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THOMAS EDWARD BOWERS, IN THE COURT OF COMMON PLEAS OF
Plaintill'
on behalf of his minor children
RAGENE TEREASE BOWERS. . CUMBERLAND COUNTY, PENNSYLVANIA
RACHEL LYNN BOWERS.
RYAN mOMAS BOWERS.
RODNEY LEE BOWERS. CIVIL ACTION. LAW
RILEY TAYLOR BOWERS, and
RISA LAUREN BOWERS.
v, NO, 97-:rL1.:L.. TERM
USA GA YE BOWERS and
MAX SALEEM.
Defendants PROTECTION FROM ABUSE
ftRV PROTECTION ORDER
AND NOW, lhi.
day of September. 1997. upon presentation and consideration of
the within Petition, and upon finding Ihat the plaintill: Thomas Edward Bowers, on behalf of his
minor children, Ragene Terease Bowers, Rachel L.ynn Bowers, Ryan Thomas Bowers, Rodney
Lee Bowers, Riley Taylor Bowers, and Risa Lauren Bowers, who reside with the defendants at
1615 Mathew Drive, Camp Hill, Cumberland County. Pennsylvania, are in immediate and present
danger of abuse rrom the detendants, L.isa Gaye Bowers, their mother. and Max Saleem, their
step-father, the lollowing Temporary Order is entered.
The defendant, Usa Gaye Bowers (SSN. Unknown)(DOB 9/29/65), and Max Saleem
(SSN. Unknown)(DOR Unknown). now residing at 1615 Mathew Drive, Camp Hill, Cumberland
County, Pennsylvania, are hereby enjoined from physically abusing the minor children, Ragene
Terease Bowers, Rachel Lynn Bowers, Ryan Thomas Bowers. Rodney Lee Bowers. Riley Taylor
Bowers, and Risa Lauren Bowers, or from placing them in fear of abuse,
The defendants are ordered to stay away from the plaintill's current residence loclted It
831 Fremont Street, Apt. 12, Lancaster, L.ancaster County, Pennsylvania, a residence which is'
leased by the plaintiff, and is ordered to stay away from any residence the plaintiff mlY in the
future establish for himself
The delendant, Max Saleem, is prohibited from having any direct or indirect contact with
the minor children, including. but not limited to, telephone and wrillen communications, and the
defendant, Lisa Gaye Bowers, the mother of the children, is prohibited from having any direct or
indirect contact with the minor children. except during supervised visits,
The defendants are enjoined from harassing and stalking the minor children,
The defendants are enjoined from entering the schools and day care facility of the minor
children,
A violation of this Order may subject the defendant to: i) arrest under 23
Pa,C,S. 56113; ii) a private criminal complaint under 23 Pa,C.S, 56113,1; iii) a charge of
Indirect criminal contempt under 23 Pa,C.S. ~6114. punishable by imprisonment up to sil.
months and a nile of 5100,00-51.000,00; and iv) civil contempt under 23 Pa,C.S, 56114,1.
This Order shall remain in effect until modified or terminated by the Court and can be
extended beyond its original expiration date if the Court finds that the defendants have committed
an act of abuse or has engaged in a pall ern or practice that indicates risk of hann to the minor
children,
Temporal)' custody of Ragene Terease Bowers. Rachel Lynn Bowers. Ryan Thomas
Bowers. Rodney Lee Bowers. Riley Taylor Bowers, and Risa Lauren Bowers, is hereby awarded
to the plaintiff, Thomas Edward Bowers,
the defe//da11l.~ are ordered to del/I'er the mi//or ,'hi/tlrell to the clutody of the plaintif/.
Thomu.~ l-:dwurd Howers. Jhe Sheriff~ /)epartmelll ellltl or elllY law I!fIfo,,'eme11l agtncy willi
jurisdictio// to I!I!fo"'1! thi.~ Order shall C1....~ist thl! plai11l!ff ill retrievlllg the childnn.
4. Since approximately March 1997, the delendants have allempted to cause and has
intentionally, knowingly, or recklessly caused bodily injury to the parties' minor children, and
have placed them in reasonable leal' of imminent serious bodily injury, have knowingly engaged in
n course of conduct or repeatedly commiued acts toward the minor children under circumstances
which have placed them in reasonable leal' of bodily injury. This has included, but is not limited
to, the following specific instances of abuse:
a) On or about August 10, 1997, the plaintiff' discovered bruising about the
backs and buuocks of the parties' 5-year old son, Riley, while bathing him. The
child told the plaintiff that his mother, the defendant, had struck him and his 11-
year old brother, Ryan, repeatedly with a hanger. According to the children, this
incident occured on Friday, August 8. 1997. The plaintiff notified the ChildLine
Hotline and took both children to Lancaster General Hospital to be examined.
Cumberland County Children & Youth Services investigated the allegalions and
filed a report of "indicated" abuse against the defendant (See Exhibit A,
incorporated by reference and auached hereto) The agency has opened a
Protective Services case on the children.
b) On or about June 21, 1997, the plaintilf was told by his 7-year old son,
Rodney, that his step-father, Max Saleem, struck him on his penis with a broom
handle and choked him. The plaintiff reported this incident to Lancaster County
Children & Youth Services.
c) In or about March 1997, when the plaintiff asked his son, Riley, why he
had scratches on his ear and bruising on his cheek, the child told him that his step-
father struck him on the helld 1I1llllhe ~Ille of the Ill~e wllh II helt The plllhlllf1's 4-
year old daughter, /tiSII, who !lIId II red IIl11rk Oil her Ih1llh, lold him thlll her step.
father had IIlso stru~k her on the lell with Ihe hl'll dllrinlllhe ~lIl11e incident
d) Since IIpproxinllltely MlIr~h 1')')7, Ihe dcli.'fldllJII~ hllve IIho~ed Ihr minor
children in WIIYS including, but not Iilllill'd to, ~triking them" ilh ohje~lK, ~hoklng
screaming al them, and threatening Ihem wilh phy~kllllllnm In IIddition, on or
aboul Augusl 21, 11)'17, one of Ihe ~hihh'l'n ~lIid Ihlll the defendllnt, SlIlelm, kicked
the door in oHer Iheir lIIother lo~ked him 0111. IIml when he l!ot in the house, he
grabbed her by Ihe f'n~e IInd ~llllel'/ed it !'cllrin!! Ihr their ~lIlcty. one of the older
children ran tOll ncil!hblll"~ hOllle IIml reported the incidenttolhe East Pennshoro
Township Jlolic~. During IInolhcr incident the mother of Ihe ~hildren made Ragene
eat eggs off' of the l1olll' The ~hildren~' lIIother hu~ threatened them repeatedly
telling them that they will end lip in lil~ter hml1e~ or a ~hildrcn's home where
terrible IhinM~ will !lIIllpen 10 them if they loldlheir lillhcr, the plaintiff. about the
abusive incident~ Ihal hltve o~cured The plllintiff ICllr~ thatlhe SlIlety and welfare
of his ~hildren lire III risk while Ihey ~onlinlle 10 re~ide in Ihe same household with
the defendant~' pl'Upen~ity lilr violenl behavior towlIrd the children and each other.
S. The plaintitl' believe~ and therefore aven Ihllllhe minor ~hildren are in immediate
and present danger of abuse from the delendant~ lInd thaI they are in need of protection from such
abuse.
6. The plaintitl' desires that the defendanl. Ma~ Saleem, be prohibited trom having
any direct or indirect cllnta~t with the minor children, including, but not limited to, telephone and
12. The parties have a Custody Order (BOWERS v. BOWERS, No. 94408-1995,
Court of Common Pleas of Lancaster County, Pennsylvania) entered on November 15, 1995 (see
Exhibit B. incorporaled by reference and all ached hereto)
13 The plaintitl' has no knowledge of any custody proceedings concerning this
children pending before a court in this or any other jurisdiction.
14. The plaintiff does not know of any person not a party to this action who has
physical custody of the children or claims to have custody or visitation rights with respect to the
children.
15. The best interests and permanent welfare of the minor children will be met if
custody is temporarily granted to the plaintiff pending a hearing in this malleI' for reasons
including:
a) The plaintiff is a responsible parent who can best take care of the minor
children and provide for their emotional and physical needs.
b) The defendants have shown by their abuse of the minor children that they
are not an appropriate role models for the minor children.
WHEREFORE, pursuant to the provisions of the "Protection from Abuse Act" of
October 7, 1976,23 P.S. ~6101 ~ SSj., as amended, the plaintiff prays this Honorable Court to
grant the following relief:
A. Grant a Temporary Order pursuant to the "Protection from Abuse Act:"
I. Ordering the defendants to refrain from abusing the millQr children
or from placing them in fear of abuse.
telephone and wrillen communicalions, and that the defendant, the mother
of the children, be prohibited lrom having any direct or Indirect contact
with the minor children, except during supervised visits.
3. Ordering the detendants 10 retrain from harassing and stalking the
minor children.
4. Prohibiting the defendants trom entering the schools and day care
facility of the minor children
5. Ordering the defendants to stay away from the plaintiff's currenl
residence located at 831 Fremont Street, ApI 12, Lancaster, Lancaster
County, Pennsylvania, and ordering the defendanls to stay away from any
residence the plaintiff may eSlablish for himself pending a final order in this
mailer.
8, Schedule a hearing in accordance with the provisions of the "Protection from
Abuse Act," and, after such hearing, enter an order to be in effect for a period of one year:
1. Ordering the defendants to refrain from abusing the minor children
or from placing them in fear of abuse.
2. Ordering the defendant, Max Saleem. to refrain from having any
direct or indirect contact with the children including, but not limited to,
telephone and wrillen communications, and that the defendant, the mother
of the children, be prohibited from having any direct or indirect contact
with the minor children. except during supervised visits.
0030346.01
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IN THE COURT OF COMMON PLEAS OF LANCASTER COUNTY, PENNSYLVANIA
THOMAS E. BOWERS
v.
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of :l: 'fl
No, 4408 1995 !.1 0 fH
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ORDER (I Co)
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LISA G, BOWERS
AND NOW, THIS
Ilf .71day of ~ "'W!.-~~~1995,
following
a custody conference which was held before Custody Conference
Officer, Susan M. Kadel, Esquire, and was attended by each of the
parties hereto and their counRel, and an Agreement having been
reached, and after the parties having waived any objection to the
conference being held before said Custody Conference Officer, the
fOllOWing Order is hereby entered regarding custody of the
parties' minor children, namely: Ragine Bowers, Rachael Bower.,
Ryan Bowers, Rodney Bowers, Riley Bowers and Risa Bowers.
EXHIBIT B
0030346.01
1. The parties shall have shared legal custody of the
children, so that each shall participate equally in major
decisions affecting the best interests of the children,
including, but not limited to, medical, religious, and
educational deciuior&s, and each parent shall have access to
medical, d~ntal and school records.
2. Mother shall have primary physical custody of the
children.
3. Father shall have supervised visitation of the children
every Wednesday from 6:30 p.m. until 9:00 p.m. at Glad Tidings
Assembly of God Church and the first Sunday and third Saturday of
each month from 9:00 a.m. to 6:00 p.m. Pursuant to the Court'.
October 26, 1995 PFA Order entered against Father, Pastor Alan
Richard Ryman, or any other supervising individual, shall be
accountable to the Court for supervision and shall execute an
,1'1
affidavit of accountability.
di'
4, Father shall be permitted to contact the children by'j
telephone one time per week before 8: 30 p.m.. at a time of hi.,J
choosing.
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1)I:C,lILAE
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"'lt1NON\Y~:ALTII OF' PENNSYLVANIA,
rnUNTY OF CUMBERLAND
n I] \oIg:B.~! _"T.!l~) M.A 5.... E !!_I1__~J~ D _.____"._ __... .._0 0_
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ng\olfJ!.~',;..J.IUA. G,\YE
_J?lt:;Jl!_J'1r,:Ji_l~.tlJ;;.:L.._._._o..__.____o._~____, ShC'I'U.f Uf' DlJ'puty Sheriff ,~f
I:IJMBEHLAND County, Pellrlsylvo"lia, who being ~uly OWOHI ac,:ouding
to law, soy:a, I,h", ...ithin p..Rr;LTt.r.;IJ.Q1:LffWM Al,LtmE_________ was served
\I P U n..m]__\i~IiiL.1..I.S1L..rd.b..Y. E
the
d'>f-?nd.,nt., at. '.17:J5;~, flOUHS, on the 2f,;.!J1 day Qf ;jeptemo,.o.;>f'
1'3")7 at .._.~~~Jl~._
~~^M.f_.__f!J11~_1 701 L_______._.
,CUMBERLAND
,
("H,nt. y, P"nnsy 1 vania, by handlng to UlL~,..Q!i.YE BOWE@
" tflJP '.nd att"""tl!?d 'copy (Jf th'! _l'ROTECrIQIJ....FR'1llLll.e.illili-___
t.o',l'?ther ...Uh TEMPORARY FROTEr;TION ORDE:!Lt!Q.TICE MLQ..J:gJITION
and ."t thl!? s'fmF./ t.im"-' dlro;oc+..l.ng [-flU' aU:enU"n to the contents thex;eof..
"
Sheriff's Costs:
Dockeoting
Service
Affidavit
Surcharge
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'3.30
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2.00
So ,an?~~~<~~
H. ThfJnliHJ r<llIH?, Sher1.1i
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EMERGENCY DEPARTMENT
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LANCASTER GENERAL
HOSPITAL
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15M Ncrth O'JIt. Str..t, PO. Bolt 3555, uncut", PA 17604-3565
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DISCHARGE CONDITION: SATISFACTORY 0 FAIR 0
AUTHORIZATION TO RELEASE INFORMATION: I hereby
authorize The Lencaster Generel Hospital to release the above
in'orm.tIO~"led by my In",ce Company.
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VALUABLES
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DISCHARGE AGAINST ADVICE
. ~, . .
contrary to llie advice of the attending physician, Dr.' ,
or of his assistant or designee. I acknowledge that I have been informed of the risk in,olved, and I hereby release the attending
physician and/or l1is assistant or his designee and the hospital from all responsibility lor any III eHects which may result from this
discharge against advice, .:
IN.m.'l1 P"lIltf1t1
'.\ ... . i . \:
is being discharged from The Lancaster General Hospital
$Kpllltlllll 01 p.u.nl Of 01 ~n
*,ll'IoI1r~ 10 *" lOf him . N'.
-~
Clillll
w......
fREA TMENT CONSENT FORM
-'~7k',
.. ~.~ ~"
do hereby ~I~f'cons~nl;o "'~~y' pro:edures and to s~ch medical, ob~;e;~~;, 'Na~ -~;.. ~u;~ ~~.~~ t:::
'--' -\ - .. , his assistants' or his designees ij's is necesSary In hls'judgem~,"1 or Jr.th.~
judgement of any of Ihem..includlng the performance of such diagnostic prOCedures to dete.rmlne thlt presence'O{J"'lIC\tQua.Qf..
communicable diseases as may be deemed advisable to facilitate my treatm~nt and/or protect- me. hospital pel'lOfll14ll"
physicians and other patients. .. __ ., _. ___ ___...
OM ,I,,".
I am aware thaI the ~ractlce of medicine and surgery IS not an exact science and I acknowledge thaI no guarant~. have betn
made to me as to the result of treatments or examinations In the hospital
The form has been fully explained to me and I certify that I understand Its contents.
;:j"II',IIl"",..I"l''''''ll
N.ll"H
(If patient is unable to consent or IS a minor, complete the fCllowing):
Patient (is a minor, years of age) or IS unable to consent because
., , r- .-,
.,
".i!.1t111l1l\",,'I..If!;JI'...."'It,,"
,
"
I
-:'
,: I
. 1M..
Emergency Department
MEDS/DOSAGES: -~
..~-~-
Protocol Algorithm
PT.NAME:_(?,lr" rd.-y!.." 'PuUUd' OATI!:g;'C.h'~
I
701 '14 < ~'7 5.'" FMD:
PMH:
ALLERGIES:
u-
TETANUS:
<5yr>
<IOyr>
TRIAGE ACUITY: /'
L U vN A
L-LJ" Thrlal v-U'otnt N.N'"Cn.U~ R..Roulln.
REASSESS:
U:) 30 mln, in WR
N/R: > 1 hr. in WA
CONDITION: Stable V Unstable
DISPOSITION: ED-LFC_FHS_
OTHER
Time BP P R T SA02 TRIAGE: ?Ju.'7
SUSPECTED CHILD ABUSE Initial Gras ow hou Iy
Assess and report any suspecled abuse traum s)l.~lIe Is CC: '5"'ltD. ~t. ~ (;-2)
Nollfy Social Service, Ex!, 7264 (eve/nights call nlflJ .:.;r.; '?() Zo Z ':h~ ~ Vi qz-.
Operator) and Nurslng Supvs. ~ . U..-LR eI .Wl.~ tf-t-." (C.~
ContacT Children & Youth Agenr.y: tU;7A.-u-i '8-., ,/ ' A~'I-L-.
Days. 298.7925
Eve/nights. 396.8085 fn., '7:f-A.<..J-L.... tu~-r~
Photo of Injured areas taken by physician (at gt:w."jc. a tA.. ~~ tn-,
their dlscrelion) document on back of photo. PI. t-u.-Ifu.. (C..s ~ .I2.,y .
name, 70N, date, lime, Identify area In photo,
tape to MO "Treatment Progress Record' 1m[ €.c.ch..:J; l. ~. Q/J U",""~],r
If medical records are requested by outside rj-fl:Y P:1:~j)<dtU. {L'l~U
authorities - consent must be obtalned on ? .J ^- ../. ~ ~~~ h".. 4
"Releaee of Informallon" torm and the requesting ~; J(..
person directed to the Clinical Correspondence ~ H,. t.." 1.<;'_ ,JJ.~ '-~
Secretary In Medical Records from 8:30 a.m. . II/. ~ 'Ail _ .-/.L
5:00 p.m. (weekdIlYs) or call 290.5813 N_.
Call Security to remove suspected abusers that IqlJo l\J.li'7~, I'__o\,~:./ e.VA (UJ..1'r./11
threaten pI/staff safety l:l~"\ ..,,~. AO..... r..... l.~ (I,.U....
File a CY.47, Make 3 caples, Give cuples 10 the C:d... ..... M, ! u .
Ao
following: - ~. r-:- . /Nt. flL,'4.1 ~
-Original: Lane. Co. Children and Youth Sac,
Sve, Agency II In ED, t.NI(I,,~., I J 1'... .. Cti 'J A"
-ED Cho/ge.Nurse to send form to CYA if not 1'I:l,., ~ 1'15)' (11. I " ~. '* 0-... r ..! ..~
In ED ~~ ~
-PT. Chert /-'iJ(J ,-'13 .3 ;:) - - U
-Risk Management - 11_ I I. ,~A_~
C:>mmunlcate Involvement of Children Youth ": Iq<;'f ~ /I. .~ '- ~-t t'..V-~~
Social Service Agency to family LQH A.2842-08 ~ f...... ,Ju~ J ;: 11h< J~. "-~. AlA .j)J~'" t
Tlmo GLASCOW - MEDICATIONS IV / Blood I 0
. Pupt;a Fluldl Plod,
-
% % MEOS. 0000 AouI, 'M. 1'ypol 'SlIe """ JJ:;. I'oIeI
e,. """"' ""'" Total Tlm, """"'.. ,..
tV, NOT
Blood 0IIw
OIIW 0IIw
1lltol -
ld
/Z.,
REPORT OF .SUSPECTED CHILD ABUSE
(CHILD PROTECTIVE SERVICE LAW - p,S, " 2201 - 2224)
INSTRUCTIONS TO MANOATUO PERSONS: Any plt.onl,wno, In Ihe COUI" 0' thllr Imployml"'. Occupltion. or ptlulu of 1".1' plo'...lon com.
Into IIIQnl.e' wlln 1II1'\lld,," Ihlll "POrl ~, nu.. . 'Iporl 10 tt. ",1'" 10 C"'''JLi". IIOO.U2'0:n:U Wftl" th.y tin. ,...on 10 bllllVI, on thl b..11 0' Itlll,
ml'UClI, l)Io'...lon.1 0' ..Hh.~ ".Ininl tnd IMPI"'"". """ . lithlld 1II0mlt'll Iit,for. U..", In lh,l, plO'....IO".1 or .)"11:1.1 IIplolty i. . vlotlm of cll'l~
Mun. Within'" l'Iour' ,It., Ih, 0'11 ,.port, .,nd 0"' cop." <)1 lhlt "pOrl 10 Ihe Child "0111I11"1 Se,"I'" Unit of thl County Chlldra" .n4 'foul" A""IIIY,
NOTE: If Ihl el'llld ".. b..n I..." Into CUlt ad." you mutl Ilia Immldll'lly conUcl Ihl County Child,," end Youlh .,.ney wf'I". u,. .bu.. 04C"".lt.
E~CEPT 'OR SIGNATURE, PLEASE
PRINr OR TYPE
1. NAMa 0' CHIl.D IL.II. Plnl. Inl!I.I)
1.V~;:rz...S R,Le"" I.
AOD"ISS tSln". Clly. "". Zip CQ"}l
/ ~ h- (f) <( ffA-eL UR
1A. '''ISINT l.OCATION I' DI"II'INT THAN AIlOVI
SOC. SIC. NO.
ISIRTHDA TI
/0-3-'1/
COUNTY
SIX
~M
0,
C!. a rYJ;? If; / (J d-
170/(
COI.,INTY
~
~
1-1, / (
soc. SIC. NO. A~I T1LI'HONI NO.
3J 717 - 7.:J
C~.(Y
,o~ /7d Om h
SOC, SIC. NO. Aal T11.1,HONI NO.
~c1C -lJ~ 'Iq I - I...j<:l
'" t7~ (7~ :...
-
soc. SIC. NO.
InIH.II
AOD"ISS iSl,..,.
810l.0 leA
InIH.11
I
AOORISS 151'.". C~W. lit.. Zip Colt.'
rf("
<::....
iF
4. l.IO...l. OI.,lAplIDIAN
o~
ADDRISS ISu.". City. SII" . IIp Cod.t
COUNT V
5. Al.l.IQIO 'IRPSTRATOR 11.'11. III,... Inlti.rr--
SOC. SIC. NO.
A1LATION$HIP TO CHU.a
.1 rht'r
COUNTY
C
Aca"l 5 lsudl. City. $1.1. . Zip Cod.1
-) IYJ Ii'. J
5. IIAMIl.Y HOUSIHOL.D COM'OSITION lI.11Gludlnl
AbOY. H.mlll
...M FI, Inl
REL'" TIONSHIP
TO CHILD
N M
L
FI, Inll It
RELATIONSHIP
TO CHILD
....
8.
C. '..,
DISC"181 INJU"'UICONOITIcJ'N AND WHY YOU SUS'ICT AIUSI IGLICT.
INCl.UDI IVIDINCI 0' '''1011I ..ausl TU THIS CHll.C OR SIILING. t'LIAsa
1'1111" TO O,"OSITI 01110" ADDITIONAL IN'OAMATION.I
:::l
D.
e.
F,
010 TI1.' _I'CIDI
c:....,,~...I"'''' c.,~ ,d" S- $if 7
, $~OV~ la.Jl#Il1___~, tj.... pd.."
~~~ ~#.-.6), 5~~~.!.~P'- }
,
COUNTY WHIIU "BY 51 OCCU"".O
7. ACTION' TAKIN 0" ...au 0 II TAKIN
NOTII-leA'
O TION 0' 0 )(-"""YS 0 ~OT04 0 IoIOS"TAL.' 0 'OLlel
CO"ONIPI QltAPMS IlATION NOTI"IO
INTrAL)
OTHlfI IS"clfyl
O MIOICAL 0 IMI.OINey 0
IXAMIH4 CUSTOCY
AflON TAKIN
flTLI alii ".L.ATIONSM." TO CHILD
J">1 .
>- N. O"b
CHILOLINI U Ii ONl. Y
SOU.CS OM. ON. 0 ""
A AL
Ol~; TO ~ LL.LJ
COl'flmOnwl.\tft of 1II.""".,h"",.
"'.''''
"ICIPII.O ....~
~IlOMC"Sr . .
CI"."",.nl af l,bllo W.lf.r.
PLEJ,SE NOTE THE EXACT LOCATION OF THE INJURY BY PL..CING A LETTER OR NUMBER ON TIlE MODEL BELOW. USI THE
LINES BENEATH THE MODEL TO DESCRIBE THE CORRESPONDING INJURY THAT EACH LETTER OR NUMBER REPRESENTS.
.
, . .
~. '" :>
:;) OJ
:> J
)'. ,.,
S " >" -
,. -<
Fh., P.lmtt
L.to.Oornl
L.t.. PII",.r
Rt.,Oonll
,
PLEASE CHECK TH& CATEGORY 0' INJURIES DESCRIBED BELOW:
~ PHYSICAL INJURIES
o SexUAL ABUSE
o PHYSICAL NEGLeCT
0'11011
CY.' 4 tll'
~.
LANCASTER GENEAAt
HOSPITAL.
_u.-_oj>IoIU......
LEA Charge Code
. EMERGENCY MEDICINE DEPARTMENI'
Charae Sheet
:~~~7!Jir~~&)1
Charg.. Completad
Chargee Checked
Primary Num Inltlala:
Charge RN Inltlale:
~~
LaveluO.
Non-Urgent
Chao.. It ADDroarfate:
Critical Care 1st Hour
Critical care Add. 30 MIn.
AIRWAY AND CARDIAC
Bag . Valve. Mask
Code "R. Response
Code "5. Response
C02 Monitoring, Continuous
CPR
(emergency) EKG Appt
Endo Tube. Intuballon Equipment
Monitor Tracing
Nasal/oral Alrway
. Oxygen Admin
. Pacer Defib Pads
Perlcardlocenllsls Tray
Pulse OX Single Reading
Pulse OXimeter Monitoring
Thrombolytic Infusion "
EHI
Anterior Nose Bleed Packing
Dental Tray
Ear Wax Removal
Eplstat . Posterior Nose Bleed
Eye Burr Tlp
Morlan Therapeutic Lens
(Chargll tor IV Solution)
Posterior Nose Bleed Packing
(Cotton Belle, ael Foam, ate).
Pr_petch Eye Shield
EMERGENCV SERVICES
Muat Pick On.:
Level I Emergency Room Vlalt
_ l.!JlIel II Emergency Room Vlelt
.....-Gv.. III Emergency Room Vlalt
V levellY emergency Room Vlalt
Level V Emergency Room Vlalt
PrlmeNIIt ER Non-Emergent
Left wtthout being _n by MD, NO CHARGE
Drug Admlnlatnltlon Only
MED SURG AND TUBES
Absorbent Pads >6
Accu-check Glucose TESt
Blood Alcohol Klt and Procedure
Breath Alcohol Conflnnalion
Breath Alcohol Screen
__ Blood Transfusion
Disposable Scrubs
Disposable Slippers
Disposable Speculum
Edllch Tube Insertlonllavage
Endo Trach Suction Catheter and Equipment
enemaKlt
Gastric Lavage
HemoccuJt Test
Hickman Repair Klt
1M sa Injection
1M Injection, Antlblotlc
IV Start
Lumbar Punctura Tray
NG Tube Procedure end equipment
OB Klt
PedlaJyte
Penrose Drain
Phlebotomy Procedure
Posey V... Restraint
Protective Restraints. (10ft Wrtet)
Rape Exam Kit
__ Shroud
Urlnlllysis - Dlpltlck
Yankauer . Suction and Equipment
-..........-
ORTHOPEDIC
Active Ankle Brace
AII' Splint Application
Appllc Post Long Arm Splint and Equlpmllnt
Application Short Arm Splint and Equipment
(Includes Gulter, Sugar Tong, Thumb Spica,
Volar Splints)
Bucks Traction Kit
Balanced Suspension
Bryants Traction
Cast Orthopedic Supplies
(No Application Fee)
Cervical Collar
Clavicle Brace
Crutches
Hare Tractfon
Knee Immobilizer
Knee Sleeve wMsco
Padded Alum Splint
Rib Belt
Robert Jones Splint Appl
Russells TracIlon
Shouldor Immobilizer
Sling
Strapping Ankle - Ace Wrap
Strapping Knee . Ace Wrap
Strapping Wr1st'elbow - Ace Wrap
, Universal Toe Splint
Velcro Finger Splint
Velcro Thumb Splint Spica
.....elcro Wrist Splint
Walking Heel
.
"
,
TRAUMA AND WOUND CARE
Arrow Emerg Infusion Device. 8.5 Catheter
Arrow Trauma KIt
Arrow - shealh/Wlre Guide . Multllumen Catheter
Arterial IV LJne Kit
Aulotransfuslon Kit
Central Una Kit
(Percutaneous Sheath Intro, Tray)
Chest Tube and Equipment
Cut Oown Tray
Oebrlment Skin TIssue
OlspoMble BP Cuffs
"
Large Bandage Supplies
Mast Application
Periocardlocentesls Tray
Plastic Suture Tray (+ Sutures)
Pressure Infusor Bag, Dlsp
Rapid Infusor (Equipment)
Removal Of Foreign Body, Skin
Small Bandage Supplies
Sterile NSSIH20
Stryker Irrigation Equipment
Subungal. Release
Suture Tray end Sutures
Suture Removal KIt
Thoracotomy Tray
Touml-cot
Tracheotomy Tray
TRAUMA RESUSCITATION
Trauma Tray
__ Treatment Of Bums 1st Oegr/LMa than ll%
Treatment Of Bums 2nd Oegr/8-10%
Treetment Of Bums 3rd Oegr/GrMter than 18%
Wound Irrigator System
UROLOGICAL
Bladder Irrigation
Caude Catheter
Foley Catheter - (Tray & Insertton)
Foley Catheter (Only)
Leg Bag
__ Pedlabic Urine Bag
Straight Catheter
Urine Slralner
Other.
(. )
Seclusion. Restraint
· Extra equlpm.nt or charge for bundled Item . look In
Charg.. Book and writ. the number precMdlnll the
.rtIcla,
~-
LANCASTER GENERAL
HOSPITAL
~l...~_tl"""."""""
Ma NORTH DUKE STREET, PO. BOX 306&, l.ANCASTER, PA 17004.36M
'ID. TAl 10 U.1MNU
EMERGENCY MEDICINE DEPARTMENT
AFTERCARE INSTRUCTIONS TO PATIENT
NOTE: The exemination and ~aalment you have raceivad in tha Emargency Departmenl heve been rendered on an emergency basis only, and
are notlntanded to be a substitute for or an effort to provide complete madlcal care. Your follow.up doctor (named below) Will receive a copy 01
your records and all test reports. It Is Important thai you leI him check you again, and thaI you report to him any new or ramainlng problems Blthat
time, because It Is Impossible ta recognize and Ireel all elements ollnlury or Illness In a single Emargancy Dapartmenl visit. Meanwhile, FOLLOW
THE INSTRUCTIONS BELOW as Indlceled for you, .
ll(lW[/~!i. flll r Y 'r ^ YI. 111{
111.17E\..077'J
011110/')/ ()(J(J!','):lfo:ll l()'M!',:I'I~.
lill!; MArnll':W IJrl
CAMP HJI 1.
r'A 1/011
o WOUND CARE (cuts, ebraslons, bums elc.)
Keep the dressings clean and dry
eJevate the wound to help relieve soreness and help speed
wound ~eallng,
_ Despite the greatesl care, any wound can be Infected, It your
wound becomes red, swollen, shows pus or red streaks, or feels
more sore Ins teed of less sors as deys go by, you must report 10
your doctor right away.
o SPRAIN AND FRACTURE, SEVERE BRUISES
Elevate the Injured part to lessen swelling, It pillows natten, use
chair cushions with pillows or blankets for comfort.
Ice packs also help prevenl swelling, especially during lt1e first 48
hours. Place Ice In plastic or rubber bag, cloth covar.
It you h8'le an elattlc bandage, rewrap it If too tight or loose,
It you heva a Cllt, keep II periectly dry at all times,
Walt 48 hours lor the cestlo become strong before you allow
pre5Sure or. weight on any pert of the cast.
Wrtggle loe~ or flngers to help prevent swelling in the cast. This
should 6a done often it It does not causa pain.
It the part swells anyway or galS cold, blua or numb, or If pain
Increases In aeventy, have it checked promplly.
Your care has been provided by: Lanc8slar Emergency Associates. LTD.
o HEAD INJURY INSTRUCTIONS
Report 10 your doctor Immediately If anything listed occurs (even
within several months),
Persistent heedache
Persistent vomiting, stiff neck, fever
Unequal pupils (one pupil large, one smalll
Confusion or unusual drowsiness
Convulsions or unconsciousness
Stumbling or olt1sr problems wilh nonnal use 01 anns or lags; or
areas of skin numbness.
Nole: Stimulata patlent hourly the flral night 10 check for the.. signa.
o ABDOMINAl. PAIN
There Is Insufficisnt evidence 10 warrant the diagnosis 01 any
acute abdominal condition requiring surgery, This may change
with lt1a passage 01 time. For your safety you should observe tha
following rules:
1, Follow the ordem given you regarding dlel, medicine, etc,
2, Saa your personal phYSICian for reevaluation in 24 hours.
3, Increasing and persistent pain, increasing soreness In ab.
domen, distention, perslslant vomiting, fever may Signify a
change and require reevaluation before that tima. In such an
event call your personal physician or the doctor taking his calls. If
you are unable 10 locate them, call the Emergency doctor for
--: _. _ .1 furthe(1?)s~ructlIlllS:
r~ IUJ &l.~ a...J.../TI. OD(;!~Iorfollow.up
o AVOId any use 01 lt1e injured part
o Allow only limited use 01 the part,
o Umll general activity
EKGIX.ray readings are emergency reectngs only. You WlII be notilled by lelephone if any discrapencles exisl.
Yes 0
(Tetanus No 0
OTHER I CTIONS:
~NERAL INSTRUCTIONS '
_ Call to arrange an appoinlment al hla office to see Dr.
care. Call sooner if you think necessary, Until you see him:
Follow label Instructions for any prescription given by the
Emergency Physician.
_, M.D. Data
I hereby acknowledge receipt 01 the instructions Indicated above. I understand that I hav had emergency trealment only, and lhat I may be
released be/ore all 01 my medical problems are known or treal d. I will arrange for 101l0~ as Instruc~
Wltnass iMlal IJ4 Dale<<) X iJ?'Vl- ~
(Panent or representative signature)
:
.~:.' "
nED4~T^~ENT" ." "'l!:"C"','" :
INSTRUCCIONES AL 'PACIENTF. Ot:';;,,:~;- :: -.;;~. 7~MIENTO MEDICAL
I'h)i,~: : ':'!),I 'r:1I1(",.,'!': :1.13 ',; "V:I:~I_' :';\.,1 JI' .; :.j i :\~ '. ,j .'; ': .~";11 ;,:'.: ~ ,J::;le,j ocr un base Je urgt:nClil, y no puede a
t,I):.i:fH' ~':'tJ IU*'1I1Ip"11'" ",P}il "wdorll) rOlT'rk'f), Su met'jlca fJe fl)mHfB :rn~I'\:i:"a(~o JblllCI '/8 J fee:Clr copias de sus datos meclir:l')s Y 1e
1 " re.;u,I~'J03 !JO ~".1lT:efle,. Es nHJv ImCQrtcnle Que III >n~OI[) :0 ee l'l'.leo un 011'() exam en camelete, val mlsmo trempo indlquele al doc.
IOII.lI,jjJl';It'i;t.'i l'IUd',c.l.:j, v ~Hj(~II~H1,~ ~l.d 111: sa I~ 4UllarOllt porqlJ'? ~s ImpOl,ILll/d i! ~dUEr 0 CUI,Jr 1.0085 problemas medlcas en ura Vlslta en Ie saia
l.: ;111';1<;.;li";..;., :1;.lS;n ~I.I ';,W ";';O':'L,; I,jc>::cr ''';\3 :':I1',;I,J, ~'GUI: (,,;~'c.:);c/'~~)..~ .~i~~II:H1tej,
-. WOUND CARE ICuts, ~br3slons, Burns) ';11 .;,;,,;r, .r~ sensa';lcn JoJrmida, oJ dolor fuerte, lIame.a
CUICAOO De HeRIC~3lCJrtadura3, Quemacums) ,II "'~"'r.o I1n'eGI:;!>;I~ente
La heri,1a tralla ,;,~" ,.,r 'rnl;l~ '1 ;~C1 HE,~D WOUNDS
EI.;vante la hanoa ~ora oliviaI' ~I dolor y dY~u~( " liERIDAS DE LA CABEZA
';~:JI!e 1'1~5 rRcido , . i.-a"~ .1 su rneolco InlTltiOl(ltamente :;1 Ilene algunas de
,~.,;I'.a~e ha daoe buen cuidade '1a'/ !a ~c~lbllld:lC de ;n, :J'; iintomds 3IguI6l1Ias:' . . , . . .
facclon SI camele an .;clcr. SI >is 'nIl31"005. :il 1av ~n deler que 11') se ie q\Jlte,
Cll;. ,; ';11 nay ma$ OOI.;r en vel oe '"el":, 'lame 31 de,;- \11;("0 'It)mll~. .;.;eilo e~tcr~"cido, fiebre.
',:.. "'I'-.;dialel~~ntll. P':CI'J:~:; ~'~,: no 3.;n eJuJI (UnaJrJ~de Y IJna' Pll'
U! S;lRAIN AND -RACTIJFiE 'l,"~n2'
TCRC::CUR,~3, ~RACTURA.s '( .::::m:"S;CNES I";,;,,,'j le"i'l;,r.~~sitiHdjd
.. ~ '.: ,:, ,.'; ~'..:\2i:':~rr;': ::3r',~ ~'::,'''';' ji \q 1,'II,_.,~': \:vli'~t..,s:crt~5 r) ;rr.t;ns~[~",:la'
:;.~.. 1 :'~,: '1!',('r,"l~,1'3 " :i '!!:J rt~'~:'r "":'" 111"',:r,"!"'r!':' :~ O~~~I,?"",~:~ '"!f! '!~~' I~-: '1"~"f)-= I') las ryler"t1S' "artes de la
. ;:r: : l'(~.~:'., ",~ ,r)iJ; ~'~.c: scr ,icrrl"ic~s .,
C'l~1.;re8a$ 1.10 h,elo I":"~"," )' :le'lp',11l ".Ne< fir, ',. 'kla: Stimule at paciente la primera 110che para ver sl el
. . :Ion, .' ;c~c,a ,"eme crura"la .je I.,S ,)(lmams..; 1);JCleme :Iene unas de estas slntomas,
,'~,;,,:, ilIelO en una oclsa ~~ clasuco 0 en ["" ABCOMINAL PAIN .
DOLOR DEL ABDOMENlESTOMAGO
',e "'1 datos medj,;c, sulic:eme oara nacer un
~,l~'~ . :~IS de GlrUJl8 pcr Sll I]GltJr del J':~Grn~n l~erfJ!o
:I;'~ >_lhJe hacr:r FJ~:
S'qlJe ~an la clela y la mediCln, ,)ue $e Ie diO a usted el
n-:I~(~iC':
Haga uria clla con su meolco oe familia 24 horas
:.;s:'~.;s oe eSla v,.,ta, .
3, ilay dolor muY fUorte, mu~ho ,0m110 y n.:bre lIame a su
'n~~Ir.',) 'nmediatarr:ente. Si no p.eoe 3 communicar con
..u ,~"dlco, lIame a la sala de emorgel1cla para mas
:r.::-.:::i6nes medlcas.
I,._....,r, .
St :I~:'.r: '~r '';:'(:Ji~ ce e!a:)UC~ reOtJl1,:rlO SI 12"i rr...,
~"":,,do Q muy rcIQaoo.
31 'i.~r'€ un rr,:iC<?lg '~,sr~ 31 'r: ':13]": 56C~ ,3i~lr.prG.
::~~~ft:S..: iJ j~c(a~ n~s,ii (ju.: J:;)t~d ~~r~gJ ~raSSj~i'1 \j
':'!l?~r; ,:r~ 1,1:5 r.~:~',=~ jf~ iU .,..,:f~~
,\h,j";"!~ I~$ ~,?lj"s ~e I::! rrla~o 0 -1el piel~ mLJch3.s ',ece~ ;'
j:a ~: la acc:6~ no Ie de 1 Ud m\'~~~ ~c'cr E.::e .,~.".
ch:~c Ie protege arlllS de rntl~I"'aci6n.
!'Oi, d~splJe; 11l ha~er lodo I'>.?'I inflamac;6n 'In c~m,;:
trISTRUCC:ONE3 GeNERAL
L.1d.1l1~ J la ~:!r.;"Q oje! dcctcr .__..____ .____ ::~';,.\ ';.j/:~( JI~J ..,tJ. ~n __._____ ..____,.___ dias oera continuar su
trataC1lerlO I-I,:lsta qua J6ted vila al lcet:,.
rrJme la madlr.ind ,:cmc ~'it.1l~drr:I1~\j ~n III t:'ct,~11.3,
N" l.Js;1la cartl? ~~'Jl! r:'ueroc ~m~ rc "I?rida.
No lJsa rrl't:~')lt:~n f'~t;I.!~"r.'? I~ 1)~1e r:cn la hl=)('i;3
'_ ,:.';1:.3.' ;,~,3<? :' -',: I'~;l~:.' ....liC'.O 1p. n:H'frt,
L~'S ';';.::iIJIIBdM oitl~; 1(CI',;1rRf"I1~. ,;>J1A3 I'lf'lq S"1C ,eirioJ ,.::~IC..:.~ 1.',jP.glJ 1~r.:!t' -= OQS con mas detalle.
" .. - ",- ;,""-, ':,1, '>,';, ' '.;' rei." .. 1'% ;rJ,'IQ IlU"~I~ par 151elo110.
',i'"
,n;1 no. T"'.lnus
~f(; r--,
'....ci.:,~,_.__
'.:,-; "t,.
1':':'~"'''1
. ~ ...., . r
_ ..1 .
..1 : ~ ;.J urrJ~""
"1':- I;r' r: !I~~a.~ r. ;1,:.35 .1 ~i~tt:::.: (>
'. ..~..., ;.,~q...:...::'.~'..:..... "::,:.:..l ~J~t;jl';.;
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: I..... ,1..1,,;":
. .'; 1
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~-
Emergency Department
MEDSlDOSAGES:_ er-
-;""';>
PT, NAME: 1<... ~ ~
701 1 ~ f 'i'l
PMH: -H- a...ff-- ~L"'"
protoc'ol Algorithm
!3z,.,. J I!.I !>' DATI!: '8/'0 /S r
FMD:_
ALLERGIES:
.tJ
TETANUS:
<~yr>
<lOyr>
TRIAGE ACUITY: ./
L U VN R
l.-w.. nv.lt U"Urollf'll N.Non.Urgent R.ROUllne
REASSESS:
U:> 30 min. In WR
N/A: > 1 hr. In WR
CONDITION: Stable V" Unstable
DISPOSITION: ED V"FC_FHS
OTHER
Time BP P R T SA02 TRIAGE: ~;~
SUSPECTED CHILD ABUSE Initlat I~~~~ ~~ ~ou Iy
Auess and report any suspected abuse traum all CC: g1cJ /)v~~ f,. f:;7) .:.
I....
Notify Social Service. Ex!. 7264 ("va/nights call ( 701) 4!' g; /1, ~7 171" 'fa ~~ t..o-h ;t.T' ~. 'hi .....r-
Operalor) and Nursing Supvs. I!. L<..J.. "'s /J,,,,,-~~ li.CuyC'~
Contse! Children & Youth Agency: tun...JJZ.~V tfh Uk '
Days. 299.7925
Eve/nights' 396.8085 lifo. , j /... 1J..t:C(.c.k. (!4U e
Photo 01 Iniured areas taken by physician (at 0.. '-I!-.L ,,<~ ~, 6'....:., ~'-
their discretion) document on back 01 pholo . PI, 'inm/'';:' . "S.1L2, A"~ cot ~
name, 70N, date, time, identity area In photo,
tape to MD "Treatment Progress Record- li'ir ~ '~4~ M-~ ~
If medical records are requested by outside IL... f L J.J. ,.L.J26... tJJt:
authorities . consent must be obtained on ~'u. ,.- u 411, U I L- .....:, _
'Releue of Inlormatlo.," form and the r~questlng
person dlre,1ed to the Clinical Correspondence \qCP !}, ~ \c..J..!;\~ C' ""'.....rV+."l' ey /lJ'If'lr- C
Secretary In Medical Records from 8:30 a,m. ' q:'.D
5:00 p.m. (weekdays) or call 290-5913 d". .. ;" J c,.,.,,~" , C...~
Cail Security to remove suspected abusers that '-"-'" oJ J, CvL .~... ,,4/. ,....
lhreaten pl/staft salety .r., . I , ~f'I~1'J ./.' .,
File a CY,4r. Make 3 copies, Give copies to the (I. ' '''-0. I .. '..... -- .t0J7/ ~
following: jQ.~- 1'154 (lj,L4 -d," . (J ~ G.,*,=,,'
-Original: wine, Co. Children and Youth Soc. . A "
Svc, Agency II In ED, J-8o -'13 :l _ /13 I_~ .J=.. . /7 A_.~! - .~. -';;uJ,.u.
-ED Charge ~UI38 to send form to CYA If not !I '7i"., ~.. ../! . J fDA.'. A(7';" C!.. y. U
In ED , -at) :x')
-PT. Chart )))/0 ~ ~ J '" ' . . I ~~ .r. j. . sa
-Risk Management -
Communicate Involvement 01 Children Youth , '-'_J1./,A, i.- " .tJ /. ,'h-'_' Al ~
Social Service Agency to family lGH A.2802.Qll ~~ ~
11m. GLASCOW -- MEDICATIONS IV /= I 0
. ....... FluIdO
-
1% % MEOS. DoH Rout. 'not. ""po/ .Slt. AmI .t;. Foloy
Eyoo -.. ....., TOIoI 11m. - In!
I,V. NOT
- 0llI0t
oe... 0llI0t
- 1bIoi
D-
e,
~.
I:..ANCASTER GENEIW.
HOSPITAL.
Me~ a...na.. H.J\h AUI.....
EMERGENCY MEDICINE DEPAR1MENT
,
Ch.rae Sheet
Prlmery Nurse Inltlell:
Chlrge RN Inltlale:
flfl-
" N~'.c;:~W $'; So /]
ED It: 'J - (, ~ <?-t-
Chlrglla Completed
Chargea Checked
LEA Charge Code
~~.
Llvel MO"
Non-Urgant
EMERGENCY SERVICES
Muet Pick One:
Levall Emlrgency Room Vlllt
Livelli Emergency Room Vlalt
/Uvellll Emergency Room Vlllt
/' LlvellV Emergency Room Vlllt
Llvel V Emergency Room Vlllt
PrlmeNet ER Non-Emergent
__ Lift without being lien by MD, NO CHARGE
Drug Admlnlltrlltlon Only
Choa.. If ADDroDrtata:
Critical Cere 1 at Hour
Critical cere Add_ 30 Min.
AlRWAV AND CARDIAC
88g . Valve - Mask
Gode 'R' Response
Gode 'S' Response
CO2 Monitoring, Continuous
CPR
(emergency) EKG Appl
Endo Tube . Intubation Equipment
Monitor Tl'llclng
Nasallorall>Jrway
.Oxygen Admin
PllC8r Deftb Pads
~ericardlocentlsls TI'llY
Pulse OX Slngla Reading
Pulse Oximeter Monitoring
Thrombolytic Infusion
.
"
,
MJ!D SURG AND TUBES
Absorbent Pads >6
Accu-check Glucose TEsI
Blood I>Jcohol KIt and Procedure
Breath I>Jcohol Confirmation
Breath I>Jcohol Screen
Blood Transfusion
DlspoQ"ble Scrubs
Disposable Slippers
Disposable Speculum
Edllch Tube InserUon/lavage
Endo Trsch Suction Catheter and Equipment
Enema I<lt
Gastric Lavage
Hemoccull Test
Hickman Repair KIt
1M sa Injecllon
1M Injectlon, Antibiotic
IV Start
Lumbar Puncture Tray
NG Tube Procedure and- Equlpmant
OB KIt
Pedlelyte
Penrose Drain
Phlebotomy Procedure
Posey Vest Restraint
Protective Restralnts - (110ft Wrlst)
Rape Exam KIt
Shroud
__ Uri~alysls - Dipstick
Yankauer . Suction and Equipment
mI
Anterior Nose Bleed Packing
Dental TI'llY
Ear W8J< Removal
Eplstat . Poetertor Nose Bleed
Eye Burr Tip
Morlan Therapeudc Lens
(Charge tor IV Solution)
__ Posterior NOli Bleed Packing
(Cotton BallI, Gel Foam, etc).
. Pres.spatch Eye Shield
LlIHM'."""
ORTHOPEDIC
Acttve Ankle Brace
AII' Splint Application
Appllc Post Long Arm Splint and Equipment
Application Short Arm Splint and Equipment
(Includes Gulter, Sugar Tong, Thumb Spica,
Volar Splints)
Bucka Traction Kit
Balanced Suspension
Bryan18 Traction
Cast Orthopedic Supplies
(No Application Fee)
Cervical Collar
Clavicle Brace
Crutches
Hare Traction
Knee Imll'K)blllzer
Knee Sleeve wNlsco
Padded Alum Splint
Rib Belt
Robert Jones Splint Appl
Russells Traction
Shoulder Immobilizer
Sling
Strapping Ankle - Ace Wrap
Strapplng Knee - Ace Wrap
__ Strapplng Wrist/elbow - ""e Wrap
Universal Toe Splint
Velcro Finger Splint
velcro Thumb Splint Spica
Velcro Wrist Splint
Walking Heel
'.
,
TRAUMA AND WOUND CARE
Arrow Emerg Infusion Oevk:e - 8.5 Catheter
Arrow Trauma KIt
Arrow - sheathlwfre Guide. Multilumen Catheter
Arterial IV Une KIt
Autotrans1uslon KIt
Central Une KIt
(Percutaneous Sheath Intra, Tray)
Chest Tube and Equipment
Cut Down Tray
Oebrlment Skin 11asue
Olspoeab,. BP CufIa
,
Large Bandage Supplies
Mut AppllClltion
Periocardlocentesls Tray
PlulJc Suture Tray (+ Sutural)
Pressure Infusor Bag, Olsp
Rapid Infusor (Equipment)
Removal Of Foreign Body, Skin
Small Bandage Supplies
Sterile NSS~20
Stryker Irrigation Equipment
SUbungal Release
Suture Tray and Sutures
Suture Removal KIt
Thoracotomy Tray
Touml-cot
Tracheotomy Tray
TRAUMA RESUSCITATION
Trauma Tray
Treatment Of Bums 1st Oegr/Leu than ll%
Treatment Of Bums 2nd Qegr/8-18%
Treatment Of Bums 3rd Degr/Grestar thin 18%
WoundlmgatorSystem
,
UROLOGICAL
__ Bladder Imgation
Caude Catheter
Foley Catheter - (Tray & Insertion)
Fol8y Catheter (Only)
Leg Bag
Pedlalrfc Urine Bag
Straight Catheter
Urine Stralner
Other:
(*)
Seclusion . Restralnt
· ExtnI equipment or charge for bundltd Item . took In
Charll" Book and write the number pr_dlng lIla
arUcle.
~-
LANCASTER GENERAL
. HOSPITAL
~L..._..lto.k)o'"......
&55 NOATH OUI<! STREET. PO. BOX 345&, LANC,A.STER, PA 11004.3655
'ID. TAllO n-l:MIW
EMERGENCY MEDICINE DEPARTMENT
AFTERCARE INSTRUCTIONS TO PATIENT
NOTE: The examlnetion and treetment you have racelved in the Emergency Department have been rendered on an emergency basis only, and
are not Intended to be a substitute lor or an eHon to provide complete medical care, Your follow.up doctor (named below) WIll receive a copy of
your records and alltesl reports. It Is Importanlthat you let him check you again, and that you report 10 him any new or remaining problems atthel
tima, because It Is Impossible to recognize end treat all elements of Injury or illness In a single Emergency Department visit, Meanwhile, FOLLOW
THE INSTRUCTIONS BELOW as Indicated for you. .
f1C1wrrm. IlYAN T
/ II. I;.>fl . O??'}
"
OO()!.1(.:1I1 /(I'J-t !,:l')~
1(, I~; MA flHF.W OIl
r:AMP IHlI
I'A l10l1
o WOUND CARE (CUIs, abrasions, burns elc.)
Keep the drasslngs c1aan and dry
Elevate the wound to help relieve soreness and help speed
wound healing.
Despite the greatest care, any wound cen be Infeclad, II your
wound becomes red, swollen, shows pus or red streaks, or feels
more sore i"slead 01 less sore as days go by, you musl report to
your doctor right away,
Your care has been provided by: Lancaster Emergency Associales. L TO.
o SPRAIN AND FRACTURE, SEVERE BRUISES
Elevate the injured pert to lessen swelling. II pillows Hatten, use
chair cushions with pillows or blankets for comfort.
lca packs also help prevent swelling, ospecially during the first 48
hours, Place ice in plastic or rubber bag, cloth cover.
II you hlive an ellltlc bendege, rewrap It If too tighl or loose.
II you have a cuI, keep It perfectly dry at all times.
Wall 48 hou~ for the cast to become strong bafore you allow
pressure or weight on any part of the cast
Wriggle toes or fingers 10 help prevent swelling In the cast This
should be done often 1111 does not cause pain.
II the pert swells anyway or gelS cold, blue or numb, or If pain
Incrllases In sevanty, have it checked promptly, ,
. \
o JliNERAL INSTRUCTIONS
l.L' Call to arranga an appointment It his olllce to see Dr.
care, Call sooner if you think neces~ry. Until you see him:
Follow label Inslructions for any prescnpllon given by Ihe
Emergency Physician,
o HEAD INJURY INSTRUCTIONS
Report to your doctor Immediately If anything IIsled occurs (even
within several months).
Perslstenl headache
Perslstenl vomiting, still neck, fever
Unequal pupils (one pupil large, one smalij
Confusion or unusual drowsiness
Convulsions or unconsciousness
Stumbling or other problems With normel use 01 arms or legs; or
arees of skin numbness,
Notl: Sllmulata pltl.nt hourly tha Hrat night to check lor !ha.. signa,
o ABDOMINAl, PAIN
There is Insufficient evidenca to warranl tha diagnosis of any
acute abdominal condition requiring surgary. This may change
with the passage of time. For your safety you should observe the
following rules:
1. Follow the orders glvan you regarding dlel, medicine, etc,
2, See your persbnai physlclen for rlIevaiuation In 24 hours.
3, Increasing and persistent pain, Increasing SOrlll18SS In ab-
domon, dislantion, persistent vomiting, fever may signify a
change and require reevaluation belore thaI time, In such an
event call your personal physidan or !he doctOllaklng his calls, If
you are unable to locate them, call !he Ernargency doctor for
furth slructions. j ._
in a;J /')'I. d 'LA .....teys for follow.up
o Avoid any use of lI1e Inlured part
. 0 Allow only limited use of !he part,
o Urn it genaral activity
EKGIX.ray readings are amergency rasdlngs only. You will be notified by telephone ,f any dlscrllpancies exist.
Yes 0
(Tetanus No 0 type:
OTH R INS rRUCTIO S:
.0. Oat
I h.reby ecknowledga r elpt 01 the instructions indica above. I understand at I hava had amargancy treatment onty, and IIlIt! may be
raleased before all of my mltdlcal r lame are known~r traet arranga (fOIlOW'UP c "' as Instruc~bova.
Wll11ess Initial . Dete ,_Jls/lA.8Y
IPalltnt or representdvt lignIaMI)
~,
~.:~ ','IG( ," :IJ'.~ ;it":-!'
(J,;:. 3tJ,( :.:';5 ~ll~C,l:i~'''''' IJ'mn:i'i~'I,lnl.l 171~~,1.:.~.;j
. .
DEPARTM!:~lrc ~E ~i,1ERGE:ICUS
INSTRUCCIONES AI. PACIENTE ~~SPUE:3 DE r?AnMIENTO MEDICAl.
NOTA: EI '1~.:J.1\.t.l!l /' 'r,ltilr.,r;,"''1 '1lJl'J !',\ ';( ,. ':c :leu ,~" i,l ~', ,) >~ ;'''lj'~':I''':-'.1 ':;~ ': i\111,L'i'1';; ..::::~r1 !:cr ,m bas.; Jt1 '..:r,,:~rl:(.l Y": ';l..:'iall a
~IJt~tf~lIr ~~lle ~rl:ttc,",ll!"!') ~:,q1.1 t;uir1~dl~ '~''''~'~'r: SIJ ",~rt',~" ~~ 1:~""II,.1 IIN~I'I~'r:"fl!j" ,1b~lcl':A 1 rQ~I"jr l:OOIO:i ~ft 'i1J~ ~1j3tCB ltP.r:1ir.~'i '/ rje
:iI,S rt:~ultat10$ 11U f);tJIMnt1$, E$ rl'll"y Imr:cr:UI'113 OW? SU (',edIC') 10 rift :1 usted un C!(O f!);FimtJn ccmr;I~111 Y AI ml:\lllO hamoo InrtltllJete al ocr;.
l..:,t pfr:lbltima~ IlIJtJ'joJ,S. l) pr\JCllmM~ '~l..~ Ilf) SJ IljIJull,\Ic:n, P"II.~,l".I~ vb In'IlIJSI~le ,) "jdOe' tJ cur,lr 1000as ~r~lltlftnllS rneolG8S 81l una '/l'ilta I:!n 10 said
'l~ 'llnefg~r.Cla. HJo(.:\ ~u ~lta ':;i'. ~u 4':L~tCI .;~ IJrndl.1. ...:~~tJ ":Oll :c.;~ c:cr;)iJlc~ :)'~l..iGnfe~,
-! WOUND CARE ICuts, Abrasions. 3um~) en C~h;r ~n;; ."nSJC:0n aormlua, 0 dolor fu~rle. llama a
CUI DADO DE HERIDAS (Cortaduras, Quamaduras) SIJ .no.dlco Inme,jialr,lnente . .
La h~r;r1a tll~re~1 :1: ~-.;r '11':'PI;l:, )p.CJ. ..., HEAD WOIJNDS
EI"'lrtnle fa 11d(,ua ~,;ra ""'''n' "I dOlor y ayuddr , HEIiIDAS DE LA CABEZA
cur,lll" '~dS r.1pl~C L1an'e ,) 5U Iredico 'nlnedlSlements SI Ilene algunas de
Aunq"e 1101 dado b~en eUldado l~dY la PCslblhdad de in- las .intcmCiS ilgulenter .
lace:,:,.. S, ,;.1rr.1:19 ~n e,;10r. " 85 Intlal11ads. II nJ'j Un ,~CI';r qLe1') 5e I" qUite.
pUo .: 511 'la, '11.!, ':<:l/lI 'JIi"?: ,:e 'renos. 1I.11r9 .11 ,:e,> ~tuchc ',omll';. CLllllo enICrpp.cldo. liabre.
'~rf~r:;e,ji.lt':n'!?I'tt' PU~I:~1!';S ":::ljl~ rl:)I:I' ~t;ual lU~3 :1r~;"'1t3 Y l.:ra Pt?-
3PF.lINol.NO FRACTURE ':~o;""
TCRC::uURAS, FR.lCTURAS '( C::NTUSIONES ',L"ee. '. G'~;gc, :"s.:sii;,I"j~d
C::":"j.'lf(~ ';1 ~.lItt! ',~p'i i::~{W:I;. ~,."'J ~i~~'l"~il( 'oj 'r~"ln1iJ' c..:;f''.'!;IS~I:r''I::'i j "'I:\~I'l~~ii;I'r:i,1
c:c-l'" 'wl':3 1!r;11:h,1'1"'!'ji 5! ~I'! :!'::!'~"'Jr, ',;').1 1'rr:<:r~~~$ -;';' r=rr:CIt:,n:E ':+d w~8r l.-l-:r",Jr~cS.-: a~ ~!c~"',1~' ':,1i~eS riG '..I
:1 7' ;1-, ; ,.l!(':.::s .:.: ~iel .,U~ ,!;,~r' '!~r""';d:)s
'.:'~ Il~(":'j,.~ ~ '~r: '1',:: ',.!"~I:'I:" ':,:tP'!~dl? .'::If1t~-: r4~.,. ~jotJ: Stjmul~ .JI rJacl~nte IJ ~rimer:J nocr.~ ',ar! '1t!!' 51 el
" """ .;:' . ,,;.;,; : . 'nm ,1I1,..rrA Ie I..S pnmAf~s;:j IMr.lente ti~nll 'mJS de ~513$ slntomas, .
1'>1 i. >,;.; :'510 e 1 IIl'a oclsa r:e CI~StlCO 0 en I"~ - A3CCMINAL PAh'l .
,j "C:, OOUIi C.:L .~BDOMcNIESTOMAGO
,~I i": I,in .";1'1'';;'; Jl~ ~1~.s(I~lj t".;~I.lI'~t'lQ 51 ';0 rtl<-.i' r,l: "T, ";,J::.S r~;,;;;<r..; ~;..rlr~:~I'ie ~~Id 'ldcer l..II'
apr,,;:,,:a~;v 0 n'~y" h':!~Il";'~ :'JI.;r :~.3 ~~ ;"'1.;,,"1. ,::- ~L., ,:,:;IG( ,~.? .~::;:':'''''''';'1 =r:'r') 0
-::1 "'-I" n l' oil".. ',. .~...' " r ...." ..o"..,~ 'cr."l" ,',I,,:'. '..,. .J.~,~.. h!"l!."." ~~
.~ ~ t";'..I_"L:\.,;,~'':::,'. ),.~,,,,l.;I:;;o)...........l;;l ''''~... lo:;_ C1 __
":'~;:I.;i;:;t3 .Hl Jr;ra.i .~J:;t':i ,~Ut; ;.:~'ica pcr:gJ r,~S~Sil,jn ~llJIJP. ('.J" 1.'3 !:~~a y la 'TI~diclI"~ r.UI? S~ I~ 11i,.i a 'Jst~d.::;1
j>~'=C I:' la:: ':,1r~..;d ".:9 :iG .r:'.:k~~. 'ir~':tCJ ..
\h~.:\,} I;S ,,~tiOQS ~t? ,1 ''11.111'.11: ':1;1 ::;:en r.1L.cl"as', e"=~$ '3' .~ hac;a Jl1a clIa con su meolCO de larrll!la ,ol noras
dla 31 '3 1CCicr re '3 :0 1 Ud. "I"~cho defer. E,!~ ~xr,r. :es~:" ;0;).. ~n YISila,
t:ir::o Ie Jr"fege arre~ de ;nfl13I~:!~io!" ::. SI fiat \J~lul' n1uy luelta, iTIu~no 'wOlnI(O ~ ilt30re llama a $U
Si' dli~r.ue~ d~ haee' tono M'I ihfldrr~ci6n. un ':3mbh) Ir.;G'C,; r"'~GC,a:6men:Q. Si n.o ~u6oe a commUl,lcar con
;~r.edlc:;, ilJ;::e a la sala d~ emargerc:a "lra mas
ii~strl..~cj,;r.~s :,..~diC3S. .
INSTRUCCIONE3 G2NEM/\L
L::1m8 1 ',1 :r;~:nJ ;;i ;;.:c:~.- .___
'r1tan'ip"'!Q. 1-',,$ra<L~ '"sled 'lea ?-I acetof:
TOr1"A 'n m~~!c!r.l'~omc esti :ndictdc en '3 tete I'.],
N~ usa la carte ~e su cuomo con la henda,
No usa ,"ucne.ccn frecl,anela :a oa~fe ccn la herloa.
'J..sC,1r,ese:, :O1.,~3 <"1ucr,; .1e nada. .
co> "~\U,I~do.! c..1 'afalo"rJm~ y In ~',;,a han sido leldas rapldJs Lu..~o ~erJn le'oas con INS delatle.
~. ,1r:,18.; )1: 'Jr':~.I12'i:~~l ,;...n.1 ~ifl1rr:r"::i1 .; ()r~Ci~fra ~ 'r;:I~ICalJiT1~S ,oj rr.1S ';1':)1110 I)OSllJud ~or t~le'Ollo.
31 -,
'!Ij r-"
_p.,ra :'dC,?,'.lrI,; ,;11<1 ':rJ ___._________ dlas oem ccnllnuar su
j",',:r::.,r'J '16 7";r~'I'Lj
Cil;s: __,___._,_..._____. ____) __
':'''/'''';1'';'
.-.- -, .._,-- ,---------- -..--.--,--" --------..------...---.-
'~...~.~~: '.e,,:l"";
, " ~ ~
, , ~.I"':':' _:.
:' :.~. ',~~.,) Jt:
... ,!'Ie .. ,d'l :',r I,' '.., ! Je ,;':2nCI.l
: """ T':~(~IC~ '"j ~12 ~Ic; pr';lld:"\~S .....~ '1':1:; y ,11;:~S ce
~.,:.' },...I;_ -'.. _~... :'~.'~~'~.~.:lJ.;~: ~):; ;a~r;:..:e :1"
,:,;'. :,'.'
''';:1.' ,.11:.~ r" ..
., '~:..} - . ilf:di'