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11974184811- 2
COMMAND INFORMATION:
M.dloll Com mind: PIWTO<:OL
NARRATIVE:
PIll,nJ R,..h',d By: 113411H
MICU D1SI'A'I'CII FOR IIICYCI.IST STRUCK. ARV'I> OIS Tn' A.1') YO -HS KO WI' SITTINO ON TIlE
(lIWUNll SIIE WAS AAO ANI> IN NiAll), SIIE STATES SIIE WAS AT AN INTERSECTION ON IIER IIICYCI.E
AND WAS STRUCK DY A MOTOIUST AT A LOW ItATE OF SPEED. TIIERE WAS NO VISABLE I>AMAOE TO JlER
mCYC!.E OR TilE MOTORIST VEIIICLE. SIIE WAS IItJMPED OFF IIER IIIKE. SIIE C/O: (R) POSTElUOR
THIGIII'AIN. SIIB DENIED I lEAD, NECK. BACK. CIIEST. AllD.PEI.VIS OR OTIIER EXTREMITY TRAUMA.
. (-) SOO, VERTIGO. OR NUMIINESSfI'lNGI.ING, SIrE STATES slm "WALKED AROUND AFTER TilE
INCIDENT" AND WAS UNSURE IF SIIE WANTED EMS. SIIE REQUESTED WE WAIT UNTII.IIER IIUSBAND AR V'I>
O/S. PIE: MO. SKIN: PINK. WARM AND DRY. NO OIlVIOUS IIEAD, NECK. BACK OR CIIEST TRAUMA.
PERRLA. AIRWAY NA TURALl.Y PATENT. N(.) BLOOD OR SF DRAINAGE. NECK: NTII' (.) DEFORMITIES
NOTED. CHEST: EXTERNAI.LY ATRAUMATlC: (+)(=) Bns CTA WI NORMAl. EXCURSION. AIID: SINT WIO
C/NR/P.I'ELVIS: STABt.E TO l'ALPATlON, (.) DEFORMITIES NOTED, NTn', (R) 1'111(;11 (-) ('G
POSTERIOR IIEMA TOMl. NOTED. (-) OISCOLOJtA TION. (.) DEFORMITIES OF THE FEMUR PALPATED, (+)
DISTAl. SENSATION AND MOVEMENT. (.) PAIN WI MOVEMENT. (+) DISTAl. PULSE. IWMAINDER OF I'm
NSF. VS AS NOTED. RESULTS: TIlE PTS IIUSBAND ARV'D OIS AND REQUESTED SIIE BE TRANSPORTED BY
EMS. SHE AMBUI.A TED TO TilE AMIl. AND WAS TRANSPORTED TO IISII WIO FIJRTIIER INCIDENT TOI TO A
STAFF RN END.
DETAIL INFORMATION:
!!Mli f !! nn' RII"TII~I TltE.\TMENT
I~J5 liT. ASSESSMENT
1.08 120 20 16111100
J4U
J4-l6
J~~8 112 211 I.UII'
14~ 92 211 IJ2n'
SIGNATURES:
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116.lls.l
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06-4 1 5.a
116-1'5.&
RESI'/C()~I\IE:"lTS
COW I'.\I.: TO At'FR "\0:1) AIIEA
ENIlOUTE
PERSON RECEIVING PATIENT TIME
A#2:
KIllE MICHELE
1\#3:
COMMAND PHYSICIAN ID#
A#4:
Sll.I,!ER SPRING POLlCE
p~p tarllalt,pa
TEL:71 ;'-;'66-5'):34
717 2/.9 077Y
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1;'::,:.110,001 P,03
UI122 '96 15:26 NO.S'7 03104
-JjNCiffiiNT II: J/;' -l
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TRIAGE I CHIEF COMPLAINT: /Jx"'L~(.-'I., ,J,1 I rI....'*' ".. q,"L,,.t.
IHmAL TRIAGE: J ,
.
.
.
.
,
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Ago:
.17"
.
Log.,n Time:
Triage Timo, I "\ I ()
Tlmo to Exam Room: i 0; ,I.;
Pile. InjUry occurred: I I tiomo I llncJu~.lry I I nucrn.lllOn I ] Othlll
Inform.llon obtained t,om: _PAIl,n' _Famlly/S.O. _Rocords
I.ItremttY!".Iu.tJon: TrlDC;od to radiology for:
Deformity Yes I No Slt.ln f..-np W.um i C0QI
IIdnCofor PInk I Cyal\Obc I Mottled 'alnU.fO)
_EMTlPar:Jmodlc
ItItervention:
ASSESSMENT I
Disl.,1 PUlllll P't!!.qnl Absenl OQstlnatlon:~U [ ] EOF
P.'.5th..11 Pre~enll Absent Time:
Signature:
Tomp: W;- Pulso: WI.- ResPJi~ons:_;J,.L- SIP: /-If:!? Pulse 0.,:
Allergles/Roactlons: l.llf'. . v,.,,)I(i,:; " -7r..~"", '\
last Tetanus: 1.iA,..../!.- -' ) lMP: Waight: _scale/estimate (If pertinent)
'lJ~ A , VI',usl Acuity: Of.. -:O.S. O.U. :;-;::-/cerrO~,lIVOlo~se. /:j' .;', _
Su eellve: -f.li'/. /".-4'" 4;,'. h _#~ ".-f' J.C.~.,~"h.... ;>./ /'a '.H'rk.:I-?"~. /7_ .
V !':o' ~ ~m-< ) "-/70 /tJ '.;; 'In _.... .",-,,' /.. $'~A"~, "^.l / A. /", -IrL -;; ace. ,,(". <:4. II.....
-/I .-\, A,,1/ ',. (.7 J.. . ../,., hD.! {!J;~, _. {
ObJeellve:
Prehaspltal Treatment:
JIUlbo7/,1
.-:.' I.J"
Medlcallon/Dose/Fre<luencv
~ -:.1 ^ ^ ;;r~. IQ,
, if
Last Dose Medication/Dose/Fre<luencv
.r.91~
Last Dose
,
Past Medical/Surgical History: . },. '^/ h-4-h. " ,: .I
t.I I
Has pallenl had exposure to measles, chiCkenpox or TB in past month? ~Are there advance directives? .d..!!:lls copy available?:!:dtl..
NURSING DIAGNOSIS EXPECTED OUTCOMES
~ atdiac Outpul, alteration in Improvement in cardiac outpul demonstrated by improved v,s. and diagnostic lests.
~Comlort, alteration in """'--Oecrease or relief of discornfon
- Fluid volume, alteration in _Improvement in fluid vel. demonstrated by decrease in symptoms oflluid vol. imbalance
_Impaired gas exchange _Improved gas exchange demonstrated by improved oxygen..ltion and VItal signs
- Potential/Actual infection _ Oecrease in symptoms indjc3~g infection or pOI,enliallor in/eclion
- Knowledge De/icll Improved knowle.Qge demonstra\ed by verbalizatIon f relurn demonstration
Assessment completed at J "\ I S by" VYl?1I C.)' /i -". J A.N.
Data obtained by: ' M.A
AdmIssion Called: [ J Admission [ J Observation
Report Called: ~ Admined to at
Dlsposilion~ Hg,cne ( Aot'~A [ J 9Pf at
Dlsohsrgod: 'l{ ~ I '1}" [ rOischargo Instructions
[ ) Old Records Sont _
_}*s. Tr~nsferred to ---....... at by
0" Satisfactory till [~rox~~~a.1 fi! De~a~ morgue at
Dlschargo R. . ,
Holy Spirit Hospital
Camp Hill, PA
ECU Nursing Assessment
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CHART COPY
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Thl!! I~ u J9")'t:dr.uhJ ",hite ((,ll1ale III com", liS!. (rum an aCtident, bicycle
acchJfnt Invol"lni: a c:ar. She come, immnhlll/C'll :u:comJ1:.1nlrd by her
hu,hand,
IIPI
The pallenl ,tate' Ihal ,he was a helmeted hie)'de rider tra...Uing arnund
10 mile. an hour, around 12:20 when ,he wa, struck by a ear Ira...lling
aboul S 10 10 mile. an hour Ihal was eomin~ orr or a Slop ,ign~ The patienl
state. thaI Ihe driver was u young man who,e nlusl< was blaring and he
wa,n'l paying allenllun and knocked her down, The pallen I 'Iat.. Ihal ,he
was hit on Ihe len ,Ide of her hieycle and ,he wa, knoeked over 10 Ihe
ground and struek her righl leg and elhow, She .omplaln. only of
(enderne.. 01 her righl hip and ,he poinl. 10 the posterior a'p..1 of her
Ihlgh where Iherel, a hematoma. She at,o eomplain, of an ahra,lon 10 her
rlghl elbow and forearm. Ifer last lelanu, ,hot wa' unknown. One was
ordered for her today. She denies any head or neek Injury, She has no
head or neck pain. No loss of consciousness or time that she can't account
for. No ba.k pain, no abdominal pain. no chest pain, She was abte 10 walk
after the Call. She has no other concerns or cum plaints. Denies any
previous injury to the same.
Nurses notes reviewed.
PMH
Thyroid disease. She had th)'roid surgery. She is 00 Synthroid right now.
Past surgical history - only hcr Ihyroid. ALLERGIES: PENICILLIN.
Medications: Synthroid. Ifer doctor is Gellyshurg Family Praclice and il she needs an orlhopedisl, it would
he Dr, Wotl.
ROS
Constitutional: No weight loss, weight gain, fever, or chills.
Eyes: No vision loss, eye pain, double vision, glaucoma, or cataracts.
ENT: No vision loss, earache, dizziness, nosebleeds, sinus trouble, or sore throat
Cardiovascular: No chest pain, palpitation~, swelling of feet, or heart murmur.
Respiralory: No cough, spulum production, wheezing, or coughing up blood.
Gastrointestinal: No nausea, vomiting, diarrhea, constipation, abdominal pain, or rectal bleeding.
Genitourinary: No blood in urine, painful urination, or frequent urination.
Musculoskeletal: No muscle pain, joint pain, arthritis, or joint swelling.
Skin: No rashes, lumps, dryness, itchiness, or sores.
Neurological: No dizziness, blackouts, seizures, paralysis, numbness, or tingling.
Psychiatric: No depression, mood change, or nervousness.
Endocrine: No diabetes or thyroid disease.
Page 1
HOLY SPlRIT HOSPITAL
Camp Hill, PA
/7011
NAME: DONNA, KLUCK
MR#: 395546
ROOM #: ECU
DR.: Dtlbill,
EMERGENCY ROOM REPORT
DIAGNOSTIC I'LAN
X-ray. of Ihe rl~hl femur and hilI and rl~ht elhow and forearm were
ordered.
INTERVt:NTION
Ice, lclanUi shot was ortlrred.
Jo
JD/.z
D: 07/02/1998
T: 0710311998
6112
i/
ADDENDUM:
The paUent wa. on a bieyele and was hit broadside. Complaining of ten femur pain and len forearm pain
with an abrasion. X-rays eame baek negative for any fraeture of her hip, elbow, forearm, femur, and pelvis.
The patient was given a tetanus shot and we gave her instructions on strains and sprains and Norne~ for her
strains and sprains, Tylenol or Advil. Give her off from work for a day and use lee, elevate her leg and her
etbow. Will offer her a sling if she wants one.
Page 3
HOLY SPIRIT HOSPITAL
Camp Hill, PA
l70Il
NAME: DONNA, KLUCK
MR#: 395546
ROOM #: ECU
DR.: Dubin,
EMERGENCY ROOM REPORT
.~'
(
"
OTP, OT, OTP A andTd
I have read or have had explained to me the information on this form about diptheria, tetanus,
and pertussis and OT?, OT, Td and CPT A vaccine. I have had a chance to ask questions
which were answered to my satisfaction, I believe I understand the benefits and risks of the
vaccine and request that the vaccine be given to me or to the person named below for whom I
. am authorized to make this request.
\~........
OOT OCT? A OTd
Vaccine to be given: OOT?
INFORMATION ABOUT PERSON TO RECEIVE VACCINE (please print)
FOR CUNIC USE
Last Name
Fm Name
MI
Birlhdale Age
Clinic ldenlificalion
tlSH-
DateVaccina%ed
ry-J.-'18
ManufacWr~and L.ot No,
~~ q ~ Go() 1/96
Site 01 Injection
L1J
Address
City
County
Slate
Zip
X..
Signallll'e 01 person to receive vaccine or
person authorized to make ll1e request
Date
I '.
1.-
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DEPARTMENT OF RADIOLOGY
HOLY SPIRIT HOSPITAL
. . .
PRELIMINARY X.RAY INTERPRETATION
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RADIOLOGIST FINDINGS:
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ED/HOUSE PHYSICIAN FINDINGS:
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RADIOLOGIST ,/
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ED CHART COpy
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A.....",,",: Time: ,.,"~~ 1t,1- .!'; ,\'1 \ I I
VIIal S"ln.
Monitor
Physician AII..'mttl'll 11'\v.l..-,'"'
02 SatufAtlon
Lung Alllum.1'I1
VISual Acuity
DIIonosUCI:
EKO
Lab.
PCXRlPo,\. C.Sp'ne
Sen, 10 Radoolo<Jv "" r:1
Returned from RadlotoQV
Procedurls:
Respiratory Treatment
Ice
Foley Insortlon
NG Insertion
Wound Care
SplinUOCUSllnqlCrulches
Miscellaneous:
Pain Scale (0.10)
Level 01 Consciousness
Siderails
Intake & Output
Patient Education 11'110 lei -I'lfIJ J
Other: 1""6
nitlals:
I II. f,D1l\C1 . :r(.~,,' ,,~ """f.."....i..t'" t ro M I('\~"" -
_ ~^ .,' '\" ^ 'LA ,i\('\.r'l. .,..,,,,.r... UC\ ~l-t\{\r\ ll\)~~\"",r\., ,-,....
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IV Therapy
Date Time
Amount Solution Catheter
Site
Rate
Rate
Control
Condition Attempts
Initials
Initial: II::;)
Inilial:
Initial:
Initial:
Signatu .
Signature:
Signature:
Signature:
Condition Codes:
Q.No Inflamation
l-Edema
2A.Erythema
2S.Ecchymosis
3-Pain
4-Hardness
5.Warmth
Rate
~
1.AVI
2-StatMasler
Holy Spirit Hospital
Camp Hill, PA
Emergency Palient Documentation
1.~lT::Vi
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205 ECU Revised 5/96 JD, SR. MD
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CONSENT TO MEDICAL TREATME:-;T
I hereby consent and 3uthOrlZC Holy Spirit HO\Plt31. iu 018:(,015, and employee".' 10 the renJ(,f1n~ \)( mC"d1l:JI care, ..hll.:h mOl)' indul.Se mullne JiJgno~tic
procedures and such medicallreatmenl 3S my allendini or I:on!lulllng phY\h':lan ~,'n!lI!J(,f\ to be nCl.'c!lury. I Jiron understand It III CU\IOm3ry. absent
emetiCRc)' or extraordinary circUm)lanCCS, Ih<st no suhloUnllJI pn)l,;NUrC\ will be: pcrfomlcd upon me unlc" nf uoul I have had "In tlpponunuy Co
discuss them with a phY\lCIOln or orner health care pru(c)\ional, to my ~all\fJctl()n. If I am J ,nmpctCnl 3dull. 1 ha\'c: the fight 10 con\Cnt or ren.!tC
to consent to any propo~d procedure or thcfapcutll: trcatment. 1 Will nut he In\'Ul..'cd In an)' rc\cJTl:h lIt c'fICnmcnul prflt,:cdure .....lthout m\' full knu""lc:d~e
and consenl. 1 undenlilnd lhill the pr3C11ce of medl~'me and surgery III not J,n (uct \Clr:nl,'e .1nl.l Ih.u dIJ~n(l\lll JnlllrCalnlent mOl)' 'IO\'OI'-'e rtd;.s of
injul')' or even death and acknowl~dgl! that no guaranlee has been l1\ade In mt: J~ HI lht' rc\ult.. of Jny e,lIl.allllnalltln m trealment in thas Ho\pilal.
1 understand many or the physicians on the !iufr o( Huly Sl'int Hospital are not empluyee\ ur J~enl' or lhl: Ifihpll31. but father arc indl:pCnd.:nt ~onlra,lun
who have been gr:mted the priVilege oC usinr.; thc~C' (acllltlcs for the c.ne and treatment of thear pallenls, Funhcr. 1 reallle Ihis HO'ipital is a teaching
Hospital and at the Hospiularc health r:are personnel in training who. unl.:n e:tprc!!slv rrque\fed l)lhr~l~e. ma~' participate or may be present dunng
my care as pan of their educ:J.tion. Still or motion pictures and dosed~ucuit lelcvi,lon monitoring ()f pauent care may 3bo be used (or educational
purposes. unless;1 cxprnsly request otherwise, 1 t I
Date 7 /.;(. 'N' Signature X (01--'..... <I _ .I -Y r1l.l(' 4- ~~I~~~~':'iP .is-R- ./
RELEAse OF1MEDlCAL tNFORMATION '. (...1
I authorize Holy Spirit HospitlJ to release (0 requesting heallh insurance carrierlsl.their rcpn:~ntali\'c5 and 3udilors. and any n:fcrring he31th care providers.
such diagnoscic and therapeutic information (including any information relating to treatment for akohlll and \uh'il:inCl! abme Jnd/or lre:llmenl of ns\'chi:uric
disorders. and/or confidential HIV rel:lled in(nnn3Iion). as milY be necessary for them to determine benefit enllllcmcnt~ to process paymem claims (or
health care services provided during thi!i hospilalilJl1onltre:ument episode. and for continuing care/Ileatment, A pholostatic o"~ c:ubon copy of this
authorization shall be considered as effective and valid as the original. The undersigned also authorizes Medic:ue. when 3pplicablc. to release (0 ilnother
insurance carrier. upon their request. medical informal ion nceded to make payment upon th.u ,"'laim.
t understand and consent that the manufacturer of any implantable device insencd by my physician during the course of my surgery/procedure mOlY be
provided with my identification information. including social security number. 3S mandated by Federal Law, k /,
Date 7/ a/?! Signature x~.i ahA;' -" ~~I~~~i~~iP '_c/
INSUR~CE ASSIGNME:-;T ..)
t authorize payment direcdy to Holy Spirit Hospital and for physicians of atl benefits payable under my insurance policies. 1 understand I am resJ'onsible
to the Hospital for all charges not covered by this assignment and/or photocopy of this assignment. A.... U
7/0 A~r? I '..... fl . / 1/. ,,_ Relation,hip - <-',.
Date l.\. -J~ Signature X A..iA.-A.JlI!J./ A, f/j'J.1..Iftr ..; To Patir:nt ...
I / /
STATEMENT TO PERMIT PAYMENT OF MEDICARE BE:-;EFlTS
TO PROVIDERS. PHYSICIANS AND PATIE:-;T
1 request p3yment of Authorized Medicare benefits to me or on my behalf for any services furnished me by or in Holy Spirit Hospital including physician
services. 1 authorize any holder of medical and olher infonnation 3bout me. to released to ~1edicarc and its agencies any infonnation needed [0 determine
these benefits for related services,
DATE: SIGNATURE:
HOSPITAL BENEFITS/PART A/EFF, DATE:
MEDICAL BENEmS/PART B/EFF, DATE:
MEDICAL ASSISTANCE RECIPIENT
My signature certifies that I received a service or items from Holy Spirit Hospital and Dr, on the date listed below,
1 underst;lnd that payment for this serv~ce or item will be from Federal and State funds, and that any f3lse claims. statements. or documents. or concealment
of matenal may be prosecuted under applicable Federal and State Laws,
I have read and agree with the above statements:
RECIPIENT/AGENT SIGNATURE:
RELEASE AGAINST MEDICAL ADVICE
Thi~ .is to certify that I, . a patient at Holy Spirit Hospital. am leaving the hospital
against the advice of Dr. and the administration, I have been infonned of the risk involved and hereby
release the physician and the hospital from all responsibility and legal liability,
SIGNATURE: WITNESS:
RELATION TO PATIENT: TIME: DATE:
FORM WITNESSED BY () r / / / ,1 '
Date 7 /~ /9,t Signature U ~
DATE:
HOLY SPIRIT HOSPITAL, CAMP HILL, PA
I ': I ;,-, -".,
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CONSENT FOR TREA TMENT/REL&ISE OF INFORM"! TION
INSURANCE ASSIGNMENT
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HOLY SPIRI7 'HOS~TAL
DEPARTMENT OF RADIOLOGY AND DIAGNOSTIC IMAGING
CAIIP HILL, POlNSYLVANIA 17011
(717) 763-2600
PATIENT I KLUCl<, DONNA S
IIR: 395546
SOC SECt 178-50-6295
ORC DR.: ED GROUP,
PT TYPE: E
ADM DATE 07/02/1998 03:19PM
LOCATION ECU
DICTATION DATE: 7/2/98 4:55 PM
TRANSCRIPTION DATE 07/02/1998 06:28PM
ARRIVAL DATE:
HOSP SERVICE: ECU
I
EXAMINATION: PELVIS AND RIGHT HIP (3Vl
COMMENTS: An AP view of the pelviS and AP and lateral views of the right
hip do not show a fracture. The hip joint spaces are normal.
CONCLUSION: Normal pelvis and right hip.
."h~ 0/7
~Pft'~;14qt ~
DICTATED BY: G, S. Durisek,
DATE OF EXAM: 07/02/1998
M'D./me&11O
.
. HOLY spiT HOSPJTAL ·
DEPAR'l'IIENT O. RADIOLOGY AND DIAGNOSTIC IIIAGING
CAIIP HIlL, PENNSYLVANIA 17011
(717) 763-2600
.
PATIENT: KLUCK, DONNA S
IIR: 395546
SOC SEe: 178-50-6295
ORD DR.: ED GROUP,
PT TYPE: E
ADM DATE 07/02/1998 03:19PM
LOCATION ECU
DICTATION DATE: 7/2/98 4155 PM
TRANSCRIPTION DATE 07/02/1998 06:27PM
ARRIVAL DATE:
HOSP SERVI CE:: ECU
EXAMINATION: RIGHT ELBOW (4V)
r
COHMENTS: I do not see soft tissue swelling or joint effusion. There is no
acute bone or joint abnormality.
CONCLUSION: Normal right elbow.
Dote "1 Lf ( qCY
P;.~t.Jlts reviewed by
M.D./D.O.
DICTATED BY: G. S. Durisek.
DATE OF EXAM: 07/02/1998
,-,-/,,&41
.
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HOLY SPIRIT HOS~ITAL
DEPARTMENT OF RAOIOUlGY AND DIAGNOSTIC llIAGING
CAMP HILL, PENNSYLVANIA 17011
(717) 763-2600
.
PATIDn'1 1<I.lIc:K, DONNA S
IIRI 395546
sac SEeI 178-50-6295
ORD DR. I ED GROUP,
PI' TYPE I E
AOK DATE 07/02/1998 03:19PM
l..OCATION ECU
DICTATION DATE: 7/2/98 4:55 PH
TRANSCRIPTION DATE 07/02/1998 06:27PM
ARRIVAL DATE:
HOSP SERVICE: ECU
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EXAMINATION: RIGHT FOREARM (2V)
COMMENTS: I do not see soft tissue swelling. I do not see acute or focal
bone abnormalities.
CONCLUSION: Normal right forearm.
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DICTATED BY: G. S. Durisek,
DATE Or EXM: 07/02/1998
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1OfD51 H1SU.(O\I'fTCON'O""lION'JO'(;IlO~I~ "
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J tl TilE COURT ot' COMMON PI.EAS
CllMIlEHI.AND COUNTY, PENNSYI,VANJA
. ~"(,,
NO, 1'/) {.J<~J . 1(" I I ..._
CIVIL ACTION - LAW
DONNA KI.UCK and BRIAN KI.UCK,
Plaintiff n
MATTHEW NEGLE'{,
Defendant
NOTICE
TO DEFENDANT NAMED HEREIN:
'{ou have been sued in Court. If you wish to defend against
the claims set forth in the following pages, you must take action
within twenty (20) days after this complaint and Notice are
served, by entering a written appearance personally or by
attorney and filing in writing with the Court your defenses or
objections to the claims set forth against you. You are warned
that if you fail to do so, the case may proceed without you, and
a judgment may be entered against you by the Court without
further notice for any money claimed in the complaint or for any
other claim or relief requested by the Plaintiffs, You may lose
money or property or other rights important to you.
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU
DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE
OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP.
CUMBERLAND COUNTY BAR ASSOCIATION
2 Liberty Avenue
Carlisle, PA 17013
(717) 249-3166
Le han demandado a usted enla corte. si usted quiere
defenderse de estas demandas expuestas en las paginas siguientes,
usted tiene viente (20) dias de plazo al partie de la fecha de la
demanda y la notificacion. Usted debe presentar una apariencia
escrita 0 en persona 0 por abogado y archivar en la corte en
forma escrita sus defensas 0 sus objeciones alas demandas en
contra de su persona. Sea avisado que si usted no se defiende,
la corte tomara medidas y puede entrar una orden contra usted sin
previa aviso 0 notificacion y por cualquier queja 0 alivio que es
pedido en la peticion de demanda. Usted puede perder dinero 0
sus propiedades 0 otros derechos importantes para usted.
LLEVE ESTA DEMANDA A UN ABOGADO IMMEDIATAMENTE. SI NO TIENE
ABOGADO 0 SI NO TIENE EL DINERO SUFICIENTE DE PAGAR TAL SERVICIO,
VAYA EN PERSONA 0 LLAME POR TELEFONO A LA OFICINA CUVA DIRECCION
SE ENCUENTRA ESCRITA ABAJO PARA AVERIGUAR DONDE SE PUEDE
CONSEGUIR ASISTENCIA LEGAL,
CUMBERLAND COUNTY BAR ASSOCIATION
2 Liberty Avenue
Carlisle, PA 17013
(717) 249-3166
~
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Dated:" \...tQ;1l\"\;'t"- './11 (Ie
FRIEDMAN & FRIEDMAN, P.C.
( , '. /)/
,/jr(t, ' \r'-~
JOhn,F. King, Esquir;le
600 North Second S~
Pen~house suite /
P'/O. Box 9B4
Harrisburg, PA 17108
(717) 236-8000
(
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5. At that same time, d~te ~nd pl~ce, Plaintiff,
Donna Kluck, had a flashing yellow light while traveling in her
northbound direction on williams Grove Rd. at the intersection of
Lisburn Rd.
6. At that same time, date and place, the Defendant,
Matthew Negley, operated a 1986 Subaru, owned by his mother,
Cindy B. Negley, in a westbound direction on SR 2004 (Lisburn
Rd.) .
7. At that same time, date and place, Plaintiff,
Donna Kluck, slowed as she approached the intersection and took
note of the Defendant's, Matthew Negley's, approaching vehicle.
8. At that same time, date and place, the Defendant,
Matthew Negley, did have a flashing red light and stop sign, at
the intersection of Lisburn Rd. and Williams Grove Rd. in his
westbound direction of travel.
9. At that same time, date and place, Plaintiff,
Donna Kluck, after having observed the Defendant, Matthew Negley,
stop at the intersection of Lisburn Rd. and Williams Grove Rd.,
did proceed slowly into the intersection.
10. At that same time, date and place, the Defendant,
Matthew Negley, did also proceed into the intersection, striking
the plaintiff's, Donna Kluck's, bicycle and her body on the right
side.
11. At that same time, date and place, there was
sunshine and the road was dry.
12. At the time of the accident, the Defendant,
Matthew Negley, was negligent, recklcsn and careless under the
circumstances in:
A. Failing to have his motor vehicle under proper
and reasonable control.
B. operating his motor vehicle in such a manner
as to cause it to collide into and against Plaintiff, Donna
Kluck, and her bicycle.
C. Failing to give prompt, proper and adequate
warning of his approach.
D. Failing to yield the right-of-way to
Plaintiff'S, Donna Kluck's, bicycle which was lawfully entering
the intersection of Lisburn Rd. and Williams Grove Rd.
E. operating his motor vehicle without due regard
to the presence and safety of Plaintiff, Donna Kluck.
F. Failing to bring his motor vehicle to a stop
in time to avoid the collision.
G. Failing to operate his motor vehicle in a safe
and proper manner.
H. Failing to comply with the laws, rules and
regulations of the Pennsylvania Motor Vehicle Code and the
ordinances of Monroe TownShip pertaining to the operation of
motor vehicles in or about the public highways, and particularly
section 3323 of the Pennsylvania Motor Vehicle Code pertaining to
a duty to stop and yield, which conduct constitutes negligence as
a matter of law.
c. A tetanus chot:
d. The uce of prDn~ription and over the counter
medicationn; <lnJ
e. Three (3) vicltc with her family doctor.
17. As a direct and proximate result oC the collision
and minor Defendant's negligent and reckless conduct, plaintiff,
Donna Kluck, has suffered, and will cuffer in the future, pain,
agony and inconvenience.
18. As a direct and proximate result of the collision
and minor Defendant's negligent and reckless conduct, Plaintiff,
Donna Kluck, has been unable to undertake her normal duties, and
believes that she will continue to suffer impairments and
disabilities in the future affecting her ability to undertake her
normal daily duties and activities, including the care of her
home, property and children.
19. As a direct and proximate result of the collision
and minor Defendant's negligent and reckless conduct, Plaintiff,
Donna Kluck, has suffered a diminution of her ability to enjoy
life and life's pleasures.
WHEREFORE, Plaintiff, Donna Kluck, demands damages from
Defendant in an amount not in excess of $25,000.00, exclusive of
interest and costs, and therefore bound for compulsory
arbitration.
COUNT II
Brian Rluck v. Matthew Neqlev
20. plaintiff, Brian Kluck, incorporates by reference
all of the preceding paragraphs of this Complaint as if each and
everyone were individually set forth within this Count.
21. As a result of Defendant's negligence, plaintiff,
Brian Kluck, has been deprived of the society, companionship,
contributions, and consortium of his wife, Plaintiff, Donna
Kluck, to his great detriment and loss.
22. As a result of Defendant's negligence, the
Plaintiff, Brian Kluck, has suffered a disruption in his daily
habits and pursuits, and a loss of enjoyment of life.
WHEREFORE, plaintiff, Brian Kluck, demands judgment
against the Defendant in an amount not in excess of $25,000.00,
exclusive of interest and costs, and therefore bound for
compulsory arbitration.
Respectfully submitted,
Date:fJ)llA'Y\~J€-"---;J. n?;~
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'~~~"""A"'
Joh~ F. King, Esqu re
600' N, Second Str et
Penthouse suite,
P. O. Box 984
Harrisburg, PA 17108
(717) 236-8000
P.C.
Attorney for Plaintiffs
k/p:pleadings\dkluck.cmp
IXl:-lNA WICl\ ,\';P
Bill J"'\ l\IJICl\.
ltI TilE counT Of COMMON Pl..EM
'iMl'i~N't~ COUUTY. PEUNSYl..VMl I h
ClI~U\EHlA\P
1'1 ., I II tiC f"
vo-
CIVIL hCTION - IA~
~L\'I'I1IEW N:(:!EY.
Ue fend.\I\t
NO. DB-(,B3R Ci vi I
. Defend"nt(o)
To ~htthe\; i'il-~ll')'
You are hereby notified that on
,January 22 . 19DD, the following :oo.Mli.~\XU~:e.~e:1i1
(Judgment) has beenentered against you in the above-
cllptione,t cnse.
lufault .iud~ment for fni lure of I\.'fenllnnt to fi lc nn Ansl<er
to the Cbnv1aint. Pamages to be assessed at trial.
"T" 1/..>)99 f.'l.lLr!:; .2 i! ~
I hereby certify thi\t the name and address of the
proper person(s) to receive this notiee is:
~htthe\; 1\eg1cy
c/o I\aren DurKin, Esqu1re
Jrurcs, Smith, Durkin f, Connelly, LLP
P. O. Box (,SO
IIcl'shcv. PA 17033-0650
h ~k~tthe" t\c g ley
De fend idol"
oefendidos/as
Por este me,lio se te estn notifieando que e1
de January 22 det t999 ,et/ta siguiente
(~~ali.n~\XXt~~~gg~. (Fotlor-r,a sido anot.do en contra
suya en el easo ,neneionado en et epigrafe.
FF.Cllh:
l'rotonotario
Certifieo qu~ ln oiguiente direccion es La del
defendido/a segun illdicada en el certlf.ieado de
resideneia:
~latthcw Negley
..../v I~(I!l,,;JI l:)lllk~.II, R;:,qu.ilL:
Janes, Smi.th, Durk.i n f, Conncl ly, LLP
1'3. o. !}u.\. U5l1
lIershey, PA 17033-0650
hbogado clol Demal1dante
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DONNA KI.l '(''' and BHI.,\N
KI.\IC " ,
IN TilE COlfHT OF (,O~I~10N I'I.I':\S
CI r:o.lIIERI.ANIl ('OliN I y, PI'.NNSYI.\'ANIA
:'\(). I)X.hX3X
Plainlin,
v.
CIVIL ACTION - LA W
MAITIIEW NHiI.FY.
Iktcndal1l
JURY TRIAl. D1:~IANIlEI>
IlEFE:'\IMNT'S ANSWER WITlI NEW MATTER
r
ANIl NO\\'. ClImes the Ikli.'ndant. Mallhew Negley. by lllld through his allorneys.
James. Smith. Durkin & ('onnelly.I.I.P. to answer Plaintiffs Complaint and awl' New Maller as
follows.
I.
Admilled.
"
~ Admilled.
3.
Ilenied. Alkr reasonahle invcstigation. the Dcfendant is withoUI knowledgc or
i
,
inli>nnation sunkient to limn a bclicfas to the truth ofthc avcrments of
paragraph thrcc (3) and strict proofofthc samc is demanded at trial.
J
I
4. Admitted.
5. Denied. Alter reasonable invcstigation. the Detcndant is without knowledge or
inlilmmtion sui'licient io form a belief as to the truth of the avermcnls of paragraph
live (5) and strict proof of thc same is demanded at trial.
6.
Admillcd.
~.
\
7.
Denied. Altcr reasonable investigation. the Defendant is without knowlcdge or
inlormation sunkienl to tann a beliefas to the truth of the averments of paragraph
seven (7) and strict proof of thc same is dcmanded altrial.
\
X. ,\dmill."1.
II. I knil-d, ..\tkr r,'a,..nahk in\..,ti~atlllll. Ih.' I ldcndantls \\ ith..lIl ~n..\\ kdg~ or
inlimllali..n slIni~i~nll" li,,",., I '\.'Iii-I' ii' ," lh.' lnuh ..fth~ a\~nnenls ..fpilragral'h
nine (1'1 and ,tril-t pr....f..fth., ,am.' is d~l11alllkd 011 trial.
I 0. "dmill~d,
II. I\dmilled,
I:!. ))~nic", Th~ awrmellts of paragraph t\\c1w ( I:!) stat~ ~onclllsi..ns of law 10 which
no r~sronsiw pleadillg is dcem~d nccessary :md strict pro. If th,'re..f is dem'md~d at
trial.
13. lknicd. Th~ awrm~nts ofparagral'h thirle~n (13) stale condusions of law to which
no r~sponsiw pl~ading is d~cm~d n~c~ssary and strid proof th~r~of is d~mand~d at
trial.
COllNTI
I>ONNA KUleK v. MATTIIEW NEGLEY
14. Th~ answers in paragmphs on~ ( I ) through thirleen (13) arc incorporated by herein
hy rclcrenee.
15, Denied, The awrments of paragraph tilieen (15) stale conclusions orIaw to which
nu responsive pleading is deemed necessary and strict proof thereof is demanded at
trial.
16, Denied. Aller reasonable investigation. the Dclcndant is without knowledge or
in((lfI11ation suflieienttolllflll a belicfas to the truth of the averments of paragraph
sixteen ( 16) and strict proof of the same is demanded at trial.
DONNA KLUCK and
BRIAN KLUCK,
Platntiffn
I N Tilt; COUIlT OF COHMON PI,EAS OF
CUMIII;!tI.ANIJ COUNTY, PENN~\'I.vMIIA
/10. 9K-hIUK CIVil. TEIlII
v.
HATTIIEW NEGLEY,
Defendant
CIVil. AC'1'ION - I.AW
l>onCE OF IlImTlm; OF A1tIIlTItATO!tS
Plense take notice that the arbItraturs apjlUlnted in the above-captioned
action will sit for the purpose of their appointment on Wednesday, July 28,
1999 at 10:00 A.M. in the Second Floor lIearlng !to om of the Old Cumberland
County Cuurthouse, Carlisle, Pennsylvania.
Date
h ';IIJ 7, /717
/ ,
BY:
/,
WIlliam A. Yocum, .
.
"
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1,
Chairman
TO:
Maura Quinlan, Esquire
2303 Market Street
Camp Hill, PA 17011
Arbitra tor
!tichard S. Friedman, Esquire
600 N. Second Street
Penthouse Suite
P.O. Box 984
Harrisburg, PA 17108
Attorney for Plaintiffs
Karen Durkin, Esquire
P.O. Box 650
Hershey, PA 17033-0650
Attorney for Defendant
Michael Rentschler, Esquire
28 N. 32nd Street
Camp Hill, PA 17011
Arbitrator
Thomas F. Cheffins
1 Courthouse Square
Carlisle, PA 17013
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DONNA KLUCK and 1I1{IAN
KLUCK
IN TilE cot IRT 01 COi\lMN I'I.EAS
('IIi\lIll,RI.ANI> {'( lllNTY, PENNSYLVANIA
Plaintiffs
v.
NO.IJIl-611311
MAITI IEW NEGLEY
Defendant
CIVIL ACTION LA \V
JURY TRIAL DEMANDED
ENTRY OF APPEARANCE
TO TilE PROTIIONOTARY:
Kindly cnter the appcaranee ofthc undersigncd on bchalf of the Defendant. with
respect to the above-captioned aetion.
Respectfully submitled,
,JAMES, SMITH, DURKIN & CONNELLY, LLP
~
Datcd:/.((;Cc,.. ,2-,? /fl f
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KMEN'DURKIN. ESQUIRE
Attorney LD. #29563
JOliN 1. MCNALLY. III. ESQUIRE
Attorney J.D. #52661
1'.0. Box 650
lIershey. I' A 17033-0650
(717) 533-3280
Atturncys lor Defendant
DONNA KLUCK and BRIAN
KLUCK
1:-': TilE COURT 01: CU:-'IMN PLEAS
CUMBERI,AND cot JNTY. PEt\;-.JSYI.V A:-JIA
Plaintiffs
)
"
,
v.
NO. 98-6838
..
MATTHEW NEGLEY
Defendant
CIVIL ACTION LA W
. ,
JURY TRIAL DEMANDED
c:,
ENTRY OF APPEARANCE
TO THE PROTHONOTARY:
Kindly enter the appearance of the undersigned on behalf of the Defendant, with
respect to the above-eaptioned action.
Respectfully submitted,
.JAMES, SMITH. DURKIN & CONNELLY, LLP
~
/fi ""fetf
Dated~,-(L{ c.,. . k:? 1/
,
By' <~..... ;/ ,.' " .
.(. ,~KREN:D~ll.K'IN, '~QUIRE
, Attorney J.D. #29563
JOI-IN J. MCNALLY, III, ESQUIRE
Attorney J.D. #52661
P.O. Box 650
Hershey, PA 17033-0650
(717) 533-3280
Attorneys for Defendant
CEIHIFIC,\TE OF SEIH'ICE
I, KAREN f)IJRKI~. "St.lI :IRL d" hcrcby ecrlilY that I Sl'r\eJ 1I true and correct copy
of the foregoing Interroglllorics upon the Il,/Iowing below-named individual(s) by depositing
same in the U.S. Mail, postage pre-paid atllershey, Dauphin County, Pennsylvania this
J-aay of February, 1l)l)9.
SERVED UPON:
John F. King, Esquire
600 North Second Street
Penthouse Suite
P.O. Box 984
Harrisburg, I' A 17108
n 01 n, Esquire
JAMES, SMITH, DURKIN & CONNELLY, LLP
0'l+flNWI':I\I:!:" 01" l'mctL~NlI^
--
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DONNA KI.UCK and BRIAN KI.UCK
v,
Fi 10 No,
98-6838
MATTHEW NEGLEY
SUBPOENA TO PRCaX:E llOCl.M::NTS OR TH I NI3S
FOR DISCOVERY PUlSUANT TO RtJ\.E 4009..:.ll
TO: Records Custodian for Holy Spirit Hospital
(Nane of Person or Entity)
Within twenty (20) days after service of this subpoena, you are or-dered by the court t,
produce the following docunents or things: Copies of any and all medical records,
reoorts. oroaress not~s, opinion letters, bills, prescriptions, x-ray films,
MRI films, and other diagnostics regarding treatment of Donna Kluck.
at James~ith, Durkin & Connelly, 134 Sipe Avenue. Hummelstown, PA 17036
(Address)
You may deliver or mail legible copies of the docunents or produce things requested b'
this subpoena, together with the certificate of COl"!)liance, to the par-ty making thi,
request at the address listed above, You have the right to seek in advance the reasonabl,
cost of preqar-ing the copies or producing the things sought.
If you fail to produce the documents or things required by this subpoena within twent~
(20) days after its serv~ce. the par-ty serving this subpoena may seek a court order
ccmpel1ing you to comply with it.
TH I S SUBPOENA WAS I SSUED ~ T THE REQUEST OF THE FOLLON I NG PERSON:
NAME: Karen Durkin, Esquire
ADORESS: P.O. Box 650
Hershev. PA 17033
TELEPHONE: (717) 533-3280
SUPREl-E COURT I D II 2 9 5 6 3
ATTORNEY FOR: Defendant
BY THE CCURT:
DATE:
Prothonotar-y/Clerk. Civi 1 Division
Seal of the Court
Deputy
(Eff. 7/97)
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DONNA KI.lICK mlllllRIAN
KLlICK
IN TIlE COIIRT OF COMMON PLEAS
('1 i~I/IERLAND CO! INTY. PENNSYLVANIA
Plaintiff:,
Nt >. '1X.MOX
v.
CIVIl. ACTION - LAW
MA'ITIIEW NEGLEY
Dcfendant
J\IRY TRIAL DEMANDED
CERTIFICATE
I'REREOUISITE TO SEIH'ICE OF A SLJBPOENA
PURSUANT TO RULE ~OIl9.22
As a prerequisitc to servicc of a suhpoena for documcnts and things pursuant to Rule
4009.22, Defendant Matthew Negley cerlifics that:
(I) a notice of intent to serve the subpoena with a copy of the subpoena attached
thereto was mailed or delivered to each party at least twenty days prior to the date
on which the subpoena is sought to be served:
(2) a copy ofthc notice ofintcnl. including the proposed subpoena, is attached to this
cerlificate;
(3) no objection to the subpoena has been received; and
(4) the subpoena which will be scrved is identical to the subpoena which is attached
to the notice of intent to serve the subpoena.
Date:
~/11!fi
/",-
DON:-JA KLUCK and IlRI:\:\
KI.lICK
IN TIlE conn OF cml:-'Io:-J I'I.I':\S
('1 !:-'II\FRI,ASI) ('( )\':\IY. I'E:\J\SYI.V A~IA
Plaintiffs
NO.I)X-6XJX
v.
: CIVIL ACTlO:\ -I.AW
MATrHEW NEGLEY
Dcfendant
: JURY TRIAL DE~IA:-':DED
;liOTICE OF INTENT TO SERVE ^ SliHI'Of.;I;:\
TO PRODUCE DOCUMENTS ANI> THINGS FOR IlISCOVERY
PURSUANT TO RULE 4009.21
Defendant Mallhew Negley intends to servc a subpocna identiculto thc one thut is
allached to this notice, You have twenty (20) days from the dutc listed below in which \0 file of
record and serve upon the undersigned an objection to the subpoena. Ifno objection is made the
subpoena may be served.
Date:
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Attorney'Cor Defendant
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DONNA KLUCK and BRIAN KLUCK,
Plaintiffs
IN TilE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 98-6838 civil
v.
MATTHEW NEGLEY,
Defendant
CIVIL ACTION - LAW
PRAECIPE
Kindly make the attached ten day notice part of the
record in the above captioned-matter.
Respectfully submitted,
FRIEDMAN & KING, P.C.
\. ' .
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Joh~ F. King, ESqUirj'
600 N. Second streft
Penthouse suite "
P. O. Box 984
Harrisburg, PA 17108
(717) 236-8000
Date: (
I
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FHllmMAN & KINO. Pc.
:\'1"1 flU , I':"'''' AT LAW
(U)( I ~ SI:('OSII S'I
1"11'111 Fl.flllH'
PO Box ""."
1I^ltHl~lll'ltl'. P,~'N'"'iYl.\'^SI^ 17JOfl
! 111: ~'~ 111 . 11111111
1"l.tl'OI'It'''~'' {1111l.':II"1l1l1l0
IhclIAllIl S. FIHf.IIMAS
.Iolls F KINI'
May 17, 1999
william A. Yocum, Esq.
3001 Market street
Camp Hill, PA 17011
In re: Kluck v. Neqlev
Dear Bill:
Thank you for your Notice of Meeting of Arbitrators in the
above matter. I would appreciate your pushing the time back from
10:00 a.m., on Wednesday, July 28, 1999, to 10:30 a.m. As we
discussed, I have a lengthy dentist appointment scheduled for
8:00 that morning, and I would feel more confident of my ability
to start on time if the hearing were at 10:30. As we also
discussed, we already have a judgment on liability, and I
anticipate calling only Mr. and Mrs. Kluck. I doubt that the
hearing will last more than an hour.
I appreciate your assistance and will look forward to
hearing from you.
Very trulYj yours,
ll{
Richard~. Friedman
RSF/mf.corresmz\yocum.esq
cc: Mr. and Mrs. Brian Kluck
Maura Quinlan, Esq.
Michael Rentschler, Esq.
Karen Durkin, Esq.
Thomas F. Cheffins
I>ONN/\ KI.I JCK and BRIAN
K I.liCK
1:'1: 1111 ('( II RI OF C()~l:-'I()N I'I.FAS
('I ::-'III1.IU1\NI> C()liN JY. I'L:'I::'I:SYI.VANIA
I'laintifls
N( J, 'll;.(,X.'X
v,
('IVII. ACTION. 1.1\ \\'
MATTI IEW NE(iI.EY
Ddcnd,l1lt
JURY TRIAl. DH\I1\NDED
CERTIFICATE
PIU:IU:O{lISln: TO SEI{VICE OF A SlJBl'OENA
PlJl{SlJANT TO IUlLE 4009.22
As a prcrcquisitc to scrvicc of a subpocna for documcnts and things pursuant to Rulc
4009.22. Dcfcndant Matthcw Ncglcy ccrlilics that:
(I) a noticc of intcnt to scrvc thc subpocna with a copy of thc subpocna attach cd
thcrcto was mailcd or delivcrcd to cach party at Icast twcnty days priur to thc datc
on which thc subpocna is sought to bc scrvcd:
(2) a copy of thc noticc of intcnt. ineluding thc proposcd subpocna. is attachcd to this
ccrtificate:
(3) no objection to thc subpocna has becn rcccivcd: and
(4) the subpoena which will bc servcd is idcntical to thc subpocna which is attached
to thc notice of intent to scrvc thc subpocna,
Datc: 3/(./r f
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Atto~~r.lJelcndant
1
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DO:'llNA KLUCK and BRI..\:'I:
KLUCK
: 1:\ TI IF COURT OF (.'o:-.I:-'IO:-J I'I.I':AS
: ('l1~IIlFRI.AN() CO! INlY, I'(;N:-JS\'I.VANI,\
Plailllifls
: NO. lJX.6X3X
v.
MA lTHEW NEGLEY
Dcfcndant
: CJVIl. ACTION. LA \V
: JURY TRIAL DEMANDED
NOTICE Of INTENT TO SERVE A SUBPOENA
TO PRODUCE DOCUMENTS AND TUlNGS fOR DISCOVERY
PURSUANT TO RULE 4009.21
Defendant Matthew Ncglc)' inlcnds to scrve a subpoena identical to thc onc that is
attached to this notice. You ha\'e twcnt)' (20) days from the date listed below in which to tile of
record and serve upon the undersigncd an objcction to the subpoena. I I' no objection is made the
subpoena may be served,
Date: 7{;;;l~
,
/ ;.
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Attomeyi'or Defendant
~m OF PrnNSYINANJA
<nMl'Y OF aJMIlrnJJ\ND
DONNA KLUCK and URIAN KLUCK
v.
MAT1'IIEW NEGLEY
Fi Ie No. 98-6838
SUBPOENA TO PR<XlU::E llOCU1ENTS OR 'THINGS
FOR DISCOVERY PURSUANT TO RLn..E 4009. 22
TO: Records Custodian for Steven B. Wolf, M.D.
(Nane of Person or Entity)
Within twenty (20) days after service of this subpoena, y~ are ordered by the court to
Produce the following docunents or things: Copies of any and all medical records ,
reports, proq~ess not~s, opinion letters, bills. prescriPtions. x-rav films.
and other dia nostics regarding treatment of Donna Kluck.
at James, Smith, Durkin & Connelly, l34 Sipe Avenue, Hummelstown, PA 17036
(Address)
You may deliver or mail legible copies of the docunents or produce things requested bl
this subpoena, together with the certificate of compliance, to the party making thi~
request at the address listed, above. You have the right to seek in advance the reasonable
cost of preparing the copies or producing the things sought.
If you fail
(20) days after
ccmpe 11 ing you to
to produce the documents or things required by this subpoena within tw.enty
its serv~ce, the party serving this subpoena may seek a court order
comply with it.
'THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLCWING PERSON:
NAME: Karen Durkin. Esquire
AOORESS: P.O. Box 650
Hershey, PA l7033
TELEPHONE: (7l7) 533-3280
SUPREl-E COURT 10 # 5266l
ATTORN~FOR: Defendant
8Y THE COURT:
DATE:
ProthonotarY/Clerk, Civil Division
Seal of the Court
Deputy
(Eff. 1/97)
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1'llIllIt Ufo
III Th', Cuurt u( COr.unOIl Pleas of
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Cwnuo.!r 1~1I\! ';uullty, ?clln9:tl'/ania
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HATTIIEW NEIOI.EY.
Ill'fl'flllallt
/JATll
lle do solelllllly swear (or afCirm) thilt ...e will support, obey and defend
the Constitution of the Unite\! States .lnd the CoJnstitut~on of this COllU!\on-
'~ealth and that we '~ill discharge tho.! dut ia9 of our of fice .~ith fidelity.
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(or
havim.\ been duly appointed and sworn
award:
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Arbitrator, dissents. (Insert name if
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applicable. )
Date of Rearing: '} -2.~- '1 oJ
Date of Award: 7- 2 IS" - q "')
~,atn'LLatr.~
'~('''M''-'' ~:t%:~----
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NOTICE OF ElITRY OF AWARD
Now, the,;zP!-),ay of JkLI./ , 19.22-, ar:. Ja2., fl..a., the above
award was entered upon the docket find notice thereof given by mail to the
parties or their attorne:rs.
,
~
Arbitrators' compensation
paid upon appeal:
$ .:29(') () ('\
ir / (l'/ %) ..J j) ~~_
'I ~ . thono tary
By..: 0" (' P ~k??"'l'Yr--"
.. De, ty ,
to be
Cop y -Ie,) C ()
W;Ll,~", YOCtt/l\
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(ll'J.Lt.t!...d. QlllUb".l - a,eLl... Jbi'{'/, (l,-.<.4~.,- . C,~.~J t
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NOTICE OF APPEAL FROM AWARO OF BOARD OF ARBITRATORS
DONNA KLUCK and BRIAN KLUCK
VS.
No.
98-6838
19
MATTHEW NEGLEY
TO THE PROTHONOTARY:
Notice is given that Matthew Negley
appea 1 s from
the award of the board of arbitrators entered in this case on July 28, 1999
A jury trial is demanded /x/. (Check box if a jury trial is demanded.
Otherwise jury trial is waived).
I hereby certify that
(1) the compensation of the arbitrators has been paid,
or
(ltkXmJR~x~Jtwlt~XIK~xtm{~~xex~~ . XOOlVNXl<~X~.
(Strl ke out the lnapp1 cable c1 use.) -..
governed
NOTE: The demand for jury trial on appea
by Rule 1007.l(b)
(cl No affidavit or verification is required.
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I. J< 1I1N .I. ~I( 'NAIJ, Y, I'SI.ll 'I R I,.. do hcrcl,~ wrtil~ thai I ,,'n ~d a Inl.' and
SHWED (IPON;
corrcct copy of thc li.rcgoing Praccipc npon thc lillhl\\ ing hclo\\-Ila/llcd indi\ idual(s) hy
dcpositing sllmc in thc II, S. ~lail. postagc prc.paid at Ilcrshcy. I>anphin ('ounl~.
Pcnnsylvania this.. l
.,1, ,.
day of (J~lobcr. 1'1'1'1,
John F. King. ESLJllirc
Clon Norlh Sccond Slrcct
Pcnthousc Suit.:
P,O. Box I)X4
lIarrisburg. I' A I 7 lOX
c:\ ~-~~-~
John.l. cfila~'. liliEs lirc
.IAM f,' 8MITlf;\)UR N~CONNELL Y, LLI'