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Home My WebLink About01-06923 W' JOEL NICOLE BRYAN, Plaintiff : In The Court of Common Pleas of : CUMBERLAND County, v. : Pennsylvania : Civil Action - Law KEITH DAVID JOHNSON, Defendant : No. 01-6923 . . : Protection From Abuse and : Custody FINAL ORDER OF COURT Defendant's Name is: KEITH DAVID JOHNSON Defendant's Date of Birth is: August 9, 1966 N ame( s) of All protected persons, including Plaintiff and minor children: 1. JOEL NICOLE BRYAN AND NOW, thiA~~Day of December, 2001 the court having jurisdiction over the parties and the subject-matter, it is ORDERED, ADJUDGED and DECREED as follows: Plaintiff, Joel Nicole Bryan, is represented by Joan Carey of MidPenn Legal Services; Defendant, Keith David Johnson, is unrepresented, but has been advised of his right to representation in this matter. Defendant, although agreeing to the terms of this 'brder, does not admit to the allegations made in the Petition. Plaintiffs request for a final protection order is granted.. 1. Defendant shall not abuse, stalk, harass, threaten the Plaintiff or any other protected person in any place where they might be found. ,iiq!;'M"J .!J1>,!"iil '~)"C--""" -~h .n,~_"_,", '" _~ ~, _" _,^ _", _~"""'-,,,r ,'"'~""" !'<., " . ",." ",,<<__ , ". .' _v~,-. ". ,. -._ _ . - ~ ~ " ~ - 2. Except as provided in Paragraph 4 ofthis Order, Defendant is prohibited from having ANY CONTACT with the Plaintiff, or any other person protected under this Order, at any location, including but not limited to any contact at Plaintiff's school, business, or place of employement. Defendant is specifically ordered to stay away from the following locations for the duration of this order. Plaintiff's current residence or any other residence she may establish during the term of this Order: 68 East Main Street Newville, PA Defendant's contact with Plaintiff of a non-harassing nature by telephone and/or in person during transfer of custody of the parties' minor child at Plaintit1f's residence or any other location, shall not be deemed a violation ofthe CONTACT provisions in the above paragraph (2) and/or paragraph 3 ofthis Order. Defendant's communication with Plaintiff shall be limited to information regarding the parties' minor child. 3. Except as provided in Paragraph 4 of this Order, Defendant shall not contact the Plaintiff, or any other person protected under this Order, by telephone or by any other means, including through third persons. 4. Custody of the following minor children: 1. JARROD SCOTT JOHNSON shall be as follows: . Primary physical custody of the minor child/ren is awarded to the Plaintiff. . Defendant shall have periods of partial custody with the parties' minor child as set out in the attached Custody Order. Defendant's contact with Plaintiff of a non-harassing nature by telephone and/or in person during transfer of custody of the parties' minor child at Plaintiff's residence or any other location, shall not be deemed a violation ofthe CONTACT provisions (paragraphs 2 and 3) of this Order. Defendant's communication with Plaintiff shall be limited to information regarding the parties' minor child. '~'~"<',"--"~,,,-- .-" .- ,-- ;,'~" ,- ~- , "'-" - -" ";-"-'~d -"!, . -"\"'., '- ~,"- - ~, t _. ~,- 5. The following additional relief is granted as authorized by g6108 of the Act: Defendant is prohibited from having any contact with Plaintiff's relathres, except as may be necessary with respect to communicating information regarding theiparties' minor child. Defendant is ordered to refrain from harassing Plaintiff's relatives. Defendant is enjoined from damaging or destroying any property ownlld solely by Plaintiff. The court costs and fees are waived. 6. A certified copy of this Order shall be provided to the police department where Plaintiff resides and any other agency specified hereafter: NEWVILLE POLICE DEPARTMENT 7. THIS ORDER SUPERSEDES: 1. ANY PRIOR PF A ORDER 2. ANY PRIOR ORDER RELATING TO CHILD CUSTODY 8. All provisions of this order shall expire on: June 17, 2003 NOTICE TO THE DEFENDANT VIOLATION OF THIS ORDER MAY RESULT IN YOUR ARREST ON THE CHARGE OF INDIRECT CRIMINAL CONTEMPT WHICH IS PUNISHABLE BY A FINE OF UP TO $1,000 AND/OR A JAIL SENTENCE OF UP TO SIX MONTHS. 23 PA.C.S. g6114. VIOLATION MAY ALSO SUBJECT YOU TO PROSECUTION AND CRIMINAL PENAL TIES UNDER THE PENNSYL VANIA CRIMES CODE. THIS ORDER IS ENFORCEABLE IN ALL FIFTY (50) STATES, THE DISTRICT OF COLUMBIA, TRIBAL LANDS, U.S. TERRITORIES AND THE COMMONWEALTH OF PUERTO RICO UNDER THE VIOLENCE AGAINST WOMEN ACT, 18 U.S.C. g2265. IF YOU TRAVEL OUTSIDE OF THE STATE AND INTENTIONALLY VIOLATE THIS ORDER, YOU MAY BE SUBJECT TO FEDERAL CRIMINAL PROCEEDINGS UNDER THAT ACT. 18 U.S.C gg2261-2262. IF THE BRADY INDICATOR PARAGRAPH APPEARS IN THE ORDER, YOU MAYBE SUBJECT TO FEDERAL PROSECUTION AND PENALTIES UNDER THE "BRADY" PROVISIONS OF THE GUN CONTROL ACT, 18 D.S.C. g922(G), FOR POSSESSION, TRANSPORT OR RECEIPT OF FIREARMS OR AMMUNITION. ",,>(I _ 1il _~ _ ~!!, , ' ,_ ,,' ~'_,"_ . _'. '._' _',_"_"'_ "'C,',r " _ _ c, ',. " c ~ - 'I'-_k ,'_ ,-~ q',-" . -~ . . ~ --, 1 . ~r' 1JF' NOTICE TO LAW ENFORCEMENT OFFICIALS The police who have jurisdiction over the plaintiff's residence OR any location where a violation of this order occurs OR where the defendant may be located, shall enforce this order. An arrest for violation of Paragraphs 1 through 4 of this order may be without warrant, based soley on probable cause, whether or not the violation is committed in the presence of the police. 23 Pa.C.S. ~6113. Subsequent to arrest, the police officer shall seize all weapons used or threatened to be used during the violation of the protection order or during prior incidents of abuse. The shall maintain possession of the weapons until further order of this Court. When the defendant is placed under arrest for violation of this order, the defendant shall be taken to the appropriate authority or authorities before whom defendant is to be arraigned. A "Complaint for Indirect Criminal Contempt" shall then be completed and signed by the police officer OR the plaintiff. Plaintiff's presence and signature are not required to file the complaint. If sufficient grounds for violation of this order are alleged, the defendant shall be arraigned, bond set and both parties given notice of the date of the hearing. . s Order is entered pursuant to the consent of Plain t Judge J6an Carey, Attorne or Plaintiff MidPenn Legal Services ~ 8 Irvine Row ~ ~ I.;/.I'r.ol Carlisle, P A 17013 j~..o~ ~..~ '. 1.<;. ,,- fs fJ, (!.(I ~ fWPL.5 ;"i!;~"~ 1 T!ilI!'II'I!'/l: ",__;." ,,__ ~_", :_ "_,>,,, -:'/""r.:::,' -" - ;-,- . -~., ~~_bL~C'~-~h-'~~@~~ij,j~J~""',ti,\;~l!'~~ili%'~')i.,_;,,,,,,,;;;k:!"i;';'fi)~;1~~cM~~,:Si;t,",,~;ill~i<lijJ..&!'~ji':"'.i.,~;',;..L"~J;; '", "-i~Il~Jli~itJ( q.,,^,'_"l, ~~", "" .,"'~_, ~.'"~,,'._',,6_'< _~_~ ~ I' , e", ':;"~/'dlY U G~:r:: I 0 i I : ~n i C) "- r~-, I I ~. - , \...'Ui"J:l.- - ,.' ~)I.J:<TY f ;J~,'<,:;'(~l/\, I,{\ "~ OH _ - ~ ~".' ,-" ~~_~,",," _~..h ":'l:{-"JrN:" -k., ,-.- i i~' .~~ _ <_N_~_'-" '"., ,.,. - JOEL NICOLE BRYAN, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYL VANIA vs. : NO. 01- 6923 CIVIL TERM KEITH DAVID JOHNSON, Defendant : PROTECTION FROM ABUSE AND CUSTODY CUSTODY ORDER AND NOW, this Iff?' day of December, 2001, the following Order is entered by consent of the parties with regard to custody of the parties' child, Jarrod Scott Johnson, D.O.B.: 3/21/01. 1. Plaintiff, hereinafter referred to as the mother, and Defendant, hereinafter referred to as the father, shall share legal custody of the child. 2. The mother shall have primary physical custody of the child. 3. The father shall have partial custody of the child on alternating weekends from Friday at 4:00 p.m. until Sunday at 6:00 p.m., two weekday periods (days to be agreed by the parties) from 4:00 p.m. until 7:00 p.m., and on other days and at times mutually agreed by the parties. 4. The parties shall share the Thanksgiving Day holiday with the mother having the child until 3:00 p.m. and the father having the child from 3:00 p.m. until 8:00 p.m. (or through Friday at 6:00 p.m. ifhe does not work the day after Thanksgiving, and through Sunday at 6:00 p.m. if it is his scheduled weekend with the child 5. The father and mother shall alternate the Christmas holiday with one parent having the child on Christmas Eve from noon until Christmas Day at noon, and the other parent having the child from noon on Christmas Day until December 26th at noon. The mother shall commence the schedule having the child on Christmas Eve in 2001, and in odd years thereafter, and the father shall have the children in the even years. 6. The mother shall have the child on Mother's Day from 9:00 a.m. and keep him for the remainder ofthe day, and the father shall have the child on Father's Day from 9:00 a.m. until 6:00 . p.m. -'~'_'"",,-,, >n" -'I-,r ','-- ., -'. ~~ 7. The father shall have the right to partial custody of the child for 1 week of vacation each year. The father shall give the mother two weeks notice as to when his period of custody will take place. The mother shall have the right to have the child on weekends during that time unless the father takes the child on a vacation trip including weekends. The mother also has the right to take the child on a vacation including a maximum of 2 weekends. The vacationing parent shall provide the other parent with a complete address and telephone nurnber where the child will be during the vacation period. 8. The mother and father, by mutual agreement, may vary from this schedule at any time, but this Custody Order extends beyond the expiration of the above-captioned Final Order of Court and remains in effect pending further Order of Court regarding custody. 9. The mother and father agree that each shall notify the other immediately of medical emergency which may arise while the child is in that parent's care. 10. Neither party shall do anything which may estrange the child from the other parent, or injure the opinion of the child as to the other parent or which may hamper the free and natural development of the child's love or respect for the other parent. an Carey, Attorne or Plaintiff MidPennLegalServces ~ ~ j,J.../loO/ 8 Irvine Row Carlisle, PA 17013 b, . (J,n- fj../r-D! ~ ~ '-, j.~ ys P, (I, (J /Ill (JI-':; 1,""--.. ", :~:- " ~, ,', ,- ", '!~ , 'oc,-r--- , '~;'r ~ ;~;~::tlln ~,~i~~M~~!f!;ji~W~\~~jYitJi<.%~i;jjif$-;',if::gt'ei!1ir;"-ifW.>ij;;j~!'J";~I;*,!';',~~~i~i~.-.-/,J.". O::';~-"~~i ,',-<;-, ". ';.': ~,:~~ .:- __~(;ri u,.-" p.':'"__~, "h;;;;';';'~'~'''''~~'-' ,-,"~--' x..; ~c" ft '.. :;:/\Fi/ i.: ..""~ (' ~\ " o .-I;, ii: S J ""j_', "..<'" ';~; Ci -if !,\ITV J-"~'J\::\rL.~\!i \ It-. ,":Vl Vi f ..... ,/ "..)JUI~r-\J\I'/\ 12118/01 TUE 13:54 F~,{ 717 240 6573 I CUMS CO PROTHONOTARY ~001 *************************** *** MULTI TN REPORT *** *************************** Tll/RX NO INCOMPLETE TX/RX TRANSACTION OK 2904 01j9p2490779 03j9p2405331 04]92438026 PSP CP LS ERROR . . ,. OFFICE OF WE PROI'HCHJtARY CUMBERLAND COONTY COUR'mOOSE ONE cnJRTHOOSE OOUARE CARLISLE. PA. 17013-3387 . (717) 240-6195 FAX (717) 240-6573 VIA !ELECOPIER 'l'O: PA STATE POLICE . Ct"t. flltllu.u. , " FAX #: 717-249-0779 RKM: CURTIS R. LONG RE: PYA ORDERS MESSAGE : -..--' ~--... Jfl- 00. OF PAGES (IOCLUDING CCJVER SHEET) '!his Il'\l:r \1' is int:a"drl o1ly fix' tte \.Be of tte irrlivid.Bl ~ Entity In IItdch is is ...lJ. :I. om !ref{ ttrJtain infi:llm3l:itn ttet is p:ivi)f;grl. o:nfidEntial a:rl ~ fron rli....'O"'lre ~ "{PU",*"" larJ. If ttE nEB: c4: this ~ is rot lle inte'lkl m::ipiEnt. }Q.I are ~ rotifiai ltat art dis;anirel:.kn. tti$trib.1tio:l cr ~ d. this OO'I1l\ni.ca".Jm is strictly IWtihited. If}Q.I te\e :rEmiwd ltus ~~" ,H"., in ......-r. clJ1la;Je rotify 1,S ~y b{ ~~re a"d retum tie p:igirel ~ to 1,S ill ">-''''''-'''''''W~ _ """. _ r_~ " ~" ~ ., ,~ , ? ,~ . . ~"..~,...",~~~-",-,..,.-'I""~~"~; RECEIVED AUG 22 2005)1" JOEL NICOLE BRYAN, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA v CIVIL ACTION - LAW KEITH DAVID JOHNSON, Defendant NO. 01-6923 CIVIL TERM IN CUSTODY COURT ORDER AND NOW, this Z'-\. day of August, 2005, upon consideration of the attached Custody Conciliation Report, it is ordered and directed as follows: 1. A hearing is scheduled in Court Room No. 2 of the Cumberland County Courthouse on Thursday, August 25, 2005 at 3:00 p.m. At this hearing, the Father shall be the moving party and shall proceed initially with testimony. In addition to other issues to be addressed at the hearing, the following issues will be addressed: A. Mother's unwillinguess to advise the Father where she resides so Father could pick up the child for exchange of visitation. B. Mother's unwillingness to advise the Father of where the child is attending day care. C. Mother's apparent unwillingness to abide by the existing Order to ensure that Father has his alternating weekend custody times and other times as pursuant to the existing Order. 2. Mother is directed to bring the minor child to the hearing. Furthermore, the parties should be prepared to address at this hearing the potential of the Court transferring cnstody of the minor child to the Father in the event Mother is held in contempt and the Court determines that a change of custody is reqnired. Mother shall bring a third party to the Courthouse to take care of the minor child outside of the Court Room during the proceedings. / BY T~O // /' Cc: LR'uby D. Weeks, Esqnire ....,Jessica Diamondstone, Esquire ~~dgar B ~ ~~~q~ ~:;;;":'J.:j;., ~ -,~- ~"" _",,~,:o: ';'j'}"A_"'"''-'!'''')i;:'"0-;'_:'''-,,r~-~ c>S ,;'; ,-_,,,,;~=;,~_~~~_ "-::'''' p _"_'. ~>', - ';"',. :'~""I, ,,",",:>_J"'"_:-_','\ ' ,'. -," I;~ - ; -~ ,"-~-'"'~- ",--~ -"~-,"~:"'-'''' ,.,":-,'j' -.;,~~~~~(~_~~(.);.tiiKli;~~~~'- , J.' ~"/U~ " , -., i':~-t~'-'-" " ,. ';.-' q " ,0.." . . ,- ~'.'\O- r\\S:Q:YJ00~\Q\fI?~ or "(\-\\;. ?;")'" . p\"\' \\)'. \\2- ,,- 0h ,I 1~~~ ['.Db (.. . ..' C'\l"'.! )lJ1'\ .!.~-\y;~T{ ':.W0__',;'~r, J;,,!~;\~,.':_'-,5\. rj)T,,_~_~,,~_'" . i",".~ "'~""'''~_''~'''''' '~'\'>-__"--~'" .~_" . ~ ~;:'''''-- '. _ '",,"'"'. ,__,'_.r_ ~_ _ .: JOEL NICOLE BRYAN, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA v CIVIL ACTION - LAW KEITH DAVID JOHNSON, Defendant NO. 01-6923 CIVIL TERM IN CUSTODY CONCILIATION CONFERENCE SUMMARY REPORT IN ACCORDANCE WITH THE CUMBERLAND COUNTY CIVllL RULE OF PROCEDURE 1915.3-8(b), the undersigned Custody Conciliator submits the following report: I. The pertinent information pertaining to the child who is the subject of this litigation is as follows: Jarrod Scott Johnson, born March 21, 2001 2. A Conciliation Conference was held on August 18, 2005 with the following individuals in attendance: The Mother, Joel Nicole Bryan, with her counsel, Jessica Diamondstone, Esquire The Father, Keith David Johnson, with his counsel, Ruby D. Weeks, Esquire 3. There is an existing Order of Court from 2001 which was entered! pursuant to a Consent Agreement that provides Mother with primary cnstody llItld Father with times of temporary cnstody to include alternating weekends, a few evenings per week, holidays, etc. Father rded a petition in May of this year seeking to modify the Order and to find the Mother in contempt becanse of the Mother's IilDwillingness or inability to abide by the Order. The parties had an initial Conciliation on May 26, at which time an agreement was reached for the Mother to abide by the Order with provisions that exchange of custody would take place at a WalMart. Since that time, Father has shown up at the scheduled times for exchange of custody and Mother has ' not attended on a number of occasions. Mother has not given Father a phone nnrnber he can reach her. Mother has not provided Father with an address where he can come and pick up the child. Mother asserts some vague allegations of prior misconduct of the Father with respect to a protection from abuse matter as a basis for these concerns. Father indicates that there was never a permanent protection from abuse order entered against him and that the matter was dismissed. He denies any abuse toward the Mother and suggests that there is no reason why exchange of cnstody cannot take place at the Mother's home. 1; ,:f'" J, "-<'" "-'o"/';"""."~;"'cW>",r-_,t"t":"__,,,,,", ";'''''''':~_ ",-'."'tr>_"~-_~;~',c"S'!~-"""" ". ,_1, ,-,eo? ,_"*t')'<;"'~,c,-",.a__,,~,, ","" ""', '_',"_'1' ,=,___",~_~ _ "~," ,"',"" ,__,~ "_~ __. _ '__<~~,'" '," ~ _ ." ,~o,__ '~_o"' __ ~_" __ '___'_0_ . ~, ' _. 0 "__'" , - ",,"": ! , . 4. Despite the Conciliator's suggestion that Father be able to see the child! by picking the child up at the Mother's home (it is also noted that the Mother does not have a car and is unable to provide transportation herself and must rely on family friends), Mother refused at the Conciliation to provide an address for her home in order to facilitate Father seeing the child. Mother also refused to provide the location of the day care center where the child is enrolled in day care. It is noted Father is paying support through the Domestic Relations Office, and it is assnrned that a portion of that support reflects day care expenses. 5. The Court must conduct an immediate hearing to address these issues, and the Court should consider the possibility of transferring custody of the minor child to the Father in light of the Mother's blatant obstructionist behavior and violation of the existing Order. 6. The Conciliator recommends an Order in the form as attached. ~,-{f~OS- DATE ,~, J!li\: _ _,... - '~~--"'.", ._,' ~-\-'?'i_",,_'__:;__"_~_:'C," -. .,-\'" U,,_". ""'; / "'-'-Jc',' -< <,-_7'~_'''_'1~:'. __ < _ -,.' "C:'," !-_~,_o,,_,:, ,;'_'" :,' . .','u__,.,>_'...,'''- ,'>"'N",,'"':"""" I . ~.._=." ~, .' '" 'e .~. ""~~,, "" , ,----~. ,. "~ <~, .' ", ~ -'.--' ',-, -"~'--"'jHltUi'.":~-iFI1fr .. <s- t:r -;"1!m"~q:.~._ 'C. 1 ._,~__ ~"~""_,_,~,~_"~",',';<",,,,,__~ ,.'),.~;J~'Jr"f'-'>~" '0'",,-- 0-,-"" ,~' ' '-IQII!!,'--?-_'~'+ :""'"'-:'> >" !' P"; ,"T,''''"', __~~~~~'w.~~_,,"_,,1,~4;~.,._~,_~,\~~~,~:,::,y,_:-}~"-_ 'c.";v_ _J(iJ : :~ JOEL NICOLE BRYAN, Plaintiff : IN THE COURT OF COMMON PLEAS OF vs. : CUMBERLAND COUNTY, PENNSYLVANIA ; NO. 01- <0923 CIVIL TERM KEITH p,qll',1\JOHNSON, Defendant : PROTECTION FROM ABUSE AND CUSTODY NOTICE OF HEARING AND ORDER YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following papers, you must appear at the hearing scheduled herein. If you fail to do so, the case may pmceed against you and a FINAL Order may be entered against you granting the relief requested in the Petition. In particular, you may be evicted from your residence and lose other important rights. A heariD,g on this matter is scheduled on the /7 r;ta'y of December, 2001, at / ~ 30 ~m., in ~ tb ' Courtroom NO......L.- on the 4 Floor ofthe Cumberland County Courthouse, 1 Courthouse Square, Carlisle, Pennsylvania. You MUST obey the Order that is attached until it is modified or terminated by the court after notice and hearing. If you disobey this Order, the police may arrest you. Violation oftms Order may subject you to a charge of indirect criminal contempt which is punishable by a fine of up to $1,000.00 and/or up to six months in jail under 23 Pa.C.S. g6114. Violation may also subject you to prosecution and criminal penalties trllder the Pennsylvania Crimes Code. Under federal law, 18 U.S.C. g2265, this Order is enforceable anywhere in the United States, tribal lands, U.S. Territories and the Commonwealth of Puerto Rico. If you travel outside of the state and intentionally violate this Order, you may be subject to federal criminal proceedings under the Violence Against Women Act, 18 U.S.C. g 2261-2262. You should take this paper to your lawyer at once. You have the right to have a lawyer represent you at the hearing. The court will not, however, appoint a lawyer for you. 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. If you cannot find a lawyer, you may have to proceed without one. CUMBERLAND COUNTY BAR ASSOCIATION 2 Liberty Avenue, Carlisle, Pennsylvania 17013 Telephone Number: (717)249-3166 AMERICANS WITH DISABILITIES ACT OF 1990 The Court of Common Pleas of Cumberland County is required by law to comply with the Americans with Disabilities Act of 1990. For information about accessible facilities and reasonable accommodations available to disabled individuals having business before the court, please contact our office. All arrangements must be made at least 72 hours prior to any hearing or business before the court. You must attend the scheduled conference or hearing. ~~-~~~ ''''^". ""'~f'"::':,"'_"'~~_ .'.'. ~. _ _ '~,_ ,.-..t ~ --r ---~~-'~'", JOEL NICOLE BRYAN, Plaintiff : In The Court of Common Pleas of : CUMBERLAND County, v. : Pennsylvania : Civil Action - Law KEITH DAVID JOHNSON, Defendant . : No. 01- (.,'1203 : Protection From Abuse and : Custody TEMPORARY PROTECTION FROM ABUSE ORDER Defendant's Name is: KEITH DAVID JOHNSON Defendant's Date of Birth is: August 9,1966 Name(s) of All protected persons, including Plaintiff and minor children: 1. JOEL NICOLE BRYAN AND NOW, on 7th Day of December, 2001 upon consideration of the attached Petition for Protection from Abuse, the court hereby enters the following Temporary Order: Plaintiffs request for a temporary protection order is granted. 1. Defendant shall not abuse, harass, stalk or threaten any of the above persons in any place where they might be found. ""~'~~,:',-- ,.". ",.';"'':L-;:yo ':;'~'''''''''___ --'V'~-,y" ,'., ,'-' '" '-"'~:'-'.r ". ,,". .".0. 7'" " ,~~.,.-,.,...~ ~r 2. Except for such contact with the minor childlren as may be permitted under paragraph 4 of this Order, Defendant is prohibited from having ANY CONTACT with Plaintiff, or any other person protected under this Order, at any location, including but not limited to any contact at Plaintiff's school, business, or place of employment. Defendant is specifically ordered to stay away from the following locations for the duration of this order. Plaintiff's current residence or any other residence she may establish during the term of this Order: 68 East Main Street Newville, PA Defendant's contact with Plaintiff of a non-harassing nature by telephone and/or in person during transfer of custody of the parties' minor child at Plaintiff's residence or any other location, shall not be deemed a violation of the above CONTACT provision and the provisions in paragraph 30fthis Order. Defendant's communication with Plaintiff shall be limited to information regarding the parties' minor child. 3. Except for such contact with the minor childlren as may be permitted under paragraph 4 of this Order, Defendant shall not contact Plaintiff, or any other person protected under this Order, by telephone or by any other means, including through third persons. 4. Pending the outcome of the final hearing in this matter, Plaintiff is awarded temporary custody of the following minor child1ren: 1. JARROD SCOTT JOHNSON Until the final hearing, all contact between Defendant and the childlren shall be limited to the following: Pending the hearing scheduled in this matter, Defendant shall have periods of partial custody with the parties' minor child, JARROD SCOTT JOHNSON, on dates and at times mutually agreed by the parties. Defendant's contact with Plaintiff of a non-harassing nature by telephone and/or in person during transfer of custody of the parties' minor child at Plaintiff's residence or any other location, shall not be deemed a violation of the contact provisions (paragraphs 2 and 3) ofthis Order. Defendant's communication with Plaintiff shall be limited to information regarllling the parties' minor child. The 10callaw enforcement agency in the jurisdiction where the child1ren are located shall ensure that the childlren are placed in the care and control ofthe ,~,~,t" ,~ _ "':r'~ ~<""..'\:<\"';~':"'" "'. _ ,.,r-.' "::' ',. 'r'-!" _.,_0,,"_". n ~-,~ ,.ill Plaintiff in accordance with the terms of this Order. 5. The following additional relief is granted: Defendant is prohibited from having any contact with Plaintiffs relatives, except as the court may find necessary with respect to partial custody with the minor child. Defendant is ordered to refrain from harassing Plaintiffs relatives. Defendant is enjoined from damaging or destroying any property owned solely by Plaintiff. 6. A certified copy ofthis Order shall be provided to the police department where Plaintiff resides and any other agency specified hereafter: NEWVILLE POLICE DEPARTMENT 7. The sheriff, police or other law enforcement agencies are directed to serve the Defendant with a copy of the Petition, any Order issued, and the Order for Hearing without prepayment of costs. The Petitioner will inform the designated authority of any addresses, other than the Defendant's residence, where Defendant can be served. The Prothonotary is directed to file this Petition and Order without prepayment of costs. 8. THIS ORDER APPLIES IMMEDIATELY TO DEFENDANT AND SHALL REMAIN IN EFFECT UNTIL JUNE 7, 2003 OR UNTIL OTHERWISE MODIFIED OR TERMINATED BY THIS COURT AFTER NOTICE AND HEARING. NOTICE TO THE DEFENDANT Defendant is hereby notified that violation of this Order may result in arrest for indirect criminal contempt, which is punishable by a fine of up to $1,000.00 and/or up to six months in jail. 23 Pa.C.S. g6114. Consent of the Plaintiff to Defendant's return to the residence shall not invalidate this Order, which can only be changed or modified through the filing of appropriate court papers for that purpose. 23 Pa.C.S. g6113. Defendant is further notified that violation of this Order may subject him/her to state charges and penalties under the Pennsylvania Crimes Code and to federal charges and penalties under the Violence Against Women Act, 18 U.S.c. gg2261- 2262. NOTICE TO LAW ENFORCEMENT OFFICIALS ",j"'jf,l~~r.," ,-", ,--- '::> +,.-~ -" -- '-" ,- <-- r--,'-'- .." .,."" This Order shall be enforced by the police who have jurisdiction over the plaintiff's residence OR any location where a violation of this order occurs OR where the defendant may be located. If defendant violates Paragraphs 1 through 4 of this Order, defendant shall be arrested on the charge ofIndirect Criminal Contempt. An arrest for violation of this Order may be made without warrant, based solely on probable cause, whether or not the violation is committed in the presence oflaw enforcement. Subsequent to an arrest, the law enforcement officer shall seize all weapons used or threatened to be used during the violation of this Order OR during prior incidents of abuse. Weapons must forthwith be delivered to the Sheriff's office of the county which issued this Order, which office shall maintain possession ofthe weapons until further Order of this court, unless the weapon/s are evidence of a crime, in which case, they shall remain with the law enforcement agency whose officer made the arrest. Judge Jhbv Distribution to: Joan Carey, Attorney for Plainyff 1;)-7-6 ( J MidPennLegalServices - cci,es ~C5oNall" G\lV/2.N ie ~ @ ,Mi:JI-< 8 Irvine Row, Carlisle, PA 17013' \ . 1 '.J ,:..uj; lrd.. (717) 243-9400 or 1-800-822-5288 VI\+' CA)()./':, fJO+- P reseP.\- FAXed & mailed to PSP ~ '3;;',11 t=C\l(trl k, tp ~ )IWlS ~6; I { '''~'?~,,4 B , \~"7::;-~,Yv''', . . "'_n_ ',- ~I,:,'F_ ~,,, ,- ,,1' .'-,--,c,,"'- ".. .'---' .-~'- " ,,"' "c""',,,,,,,,,"" """""co"',q,, .~r_iI~~i1fiflf~_ " .-', " 0"'. '".<'~ ~_"~~ -'. ~..-~ () c.:: ':?: -ol.;:.1 ~;0 -'---' r::::c, ~- ~~.c; L-_r", >~; ::::~ -< '%~ ,~ ~~ ,~~') I '" ",,~"y"O-"~'~ rnn-->'-'ff;~~'%-~t ;<""i3if''t'( C>,:; ,'- -' -' ~';:1 --,-' -'" r:;~ J) ~~ J, ."""'(~<f.<-1':,;;_"i1"yt:. '~'Y_~t,~~~~.w\<!~~-~~'!"0f~~4t~-~7!~~WM)r,;rf"~Wi-'~~~~L._I_l___:~~:~~;,~'}' PF AD Number: V A1383446M JOEL NICOLE BRYAN, Plaintiff : In The Court of CommQn Pleas of : CUMBERLAND Countly, v. : Pennsylvania : Civil Action - Law KEITH DAVID JOHNSON, Defendant : No. 01- . : Protection From Abuse and : Custody PETITION FOR PROTECTION FROM ABUSE 1. Plaintiff's name is: JOEL NICOLE BRYAN 2. I, (the Plaintiff), am filing this Petition on behalf of: - myself 3. Name(s) of ALL person(s), including minor children, who seek protection from abuse. a. JOEL NICOLE BRYAN 4. Plaintiff's Address is : c/o Sharon Bryan, 68 East Main Street, Newville, P A 17241 5. Defendant's Name is: KEITH DAVID JOHNSON j",Ji<:~IiS)'W,WJ'!!, ~ ~ ~,:-:'f-"' -,', -- ~." ,"- ,.., >'" . -~ . 'I'~ "'" ''C'''' ~ " ,,,,...,.""" l" h~'~,~.\{,~ 6. Defendant is believed to live at the following address: 4 Fairfield Street, Apt. 1 , Newville, PA 17241 7. Defendant's Date of Birth is: August 9, 1966 8. Defendant's Place of employment is: Allen Distribution, 600 Allen Road, Bldg. #5, Carlisle, P A. Telephone: (717) 258- 3040. Shift: 5:00 a.m.-3:30 p.m. 9. Defendant is an adult. 10. The relationship between the Plaintiff and the Defendant is: Parents ofthe same children Current or former sexual/intimate partner 11. The Plaintiff and the Defendant been involved in the following court actions: a. Custody 12. Other details of the court action are: JOHNSON v. BRYAN, Cumberland County, Pennsylvania, No. 01-5378, Civil, Custody. No custody order was entered. The parties reconciled prior to the custody conciliation conference scheduled for October 29, 2001, with Conciliator Melissa Greevy, Esq. The conference was cancelled at the request of Matthew J. Eshelman, Attorney for Plaintiff, and on October 25, 2001, Ms. Greevy relinqnisll.ed jurisdiction of the case. 13. The defendant has been involved in a criminal court action. 14. Plaintiff and Defendant are the parents of the following minor child/ren: a. JARROD SCOTT JOHNSON Age: 8 months. Child's address is: c/o Sharon Bryan, 68 East Main Street, Newville, P A 17241 ,- 'Ct', . - ,~,,~",' "",'--".'-;-, """'1' ,:c~",- '-:~-' ," ~ ",~,.- -,> " , ~h -; -'~-"'""'" " ,-' o _ fer 15. Plaintiff is seeking an Order of child custody as part of this petition. The following is a list of the children and where they have live for the past 5 years: a. JARROD SCOTT JOHNSON For the past 5 years, this child has lived with: Plaintiff, and her step-mother, Sharon Bryan, at 68 East Main Street, Newville, P A, from December 5, 2001, to the present. Defendant, at 4 Fairfield Street, Apt. 1, Newville, P A, from December 3, 2001, to December 5, 2001. Plaintiff and Defendant, at 4 Fairfield Street, Apt. 1, Newville, P A, from early November 2001, to December 3, 2001. Plaintiff, her .cousin, Heather Reagan, her husband, Bill Reagan, and their children Harley Reagan and Juel Reagan, at 224 B Street, Carlisle, P A, from October 2, 2001, to early November 2001. Defendant, at 4 Fairfield Street, Apt. 1, Newville, PA, from September 2, 2001, to October 2, 2001. Plaintiff and the Reagan Family, at 224 B Street, Carlisle, P A, from the child's date of birth on March 21, 2001, to September 2, 2001. 16. The facts of the most recent incident of abuse are as follows: On about Monday, December 03, 2001 location: 4 Fairfield Street, Apt. 1, Newville, PA. Defendant argued with Plaintiff when she tried to leave with the parties' 8-month-old baby, grabbed her wrist and restrained her, grabbed the baby out of her arms, and flung the child into the crib. Defendant shoved Plaintiff down onto the couch, grabbed her by the neck with both his hands, pushed her down to tb.e floor, choked her, and threatened that he would kill her with his bare hands if he had to. Plaintiff got away from Defendant and left the residence to avoid further abuse. Plaintiff reported the incident to the Newville Police, who issued a citation to Defendant for harassment. Plaintiff sustained scratches on her neck and arm, and bruising and soreness about her arm as a result of this incident. 17. The police department( s) or law enforcement agencies that should be provided with a copy of the protection order are: NEWVILLE POLICE DEPARTMENT 18. There is an immediate and present danger of further abuse from the Defendant. 19. The Defendant owes a duty of support to Plaintiff and/or minor child/ren. -'-~""i~"!I'~'_'('_'''__~_ '_'_'__',<,_'_ , ~--, -.---,'-f,d"C-.- "" . '"_~__ .of _p", . . ;Blli ;,'ioi:,~ry:'B:lWl'!, 20. FOR THE REASONS SET FORTH ABOVE, I REQUEST THAT THE COURT ENTER A TEMPORARY ORDER, and AFTER HEARING, A FINAL ORDER THAT WOULD DO THE FOLLOWING: a. Restrain Defendant from abusing, threatening, harassing, or stalking Plaintiff and/or minor child/ren in any place where Plaintiff may be found. b. Award Plaintifftemporary custody of the minor child/ren and place the following restrictions on contact between Defendant and child/ren: Pending the hearing scheduled in this matter, Defendant shall have periods of partial custody with the parties' minor child, JARROD SCOTT JOHNSON, on dates and at times mutually agreed by the parties. Defendant's contact with Plaintiff of a non-harassing nature by telephone and/or in person during transfer of custody of the parties' minor child at Plaintiff's residence or any other location, shall not be deemed a violation of the CONTACT provisions in paragraphs 2 and 3 of the attached Temporary Protection From Abuse Order. Defendant's communication with Plaintiff shall be limited to information regarding the parties' minor child. c. Prohibit Defendant from having any contact with Plaintiff and/or minor child/ren, either in person, by telephone, or in writing, personally or through third persons, including but not limited to any contact at Plaintiff's school, business, or place of employment, except as the court may find necessary with respect to partial custody and/or visitation with the minor child/ren. d. Prohibit Defendant from having any contact with Plaintiff's relatives and Plaintiff's children listed in this petition, except as the court may find necessary with respect to partial custody and/or visitation with the minor child/ren. e. Order Defendant to pay temporary support to Plaintiff and/or the minor child/ren, including medical support . f. Order Defendant to pay the costs ofthis action, including filing and service fees. g. Order the following additional relief, not listed above: Order Defendant to refrain from harassing Plaintiff's relatives. Enjoin Defendant from damaging or destroying any property owned solely by Plaintiff. h. Grant such other relief as the court deems appropriate. , \ ',".,-'- " ;"'_'r"' '1'-0: "';-'''''',l~','-~ ,^ ~, ", ~-- . . "-- -f' --~,- r . ~ " ~~- ,"~~'i'l";'~ .. 1. Order the police or other law enforcement agency to serve the Defendant with a copy of this Petition, any Order issued, and the Order for Hearing. The petitioner will inform the designated authority of any addresses, other than the Defendant's residence, where Defendant can be served. Respectfully Submitted by: /l,--< _, (22 " - / ~,A~ Agency: MidPenn Legal Services 8 Irvine Row Carlisle, P A 17013 (717) 243-9400 or 1-800-822-5288 .-"'.""""Ie ._ .),'.':' ~;"," .,.0,'". "'.': ., -","'1,.-.0' 1'.'.-.-:- - ,- -~ ", ~- ", , .,.t"-i-'~- ~. " VERIFICA nON I verify that I am the Petitioner as designated in the present action and that the facts and statements contained in the above Petition are true and correct to the best of my knowledge. I understand that any false statements are made subject to the penalties ofl8 Pa.C.S.~4904, relating to unsworn falsification to authorities. Dated: I? / DS.j 01 I i>!~".]_iIl!l JI'_':_~'''T ';'_,' .J"" .',?,.,.___<. , " ~I___ .",;;,_c .- ~'^ ^ '^_ ~ ~M "~, <~< ~ < <<'r" <--< I1nCTf'" \' 0 c.:, (-~I C .. ~.;.~ C:"J V t'~~ '" t;.1 [ c') ~ 2: \:. (j) ...J -~ --- r: --r:' C; ...,;::: ~ ~,...' c -- ;-:~; n '" )..'" '-' , ...... \A. (-~-~ ~~ 't ~- :.n :XJ ~-j -< 1-- -< ;- 'C'-c ._,,~, . '.~_ " ",,",;/. p _ '. ~ ,T",,- ,~~L-, ", - 1., _,._ _,,,",,J) .~~~u;~-:'o;~_'~, ,_~ );tn~~r1}.-C,"!c{"" _~, _~J.J~tm~~il\"ffl~"i"'~IF.JN!jN\~f~1'1:J';~'fj!~~~~~;,.(1I~,__~~_1'< ,,-;,,-, ,_,~:,,:j~~i 12/07/01 FRI 15:11 FAX 717 240 6573 CliMB CO PROTHONOTARY 141001 *************************** *n MULTI TN. REPO~ *** *************************** . TX/RX NO INCOMPLETE TX/RX TRANSACTION OK 2893 . . . . - 0119p2490779 0319p2405331 04]92438026 PSP CP LS ERROR . . . OFFICE OF 'IHS PROIllCNOTARY CUMBERJ:J\ND a::.uNTY COURTHClJSE . ONE c::cmm-fOOS E SQUARE: CARLISLE. PA. 17013-3387 .. (717) 240-6195 FAX (717) 240-6573 VIA TELECOPIER 'TO; Pl< STATE POLICE - Cellf. f'dfJc.t.S~.. ,.." (J. t...S. ; ") . FAX g; 717-249-0779 ~: CURTIS R. LONG RE: PFA ORDERS MESSAGE : -9~ N:>. OF PAGES (INCLUDING COVER SHEET) This n -:J:' is itltel.W ally fir lte \&!) of lte irdi.v:iO..el cr: 6'lti.1:1/ to Irkrldl is is <111. I, <nl mJf a;]'Itain :irifi::mBtim \tat is p:iYilegrl. anfi&ntial an ecsrpl; fmn rji'7'l.......o:e I.1'IEr WI ;""'1<> la;t. If tte n:eier' of this ~ is rot 1:I-e inlBlirl recipiart:. ~ are ~ rotif.i6:11ltet <'fl/ d.is;Emir'atial, d.i.striI:lItir cr: a:p;ifg of. this arnn.nicatim ll; strict:l,y~. If 1rW 11M': remiw1 ltilS Cl:JlJI\.I1.i(,~ticn in =. pl.e:ee rot:ifY l.B .imra:liatel.y ~ telepwe a:d mI1D:n tle .jdgiral ,,: W 1:0 LB at '''"q~,-~ ~,- "~ ." OJ" _ ,"'!f,,-i"' _, - -~ -". ~ , ~ ,..".,~-.".~~ '-',,~ -~., '"" "'.".- , JOEL NICOLE BRYAN PLAINTIFF IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA V. 01-6923 CIVIL ACTION LAW KJoITH DAVID JOHNSON DEFENDANT IN CUSTODY ORDER OF COURT AND NOW, Wednesday, May 11, 2005 ,upon consideration of the attached Complaint, it is hereby directed that parties and their respective counsel appear before Hnbert X. Gilroy, E.q. , the conciliator, at 4th Floor, Cnmberland Connty Conrthonse, Carlisle on Thnrsday, May 26, 2005 at 9:30 AM for a Pre-Hearing Custody Conference. At such conference, an effort will be made to resolve the issues in dispute; or if this cannot be accomplished, to define and narrow the issues to be heard by the court, and to enter into a temporary order. All children age five or older mav also be present at the conference. Failure to appear at the conference may provide grounds for entry of a temporary or permanent order. The court hereby directs the parties to furnish any and alI existing Protection from Abnse orders, Speci311 Relief orders. and Custody orders to the conciliator 48 bours prior to schednled hearing. FOR THE COURT. By: /s/ Hubert X Gilrov, Esq. Custody Conciliator y The Court of Common Pleas of Cumberland County is required by law to comply with the Americans with Disabilites Act of 1990. For information about accessible facilities and reasonable accommodations available to disabled individuals having business before the court, please contact our office. AlI arrangements must be made at least 72 hours prior to any hearing or business before the court. You must attend the scheduled conference or hearing. YOU SHOULD TAKE THIS PAPER TO YOUR ATTORNEY AT ONCE. IFYOUDONOT HAVE AN ATTORNEY 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 32 South Bedford Street Carlisle, Pennsylvania 17013 Telephone (717) 249-3166 '-1i!it.'mi!f","",., , ,~, - ,~ rr ,I . - ~~'~., ~'alM .~i1Mflf,i;ili!l'.r"'~.\!;;!ll&;~H':':;"'i-'_ L;c lh " ~"R',"r'~,-""_,,, ~,,'..'~ ,-""<,;~~,,.< ,-,,,<:,_~"$Q.Y"'~I"L'-,/:c:80::,,,\,!~,_,'-,:,,i:,cG,'''''']'~"-,-,i.,,~_;"-';:",,;jgH!~~~~~~i~;"ili[!1l:;i#'i''o@'~':'MH<i~~- '-~ '" '" ""~ ~ "';";~"';~~ii~!!l:I'''-' n RlED~()Ft\CE. ,_ 0- TIT ()"crYi"I"ln1\\(,ll/,HY r \ Ii: l' i'v'v'" 'lOOH\I\'I \ 3 PI'i 2: G2 ",.., t~ rr\/ ~ll' ,r-, "\ "'i'" \ G )i\,i:'~>,,-, ,:__~'~'V ~ Pt\,,!\,,,\S'y'l:J i\\\ I,A. ~-/ 3 -[6 .5',/,] .05' .5 /3 -t;!) M.~~-a4uk4J n~ ~ ~ /ft- 0t,~~#-~~- .~_n ___,_ ' -, ~" - :;':""'''^' .- .. ~ECEIVED MAY 06 2005rJ D JOEL NICOLE BRYAN, Plaintiff : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY : PENNSYLVANIA CIVIL ACTION - CUSTODY vs. KEITH DAVID JOHNSON, Defendant : NO. 01-6923 CIVIL ORDER OF COURT AND NOW, this day of ,2005, in consideration of the within Petition, a Rule is issued upon Joel Nicole Bryan, to show cause, if any she has, why she should not be adjudged in contempt ofthe Order of December 18, 2001, and primary physical custody of the child placed with Keith David Johnson. Said Rule is returnable and to be heard in Court Room No. , 4th Floor, Cumberland County Court House on , the day of 2005, at o'clock, .M. If you fail to appear as provided by this Order or to bring the child, an Order for custody, partial custody or visitation may be entered against you or the Court may issue a warrant for your arrest. Service to be made by certified mail upon Respondent. BY THE COURT, J. CC Ruby D. Weeks, Esquire for Defendant-Petitioner Joel Nicole Bryan, Plaintiff-Respondent ~!l!"", ", "'>.,'-:--, -: .!,-"':,,\,'(.:.-:r:':",'''''?f~_:'':.:',,'':'''--- '", ,', -.' --, ''''' <' ">;:,.,_,<":"~1::1^:;""_ . _ ,-."""<,, ,'.. "," " . "-,,' " "" - ---"~'~ ,,-"~, -'~..- -- , ~ ,- ." "" $)r~ JOEL NICOLE BRYAN, Plaintiff : IN THE COURT OF COMMON : PLEAS OF CUMBERLAND :COUNTY, PENNSYLVANIA vs. CIVIL ACTION - CUSTODY KEITH DAVID JOHNSON, Defendant : NO. 01-6923 CIVIL PETITION TO MODIFY CUSTODY AND FOR A FINDING OF CONTEMPT AGAINST PLAINTIFF AND NOW comes Keith David Johnson, by his attorney, Ruby D. Weeks, Esquire, and petitions the Court as follows: 1. Petitioner is Keith David Johnson, the father, who resides at 4 Fairfield Street, #1, Newville, Pa. 2. Respondent is Joel Nicole Bryan, the mother, who resides at Apartment 6, Building 3526, September Drive, Camp Hill, Pa. 3. The parties, who were never married, are the natural parents of Jarrod Scott Johnson, born March 21,2001, the subject of this Petition. 4. The parties were before this Court on December 18, 2001, at which time the mother was granted primary physical custody and the father periods of partial custody, with shared legal custody. 5. Following entry of the December 18,2001, order, the mother and the child lived with the father for three years; two days after Christmas 2004, the mother left, taking the child. 1f~,,~__" , .~ ''''. "'"',~o,'".-":-,'''',;J'' _";_-::::,_~"',,' "M, -,-,~".,-,.^ ';-":':'-,-'-'~'<fZI- "--,~,~-~ .," --~ _"~~<,.-~,u':'F_,'_'_'" ,,-,-, - C? ,_c_; "~''''-(-___''''_'__''__ ,_" - ,. . -, ;<r"" 6. Since Easter weekend 2005, the mother has refused to abide by the Court Order and has refused contact with the father or to allow him his periods of partial custody with the child. 7. The mother resides with her step-mother, Sharon Bryan and her adult daughter, in a two bedroom apartment, and the father believes that the step-mother is also responsible for his inability to see or have his child. 8. Additionally, the father does not know whether or not the mother is currently employed, or whether or not she is receiving the mental health treatment and medication. WHEREFORE, Petitioner respectfully requests your Honorable Court to issue a Rule upon Joel Nicole Bryan to show cause, if any she has, why she should not be adjudged in Contempt of the prior Order and further prays the Court to transfer primary physical custody to Petitioner, with the same periods of partial custody to be with Respondent. Respectfully submitted, ~~. Date: May 5, 2005 Ruby D. Weeks, Esquire Attorney for Petitioner-Father cc Keith David Johnson, Petitioner-Father Joel Nicole Bryan, Respondent-Mother ;~.'11~_l~ _, , "---:%".;,.-. ~_''''.-'_>" "'~""_ ",..,~_" - ,,:.<C,' .-_ ~_~>, -.- ~, ~'f,t~..,.." - , - ,",-' - ._N,;" .- , ';i:',,",,~.,_. , , COMMONWEALTH OF PENNSYLVANIA : ss COUNTY OF CUMBERLAND Personally appeared before me, a Notary Public in and for the Commonwealth and County aforesaid, the under-signed, being duly sworn according to law, deposes and says that the facts set forth in the foregoing Petition are true and correct. Sworn to and subscribed to before me this ~d day of cmay ,2005. Common of Pen nla NOTARIAL SEAL SIIlIlI.EY p, C\.E\IENGER. NolaIy Public C8dIsIe Boro. CUmbe/l8I1d CourtlY o..oi$8IOII EIpiIII '14, 2IIIB '';>t.\~ - "~"-..""'7".,.:.,!.,~n", "_'>:'~_'-'."" .,~;.'V--. !,,:,,>. ',. k '. -, - .,. ,c" ~., c"F",c,- :.-,,:,. - ~.-- ---, - "..>-, .'. ,.~",,, -,-,-~.,., ,",. I '. '\ .'~ Plaintiff : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYL VANIA JOEL NICOLE BRYAN, vs. : NO. 01- 6923 CIVIL TERM KEITH DAVID JOHNSON, Defendant : PROTECTION FROM ABUSE AND CUSTODY CUSTODY ORDER . AND NOW, thisi3' ffy day of December, 2001, the following Order is entered by consent of the parties with regard to custody of the parties'child, Jarrod Scott Johnson, D.O.B.: 3/21/01. 1. Plaintiff, hereinafterreferred to as the mother, and Defendant, hereinafter referred to as the father, shall share legal custodyof the child. 2. The mother shall have primary physical custody of the child. 3. The father shall have partial custody of the child on alternating weekends from Friday at 4:00 p.in. until Sundafat' 6:00 p.m.,two weekday perioas (days to be agreed by the parties) from 4:00 p.m. until 7:00 p.m., and on other days and at times mutually agreed by the parties. 4. The parties shall share the Thanksgiving Day holiday with the rnother having the child until 3:00 p.m. and the father having the child from 3:00 p.m. until 8:00 p.m. (or through Friday at 6:00 p.m. ifhe does not work the day after Thanksgiving, and through Sunday at 6:00 p.m. if it is his scheduled weekend with the child 5. The father and mother shall alternate the Christmas holiday with one parent having the child on Christmas Eve from noon until Christmas Day at noon, and the othe:r parent having the child from noon on Christmas Day until December 26th at noon. The mother shall commence the schedule having the child on Christmas Eve in 200 1, and in odd years thereafter, and the father shall have the children in the even years. 6. The mother shall have the child on Mother's Day from 9:00 a.m. and keep him for the remainder of the day, and the father shall have the child on Father's Day from 9:00 a.m. until 6:00 p.m. :1}tlJ~". ~ -".':W--j, ,_~~-:1"_"'Yf~'_~~"-"""' __"'_'__~ i-"",,_ ',""';' '"~"_\'-'*-'''''~''--~'\~'~?'>.h' ,,'0",=..' '0 c ',," '_"__0""-"',__' _ _ '.', ""'- ,+_?,,". ,.~"^",.,, ,~,_. ',_" - -~"~ '. " .-. 7. The father shall have the right to partial custody of the child for 1 week of vacation each year, The father shall give the mother two weeks notice as to when his period of custody will take place. The mother shall have the right to have the child on weekends during that time unless the father takes the child on a vacation trip including weekends. The mother also has the right to take the child on a vacationjncluding a maximum of 2 weekends. The vacationing parent shall provide the other parent with a complete address and telephone number where ,the child will be during the vacation period. 8. The mother and father, by rnutual agreement, may vary from this schedule at any time, but this Custody Order extends beyond the expiration of the above-captioned Final Order of Court and remains in effect pending further Order of Court regarding custody. . 9. The mother and father agree that each shall notify the other inunediately of medical emergency which may arise while the child is in that parent's care. 10. Neither party shall do anything which may estrange the child from 1ne other parent, or injure the opinion of the child as to the other parent or which may hamper the free and natural ~ ,"!,~ ",'" development of the child's love or respect for the other parent. By the Court, JQ.an Carey, Attorne or Plaintiff MidPenn Legal Scrv ces 8 Irvine Row Carlisle, P A 17013 'rp~ 1~ r"~/'1O"J r:;nr.\$..~ r.~~~~oqr' t f!""l"_ v......~{ '! t ~~;;.d.;,...~ ~ ."li."...V :::.ok! In Te~~t~rnony ~~V~~$;~'i;ft j h-2rs ~:'0tc! S$t fny hand a;lC 1~j{; s.~':aj 0; cz.~d Gr;u{{ ~>t t2:ri~S~'el Fa. This /8' ~ day /if) ~: .;loaf ( -'In- (). -- -~ , Protnonttari ~;J~jl~"e,J.,~}_;, ,.-, ::-~~ ""_~,..,^~,..,,,7"'.=~,,".."__"_'" ,.,",-', -'F~ _'d,,_, :",_,__~,-~_,:.':'N;" ,:J "_"._",,_,i.tC-,'.,.""_ ,<'" -,,'1",Y'_ ",' ,~., ','H" ,Y'_,: _ ","r__, ,.. 0.;,,'-.' ,.x-,. ,- ,- ',"-~-" , ,-F.,,' ~~ "',, '. H~".~"..~,,, "~5,'"' .,._ , ;~,,"-X/C"'i! ~,,,;-,,,'. ,. ,0'-'C~,~ 0" -"" "'.' .~ u_ _ __~__~ Co_' ,. ." , ..--.... () ,.., ~ <= ~:;~ = "" ~ 0, ~ ::;:: .-\ , :t:-n i'. );;.... f"nF 'l ~ -< '. -om c" 0 coy t.n r-j ~ r~;t:.; :c.,Q R ',. -Y', ~ 2;c~; -0 ("'):8 --- ::u: --rO t; ,"- (-, Om v $oe N (5 .-~ \' .V ~ ;:0 f-- _J '< ~ ~f: -J- " r _.)1 _~, -?-'i"""~I<', _; . , _ ,_ ,~~, ,-~-'1";'-_\-~--'-"c-" ," <,~~''''''"'~--~, ""_'<t~_c ''''~! --~~~"~-'~-'~_'''1PS,. ,-v .,",~;'e;;$~; SHERIFF'S RETURN - REGULAR CASE NO: 2001-06923 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND BRYAN JOEL NICOLE VS JOHNSON KEITH DAVID RICHARD SMITH , Sheriff Dr Deputy Sheriff of Cumberland County, Pennsylvania, who being duly sworn according to law, says, the within PROTECTION FROM ABUSE was served upon JOHNSON KEITH DAVID the DEFENDANT , at 0820:00 HOURS, on the 11th day of December, 2001 at ALLEN DISTRIBUTION #5 600 ALLEN ROAD CARLISLE, PA 17013 by handing to KEITH D. JOHNSON a true and attested copy of PROTECTION FROM ABUSE t0gether with and at the same time directing His attention to the contents thereof. Sheriff's Costs: Docketing Service Affidavit Surcharge So Answers: 18.00 3.25 .00 10.00 .00 31. 25 r~~~~.e R. Thomas Kline 12/12/2001 LEGAL SERVICES Sworn and Subscribed to before By: -" me this l<- f3 day of Sheriff .~ 02"", A.D. ~ (2 JnjO, . ~O~~ Prothonotary , u ";:'~<:,""!-5'"'''''T_~~'''~~___,~_ I!\Il . - ." -_.~~ ~- ~~-"'''''''tT''"~ 'f~""~,,, I" r"" ,~U,., ,,''''''"J'" ",--, " ,_.,,-. "~-, 'd '". , "~-,, -,,;'-'-' ,,, ,~- _-h-.' -~~-" -~-~"_~'m'" "'"-""';;;<j":Ml"t'l.'~';~~"f!i ~ _~ < _ jij~",-f', < ",,~I~Jn~. j!J~~~~'~'~~~_~i'l.H~i',,,,'*!i'T.o$"""i'JV'-";'Ht->-<f~f,~!t"!"'71''""'"*:w~~~~Ji!W!r~i.l!t\i;'lfifl!'r.~~IJ,,H l~~r~J~'!~I~~'- -r ,-' ,. ,~- '~n EXH!B!T Fe" '..f'::: ) i '6 -~s. -,> :;'-' .......-- 220 Wilson Street,: SUiIe 213 CmbIe. PA 17Ot3 2G-754O -Far; 1 243-995B MEDICAL ARTS ALLERGY, PC "'.... '__CenIOr 2lI25T___.Su!e310 _PA17D5Q 1 .791--2640 FalC: 1 791-Z646 4310 I --au""", Road, Suite 109 PA 17109 Fax:: 92t)...G41 ,... PATIENT: >6I rod ~. :t,!.. '^ ~nn- .. - DATEOF-BI~T~:i :J../r,/ /0/ .. ." ~ p.R/C~ I PUNCTURE , ' D 'NiRADERMAL : TESTING 'OA.TE: i"~' . . DATE: i . . P<irlOnilei:I ,," :ara_P8cll!vice ' . P",r...".dby'injec6onafO.02a:ofextnld - 'h'-" .. ~ . 11iEEs(1:2D wIv) . .' -- ., .......~ 10 .... ENVIR' '. .' Punct1Jre ID A 1. ASH, WHITE . .- - Cl'-" I . A 34. DUST MITE - D.f. (3O,IooBAU/mI) . :J15.Jt' . A 2. BEECH, AMERICAN .' J A 35. DUST MITE - D.p. (3D ClOO BAUIml) ?-/5 '1" A 3. BIRCH, MIX I A36. CAT paT -AP (10,0( BAUlmI) &4 ...; 15;..r' A4. BOXElDER I MAPLE . J 11.37. DOGDANDER(1:10~ v) a//l -r A 5. ELM, AMERICAN I . A 38. COCKROACH MIX (1~. Ow/v) . CJ~..... A.6. HACKBERRY IDlio I - CONTROLS I "- P,7. HICKORY '\ 6Z I A 39. DILUENT (~con! 01) A 0,1;, I J A 8. MUlBERRY TREE A4(l. HISTAMINE(1mqmtI- . , '/,/'JJ.C: r / I . I .<-:" conI1D1) \. ' A9. OAK. MIX . . . J I ONALAERO" ._~ ~ENS (1:211 ""~, A 10. POPULAR I COTTONWOOD I OA41. TREE MIX #11 I A 11. SYCAMORE I o A 42. CEDAR. RED ,\ o' I o A 43. PINE . I A 12. WAlNUT TREE , . . t13.W1LLOw,BLACK '.' . . . -,- I O.A44. SWEETGUMTREIE I GRASSES (100,000 BAU/mt) \ o A45. RED TOP GRASS (100,000 BAU) , I A 14. GRASSMlX#7 (Nodhem p/ains grass) l( I/) ! D A46. ,RYE GRASS (100, boo BAlJ') I. ! ~"~(,.,.. . I o A47. WEED MIX#2630 , A 16. TIMOTHY r [] M8. MARSHElDER I P )veRTY MIX . I . ' .. WEEDS (1:2I1w1v) '.. . . o A 49. MOLDMIX#11 I A 17. COCKLEBUR, COMMON 10.. ~ I D ASO. FEATHER MIX ' I A'18; DOCK I SORREL MIX I o A51.GUINEAPIG ; I . . A '19. LAMBS QUARTER I D As2. HAMSTER HAIR I A 20. MUGWORT I OA 53.. HORSE HAIR ~ I A 21~ PIGWEED. R,ED ROOT . I DAM. PARAKEET I A.t2. PLANTAIN, ENGUSH I o A 55. RABBIT . , .A'~..RAGVVEED,GSVV 1 ....., . . FOODS~/NG PAJ a (1:10) . ., MOLDS (1:10 wIv) F 36. CACAO BEAN (Gri \er, 1 :2Ow/v) c;; 161 A2.4. ALTERNARIA TENIUS ~ A I I: 37. CClWSMILK, WHI LE I A25. ASPERGiLLUS FUMIGATUS'. I . F.38. EGG, WHOLE I A 26. FUSARIUM VASINFECTUM ';;, 1 F 5: PEANUT, MIX 1 . A Z7. HORMODENDRUM CLADOSPORIUM 0;, I .~. F 9. SOYBEAN, WHOLE , A2!l. HELMITHOSPORIUM I 'X F 10. WHEAT, WHOLE ( rear) I' I' CCMOSU&:- .. . ,---- ~ ('t--{c-..- . ,. - .--.- .--_.-..- ---- n._ '."JIf3D': rmTl7<lVl' 7'j7,J:;,-- - ...- -"W--,.ij;i.~ . . ~.~.... 1/ ! ~f.--P'FlOMA:i'ft:RdA.1'tlM % 1 ~ . ~f'I:lUARIA PUll..-uLANS I _ -.--_., --.-. A 33. RHIZOPUS NIGRICAN I MAA--F:ULL.PANELSKlN TESTlNG-4f2004. . W,,?,,"-''''''''-P;''~'''''!>'''I~'I;~!liNr'lI1-W'lnr'f1'1Jm-'~-'-II~l~II~~I~!!'~!""""'l'!!r!~,, ~ ~I 11r1! I,. ,~ ........ "_o,?,_, >., 11!l~_ ~"~, "' -~ 04/08/2005 00:51 PinnacleHealth Hospita~s James A. Piper, M.D., Medical Director Harrisburg, PA Pt. Name: Pt. Phone: Age/Sex: Hosp. No.: Account #: JOHNSON,JARROD 7173950923 4Y M 800466423 250242286 Lac.: FREDRICKSEN CENTER Dr Joan Montello 220 Wilson Street, Med Arts Bl Carlisle, PA 17013 T33461 COLL: 04/04/2005 UNK Ordering Physician REC: 04/05/2005 08:14 Dr. MONTELLO,JOAN RAST NORTHEAST REGION SEE NOTE (NOTE) \ !Allergen Name 1 CONVl % ofl MOD 1 !' kU/L lCLASS! Ref. !CLASS! NOTE# ! !Dermatophagoides farinae (d2) .! <0.35! O! 36! O! !Cat dander (el) . ! <0.35! O! 44! O! !Dog dander (e5) .! <0.351 01 43l 01 !Timothy grass (g6) . <0.35! O! 37! 01 1 House dust Greer (hI) <0.3-5 ! O! 37! O! ! Penic-illium notatum (ml) . <0.35! 01 411 O! !Cladosporium herbarum (m2) . <0.35! O! 401 01 !Aspergillus fumigatus (m3) . <0.35! O! 47! O! J !Alternaria tenuis (m6) . <0.351 O! 511 01 !Common silver birch (t3) . <0.35! O! 39! O! !Oak (t7) . .1 <0.351 O! 461 O! !Walnut (tlO) . . ! <0.35! O! 41! O! !Maple leaf sycamore (tU) .! <0.35! 01 451 Ot ! Japanese cedar (tl7) . .! '<0.35! O! 37! O! 1 Pecan, Hickory (t22) . .1 <0.35! O! 47! O! !Mulberry (t70) . . ! <0.351 O! 37! O! !Common ragweed (short) (wI) .1 <0.35! O! 42 ! O! lCommon mugwort (w6) .. <C.351 01 38! 01 lEnglish plantain (w9) . ! <0.35! 01 46! O!~ !Common pigweed (w14) . .! <0.351 O! 631 O/~(U !Sheep sorrel (w18) . .1 <0.35! 01 46! ---------------------------------------------------------------------- Note 1 Common pigweed highly cross-reacts with Careless weed Note 2 Sheep sorrell highly cross-reacts with Yellow Dock Immunocap allergen results may be expressed in either kU/L or as a percentage response of the patient specimen compared to the 0.35 kU/L calibrator (ASM: Alternate Scoring Method-Modified allergens) . SPECIFIC IgE CLASS j(~ kU/L % RESPONSE LEVEL OF ALLERGEN SPECIFIC IgE ANTIBODY 1-/5'" i' ~ c;~ JOHNSON,JARROD CONTINUED PAGE 1 ~ ~ '//;310:> 0/11 .If ~ lJ",. JJL ~/ -:-" :o.-'i!i'~'!.1'~~ ""~' '_ _, "_ ~ .., .",", '-- '''' , ~~~. 1 - '''~". _,",'~'_ ~_" v.- " 04/08/2005 00:51 PinnacleHealth HospitaLs James A. Piper, M.D., Medical Director Harrisburg, PA Pt. Name: Pt. Phone: Age/Sex: Hosp. No.: Account #: JOHNSON,JARROD 7173950923 4Y M 800466423 250242286 Loc.: FREDRICKSEN CENTER Dr Joan Montello 220 Wilson Street, Med Arts Bl Carlisle, PA 17013 T33461 COLL: 04/04/2005 UNK Ordering Physician REC: 04/05/2005 08:14 Dr. MONTELLO,JOAN RAST NORTHEAST REGION (CONTINUED) o <0.35 < OR = 70 ABSENT/UNDETECTABLE ~ 0.35 - 0.70 7~ - ~~O LOW LEVEL 2 0.71 - 3.50 ~~~ - 220 MODERATE LEVEL 3 3.5~ - 17.5 221 - 600 HIGH LEVEL 4 17.6 - 50 60~ -2000 VERY HIGH LEVEL 5 51 -~OO 2001 -6000 VERY HIGH LEVEL 6 >100 >6000 VERY HIGH LEVEL See notes for designation of allergen tests using one or more analyte specific reagents. In those cases, the test was developed and its performance characteristics determined by Quest Diagnostics. It has not b~~n cl~ar~d or approved by the U.S. Food and Drug Administration. The FDA has det~rmined that such clearance is not necessary. {AM} = Test performed by Nichols Institute Quest Diagnostics JOHNSON,JARROD END OF REPORT PAGE 2 !"'-i!l.~,~~m;~~ ''<'"'''' I I ~ ~ r MEDICAL ARTS ALLERGY, P.C. Joan M. Montello, M.D. . Donald S. Harper, M.D. Jack L. Armstrong, M.D. . Jodi L. Johnson, eRN.p. AMERICAN BOARD OF ALLERGY, ASTHMA AND CLINICAL IMMUNOLOGY MEDICAL ARl'S BUILDING 220 WILSON STREET. SUITE 213 CARLISLE. PA. 17013-3657 Phone: (717) 243-7540 Fax: (717) 243-9968 FREDRICKSEN OUTPATIENT CE.NTER 2025 TECHNOLOGY PIW'IY., SUITE 310 MECHANICSBURG, PA 17050 Phone: (717) 791-2640 Fax: (717) 791-2646 BLOOM OUTPATIENT BUILDING 4310 LONDONDERRY ROAD, SUITE 109 HARRISBURG. PA 17109 Phone: (717)920.4340 Fax: (717) 920-4341 RE: Jarrod Johnson BD: 3-21-01 Visit: 8-10-05 I had the pleasure of seeing Jarrod for visit 8-10-05. Jarrod continues to have significant nasal symptoms and nasal obstruction. His. mother and grandmother, who bring him here today, feel that Nasonex at times does not even penetrate due to the nasal obstruction. Of note: He does not appear to have frequent respiratory tract infections such as otitis, sinusitis or bronchial infections. CURRENT MEDICATIONS 1. Nasonex is used only pm. 2. Tylenol Allergy prn. The child did have RAST test done to some common allergens such as dust mites, cat, dog, grass, molds, tree pollens, ragweed. All of which were negative. PHYSICAL EXAMINATION Temp: 100.20 Pulse: 92 and regular Resp: 20 and regular 16.5kg. HEENT: HT: 102.0cm. WT: E: Conjunctivae are pink. The lids are normal. E: Tympanic membranes are clear and mobile. External auditory. canals are normal. N: Nasal turbinates are pale with clear mucoid discharge. There is SOme crusting about the turbinates. T: Oropharynx is normal including: teeth, gum, palate, tongue. There is no exudate of the posterior pharynx. NECK: Neck is supple, there is no thyromegaly or cervical lymphadenopathy. LUNGS: Lungs are clear to auscultation, there are no retractions. CARDIAC: Cardiac exam is normal without murmurs or extra sounds. ;'~~'~11lt-"''''''''"'''~ \._-\ -~" "'- -:' r .., ""~"-~ ~ ' Page 2 Jarrod Johnson August 10, 2005 IMPRESSION 1. Chronic non allergic rhinitis. 2. Negative allergy skin tests/Negative puncture skin tests. RECOMMENDATIONS 1. I did recommend that the family use nasal saline irrigation and a handout was given to them which gives them a "recipe" describing iodized salt, baking soda and distilled water to be administered by either bulb syringe or bottle. 2. I also asked Jarrod to see Dr. Abram to be sure we are not dealing with obstruction from large adenoids or other anatomical problems that might be helped. The mother seems most agreeable with this plan. I have asked to see Jarrod after he has an ENT consult. Joan M. Montello, M.D. JMM/ambM c: Denise Barr, M.D., Good Hope Family Practice, 1830 Good Hope Road, Enola, PA 17025 ':;;>ii,""~';;0~" ~~ _,~__f,"", __? _. I' , . "-- - MEDICAL ARTS ALLERGY, P.C. Joan M. Montello, M.D. . Donald S. Harper, M.D. Jack L. Armstrong, M.D. . Jodi L. Johnson, C.R.N.P. AMERICAN BOARO OF AlLERGY, ASTHMA AND CLINICAL IMMUNOLOGY MEDICAL ARTS BUILDING 220 WILSON STREET, SUITE 213 CARLISLE. PA 17013.3657 Phone: (717) 243-7540 Fax: (717) 243-9968 FREDRICKSEN OUTPATIENT CENTER 2025 TECHNOLOGY PKWY., SUITE 310 MECHANICSBURG. PA 17050 Phone: (717) 791~2640 Fax: (717) 791-2646 BLOOM OUTPATIENT BUILDING 4310 LONDONDERRY ROAD. SUITE 109 HARRISBURG. PA 171 09 Phone: (717) 920-4340 Fax: (717) 920-4341 RE: Jarrod Johnson BD: 3-21-01 Visit: 3-16-05 1 had the pleasure of seeing Jarrod for visit 3-16-05. We were not able to do intradermal testing today as the child resisted this procedure so we declined continuing with testing. His mother and grandmother, who bring him in today, feel that Nasonex has definitely helped his symptoms and he does have better nasal breathing. PHYSICAL EXAMINATION Temp: 98.90 Pulse: 120 and regular 16.2kg. HEENT: Resp: 24 and regular HT: :t00.5cm. WT: E: Conjunctivae are pink. The lids are normal. E: Tympanic membranes appear clear and mobile. External auditory canals are normal. N: Nasal turbinates are pink without mucoid discharge. T: Oropharynx is normal including: teeth, gum, palate, tongue. There is no exudate of the posterior pharynx. NECK: Neck is supple, there is no thyromegaly or cervical lymphadenopathy. LUNGS: Lungs are clear to auscultation, there are no retractions. CARDIAC: Cardiac exam is normal without murmurs or extra sounds. IMPRESSION 1. Chronic rhinitis. RECOMMENDATIONS 1. Because I was unable to do intradermal tests to really determine if there is an allergic component to his symptoms I did ask Jarrod to get a RAST test to Northeastern pollens as well as dust mites and ~nim~l danders. The results of the RAST tests are pending at the time of this dictation. i:,"<;j~.'I!!I~ '--1;'-.-,,- ". - -',~ _ "0 1"''":'- ~ ~..."" .' ,. Page 2 Jarrod Johnson March 16, 2005 2. Both his mother and grandmother seem most pleased with the use of Nason ex and I asked them to continue this at one spray per nostril daily until I see Jarrod again which would be in two months. The family was invited to call sooner if there is any change or worsening of symptoms. Joan M. Montello, M.D. JMM/ambM c: Denise Harr, M.D., Good Hope Family Practice, 1830 Good Hope Road, Enola, P A 17025 ,;;-,,~';j ~~. . '---,,':';--'"Tc'-"- ",__-r-'~ ~ ','I .,- , '],,' ....',.- '~, '-:<, ,,".~"- ---'",", -;- --, -~- ,-' . MEDICAL ARTS ALLERGY, P.C. Joan M. Montello, M.D. . Donald S. Harper, M.D. Jack L. Armstrong, M.D. . Jodi L. Johnson, eRN.p. AMERICAN BOARD OF ALLERGY, ASTHMA AND CLINICAL IMMUNOLOGY MEDICAL ARTS BUILDING 220 WILSON STREET, SUITE 213 CARliSLE. PA 17013-3657 Phone: (717) 243-i540 Fax: (717) 243-9968 FREDRICKSEN OUTPATIENT CENTER 2025 TECHNOLOGY PKWY., SUITE 310 MECHANICSBURG. PA 17050 Phone: (717) 791-2640 Fax: (717) 791-2646 BLOOM OUTPATIENT BUILDING 4310 LONDONDERRY ROAD, SUITE 109 HARRISBURG. PA 17109 Phone: (717) 92Q.<\340 Fax: (717) 9204341 RE: Jarrod Johnson BD: 3-21-01 Visit: 2-23-05 I had the pleasure of seeing Jarrod Johnson at the request of Dr. Denise Harr. He is a 3 11/12tb year old child who is "always stuffY" and "sounds like he has a cold". The mother and grandmother, who accompany Jarrod today, states that he has been like this most of his life. In early infancy he had frequent episodes of otitis, but never required PE tubes. Currently he seems to have frequent respiratory tract infections during the winter months. Fortunately, he does not seem to require frequent courses of antibiotics. He is here today primarily because of nasal congestion. The mother states he does have noisy breathing if not snoring at bedtime. The family does not notice a seasonal pattern that may be significant for pollenosis. The child has no history of recurring infections such as sinusitis or bronchial infections. The ear infections were primarily in the first year oflife. The child denies a history of allergies to medications such as Penicillin, Sulfa. There are no known food allergies, bee sting allergy, latex or other contactants such as metals, etc. CURRENT MEDICATIONS 1. Zyrtec 1 teaspoon once a day prn nasal congestion. NEWBORN mSTORY The child was the product of a full term normal pregnancy, labor and delivery. Birth weight 6 pounds 7 ounces. The infant did have some hypoglycemia in the neonatal period, but other than that everything was normal. The first year of life he did have recurring otitis. ;;Ni'I'W'j''-'W~~,__..,.-",_c_,_,___,o_''':?_ ~ ' r'S_T, '<- ," "~>""'< . <,,%"" ^'.~ "-","-~-, ---".^ .".~~- Page 2 Jarrod Jolmson February 23, 2005 : I 'i i REVIEW OF OTHER MEDICAL PROBLEMS Essentially unremarkable. PAST MEDICAL mSTORY Non contributory for hospitalizations or surgeries. FAMILY mSTORY A maternal grandfather has allergies but no other relatives are !mown to have allergies or asthma. ENVIRONMENTAL mSTORY A complete environmental history was reviewed with the patient's family. PHYSICAL EXAMINATION HR: 90 and regular Resp: 20 and regular 100.5cm. HEENT: Temp: 98.80 WT: 16.2kg. HT: E: Conjunctivae are pink. The lids are normal. E: Tympanic membranes appear clear and mobile. External auditory canals are normal. N: Nasal turbioates are swollen without mucoid discharge. T: Oropharynx is normal including: teeth, gum, palate, tongue. There is no exudate of the posterior pharynx. NECK: Neck is supple, there is no thyromegaly or cervical lymphadenopathy. LUNGS: Lungs are clear to auscultation, there are no retractions. CARDIAC: Cardiac exam is normal without murmurs or extra sounds. ABD: Abdomen is soft without hepatosplenomegaly. There are no abdominal masses. There is no lymphadenopathy. EXT: There is no digital clubbing, cyanosis or infection. SKIN: The skin is clear of rashes and lesions. PROCEDURES The child was skin tested by the puncture technique to inhalants, animal danders, mixed grasses, weeds (including ragweed), tree pollens, molds and foods. He had mildly positive test to dust mites, but they did not match the histamine control as well as fusarinm, mucor and penicillium and one tree hackberry. <q~"",~_!,!'1, ~j,____^ ,,_'"'~:'__~ . '" ,_p,,,' if-" ~"",", --p_.! ' ',0 , "--' \i'.li;';'^*"""',t'~" . ~:W' -~." -~,"'~ ""'--, ;-~,--- .. " Page 3 JllITod Johnson February 23, 2005 IMPRESSION 1. Perennial nasal congestion. 2. Mildly positive skin tests dust mites/mold (Did not match histamine control). RECOMMENDATIONS I started Jarrod on Nasonex 1 spray per nostril daily and our nurses instructed the family on the proper use of the intranasal steroid spray. I would like him to stay on this until I see him again and at that time do further intradermal tests. The family seems most agreeable with further testing and they were invited to call at any time should there be any further problems. Joan M. Montello, M.D. JMM/ambM c: Denise Harr, M.D., Good Hope Family Practice, 1830 Good Hope Road, Enola, P A 17025 'NP~""'~--=-"'i1'(~.. -<;,,-r 1"~'" _~,,~" ~ I" "'" ~ ~w DOCTOR RATIO V~KiFiCATION EXHIBIT ~ {A7H~;,!~'S j =f;E- =? r-as-oS; A -_.'-- ----- Dale. sf 21!ns KinderCare Dear Dr. _~ '1 r Your patient J CcrrD d j 0~ ::')<Z>() is applying for enrollment for childcare services at KinderCare learning Centers, Inc. We ask for your cooperation in helping us to ensure that KinderCare is able to provide the best possible environment for this child. Your medical opinion is critical In deciding whether to enroll this child. We do not promise enrollment to every child. KinderCare is not a medicallrealment facUity, medical services are not provided, and the teachers are not medically trained. KinderCare does not provi?e one-on-onecare. . KinderCare is a'group care.facility. We provide meals and snacks, rest times, outdoor play times, and follow an established curriculum. In addition, we provide periodic field hips to nearby parks and places of interest. In. accordance wit state law, the ratio in this area is I teacher for every (0 children and there will be a maximum of ' children in this area. The children in this area range in age from ~~cro ,f)-'fUr.S KinderCare's policy.is to accept children in compliance with the Americans With Disabilities Act (ADA), its implementing regulations and any other applicable federal, state or local laws that apply to the provision of services to those with disabili!ies. We review each child's slluation on a case-by-case basis to determine how we can best meet the needs of each child within the KinderCare setting. " . Do you believe your patient req,jires any modifications or accommodations In order to be ca~d f rand participate in.;the activities provided in the KinderCare setting as described above? DYes No If yes, indicate. beiow what these modifications would be. If necessary, use additional sheets of paper 0 the back of this fonn.:., . '""'" If you have any Huestions or concerns please coniact me at '1'2_ '? - 11 2...0 KinderCare's Disabllity Services Coordinator at 1-800-633-1488, ex!. 1440. or you may contact Sincerely. 1--\ (\;";~.~"" ~ Doctor's Signature ----- IIJu ~LYl ~ ~OqL ~d, r Ph 111)5' . '11111W11 Doctor's Add ress KinderCare Center Director ". Doctor's Phone Number PLEASE RETURN THIS LETTER TO: Kindel'C(~ '("arb Ill; Center 730 Wertzvllle Road Enola, PA 17025 KinderCare does not discriminate on the basis of disability. KinderCare has appointed a Disability Services Coordinator to attempt to resolve disab~ity-related issues. You can contact this person at the address listed below or the tolllree number listed above. (CENTER STAMP) KinderCare learning Centers, inc. Disability Services Coordinator 650 NE Holladay Slreet, Suite 1400 Portland, OR 97232 1~800-633-1488, ex!. 1440 FPP-HR5-315iiE 12'QJ. ,~~.a;J; ",-:'.1_" -"~-, ~ -'_:_-j:'-;/~,","'_'~"","':_,__" _, '':'' ~r- "'c.- " "-"~',~"C, -,'.,C:::',-"['; ,.r - --, ''''','-'- -- .'I .. --.'- ~ ~" ~ HERITAGE MEDICAL GROUP ADULT PATIENT INFORMATION SHEET PATIENT INFORMATION Date: . 5119105 10:40 am Patient Name: Jarrod S Johnson Date of Birth: 03121/2001 Age: 4 yrs Mailil1g Address: 3526 September Drive Apartment 6 City/State/Zip: Camp Hill, PA 17011 Phone #: (717) 395-0923 (Home) Phone #: 0 Marital Status: []Married [XlSingle []Divorced []Widowed []Other SS#: 170-80-1791 Sex: M Employer: Address: Emergency Contact: Sharon Bryan Telephone #1: (717) 395-0923 Family Physician: Denise F Harr MD (Work): Ex!. Relationship: Grandmother Telephone #2: Ex!. Other: Referring Physician: Denise F Harr MD Do you have insurance? 0 Yes 0 No If yes, complete the following Insurance/ Billing Information: PRIMARY INSURANCE Group #: 02869100 Insurance Company Name: Blue Shield . # ID #: ZAR110813318001 Subscriber's DaB: 12/02/1958 Relationship to, Subscriber: Other Subscriber's SS #: 209-50-9595 Subscriber: Sharon K Bryan SECONDARY INSURANCE Insurance Company Name: ID#: Group #: Subscriber: Relationship to Subscriber: Subscriber's DaB: Subscriber's SS #: GUARANTOR. (Person responsible for co pays and for charges which are NOT covered by insurance) Guarantor's Name: Sharon K Bryan Guarantor SS #: 209-50-9595 Address (required for accurate billing): 3526 September Drive Apartment 6 Camp Hill, PA 17011 AUTHORIZATION: .:. I HEREBY AUTHORIZE HMG TO FURNISH INFORMATION TO ANY INSURANCE CARRIERS CONCERNING MY MEDICAL CONDITION, AND I HEREBY IRREVOCABLY ASSIGN HMG ANY PAYMENT FOR SERVICES RENDERED. .:. I UNDERSTAND THAT I AM RESPONSIBLE FOR ALL CHARGES WHETHER OR NOT COVERED BY INSURANCE. .:. I CERTIJ=Y THAT THIS INFORMATION IS ACCURATE AND CURRENT AS OF THIS DATE. SIGNATURE ~~-Y7 DATE5-}Q-O<)INITIAL sK!3 DATE ,,-to-o<i INITIAL S/<(:] DATE INITIAL DATE INITIAL DATE INITIAL DATE INITIAL f(. fL;r DATE DATE DATE DATE DATE DATE DATE INITIAL INITIAL INITIAL INITIAL INITIAL INITIAL INITIAL INITIAL INITIAL INITIAL INITIAL INITIAL DATE DATE DATE DATE DATE DATE Rev, 04101/04 dll ,'~[!L rr .p ,.", --~-, -~'--',~-" ~,' {,-" ":-~: ',,_C'Z'~';_, " ,-"c-"~FF- ,~ "" . " -~. NAME ~~i('{0J 'J i f,.n S; jf\. BIRTHDATE:3 / [) / J () I . I AllERGIES: NKDi\ 55' nb-Ko~rt-lJ , eo . PROBLEM/DESCRIPTION .' . . RESOLUTION ,. o NONSMOKER 0 SMOKER d"J' 1"01 ,\\",I~ . ,~" v ACTIVE PROBLEMS GHFP FORMlll1 (SI98) "i'i~"~,ij.,*,- L ~"'-'''''o:"_':~,r;'' "yo"-,-,,*'. ..~,-- Y'''_'''o'"- - -"~ ~'-'- ?"P.-'!!'f'.:"-'~:-'--::}__\ -~"-- ,"-~- -, ;-, , ,~ . " ."~ .--. ,.",.- - )ariem Name- \\\iVotl '111"1,,_ MEDICATION LISTING , - Date i\\\fvi .sb\ 1\tkt r)~^'1 Dose 'I,ll;.. rAA Freq ,t #jRefill il."b Date ~ 1'1 NU~Jt1li Dose .Ip ~( ~\\;kti. Freq Iw,~\,,1 #jRefill Date - Dose Freq #jRefill Date Dose Freq - #jRefill Date Dose - Freq #jRefill Date Dose Freq #jRefill Date Dose Freq #/Refill Date Dose Freq #/Refill - Date Dose Freq #jRefill Date Dose Freq #jRefill Cood Ilope l"C1rnily Phy~icii1llA', 1830 Good Hope Road. Enola . PA . 17025 (717) 732-8877 . FAX (717) 732-9241 MEDICATION LISTING HMG/GHFP FORMI118 (3/99) :'JJ~" "'~',- ~ -,-,~~'j;~"-'~'.;''>''':''''''- ,<;, ,'n -,',' 't -' ,. ." ',~__ ~ -\_'-:",-. T' __~_ '~" ': -,- """-~"'",}-"'-"f ''"r>''. "" ~, - rr - ~- -< --- -- Patient: JOII,! J~\,"\tl--- Ih.lVerI!Jd!mdundl!(Slandlhelll.Jtcrial,mdinfoml"li<.lllexrIJin. in!: lhl! ri,k~ .,,,d benefits of Ih... if1lll1uni~"li(Jl1. The doctor h.15 .mswered In rny s,ltisl,lCtilln ,lilY questions Ih,'l I hJ."e. I cons enl Ih"llhisim'.m"'i7.,'liOr1l~gi\"enton1t'OrIOlhisp.llienloiwhlln' 1;llllthepJ.rel1t,gu,udii1nOrOlhe'''Ulhoriledrepre>enl.,tive. Not Given Age Immunization Date Here nllas ., DPT/Hib/OaPT 1 ~ .1~ 1~ I /' O.SmIIM OPT/Hib/DaPT 2 ~ 'i\~ I O.SmllM / DPT/Hib/DaPT 3 I~ 1\1'1 / O.SmIIM . DPT/Hib/DaPT 4 11,\II.J I O.SmlIM DPT/DaPT 5 O.5mIIM DPT/Dal='T' O.SmIIM DPT/DaPT 2 O.SmIIM OPT/DaPT 3 O.SmIIM DPT/DaPT 4 O.SmIIM . DPT/DaPT 5 O.SmlIM I Hib 1 SI"I,I /' O.SmIIM Hib Z &1 ~ I /' O.5mIIM Hib 3 1'1 \ "I /' O.SmIIM Hib 4 '1 ~ ~1 / . O.SmIIM OPV/IPV 1 5,j. '! , PO/O.5ml SQ OPVftPV 2 e 1 "I / PO/O.Sm! SQ OPVftPV 3 11 .J /' PO/O.Sml SQ OPVftPV 4 PO/O.5ml SQ . OPV/IPV 5 PO/O.Sml SQ . MMR 1 1 hd<"J / mlSQ MMR2 mlSQ , H.ep B 1 ~ )alo i /' mllM Hep B 2. 81 ul / mllM HepB3 Will L.l /' mllM Varicella 4/')/u /' mlSQ Varicella mlSQ dT O.SmIIM RESUU PPO- Tine/Manloux /O.1mllD RESULT PPO-Tine/Mantoux /O.lmlID RESULT PPO-Tine/Manloux /O.1mIID 'f I Amt Route & Site Lot#/Manufacturer Authorized Signature Handout Given .. E t, Signature of Vaccine Administrator *Site Given legend RA Right Arm LA Left Arm RT Right Thigh . LT Left Thigh Ulnitials Signature of Vaccine Administrator *Site Given legend 0 Oral RD Right Deltoid LO Left Deltoid PEDIATRIC IMMUNIZATION FLOW SHEET Good Hope family Physicians 1830 Good Hope Road. Enola . PA . 17025 (717) 732~8877 . FAX (717) 732-9241 HMG/GHFP FORM /j2 (9.02) !~~"_.~~" C.," o_<-_,~\".,r,,,'>':>'.~'"-'" ~,;, """-.".-?'^'"I'. -'.._", '.'r_ . ~"-.' ' 1 - ,!Ill " Good ~ope family Physicians 1830 Good Hope Road. Enola. PA. 17025 (717) 732-8877. FAX (717) 732-9241 PAGE NO, & ~- 1 I NAME: ,,\ C~ rr(~--;'\~'''(\ "Sh 1\ s: - Mn'r fJ4n JOQ/- ~ },.VJ(Ij)S (SrJ btNh ~ leu () /'J tL: q, 0 "d ocit5l <WJe(L/;I~~hJi{'j)J So'e Throe! __ Stuffy ~ W ~a~C, Itn.,ft,i.1 J':fm(,l..y ~':eaC:Zc':2 Fever l.:tL- Ear Pam _PND - I U () , MY2:9:as _=c~~~ (Prod. _) MedS{' 1'Jc/ ? '. ~lli\h Handouts giver. ~I DST 0 Fever 0 V/D () - 0 J o Temp 9 ~s WL f"'J,. /rm1i1W - , ~ r ' ftf'i..tiIJ tl',>;,. J qri'r(,/t lEe 2 (J :1(0 ur ~r ) c.lRI (V\.C (( s TMs --L- Nose Con'ul1ctivae , Throat Neck Nodes Lun s Heart Presents today as a new pt for evaluation of ongoing URl symptoms for ab01.1t the last month associated with soine lumps on both sides of his neck that have been present since appr~ximately September 2004. Jarrod had been under the care ofDrs on Walnut Bottom Road and the last time he was seen was September 2004. Apparently there' was some miscommunication between mpm and dad who are in the procd~ofseparating and then soineother information that was provided by ~ maternal grandmother who aC,companies them on the visit tonight about how he was supposed to be recJjecked with regard to these presumed swollen lymph nodes. Either way, mom and grandma Were very c011cerned because they were noticing these lumps on his neck. He has had congestion and runriy nose foriat I~ast the last month associated with some intermittent fevers. No complaints of ear pain. Occaslonal cough. Appetite occasionally decreased but no vomiting or diarrhea. Both parents are smokets. Jarrod has been exposed to a lot of second-hand smoke. He did have a history of recurring ear infection~ early on his life but this has been better more recently. He never had tubes. Never had an overnight hosJilital stay or any surgery. No medication allergies and does not take any routine medications. He was bOr$ about 1 wk early. Had a NIeD stay at birth because of some type of a respiratory infection and low blood sugar. He did not have any residual complications after his discharge. According to mom, his immJnizations are up-to-date. Medical records have been requested but have not yet been transferred to our office. Family history significant for mom, herself, with allergies. 0: NAD. He is active and well. TMs clear. Nose congested. Purulent discharte noted bilaterally. Oropharynx with some mild erythema and PND. Neck supple. Has shotty I~ph nodes on both side of his neck anteriorly and posteriorly. Has a cluster of nodes in the left posterior c~rvical chain and an approximately 8mm in diameter node in the right posterior cervical area andia couple of scattered nodes in the left anterior cervical chain. Heart regular. Lungs have clear breath sounUs throughout. 1) Acute sinusitis. 2) Reactive cervical lymphadenopathy. Amoxicillin suspension 250mg/5m1 1.5 tsp bid x 10 days. Reassured mom apd grandma that these reactive nodes are exactly that and should resolve as we clear the infection. I would like to recheck him in about 4 weeks to ensure that the lymph nodes are stable and to ensure that his respin.ltory symptoms have resolved. I did discuss the effects of second-hand smoke on recurring respiratory infeqtion. We may need to entertain the possibility of allergies also as an underlying etiology given the family history. Will await medical records to determine when he is next due for his well exam but probably in March 2005 upon his next birthday. With any problems or worsening of symptoms prior to the next vi~it, they will contact the office. PUI. 12/30/04 HMGlGHFP FORM #1 (10/97) :,,'--CIJl1i,"?;~ "'~;'" ""~'-~'~'''''?'~',. ",. '-r.. --"," ,'"I!:':--c_ ----'''1- I" ~"-"-~= "" " ~ ~- --~ , , NAME~-Z;:/? / , k An s .:? ---'- '-'................."'-'[-'..... family Physicians 1830 Good Hope Road. Enola . PA. 17025 (717) 732.8877 . FAX (717) 732-9241 PAGE NO. a JA~1. ~() iVT ,3 --1 % (I 0RI s: "', >> ,/~ l Sore Throat _ Stuffy Nose W- Na~/C -=-.. Headache Fever ~ Ear Pain 's;;::;;LPNO _ Myalgias _Cough :iL..- (Prod. _) Meds: Handouts given: 0 URI DST 0 Fever 0 VIO !2 lor J;.. ~ l~iI",liV ~ =@= 0: Temp nl TMs Nose Conjunctivae Throat ~odes Lun s Heart P: He presents today for recheck of his sinus infection and reactive cervical lymphadenopathy. He completed the Amoxicillin. He is no longer having cloudy discharge from his nose. It is now ~ore Clear. He seems to always be congested and having a runny nose, blowing his nose a lot Grandma does think that the reactive lymph nodes that we previously evaluated are much less thenthey had b~lln before. . Jarrod and his . mom are currently liv.ing with the maternal step-grandmother and Jarrod's 2 maternal. step:aunts.'There is second-hand smoke exposure. , .'" " ,. NAD. Appears well: TMs have some chronic changes. No acute disease, Nose' is congested ,with Clear rhinorrhea. Turbinates are somewhat pale and boggy.. Oropharynx with some mild eiythemllarid PND. Neck supple. He continues to have some reactive cervical lymphadenopathy especially in the left posterior cervical chain. Heart regular. Lungs - Clear breath sounds throughout. . . I) Acute sitlusitis, resolved. 2) Allergic rhinitis. No further antibiotics are necessary. Zyrtec syrup Y, to 1 tsp po qd. Samples and script provided. Will check him back in about 4 weeks for re-evaluation but sooner pm. PUr. ,. I'; t-' . I , D~W 01/20/05 i'- I' I i- , ~: . " I, HMG/GHFP FORM #1 (10197) ~1.~J, ':". ' 0, .^ ':' _" _'"!., ,',"'7' OJ_ C.__",,;_,,__:- ,';" -', ,." '/ j.. " :-;r,"",~~-- -;--:~-,';t-,-,,--_.. c _ ~ L_ _ n "0" --i-;''''''-'' -~. ~ ~ - -';~T""" - 7,;, ',,"", -, ~---,- ~J1Il Good HODe t'amily Phy~icians 1830 Good Hope Road. Enola . PA. 17025 (717) 732-8877. FAX (717) 732-9241 PAGE NO. .3 NAME.,1qJ J 0 hrtY-TV) Wr 2>lv Ib>, ;z 7""';5" '7~ ;, . ;2-.;z ;3?"'dc z: /-{).-;.;r, ~- ~./",. , ,J ?~. //-~,.....,"'" .,.A'~<.,.J; C7~--'(: =@ 1,1/1. f'\ (; l'j ~A2~J{ (.7 ,:: '1;''Lll1TI.l t lJ,w ~ jvVo-0rt t.t dll u": ^ bc.itM I/{ , (Mll.W''t Presents today for follow-up of allergies. They have been giving him Zyrtec syrup I tsp at HS. He is definitely doing better with this but mom and grandma still state that he "breaths funny" at times. When I tried to get a feel for what they were describing, they said sometimes he sounds like he is trying to "get something out" and I really could not determine ifthis was out of his nose or out Qfhis mouth. He does tend to snore a fair amount. His cough is definitely better as is his congestion. He does have second-hand smoke exposure as noted previous. NAD. Appears well. Nose - significant congested pale appearing turbinates are still noted in the nose. Oropharynx clear. Tonsils are not hypertrophied. Neck supple. He continues with some shotty lymph nodes bilaterally. Nothing pronounced, fixed or mobile. Heart regnlar. Lungs clear. Allergic rhinitis. Continue Zyrtec syrup. Get him seen by Montello and Armstrong for an evaluation to consider if any further testing or intervention would be recommended by theJIl especially because we are not even in the heart of allergy season yet and I have a feeling that things may flare in the spring. Will await that . evaluation and otherwise schedule in about 6 to 8 weeks for his 4 yr peds check. PUI. 'D~W 02/17/05 Ii' 1. b, IYJ ""tdLo f fI1 5l2- J arrod is here for a pediatric examination. He is here with maternal grandmother. She voiced to me some concerns about how Jarrod is being cared for by his mother, Joelle, and dad, Keith. They were never married and are now separated. Joelle lives with her step-mother who is here today with Jarrod. Apparently Joelle decided not to come.to the appointment today. Maternal grandmother does not feel that. he is being adequately cared for. She does not feel that his nutritional needs are being met, that Joelle . frequently does not cook appropriate meals for him and allows him to drink juice all day. She really has no control over what happens when he visits his dad. He is supposed to see his dad every other weekend and was seeing him a couple of times throughout the week, but because of some differences in where they are both living now, that does not happen quite as often. Joelle does have primary custody of Jarrod. I explained to grandma that Jarrod seemed to be appropriate as far as his height and weight today and he seems to be developmentally showing no signs of concern. On review of records, it was indicated that he weighed 36 pounds a year ago, although different scale, different office, I could not really validate that definitively. I have discussed with grandma about trying to ensure that he is getting regnlar meals, to encourage a variety offoods being offered and trying to limit juice. Because if he is truly drinking juice all day he is obviously not going to want to eat a lot of solid foods throughout the day. If grandma had additional concerns as far as competency of either parent to be caring for the child, then I have recommended that perhaps she consider consultation with Social Services. Apparently there were some allegations made in the past when J arrod was very young, so there is a file on this child. There was nothing that I felt was threatening the welfare of this child based on the alleged information given to me today, so I did not feel that I could make any additional intervention at this point. I did ask grandma that if continued concerns on her part was there to request mom accompany Jarrod to a visit that we could discuss further. PUI. DF b 3/23 HMGlGHFP FORM 111 (10197) ,-",,'~ c ....j':-'l'!'"-"j<,,J' w r_c'_".- ,. '"'J OC'_ - ," "l ~ , "r'- ,'""""1'__ r Any parental concerns: _ ./.j,~ c 104{ .v.r14114Ears iVt (JOifa f - rwlt. ftlp;d,ii /<Vit<..J f" Nose/mouth t. /1._7,1/1' NIJJD"'f hM"li f. fW fm . Nutrition 1rk, fJ ~^f1'J;/;//' f J ' . a/&'H-iumJ! ~J!)I"(4"1 mM;" i!'''-Y J!!I~ . 00 U . Ehminationproblems(Yes~ )". _, . fri'I"'ft"t( J"""q(/,,~, f h./ J( Fully toilet trained? '/ 0 J J , . Abdomen -r /)10f1U aWl /!"'~I - . ~~ ~~~k' ~ Sleeping through the night? )1'1 dJ iY'f'~iI~ft - )( Able to fall asleep alone? j, ;R:. Napping (J nap/day)? -I- (11"" ~r (' ",i/a p~ Name Vi rr~ -1hn~ Date , , < i', ~-~ :.~ ;}'~;nr:;: i"lU....H\ ~ tv L~.-.....V 4-, II tlH1 3 - 4 YEAR OLD EXAM Age Wt Length q "".. ~? 3C1YL L/q .q(') % % BP _ qj f <./1 'f". lOLQ · Social History [J Daycare or Preschool? E) wi in"", 11M r/,(; i i.-'i DEVELOPMENTAL MILESTONES - g and tOileting?@O) Knows age/name/sex? ... es 0) Knows 3-4 colors? es 0) Kicking a ball? Ye Imaginative pia . Jumping in place? Riding tricycle? Yes . . . . . . . ANTICIPATORY GUIDANCE .-e( Helmet use/supervised play A Booster seat in back of vehicle (age 4/40 Ibs) jI Oral care/Dental visit -dIU f -~ .1- O P d. k'll ''''''rul'iH<- e estnan satety S I S p/ Limit TV !:Y Praise good behavior 9'" Certain body parts private Y Provide choices, reinforce limits, use of "time out" t'_~:~,r ,~~"~?-7;;~ -.-,<~tt>"__"l -)f "-;.,. ,.' ,-,--~---"--,,., '-'-"';""'_'!_,_",,,_ --[',:.,-, PHYSICAL EXAM NL 4 JY ;Y )J ? 7 Generai Skin Head Eyes Neck/clavicles Lungs Heart/pulses Genitalia Extremities ASSESSMENT y y ,/f:f )" ,9' 1t: jv<l/I/"Yri. )I1~t I/"~,j.j PLAN Page # ~ o Abnl [I 0 0 0 0 0 /f /;1h,Jj dl<n'f"_ [I D [I [] [J o Screening U/ A xl o Hearing/vision screening' (VO CI!/1~.",y, Immunizations: UfO h,u,nrd l/V /N.t" //J;',j,~( - - I U /w'(J., . o. ~'ri~ t,.! Vq,~ f FW' RTO IfrfM Y PUI signature r '" H~ ,__7" _ ",~ ",- - ~ J rM~ NAIvlE: () JIll j) JM, I J H.1)I1' /,if') MAy 1 9 2005 ~'3/C6 I () : 40AfYl Lut - 8,F- ~ <67 lb. ~~ ~-';:d~~-V"-- '. ,-' h_ ~,T '/ IQ,-,*n;~ '1:~;I~c~~r_ ,<BL.)""'-':;;,.t ~c.".PNO _ "" __.L__,C,'" ': ",,' -)U Meds: ()CUlOfUJK (.,-,i).._- (\.1/1);..1. NUC'~_ _ . :; C)e:: [,J f'(!V;>f [J VjO ~ a , (','i'pc", (j'9/~ ."'_' V,"" """'.~ ~-= D.L..vl Ii :,<,;,:;~S~l>, . ':"",:_"m~j)J~.~~ ::_~2~'-:?_~~~;:~~:":~~~-.~1~ ~:,jD~~~__~ " , ,.:!~::::",~__.-l:::_ 'h--L:., ~'~ f\l~~ d--0~~D (j\ ~ ./Y\..~ \J iJ ~i4-4 bHr:s- AuT. ~jJ~/ ~ ~h,- -'0 y PAGE NO: 5 J. Sl9Lp;n'O laM:. 11(~/~ . --IV \ \I \(j "S1:D-Mu.c\"" \.."u,,- b \ \(,.';.1 Y'> \ u~\., \- @~ '""/ . ~ r~ C05~ "".""""".,?_,..,"_ c_~_,_,_ -'0", ' ." - '. ..Ct" , _,' ,'_"~_ ,. ,d." - .-''-.'e. -"C'-,-,""T""'" --'"".' ,.,. " -- -~ ,.._~, " __l''''''' ~_ _ . "'M,~nIlDd ~%IiW11 - u I D IE: TIME: WM -)-65 I LOD DPM WHEN FORM PRESENTED TO OFFICE: ~T PORTION OF FORM COMPLETE [J FORM FEE IS $10.00 I DUE NOW [] PCP WILL REVIEW CIHH &JHEN COMPLETE FORM LASTPE M~ ;;l,,{.Jca5D ,2YRS-APPTSCHEDULED o < 2 YRS - CIHH GIVEN HT, wr, BP 0 CURRENT I WITHIN 1 MONTH o ,SCHEDULED I, 1 MONTH AGO CIHH 0 COMPLETE o "YES' ANSWERS EXPLAINED [J GHFP PORTION OF FORM COMPLETE [J PT NOTIFIED FORM READY FOR PICKUP [J FORM COPIED -~"-'llir~r.'""",'~.. - Cood Hope family Phyoicians 1830 Good Hope Road. Enota. PA. 17025 (717) 732.8877. FAX (717) 732.9241 PAGE NO. k PATIENT: \ d ~ o.rro REC'D BY: 7rJ{3, <<L .~~j) v.-. .~~ \----0 i--=> \ '-\ / ""'-~ . '. ~ /jf ?/& /17 ~ ,K0 initials ~s;.' . b l..:. C~D} \'.~~\ o.....>......A..:)~ ) PHONE: (HI (W) DISPOSITION: o IMMUNIZATIONS UP TO DATE o PROBLEM LIST & MEDICATION LIST REVIEWED AND UPDATED o CLEARED FOR ALL SPORTS & EMP~OYMENT ACTIVITIES o CLEARED WITH THE FOLLOWING RESTRICTIONS: ~ ~ ~ Il: ~ " o NEEDS PHYSICAL BEFORE THIS F(!)RM CAN BE FILLED OUT o ~'"r, "7'" t,; "I I'- tort J...*' ~ tr~" CY'-<;V~1- . A.~ p--A- . 'l'"YL= 0'-9-/\ ,JRI ('(' ~'l c'. ."...,.......',~."..@, L "''''', ,'_ ' "IDle G\\\ f:t\Cf\vw~d w. ,_ _ ,1:1:1....',1.:, .~,.~~i!/ ,"!!.JC:<-' _"~_ I-~asa i2.L.. '-:J \J '-'J- ""'():::.:~;'" 't ,'::-Vel" ~ Ear Pain PND .' ,'C' ..::,:~~)~;~);i =--_ (Prod. _) Meds: --:ru.\..Q.D~ ~d q. n c ()O~ "';":"':'.;;:: UUFl: DST DFever OVID I.,) -+h..G~' \lD . o l(Jr';:: __9c:l..!._~~-*~') -',' /.," I ~" .,.....)~I"# tiZS;- I ~ ~ Conjunc;.tiv88 Throat Neck Nodes Lun s Heart ;f .:::.}~/" ~ kJ)' G[ ~ N"~ tll (lJ.. r- r ;'-J~W _l"~"Wp:'~ ,-"c., - "'in "_.'0" '(_'<('--" -',"J' ' '",,",'>0"" " ~~~~ v.-~- ~ I('~~ ~Jr I) ~) ?) ~ ~~ ~ 4-~ k It'',, J/~~ ~) 7::r- c:-.,- ~~ JSr.J> ~ r.... ';j' ~ HMG/GHFP FOAM #1 (1019 ,_,e',,^,,_ '7,."",'" '''._',.1'',., -I ~ ,'~ s~ NAME vUlJU IIU[-'C family PnY,l\iciaof. 1830 Good Hope Road. Enola . PA. 17025 (717) 732-8877' FAX (717) 732.9241 PAGE NO.-2 ~ 0;) Oe.. 1\.1\0" ~l t "" I-,~tda):v. ~ /YIr 7fd~ ~J/fA'JjYUUJ- f [,~ -,c HMGfGHFP FOAM #1 (H i"'~~~'J1il"" '~'CO, "~"[!:" .,,,,;;::\?"~ ,0:\ /" "t.' " h'_ - ,_~\_,.._' ~'. '--'-1-''''''': ,0 ~ 'HILD HEALTH ASSESSM 'IT \. I - 11 (}C) COUNTYClA.rv:berlC\.>"I -l-.L t' CHllD"S NAJ\.lE: '" C. '" :c - To Parents: Submission,of this form to the child care provider impfies'Consent for the child care Drovider to discuss the c/iliJd's health with the chi/d's clinician. PA child care providers must document that enrolled children have received age appropriate health services and immunizations that meet the current schedule of the American Academy of Pediatrics 141 ,Northwest Point Blvd., Elk Grove Village. IL 60007. The schedule is e available at < www.aap.org > or Faxback 847/758-0391 (document #9535 al1d #9807). Print copies providek:! by DPW have the schedule on c3 the back of the form. }1 " .- Health history and medical information pertinent to routine child care and Date of most recent well-dhild exam: .c emer\lencies (describe. if any): ,A1~; '. . JIU{a5 '" o NONE . I~'Y; r/"h'Iu C Allergies to food or medicine (describti) if any): Do not omit any informati~n. This form may be updated by " ,0'NONE . health professional. (Initi I and date new data.) Child ;;;, care facility needs 2 copi~s. a. " LENGTH/HEIGHT WEIGHT . HEAD CIRCUMFERENCE BLOOO PRESSU'RE J~'!J.. ~~M JO .is ~G 19 (BIRTH TO AGE 2} IBEGJNNING AT AGE 3) %ILE %ILE INICM %ILE ?S /11 PHYSICAL EXAMINATION . ? v=NORMAL. . '.IFABNORMAL-COMM~NTS . '" HEAD/EARS/EYES/NOSEfTHROAT 7 :;; TEETH / " '" CARDIO'RESPIRATORY v " ABOOMEN/GI ./ - ., GENITALIA/BREASTS . v n E EXTREMITIES/JOINTS/BAcKlCHEST .1 v- 0 v/ (.) SKIN/LYMPH NODeS. '0 v c: NEUROLOGIC &.DEVELOPMENTAL . '" P IMMUNIZATlON$'. ""DATE ,.",." , .. i'DATE '.: ['i,iiOATE '.....,' .' DATE' , "DATE' ,. . ..... COMMENTS ~ , , ~ DTaP/DTPfTd '0 :; POLIO - 1"'\ 0 .c '::j; pJl, .L,/ '" HIB ., '" " c: HEPB 0 'iij MMR. ., . ., '0 VARICELLA ~ .c PNEUMOCOCCAL - rn " .<: OTHER . en . " SCREENING TESTS >". DATETESTDONE "'. ' , ',' . -" NOTE HERE IF RESULTS ARE PENqlNGORABNORMAl<::;', " 1ii LEAD . c: ANEMIA (HGB/HCT) -.. - ...,.,....,'" .2 , m URINALYSIS (UA) (at age 5) -..-nT Ta;I;l"'W ! !:! HEARING (subjective until age 4) v . .-... .... . . c: " VISION (subjective until age 3) V" E . E PROFESSIONAL DENTAL EXAM 2 HEA,LTH PROBLEMS OR SPECIAL NEEDS, RECOMMENDEO TREATMENT/MEDICATIONS/SPECIAL CARE c {ATIACH ADDITIONAL SHEETS ;: }(t1~ r/llni1u IF NECESSARY) 10 E MI<INj. 7A'4;J, rJ~ jJ JIUb ., DIlONE c: NEXT APPOINT ENT - MONTHIYEAR: " ~ MEDICAL CARE PROVIDER: ~bJ J-k ~~~ P~I~ SlGNATURE OF PHYSICIAN 0 PNP: '" I AOl;}RE$S: (~3~ ~uJ u're ~Od! D , 11\ /JJA. ~ ~hol~ 1 r~ I I PHo""11aBB11 LICENSENUMBEA Moo~i1bb~. ( I DATE Fbf lr05D IN, D413lA , CYSI.2fO u '" a. (""'UIr G r'l'.ct:: ,....n....lnnc:-n l'!~-~."'_H__~,.__"'"., - " ',; t,.~ ~"~ .-,"" D--- f ~ ~ r"PO~11'0i'\\Ohl?' 04103' ." f: '"..' r., i!'~. '.' tH? . H:..2;"t:;U~ -M- ,.--. 150516@'- t '" a. '" fi c J: -= CHILD. HEALTH ASSESSMENT I)r c::I\.(\ 5Q:- ~^",bQ-f' Df'. 'I t, It ~/C> II (, 3-';)1 DO t.L '" ~ '" "0 To Parents: Submission of this form to the child care orovider impfies consent for the child care provider to discuss the child's health with the child's clinician. '" e PA child care providers must documMt that enrolled children have received age appropriate health services and immunizations that meet 0.. the current schedule of the America~ Academy of Pediatrics 141 Northwest Point Blvd., Elk Grove Village. IL 60007. The schedule is e available at < www'aap.org > or Faxback 847/758-0391 (document #9535 and #9807). -Print copies provided by DPW have the schedule on '" the back of the form. o ;!:! .c o caUNTYClAtv'lber I (An - Health history and medical information pertinent to routine child care and Date of most recent well-child exam: emergencies (describe, if any): ,A/L' . JIJ~/o{ '" o NONE "-'Y; vll1h''lu '" - Allergies to food or medicine (describ<i) if any): . Do not omit any information. This form may be updated by c '" ,i;2fN-ONE health professional. (Initial and date new data.) Child iO- care facility needs 2 copies. 0.. . ...' .L,EN(ll"I:I/l:iEIGIH '.'- . -WEiGHT. ... . HEAD CIRc:UMFERENCE ... .... BLOODPRSSSU'RE . . ,Ji 1a. -6NtM Jo JS ~G 19 (BIRTH TO AGE 2) (BEGINNING AT AGE 3) %ILE %ILE IN/CM % ILE 95 / 11 . PHYSICAL. EXAMINATION . v"NOR!!IAL c IF ABNORMAL - COMMENTS . . oj HEAD/EARS/EYES/NOSE/THROAT ,,/" . - '" TEETH ........ '0 '" CARDIORESPIRATORY V '" ABDOMEN/GI . ./' - '" GENITALlNBREASTS a. v E EXTRI:MITIES/JOINTS/BACK/CHEST ....- -~--- 0 0 SKIN/LYMPH NODES ......../ . '0 c NEUROLOGIC & DEVELOPMENTAL v '" :t IMMUNIZATIONS:. -PATE:. ...oAtE DATE DATE DATE ..COMMENTS '" DTaP/DTprrd > !! POLIO (\ " 0 .c \P atl~ luL- U) HIB U) '" HEPEl c 0 .;;; MMR U) '" - 0 VARICELLA ~ a. fi PNEUMOCOCCAL . ro '" .c OTHER '" J '" SCREENING TESTS DATE TEST OONE ---:- NOTE HERE IF RESULTS ARE PENDING OR ABNORMAL 10 LEAD '0 c ANEMIA (HGB/HCT) 0 ~ URINALYSIS (UA) (al age 5) .!:! HEARING (subjective until age 4) ,,/" c " E VISION (subjective until age 3) ........ E PROFESSIONAL DENTAL EXAM '" HEALTH PROBLEMS OR SPECIAL NEEDS. RECOMMENDED TREATMENT/MEDICATIONS/SPECIAL CARE :E (ATTACH ADD!TIONAL SHEETS ;: jrf&1; dllnl!ll. . IF NECESSARY) 1; E o NI/(INf- It..~ lykG rJ JI~b U) - NONE _ " NEXT APPOINT ENT - MONTHIYEAR: c '" MEDICAL CARE PROVIDER ~~ 4~ ~ P\ ~ SIGNATURE OF PHYSICIAN 0 PNP' OJ ,J I ollill~ \'V{!'O"'-l 0.. ADORESS: I ~3~ ("oJ ~I" r.""~ D II U~ I^ -~ r-- ft~.,~..,.,- , i'::'::: .1 : ~ ," -~~"'-""', --.r . "- ,"", .~. ~TiO VERiFiCATION ~~.' ~ c... ., A ~ ----- ----- KinderCore. 21 Ins . _\+ct,r patient ,,\o..rro d J C>~ ;')0() is applying for enroliment for childcare vices at KinderCare learning Centers, Inc. We ask for your cooperallon in helping us 10 ensure that KinderCare is .,51e 10 provide Ihe best possible environment for this child. Your medical opinion is critical in deciding whether to enroll this child. We do not promise emolimenl to every child. . KinderCare is not a medical treatment facility, medical services are not provided, and the teachers are not medicaliy trained. KinderCare does not provide one-an-one care. I KinderCare is a group care.facility. We provide meals and snacks, rest times, outdoor play times, and foliow an established curriculum. In addition, we provide periodic field trips 10 nearby parks and places of interest. In accordance w~state law, the ratio in' this area is ~ teacher for every 10 children and there Will, ~e il maximum of 0 children in this area. The children in this area range in age from ,~~o /5ifur.6 KinderCare's policy is to accept children in compliance with the Americans With Disabilities Act (ADA), its implementing regulations afld any other applicable federal, state or local laws that apply to the provisiofl of services to those with disabilities. We review each child's siiuation on a case-by-case basis t6 determifle how we can best meet the needs of each child within the KinderCare setting. . ' Do you believe your patient requires any modifications or accommodations in order to be ca~d rand participate in the activities provided in the KinderCare setting as described above? oVes No. If yes, indicate belbw what these modtlications would be. If necessary, use additional sheets of paper 0 the back of this fonn. . If you have any questions or COflcems please contact me at '12_ '? - 11 2..0 KinderCare's Disability Services Coordiflator at 1-800-633-1488, ex!. 1440. or you may contact ~:",.~,~~, ~ Doctor's Signature ------ KinderCare Center Director Doctor's Phone Number IIJv (loci ~~~L 61101. I f~ 11t)5 'l111mW7 Doctor's Address PLEASE RETURN THIS LETTER TO: ; Kil1d,~~~Le'ai'i:lil:fg Center 730 Wertzville Ro&d Enola, ?A 17025 KinderCare does not discriminate on the basis of disability. KiflderCare has appointed a Disability Services Coordinator to attempt to resolve disability-related issues. You can contact this person at the address listed below or the toll free number listed above. (CENTER STAMP) KinderCare Leamiflg eeflters, Inc. Disability Services Coordiflator 650 NE Holladay Street, Suite 1400 Portland, OR 97232 1-800-633-1488, ext. 1440 PPP.HRS-3166E 12/03 ;\~~j,:W '-",7 ,- _',,,, "_, _.e<_,' _ ^>,<,_",,~>~ ~ f"-'I ",~, _'c,'- ,-. -:.'1. - .,,,~-- ' " t'- :"] ~ .,. ",' -.~ " -~ ~' - < ~- cRUb-y 2). CWee;~ TELEPHONE 717-243-1294 ATTORNE:Y AT LAW August 18, 2005 TEN WEST HIGH STREET CARLISLE. .:ENNS,i~.tNlt ~P2US59S5 Recer'l1:a _______......c"""~ __ RAV __. SSE Pi~~nGLE5~S NOTE 1'.1;.~_:_,_::..:':,; - ~:>!-':.-;:u,i.l'-lT Done ---0.... ____.~ ;:",_< :!~:.::. t.:\:-:~~ ,:,_,: -." "::1 :\..c-:'J:': ~:.:ent _____. R":-.p-r:;1.t Good Hope Family Physicians 1830 Good Hope Road Enola, PA I\'(,,~~::~ ;c'-!.';-"i"~{',:; -- -F Ll~') t4 - -"..;.J "_- p"P..0VJrY:"R ~Mf --iiB~i._-fFo/~~ ~".- Re: Jarrod Scott Johnson Dear Doctors: 7 I represent Jarrod's father, Keith Johnson, in a cus y matter. Mr. Johnson has shared legal custody per the enclosed ordC<LoLcu Qdy, Mr. Johnson will be contacting your office to discuss Jarr9d'-sasthma ~ems-~ith th~ doctor in your practice who has seen Jarrod and to<O.htaiii:zrropy of his medical records from your office. Mr. Johnson understands that you may charge him for these copies. An emergency custody hearing is set for 3:00 p.m., Thursday" August 25, 2005, before The Honorable Judge Edgar Bayley. At the present time it is not anticipated that your testimony will be necessary. If it becomes so, I will let you know at the earliest possible moment and will try to work it out so you could testify by telephone. Please do not hesitate to call if you have any questions about any ofthis. Thank you in advance for your help in this matter. Sincerely, RubyD. Weeks RDW:wkh Enclosure(s) as noted above cc Jessica DiamQndstone, Esquire, attorney for mother Keith Johnson, father :i';1j';~~,,,,,. ,'^? -, " ",0 !',_;, . T'?""""''''~F\'~''7' ''':_;'_'-''>:____" ~,TH-h,-~ ".-,-~" ,~, _',,' "-I" , . ''','' ,,,_?, ~o JOEL NICOLE BRYAN, : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA vs. : NO. 01- 6923 CIVIL TERM KEITH DAVID JOHNSON, Defendant : PROTECTION FROM ABUSE AND CUSTODY CUSTOD'Y ORDER . AND NOW, thisl\" '!iv day ofDeccmber, 2001, the following Order is entered by consent of the parties with regard to custody of the parties' child, Jarrod Scott Johnson, D.O.B.: 3/21/01. 1. Plaintiff, hereinafter referred to as the mother, and Defendant, hereinafter referred to as the father, shall share legal custody of the child. 2. The mother shall have primary physical custody of the child. 3. The father sh~il have partial custody of the child on alternating weekends from Friday . . at 4:00 p.m. iii:dilSunday"':at6:00 p.m., two weekday periods (days to be agreed by the parties) from 4:00 p.rn. until 7:00 p.m., and on other days and at times mutually agreed by the parties. 4. The parties shall share the Thanksgiving Day holiday With thle mother having the child until 3:00 p.m. and the father having the child from 3:00 p.m. until 8:00 p.m. (or through Friday at 6:00 p.m. ifhe does not work the day after Thanksgiving, and through Sunday at 6:00 p.m. ifit is his scheduled weekend with the child 5. The father and mother shall alternate the Christmas holiday with one parent having the child on Christmas Eve from noon until Christmas Day at noon, and the other parent having the child from noon on Christmas Day until December 26th at noon. The mother shall cornrnence the schedule having the child on Christmas Eve in 200 1, and in odd years thereafter, and the father shall have the children in the even years. 6. The mother shall have the child on Mother's Day from 9:00 a.m. and keep him for the remainder of the day. and the father shall have the child on Father's Day from 9:00 a.m. until 6:00 p.m. .~--! -, "i-:_'",:-!'-c"?'<~',p-,~,-^,,- .,---.. ~, - ,- ~ ), - - l' -.' _ ."'1'_',__0-,- ',';':' 1-"' '__""~ 'r _-of, ". n. _ "," "r,_ 1-- . ,.-~_ ~. ~J " .' 7. The father shall have the right to partial custody ofthe child for 1 week of vacation each year. The father shall give the mother two weeks notice as to when his period of custody will take place. The mother shall have the right to have the child on weekends during that time unless the father takes the child on a vacation trip including weekends. The mother also bas the right to take the child on a vacation including a maximum of 2 weekends. The vacationing parent shall provide the other parent with a complete address and telephone number where .the child will be during the vacation pedod. 8. The mother and father, by mutual agreement, may vary from this schedule at any time, but this Custody Order extends beyond the expiration of the above~captio!led Final Order of Court and remains in effect pending further Order of Court regarding custody . . 9. The mother and father agree that each shall notifY the other immediately of medical emergency which may arise while the child is in that parent's care. . . , 10. N either party shall do anything which may estrange the child from the other parent, or injure the opinion of the child as to the other parent or which may hamper the free and natural ~,_1." ~.",' development of the child's love or respect for the other parent. By the Court, ;; Trlls Order is e"tered~JrSuantlO the consent of Plaintiff and !j i . ,'.~ .'. - 1Q1!n Carey, Attorne or Plaintiff MidPenn Legal Serv ces 8 Irvine Row Carlisle, P A 17013 r,' Q3!j."': ("~.j''''H'.r),,'''' c;cr:~..,:f r}t";,.7'''''l~.o\'l~D -! \ t\".~_, \..J__'"l '~ , ~ ,;"I..::?~f~ 1: ~\.,-,,'\.,il......~~'!; In Te.~~~htor;y t.'il~~;~:-f)i:. j h~r::.~ :,'~!~i) ,):~t :ny h~~nj ai:': th!~ s~',ai 01 ~2~d Cm.~;t .~t C:;:rlh;je: Fa. This I,[~ 'day ,()t,(~;~ :kaf (- 'r . n. -~--- ~ . Prothonotarl' ;;''j.~",,'':!l_ __-r .. '.,_"c \'~,'r < ". '_>_7',,'_'"~"_"'_ I' '",-,'-., l"~ -~~ r':;,;rUJ,=.:,,' , ... MEDICAL ARTS ALLERGY, P.C. Joan M. Montello, M.D. . Donald S. Harper, M.D. Jack L. Armstrong, M.D. . Jodi L. Johnson, C.R.N.P. AMERICAN BOARD OF ALLERGY. ASTHMA AND CLINICAL IMMUNOLOGY MEDICAL ARTS BUILDING 220 WILSON STREET. SUITE 213 CARLISLE. PA 17013-3657 Phone: (717) 243-7540 Fax: (717) 243-9968 FREDRICKSEN OUTPATIENT CENTER 2025 TECHNOLOGY PKWY., SUITE 310 MECHANICSBURG. PA 17050 Phone: (717) 791-2540 Fax: (717) 791-2546 BLOOM OUTPATIENT BUILDING 4310 LONOONDERRY ROAD, SUITE 109 HARRISBURG. PA 17109 Phone: (717) 920-4340 Fax: (717) 920-4341 RE: Jarrod Johnson BD: 3-21-01 Visit: 8-10-05 I had the pleasure of seeing Jarrod for visit 8-10-05. Jarrod continues to have significant nasal symptoms and nasal obstruction. His mother and grandmother, who bring him here today, feel that Nasonex attimes does not even penetrate due to the nasal obstruction. Of note: He does not appear to have frequent respiratory tract infections such as otitis, sinusitis or bronchial infections. ReOOl'led .' . AlJJ~' T ~PFOOFJ300 ~ 1 72005 CURRENT MEDICATIONS -- j>T<.y,.,,,j.. C.\FCiRM Bi\TIEr'rr Done___ -'"'~<~ '~ Lc~:t-t';r S0ut 1. Nasonex is used only pm. . ~eT:~::o~i;~:::Y:T test done to some co~mZ~:~sUCh cat, dog, grass, molds, tree pollens, ragweed. All of which w~n1~ve. Staff Da PHYSICAL EXAMINATION Temp: 100.20 Pulse: 92 and regular Resp: 16.5kg. . HEENT: 20 and regular HT: 102.0cm. WT: E: Conjunctivae are pink. The lids are normal. E: Tympanic membranes are clear and mobile. External auditory canals are normal. N: Nasal turbinates are pale with clear mucoid discharge. There is some crusting about the turbinates. T: Oropharynx is normal including: teeth, gum, palate, tongue. There is no exudate of the posterior pharynx. NECK: Neck is supple, there is no thyromegaly or cervical lymphadenopathy. LUNGS: Lungs are clear to auscultation, there are no retractions. CARDIAC: Cardiac exam is normal without murmurs or extra sourlds. ';"':'~'~-':~";)!':O;:" .'^' ',' ~_"r,'''" .,"< ""'". ,.,<.:"r -,' ,", - ~ Page 2 Jarrod Johnson AugustlO, 2005 IMPRESSION 1. Chronic non allergic rhinitis. 2. Negative allergy skin tests/Negative puncture skin tests. RECOMMENDATIONS 1. I did recommend that the family use nasal saline irrigation and a handout was given to them which gives them a "recipe" describing iodized salt, baking soda and distilled water to be administered by either bulb syringe or bottle. 2. I also asked Jarrod to see Dr. Abram to be sure we are not dealing with obstruction from large adenoids or other anatomical problems that might be helped. The mother seems most agreeable with this plan. I have asked to see Jarrod after. he has an ENT consult. Joan M. Montello, M.D. JMM/ambM C: Denise Harr, M.D., Good Hope Family Practice, 1830 Good Hope Road, Enola, PA 17025 " I ;,-<\-'#L, '-'-(, ",3~":_~'f,-",<,_.,-"~,;:,, __To.;'_'_' --', -, C',VJ:--.,'^"'_' "1 ~' -, - '. -~--~,~,,:~, .," " '0" La ""~~'. ~..,- '~. .. '"-- ,-11I RE: Jarrod Johnson BD: 3-21-01 Visit: 3-16-05 MEDICAL ARTS ALLERGY,. P.C. ~~v~l..0.'~-.:L,F: 0(':'(",'~ Joan M. Montello, M.D. . Donald S. ~~:D. '- - : 'C'.",' .. _ Jack L. Armstrong, M.D. . Jodi L. Joh~:~~&,,~~~ .' r .' ..,-; ~"i'.~;;; HOJE AMERICAN BOARD OF ALLERGY. ASTHMA AND cLI~.ti~R~;~.%~;~~i'U,4.~~:nat;y Dcofle ~ .ftli.~,f~..,.. "., <, :.i.,4'r~{."~n.! - ,.-.,.-_./.,.r,., 1,3~ FREDRICKSEN OUTPATIENT CENT~~..P.'';~I.~ B'~QO!il1)UTPATIENT BUILDING 2025 TECHNOLOGY PKWY., SUITE 310 43td"t5'fiIl?J IDERRY ROAD, SUITE 109 MECHANICSBURG. PA 17050 _ '!fill., 11>< HAR BURG. PA 171 09 Phone: (717) 791-2640 - 'Ji:< Ph : 7) 920-4340 Fax: (717) 791-2646 ~. 920-134.tO". .i....... Stair .' .n{ . 'wcli ~_3J29J/OtL MEDICAL ARTS BUILDING 220 WILSON STREET, SUITE 213 CARLISLE. PA 17013-3657 Phone: (717) 243-7640 Fax: (717) 243-9968 I had the pleasure of seeing Jarrod for visit 3-16-05. We were not able to do intradermal testing today as the child resisted this procedure so we declined continuing with testing. His mother and grandmother, who bring him in today, feel that Nasonex has definitely helped his symptoms and he does have better nasal breathin~. PHYSICAL EXAMINATION Temp: 98.90 Pulse: 120 and regular 16.2kg. HEENT: Resp: 24 and regular HT: 100.5cm. WT: E: Conjunctivae are pink. The lids are normal. E: Tympanic membranes appear clear and mobile. auditory canals are normal. External }O1: 1'1asal turbinates are pink "vithout mucoid discharge. T: Oropharynx is normal including: teeth, gum, palate, tongue. There is no exudate of the posterior pharynx. NECK: Neck is supple, there is no thyromegaly or cervical lymphadenopathy. LUNGS: Lungs are clear to auscultation, there are no retractions. CARDIAC: Cardiac exam is normal without murmurs or extra sourlds. IMPRESSION 1. Chronic rhinitis. RECOMMENDATIONS' 1. Because I was unable to do intradermal tests to really determine if there is an allergic component to his symptoms I did ask Jarrod to get a RAST test to Northeastern pollens as well as dust mites and animal danders. The results of the RAST tests are pending at the time of this dictation. ~'J,.-~ TI'W:" "',":H-'-',':,-''''--2%;, .-.'_--~,-,,"- -"'''/i '-r_, 7~-~'~ ~,.:m:I'_"_ or' ,---,.,,-~ "1... i.li!'" " ~'~ ;, ---, <~- 'w ~ ~ .~ -., ,'-' ,'. Page 2 Jarrod Johnson March 16, 2005 2. Both his mother and grandmother seem most pleased with the use of Nasonex and I asked them to continue this at one spray per nostril daily until I see: Jarrod again which would be in two months. The family was invited to call sooner if there is any change or worsening of symptoms. , , Joan M. Montello, M.D. "I "1 II ~; ~~ !;1 JMM/ambM c: Denise Harr, M.D., Good Hope Family Practice, 1830 Good Hope Road, Enola, P A 17025 f! " \,) l:; 1-, Ii L! ;,) i:i !-! :-, i: :-1 f,; , Ii , ;,1 ~. , :~ ii, r-i;1!",-- :,:;;'F,;': "'''-1''.,,;::C',<,'-'-' -- - "d' " , '-~ -' - --'-,0",'''- - roo: -,,~ - ~-,' '--'<'-_. ,,' _ ... o~, _,,,__,,,, ",' ., ~ CC, "0 MEDICAL ARTS ALLERGY, P.C. RE: Jarrod Johnson BD: 3-21-01 Visit: 2-23-05 Joan M. Montello, M.D. . Donald S. Harper, M.D. Jack L. Armstrong, M.D. . Jodi L. Johnson, GRN.P. iLilt) 'jj (.',~,-., "-r"" .," Mi"\f . v ',i~"" AMERICAN BOARD OF ALLERGY. ASTHMA;!;Ni:r~NlS .' OLOG~{.~ _. Ar>.V FREDRICKSEN OUTPATIENTC~j~~~'OGRES~'iiOOIiEOUTPATIENT BUILDING 2025 TECHNOLOGY PKWY:7'StJl'tE'.3fi}!. . ~.'.] '.'H!q:1M-P.Il:!\l~RY ROAD, SUITE 109 MECHANICSBURG.PA-1'.l050',:," _ ~RR\1iBUR~~.- Phone: (717) 791o~Q..: ..., "- ...: ~4li\Ofto!lllilF) 920-434()'" Fax: (717) 791-2646 ...,...".... -- Fax: (717) 920-4341 ~...._l,t"":.:;:.;.,......., _I~ILE~..- - PROVIDER '>taft .._~ Date _3/ajD'f_ -........ MEDICAL ARTS BUILDING 220 WILSON STREET, SUITE 213 CARLISLE. PA 17013-3657 Phone: (717) 243-7540 Fax: (717) 243.9968 I had the pleasure of seeing Jarrod Johnson at the request of Dr. Denise Harr. He is a 3 II/12th year old child who is "always stuffy" and "sounds like he has a cold". i, The mother and grandmother, who accompany Jarrod today, states that he has been like this most of his life. In early infancy he had frequent episodes of otitis, but never required PE tubes. Currently he seems to have frequent respiratory tract infections during the winter months. Fortunately, he does not seem to require frequent courses of antibiotics. He is here today primarily because of nasal congestion. The mother states he does have noisy breathing if not snoring at bedtime. . The family does not notice a seasonal pattern that may be significant for pollenosis. The child has no history of recurring infections such as sinusitis or bronchial infections. The ear infections were primarily in the first year oflife. The child denies a history of allergies to medications such as Penicillin, Sulfa. There are no known food allergies, bee sting allergy, latex or other contactants such as metals, etc. CURRENT MEDICATIONS 1. Zyrtec 1 teaspoon once a day prn nasal congestion. NEWBORN HISTORY The child was the product of a full term normal pregnancy, labor and delivery. Birth weight 6 pounds 7 ounces. The infant did have some hypoglycemia in the neonatal period, but other than that everything was normal. The first year of life he did have recurring otitis. ;.:'~~,~,. "'1"""',,- ',"",_ ;_'?>'''~'_ _;"~ _Y.'<:,_ -.;". '. " .,' 'v:'''~f,~':-.;''e:,'..r:-r'- --~". _' -.r., "';,.?_.. :u.- ,.- .. ". :'-.1 Page 2 Jarrod Johnson February 23, 2005 REVIEW OF OTHER MEDICAL PROBLEMS Essentially unremarkable. PAST MEDICAL IDSTORY Non contributory for hospitalizations or surgeries. FAMILYIDSTORY A maternal grandfather has allergies but no other relatives are known to have allergies or asthma. ENVIRONMENTAL HISTORY A complete environmental history was reviewed with the patient's family. PHYSICAL EXAMINATION HR: 90 and regular Resp: 20 and regular 100.5cm. HEENT: Temp: 98.80 WT: 16.2kg. HT: E: Conjunctivae are pink. The lids are normal. E: Tympanic membranes appear clear and mobile. External auditory canals are normal. 'l..T 'l..T___1 .....__L~__....__ ___ _.___11__ ___:...L_~_... __.__~...t .J~__L____ 1'1: 1'1~W. lW'U111C1U;:;:S IDe :SWUllCll,WlWUUl lllU\,;;VlU Ul:S\';;lli1J.~C. T: Oropharynx is normal including: teeth, gum, palate, tongue. There is no exudate of the posterior pharynx. NECK: Neck is supple, there is no thyromegaly or cervical lymphadenopathy. LUNGS: Lungs are clear to auscultation, there are no retractions. CARDIAC: Cardiac exam is normal without murmurs or extra sounds. ABD: Abdomen is soft without hepatosplenomegaly. There are no abdominal masses. There is no lymphadenopathy. EXT: There is no digital clubbing, cyanosis or infection. SKIN: The skin is clear of rashes and lesions. PROCEDURES The child was skin tested by the puncture technique to inhalants, animal danders, mixed grasses, weeds (including ragweed), tree pollens, molds and foods. He had mildly positive test to dust mites, but they did not match the histamine control as well as fusarium, mucor and penicillium and one tree hackberry. ':,~~ H _~'-'_ _ 'l",'-, '_:C"""1'-7:"('~~,,-1 ~-/.-",,~;-~ .. - -, -~, _,-I',' _ ~ :''', 'C".'C'C",- ~, t-'-_. - --:-,~<", -~, " ." -., _ "w ~ ,. "' " ""~ ,=~.-'< ~-~ ,. Page 3 J arrod Johnson February 23, 2005 IMPRESSION. 1. Perennial nasal congestion. 2. Mildly positive skin tests dust mites/mold (Did not match histamine control). ro:COMMENDA TlONS I started J arrod on N asonex 1 spray per nostril daily and our nurses instructed the family on the proper use of the intranasal steroid spray. I would like him to stay on this until I see him again and at that time do further intradermal tests. The family seems most agreeable with further testing and they were invited to call at any time should there be any. further problems. Joan M. Montello, M.D. JMM/ambM c: Denise Harr, M.D., Good Hope Family Practice, 1830 Good Hope Road, Enola, P A 17025 (;~:--_.~, - ,I - '-1 .'-':";',t'l'_~",,! ,'"of' !-''-:''- ,'. - --,,,.<.~ --'" ~'-'7"___"- '_~,._ ,_ " "'_,~_n .,_ _, C',__ - , n~ y- ,~~ " \ "= {;");C;J;'-',"'~'-l('--"""'-"-~"- '-,',0 ,~~ JOEL NICOLE BRYAN, PLAINTIFF IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ( V. KEITH DAVID JOHNSON DEFENDANT CIVIL TERM 01- (/,9.23 ORDER OF COURT AND NOW, this z:Cfl- day of August, 2005, Joel Nicole Bryan is adjudicated in civil contempt for violating the custody order of December 18,2001. She may purge herself of contempt by complying with all provisions of the new custody order Jessica Diamondstone, Esquire For Joel Nicole Bryan entered this date. I :sal ~~ fv~9,d Q- Ruby Weeks, Esquire For Keith David Johnson r(~~__~"." ~,,':-,~:T,~'0-,",-P" l'>-~-':'''''_,r,.-~ . -'-, ,~ - .' :''' --' ;., 1- ': ' -- ',-'.- ' - ?: f.2 (") ~ "-7 Co ',~-~) U.J~; ,- :::2_ 0/- .e- t+~~ ~"" 05 Cf\ 60: N uJO- '-" duJ ::~ U-:r:: ....r.:r: -. 1- if.> ~'-- LL = ::) 0 = (,) <-' ",.,., .,Jnl"J!JI.~,,,,,,,[,,.. ' _,'i'-><,~,' fCi' ~- ,~" ," J , , <--~ : , ~ ~ ~~'" .,.,..,;,.;" ~~ ;~ 'j(.iiilk'- ',-' ::.' t'n ;:if"_ 't"'"-'\i?-:--':r-'~[f j"-'"Q"J',"'::"trr:"-"T i<cl'F':-;>j :"'~'i 'X~'~' , E~ ~ ~, , _ ,_,.".,_"~. ~_ ".,_ ~._~_;~".~f~~,~I'i;t~~~W;-fr'~"I'i!'-9'>~9~1~~-__ -;~~_<Jl,l;}t~l~~~~r,;;iJ;wj\'S"~~:'; ~~~-,,-^,-- < .,. - "' " . JOEL NICOLE BRYAN, PLAINTIFF IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA V. KEITH DAVID JOHNSON DEFENDANT CIVIL TERM OI-(P9~ AND NOW, this ORDER OF COURT "2q~ day of August, 2005, following a hearing on the merits, IT IS ORDERED: (1) All prior custody orders are vacated and replaced with this order. (2) Joel Nicole Bryan and Keith David Johnson shall have shared legal custody of their son, Jarrod Johnson, born March 21, 2001. (3) The mother shall have primary physical custody of Jarrod. (4) The father shall have temporary physical custody of Jarrod: (a) For as long as he is working on his current shift of 6:00 p.m. to 4 a.m. Tuesday through Saturday, every other weekend from 7:00 p.m. on Friday until 7:00 p.m. on Monday. (b) If his shift changes as anticipated to 4:00 p.m. to 2:00 a.m. Monday through Friday, every other weekend from 7:00 p.m. Friday until 7:00 p.m. Sunday. (5) The parents shall share the Thanksgiving Day holiday with the mother having Jarrod until 3:00 p.m., and the father having him from 3:00 p.m. until 8:00 p.m. or through Friday at 6:00 p.m. if he does not work the next day, and through either Sunday at 7:00 p.m. or Monday at 7:00 p.m. depending on his shift schedule, if it is his scheduled weekend. '$.U-,, ,,-- :"',,_' ,,'~:~"'_' .._ -, -- -- '''"1 .co.,,' _",- "."~ -' 1'-..' - ~-~ i't~'.~ .~. - -- . . (6) The father and mother shall alternate the Christmas holiday in two segments. One parent shall have Jarrod from Christmas Eve at noon until Christmas Day at noon, and the other parent shall have him from noon on Christmas Day until December 26th at noon. The segments shall alternate.as per the schedule set in the prior custody order. (7) The father may have Jarrod for a continuous two week period each summer, Sunday to Sunday, and the mother may have him for a continuous two week period each summer, Sunday to Sunday. Each parent shall give the other at least 30 days notice if they intend to exercise these two week periods or any lesser slilch periods. (8) The father shall arrange for all transfers. Transfers shall be at the mother's home with the mother taking and bringing Jarrod to and from the vehicle used for the / Jessica Diamondstone, Esquire For Joel Nicole Bryan transfers. Ruby Weeks, Esquire For Keith David Johnson MfW ~ ~,J-.9,ol Cf- :sal i~:~.~,:_ ,_~,,,.,,.W:Jil '- '-"'-::" -~-''''~'_':<' ,. "-, '''-"-'''0 -, -- ; -':-O,,,::_,,,r., '-'1'-~~"""--' '.'--,,0,,'"--,-- ". - ~~ " , ,< ,-' .' , ,;; ~ 'Z. ~~; ,,:;-:c -0'(==) ?-or" ~-,,-;~ 1.,L.;~ ~U-l w- :t: l- lt.. a ~'J iY') 6 - ...~ :'~ Cf' N ~-2 ~ if> = ~ C' "'0'''':'''"'' '"_'"" "'_;"d ' '" ~'w~~" is ~;~1 ~~~, -,:?::\ ..:,-~X2. . '\'.-~ ',,"\ -- ~,:) D f:7 6~ . r--- 'T~l"~ . "r'i't , -""NJ_, _"","~ ,<\' :",:>'_r,>_~_~-~_l1p$ift~ln)i~ill'='!'~~~~~~;~_~:l_~f;: )C~,_~.'T';> _:"J~~~'_ ::"'-'_;~-'~_~_i:_: ,;.~~!~' <~,-;-- - <__7, ,~'" ,,~ 7,~"/"_"'_' _,;'__' 1,J!-'iD-~~"~fR'-~_._~:,_"-,.-/-