers: r~?/~ R. Thomas Kline 10/04/2002 HANDLER HENNING ROSENBERG Sworn and Subscribed to before By: \)~ a. ~ me this f ~ Deputy Sheriff day of {Y~ ;Lo,;.J.., A.D. w.Q)u';#I~ ,~ Prothonotary - .' -"'""i . ~ ALLSTATE INSURANCE COMPANY, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA v. NO. 00-4783 __ _ '---'.. T.n ~ ,ry , i~l',.rl " '\ t, ,:/ \\.- ~i U " U JOSEPH ALDINGER, JAKE ULRICH, BRANDI M[LLER, GLENN SHOLLY and WILLIAM McCLOSKEY, Defendants CIVIL ACTION - AT EQVITY Rl'LE , AND NOW, this /~ day Of~. 2002. a Rule is hereby issued LIpon Joseph Aldinger, Jake Ulrich, Brandi Miller and Glenn Sholly, Defendants in the above captioned matter, to come forward with proof of their claim or be fore\'er barred in sharing the interpleaded funds paid to the Prothonotary of Cumberland County on February 25, 2002 by Plaintiff. Allstate Insurance Company. and to Show CaLIse why Defendant. William McCloskey, should not be permitted to be paid the policy limits of$25.000.00 from Plaintiffs inkrpleaded ,/ funds. Rule returnable ,'10 days from service thereof. BY THE COURT: "'T~UE COpy FROM RECORD J~n ,TflStl/nony whereo I her,e~"10 Silt my hl1mi ~nd ~j of said ~ar rlislo, Pa, Th' ! ;< .' '\ r'\ J.. , - , Db.... tR\,~ ~--f . . \ }~J. '~~"11' ,I ",1 ! , ALLSTATE INSURANCE COMPANY, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA v. NO. 00-4783 Equity Term JOSEPH ALDINGER, JAKE ULRICH, BRANDI MILLER, GLENN SHOLLY and WILLIAM McCLOSKEY, Defendants CIVIL ACTION - AT EQUITY o 'Tj PETITION -', .~ -,....,. ... :~', , , -~. .. :i .:..::''-:' ~c-,-- -,-1 - .~ .~:) ~n _ J defendants to come forward with proof of their claims or be forever barred in sharing the interpleaded funds of $50,000.00 paid to the Prothontary of Cumberland County on February 25, 2002 by Plaintiff, Allstate Insurance Company, and to show cause, if any. why Defendant, William McCloskey, should not be permitted to be paid his policy limits of $25,000.00 from Plaintiff s interpleaded funds and in support thereof avers as follows: I. Plaintiff, Allstate Insurance Company, initiated this action by filing a Complaint in Equity, requesting, inter alia, that the court accept an interpleader of Allstate's policy limits of $50,000.00, against Defendants, who are Claimants for personal injuries arising from a motor vehicle accident involving Plaintiffs insured, Robert Gill, which occurred on or about September 25, 1998. 2. As a result of this motor vehicle accident, Defendant, William McCloskey, suffered severe injuries including but not limited to torn ligaments in his left shoulder, a - .1- ,'~ ' , ~; . herniated disc at L5-S 1, and an accessory navicular of his left ankle. Attached hereto and marked Exhibit "A" are some of Defendant McCloskey's pertinent medical records. 3. On October 12, 1999, Defendant, William McCloskey through his counsel, David H Rosenberg, made a claim with Plaintiff against its insured seeking policy limits of $25,000.00 for the severity of William McCloskey's injuries. A copy of the aforementioned correspondence is attached heTeto and incorporated herein as Exhibit "B." 4. On July 12, 2000 a Rule was issued upon Defendants to Show Cause why Plaintiff, Allstate Insurance Company, should not be pem1itted to pay its policy limits of $50,000.00 into Court. This Rule was served on Defendants by letter at their last known address , . on July 19,2000. 5. David H Rosenberg, Esquire, filed an Entry of Appearance for Defendant, William McCloskey, on September 22, 2000. 6. On September 25, 2000 the Court entered an Order allowing, Plaintiff, Allstate Insurance Company, to pay its interpleaded funds to the Prothontary of Cumberland County. 7. On October 10,2000, a Writ of Summons was filed by William McCloskey against tortfeasor, Robert Gill. 8. On February 25,2002, Plaintiff, Allstate Insurance Company, paid its $50,000.00 in interpleaded funds to the Prothonotary of Cumberland County. < ,__','>>il"; WHEREFORE, Defendant, William McCloskey, respectfully requests that this Honorable Court issue a Rule upon the Defendants requiring all defendants to come forward with proof of their claims or be forever barred in sharing the interpleaded funds of $50,000.00 and Show Cause why Defendant, William McCloskey, should not be paid his policy limits of $25,000.00. Respectfully Submitted, HANDLER, HENNING & ROSENBERG Date '-{<<to A By . Attorney for Defendant ';"',. , ADM. DATE: 09t:!6/98 (',. Motor vehicle acc,den!. ! !.'-'! Seventeen year old whIte male here wIth his mother (onowlng 8 malor vehIcle acc,denl. He was ambulatory to the Emergency Department. The pabent Was l'l1'folved In a motor vehicle accldent'several hours before admission. He IS realty not sure when. We bave :;~~,; : .1,.i 'Jthtr people Irom this acc:adent here in thc Emergency Department. The patient was a front seat )~..,~,~:;.-:?JrJ u:lnstramed, ~n an buzu Trooper. The driver was drinkmg and swerved to miss another velucle, ~t:-1t :.:-;:lr1)1 of Ms vchlde and It rolled several times. 1 have gotten thiS history from other people. The patient "".n:ol! ',,"not rememher the aCCIdent. The pallent beheves he was ejected rrom the vehIcle. He says this .;..~i:':l'j:z:: bot .tates he remembers the car swervml: and tbe next thing he remembers he was On the pavement .. .: :;}f the vehicle and then he ran home. He denies any alcohollDuke tOOl~ht. He complains or pam lR hIS ~.~~~ fcot Mnd ankle arta, left posterior pelv1C~ nm areal left should,cr are., posterior and s.up.enor and the ::<'pilol or.a of the scalp. Minimal neck discomfort at the present lime. Hc abo has mId back paIn. He d:olcs shortness of breath. Pl'rlH Unremarkable. Last tetanus .hot " unknown. MEDICATIOi'<S NOde. -,!,r.ERGlES No known allerglcs. PHYSICAL EXAMINATION Vit: I Signs rcvinrcd On aunc:s'. Data.. ,;OiiSTfTImONAI...: Alert, anXIOUS, appears uocomfortable POSItIve odor of alcohol on the breath. HEAD: Abrasion and moderate swelhng on the OCCIpital are. somewhat 10 the left SIde. EYES: Conjunctiva Without dIScharge or mJectJon. LIds 'without lesJOns. PERRL F.N7: Ears: Tympanic membranes WIthout perforation, IDJection, or bulging. i~l:)uth: LipS, teeth, and gums normal. ihrr.,.l: Oropharynx WIthout ,..Ions or exudate. Alrwa)' patent. NGse: Nasal mucosa normal :)muses: No sinus tenderness. ffECK: Some muscular te'nderness. No vertebrsl spine tenderness. IU.nge of mohon IS near normal. HACK: He has mId to lo","er T-spine vertebral spme tenderness. There IS no lumbar area tenderness. LUNGS: Normal respIratory errort. Breath sounds equal. No ra1es, rhonchi, or wheezes. Page 1 HOLY SPIRIT HOSPITAL Camp Hill, PA 17Ql1 NAME: MCCLOSKEY, WILLIAM MR#: j4j877 ROOM #: ECU DR.: Luley, ~GENCY ROOM REPORT , ,. ~.u; .- , --=~-,-",- ;JbY'J- ADM. DATE: 091l6l98 The patIent WJlS sJined out to me by Dr. LuIey wIth instructIOns to check the x-r2Ys, suture Jactnltmn and get a surg~cal topsuIt. DIAGNOSTIC TESTS: X-rays of the cervlcal.pine were negallve. X-uys of the left foot and ankle a. read b)' the r.adlologist was th.at there was acces5ary tarsonavicular bone not aD acute fracture However,oD my physical e:u.mmatioD, the pahent IS tender OYer that area, so I thmk cDntury to what the radiologiSt said, I am concerned that It ml2ht be a fncture. The wound on the left forearm was approximately 1 5 em. I cleaned It WIth Betadme scrub, prepped It WIth lktadmt., mfiltratco with :z.% Lldoc3.tne, draped it, reprepped 11 wlth Bebdine and sutured It wlth six #4/0 nylon sutures. I consulted Dr. Froelich for further evaluatIon and management. DIAGNOSIS: 1. Laceration, left forearm. 2. Muluple contusIOns and abrasions. HRlJC D: 09126/1998 T: 09/26/1998 8900 Page 1 HOLY SPIRIT HOSPITAL Camp Hill, PA /70II NAME: MCCLOSKEY, WILL/AM MR#: 343877 ROOM #: ER DR.: Rudnick EME1l.GENCY ROOM 6.EPORT ~. -.. ""; .- --)~. [, Initial Lab & X-Ray Order.: Time Seen: LaN I Uri"" Sp""Jin"". Cardl"" R..plratory I 1 AcetamInophen I IESR I 1 Serum ACelOn1l JMonltor I ) AOO', paged at I } Alcohol I IGlueo.e I ] Theophylline I EKG ",1)Od" I J Peak Flcw6 Betcl'BlAhet AtMp T.I I ) Amyl.astllLlp&se I ) HCGS I )Thyro.c1Prohle 102 L/J.M I 1A..-.pratoryTx I )APTT I ILJvIlr ( ) lox $cMln ) 02 Salumhon I } Blood Culture" prollkl I )TPALaba I lCBe 141115 I I 'Type II. Cron ---.J 01 units I ICK...a I PTI' I I Typo & Sc<eon Medicatlona ( IV's I Addltlon81 Orders I ICPRO IRe,," I lU:'" Time Dale!Tlmallnt I leRP' Proble l )UnneC&S IV: NSSI D5WI LRI D5I.45NS/ D5.9NS I }OIOOx1n 1 Oulfltdine I ) Workmen's Comp Dll~ Screen Infuse at cclhour. I )Dllanhn I S.ilihcylal8 I JOther Radiology , /"'11-...1- ....1,.., __..........,..,.. I I AbdIQb6tr Senes I IKua J --.-.., ....-. ...-....__. I IAn"'" A L I 1 us Spine I )CLa'llCle A L I ]MB/"ldlble I ) Carv Spine Leteral I ]Nual ~ .. I ] Ctt<'V Spone Routine I JOrol\ R L I J Chosi Rtn I flon I TPA I 1 Pelvl, I ) Elbow A L I ] Pyelogram IVP I ] Filelal I ) Rlba A L I ) Femur A L I )SIloulder R L I ) Fngor R L I IS,,"" I IFoct A L I lS:lffrJm I ) Forearm R L I l'i/Spll'\. I ] Hand A L I )T1b/Flb R L I I"" A L I )'Toe_R L 'JJ I J Hum6N8 A L I lWnBt A L I IKn.. R L [ ]OG'lflr T1"-RJr:RT,1nf Special ProcedUrN. Uttra.Qund ) Abdomen ) Duplex DoPPler ) Gallbklddilr 1 FelYlc Culturss ] Beta Strnp AG I CultlJre )Cel"llclll lChlamydL4 1 GC Cut:ur. I CT Scan" I VQ Scan } Other TII'""~,'CPTIl~ ]SpLrtlJmC&S )SloolC & S l 51001 0 & p ]SloolC Oafl:l" ]WouooCAS Billing CI.....ltlc.tJon [ ) L9Wl I [ )FoIIOw\lP I }"'...." I )o...J I 1l<M>1IJ1 I I Level IV I I Level V ]AQ;lClmt /...."',,," ) MedICal Non.Emergenc:y Holy ,Spirit Hospital Camp Hili, PA Emergency Care Unit Phys!lclen Order Sheet 206-EOJ REV e.?l3 JO BR,MO CHART COPY v7A- Initials: Initials: Initials: Initials: Signature: Signature' Signature: Signature' RN FIN FIN RN Signature: Date: MDlDO f!sr;/lt~hJ,: ~//;~ ~CClOSrrY ,wlLllH I ~I r CCL'HBf. HE [eU [ ^ll p. 17025 (I'IHIQ~) 732-55H 21 ..n-"b~ [0 .~our (, I 7 ) I "l1. =- "~ , .' -, t,'=",,- ~ ' >1 ~ ~ , Log"n Time Triage Time Time 10 Exam Room or R9C(lrds _EMTlParalMdlC E:r:i':~',~,:~ ~'.' :~\:::l:eJ"I Oofn"""Y Y8.li/Nc Warm I Cool o.stal Pulus Present I Absent Pant.alheSla Presenll Ab&9nt 0...""8bon 'Y!1CU ( ] EOF nm. 51 natun! 3itln r:::.::;r r{.:tfC~"li.QI1C/Mot1led I I !!i:.)r.''!r.~~.~,; _.__ __ r:6lsi:?:l::~m.u I \ ' , "4 .! ", '..j ", 'l~' '." 1.";IIl!:...~3Ct '_:'11_ . , - J....--..-.-: lff'~ ;0. ";0 '. 't--- ''':>' . Lr~.......L. ~..._ '_"'.I':'" ~ , - ! O..i':~~.,.'':':..~!_..Jl , ' <, Pu'se Ox . Temp 7" ! Pulse' Allergies/Reactions. LaltU: . Yes UAP os ... .:.. M~-;';:~iJ.t crJOose/Freauen Last Dose Medlcatlon/Dose/Freauenc I I Last Dose Pc,;';t Mc,jlcaVSurglcal History: ....J..N"'.- In past month? Ate there advance dlredlves' copy aVailable' fXP.FCTEO OUTCOLlF~ t..~fovemen1ln CAfQSC oulput damOl'\Slrated by rnproveC y S and dlsgJlO:itsc lests Obcrease or 161181 of dlscom10rt _ Imprcyemenlln fluid vol demonstrated tly dtK;rea:!lC In symptoms of lk.llo vol ImbeJance Improved ga:!l e.ctlange aemon6trated by lmpr'Q'<AJd oxygena~lon and Vllel 61g~ 08creas8 I symploms lodcallng Inj~lIcn or potenllBof lor IntectJon In;! 9dglll del Haled by verbal.zallon I ",Iurn demDflslt.ol.1I0n Assessrnent completed a Data obtamed by: R.N. MA AdrT\lSSlon Called ) Adll\lsSlo'} I I k9f~va'~rr { } Old Records Sent Ae-porl Called A mrtted to ~ ~t/l z,o Hrs TransfeHed to O<sposlbQn [J Home \ ] AMA I J OR at I J Sallsfadory 1 J Imp. d J Cnllc.al[ J Discharged I I r I OIscharge lnstrucllons Discharge R N by rgue at lit Holy Spirit Hospital Camp Hili, PA ECU Nursing Assessment CHART COPY or 1._ I ,- ') ~ '.\ r) 3 K R H H 77 r ,:. -l~ sn T . wiLL 11 K I"'; ( COl'JUII In reu I .. I Pl \70t5 1'~)/lqll 7H-5SH ~\ ,"l-HbQ [0 ~QouP . v 201 ECU SlB7 6lrl ROIV JD Me BR t - ~- ~ , ,,,-,,,..iwli . -~; I I HOLY SPIRIT HOSPITAL T ..f< CAMP HILL, PENNSYLVANIA 17011 EMERGENCY AND OBSERVATION RECORO PATIENT CARE NOTES PS:J '1QO'3 ~R 343877 E ~CClosrrT .WllLIA~ ,0 151 ( COlUIl811 AY( rcu [ ~lA PA 17025 OIlIHlq~1 7H-5SH 21"-q~-3Ibq [0 ~~our , , . 1 , FORM NO 1~ (2185) 01/21/'1". -- All ORTHOPAEDIC SURGEONS'OF CENTRAL PA, LTD. MCCLOSKEY JR,WILLIAM J 371 WATTS DRIVE DUNCANNON,PA 17020 ACCOUNT # CHART # SS # 84901 31093 216983169 October 13, 1999 J. Stephen Snoke, D.O. 1800 Carlisle Road Camp Hill, PA 17011 RE: William J. McCloskey, Jr. Dear Dr. Snok.e: < I saw your patient William McCloskey in follow-up in my office today, October 13, 1999. The patient was last seen on January 26, 1999 when he was scheduled for an MRI of his lumbar spine. He missed two follow-up appointments. He returns today with pain to his back and right hip with increased activities. He apparently has noted increased pain when attempting to lift or do heavy labor type work. He attempted to find a job in this job market but was unable to perform this work. . '~', . ~ ";~~' , . ;" On exam, he has back flexion to approximately 750 with pulling pain to his right buttock and right posterior thigh. He has negative sitting root signs. He has a slightly positive straight leg raising sign at 75-800 with right buttock and posterior thigh pain. His patellar and Achilles reflexes are normal reactive. He has no extensor toe weakness nor apparent sensory changes. . 1. The patient did have the MRI performed which I ordered. This was completed on February 8, 1999. This shows a mild right posterolateral disc protrusion at L5-S1 adjacent to the right Sl nerve root. ' DX: Prominent bulging disc at L5-S1 on the right ~his would certainly account for his persistent back pain, particularly when he attempts to increase his activities. He will be scheduled for ten sessions of physical therapy for his lumbar spine. He was also prescribed Naprelan 500 mg bid as an anti-inflammatory medication. We are going to see him.in six weeks in follow-up. With his young age, if he .continues to have pain without response to the therapy, he would be a candidate for a lumbar epidural injection. Sincerely, 1 r, ,\ '~':', 7. \l \l '\IUN~tlE~lVr M'.D. "Nsrp'l'sr.<tA' :; 'TUc.,., 'vOs . > " IONS ''1..". , "~, ,';ti' .<~<.~) , . . ~'f;, '.,:r.. ',~} ':,:1:1..' "X~' '.'~'~!: .::i;~~~ Thomas H. Malin, THM/vjc (dictated, not read) TK-FAX sent to J. Stephen Snoke, D.O. :, ," r . MISSED i, APPOINTMENT \ ON 13~ \~\lJ0 ", :.'.:,.,. . ... ~-..!..; ,.-, ~. -,: . . , ~.' ::';:.1.i'7:~~~:?{~~1::f~t~{~~)~t~. . ~. . . '" ~-- ," - ,",~.~-, -- . ORTHOPAEDIC SURGEONS OF CENTRAL PA, LTD. MCCLOSKEY JR,WILLIAM J 178 WYOMING AVENUE ENOLA,PA 17025 ACCOUNT # CHART # SS # 84901 31093 216983169 07/07/2000 HARRISBURG OFFICE EXAMINATION (Rubbo, Ernest R. MOl SUBJECTIVE: William is here for evaluation of lower back pain. He has had this problem since October when he was seen by Dr. Malin. An MRI evaluation was obtained at that time which showed .:: ;-....::.~~...~u.::.2:~ ci.s..: a:" .u5-.3J..1 aujd.Ct,UL. to CIH:~ .Llgll(: b.l nerve root. However, ,the patient complains more of pain in his lower back. A trial of physical therapy was recommended, but the patient states that because of work constraints as well as care of his child, he has been unable to do therapy. He has essentially been living with the pain but is here for evaluation of pain in his lower back. . . He was suppose to see Dr. Malin two days from now but states he is having increasing pain and discomfort in his lower back and walks in a: bent over fashion because of his pain. He denies any type of bowel or bladder dysfunction or any type of radicular symptomatology. PHYSICAL EXAMINATION: He has marked paraspinal muscle spasm in his lower lumbar area. He has intact reflexes to his knee jerks and ankle jerks. No motor sensory deficits were noted to his lower extremities. There was no active clonus noted or any type of hyper-reflexia. IMPRESSION: HNP L5-S1. PLAN: I have explained to the patient that I feel it is important that he consider a trial of physical therapy 3 times a week over the next 4 weeks. I have also given him a muscle relaxant in the form of Soma 350 mg four times a day and vioxx 50 mg as an anti-inflammatory agent. I have also given him a booklet on the care of his back for him to read and instructed him on certain exercises for him to do. He may follow-up with Dr. Malin, who he was suppose to see, and proceed accordingly. However, I have told him it is very important to consider a conservative trial of physical therapy since he appears to want a quic~ fix for his problem. I have told him that these things do not B-1 0 away without being taken care of. If physical therapy does nO,t give him much improvement, one might consider a trial of epidural steroids. (transcribed 07/11/00 gbl c-. " '1..\\\\\ Jl'~\ oJ " .~ -'~ J - ~,. j fA ORTHOPAEDIC SURGEONS OF CENTRAL PA, LTD. MCCLOSKEY JR, WILLIAM J" 178 WYOMING AVENUE ENOLA,PA 17025 ACCOUNT # CHART # SS # 84901 31093 216983169 July 21, 2000 CAMP HILL OFFICE This patient was seen by Dr. Rubbo on 7/7/00, 2 days before I saw him, because of increased pain. The patient apparently has had increased back and right leg pain. He was seen by Dr. Rubbo and sent to PT. he nas had difiicui~j w:~li t~a~3~==~~~~=~ getting to PT. He lives 2 miles from Wormleysburg Health South. He did not complete the PT that I outlined to him when I saw him on 10/13/99. The patient now has leg pain right> left, weakness and walks with a limp. He was prescribed Soma and vioxx by Dr. Rubbo. ..... PE: He has bilateral sitting root signs at approx. 350-450. His patellar reflexes are present bilaterally at +3 out of +5. His Achilles reflexes are present bilaterally at +2 out of +5. He has no extensor toe weakness. His straight leg raising signs are positive on the right at approx. 350 and positive on the left at approx. 350-450. ...-.,...,..... ,. e co., L.o<'".. ...._ __ PL: The patient must continue the therapy. He must make arrangements for transportation. I recommended a Medrol Dosepak and Tylenol with Codeine for his pain. He will be unable to work during this period of time. We shall see him in 4 weeks in flu. Thomas H. Malin, M.D. THM/lms T: 07/29/00 MISSED l ONA~r;~rroT I c" l'i:,'i'J\ ~ ~) p \ ~.\\ , ' . .Jr' : '!"..,; '1 /' J\....... \~y PATIENT UNDERSTANDS ,INSTRUCTIONS .' :....:; ~"' . '"~ .i'.;lC, L;Y a ,\()'o"j,_ , , /;~~. , ~~Ao. "'lII!'~~' IG~ r~ (', I: ! ,(jCill-1 '/01'~~- , I*, r -__'H''''' ~ I ~;~~~7 f>"~~~ 0~ l FEB I 0 JI :Ii I ~'7] '~x,v~OJ,\'i L" M 31 (f13 : v '\' mi~'r~, ;';(~;;'f(;1';,,\6J;" :.~1~G.::c::.;~~~\ i'~~ February 8, ~999 RE: MCCLOSKEY, WILLIAM 371 Watts Drive Duncannon, PA 17020 AGE: 18 SS#: 216-98-3169 STUDY: MRI of the lumbar spine REFERRING PHYSICIAN: Thomas Malin, M.D. CLINICAL HISTORY: Low back pain . - MRI PULSE SEQUENCES: ~) T2, Tl sagittal 2) Tl, GE oblique axial COMMENTS: The study was obtained with the 1.5 Tesla strength magnet and compared with an AP lumbar spine film dated ~/~4/98. The lumbar spine shows normal anterior posterior alignment and marrow signal intensity is also normal. There is mild dehydration at the L5-S~ disc with the remainder of the lumbar discs showing normal hydration. The conus medullaris is normal ending at the thoracolumbar junction and there is no evidence of an intrathecal lumbosacral mass. parasagittal images though the neural foramina show no demonstrable pars defect and there is no stenosis or neural compression identified. Mild disc protrusion on the right is noted inferiorly in the neural foramen. Angle axial images through the neural foramina show a broad based right posterolateral and lateral disc protrusion without compression seen on the thecal sac. The disc is adjacent to and possibly compressing the proximal aspect of the right 51 i'lerv~ root. No left sided compression is seen and the L5 nerve root exits through the foramen without suggested compression. Facet joints are normal in appearance. L4-5, L3-4, L2-3 and L~-2 interspaces show no evidence of focal disc protrusion. Mild disc bulging is noted and most apparent at L2-3. Only minimal impression occurs on the thecal sac and there is no focal nerve root compression suggested. L5-S~ adjacent to Lumbar spine MRI scan shows a mild right posterolateral and lateral disc protrusion at the right S~ nerve root. _ ^([) -CONTINUED- ~ "<'- .?- \ ~1"l1 ,;\:-' , .j 708'1 ~. : , I_ J . CONCLUSION: ~.- i, , ''" .. _ . < _ 0\. _ _ ~ ;-;. L~.; RE: William J McCloskey JR October 14, 1998 Page 2 with abduction because that is when he brings his acromial process against the clavicle. where he sustained his contusion. I will limit his gym activities and he is to do no overhead activities during this period of time. We will see him in two months for a final visit. Overall he should do very well. Sincerely, Z~~f~ THM/vjc c: J. Stephen Snoke, D.O. OCT 3 0 1998 RECEIVE!) '"'~"-"'-D MJC"""--lY";-' - ...,.. OCT 2 6 1998 SU::;"-'.,ue:l2.:1i:& S:"::c:,:",",, .......... .... . ~ ~ . '-',,~, ,- Orthopaedic Surgeons of Cemral Rnnsylvania, LTD. October 14, 1998 Thomas H. Malin. M.D., EA.C.S. Susquehanna Surgeons 532 North Front Street Wormleysburg, PA 17043 John S. Rychak. M.D. RE: William J. McCloskey, Jr. OCT 3 0 1998 RECEIVED William J. Polacheck, Jr., M.D. Dear Doctors: L saw your paclenc Wllllam MCCLosKey In my office on October 14, 1998. This l7-year-old White male has had pain to his left shoulder secondary to an automobile accident which occurred on September 15, 1998. He apparently was a passenger in the front seat and not wearing his seatbelt when the accident occurred. He had numbness and pain to his left ankle. His left shoulder is his main source of difficulty today. He cannot abduct and flex without pain to the superior aspect of his AC joint. He has had no paresthesias to his fingers. He feels his grip is slightly decreased on the left as compared to the right. He cannot sleep on his left side. The patient also identified symptoms of low back pain without pain to his posterior thighs or legs, without paresthesias, tingling or numbness. , . Balint Balog. M.D. Craig W. Fuilz. M.D. Ernest R. Rubbo. M.D. Robert J. Maurer. M.D. Spt!dafi:.illg ill HI/nd & Uppt!r Exm:mif): - Retin'l! - CJwJllre C PUrJ/. .H.D. H'ilfllrr! H. L.n't.'. .\1.0. SaJIIl/1!! J. AmI/so. .\[.D. . Total Joint Rcplacer\'lcnt . Fr:u.:ture C:lCe . Sports Injuries His past medical history and review of systems were reviewed and are essentially negative. . Hand & Foot Surgery Examination of his left shoulder reveals he has pain over his AC joint with slight pain with compression of his AC joint. There is a slight suggestion of some prominence, but no stepoff. He has pain to abduction at 900 and pain with flexion of 90-950 of his AC joint. His bicipital and tricipital reflexes are normal reactive. His power of grip is equal. . Arthroscopic Surgery . Workers' Comp Injuric~ . Bone & Joint Surgery . Back Surgery WEST SHORE OFFICES 99 November Drive C.mp Hill, PA 17011 717.761.86-14 Fox 717.761.6860 HARRISBURG OFFICE 2800 Green St. Harrisburg. PA 17110 7 I 7.234.5976 Fax 717-234-2131 He had multiple x-rays which have all been reviewed. X-rays of his left clavicle and AC joints demonstrated no change in position of the clavicle with or without weights to substantiate an AC separation. Lumbosacral spine films were taken today, AP and lateral, which show there are no compression fractures or avulsion fragments, nor decreased disc space at any level. 5 Willow Mill Park Rd. Mechanicsburg. PA 11055 717.691.0808 Fax 717.691.0557 HERSHEY OFFICE 32 Northe:J.st Dr.. Suite 20] Hershey. PA 17033 717.5)).2348 Fox 717.53H490 This patient has a contusion of his AC joint without frank separation. This should do well with time. This can take up to 6-8 weeks. He will have pain R,..,..-,..~"" ,..-, .~~')r .-t 7 ......""'--~ ~ '\.-~.. - Providing Quality Orrlwpaedic Care to Cemral Pellllsvlv~tt2 6 1998 SU::~t.:S;"':2;-dl:: ~,-"~;,,,;c.n:.; .~ . - ~ ' '> ORTHOPAEDIC SURGEONS OF CENTRAL PA, LTD. MCCLOSKEY JR,WILLIAM J 371 WATTS DRIVE DUNCANNON,PA 17020 ACCOUNT # CHART # SS # 84901 31093 216983169 January 26, 1999 CAMP HILL OFFICE XR: LUMBAR SPINE (2V), PELVIS (lV) This patient returns returns with back pain with flexion. He has pain with standing to his low back for what appears to be a major portion of his activities. He gets relief with laying flat or almost flat. Previous x-rays of his LS spine done in 10/98 showed no gross bony abnormalities. He has no complaints in regards to his thoracic spine, his clavicle or his AC joint. PE: His back flexion here is to 750-80' with pulling pain to his low back in the area of LS-S1. He has lateral bending which is full and extension which is full. He has slight pulling pain to his right back with sitting root signs at 45'-50'. His straight leg raising signs are slightly positive for back pain at 75'-80'. His patellar and Achilles reflexes are normal reactive. He has no extensor toe weakness or apparent sensory changes. XR: He had a left and right oblique completed. These show no evidence of spondylolysis or spondylolisthesis. DX: PL: Because of his persistent pain since 10/98, we are going to schedule him for an MRI of his LS spine from L2 to 81 to r/o a bulging disc or any nerve root or cord compression in the face of his increasing disability. We shall see him in 2 weeks to evaluate that study. He was advised to use Nuprin or Advil, 2 tablets 2-3 times per day for his pain during this time. Thomas H. Malin, M.D. THM/lms RTO: 2 weeks ~ ~ \~~!j ~t'?> ....- ~~Cit;.\ .. PATIENT UNDERSTANDS INSTRUCTIONS ... ... b" .... ,\" /1l?~~'4I ~ ' y' . //~Z V ~v <g-..) '//,% ,;,.'f'r:;j~ "/ A,,"~ .. ",<' ~~ 'i"'~ .....V .<3 f<.v,;- , ~,'\ '\ . . February 8, 1999 RE: MCCLOSKEY, WILLIAM Page 2 Elsewhere there is mild disc bulging present without other areas of focal protrusion. Thank you for referring this patient to us. sincerely, #~&~ ..... P.Kjlag .,' c <) '2.\\\\'\ j~\\ \ ~~ t) .:- ' ...:.~.J' ~ . ,'- '6'f\tJ ~'USQUEHANNA 'SURGEONS LTO. '532 NORTH FRONT STREET, WORMLEYS8URG, PA 17043 PHONE (717) 761-4141 FAX (717) 761.145; October 5, 1998 1. Stephen Snoke, D.O. 1800 Carlisle Road Camp Hill, PA 17011 Re: William McClosky .... Dear Steve: I saw young William McClosky in our office on 10-05-98. As you know, he is a 17 year. old that was recently involved in a motor vehicle .accident and hospitalized at Holy Spirit Hospital. He comes in for a recheck status post his accident. The patient is doing reasonably well. He states that he is very sore and his major complainrs involve the left shoulder, his mid-back and his left ankle. His appetite has been good, his bowels are moving normally and he is otherwise having no particular problems. On examination today, his head, ears, eyes, nose and throat were within normal limits. His chest was clear, his abdomen was soft with normal bowel sounds. There are no masses or tenderness noted. On examination of his ankle, he had minimal swelling and really no tenderness except a small amount laterally. On examination of his shoulder, he did have some tenderness and swelling along the AC joint. It was somewhat difficult to tell, but it seemed as thought he AC joint was disrupted slightly. He did have reasonably good range of motion of the arm. His other complaint was of back pain and he had some tenderness along the paraspinal muscles in the mid-back. On review of his X-rays, he had a normal left shoulder as well as a left ankle X-ray. He was noted on the thoracic spine at approximately T-7 to have wedge compression deformity which they felt was probably old in nature. Gc;ORGE B, FARIES, JFl., MO KENNETH W. GRAF, MD MICHAEL J, PAGE, MD RONALD G, BARSANTI, MD ANGELA M. SOTO-HAMLlN, MD JOSEPH P. ESPOSITO, MD ROLANDO A. CASAL, MD A. DAVID FROEHLICH, MD ANASTASIUS 0, PETER, MD LISA K. TORP, MD GENE.'W. SURGERY MINlWUY WVASWE SURGERY COLON-RECTAl SURGERY SF.EAST SURGERY ONCCtCGiCAl5l;FGE.,Y VASCUlAR SURGE.Cy LASER SUF.GE.c.y - .--- Octoher 5, 1998 William McClosky Page 2 I have discharged him from our care, but I mentioned that he should se,e the orthopedist who saw him in the hospital. I am unsure as to who that is, but we are,planning to look that up for him and call and obtain an appointment. My major concern is about a possible AC separation of the left shoulder, as well as the back pain he is experiencing in view of the X-ray showing what they though was an old wedge defect in the spine. Thank you very much for allowing us to participate in this gentleman's care. I remain, . . MJP/epg '-0- . OP~'"r,t'AEDIC SURGEONS, OF CENTRJ>.' " .. , LTD. MCCLOSKEY JR,WILLIAM J 151 E COLUMBIA AV ENOLA, FA 17025 ACCOUNT rr 84623 CHART # 983217 SS # 216983169 9/25/98 ADMITTED HOLY SPIRIT HOSPITAL 9/26/98 SEEN IN CONSULTATION (DR. MAURER) HISTORY/CHIEF COMPLAINT: 17 YO white male passenger unrestrained in automobile accident that occurred 9/25/98. He had left shoulder and elbow contusion, left ankle injury and multiple abrasions to all extremities. No loss of consciousness; no apparent thoraco-abdominal or pelvic trauma. He has no significant back pain. PHYSICAL EXAMINATION: His neck is supple, nontender and he had mild tenderness over the A-C joint on the left; none on the right. There is no ecchymosis or crepitus. Glenohumeral joint motion was normal. No elbow tenderness or deformity. Pain in the area of the left hip. No ecchymosis or deformity. He had no significant pain with push/pull test of the hip or rotation and he has normal range of motion. Knee exam was normal; no tenderness or swelling. He had tenderness over the lateral aspect of the left ankle, minimal swelling, no ecchymosis, no instability or crepitus. Neurovascular exam of all extremities was normal. Xrays were reviewed. There is no evidence of neck or back injury and there was accessory navicular noted in the left ankle with no evidence of fracture or significant soft tissue injury. IMPRESSION: MUltiple trauma. PLAN: p.r.n. AUTO Ice, elevation and analgesics. (transcribed 9/29/98 /rah) Follow-up in the office NO' Vo I1~C' G 1998 t:,,, ^ l;;:1..J. "~~" . .-_. "-. ~. --.,>"""-:-,: . ~- ---- l~e (':Q!\}4f ~ -1 /f'e> "'''U LTATIo , REPORT / ~ r GI~-- y-/', Jd- ( z/ ~ c--{3-0-~ L /7 )/-<J .0-' ""'. ~~~ ~ 11-'77 ~~ry- ~ ~ ~.~~ f/~~ ~?-'/~ cs~. ~ @~rl<c --^7 0 w/ ~J:h/k /7t~ tZ.V oz./r~.>fi~ ~ JU we.. - h ,~. -- Y/~ ~oJ,J",~7r'~- rA W ~~ ~ ~;v.",~' JV d ~'0.~,f Y i-.---y' -4-----, / - rSJ ;-1 '---j~+'f-~ v,-!o tZ-uY7;&~.L;d ju_ ~~ JJ,~;~~~~-JV af'j:;.J. JVV y{-~-~T fi/?;;w-,z. L4-~ I:f--< / :"':" - IV' 0 (;;/;;';/7 ~ ~ ~ _ O/~ j,~.f'A-- -@ 1.-GcI-- fA r; wiD r"': ~--7:, ~ rlo/~ - 0 ~c(o/ f~ .~ /cf. ..e;.J~i ~~- N, ~_"'-- fi l...u- ~ J2.,_..j^-'f~ J ;"" !/~-Z f. ;1/() 7~--CY~ de-~7 )~?7 .(;!G~::z;:~~1i ~ o CONSULT [WITH CARE) ~ o CONSULT ONLY ~.~ .E"".T .~~ RE.OUESTI.O 0 RECA.D'NC R ~ 'ON"'''' 0' CD.'"."",--- ~ r:~&t- 0'" '" '" lU.l~ O'.ECTEDT:lr '\'(\(),' 1\.0\- '2~ L<...n 1}- ('..n..... ~~nr~t~'~ " tr (1.. (\ h,_\D H~~~.~:.~A~,~~~,,"" @ ~ ~ , . ~R 30~77 '1 " I. L II K , , .~l ~Cl",:, lV~ H~ 02 ,11;_/;' 7' . P1 17ClS J" -" ') '! 4 " lllll/IHI I .. A ~ I ~:CL( ~ f f i ~~ I 17 SU~~U[HUU .. ?11-le-1\l1 - " , - HANDLER HENNING& W""1lr\. Cl n ~ TTll n...,. ~ nULlc.J. 'DDnu 319 Markel Street, p.o. 80x 1177 Harrisburg, PA 171 08 (717)238-2000 . (717)233>3029 Fax October 12,1999 'LESLIE 8 HANDLER W. S~DTT HlNIIING "DAVID H ROSENBERG ", 'CAROlYN M, ANNER . ... \t'.~i:;~ \'1 S C~USl:'1 JAMES R. CARROll .. "GREGORY M FEATHER 'Rel",d(1998) '.Aha Admillcd to FL Bar ."Licensed RN in PA and NY ....Allo Adml\!ed 10 NJ Bar SAMUEl HMWlER (1922.701 '\TTOD"C'(' ". , ,:1, I, 1\ I~ [ .) ,.:..I,: _:-. I Rosenberg@hhrlaw.<forn James G. Nealon, III, Esquire NEALON 8. GOVER 301 Market Street - 9th Floor Harrisburg, PA 17108-0865 RE: William J. McCloskey v. Allstate Insurance Company Dear Mr. Nealon: I spoke with Patti Hoffman concerning the above-referenced case and she advised me that she has recently assigned this case to you, Apparently, there are several claimants and some of those are not represented by counsel. As indicated above, I represent Mr. William McCloskey in this case and It IS my understanding that the policy limits in this case are $25,000/50,000. Mr. McCloskey sustained serious injury and his claim would certainly be worth $25,000, however, I am not sure of the value of claims for the others involved. Would you please contact me and advise me what information you will need, if any, from meto assist you in moving this matter forward. I look forward to hearing from you. Very truly yours, HANDLER, HENNING& ROSENBERG By: /'7 )11.. DHRlnlb cc: William J. McCloskey ... - < ;'1 . ., ~~~~ ~\~ JJ.~Mll _~ ..,.,,~, ~',' .. .", ~,'; Of!',: c: ~ ,:' :' SEP ZiJ ~'1 ,I!L . "":R!FF ",J~;i?'f "-" in \ \. 31[t\~3J~ .J.~II-,"" ~~..,~..,.,. -' ,- ",,,,,,,,,,,l!"]P,JJI! "_ ,u~(~""'"f''''' _1!l;~~~ " ..~. ~ .~ ',.c.,o -, ',' R.j. MARZELIA & ASSOCIATES, P.C. BY: Robinj. Marzella, Esquire Pennsylvania Supreme Court 1.0. No. 66856 3513 North Front Street Harrisburg, PA 1711 0 Telephone: (717) 234-7828 Facsimile: 17171234-6883 Attorneys for Defendant, jake Ulrich IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - EQUITY ALLSTATE INSURANCE COMPANY, : DOCKET NO. 00-4783 Equity Term Plaintiff v. JOSEPH ALDINGER, JAKE ULRICH, BRANDl MILLER, GLENN SHOLLY, and WILLIAM McCLOSKEY, Defendants : JURY TRIAL DEMANDED ORDER AND NOW, this ~ day of 2003 is it hereby ORDERED that the Prothonotary of Cumberland County shall distribute the $50,000.00 funds escrowed in the above-captioned case as follows: (1) $15,000.00 plus one-third ofthe accrued interest payable to R.J. Marzella & Associates, P.c. and Jake Ulrich (2) $15,000.00 plus one-third of the accrued interest payable to Costopoulos, Foster & Fields and Glenn Sholly,Jr,/- (3) ~ c~ o 1~;crc0 I J. ( J-'~~- .. iil " . ,- , ~,- " -. .. ,-. ~" , nC v' _,_,_ ,\ "c:\("\:: '~I\ ~,')--1 :'-; \01e_ V \-\L,,:.'-::....::;:'..\ "t\1'\('f\t\R1 . -, ' " -'"\"_'1\'_ ' P~\ 2: 36 G3 fEU - 3 '," (<('U'llV C\jM~€~~~yt\j~~b, , ~.Ql'IIiil~ H_^ ".~~~~1.~~5!'l~IWt~~_~II~1!~>IlF,!~~,!ii",JfH~iOE';;'::'~^_ ~ '"' ._~^ ", . . . -~ ' ,< R.j. MARZELlA & ASSOCIATES, P.c. BY: Robinj. Marzella, Esquire Pennsylvania Supreme Court J.D. No. 66856 3513 North Front Street Harrisburg, PA 17110 Telephone: (717) 234-7828 Facsimile: 1717\234-6883 Attorneys for Defendant. jake Ulrich IN THE COURT OF COMMON PLEAS OF CUMBERlAND COUNTY, PENNSYLVANIA CIVIL ACTION - EQUITY ALLSTATE INSURANCE COMPANY, DOCKET NO. 00-4783 Equity Term Plaintiff v. JOSEPH ALDINGER, JAKE ULRICH, BRANDI MILLER, GLENN SHOLLY, and WILLIAM McCLOSKEY Defendants : JURY TRIAL DEMANDED PETITION TO DISTRIBUTE FUNDS AND NOW COMES, Movants, Jake Ulrich, Glenn Sholly and William McCloskey by and through their attorneys, R.J. Marzella & Associates, P.c., Costopoulos, Foster & Fields and Handler, Henning & Rosenberg, respectively. 1. On or about September 26, 1998, Jake Ulrich, Glenn Sholly and William McCloskey were passengers in a sport-utility vehicle driven by Robert Gill. 2. As a direct and proximate cause of Robert Gill's negligence, the vehicle flipped I and rolled-over an undetermined number of times. , I I 13. Thereafter, Robert Gill's automobile insurance carrier, All-State Insurance Compahy, paid it's policy limits of $50,000.00 into an escrow account managed by the ,. "j I I I . i - ~ - <-,~" '. Prothonotary of Cumberland County pending further Order of this Honorable Court regarding the distribution of said-funds. 4. The Movants each petitioned this Honorable Court for an equitable share of said-funds. 5. After numerous reasonable attempts to notifY all other potential parties of said-funds, no party has asserted a claim. 6. In fact, this Honorable Court issued its most recent Rule to Show Cause on May 21,2002, granting thirty (30) days for anyone to come forward and dispute Jake Ulrich's claim for said-funds. 7. To date, other than Movant, Glenn Sholly, no party has come forward to dispute Jake Ulrich's claim. 8. After corroboration and agreement of all Asserting-Parties, Movant's request this Honorable Court divide said-funds between Jake Ulrich, Glenn Sholly and William McCloskey. 9. On January 9,2003, the aforementioned Movants met and discussed an equitable distribution of said-funds. 10. As a result of said-meeting, Movants have agreed to the following distribution: (a) $15,000.00 of compensation for Jacob Ulrich (b) $15,000.00 of compensation for Glenn Sholly (c) $20,000.00 of compensation for William McCloskey -"'---~:''- 2 . , ~, ., .<_."~ . - ~" ., 01/17/03 15:31 HANDLER HENNING & ROSENBERG ~ 2345883 ~RN; ~~"~~_~ 2:~9.'"!,D~1ElR:,~~~~~~! "17;>I,141l1131 . . [;103 IIy; NO. 472 1l1{~'UE r:!R.I....'..~., P.5/5 ... p., . tIeSI ...",- :-{. '-..'-- WNnSfiOII. Mn".lIrs, J'lcc Ulrlth. -ct~f1" 5IIolly and William McCIa_ rapecdbl~ I1lqllUl Chit Honol'lble C6un Drdl!l' SBId.ftlndB p..~le IUIJ1dlnD fa thiS Peddon ro Rd. Marzella III Alisaclaw. P.c., Costopomos, foster ill1IllIds and HamilII'. H,nllln,' Io"nbell. By: ~llrl1l"i. s re AlZDI'ftIY IdeJ11lfiaeia _ 6GIlS6 'Detedl+.2Om CasulpaIDllS, ""1" field. ; ~O~I DiMdJ, oster, ' Mtllmay ldenllficmon No- 231 $1 ' 'Oatedl~' 201)3 H..dIer, Menllllll .lIoIenberl 8yl iDated: ) /I? /03 , ~003 s .M~ ~ " ~: ~ CERTIFICATE OF SERVICE I, Charles W. Marsar, Jr., HEREBY CERTIFY that a true and correct copy of the foregoing document for Defendant, Jake Ulrich was served upon counsel of record this J.L day of .:re: 1\ <WI N , 2003, by depositing said copy in the United States Mail at Harrisburg, pennllvania, postage prepaid, First Class delivery, and addressed as follows: David J. Foster, Esquire COSTOPOULOS, FOSTER & FIELDS 831 Market Street P.O. Box 222 Lernoyne, PA 17043-0222 David H. Rosenberg, Esquire HANDLER, HENNING & ROSENBERG 1300 Linglestown Road Harrisburg, PA 17111 R. J. Marzella & Associates, P.c. 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II if ~~ 'l~ :\\ YJ, V \.J'- ,"'.',." !iH,~U"- "< " .~ <" ~ , r RECEIPT FOR PAYMENT ------------------- ------------------- Cumberland County Prothonotary's Office Carlisle, Pa 17013 Receipt Date Receipt Time Receipt No. 2/20/2003 15:28:48 134772 ALLSTATE INSURANCE COMPANY (VS) ALDINGER JOSEPH ET AL Case Number 2000-04783 Received of PD BY COMMERCE BANK-INTEREST BEARING ACCT #616319142 Total Check... + 520.00 Check No. 2460 Total Cash.... + .00 Change........ - .00 Receipt total. = 520.00 ------------------------ Distribution Of Payment ---------------.------------- Transaction Description Payment Amount POUNDAGE 520.00 CUMBERLAND CO GENERAL FUND 520.00 Cumberland County Prothonotary's Office Manual Release Check Reglster Escrow Amount ."",',,0: -,~_.. "'m-""_'~,~'~, ,,- Oi!l:. il.~ > ~ -- - ~ 13005703032003 PYSA-05 Distribution Case No Accounting 3837 R.J. MARZELLA & ASSOCIATES PC Check Date: SEGREGATED ACCT2000- 04783 TRNS ESC IN Payee total: 3836 COSTOPOULOS FOSTER & FIELDS Check Date: SEGREGATED ACCT2000- 04783 TRNS ESC IN Payee total: 3835 HANDLER, HENNING & ROSENBERG Check Date: SEGREGATED ACCT2000- 04783 TRNS ESC IN INTEREST 2000- 04783 TRNS ESC IN Payee total: Grand total: ~-= iI:liIII&- 03/03/2003 15145.05 15145.05 03/03/2003 15145.05 15145.05 03/03/2003 19709.90 483.49 20193.39 50,483.49 " iJllbtUil~. i I I I :1 II , " 'I I ;1 , . . . Tran Date Page 1 3/03/2003 Date Release Check No. :9000010 2/20/2003 Check NO.:9000011 2/20/2003 , :i ,I :i '! ; " " ; q Check No. :9000012 2/20/2003 2/20/2003 ,-,--' c.. ,.'".'".'''-.''' . -".' "---'_.'-'- - ",,~'V,,--,.-,,>,;,'_I:,-_, > .<__:. --'-".x;",-.-,o -',,'-~ir-',_ --~-'-'''--_s.' "',, ALLSTATE INSURANCE COMPANY, PLAINTIFF V. -, ---,. 'L'o" .;---, '-1, 'c'-~ ,>: ."'-'_'_c<',,,, -, ._ -- ',,;,,", , "] ... IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA, NO. 00-4783 JOSEPH ALDINGER, JAKE ULRICH, BRANDI! MILLER, GLENN SHOLLY AND WILLIAM MCCLOSKEY, DEFENDANTS CIVIL ACTION - AT EQUITY JURY TRIAL DEMANDED PRAECIPE TO DISCONTINUE TO THE PROTHONOTARY: Please mark the above-captioned matter settled, satisfied and the docket discontinued. Date: <t} I ~I ( C/) By: Respectfully submitted, NEALON & GOVER, P.C. ~a~ Brian R. Sinnet, Esquire Attorney I.D. No. 84188 2411 North Front St. Harrisburg,PA 17110 (717) 232-9900 ~"-"'. -"'. .~,"-- -~'''''''-,y,',.. '''h'"er,")'" ,-,"-,__'--_"~_, .,.'',.t_,-.--''~._', "',-Ox C,>",,:__~~,-,-'_'.~,,~___<_ ., . ,c'. ",-~ -."~ ,",.>., ;~'-", ~"","_,~__.';' _,..,_ -Ji.Mlii~ . , CERTIFICATE OF SERVICE A~D NOW, this ;1{f1 day of August, 2003, I hereby certify that I have served the foregoing Praecipe to Discontinue on the following by depositing a true and correct copy of same in the United States mail, first-class, postage prepaid, addressed to: Charles W. Marsar, Esquire R.J. Marzella & Associates, P.C. 3513 N. Front St. Harrisburg, PA 17110 Brian McCall, Esquire Flanagan & Associates 150 East Chestnut St. Lancaster, PA 17602 David Foster, Esquire Costopoulos, Foster & Fields 831 Market Street Lemoyne, PA 17043-0222 David H. Rosenberg, Esquire Handler, Henning & Rosenberg 1300 Linglestown Road Harrisburg, PA 17110 ~~~ Eileen S. Smith, Secretary . ~"-- -.~ . -_.-y J..- i' 'V,"' ,V,. 'r IiIiiliii. (') a ~ c~: (.'.) u 'Tl ~~ :':'JIll -0 +--,1 n-: L C";:) :r- iJJ -.;;.0 '~ ...:;.. c Z rn VI (J'J --") G ~: . " , r:: , :", C> S;: , -1', _. " ::::: ;;;: '. .' ':) )0- C 1':,::1 rn ( -' .' :;;.:! ,. J,.';- ::'0 -1:- -< ~--- " .. 0 '" LC . . i~ ~" "-~ R.J. MARZELlA & ASSOCIATES, P.C. BY: RobinJ. Marzella, Esquire Pennsy~vania Supreme Court 1.0. No. 66856 3513 North Front Street Harrisburg, PA 17110 Telephone: (717) 234-7828 Farsimill" 1717\ 234-fi1l1l3 Attorneys for Defendant, Jake Ulrich IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACfION - EQUITY ALLSTATE INSURANCE COMPANY, DOCKET NO. 00-4783 Equity Term Plaintiff v. JOSEPH ALDINGER, JAKE ULRICH, BRANDI MILLER, GLENN SHOLLY, and WILLIAM McCLOSKEY, Defendants : JURY TRIAL DEMANDED PRAECIPE FOR ENTRY OF APPEARANCE TO THE PROTHONOTARY OF CUMBERlAND COUNTY: Kindly enter my appearance on behalf of jake Ulrich in the above-captioned matter. Respectfully requested, Dated: October 30. 2000 ." .-..' ". CERTIFICATE OF SERVICE I, Robin J. Marzella, HEREBY CERTIFY that a true and correct copy of the foregoing Praecipe for Entry of Appearance ~Defendant, Jake Ulrich was served upon counsel of record this 0() daYOf~ ~ . 2000, by depositing said copy in the United States Mail at Harrisburg, Pennsylvania, postage prepaid, First Class delivery, and addressed as follows: Christopher J. Knight, Esquire NEALON & GOVER 2411 North Front Street Harrisburg, PA 1711 0 David H. Rosenberg, Esquire HANDLER, HENNING & ROSENBERG 1300 Linglestown Road Harrisburg, PA 17111