HomeMy WebLinkAbout97-06861
COMMONWEALTH OF PENNSYLVANIA
,
IN THE COUR'f OF COMMON PLEAS Of' CUMUERLAND COUNTY
JANICE KUNKLE, Individually and as
Parent and Natural Guardian of
Andrea Gutting, and ROBERT KOHUT
Plaintiffs
vs,
SCOTT MILLER, Defendant and
Counterclaim Plaintiff
File No.
97-6861
vs.
ROBERT KOHUT Additional
Defendant and Counter-
claim Defendant
SUBPOENA TO PROOUCE DOCUMENTS OR TH~
FOR DISCOVERY PURSUANT TO RULE 4009.22
TO: SPORTING HILL FAMILY HEALTH CENTER
(Name of p'r1on or Entity)
Within twenly (20) days aiter ler"lce of this subpoena, you are ordered by the COUrllO produce the following documents or things:
A CODV of your entire file on Janice Kunkle, S'9' U1BB-62-1465
~
at_BLAKEY, YOST, BUPP & SCHAUMANN, LLP 17 East Market St, York, FA 17401
(Ade,"")
You may deliver or mailleaible copi.s 0/ the. dec'Jmentl or prceuce things requested by this subpGena, tcgother with the
certificate of complience, to the party making this re<;uesl at the adcrelslilted above, You have the right to ,eek, In advance, the
reasonable cost of preaaring the cOpits or prcducing the thinglsought.
If you fail 10 produce the eccuments or things re<;uired by this subpoena, w,thin tweor/ (20) days aiter ilS sar/ice, the par:y ser/lng
this subpeena may seek a court oreer compellin2 you to cemply with it.
THIS SUBPOENA "'/AS ISSUED AT THE REQUEST OFTHE FOllOWING PERSON:
NAME:
Donald B. Hoyt, ESQuire
17 East Market Street
AOORES;:
HL:?HONE :
York, PA 17-\01
(717) 84~-]674
suP:<:,", CCl:RT 10 1:,1 '''1 G I
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COMMONWEALTH OF PENNSYLVANIA
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY
JANICE KUNKLE, Individually
and as Parent and Natural
Guardian of Andrea Gutting,
and ROBER'r KOHUT,
plaintiffs
No. 97-6861
v.
CIVIL ACTION - LAW
SCOT.T MILLER, Defendant and
counter-claim plaintiff,
v.
ROBERT KOHUT, Additional
Defendant and Counter
Claim Defendant
ARBITRATION
CERTIFICATE PREREQUISITE TO SERVICE
Ql. A SUBPOENA PlJRSUJ\t/T TO RULE i.Q09. 22
As a prerequisite to service of a subpoena for documents
and things pursuant to Rule 4009.22, plaintiffs, Janice Kunkle,
Individually and as Parent and Natural Guardian of Andrea Gutting,
and Robert Kohut, certifY that
(1) a Notice of Intent to se:ve a subpoena with a
copy of the subpoena attached thereto was mailed or
delivered to each party at least twenty (20) days prior
to the date on which the subpoena is sought to be served;
(2) a copy of the Notice of Intent, inclUding the
proposed subpoena, is attached to thie certificate;
(3) no objeotion to the subpoena has been received;
and
CERTIFICATE OF SERVICE
I hereby certify that I have served a true and correot
copy of the foregoing document on all counsel of record by placing
the same in the United States Mail at Harrisburg, Pennsylvania,
first-class postage prepaid, on the ~ day of April, 1998,
addressed as follows:
Donald B. Hoyt, Esquire
Blakey, Yost, Bupp & Schaumann
17 East Market Street
York, Pennsylvania 17401
(Counsel for Defendant Miller)
Jack M. Hartman, Esquire
Hartman & Miller
126-128 Walnut Street
Harrisburg, Pennsylvania
17101
(Counsel for Additional
Defendant Kohut)
REYNOLDS & HAVAS
A Professional Corporation
. /
By: ~~j~~i;"Deli~~~;l14~'~;:1' ...(.
Secretary
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CERT'IFICATE OF SERVICE
I hereby certify that I have served a true and correot copy of. the
foregoing document on all counuel of reoord by placing the same in the united
states Mail at Harrisburg, Pennsylvania, first-class postage prepaid, on the
/~ day of April, 1998, addressed as follows:
Donald B. Hoyt, Esquire
Blakey, Yost, BUpp & Schaumann
17 East Market street
York, pennsylvania 17401
(Counsel for Defendant Miller)
r
Jack M. Hartman, Esquire
Hartman & Miller
126-128 Walnut Street
HarriSburg, Pennsylvania
17101
(Counsel for Additional
Defendant Kohut)
REYNOLDS & HAVAS
A Professional Corporation
By:
I' , :. (.
ifrJ "-I.--,,.,J h.tL i F~
Shat.'on Dell-Gal ag, '
secretary
JANICE KUNKLE,
PIOIinliff
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
PENNSYLVANIA
v,
CIVIL ACTION - LAW
SCOTT MILLER,
Dcfendant
NO: 97-6861
v,
ROBERT KOHUT,
AdditiOlml Defendant
ARBITRATION
ENIRy..m~CE
TO: PROlllONOTAR Y
,
Plcase entcr thc appearance of Hartman & Miller, P.c. on behalf of Additional
DefcndOlnt, Robcrt Kohut, in thc abovc-captioncd matter,
Respcctfully submitted,
HARTMAN & MILLER, p,c.
By:
;:./xl i?t/L
J' ck M. Hartman, Esquire
upreme CL I.D, 1121902
126-128 Walnut Street
Harrisburg, PAl 710 I
(717) 232-3046
Datcd:4~/~r_~_
Attorncy for Additional Defendant,
Robcrt Kohut
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MICIlA&L N. !ADO"SIU, IlSQUIRIl
Pa, .upr... Court I,D. Ho. 33646
MICHJlLII J, THOIU', I:SQUIRIl
'a, .upr... Court I,D. Wo. 11111
RIlnlOUl. A HAVAS
101 P1ne Ilt,,_t
'oat Off1ce Box 832
Ha"r1aburg, 'ennay1vania 11108-0832
Telephone:
ru:
[1111 236-3200
[1111 236-6863
Attorney fo" Plaintiffa
JANICE KUNKLE, Individually and
as Parent and Natural Guardian of
ANDREA GUTTING and ROBERT KOHUT,
Plaintiffs
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PA
NO. q'1-(..,j{, I CI.uiIKILf>\
CIVIL ACTION - I,AW
SCOTT MILLER,
Defendants
ARBITRATION
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 CQurt 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 ~WYBR AT ONCH. IP YOU 0.0 NOT
!lAVE A LAWYER OR CANNOT AlFORD ONE., 00 TO OR TEI.EFHONE THE OFFICE
SET PORTH BELQW TO FIND OUT WHERE YOU CAN GET LEGA~~~
Court Administrator
4th Floor, Cumberland County Courthouse
Carlisle, Pennsylvania 17013
(717) 240-6200
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 do plazo al partir de 10 fecha de la
demanda y la notificacion. Usted debe presentar una aparloncia
escrita 0 en persona 0 por abogado y archlvar en la corte en
forma escrita sus defensas 0 SUS objectiones a la9 demandas en
.
contra de su persona. Sea advisado que si usted no se defiende,
a corte tomara medida" y puede entrar una orden contra usted sin
previo adviso 0 notificacion y por cualquier queja 0 alivio que
es pedido en la petioion de demanda. Ustlad puede perder dil1ero 0
es propiedades 0 otros derechos importantes para usted.
LLIVII IISTA DIllMa:~A ~ : ::~ ::~~ ~=~I~;~::::. at 110
~~::: ~OOADO 0 SI NO TIll II N a ~ : ~:~~~ AI.
8IIRVI~IO;, ::Y:N~NE::::O::O~I~~~:A~~Rp=i~~:~I:U~ ~~~~~N:RCOYA
~~::~ ~~NS::UIR ASIST.NOIA LIIOAL.
Court Administrator
4th Floor, Cumberland County Courthouse
Carlisle, Pennsylvania 17013
(717) 240-6200
REYNOLDS & H,WAS
A Professional ~orporation
DATE: 17-/lc'ln
By:
MICHEl,E J. THORP
Attorney I.D. #71117
Attorneye for Plaintiffs
101 Pine Street
Post Office Box 932
Harrisburg, PA 17108-0932
(717) 236-3200
individual currently residing at 1276 West Lisburn Road,
Mechanicsburg, Cumberland County, Pennsylvania.
5. At all times relevant hereto, Mr. Kohut was the
owner and operator of a 1987 Buiok Lesabre, VIN No.
lG4HP1438HH522005.
6. At all times material hereto, Ms. Kunkle and Ms.
Gutting were passengers in Mr. Kohut's vehicle.
7. At all times relevant hereto, Defendant was the
owner and operator of a 1997 Ford F150 pickup Truck.
8. On or about october 14, 1997, at approximately
5:50 p.m., Mr. Kohut was operating his vehicle in an easterly
direction on Lisburn Road, Meehanicsburg, Cumberland county,
Pennsylvania.
9. At the aforesaid time and place, Defendant was
traveling in a westerly direction on Lisburn Road.
10. Mr. Kohut stopped. his vehicle at the inteJ;'section
of Lisburn Road and Williams Grove Road, checked in all
directions, and prooeeded to cross the intersection intending to
continue his travel along Lisburn Road.
11. As Mr. Kohut's vehicle crossed the intersection,
Defendant endeavored to turn left onto southbound Williams Grove
Road and in doing 00 negligently, recklessly and carelessly
entered the intersection and struok Mr. Kohut's vehicle.
12. When Defendant negligently, recklessly and
carelessly struck Mr. Kohut's vehicle, the mid to rear portion of
the driver's side of Defendant's vehicle impacted with the left
rear corner of Mr. Kohut's vehicle.
13. The occurrence of the aforesaid accident and the
damages and injuries hereinafter described, were the direot and
proximate result of the negligent, reckless and careless conduct
of Defendant as set forth below:
(a) in failing to yield the legal right of way to
Plaintiff's vehicle;
(b) in failing to comply with S3322 of the Motor
Vehicle Code pertaining to vehicles turning left;
(c) in failing to keep a proper look out for vehicles
being lawfully driven on Lisburn Road;
(d) in failing to pay attention and to properly
maintain control of the vehicle; and
(e) in operating his vehicle in a reckless manner.
14. At all times material hereto, Mr. Kohut, who had
the legal right of way, was operating his vehiole in a
reasonable, cautious, prudent and safe manner and in accordance
with Pennsylvania law.
15. As the direct and proximate result of the
neg\igent, reckless and careless conduct of Defendant, Plaintiffs
suffered the damages hereinafter described.
COUNT I
JANICE KUNKLB, INDIVIDUALLY
V.
SCOTT MILLER
16. The averments in Paragraphs 1 through 15 are
inoorporated herein by reference as if set forth in their
entirety.
17. As a result of. the negligent, reckless, and
careless conduct of. Defendant, as set forth above, Ms. Kunkle
sustained bodily injury in the nature of a oervical spine injury
and headaches.
WHEREFORE, Plaintiff, Janioe Kunkle, individually,
demands jUdgment in her favor and against Defendant, Scott
Miller, plus interest, costs of. suit and any and all other relief
which this Court deems proper and just, in an amount within the
compulsory arbitration limits of Cumberland County.
COUNT II
JANICB KUNKLE, AS PARENT AND NATURAL GUARDIAN
rOR ANDREA GUTTING, A MINOR
V.
SCOTT MILLER
18. The averments in Paragraphs 1 through 17 are
incorporated herein by reference as if set forth in their
entirety.
19. As a result of the negligent, reckless and
careless conduct of Defendant, as set forth above, Ms. Gutting
sustained n head injury.
WHEREFORE, Plaintiff, Janice Kunkle, as parent and
natural guardian of Andrea Gutting, a minor, demands jUdgment in
her favor and against Defendant, Scott Miller, plus interest,
costs of suit and any and all other relief which this Court deems
proper and just, in an amount within the compulsory arbitration
limits of Cumberland County.
COUNT III
ROBERT KOHUT
V.
SCOTT MILLER
20. The averments of. Paragraphs 1 through 19 are
incorporated herein by as if set forth in their entirety.
21. As a result of the negligent, reckless and
oareless conduct of Defendant, as set forth above, Mr. Kohut's
vehicle was damaged in the amount of $1,913.38.
22. As a result of the negligent, reckless and
careless conduct of Defendant, as set forth above, Mr. Kohut will
be forced to rent a replacement vehicle while repairs are made to
his vehicle.
WlIEREFORE, Plaintiff, Robert Kohut, demands judgment in
his favor and against Defendant, Scott Miller, plus interest,
costs of suit and any and all other relief which this Court deems
proper and just, in an amount within the compulsory arbitration
limits of Cumberland County.
REYNOLDS & HAVAS
A Professional Corporation
DATE: \'L/'(>/'1-'/
By:
\.. I' /J--:IJ
. {'.Viv J, h ('-1//
MICH EL . BJ'lDO, SKI
Attorney 1.0. 132646
MICHELE J. THORP
Attorney I.D. #71117
Attorneys for Plaintiffs
THOMAS, THOMAS . HAPBR. LLP
by. Todd B. Narvol
I.D. No. 42136
305 N. pront Street
P.O. Box 999
Harriaburg, fA 1710S-0999
(717) ~37-7133
JANICE KUNKLE, Individually
and as Parent and Natural
Guardian of ANDREA GUTTING and
ROBERT KOHUT, Plaintiffs
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PA
No. 97-6861 Civil Term
v.
Arbitration
SCOTT MILLER, Defendant,
Counter-claim Plaintiff
v.
ROBERT KOHUT, Additional
Defendant, Counter-claim
Defendant
DEPENDANT MILLER'S ANSWER AND NEW ~TTER TO PLAIHIIFFS' COMPLAINT
AND CROSS-CLAIM AND COUNTERCLAIM AGAINST DEFENDANT KOHUT
AND NOW, Defendant Scott Miller, by and through his attorneys,
Thomas, Thomas & Hafer, LLP, files this Answer and New Matter to
Plaintiff's Complaint, and in support thereof avers the followIng:
1-3. After reasonable investigation, Defendant Miller is
without knowledge or information sufficient to form a belief as to
the truth of the averments contained in Paragraphs 1 through 3 of
the Complaint, and proof thereof is demanded.
4. Admitted.
5-6. After reasonable investigation, Defendant Miller is
without knowledge or information sufficient to form a belief as to
the truth of the averments contained in Paragraphs 5 through 6 of
the Complaint, and proof thereof is demanded.
7-9. Admitted.
10. Denied as stated.
Plaintiff Kohut proceeded into the
intersection and failed to yield the legal right-of-way to
Defendant Miller, who was at the intersection first, and Plaintiff
Kohut then stopped or slowed his vehicle in the middle of the
intersection instead of proceeding straight through after failing
to yield the right of way and caused the collision to occur.
11-12. Denied pursuant to Pa.R.Civ.p. 1029(e).
13 (a-e). Denied pursuant to Pa.R.Civ.P. 1029(e).
14-15. Denied pursuant to Pa.R.Civ.p. 1029(e).
COUNT I
YAHICE KUNKLE INDIVIDUALLY v. SCOTT MILLER
16. Defendant Miller incorporates by reference as though
fully stated herein the averments and denials contained in
Paragraphs 1 through 15 of this Answer and New Matter.
17. Denied pursuant to Pa.R.Civ.P. 1029(e).
WlIERErORE, Defendant respectfully requests Your Honorable
Court to enter judgment in his favor, together with all applicable
Court costs.
2
SPORTING HILL
FAMILY HFALTH CENTER
A SERVICE OF HOLY SPIRlT HEALTH SYSTEM
April/. P)')X
Ms, Mlchcle J. Thorp
Rcynolds & Havas
IOl Pine SlIcet. P.O. !lox 1).12
Harrisburg. PA 17IOX-IIY.12
RE: Janice Kunklc
Dcar Ms, Thorp:
J am l\riling on behalf of Janice Knnkle. Jalllce prcscllled to IlIC on 10/20/'17 l\IIh a eomplall1l of havlIlg
had a headache slllce belllg 1Ill01led in a 1II0tor Ichlcle accldcnt II hlch occurrcd on IO/I~ She reponed
thaI she was a passenger on the nght sldc Ilhcnlhe car lias slruck onlhe letl Side inlhc renr. She liaS
lurning around looking at her daughter. handmg her a boltle of walcr II hcn the accldelll occurred. She
states Ihal she was flung around and hillhe nght SIde of her head againsllhe windoll. The mndow was
nol broken. There was no loss of consciousness. She lias wearing her seal belt. She liaS also
complallling of neck sllflness that slarted onlhe Thursday, The accidelll liaS on a Tuesday. She \\ent to
Seldle Melllonal Hospital IIhere no sludles lIere done. She had lomlting ouce on Thursday but nOlhing
since there. Slle Slaled Ihal her headache 1\1IS qmte bad at thaltllne. She look Wllmg. of MOlnn which
helped only a hllle at lhallime.
On exam al thatlllne she had lenderness III the occipital region onlhe nghlucck arca. sOllie lenderness
oler Ihe sidcs of her head. Her neck had reduced range of mOllon. She came to llIe agam on 11/5/'i7
stating Ihallhe pam \Ias not gelling any belter. bccdnn at thallllne \\as 1I0rking for her head'lches and
she \\ould take FIc.\enl for Ihe ncck sllITness at bedtime which did seem to help somc\\hat. AIlhalllllle
I ordered x-rays of Ihe C spllle IIll1Ch showed Ihat her C spiue llilS somewhaltilted DOsslbll due 10 muscle
spaslll. I also reconllllended physlcallhcrapy at Ihaltime. She again prescnted to me 0I11/IYNX \\ith
complalllt of IcnSlon headachcs. Onc day Ihe headache \\1IS so selcre she had 10 IIlISS work. She docs
adnlllto haling had nllgramcs Inlhc p,1S1 bUllhls dId nOl SCCIII like Ihat Iype of headache. I
reconllnendcd agalll range of motion exerCISes and readdressed Ihe Idea of phYSical therapy. Ho\\eler.
Ihe pallenl lias not inlereSled ,It Ihalllllle. I also lIIellllolled Ihal biofeedback may be a good pmn tehef
sllalegy. I also gale her a prescnplloll for Mldnn for her 1II0re selere headaches, At thai IISII huuce
conllnued to halc lenderness III the nghl ccmcal splllallllusculature. Hcr neck had good range of
1II0tion. Jamcc's palll ano headaches arc 1II0St hkell ",Ialeo to Ihe motor lehlcle aCCldellllhat occurred
on lOi211N7 as that IS IIhen Ihe nght neck pam alllllenderness flad slanee. I hale nOI seenlhe plllienl
slllce Ihal VISit. It f/.. '1. "'" <tAld,
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VMOlbk
Your Partner For Good rf8allh
110 s'",m SP.lning IIU! RnlJ . Mn:hlnlCsburg, PA 17055
(717)731<3223 . Fax(717)711,1951
COMMONWEALTH OF PENNS)'lVANIA
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY
JANICE KUNKLE, Individually and as
arent and Natural Guardian of
Andrea Gutting, and ROBERT KOHUT
Plaintiffs
VS.
SCOTT MI :'LER, De f endan t and
Counterclaim Plaintiff
File No.
97-6861
vs.
ROBERT KOHUT Additional
Defendant and Counter-
claim Defendant
SUBPOENA TO PRODUCE DOCUMENTS OR THINGS
FOR DISCOVERY PURSUt,\tfl TO RULE 4009.22
TO: ERIE INSURANCE COMPANY
(Nam. ef P.rsen er Enlltyl
Within twenty (20) days after service of this subpoena, you are ordered by the court to produce the following documents or things:
A "opy of your entire file on Jani"e ~1. Kllnkl" Pol try U006 2004717 F. "ncl
a copy of your entire file on Robert Kohllt Pol try UOOA 0175070 H.
~ BLAKEY, YOST, BUPP & SCHAUMANN, LLP 17 East Market St, York, PA 17401
(Add,...)
You may deliver or mail legible copies of the documents or produce things requested by this subpoena, together with the
certificate ot complience, 10 the party making this request at the address listed above. You have the right to seek, in advance, the
reasonable cost of preparing the copies or prodllcing the things sought.
If you fail to produce the documents or Ihings required by this subpoena, within twenty (20) days after its service, the party serving
this subpoena may seek a court order compelling you 10 comply with it.
THIS SUBPOENA WAS ISSUED AT THE REQUEST OFTHE FOllOWING PERSON:
TELEPHONE:
Donald B. 1I0ytL-lLsquire
17 East Market Street
York, PA 17401
(717) B45-3674
NAME:
ADDRESS:
SUPREME COuRT 10 ,1: -18.0.6 I
.\TTORNEY FOR:
Scott Miller
BY THE COURT:
, .n:
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St!Ji oi the ("urt
PralhOl1tJIJrIICl~rk, Ci\/il Oiyition
Depuly
(~/<)7)
SPORTING ~ILL FHC
TEL:717-731-1952
Mar 17'98
12:08 No.008 P.07
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KUNKLF.. JANICE
5: This pau~1I1 is a J I y/o WF who is hero for ~omplainl of problenu wilh Inl~nsc Mallaehes ill ,he nghl side, 'TheY slMt at
Ihe base of her hc::ld and mov~ up o\.or tIu: lOp of Ih~ head SO it illike 3 vic~ Oil Ibe lOp of hor head, SIll: ,lale! lhal tIu: Exc<:drin
generally works fairly wdl. "hough IWO weekl a~o lhe 11.1d \0 milS a day a' work bcc3use Ihe heaGa~hc wal so bad. She IlalOs
\lull Ihe rarely milS<;s work and Ih~ docsn'llike 10 do IMt Sho Slales lbuIlh< headacheS are QCellrrillg a minimum of twO limes
1I w~ek. If Ihe IS lookinG iuto Ihe computer fur a long ulne or st.a1ldln~ over tllO ,ink for a prolonged Ulne. Ihat ~Il\S \0 lrigger
" head3ch~, She dellles n3ul<'l. \'omilioIS She denl~S photophobia. She has had migraines in Ihe poSI aud ,hey don't seom
hke that She deni~s lIumbnCSS, ling ling. we.1knon of tile cxuamitiCS. She ~omplai1u of lltcaSioMllcl\ cur pain, She hn.I had
tymp,1noplaslY on Ih~ len car iU101 wnnl$ III<: 10 iu" check it and make sUIe lllat tllete il no problems The pain is JUSI
\n~nnillen'. nol 5O'.ere, No drainage, Sh~ 11JS a Iiltle ringing, She has a hearing loSS al a r...ull of the surgery. 'rhal s<;ellU
to be slable,
l562W
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VMO
0: On exam P.lIi~m is al~rt and no dislrC$s ii' th'S Ilm~, TM il cleM 011 the lcn. There is some scurring and cnanges fram
surgery bill no el)1hcmu 01 fluid 01 olher i1bnorlllulities ofi.flammalion, Ne~k d"mollsUale$ som~ lendon"'$S illll\~ rillhL
eervlC:"llpirol J1\\l:l~u1a\llle, Qcclpilill and parictal areas arc at Ihls lilllo lion 1~lIdcr, Trape/';uS 11 non lendel. Hor lIeek has
good ROM. H~3r1llRR I.nllg5 dear, Upper exu~lIlilies had llood dlslUI pulses. llood scn",tion 10 lighllnu,h. good grip.
DT'Rs symrnelri, and brisk ill Ibe upper eXllen,itie5, She had ~ood suenglb in Ihe upper cxuemiUu.
A: I. Tension ~r.ph3Igi,,'. 2. len ~i1r pAIR
P. I ~.or Ihe lensioll eophalKias I discussed wilh her a varlely of ,"hnique! 10 rm\lA~e Ihe>;i: h~ld3ehes, 'rcconllTlend<:d ROM
e~er""cs. I discUISCd PT hUI pallenl would like 10 hold of'[ alibis lime, I ullo mentioned biufeedhack ;\I\d Ihe has good friend
who docs this and will d,.,.;UlS Ihis with her friend. Ice for 2U millule. a' a LII"e ....hell Iho hcado"hc is bolherlnll her
2. Ga'~ her presClIpliun fur Midtin uno or two CIIcry ~ houn U lIccd<:d, Max II per 24 hours, I discll,r.cd allo III11htl) floxcnl
In Iho ~\.cnl Ih.lI 'h"se lIl"alUlel .re 1101 hclpllIl\' Palielll WIll hold off on Ille Fleselil alld PT a\ UlIS \11110. wiIIlry Ih< olll<r
lllealU'" alld go back 10 Iho ROM exerclSCS. C~rtoillly If Ihis is nol helplll~ ullhe has ullY wOlICIIII1g probl"nu, she Ih~Uld
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0: On e.xam patient is alert and no distress at this lime, She is holding her head rather sllllly. IIEENT was clear. :-Jo
raccoons. no discharge. no abnornlalities of the TMs, Pharynx unren~llkable, Cramal nerves II.XII grossly IIltaet Neck
demonstrates tenderness especially in the occipital region on the nght Some lendern<~s over the right panetalmusculalure.
She Iilld decreased ROM in the extreme ranges. lleart was RRR, L.nngs 'Acre clear. Extremities WIthout clubbing, <'yanos,s or
eden~1, Good distal pulses, Normaltondem gait Nonnal cerebellar lest mg. Good motor strength throughout DTRs
symmetne and brisk tbroughout PERLA, EOMI. The SplllOUS pro.:esses were pereassed. they "ere non lender.
A: I. Cervical stmin stalUS post MV A 2, Headache most likely related 10 the cervical main muscle tension.
P: I. Flexeril to mg, t.l.d. as ncroed for muscle spasm, #30. 0 refills. Caulioned her regarding drowsiness. not to drink or
drive with this. 2, Midnn one or two every four hou~ as needed for headache, max 8 in a 24 hour pcllOO, I rtCommended
warm compl~sses to the neck for 15.20 minutes followed by ROM exelClses which 1 gave her a list of. Cert.1mly Iflhese
measures are not helpmg or she has worscning problems or signs 0" head injury which I revIewed wllh her. she should contact
us. PVU.
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KUNKLE, JANICE
1jfll1')
IO/2o/'n
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S: ThIs pauent IS a 3') y/o WF \\ho IS here for MVA. Last Tuesday on IO/I~ she "as a passenger onlhe right SIde "hen she
\\as struck. The car \\as slruek on the len side 111 rhe rcar, Sh.: was turned around looklllg at her dauglllcr handing her a \\oa(~r
boule "henlhe accident oc;,'urrcd. She '''IS \lung around and hillhe right SIde of her head agalllstthe '\lndow WlIldo\\ did
not break. There "as no loss of conSCIousness. She "as reSllallled She Slates that her car suslamed about SlO,)O of damage
She doesn't Ihlllk that the trucker '''IS gOll1g 'cry fasl allhe I1I1Ie. Apparenlly he did about S3500 of damage, She complains
of h.wing had a headache Since Ihe aecldenl. ~eck su\l'ness slarted on Thursday. She "eOllO Seldle Memorial Wednesday and
Friday. ~o studies ,..ere done there. ShL: had \oll1lt1ng once on Thursday but lIothHlg SIlll.:C lhen. She complams of havlIIg it
headache and neck sulTness at IllIs III1Ie She stales thallhe headache IS qUlle bad. She look {,OO mg. of :-'Iollln \\hld. helped a .
little only She dt.:ntcs any ncurologlc ~ymptom.s.~llllmbncs.'i. lingling, \\cakncss of the cxtrcrllllics. balan~c lllfficultlcs.
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tiOL Y SPIRIT HOSPTlAL
SPORTING HILL FA MIL Y HEALTH CENTER
PROGRESS NOTES
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KUNKLE. JANICE
3~6239 -
9/24197
VMO
S: This patient is a 31 ylo WF who is here for complaim of left fOOl plantar's warts, She has had one on the center aspect of
the fOOl under Ille 1st melalar5al fot about a year, Now she has one in the mid forefoot It is itchy and irritated and she can reel
bumps under the skin when she sleps on iL She gelS pain that radiates from it She has tried OTC preparations such as
Compound W without SIICcess,
0: On exam the planlar aspect of the left foot demonstrates a large plan~1r'S wart with sc.1ltercd ones around it over the 1st
metatarsal joint, In the mid forefoot region is some subcu~1neous palpable plantar's warts with mosaic paltem. Skin IS
otherwise clenr.
A: Multiple plantar's warts that are painful.
P: I. I recommended a Dr, Scholl's donut nround the one wart so as 10 ~Ike pressure of it Recommended Duoplant daily as
directed. Using a pumice stone or foot file between applications so as to gel nd of the dead skill. She may schedule an
appointment also for cryothelllpy of the warts. PVU.
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FROM:-1<'oJ,,,t ('! )~~RE:
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no radicular symptoms when she coughs, sneezes or takes a deep
breath. The activities that decrease the pain are using heat,
muscle relaxers and massage by the patient's boyfriend. Tho
patient reports having trouble turning the head while moving into
traffic and has increased pain at the end of the workday. The
patient reports she sleeps right side lying and has been getting
her normal amount of sleep, but does wako up with suboccipital
pain. The patient's goal is to get rid of tho nock pain and the
headaches.
PMH:
Ear surgery, tinn1tuo. Tho patient reports
that she does stiLl have some tinnituo At the
present time which wan proount prior to the
accident.
MEDICATIONS:
Flexeril.
OBJECTIVE:
Posture:
The patient ,litn with .\ P<H1t1ldot' pelvic tilt
and moderateLy f'll'w.lrd h'J,ld and rounded '
shoulders. In Bl.andin'I, thnru io minimal
forward head .Ind r'"l1ld.,d IIhuuldel': .
Cervical act i ve range of mot ion:
All ranges withLn r;'Hm,,1. ILlnlt:1 but pain at
the base of thl] IIpinu wl.l:h rotation
bilaterally .lnd nl1'Jhl. p.lin .It tho base of
the spine with ('ll'W.lrd t 'uxton.
Strength of the cervical area:
Extension fJood with ilL i.,lIt paln at the base
of the spine. Ilut.dt.l'lll, 1.Itnt'al flexion and
flexion arn aLL t.ll",d .1:1 'food plus.
Reflexes, biceps and brachior:adl.lll:',
2/4 bilat.Jt'a Ll y,
Equal and 1I1t..I<:t In both upper extremit.ies to
light touch.
The pat 1mlt h.w ., t,lllld'.lncy to t'otate the
who Le trunk V"j, r"l. ,It 111'1 th., head to the left
or t: igllt .
Max1maLly t'ltl'.I.,!' ,H, 1'1 '(';1 ilt'ea. Moderately
tendn t' TJ olnd ,\ ,Hid I: I. C6 . Right posterior
cer~ic..ll mUH(~l~IH dt",l t.~~ndet'.
. 1 I l. .
Specla tests: AXl (;Ornpr,IHHI on lncrt!'l<JHOS paleL
Tr:act.ion ducr#ldHt!H ~k,ir\.
No pnrlph'.l!'cll1zC1t Lon Ot' centralization noted
wlth r~p~dt Elnxions or extensions.
::I"<Jrn'Hlull 1:."Jt,lnq wlth l"eft side glide of the
,:"r'llc:,ll npin.. ,It. C5. 6 and 7 increased the
pdln. ',flUI dClht side. glide there was no
dl'Hl'I" l n t hI! I'd 1 n .
Sensation:
Observation:
Palpation:
;,
Please check the following thaelY to you:
High Blood Pressure
- Heart Attack
Heart Failure
Poor Circulation
Stroke
.-
-!.. Asthma
_ Lymphedema
Bronchitis/Emphysema
_ Thyroid Problems
Diabetes
_ Cancer: (where)
_ Blood Clolllng Problems
Past Operations: (please list)
,-0(.\).,
e
e
_ Hepatitis
_ Kidney Stones
_ Kidney Infections
Hiatal Hernia
_ Seizures
~Dlzzlness~ 0 bo-t,o..*
_ Migraine Headaches. -CL~ . "
_ Metal Implants
__ Allergic to: _ Iodine _. Tape
_ Bowel or Bladder Changes: .
Recent? Yes No
_ Pregnant: _ Yes _ No _ NA
r";,,br '! if'
DLOI- O~
Past Hospitalizations: (please list)
Medications: (please list) ~
Why are you here? (please describe your symptoms)
Have you ever had physical therapy before?
Q -:nt:Aro:.
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On a scale of 1-10 where aru you now with pain?
(1 = no pain 10= severe pain)
1 2 3 \86 7 8 9 10
. What increases your pain? ~
1 What decreases your pain?!y.&.O..,.-\: \ ~
.. ~
What activities are you unable to do or have difficulty with beca1Jse of your current condition?
\~~er-.~ k~w~cL~~C-..~-
When are you seeing your doctor again?
"'/:rr../ I..,rf /~, r PI V
~ Signalure of Therapist l-'----- Signalure 01 Palient
Pain Chart: (mark an X where your pain is)
~IOlY SPIRIT HOSprrAl
503 NORTH 21ST STREET
CAMP lUll, PA 17011.2:288
PHYSICAL THERAPY OEPARTMEIIT
OUTPATIENT HEALTH HISTORY QUESTIONNAIRe
FOlm 202 PT (3/95)
J\,,~({: fVf'.fce
11J..(.,f;?s-~
j.:l~J..)7
.
,
.
--
.
CONSENT TO MEDICAL TREATMENT
I hereby consent and Burnomc Holy Spirit Hospitlll. its agenu, and cmploycu. 10 Lhe rendering of medical carc, which may Include ramine diagnQlStlc
pr<<cdurcs and such n\edical trC4btlenC a, my llttending or consulting physician considers to be necessary. I also undenl4nd II Is cu:\tomary I absent
emericne)' or extraordinary circUR14lanCCS, that no !UhSlJ1nlial procedures will be pufonned upon me unless or until 1 have had an opportunity to
Jiscuss lhcm with II physician or other health carC' profenionDJ tl) my satisfaction. If I am a compctcnl adult, I have the right to consent or refuse
to con..nllO any proposed procedure or therapcUlic treUlntent. I will nO! be involved In any reIClU'ch or eoperimenlJ1l procedure without my full knowledge
and consent. 1 understand that lhe practice of medicine Bnd surgery is not an exact science IInd mat diagnosis Bnd trClltml:nt may involve risks of
injury or even death and acknowlcdge thet no guarantee has been made to me as to the rcsulu of any examilUltion or trcaUflent in this Hospital.
I ullderstAnd lIW1y of the phy.1c1Ans 011 the .mff of Holy S~iritllo.pital B1'. nO! employees or agentl of the Ho.pilJ1l. but rather lU'e Independenl contraclOrs
who have been granted the povileac of usinS these fil<;ihties for the care and treatment of their patients. Further, I rt!lllizc this Hospital is a tCBchlng
Hospit41llnd at the Hospital arc health carc personnel in training who, unless expressly requested otherwise, mllY participate or maybe present during
my care as pan of their education, Still or mOlion pictures llnd c1osed.drcuitt evislon monitl)ring of patient care may also be used for educational
purpo... u CIa I ..preaaly reque.t erwl...
I
I
Date
Relation.hlp
To P:uient
--
I aulhol'ize Holy Spirit Hosphal rel-eue \0 t't sting health in.\urance carner(s), their Nprcsenullive~ and lluditor1, and nny referring heaJlh~..te providers,
such diagnostic and therapeutic:: in . neluding Ilny in(onnlltion relating to treatment for alcohol and slJbuanc~ abuse and/or trellttnent of psvchiaui.;
dillOrden. and/Q,~ful.entia1 HIV related infonnation}. as may be neceuary for them to detennine benefit enlil1ement; to process payment claims for
health care services provided durinz this hospltalizltian/treatnlcnt epioode. and for continuing care/treaunent. A photostatic or carbon copy of this
authorization shall be considered u effective Rnd valid a.s the original, The undersigned aho authorizes Medicare, when llpplic.lble, to relea:le to another
insurance carrier I upon their reque.,t, medical infonnation needed to mllke payment upon thai claim.
I underSland and consent that the llWlufllcturer of any implantable device inserted b my -physician during the c;ourse of my surgery/procedure may be
provided with my identification infQrn tion, including slXial securi mber, s andated by Federal Law.
~Il Cl1 Rel'tioOihlp
Dale \ Signature' To Palient ,
lIS. CE ASSIGNMENT
I authorize payment directly to I
to rhe HospitAl for all chllJ'ges not
-'
Date
payable under my insurance policies, I understand ram responsible
f thi:l assignment. .
Relation.,hip
To Palient
MENT TO PER IT PAY. ENT OF MEDICARE ilENE FITS
TO PROVIDERS, PHYSICIANS AND PATIENT
. r~uest payment of Authoriz 'e benefilj to me or on my behalf for any services furnished me by or in Holy Spiril HospiL1l including physician
services. I authorize any holder of medical and other infomunion about me, to rel(3sed to Medicare and its agencies any infonnation Ilec'Aed to detenn.i.ne
the~ benefiu for related services.
DATE: SIGNATURE:
HOSPITAr.. BENEFITS/PART A/EF/'. DATE:
MEDICAL BENEffiS/PART BIEFF. DATE:
MEDICAL ASSISTANCE RECIPIENT
My signature cerunes that I received a service or item.'1 froRl Holy Spirit Hospital :.md Dr, on th~ date listed below,
I understand that payment for this servi~e or item wm be from Federal and StaIt lUnd5, and th.u any false claims. sLllemenU, or document'\, or conce.ument
of material may be pro~cuted under applkable F~deral and State Laws,
t h.ave read and. agree with the above 5latement'l:
DATE:
RECIPIENT/AGENT SIGNATURE:
---
RELEASE AGAINST MEDICAL ADVICE
This i, to certify that I. t a patient at Holy Spirit Hospifal. am leaving the hospital
agalns1 the advice of Dr. _ ._~__ and the admini5tration'r have been infonTIl!d of the risk. involved and hereby
release the physician and the hospItal from all responSibility Jnd legal liability,
SIGNATURE: WITNESS:
REr..ATlON TO PATIENT: TIME: ' DATE: -
fORM WlTtj r .
Dale 1- l Q,Llt.~v.~_ ~.
HOLY SPIRIT HOSPITAL, CAM]' lIILL, PA
CONSENT FOR TRE.iTMENTIREU.ASE OF INFORMATION
INSURANCE ASSIGNMENT
J\&:\1 DATE: 1.....11/'37
1~
!{A :
ADDRE'::'~ :
BIRTHDATEI
&:t1PLOYERI
ADDRESS I
CHURCH:
COIlIlENT I
HArI&::
ADORES";; :
HAPIE:
ADORES':; :
ADl'IlT DR:
ATTHD DR:
REFER DR:
ADPlIT OX:
COl!PL/.I HT:
0' '/TIME:
DE~,.RIPTIOH:
HAilE:
ADORES':;:
EPlPLOYEH:
ADORES',; :
HOLY ::,l'IRI'WO',:I'ITAL ..
<:1'.. ILL , PENHS.IHIIA 17')11~
OUTPATIEHT FORM
I'T I~: ".. 11 ~..;;~752
rm II. ..". J'E!
KUHKLE ,JANICE
1:3"':3 In NER ElL VD
08/1",/196", AGE:
l'MSLIC
777 E l'ARK DIUVE
HOHE
, NO AilE
I'ATIENT INFORMATION
:;$ ..:
ICARLISLE Il'A/17013 PH II:
31 ':'EX: F MS: DRACE: 1
OI:I:UP AT I ON:
IHARRISBURG IPA/17104
AMB: NONE
18\1 ,,,,.;2,- 14':.5
71'~ '25:::~-'~5::'3
0&:1): 0411)1 0
PH II, 71" '5513-7500
EMERGENC'{ CONTACT INFORMATION
REL TO PT: wom: PH (I:
1 1 I I'H II:
REL TO PT: WORK PH #:
1 I 1 I'H Il:
CA'3E
151696 OSBORN VALENTINE
151696 OSBORN VALEHTINE
151696 OSBORN VALENTINE
CERVICAL '3TRAIH
CER'J I CAL S:TRA I N
JANICE I:UNI,LIi:
1:;:63 KINER BLVII
pn,::L II:
777 E PARK DRIVE
l'LAN lIi'::IJRANCE CO
'::UB',:(;R I EiE:R
III "81 AUTO INSURANCE
I:UNKLIi: , JANICIi:
..."
.".
11:3
114
INFORM T I 011
DO ADI! SOURCE: RP l'ATtEN'" TYPIi:: D
DO HO'::P ',:F.RV: OPT FINAN(: t AL ,:L:3': T
DO VISIT CLINIC CODE: OATh:IIAY .
ICD-';. DX: ..
ACCIDENT INFORnATION
ACC r NO I JOB RE[,A'l'ED:
[,0':AT1, "I:
GUARANTOR INFORMATION
PT REL TO GUAR: ~
ICARLISLE IPA/17013
CaNT ACT H"'ME:
IHARRISBURO IPA/17104
:..:0 tt:
PH Il:
1 :;::::'.".' -14fo::".dj
717. ;., ;':'-"'';,:.9
'. ..}'4__
PH ij: 717-~I"i":I_T501)
INSURANCE INfORMATION
COB POLICY n
PEL PC VfY CA1U'
l) 1 I) I 7032';0.;'
~ 'l
PRECIWT jl
GROUP It
PPE':WI' I' nom: #
';'
.-
:'
...
MEDICARE SECONDARY QUEST[ONSl
HilT I A [".:
MEDICARE SIGNATURE ON ~[L.
C( ENTS: PT conIWl TO PH'{SleAG TKERAI'V
EXERCISE PROGRAM 2 TO 4 WEEKS
..VAL ~ T~ TO IH':LUl>E l\ HOMS:
PERnAMEHT connEHT:
PATIENT HAnt: KUNKLE ,JANICE
REa~STiR[D ~'{: PTCMR
P'!'!tl
112';.:,17':,'::
F.!1l> OF
.
.
.
.
.
.'
-
I:
----
-.
"
-
-.
-
-
HOLY SPIRIT HOSPITAL
903 NORTH 21S'r STRUT
CAMP HILL. PA 17011.~28'
PHYSICAL TH!nAPY O!PARTM!If1'
PROGRUS NOTIS
" ..,
R JAMI6 RIYNOI.OS oJ'"
JOHN HAVAS
MICH.AU M B.AOOW''''I .
UTepttEN I. BMIKO. oJ"
ROLl' E KFlOl.l.
BARRV A KRaNTHAL
I.AURALU 8 ...."ER
MICHELE J THORIt
REYNOLDS & HAVAS
" "110.......... tOIl~U'1O+j
AnOANEYS A~D COUNSE~OR8 AT LAW
101 PINE STRElT
POST OffiCI BOX G3.l
HARAI5QUAQ. PfNNISYLVANI", I 110fJ'Ot)31
TILEPHONE
11111230':1200
'AX
11111 236.60133
I. MAIL
r.yh....Ql.pl:t,n.'
November 3, 1997
Sincerely,
Medical Records Custodian
Seidle Hospital
120 South Filbert Street
Mechanicsburg, PA 17055
Re: Kunkle/Kohut vs. Miller
R&H File No. 1808.1
Dear Madam/Sir:
Please be advised that our firm represents Janice M.
Kunkle (DOB: 8/16/66; ssn 188-62-1465) with regard to a claim she
may have regarding a recent motor vehicle accident in which she
was injured. Ms. Kunkle has provided me with a signed Medical
Information Release Authorization which allows you to provide me
with a complete copy of any and all medical records maintained by
Seidle Hospital pertaining to her. Please provide those records
at your earliest possible convenience. We will be happy to
reimburse you for the reasonable photocopying costs involved in
producing the requested records.
MJT/na
Enclosure
'r:~t',I'~,1 il. ~ 1,;,,,,1 T.-~! A,llIlIeIIt..\I II''' N'I'dl'" l!".,.,.,1 r"'l A'I'I"".ey
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AUTHo"l7.\IlOlLIQ...IRCAr. STATEM!NTS ON THIS FORM AilE TRUE TO THE BesT Of ~'t
I':NOWlIOGI. AND I HfAES'1 AVniOAIZE THE PH't~ICIAN OR PHYSICIANS IN CHARGE OF TliS CABE
0' HilS ,....T1!NT TO AOMINtSTlR AN't mEATMI!HT, OR TO AOMINISTEfI SUCH ANESTHETICS AND
"1~'OO'" SUCH OPERATIONS AS MA't BE DULleo NECES3AR't OR AQIIlSABLE IN THE OlAGN06IS
AND TRfATMINT 01' 'OilS PAn!NT. , l '
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HASTA 1.0 ME..IOA DE .... CQNOCI"'II::NTO, AllTOAlZO Al. MEDICO 0 MfOICOS ENCAAGADt"
UTE CASO v "'AC1ENTE A ADMINlSTRAA CUALQUII!A TAATAMlENTO 0 A A.OMINISTRN'I ANES
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I' ACCIDlNT. 'MiIFlI Q(CUf\~O ClAII' TIUI!. Of' ACCIDINT
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FIRSTPLACE
NURSE ASSESSMENT
IJr, '1'1.
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10/17197
K 0 Ii 1.11'
7172509529
'SIIA .JJJ 1~1t~ 4,QfII
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PI NI'IACLEHf.ALTH
rirscPlace
Heal! 11 Care
FhlllPlace II:
(7171 795.tlll56
INSTRUCTIONS TO THE PATIENT
The examination and treatment you heve received in the FlrstPlace Cenler has boan randarad on an urgant basi. only, and are nollnlended
to be a subslllule lor, or an affon to provlda com plato modlcal caro. IF YOU DEVELOP NEW PROBLEMS OR COMPLICATIONS,
CONTACT YOUR PHYSICIAN OR THIS FIRSTPLACE HEALTH CARE.
FOLLOW THE INSTRUCTIONS BELOW AS INDICATED FOR YOU
LACERATION, ABRASIONS OR BURNS EYE INJURIES
1, Keep wound clean IIld dry 24-48 hours. 21. Wear eye patch for hOUlS,
2. Atle, 24-48 hours wash with soep and water or peroxide. 22. 00 nol rlrivo or operate machinery until
3, Watch lor Ilgns of swelllng, tenr.ierness. redness, heal or 23, Return to Flr15IPlace Hoalth Care or family physlCIlY1
drainage - ,-..turn 10 FirlllPlaco I' any of Iheee signs occur , wbring sunglasses.
4. Return 10 FlrslPlace to have your sutures removud 24. AVOid brighlllghls, TV and prolonged r.adlng for _hours
25, Eye nletlicnllan
HEAD INJURIES
26, Avoid strenuous physical tictlvity tiJr at reast 24 hours,
27, Use __ 'or headnche every 4 hours as needed,
26. Ughl diet lor 24 hours.
, I 7 - L '"I n - IJ rj 2 ')
Name:
.,
5, Tetanus TaxlodfTelanulI diphtherlo given __ yes
SPRAINS, BRUISES ANO FRACTURES
8. Elevate on 2 pillows and reat.
7. LIse Ice for
lime. e deV for
8. ACQr wrap
9. Use spllnl Tor
1 Q. Use crutchua lOr
11. Begin 10 bear welgl'lt
12. Stan warm soaks on
minutes
,ymptoms present.
13. Wear cervical collar
14. No heevellftlng 101
1~. U:lesllngtor ---
mlnutos
days,
for
_ Ilme~ 8 day until rech6cIl, or no
MEDICAL INSTRUCTIONS
16. Btlfd rest for .
17, Take asplrltl of Tylenol @ ellery _ hours
18. jf 8 child has f8l1er:
A. dress lightly - don-t cover WIth blankets;
B. place In tub of lukewarm weter and sponge for 30 minutes.
ir tomperatur6 is higher than and won.t
come down with aspirin or TylerrollID
C. 91ve plenty or flUidS - oHer small amounts frequ6ntly;
O. gl..... bt!by aspirin or Tylenol@ it t.emperalure higher than
E. 00 NOr use ice pack!, cold water enemas or tllcohol balh.
19 Cleat liquid diet - advance as tolerl'\led,
20. Drink plentv af liqUid..
CALL DOCTOR IMMEDIATELY IF:
A. Unable to .rou.. pltltO', c:onru..d or Irritable
e. PaUen! contlnu.. to bl nluselllod andlor vomit.
C. PaUlnt hi' .raubl.. with balance
D. PIUlnt complalna at Inv vi lUll dlftlcully
E. H.adachl per.lotalonge, than 24 ho....r. or I' It
bleom.. mar. Intln.. art" 12 hour..
F. Convulllon.
NOSliBLEEDS
29, 00 not blow your nose.
30. It bleeding occur$ through nssal pecking or In throat
cell FlrslPfoca or family phYSician.
FOLLOW UP CARE
31. Aetum to FirstPler;e
32. FOlIow-u~:<!1I~14amIIV phV,ull.~, ,L~
33. See Dr. m4!-~_ rtJ.t.A'tJ/tNL(C Il~U4JJ{..A- l.
all -.,..,.. at AM/P
~ fzu -::-.t: I;"Ct~ -
EMPLOYMENT "'1J
34, Return 10 nornlaJ duty on
35. Unllted duty from
Umilalion
36. See Occupallonallnsuucilonal Sheet
until
-< ttuu~~ -
/LU'J;?:, N' If 4ry ,t( r'-u.M~
'tV ~A f.L!~Ar;;1'f)'M -.
X-RAY INSlAUC1IONS: Your X4("y9 have been read by Ihe Fir!JtPI~ce ~"fI\Jlh C.1Ie PhY!llcian. For your added prot.ctlon, your )I,-ray will ~e reretld by Ol
R4rdIClo9'J Oepsrtmant If any arnormAlilles fire 'ound IhiSt hdVO not been cailed to your 4l1enllQn. you and Yr.lur doclor will b.. call1td Immlildlately. Sr)meUmt
fraclur" or abnOlmatltles msy not show up on x-r81y:'J for sevftal dlt''f''- If 'Symptoms persIst or get worse, call your F'hy5iclan or relurn to (hits FlrstPlace
lole8Jlh Care C'nlfJr More lC.'4,/5 Mlay I'li!Ii'l8 10 be laken
LABORATORY INSTRUCTIONS: Call FirllPlec.
__tor "ilutt.'S of your Pltndlng lab I(lSI:\
Sla~IATURE!l I flEfleBY ACKNOWLEDGE RECEIPT OF nlESE INSTRUCTION'" AND UNDER
S7MIO THEM I UNDERSTANIJ THAT I HAVE flAD UF1GE';T TREATMENT ONLY
ttr=-- R N MID THAT I MAY BE RELEASED BeFORE ALL OF MY MEDICAL PROBLEMS AI
-&, ~I -.---- _ KNOWN OR TFlEATEO I WILL ARRANGE FOR FOLlOW.IJP CARE AS I ,lAVE
._ l.!..."" ,__.010) BEEN I/ISmucreo / /
',,".,M ''In''I1, C*~~la~~;r;:.f6- .~ 6::ZL.f:j_
OAtIWlm
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o KhU tJ,lM08IlIllR$
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oCA5'
o CUMClL COlLAR
o SHLDA IMMOeUlIR
o SllOO
OSA.IHT
o OR5G ~OR5a w
o SUTURE lI\A'tOlSPOS
o SUTlHIl RfMOVlL TRAY
o liD TRAY
a NGrualS
o IRRIG"'1ION1J\A~
o Y"GOAM
o WftpRIP
o flMAUCATH
o HfMATUT
OCATtl'AA'(
OURINIDl
&lDiQRllATION Ia....:rBUs.r. STATEMEms ON THIll FORM ARE TAUE TO THE BEST Of MY
II.NOWlEOGe, AND I HfREBY AVTHORIZE THt: PHYSICIAN on P.iYS1CI.AkS IN CHARGE 01&: THE CABE
OP THIS PATIENT TO ADMlNI9TI!R Am TREATMENT, OR TO ~MINIBnn SUCH ANESTHETICS AND
PERFORM SUCH OPfjAATlQNS AS MAY Be DEEMED NECESSARY on AOVlSASU IN THE DIAGNOSIS
AND TRlA1MENt OP "'HIS PAn!NT. ' . . . ,. .' ',. .
~'15IT
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OIVCATHEHRPRN.lOAPTtR
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o /olm~E OC~, OPTIP" f'OAYAIU:OC,SPINE 0 C)( A 0
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--- aCHEU", OPA(\JtAHCY OUIl1'NLII DflHGI"
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r.ULTURII: OSl'\lllUO......,_, OPfl.a OfOOTLR
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om.o DURlNE OOfOaJ.J.B; OVII<<JSDOPf'\.(/\ Q'dHOGl\.
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CHlAMYOlA
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AUlQ8JV.C10N PARA ~A TRATAWII!NTO: La IE5TA8U!CIOO EN ISTA 'ORMA lS CI
HAST,t. LO MEJOR Cf. Mf CONOCIMIENlO. N./TOAIZO AI. MEDICO 0 MEDICOS 1NCAAC\AOC
ISTE CASO V PACIENTE A .4DMINISTRAA CUALOUIEA TRATAMlemo 0 A AOMlNI9TRAR ANEI'
Y UEVAA A CABO Cl..W.OUI(R OI'ERACION QUE SEA NECISARIA 0 ACQNSfJAm1 f
OIAl.lN08nCO v AClA(;A OIL TMTAMlENlO 001 tlE at!: SEOUl", '~\:'
_.~~'\ Plw""ltICoo"p~tU
.J .~. .
~ I ~I ~ IE. H II ICE H
.Y ~OOR 38 38
C;;/I(,:I<}(;(, "
I \ /, I ~ IN! '1 81 '10
t Name: 'j I P ^ ' I ! - 2 5 A - <) '5 2 q
, E (717) 796-6866
I . I ' INSTRUCTIONS TO THE PATIENT
The e~amlna~on and Ireatment You hav~ received In Iha FlrstPlace Center has been rendered on an urgent basis only, and are nollntendeo
io be a 8ub8~lule tor, or an effort 10 provide complele medical care. IF YOU DEVELOP NEW PROBLEMS OR COMPLICATIONS,
CONTACT YOUR PHYSICIAN OR THIS FIRSTPLACE HEALTH CARE,
FOLLOW THE INSTRUCTIONS BELOW AS INDICATED FOR YOU.
LACERATION, ABRASIONS OR BURNS EYE IN:iU'RiES
1. Ko.p wound clean and dry 24-48 hOUlI. 21. Wear eye patch lor hours.
2. Aft,r 24-48 hOUri wash with IOap and waler or perolCldo. 22. ou nol drive Of op."ate ~Ilchln.ry unUl
3. Walch for Slgne of swelling. t,,"demelS, utdneu, hoat or 23. Aeturn to FlrslPlace Health Care or family phvslc!""
drelnage .. return 10 FlrltPlacQ I' eny 01 these aigns OCCIJr. to' -bring sunglass.s,
4. Roturn 10 Fl,stPlace to have your sulures removed 24 AVOId bright IlQhll, T.V, and prolonged relldlng fOf _hour.
2~. E~O modlcaUon
5. Totanuo To,IOOfT",."ua diphlho"o grvon __ yoa. (ffEAo INJUR~
SPRAINS. BRUISES AND FRACTURES 2ti. '" Wi ifronuoua phyolcaJ aclivlly lor iii least 24 hO<Jro.
2r. Utle tor headochB every 4 hour. as needed.
28. Ughl dlollor 24 houra,
.
.
166621H5 ..J) PINI'IACLEHEALTH
f' C <4 FimPlace
Health Care
FlralPlaco .:
6,
7,
Elevate on 2 pllloWII and rest.
Use tce tor
Urnes a day tor
Aco wrap
Use .pllnt Tor
Use crutchee tor
Beyh, to b$ar weight
Start warm soaks on
minutes
symptoms present
13. Wear cervicaJ collar
14. No heave lifting lor
15. Uoe allng for
minutes
day..
CALL DOCTOR IMMEDIATELY IF:
A, Unobl.lo orOU" pall.nt. contu.ed or I"Uoble
B. paUtnt contlnu.. to b. nlu...led 'nd/or vomit.
C, Pollont ho. trouble with balonce
0, Pollonl camplllna or any vloual dllllcully
E, HOldlch. plrll.ta long.. thin ~4 houri or lilt
become. mor,lnttnlle Ifter 12 houri.
F, Convul.lonl
S.
9.
10,
11.
12.
for
times 8 da.y unlll r(lchlSck or no
MEDICAL INSTRUCTIONS
16. Bed root for
17. Take _.__ aspirin of Tylenol@every _ hours.
18. If a chUd has fever'
A. dross lightly - don't cover with blenkets;
B. place In lub at lukewerm woter and aponge 'or 30 minutes.
if tamperature is higher than and won't
come down with aspirin or T)'16001$
C. glV8 plenty of fluids - offer smlll amounts frequently;
D. give baby esptrln or Tylonol@ If lemper81IJre higher than
NOSEBI.EEDS
29, 00 nol blow your nose.
30, If bleeding occurs through nas81 packing or In throat
call FlrslPlace or family physician.
FOLLOW UP CARE
31. Return to FlrstPlace
32. FOUOW.IJp with fdmlly_phYJICi~
~S..Dr. ph~q~
on -../ _ al
o:Jlf-'.k-..
_AM/PM
19.
20.
E. 00 NOT use ice packs, cold weier enemas or alcohol bath.
Clear liquid diet - advanco as tolereled
Orink plenty at IlquidiJ.
EMPLOYMENT
34. Return to normal duty an
35. Umlled duty trom ____until
Umllatlon
36. See Occup8llonaJ Instructionol Sheet
37'~THER
- /tJO'O/~ ~ "t' ~ ~ --'l.t.I<.&,dt. M ~,
- ____L l- .I~---;]!d6ti4h-
~f.......')_J<.PJ1.t...;J-L~ ~ _ ,_
---c... -~!J-da~ ~ ~f-~ ~4 "..Lrr'
- ~~-' .tL> 41,d.PLA<tI' ~~~4W.. 'r~,"t.,&;~ ,4-F'<1i"1-,..v'?i;1 ~
X-RAY INSTRUCTIONS: Yow' x-rdYs ha...e been (fad by the Flr,IPlace Heellh Care Physician. For your added protectlon. your "'-fay wlll b. r....~
R.ftdlology Department. If My abnormeh!les are 'olJOd thai ha...e not bElen calttld 10 your I5ttenllon, you end your dqctor will be called Immltdlelely, SOmltlh'Y18
fractures or abnormalities may not sMw up on ;c -rays for S6'\l8ral day:!. If symptoms persist or gel war", c,1I your IPhyticl.sn or return 10 thit FlrstPI.at;.
I-I€lslth Cere Cenler~. ,l(.rays may h~...e 10 be la~en
LABORATORY INSTRUCTIONS: Call FirSlPlaco
SlallATURES
, r4 N
&/ ~7iJ;i..-Y.J 0 - M 0
for results ot vour pending lab tUIS.
I ~jEReBY ACKNOWLEDGE RECEIPT OF THESE INSTRIJCTIONS ANO UPIOER-
STANO TrIEM I UNDERSTANO TflAT I HAVE ~IAO URGEnT TREATMENT ONLY
ANO TflAT I MM ~E RELEASED BEFORE ALL <';IF MY MEOICAl PAOBLf.MS A"
KNOWN OR TREA1'ED I WILL AAMNGE FOR FOLLOW-UP CARE AS I ~tAVE
BEENINSIRUCIEO
Fc:rrn1MIlt]IUI'},911
. ~) / (:,-7,j' 7
Otlte
-""f,. '~'
.
R. JAMII RI~NOLOO. JR.
JOHN HAVAS
MICHAIl M. 8AOOWlSKI I
STIPHIN L. BANKO. JR.
ROL' I KROLL
BARRV A. KAONTHA~
LAURALII B. BAKIR
MICHILI J. THORP
REYNOLDS & HAVAS
.I'tMlH"IQN"'~ CO"~"I''''O/<f
A rrOFlNIYS AND COUNIIILORS A T LAW
101 PIN I STRUT
POlST O"ICI: BOX 93.2
H.-RRIBBlJRO, PfNNlSVLV,t,NIA 17108.01):)2
TILIPHONI
17171 23B.32oo
"x
17171 230,.OB3
(.MAIL
"Vhl\lOtp...ntl
November 3, 1997
Medical Records Custodian
Seidle Hospital
120 South Filbert Street
Mechanicsburg, PA 17055
Re: Kunkle/Kohut vs. Miller
R&H File No. 3808-1
Dear Madam/Sir:
Please be advised that our firm represents Andrea
Gutting (DOB: 10/23/90; SS# 181-72-7864) with regard to a claim
she may have regarding a recent motor vehicle accident in which
she was injured. Janice Kunkle, Ms. Gutting's mother and natural
guardian, has provided me with a signed Medical Information
Release Authorization which allows you to provide me with a
complete copy of any and all medical records maintained by Seidle
Hospital pertaining to Andrea Gutting. Please provide those
records at your earliest possible convenience. We will be happy
to reimburse you for the reasonable photocopying costs involved
in producing the requested records.
MJT/na
Enclosure
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AUl1:i081WJQfll.Q.JRlAf, STATEMENTS ON THIS 'ORM ARE TRUE TO mE eEST Of lotY
I<NO....L..EDGE. AND I HEAleY AUTHORIZE THE PH)'!iICIAN OR P~i)'SICIANS IN CH,tAOE O~ THE CAllE'
0' THIS PATIENT TO ADMINISTER ANY TRfAT~ENT. OR TO ADMINISTER SUOI ANESTHETICS AND
PER,OAM SUCH OPf-RATlONS A3 MAY ee DEEMl!D NECESSARY 0 AO....15 I~l THE OlAGNOBl5
AND fR MENT Of THIS PATIENT r:~
MlT.Q8lZAC1Qtt.lA8A.DAlLIBAIAMWfi.Q: LO Ii!STABlfCIDO i!H UTA 'ORMA IS C
HASTA La MUOR DE Mi COOOCIMIENTO. AUTORIZO Al MEDICO 0 MEDICOS EHCARG.AO<
ESTE CASO )' ''''CIENTI!: A AOMINlflTRAR CUALOUIER TAATAMIENTO 0 A AOMINISTMA ANEiS
)' UEVAR ... CABO CUALOUIER OPERACION aUE SEA NECES....AlA 0 ACONSEJABlI t
OlAGNOSTlCO Y ACERCA DEL T~TAMIENlO auE ~iE DE SEGUIR
PIlIflI".~'PICI.nl.
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S . 1 L.~ "". I ,,7t#.!lt..-... AllERGIES NKOA SEE NURSES Nl
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~-pAfiENTNAMe A~IO l\ODRESS ~.-~-- f~I!:LIO\ON f--.IMSURANC-;NO~~it-'---roRouP NO'1"-P~C'1 ;IUM8ER--l- SUBSCAtSEA N.,AIV
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A
l'rlSE. I L
7)7 F(,(l r
Pi'lHI<
f1fiRHI,;BURO
PA
17
G U rr -MiG . tN OR EA H
98fJ0838lt9
10/23/1990 6
1363 KINER OIVO
( ^ ~.'I'';t+-- P A II ~!t='t~ (717) 795-6656
. I - ' Z - 7 e t 4 k I H CELl. iNSTRUCTIONS TO THE PATIENT
I 'thlIelCsnllnaliIlt13li1111ltolllll1(ent you have receIVed In lne FirstPlace Center has been rendered on an urgent basIs only. and are nollntendoo
C 0. .19;1lCl ".ub,t~\lIe lor, or ar 1l<>r14C) IIlfqvlde complete medical care. IF YOU DEVELOP NEW PROBLEMS OR COMPLICATIONS,
" c;lNTACT YOllR" I~ N 'oR' 1liIS FIRSTPLACE ttEALTH CARE.
. ,.
I' OW THE INSTRUCTIONS BFI OW AS INDICATED FOR YOU.
LACERATION, ABRASIONS OR BURNS EYE INJURIES
I I(eep wQund clean and dry 24448 hours 21 Wear eye patch lor hours.
2 After 24.48 hours win" WIth !lOOp and waler or peroxide 22, 00 nol dme or operallJ machinery until
3. Walch for 51gml 01 swelling, lendernelS5, rmJness. heal or :.?3 Relurn 10 FlrslPlace Health ewe or 'M\lly phYlIlclan
drainage - relurn 10 FirslPlece II any of lhese signs occur , ..bnng llunglasses.
4 Allum 10 Flr:stPlaC8 10 have you, rJUIUffJS rcmovtJd 24 AVOid bflght IIghl5, TV and prolongod reading lor __hours
~jcalton
!S, Tetunus TO.lllOOrrttanU5 dlphthl!f18 gl....<<m ye:s ~JURJ
SPRAINS, BRUISES AND FRACTURES r $lrenuou. physrcaJ aCl,vily lor al ,..., 24 hours.
27 U:se __ for headache every 4 hourI as neede<1
a, ere....8te on 2 pillowS and lost 28 Ught dlellor 24 hours
1. USQ Ice lor minutes
limes 8 d8Y lor _ days
8, Ace wrap
9 Use splint for
1 Q. Use crutches lor
11 Begin to bear welghl _
12. Sian warm sOlSks on
minutes
symplOf!\S presenl
13 Wtj~r corvll:a! collar
14 No hea....e hf1lng 'or
15. Uso Sling for
IUI72:t164
F C
4'>
PIN~ACLEHEALnI
FirstPlacc
Hcalth Car<:
FirstPlace ,.
i
\
tor
ItmtlS a day unlll recneck or no
CAll DOCTOR IMMEDIATELY IF:
A. Unable to .rou.. paUent, conlu.ed or IrrUable
B. PaUent contlnuee 10 be naultlled Ind/or vomlta
C. paUent hll trouble with ballnce
D. PIIUent complain. 0' any vllull difficulty
E. He.dacha perll.tl longer thin 24 houri or lilt
becume. morelnt,nl' after 1~ hour..
F. Convul.lonl
MEDICAL INSTRUCTIONS
16. Bed re51 for
17. Take aspirin of Tylenol t'!> every ___ hcurs
1 e If 8 child has 'evet
A dress lightly - don't cover w!lh blankels;
B place In tub 01 lukewarm waler lmd $pange for 30 mlnules
II temporature IS higher thon and wont
come down with aspirin at Tylenoll.'!>
C give plenty 01 flUids - otler small amuunls frequEnlfy.
o give baby asplfln ur Tylenolll!> If lernparllfure hIgher Ihan
NOSEBLEEDS
29 00 not blow your nose
30, II bloeding occurs through naSAl packing or in Ihrosl
coli FlrstPIBce or lamlly physlC,tsn
FOLLOW UP CARE
@P Relurn 10 Fir51Place
Follow-up Wllt1 ,~y pt}/slcl6n
3,. Sa. Dr 0-"'- ..cL~.t.rl.
on . I al
~N
AM/PM
E 00 NOT use Ice paCks, cold waler enemas or alcohol balh
19 Clear liqUid diet - e.d'lsnce aj lolerated
20, Ollnk plenty at liqUIds
EMPLOYMENT
34 Return 10 notmal duly on
35 lJrnlled duty Irom
lImllatton
36 Sue Occupabonol lnstructlomtl Sheet
unlll
~
37. OTHER
~ -tlu. ~~0-d?t1YL~ /""'~ __
- ti /~~'~f'~ t& >ud.,,-'_#""'-iR,,--<!~_~'~4!-~___
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Radiology Department I' anV abnormallluu Bftt 'oune' lhal n,l"la nOl been called 10. your at'iemlan you and your doc lor WIll be cBlled Immediately Somellme
lrllClutU Ot ~bnormBlltle1 ma.'f nol ,hOw up on x-rays lor selJ9re.1 dayi It 'JymplOIT'I\ per~lst or gill worse call your f'hY'lf~IBn or relurn 10 1r'1IS Fir$~PI4C.
Health Care Canler More){ -(I'y' may nave 10 be 'ahen
LABORATORY IN!lTRlJCnmIS: C"" F""PI,,c.a
SIGlIATURES
'or re~ull!\ of your ~1(l"dlnq Idole,,,
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r HEREBY ACKNOWLEDGE RECEIPT OF ntESE INSTRUC T1CJr~S AND UNDER.
STAND tf'EM I UNDERSTAND THAT I HAVE "AO URGENT TREATMENT ONLY
.NO THAll MAY BE ,lE'.EASED BEFORE ALL OF MY MEDICAL PROBLEMS AR
KNOW" OR TREArED I WILL .~RFIANGE Fa," FOllOW-UP C,~AE AS I HAVE
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BUS I (711) 697-8059 FAX: (117) '95-7755
ASE CERTIFIED
CD LOG NO 11006808 DATE 11/04/97
SHOP CONTACT. TIM
OWNER
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CITY STATE
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1276 W LISBURN RD
MECHANICSBURG PA
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COMMONWEALTH OF PENNSYLVANIA
COURT Of' COMMON PLEAS OF CUMDERI.AND
COUNTY
IN THE
JANICE KUNKLE, Individually and as
P snt and Natural Guardian of
Andrea Gutting, and ROBERT KOHUT
Plaintiffs
VS.
SCOTT MIL~ER, Defendant and
Counterclaim Plaintiff
File No.
97-6861
VS. ..
ROBERT KOHUT Additional
Defendant and Counter-
claim Defendant : ,
SUBPOENA TO PROQ,\Jc:E DO~UMENTS OR THINGS
FOR DISCOVERY PURSUANT TO RULE 4009.21
TO: ERIE INSURANCE COMPANY
IName 01 ?erlon or Enli<yl
Within twenrt (20) days aiter service 01 this subpoena, you are ordered by the court to preduce the (ollewing decumenu or things:
~ t""1""jt'''' nr Vt')Ul:' ~nt-ire file en cJA.ni.~ f(lInklp 0,.,1 ;f"Y !t11()1; ?()()J717 ~ ~nd
'l f"'''tlv of VOllr entire file on Rober.. Kohllt P,,>] ie', ~()118 n17<;n7n H.
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.t _BLAKEY, YOST., BUPP & SCHAU~IMIN, LLP 17 East Market St, York, PI'. 170101
I.~ccressl
You may de'iver or m.i1legible copies 01 the dcc'"",enu er preduce things requested by this sucpoena. tegether with the
certiiicate oi complienc:e, :0 the party making !hi~ re'::1~est at :he .1ccrass listed aco'le. You have :r.e rigr.t :0 ~e~k, in aC'/anC~1 the
reasonable c~s: of pep.ring the copies or preducing ,he things sought.
if 'leu fail :0 ;:rccuc~ the ::cc'..:ments or things r.!c;wi:ed by t~l~ sl,;:pcena, within t'.vency COl duys Jr:er ,:5 ~er',ice, the ;Ja~1 ser/ing
:;,is subpcena mJ'/ seek J C~LJrt oreer ccmj:elling YOlJ ~o ccmpiy with it.
iHIS SU8?CE~~.~ 'i1,~5 1551.:D Ai iHE REQUE57 CFiH, FOLLOWING PE.~50~1:
NAME:
Donald B. Hovt. Es~:oe
17 East ~arket Street
AOORE;S:
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YOUR CLAIM CANNOT BE PROCESSED WITHOUT ALL THE INFORMATION REQUESTED IN QUESnON IS
5. LI8T MOTOR VEHICU8 OWNED BY YOU OR >>N ~BER OF YOUR FAMILY RESIDING IN YOUR HoueEHOLD ON DATE OF TIlE ACCIDENT
IWU! LICENSE NO, cwmEn INSURER POUCY NO, VEHICLI! loamFlCAnON NO,
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PAY"ENT IN ~ULL IS EX ECTED Ul HIM 30 D YS.
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Total Reimbursement
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X 58% "
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X 58% ..
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BUS: 134 A
HCPC'S CODE
FEE SCHEDULE AMOUNT
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-
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Total Blended Fee Amount:
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. ,T obll Fe. Reimbursement Amount:
Expo/cted Payment- Leuor of Reimbursement Charges :
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FEE BLEND AMOUNT
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REG DATE: 11/~6/97
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PATIENT INFORMATION
188-62-1405
111-2~8-9529
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08/16/1966 AGE:
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JANICE KUNKLE
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GUARANTOR INFORMATION
PT REL TO GUAR: S
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CONTACT NAME:
IHARRISBURG IPA/17104
SS II: 188-62-1465
PH II: 717-258-9529
PH II: 717-558~7500
PLAN INSURANCE CO
SUBSCRIBER
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KUNKLE ,JANICE
INSURANCE INFORMATION
COB POL I CY #
REL PC VFY CARD PRECERT #
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TAL CHARQES 8500
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-in EAST PARK DRIVE ,lfARRI9BURG PA
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MAMa
JANICE HARlE KUNKLE
1363 KINER 8l..VD
CARLI8LE PA 17013
062004717
GROOP N1JMll(R POUCY NUMSER
lUAlIAMTOlI
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.ATl! OF DESCRIPTION OF
EAVlce HOSPITAL SERVICES
}I~W'I I
/., ',,' AMOUNT OF $
,:'li"' PAYMENT
'~l'o~. . ' ...._
EST. COVERAGE EST. CO~ERAG~
INS. CO. NO, 3 l'lS. CO, NO. ..
PAYMENT
AMOUNT
)ETA L OF CURRENT CHARGES, fA NENlS AN
).111 6663839 001 411.50
V8T RETURN ACCIO FlU .99212
3/17 6665229 001 41'3.50
V8Y RETURN ACCIO FlU P99212
413.50
0.00
RY OF CURRENT CHARGES
60 CLINIC
85.00
85.00
3UB- OTAL OF CURRo CHAR'E8
85.00
85.00
TYPE:
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...
SEX' F
TJ E:
GUAR NO. 188621 6S
5.5 PH PACE. EHPL RE
QUA RELATIONSHIP,
ACC DATE. 10/14/97
DJA N08J8.
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AND r.OFlflE SPONDENI:E
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WHEN ""'i BILL WAS PFlVAAEO. OFl IF ,'. ".:
l~r';URMI(E CARRIERS DO M,')T PAY Mff PAR r
OF THE "MOUNT:; SHOWN U~iOEA ESrlMAtEO
IN:311n),/'lI:E COIJH1AGE
0.01
HOLY SPIRIT HOSPITAL " . . or
. ." . .......,
ACT 6 CALCULATIONS ~'..r ' ':;
, ' \
,-
DEPARTMENT RCC
Ambulatory Surgery .637517 X
Anesthesia .311062 X
Cardiac Treatment .399007 X
Cat Scan .160068 X
'.
Dills burg 1.214233 X
Duncannon 1,247748 X
Duncannon X-Ray .538940 X
Electrocardlology .301420 X
Emergency Room ,638912 X
Falrvlew 1.337110 X
Falrview X-Ray .735382 X
Family Heallh .935358 X
Gastrointestinal Svc, .500141 X
IV Therapy
LaborlDeliv.ery
Laser Eye ROOm
Medical Supplies
Nuclear Medicine
.., " ':,.303372 . X
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Observation
Operating Room.
Pharmacy
Physical Therapy
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't ""'.1 t..~rOj....,/I~'IliI~.;,.'h-:~n.r.
Recov~ry Room .;.." .. '.398488 X
Respiratory Service ,156656 X
. "
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1.615150 X
.182304 X
Ultrasound
Rew;ad 8/95
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REG [; ATE I 1.." 11/'37
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08/16/1~66 AGEl
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777 E PARK DRIVE
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PATIENt INFORMATION
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18S-1.;2-14",~
717-2~,;13-9~~: "
OEO I 04 I C' I (,
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31 SEXI F II:S: II lU\CEI I
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IHARRISBURG 11'1\/17104
AMBI !lOIIE
PH >>1 717-55e-75~~
EMERGEN,:'" CONTAC'l', INFORl'IA'l'INI
IAMEI nEL TO I'TI liOn!: I'H Ii:
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IHARRlSBURO IpA/17104
:;:5 II: 1~::::-62-11\65
PH ~I, 717-25~-952~
PH II: 717-558-7500
INSURAHCE INFOR!1ATlOII '
COB POe..ICY II
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MEOtC,&.IO CHNolPUII CHAMPVA GROUP FECA OTHER l..IN5UAfO'S I D. NUMBER
tlEAl TH PLAN 6LJo< lUNa
1_/IOI_'SSN~VAF''''j rSSN",'Dj n I.SHj lX]/lDj 0101703e9799
tL.&alNIIM,fnt~.~lnItlall 3. PAT I ffBiiiT'H"om SEX
Ir,4U,OOIVY
KUNKI.E, JANleF. 08' 16' 66 II 0 F
5, PATlINrs ACORUS tHo, 61,"1) I. PATIENT RELATIONSHIP TO INSURED
1363 KINER BLVD. ..'[l(I""""O""'~O ""'*'0 1363 KINER BLVO
CITV STATE e. PATIENT STAtUS
CARLISLE PA -.0 M....... 0 o..,..1!J
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17013 ~17)eS8-9Se9
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.. OTHER INSUREDS POliCY OR QAOOP NUMBER
l). OTHER INSURED'S DATE Of BIRTH SEX
MM: 00: YY ,---1 Mn Frl
c. EMP\.OYER S NAME Ofl 5ClofCOl NAME
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DYES ~]""
liJd f\ESERVEOiORToc.AL USI: .
AUD BACK 0' 'OA... BlfORE COMPLETING.. SIGNING Tlfl5 fO,ry:----
12. PATlENfS OR AUTHORIZED PEASON'S SIGNATURE 1 au\hOrUllhe rlltaw 01 al1~ lTW\liC31 Of OU\lllll1I01m.woll !'IeCuusy
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. V, 1:" r PRiQNANCY(lMPI
17. NAME Of REFERRING PHY$ICWI OR OTHER 50UHCe
osaORN DO.VALENTINE
19. FlESEAVEO FOR I.OCAl U~E
0",,_11 J797
I~ If PATIENT HAS HAC SAME OR SIMilAR IllNES5
GillE FlfHjT DATE MM I DD ' y'(
-----.
\ 7a I D. NUMBER OF REfERRING PHYSICIAN
E70S204
,21 DIAGNOSIS OR NATURE all IllNESS OR INJURY. (RELATE ITEMS 1 2.3 OR 4 TOllEM 24E B', liNE I
I
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0. - IF,)/ gll~l ~1;l,m~, 1QU n.-v.Kl
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I1ECHANICSSURG PA 17055
~
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~~ 1"fIF'Pt';'tI!O 8f "\M ':,;UNI:II, CN "-11((;'1:"1. :iI!R\JiCE UIII PLEASE PRfN'r OR TYPE
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1 1.IN5URI!O'S POLICV QROUP OR FEeA NUMBER 2:
CITY
lIP COOf
17105
t, INSUREO'S DATE Of BIRTH SEX
MM I QO I 'fY
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DYES 00 flO It Y". rllum 10.r.1 complottl II.", 9 .<t.
13. IN5UAEO 5 ()R AllTHORIZEO PERSON S SIGNAT\JAIi I aut~OIIl.
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16. OATES PAtiENT UNABLE TO WORK IN CURRENTOCCUPATlCN
MMIDOIYY MMICiOIYY
FROM ,I TO' I
18. HQSPIYAlI2MIOtI DATES RELATEO TO CURRENT SEAVICES
MMIDe yy MU100 YV
FRCA.\ ' TO I
20 OUTSIDE lAB? $ CHAAGES
DVES OONO 1
22, MEDICAID RESUBMISSION
COOE ~ ORIGINAL REF. NO
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S~1~1t PHYSICIAN SERVICE
0423 N 21ST ST SUITE 103
CAMP HILL PA 17011
f'IN_
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FORM HO'" 1'\00 111901
F(1RMOWCP,I'\OI} Il"OFlM~P,8,\100
04/29/1998
10.04
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1.9971.1.06 to .1.9971:1.06
:1.99/:1.0:1.7 to :1.997:1.011
1.997:1.0:1.1 to :1.9971017
:1.997:1.:1.1:1. to :1.9971119
:1.997:1.020 to :l.99/1:1.\)5
B. Left turn. - The driver of a vehicle
intending to turn left shall approach the turn
in the extreme left-hand lane lawfully
available to traffic moving in the direction
of travel of the vehicle. Whenever
practicable, the left turn shall be made to
the left of the center of the intorsection and
so as to leave the intersection or location in
the extreme left hand lane lawfully available
to traffic moving in the Barne direction as the
vehicle on the roadway being entered.
75 Pa.C.S. 53331
section 3322. ~icle turning left.
The driver of a vehicle intending to turn
left within an intersection or into an alley,
private road or driveway shall yield the
right~Q!-way to any vehicle approaching from
the opposite direction which is so close as to
constitute a hazard.
75 Pa.C.S. 53322
Emphasis added. Therefore, the driver of a vehicle turning left
has additional responsibilities and duties of care imposed by the
Pennsylvania Motor Vehicle Code. More specifically, the duties of
a driver turning left include the duty to yield the right-of-way to
any vehicle approaching from the opposite direction within an
intersection if that vehicle is so close as to constitute a hazard.
With regard to Defendant's duty at a flashing red signal,
seotion 3114 of the Pennsylvania Motor Vehicle Code states:
- 3 -
v
Grove Road which has a blinking red traff ic control signa 1 in both
directions on Lisburn Road. Mr. Kohut checked in all directions
for traffic, and proceeded to cross the intersection intending to
continue his travel along Lisburn Road.
Defendant Scott Miller
("Defendant"), who had been traveling in a westerly direction on
Lisburn Road, entered the intersection after Mr. Kohut, and
attempted to turn left onto southbound Williams Grove Road. Due to
Defendant's negligent conduct, the mid to rear portion of the
driver's side of Defendant's vehicle impacted with the left rear
corner of Mr. Kohut's vehicle. As a direct result of the accident,
Mr. Kohut's vehicle was damaged in the amount of $1,913.38.
Additionally, Ms. Kunkle and her daughter, Andrea, suffered
personal injuries.
II. Jliscussion
A. ~~duty with relj1ard to making a
left turn at an intersection controlled
by a flashing red lilj1ht.
The Pennsylvania Motor Vehicle Code provides as follows
with regard to making a left turn:
section 3331. Required position and method of
t.uI:nin.g .
- 2 -
....
'.
COMMONWEALTH OF PENNSYLVANIA
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY
JANICE KUNKLE, Individually
and as Parent and Natural
Guardian of Andrea Gutting,
and ROBERT KOHUT,
Plaintiffs
No. 97-6861
CIVIL ACTION - LAW
v.
SCOTT MILLER,
Defendant
ARBITRATION
v.
ROBERT KOHUT,
Additional Defendant:
Counter-Claim
Defendant
REPLY OF PLAINTIFFS, JANICE KUNKLE,
Individually and as Parent and
Natural Guardian of Andrea Gutting, and
ROBER'r KOHUT. TO DEFENDANT' S NEW MATTER
23. Denied.
24. Denied. To the contrary, Plaintiffs were in no way
negligent with respect to the events alleged in Plaintiffs'
Complaint.
By way of further answer, Plaintiffs in no way
negligently or otherwise caused or contributed to CIl\ISe any
injuries or damages to themselves or any other party.
It is
further denied that Plaintiffs' injuries and damages were caused by
third parties over whom Defondant Miller had no control.
25. Denied. The allegations set forth in paragraph 25
constitute a conclusion of law to whic.h no response is required and
are, therefore, denied.
.-
26. Denied. The allegations set forth in paragraph 26
constitute a conclusion of law to which no response is required and
are, therefore, denied.
27. Denied. The allegations set forth in paragraph 27
constitute a conclusion of law to which no response is required and
are, therefore, denied.
WHEREFORE, Plaintiffs, Janice Kunkle, Individually and as
Parent and Natural Guardian of Andrea Gutting, and Robert Kohut,
demand judgment in their favor and against Defendant, Scott Miller,
plus interest, costs of suit, and any and all other relief which
this Court deems proper and just, in an amount within the
compulsory arbitration limits of Cumberland County.
REYNOLDS & HAVAS
A Professional corporation
Date: .-;~/ LI-!Ol'2'.:
By:
Michele J. Thorp
Attorney I.D. 71117
101 pine street
Harrisburg, PA 17108-0932
(717) 236-3200
Counsel for Plaintiffs,
Janice Kunkle, Individually and as
Parent and Natural Guardian of
Andrea Gutting, and Robert Kohut
- 2 -
"I
I
lr "
WHEREFORE,l'laintiffand Additional Dcfcndunt. Robcrt Kohut, dCl1landsjudgment in
his lavor and ugainst Delcndunt, SCIHt Miller, plus interest, costs of suit und any and all other
relief which this Court deems proper and just.
I{EI'LY TO NEW MATTER IN TIm NATlJJ{E OF A ('ROSS-CLAIM
28. Denied. By way of fitrther answer, Kohut hereby incorporates by relcrcncc a.l
though fully sctlllrth herein paragraphs 1-22 of Plaintiffs' Complaint and parugraphs 23-27
hereinabove.
29-31. The averments contained in paragraphs 29-31 of Delcndant's New Matter in the
Nature of a Cross-claim are conclusions of law or fact to which no response is necessary; to the
extent that a rcsponse is deemed necessary. the averments are denied pursuant to Rule 1029(e) of
the Pennsylvunia Rules of Civil Procedure.
WHEREFORE, Plaintiff and Additional Dettmdant, Robert Kohut, demands judgment in
his favor and against Delcndal1l, Scott Miller, plus interest, costs of suit and any and all other
relief which this Court deems prop,:r and just and that Defendant's New Matter in the nature of a
Cross-claim be dismissed with prejudice.
ANSWER TO COUNTERCLAIM
32. Denied. By way of lilrther answer, Kohut hercby incorporates by referenc'l as
though lillly setlllrth herein paragraphs 1-22 of Plaintiffs' Complaint and paragraphs 23-3\
hereinabove.
D. The averments contained in paragraph 33 of Defendant's Countcrclaim are
conclusions of law or fact to which no response is necessary; to the extent that a response is
- 2-
deel1led nccessary, the averments are denied pursuant to Rule 1029(e) of the I'ennsylvania Rules
of Civil Procedure.
WHEREFORE, Plaintiff and Additional Delcndant, Robert Kohut, del11l1ndsjudgment in
his lavor and uguinst Delcndalll, Scott Miller. plus interest, costs of suit and any and all other
relief which this Court deems proper and just and that De!endant's Counterclaim be dismissed
with prejudice.
IffiW MATTlm
34. The averments setl(Jrlh in Dctcndant's Counterclaim !ail to state u claim or cause
of action against Kohut upon which relicf Illay be granted fi.Jr thc reasons set forth in Plaintiffs'
Complaint, which is hereby incorporatcd by reference thereto.
35. The accident which is the subject of this litigation resultcd cntirely from thc
Defendant's own ncgligelll, reckless and c.lrcless conduct in failing to yield thc lcgal right of way
to Plaintiffs vchicle and in !ailing to pay attention and to properly maintain control of the
vehiclc and !(Jr the lIdditional reasons sct !(Jrth in Plaintiffs' Complaint. which is hereby
incorporatcd by relcrencc thereto.
36. Any claim or cause of lIction set forth i:l Defendant' s Countcrclaim is barrcd hy
operuf.ion of the contributory/compllrative negligcnce of Defcndant liS mllY be developed during
discovery, lor thc re.Lsons sct f(Jrth in Plaintiffs' Cumplaint, which is hereby incorporatcd by
rl,fcrence thereto.
37. Any c1l1im or cause of action sct !(lrth in Dcfcndant's Countcrclaim is barrcd by
operation of Ikfcndant's assumption of a known risk LIS m.IY he developed during discovery, !(Jr
. J .
reasons sct forth inl'luintiffs' Cmnpluint, which is hereby incorporuted by refcrenee thereto.
38. Any claim or euuse of uction set fimh in De Icndul1l , s Countcrcluim is barred by
the applicable stutute of limitulions, including spccil1cally, but nut Iimitcd to, any c1uim or eause
of uction which, by reason of luck of specil1city of pleading, is not directly or specil1cally set
forth in the language of Defcndant's Countcrclaim, but which Dclcndant seeks to raise at a latcr
time by further umendmcnl, cluil1ling to have prcserved such clail1l or cause of uction within
Defendant's Counterc1uim.
WHEREFORE, Plaintiff und Additional Dcfcl1liunt, Robcrt Kohut, demunds thut thc
Countcrclaim filcd ugainst him by thc Defcndant bc dismisscd with prcjudice and costs of this
action.
NOTICE TO PLEAD
You arc hercby notil1cd to plcud to thc cncloscd Ncw Matter to Countcrcluim within
twcnty (20) days from servicc hcrcof or u detault judgment muy be tilcd uguinst you.
Respectfully submitted,
HARTMAN & MILLER, P.C.
fly:
t t-
J c M. Hartman, Esquirc
~ rcmc Ct. l.D. #21902
126-128 Wulnut Strcct
Harrisburg, PA 17101
(717) 232-3046
[Mcd: ,:J.!13/fii:__.
Attorney for Plaintiff and Additional
Dcfendant. Robcrt Kohut
- 4-
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