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HomeMy WebLinkAbout03-2837ORIGINAL IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DORIS E. TIMMONS, Plaintiff V. SUSAN L. FLICKINGER, Defendant CIVIL ACTION - LAW NO. oa -7 JURY TRIAL DEMANDED NOTICE TO DEFEND You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this Complaint and Notice are served, by entering a written appearance personally or by attorney and filing in writing with the Court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and judgment may be entered against you by the Court without further notice for any money claimed in the Complaint or for any other claim or relief requested by the Plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Cumberland County Bar Association 2 Liberty Avenue Carlisle, PA 17013 (717) 249-3166 (800) 990~9108 1N THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DORIS E. TIMMONS, Plaintiff V. SUSAN L. FLICKINGER, Defendant CIVIL ACTION - LAW NO. JURY TRIAL DEMANDED NOTICIA Le han demandado a usted en la corte. Si usted quiere defenderse de estas demandas expuestas en las paginas sugnuientes, usted tiene viente (20) dias de plazo al partir de la fecha de la demanda y la nofificacion. Usted debe presentar una apariencia escrita o en persona o por abogado y archivar en la corte en forma escrita sus defensas o sus objeciones a las demandas en contra de su persona. Sea avisado que si usted no se defiende, la corte tomara medidas y puede entrar trna orden contra usted sin previo aviso o notificacion y por cualquier queja o alivio que es pedido en la peticion de demanda. Usted puede perder dinero o sus propiedades o otros derechos importantes para usted. LLEVE ESTA DEMANDA A UN ABOGADO IMMEDIATEMENTE. SI NO TIENE ABOGADO O SI NO TIENE EL DINERO SUFICIENTE DE PAGAR TAL SERVICIO, VAYA EN PERSONA O LLAME POR TELEPFONO A LA OFIC1NA CUYA DIRECCION SE ENCUENTRA ESCRITA ABA JO PARA AVERIGUAR DONDE SE PUEDE CONSEQUIR ASISTENCIA LEGAL. Cumberland County Bar Association 2 Liberty Avenue Carlisle, PA 17013 (717) 249-3166 (800) 990-9108 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DORIS E. TIMMONS, Plaintiff V. SUSAN L. FLICKINGER, Defendant CIVIL ACTION - LAW NO. JURY TRIAL DEMANDED Pennsylvania, Pennsylvania. COMPLAINT Plaintiff Doris E. Timmons is an adult individual, citizen of the Commonwealth of who resides at 315 East Catherine Street, Chambersburg, Franklin County, 2. Defendant Susan L. Flickinger is an adult individual, citizen of the Commonwealth of Pennsylvania, who resides at 415 Clifton Road, Shippensburg, Franklin County, Pennsylvania. 3. The facts and occurrences hereinafter related took place on or about November 2, 2002, at approximately 10:45 a.m., on East King Street and South Queen Street, Shippensburg, Cumberland County, Pennsylvania. 4. At that time and place, PlaintiffDoris E. Timmons was operating her motor vehicle, a 1989 Ford Crown Victoria, in a eastbound direction on East King Street, Shippensburg, Cumberland County, Pennsylvania. 5. At the same time, Defendant Susan L. Flickinger was operating a KIA and was also traveling east on East King Street directly behind PlaintiffDoris Timmons' vehicle. 6. At that time and place, Plaintiff Doris E. Timmons was stopped on East King Street and was waiting for the vehicle in front of her to turn left into the entrance to the drive-up ATM of M&T Bank at the comer of East King Street and South Queen Street. 7. At that time and place, Defendant Susan L. Flickinger operated her vehicle at a high rate of speed when, suddenly and without warning, she violently slammed into the rear of Plaintiff Doris E. Timmons' vehicle. 8. At that time and place, a violent collision occurred between the front portion of Defendant Susan L. Flickinger's vehicle and the rear portion of Plaintiff Doris E. Timmons' vehicle. 9. The foregoing accident and all of the injuries and damages set forth hereinafter sustained by Plaintiff Doris E. Timmons are the direct and proximate result of the negligent, careless, wanton and reckless manner in which Defendant Susan L. FIickinger operated her motor vehicle as follows: (a) failure to have her vehicle under such control as to be able to stop within the assured clear distance ahead; (b) failure to keep alert and maintain a proper watch for the presence of other motor vehicles on the road; (c) failure to apply her brakes in sufficient time to avoid striking the rear of Plaintiff Doris E. Timmons' vehicle; (d) failure to take reasonable evasive action to avoid the accident; (e) failure to travel at a safe speed; (f) failure to drive the vehicle with due regard for the road and traffic conditions which were existing and of which she was or should have been aware; (g) failure to keep proper and adequate control over the vehicle; 261222.1\RAS\LBM 2 0) driving the vehicle upon the road in a manner endangering persons and property and in a reckless manner with careless disregard to the rights and safety of others and in violation of the Motor Vehicle Code of the Commonwealth of Pennsylvania. 10. As a result of the aforementioned accident, Plaintiff Doris E. Timmons sustained painful and severe injuries which include, but are not limited to, dislocated first metacarpal; carpal articulation, hyperextension of web space and pollicis, injury to right index metacarpal head, and a crescent shaped bony fragment consistent with avulsion. 11. By reason of the aforesaid injuries sustained by PlainfiffDoris E. Timmons, she was forced to incur liability for medical treatment, medications, hospitalizations and similar miscellaneous expenses in an effort to restore herself to health, and claim is made therefor. 12. Because of the nature of her injuries, Plaintiff Doris E. Timmons has been advised and, therefore, avers that she may be forced to incur similar expenses in the future, and claim is made therefor. 13. As a result of the aforementioned injuries, Plaintiff Doris E. Timmons has undergone and in the future will undergo great physical and mental suffering, great inconvenience ~n can'ying out her daily activities, loss of life's pleasures and enjoyment, and claim is made therefor. 14. As a result of the aforementioned injuries, Plaintiff Doris E. Timmons has been and in the future will be subjected to great humiliation and embarrassment, and claim is made therefor. 261222.1\RAS\LBM 3 15. As a result of the aforementioned injuries, Plaintiff Doris E. Timmons has sustained work loss, loss of opportunity and a permanent diminution of her earning power and capacity, and claim is made therefor. 16. Plaintiff Doris E. Timmons continues to be plagued by persistent pain and limitation and, therefore, avers that her injuries may be of a permanent nature, causing residual problems for the remainder of her lifetime, and claim is made therefor. WHEREFORE, Plaintiff Doris E. Timmons demands judgment against Defendant Susan L. Flickinger in an amount in excess of Twenty-five Thousand Dollars ($25,000.00), exclusive of interest and costs and in excess of any jurisdictional amount requiring compulsory arbitration. 4503 N. Front Street Harrisburg, PA 17110 (717) 238-6791 Counsel for Plaintiff Date: June 16, 2003 261222.1 \RAS\LBM VERIFICATION I, Doris E. Timmons, Plaintiff, have read the foregoing PLAINTIFF'S COMPLAINT and do hereby swear or affirm that the facts set forth in the foregoing are true and correct to the best of my knowledge, information and belief. I understand that this Verification is made subject to the penalties of 18 Pa.C.S.A. Section 4904, relating to unswom falsification to authorities. Witness orls E. T~mmons Dated: 261245.1 ~RAS\MLB m:\home\bqa\litigat\statefrmWLICKINGER\entryofappearance.wpd Draft #1 July 16, 2003 Brigid Q. Al ford, Esqu/re Supreme Court I.D. #38590 Jeffrey E. Piccola, Esquire Supreme Court I.D. #1g018 BOSWELL, TINTNER, PICCOLA & WICKERSHAM 315 North Front Street Post Office Box 741 Harrisburg, Pennsylvania 17108-0741 Attorneys for Defendant Susan L. Fliekinger DORIS E. TIMMONS, Plaintiff V. SUSAN L. FLICKINGER, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA No. 03-2837 - CIVIL TERM CIVIL ACTION - LAW JURY TRIAL DEMANDED PRAECIPE FOR ENTRY OF APPEARANCE Kindly enter the appearances ofBrigid Q. Alford, Esquire and Boswell, Tintner, Piccola & Wickersham on behalf of Defendant Susan L. Flickinger. Respectfully submitted, By: Brigid Q?'Alford, Esquire Supreme Court I.D. #3~1590 BOSWELL, TINTNER, PICCOLA & WICKERSHAM 315 North Front Street Post Office Box 741 Harrisburg, Pennsylvania 17108-0741 Attorneys for Defendant Susan L. Flickinger Date: CERTIFICATE OF SERVICE I do hereby certify that I have served a true and correct copy of the foregoing Praecipe for Entry of Appearance by placing the same in the United States Mail, first class, postage prepaid, at Harrisburg, Pennsylvania, addressed as follows: Richard A. Sadlock, Esquire Angino & Rovner, P.C. 4503 North Front Street Harrisburg, PA 17110 Date: By: i~id Q. ~lford, l~s-qu~ Bfigid Q. Alford, Esqu/re Supreme Court I.D. #38590 Jeffi'ey E. Piccola, Esquire Supreme Cour~ I.D. #18018 BOSWELL, TINTNER, PICCOLA & W1CKERSHAM 315 North Front Street Post Office Box 741 Harrlsbm-g, Pennsylvania 17108-0741 Attorneys for Defendant Susan L Flickinger DORIS E. TIMMONS, Plaintiff V. SUSAN L. FLICKINGER, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA No. 03-2837 - CIVIL TERM CIVIL ACTION - LAW JURY TRIAL DEMANDED Date: NOTICE TO PLEAD TO: Doris E. Timmons C/O Richard A. Sadlock, Esquire Angino & Rovner, P.C. 4503 North Front Street Harrisburg, PA 17110 You are hereby notified to file a written response to the enclosed New Matter within twenty (20) days from service hereof or a judgment may be entered against you. BOSWELL, TINTNER, PICCOLA & WlCKERSHAM By: Brigi d~Q ~lf~ord, E~ss~ire~ :\home\bqa\litigat\statefrm\FLIl2K/NGER~Answer MTR.wpd Draft # 1 August 6, 2003 Bfigid Q. Alford, Esquire Supreme Court I.D. #38590 Jeffrey E. Piccola, Esquire Supreme Corm I.D. #18018 BOSWELL, TINTNER, PICCOLA & WICKERSHAM 315 North Front Street Post Office Box 741 Harrisburg, Pennsylvania 17108-0741 Attorneys for Defendant Susan L. Flickinger DORIS E. TIMMONS, Plaintiff ¥. SUSAN L. FLICKINGER, Defendant : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : : No. 03-2837 - CIVIL TERM : : : CIVIL ACTION - LAW : JURY TRIAL DEMANDED DEFENDANT FLICKINGER'S ANSVqER TO COMPLAINT WITH NEW MATTER Defendant Susan L. Flickinger, by her attorneys, Brigid Q. Alford, Esquire and Boswell, Tintner, Piccola & Wickersham, answers Plaintiff's Complaint, as follows: 1. Defendant is without knowledge or information sufficient to form a belief as to the truth of the averments set forth in Paragraph 1 of the Complaint; the same are therefore denied and proof thereof demanded. 2. Admitted. 3. Admitted. 4. Admitted. 5. Admitted. 6. Admitted. 7. Defendant Flickinger denies the allegations of Paragraph 7 pursuant to Pa.R.C.P. No. 1029(e), and specifically denies that she operated her vehicle at a high rate of speed and that she "violently slammed" into the rear of Plaintiff's vehicle. 8. Denied that a violent collision occurred. 9. The allegations as to causation, negligence, carelessness, wantonness and recklessness set forth conclusions of law to which no response is required. As to the remaining averments of fact, Defendant Flickinger: (a) (b) (c) (d) (e) (g) (h) (i) Denies that she failed to have her vehicle under such control as to be able to stop within the assured clear distance ahead; Denies that she failed to keep alert and maintain a proper watch for the presence of other motor vehicles on the road; Denies that she failed to apply her brakes in sufficient time to avoid striking the rear of PlaintiWs vehicle; Denies that she failed to take reasonable evasive action to avoid the accident; Denies that she failed to travel at a safe speed; Denies that she failed to drive the vehicle with due regard for the road and traffic conditions which were existing and of which she was or should have been aware; Denies that she failed to keep proper and adequate control over the vehicle; [N.B. There is no Paragraph 9(h) in the Complaint.] [N.B. There is no Paragraph 9(i) in the Complaint.] -2- (j) Denies that she drove the vehicle upon the road in a manner endangering persons and property and in a reckless manner with careless disregard to the rights and safety of others and in violation of the Motor Vehicle Code of the Commonwealth of Pennsylvania. 10. Defendant is without knowledge or information sufficient to form a belief as to the truth of the averments in Paragraph 10 of the Complaint; the same are therefore denied and proof thereof demanded. 11. Defendant is without knowledge or information sufficient to form a belief as to the truth of the averments in Paragraph 11 of the Complaint; the same are therefore denied and proof thereof demanded. 12. Defendant is without knowledge or information sufficient to form a belief as to the truth of the averments in Paragraph 12 of the Complaint; the same are therefore denied and proof thereof demanded. 13. Defendant is without knowledge or information sufficient to form a belief as to the truth of the averments in Paragraph 13 of the Complaint; the same are therefore denied and proof thereof demanded. 14. Defendant is without knowledge or information sufficient to form a belief as to the truth of the averments in Paragraph 14 of the Complaint; the same are therefore denied and proof thereof demanded. -3- 15. Defendant is without knowledge or information sufficient to form a belief as to the truth of the averments in Paragraph 15 of the Complaint; the same are therefore denied and proof thereof demanded. 16. Defendant is without knowledge or information sufficient to form a belief as to the truth of the averments in Paragraph 16 of the Complaint; the same are therefore denied and proof thereof demanded. WHEREFORE, Defendant demands judgment in her favor and against the Plaintiff. NEW MATTER 17. Plaintiff,s Complaint fails to state a claim upon which relief can be granted. 18. Plaintiff's injuries and/or damages, if any, were caused by the acts and/or omissions of persons other than Defendant Flickinger. 19. Plaintiff's injuries and/or damages, if any, were not caused by or related to the accident at issue. 20. The doctrine of contributory negligence and Pennsylvania's comparative negligence statute may serve to bar all or part of Plaintiff's claims. 21. The doctrine of assumption of risk may serve to bar Plaintiff's claims. 22. Plaintiff,s right to recovery may be limited, in whole or in part, by her tort option selection under Pennsylvania's Motor Vehicle Financial Responsibility Law. -4- WHEREFORE, Defendant Flickinger respectfully demands judgment in her favor and against the Plaintiff. Respectfully submitted, Date: ~/o) By: rigid Q. ~lford, l~squi~ Supreme Court I.D. #38'590 BOSWELL, TINTNER, PICCOLA & WlCKERSHAM 315 North Front Street Post Office Box 741 Harrisburg, Pennsylvania 17108~0741 Attorneys for Defendant Susan L. Flickinger VERIFICATION I, Susan L. Flickinger, hereby verify that the facts contained in the foregoing Defendant Flickinger's Answer to Plaintifff s Complaint with New Matter are tree and correct to the best of my knowledge, information and belief. I understand that false statements herein are subject to the penalties of 18 Pa.C.S.A. §4904 relating to unswom falsification to authorities. Susan ff.-FHckinger ~J ~ Date: CERTIFICATE OF SERVICE I do hereby certify that I have served a tree and correct copy of the foregoing Defendant Flickinger's Answer to Plaintiff's sComplaint with New Matter by placing the same in the United States Mail, first class, postage prepaid, at Harrisburg, Pennsylvania, addressed as follows: Richard A. Sadlock, Esquire Angino & Rovner, P.C. 4503 North Front Street Harrisburg, PA 17110 Date: By: Brigid Q~Alford! Esqffre IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DORIS E. TIMMONS, Plaintiff SUSAN L. FLICKINGER, Defendant CIVIL ACTION - LAW NO. 03-2837 CIVIL JURY TRIAL DEMANDED PLAINTIFF'S REPLY TO NEW MATTER OF DEFENDANT AND NOW comes the Plaintiff, by and through her attorneys, Angino & Rovner, P.C., and hereby enter the following Reply to the New Matter of Defendant as follows: 17. Defendant's averment is a conclusion of law to which no responsive pleading is required. To the extent the averment may be deemed factual, it is hereby specifically denied. By way of amplification, Plaintiffs Complaint does state a cause of action upon which relief may be granted. 18. Defendant's averment is a conclusion of law to which no responsive pleading is required. To the extent the averment may be deemed factual, il: is hereby specifically denied. By way of amplification, Defendant's averment lacks the specificity :required by the Pennsylvania Rules of Civil Procedure. Further, all of Plaintiffs injuries and damages were caused solely and directly as a result of the negligence, carelessness, wantonness and recklessness of the instant Defendant. 19. Defendant's averment is a conclusion of law to which no responsive pleading is required. To the extent the averment may be deemed factual, it is hereby specifically denied. All of Plaintiffs injuries and damages were caused solely and directly as a result of the negligence, carelessness, wantonness and recklessness of the instant Defendant. 20. Defendant's averment is a conclusion of law to which no responsive pleading is required. To the extent the averment may be deemed factual, it is hereby specifically denied. By way of amplification, Plaintiff was not negligent in any way. Therefore, the Pennsylvania Comparative Negligence Act and contributory negligence statute do not apply to the instant action. Further, all of Plaintiffs injuries and damages are recoverable in the instant action and are in no way reduced. 21. Defendant's averment is a conclusion of law to which no responsive pleading is required. To the extent the averment may be deemed factual, it is hereby specifically denied. By way of amplification, Plaintiff did not assume the risk of her injuries. Further, as previously stated herein, Plaintiff was not negligent or careless. All of Plaintiffs injuries and damages are recoverable in the instant action. 22. Defendant's averment is a conclusion of law to which no responsive pleading is required. To the extent the averment may he deemed factual, it: is hereby specifically denied. By way of amplification, the Plaintiff selected the full tort option on her policy and is, therefore, entitled to maintain an action for non-economic losses. Further, Plaintiff did suffer a serious injury. Plaintiffs Declaration Page is attached hereto as Exhibit A. 262353.1~AS\MLB WHEREFORE, Plaintiff respectfully requests this Honorable Court to dismiss Defendant's Answer and New Matter and enter judgment in her favor against the Defendant. ANGINO & ROVNER, P.C. Date: August 20, 2003 Rich'~d A:~llock, Es~t~e I.D. No. 47. 1~1~.,~~ 4503 North Fronb-~Street Harrisburg, PA 17110 (717) 238-6791 Counsel for' Plaintiff 262353. I h~4.S\MLB ___~ CENTURY II AUTO POLICY · DECLARATIONS Page I of ?mese Decfa~etiona are a Oa~ of Ine gobcy named adore a~ I~nt~led by p~Jcy number b~ T~ey schedule et c~?ages. They ao~y to each ~nsur~ vehicle as ]~dlcalad. You' policy commies w~h ~niu~ Lia~il~y c~eragOs Itl ~tovi~o~. Policyholder: 5~ 3~ 2~7~50 82~22 ~RI~ E T~S 315 E ~TH~RI~E ST ~SSU~: C~E~BU~. PA ~ Z~O I · 2 Policy Period From: JUN er 200;' to O~C 07. 2002 ~utonyillhelequiredpremlumlorll~leperlOdheslaeenpaldandonly~or INSURED VE~ICLE(S) & SCHEDULE Or COVERAGES 1999 ~ CI:IOaN YT Coverages CC~aE~E~SivE COLLISION ~;~OPERT"Y O,',M~GE ~lA~lLIm¥ ~ILY INJU~ LI~IL~ On'l~ 4.CUNE~L BENEFIT ~ULL ID ;2FABP74FXKXl?9891 Limila OILlabilily ~OTUAL CASH VALU~ LES3 S S0 ACTUAL CASH VALU~ LESS 9 100 $ ~o0,00O F. ACH ~CCUaRENCE 9 300,000 ~ACH OCCURRENCE S ~CO,O00 E~ S 300,000 ~ ~N~ENT 2380 EN~ENT 2311 S 25 PER DAY ~O0,O0~ S 1.50~ SIx Month Prem;um $ 22,t0 S 99.00 S SS.BO S 7.20 S 32.90 9 11.20 41.10 ,30 TOTAL S 300.20 O! (~XD~IS E TIk4d0NS 0~ JOSEP~ E Tzs~S O~ 3~ 2~ .u, ARRIED 07562296 Ot 23 19 UARRqED 04974043 *CCIOE~r tREE DEFENS v~: DRtVER ~t. ILTI LINE FR,.\~IE: A 22 Page 2 ol 2 Ollice Ute: NATIONWIDE MUTUAL INSURANCE COMPANY ~3787 HOME OFFICE: COLUMBUS. OHIO a3215-2220 IMPORTANT PHONE NUMBERS Hallenw, de 24-Haut Clairol Numi~er: 1-100.421.3535 717-2e3-~977 FR.-\g'1£: B 22 ** TDTRL PAGE.03 ** TOTAL PAGE.03 ~* VERIFICATION I, Doris E. Timmons, Plaintiff, have read the foregoing PLAINTIFF'S REPLY TO NEW MATTER OF DEFENDANT and do hereby swear or affirm that the facts set forth in the foregoing are true and correct to the best of my knowledge, intbrmation and belief. I understand that this Verification is made subject to the penalties of 18 Pa.C.S.A. Section 4904, relating to unswom falsification to authorities. Wimess Dated: ~q)En I,_W :Loo _.~ 261245. I\RAS\MLB CERTIFICATE OF SERVICE I, Marcy L. Brymesser, an employee of the law firm of ,~mgino & Rovner, P.C., do hereby certify that I am this day serving a true and correct copy of PLAINTIFF'S REPLY TO NEW MATTER on the following via postage prepaid, first class 'United States mail, addressed as follows: Brigid Q. Alford, Esquire Boswell, Tintner, Piccola & Wickersham 315 North Front Street P.O. Box 741 Harrisburg, PA 17108-0741 Date: August 20, 2003 Mar6y L. B~m~ser (J' 262353.1 ~-JkS~vlLB SHERIFF'S RETURN - OUT OF CASE NO: 2003-02837 P COMMONWEALTH OF PENNSYLVANIA: COO-NTY OF CUMBERLAND TIMMONS DORIS E )~ VS FLICKINGER SUSAN L COUNTY R. Thomas Kline duly sworn according to law, and inquiry for the within named DEFENDANT , FLICKINGER SUSAN L but was unable to locate Her in his bailiwick. deputized the sheriff of FRANKLIN County, serve the within COMPLAINT & NOTICE , Sheriff or Deputy Sheriff who being says, that he made a diligent search and to wit: He therefore Pennsylvania, to On July 24th , 2003 attached return from FRANKLIN Sheriff's Costs: Docketing 18.00 Out of County 9.00 Surcharge 10.00 Dep Franklin Co 32.00 .00 69.00 07/24/2003 ANGINO & ROVNER Sworn and subscribed to before me / ' Prothonotary I-, this office was in receipt of the So answers. Sheriff of Cumberland County SHERIFF'S CASE NO: 2003-00155 T - COMMONWEALTH OF PENNSYLVANIA: COUNTY OF FRANKLIN DORIS E TIMMONS VS SUSAN L FLICKINGER RETURN - REGULAR ROBERT C MURRAY County, Pennsylvania, says, the within COMPLAINT FLICKINGER SUSAN L DEFENDANT , at 0014:55 Hour, at FCSO CHAMBERSBURG, PA 17201 SUSAN L FLICKINGER a true and attested copy of COMPLAINT , Deputy Sheriff of FRANKLIN who being duly sworn according to law, was served upon on the 30th day of June 157 LINCOLN WAY EAST by handing to the , 2003 together with and at the same time directing Her attention to the contents thereof. Sheriff's Costs: Docketing 9.00 Service 9.00 Affidavit 4.00 Surcharge 10.00 .00 32.00 Sworn and Subscribed to before me this / ~-~A day of &00 So Answers ROBERT C MURP~AY By e~pu~ty S~er~f~f ~ 07/17/2003 ANGINO AND ROVNER My Commissio~ E.~ Jan. 29, 2007 In The Court of Common Pleas of Cumberland County, Pennsylvania Doris E. Tinmons ~3_t %-5- q- ys. Susan L. Fllckinger SERVE: same NO. 03-2837 civil NOW, June 19, 2003 , I, SHERIFF OF CUMBERLAND COUNTY, PA, do hereby deputize the Sheriff of Franklin County to execute this Writ, this deputation being made at the request and risk of the Plaintiff. Sheriff of Cumberland County, PA Affidavit of Service ,206~ ,at /~(:Yfo'cloek /9 M. servedthe NOW, within Co by h~dingto ~d made ~o~ to copy of the original the contents thereof. So answers, County, PA Sworn and subscrib/e~efore me this ___fo_ da~.~ ~f~. ,20~5 COSTS SERVICE MILEAGE AFFIDAVIT Brigld Q. Alford~ Esquire Supreme Court I.D, #38590 le fflrey E. Piccola, Esquire Supreme Court I.D. #18018 BOSWELL, TINTNER, PICCOLA & 315 North Front Street Post Office Box 741 Harrisburg, Pennsylvania 17108-0741 Attorneys for Defendant S~san L. Flic DORIS E. TIMMON SUSAN L. FLICKII~ C] As a prerequisi~ Defendant certifies tha (1) anoticc was mailed or deliver¢ is sought to be served ?laintiff 3ER, Defendant : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA .. : No. 03-2837 - CIVIL TERM : _. : CIVIL ACTION - LAW : JURY TRIAL DEMANDED ;RTIHCATE PREREQUISITE TO SERVICE OF SUBPOENAS PURSUANT TO RULE 4009.22 e to service of subpoenas for documents and things pursuant to Rule 4009.22, 7intent to serve the subpoenas with copies of the subpoenas attached thereto d to each party at least twenty days prior to the date on which the subpoena (2) a copy certificate, (3) Plaintit )f the notice of intent, including the proposed subpoenas, is attached to this counsel waived the twenty (20) day objection period; and (4) the sub to the notice of intent .oenas which will be served are identical to the subpoenas which are attached serve the subpoenas. Respectfully submitted, By: ~rigid0Q. Alfo~d, F, so~ire Supreme Court #385~0 Boswell, Tinmer, Piccola & Alford 315 North Front Street Harrisburg, PA 17101 (717) 236-9377 Attorneys for Defendant Susan L. Flickinger Brlgid Q. Al ford, Esquire Sup~me Court I.D. #38590 Jeffrey E. Piccola, Esquire Supreme Court LD #18018 BOSWELL, TIN'TNEIL PICCOLA & 315 North Front Street Post Office Box 741 Harrisburg, pennsylvania 17108-0741 Attorneys for Defendant Su~an L. Flit] DORIS E. TIMMON~ SUSAN L. FLICKIN N( Defendant Sus; attached to this notice inger aintiff ;ER, }efendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA No. 03-2837 - CIVIL TERM CIVIL ACTION - LAW JURY TRIAL DEMANDED lICE OF INTENT TO SERVE SUBPOENAS TO ?RODUCE DOCUMENTS AND THINGS FOR DISCOVERY PURSUANT TO RULE 4009.21 L. Flickinger intends to serve subpoenas identical to the ones that are on the following: oly Spirit Hospital Emergency Room, Dept. of Occupational Therapy and Radiology) ~iesswein Plastic Surgery }arly White, M.D. ,llstate Insurance You have twer upon the undersigned served. Date: Oct. 29, ty (20) days from the date listed below in which to file of record and serve tn objection to the subpoena. If no objection is made, the subpoena may be Respectfully submitted, By: Boswell, Tintner, Piccola. & Alford 315 North Front Street Harrisburg, PA 17101 (717) 236-9377 Attorneys for Defendant Susan L. Flickinger 2003 · DORIS E. TIMMONS, sUSAN L. FLICKINGER, D( SUSP FO~ TO: Holy Spirit Hospita Nkhin ~en~ (20) days a~ersea documentsor[hings: Copies of any and all referrals, x-rays, etc. January 31, 1928; from at 315 North Front S~r~ You may detiver or mail legible cop ,vith the certificate cf compliance, :o seek in advance [he reasonabl~ ~f you fail to produce the document :he path/serving this subpoena m THIS SUSPOENA WAStSSUED/ ~Name Brigid Q. Alf¢ 315 N. Front St Harrisburg, PA Telephone: (717) 236-9377 Supreme Court iD ~ 38590 COUNTY OF CUMBERLAND aintiff File No. 03-2837 fendant ~ENATO PRODUCE DOCUMENTSORTHINGS DISCOVERY PURSUANTTO RULE 4009.22 (Emergency Room, Dept. of Occupational Therapy an (Name of Person or Er~Oty) Radiology) :e of this subpoena, you are ordered by the court [o produce the tedical.records~ treatment records, correspondence for Doris E. Timmons~ SS~162-22-3833~ date-of-biz Jan. 1, 1992 to present. es of the documemts or produce thin~s requested by this subpoena, roger ~ the parW making ~is request at the address listed above. You have the cost of preparing the copies or producing the ~ings s~ught. ; or things required by this subpoena within ~en~ (20) days after frs sar, ~y seek a cour~ order compelling you to comply with ,T THE REQUEST OF THE FOLLOWING PERSON: ,rd, Esquire =' ~:crney For: Date: ., P.O. Box 741 17108-0741 '~ Defend-nat Su~an L. Flickinger al of the Court BY THE COURT: Prothonotary/Clerk, Civil IDivisk oeP, S6 d ~lng th lek (Eft. Y/-< 'TO: · DORIS E. TIMMONS, P: SUSAN L. FLICKINGER, D~ SUBP FOI Gie: Within twen~ (20) days a~ersen documentsorthings: Copies of any and all referrals, x-rays, etc January 31, 1928; from 315 North Front You may de!iver or mail legible cdc ,vith the certificate of compliance, ~o seek in advance the reascnabk ~f you fail to produce the document :he part,/serving this subpoena m THIS SUBPOENA WASISSUED~ Name Bri~id Q. Alf¢ Address: 315 N. Front Harrisburg, PA Telephone: (717) 236-9377 :Dupreme Court lO ~ 38590 COUNTY OF CUMBERLAND aintiff File No. fendant DENA TO PRODUCE DOCUMENTSORTHINGS DISCOVERY PURSUANTTO RULE 4009.22 swein Plastic Surgery 03-2837 (Name o¢ Person or ~.ndty) ice of this subpoena, you are ordered by the court to produce the folio ~edical.recordsr treatment records, correspondence~ for Doris E. Timmons~ SS~162-22-3833, date-of-bit Jan. 1, 1992 to present. t. ~arr~burq. PA 1710~- ' ' (Ad~ress) es of the documents or produce things requested by this subpoena, roger ~ the parW making this request at the address listed above. You have the ri cost of preparing the copies or producing the things sought. ; or ~ings required by this subpoena within twenty (20) days a~ter its Beryl ~y seek a cour: order compelling you to comply with it. ,T THE REQUEST DP TH~ FOLLOWING PERSON: .rd, Esquire .., P.O. Box 741 17108-0741 ~ Attorney For: date: De fendnat So-' S~ an L. Flickinger BY THE COURT: Prothonotary/Clerk, Civil Divisic Oept (Eft. 7/<- al of the Court uing th ht TO: DORIS E. TIMMONS, p- v. SUSAN L. FLICKINGER, D( SUBP FOI D Within ~enty (20) days afferse~ documentsorthincjs: Copies of any and all referrals, x-rays, etc. January 31, 1928; from 315 North Front You may deliver or mail ecj bio coo ~vith the certificate of compliance, :o seek in advance the reasonabl~ ~f you fail to produce the document; :~,e part7 serving this subpoena m THIS SUBPOENA WASISSUED/ Name Brigid Q. Alf¢ &ddress: 315 N. Front St Harrisburg, PA -elephone: (717) 236-9377 Supreme Court ID ~ 38590 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND .aintiff File No. 03-2837 :fendant DENA TO PRODUCE DOCUMENTS ORTHINGS DISCOVERY PURSUANTTO RULE 4009.22 (Name of Person or Emi~) ice of this subpoena, you are ordered by the court to produce the foil< tedical.records¢ treatment recordst correspondence for Doris E. Timmonsr SS#162-22-3833, date-of-bir Jan. 1, 1992 to present. (AdCress) es of the documents or produce thincjs requested by this subpoena, tocjeti' } the part'y making this request at the address listed above. You have the ri! cost of prep~rincj the copies or producing the thincjs soucjht. ; or things required by this subpoena within twenty (20) days after its servi~ ~y seek a ccur~ order ccmpellincj you .h~ comply with it. ITHE REQUEST OF THE FOLLOWING PERSON: rd, Esquire · P.O. Box 741 17108-0741 ~ -%~torney For: Defendnat Su~an L. Flickinger SE si of the Court THE COURT: Prothonotary/Clerk, Civil Divisio Depu (Eft. 7/9 ¢incj -h er r) TO: DORIS E. TIMMONS, SUSAN L. FLICKINGER, D~ SUBP FO Allstate Within twenty (20) days after sen documents or things: Copies of any and all COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND .aintiff File No. 03-2837 ;fendant DENATO PRODUCE DOCUMENTS ORTHINGS DISCOVERY PURSUANTTO RULE 4009.22 Insurance Company, Chambersburg, PA (Name of Person or Entity) 'ice of this subpoena, you are ordered by the court to produce the employment records, personnel records, performance evaluations, salary records and employment applications for Doris E. TiM SS#162-22-3833, date-cf-birth: January 31, 1928; from Jan. 1, 1995 to pr( at 315 North Front You may deliver or mail legible cop ,vith the certificate of compliance, t to seek in advance the reasonable if you fail to produce the document :he party serving this subpoena m THIS SUBPOENA WASiSSUED, Name Bri$id Q. Alfc &ddress: 315 N. Front Harrisburg, PA ~arrlsburq. PA 17101- ' ' (Address) es of the documents or produce things requested by this subpoena, togeth 2 the party making this request at the address listed above. You have the ri¢ cost of preparing the copies or producing the things sought. ~ or things required by this subpoena wthin twenty (20) days after its serv ~y seek a court order compelling you to comply with it. cTHE REQUEST OF/HE FOLLOWING PERSON: ~rd, Esquire :., P.O. Box 741 17108-0741 ~ ~lephone: (717) 236-9377 SupremeCourtIO~ 38590 &ttorney For: Date: Defendnat Su~an L. Flickinger SE a[ of the Court BY THE COURT: Prothonotary/Clerk, Civil Divisio~ Depu (Eft. 7/9' tons, ~sent. er I do hereby cet Flickinger's Notice of Pursuant to Rule 400! addresses set forth bek Date: CERTIFICATE OF SERVICE Iify that I have served a tree and correct copy of the foregoing Defendant hatent to Serve Subpoena to Produce Documents and Things for Discovery ~.21 by first-class United States mail upon the following parties at the W~ Richard A. Sadlock, Esquire Angino & Rovner, P.C. 4503 North Front Street Harrisburg, PA 17110 Bfigid Q. ~Alford,'~E~squire ~j I do hereby ce~ Prerequisite to Servic~ addressed as follows: Date: CERTIFICATE OF SERVICE tify that I have served a tree and correct copy of the foregoing Certificate of a Subpoena on the following by first-class mail, postage prepaid and Richard A. Sadlock, Esquire Angino & Rovner, P.C. 4503 North Front Street Harrisburg, PA 17110 By: Brigid Q. {Alford, Esquire IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DORIS E. TIMMONS, Plaintiff SUSAN L. FLICKINGER, Defendant PETITION FOR APPOINTMENT OF ARBITRATORS CIVIL ACTION - LAW NO. 03-2837 CIVIL JURY TRIAL DEMANDED TO THE HONORABLE, THE JUDGES OF SAID COURT: Richard A. Sadlock, Esquire, counsel foFth, e Plaintiff in the above action (or actions), respectfully represents that: 1. The above-captioned action (or actions) is (are) at issue. The claim of the Plaintiff in the action is $ The counterclaim of the Defendant in the action is $ The following attorneys are interested in the case(s) as counsel or otherwise disqualified to sit as arbitrators: WHEREFORE, your Petitioners pray Your Honorable Court to appoint three (3) arbitrators to whom the case shall be submitted. AND NOW, this petition, and ORDER OF COURT uire __ day of ,2004, in consideration of the foregoing , Esq. Esq. , Esq. are appointed arbitrators in the above- captioned action (or actions) as prayed for. BY THE COURT: 270546.1 \RASWiLB Brigid Q. Alford, Esquire Supreme Court I.D. #38590 Jeffiey E. Piccola, Esquire Supreme Court I.D. # 18018 BOSWELL T[NTNER, PICCOLA & WICKERSHAM 315 North Front Street Post Office Box 741 Harrisburg, Pennsylvania 17108-0741 Attorneys for Defendant Susan L Flickinger DORIS E. TIMMONS, Plaintiff V, SUSAN L. FLICKINGER, Defendant : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : No. 03-2837 - CIVIL TERM : .. : CIVIL ACTION - LAW : JURY TRIAL DEMANDED CERTIFICATE PREREQUISITE TO SERVICE OF SUBPOENAS PURSUANT TO RULE 4009.22 As a prerequisite to service of subpoenas for documents and things pursuant to Rule 4009.22, Defendant certifies that: (1) a notice of intent to serve the subpoena with a copy of the subpoena attached thereto was mailed or delivered to each party at least twenty days prior to the date on which the subpoena is sought to be served, (2) a copy of the notice of intent, including the proposed subpoena, is attached to this certificate, marked Exhibit A, (3) Plaintiff's counsel waived the twenty (20) day objection period; and (4) the subpoena which will be served is identical to the subpoena which is attached to the notice of intent to serve the subpoena. Respectfully submitted, By: rd, Esqu~fi Supreme Court #3859ff Boswell, Tintner, Piccola & Alford 315 North Front Street Harrisburg, PA 17101 (717) 236-9377 Attorneys for Defendant Susan L. Flickinger Date: /tt/~O /65t DORIS E. TIMMONS, Plaintiff V. SUSAN L. FLICKINGER, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA No. 03-2837 - CIVIL TERM CIVIL ACTION - LAW JURY TRIAL DEMANDED NOTICE OF INTENT TO SERVE SUBPOENA TO PRODUCE DOCUMENTS AND THINGS FOR DISCOVERY PURSUANT TO RULE 4009.21 Defendant Susan L. Flickingcr intends to serve a subpoena identical to the one that is attached to this notice upon Medco Health. You have twenty (20) days from the date listed below in which to file of record and serve upon the undersigned an objection to the subpoena. If no objection is made, the subpoena may be served. Respectfully submitted, By: 'g' Q. ford, Esqu~e Supreme Court #38590/ Boswell, Tintner, Piccola & Alford 315 North Front Street Harrisburg, PA 17101 (717) 236-9377 Attorneys for Defendant Susan L. Flickinger TO: COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMSERLAND DORIS E. TIMMONS, Plaintiff File No. SUSAN L. FLICKINGER, : Defendant : SUBPOENATO PRODUCE DOCUMENTS ORTHINGS FOR DISCOVERY PURSUANTTO RULE 4.009.22 Medco Health 03-2837 - Civil Term (Name of Person or 5nt:,'7, ) ?,'ithin~¢zenW (20) days afferse~ice ofthis subpoena, you are ordered bythe courtto producethefo[lowing dccumen:sorthings: Copies of any and all prescription records~ m~c~] rmmm~.tr~a~m~m~ ~¢~ correspondence, referrals, etc. for Doris E. Timmons, date-of-birth: Jan. 31, 1928; SS~ 162-22-3833 from January 1, 1992 to present. 315 North Front Streett Harrisburg, PA 17101 (Address) ,, a~' .e,~v., .r mail legible cocies o~ the documents or produce tnincs revues:ed by this subpoena, tocether m=.<,. ,g ~ms request at the address listed above. You have the right .,;ith the certificate of compliance, t,= ~he par~/ -' ;~ "' · - ~r~=,,~= ,he c.~l.s or producing the things sought. .~ seek in advance the reasonable ccs~ cf f you fail to produce the documents or things required by this sub2cena within t~venry (20) days after its service, :,-,e carW serving this subpoena may seek acou:; order compelling you to comply with it. T~IS SUEPOENA WAS ISSUED ATTHE REQUEST OF THE FOLLOWING PERSON: ~ame Brigid Q. Alford, Esquire 315 N. Front Street Harrisburg, PA 17108-0741 "eieuhone: (717) 236-9377 .~u2reme Court iD # 38590 -~r.,s/ For: Defendant Flickinger Date: -- 'Seal of the Court BY THE COURT: /) Prothonotary/Clerk, C iv~,'i sio n DepuW (Eft. CERTIFICATE OF SERVICE I do hereby certify that I have served a true and correct copy of the foregoing Defendant Flickinger's Notice of Intent to Serve Subpoena to Produce Documents and Things for Discovery Pursuant to Rule 4009.21 by first-class United States mail upon the following parties at the addresses set forth below: Richard A. Sadlock, Esquire Angino & Rovner, P.C. 4503 North Front Street Harrisburg, PA 17110 Date: By: Brigid Q) Alford,'~Esqt~ CERTIFICATE OF SERVICE I do hereby certify that I have served a true and correct copy of the foregoing Certificate Prerequisite to Service of a Subpoena on the following by first-class mail, postage prepaid and addressed as follows: Richard A. Sadlock, Esquire Angino & Rovner, P.C. 4503 North Front Street Harrisburg, PA 17110 Date: By: lford, Es~pire 1N THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DORIS E. TIMMONS, Plaintiff CIVIL ACTION - LAW NO. 03-2837 CIVIL SUSAN L. FLICKINGER, Defendant JURY TRIAL DEMANDED PETITION FOR APPOINTMENT OF ARBITRATORS TO THE HONORABLE, THE JUDGES OF SAID COURT: Richard A. Sadlock, Esquire, counsel for-thg Plaintiff in the above action (or actions), respectfully represents that: 1. The above-captioned action (or actions) is (are) at issue. 2. The claim of the Plaintiff in the action is $ ~,~ ~0 b The counterclaim of the Defendant in the action ~s $ _. to sit as arbitrators: /~ q, /~ WHEREFORE, your Petitioners pray Your Honorable Court to The following attor~neys are interested in the case(s) as counsel or otherwise disqualified arbitrators to whom the case shall be submitted. appoint three (3) ORDER OF COURT AND NOW, this lq*day of-,-~9~l?ff~ , 2004, in consideration of the foregoing petition, ~/~ ~/ ~/~ ~ , Esq. Pb2~t/c&~t&/~. ~ , Esq. , / and 5~_~t~ ~~ , Esq. are appointed arbitrators in the above- captioned action (or actions) as prayed for. 270546A\RAS\MLB IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA OATH NO. 0 ~ 2.~'3 7 , TERM We do solemnly swear (or affirm) that we will support, obey and defend the Constitution of the United States and the Constitution of this Commonwealth and that we will discharge the duties of our office with fidelity. AWARD % We, the undersigned arbitrators, having been duly appointed and sworn (or affirmed), make the following award: ~ (Note: Ifdqmagesfor delay~are awarded, they s~hall be separately stated.) · Arbitrator, dissents. (insert name if at~ica~le.) Date ofHearing: ~/kk-.~-c ~x 5'-~ooc/ DateofAward: ~c ~ ~ 2oo9 NOTICE OF ENVY OF AW~ Now, the ~ ~y of ~ ,20 ~ , at ~: /~ , ~ .M., the above award was ~tered upon the docket and notice thereof given by mail to the pa~ies~r ~eir a~omeys. Paid upon appeal: Pm~onom~ , 0.00 1N THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DORIS E. TIMMONS, Plaintiff V. SUSAN L. FLICKINGER, Defendant CIVIL ACTION - LAW NO. 03-2837 CIVIL JURY TRIAL DEMANDED NOTICE OF APPEAL FROM AWARD OF BOARD OF ARBITRATORS TO THE PROTHONOTARY: Notice is given that Plaintiff Doris E. Timmons appeal from the award of the Board of Arbitrators entered in this case on March 5, 2004. A jury trial is demanded. (If not checked, jury trial is waived.) I hereby certify that the compensation of the arbitrators has been paid, or application has been made for permission to proceed in forma pauperis. lock, Esqui] Date: March 10, 2004 273273.1 \RAS\MLB PRAECIPE FOR LISTING CASE FOR TRIAL (Must be typewritten and submitted in duplicate) TO THE PROTHONOTARY OF CUMBERLAND COUNTY Please list the following case: (Check one) (× ) for JURY trial at the next term of civil court. ( ) fo.r trial without a jury. CAPTION OF CASE (entire caption r~ust be stated in full) (check one) ( ) AssumPS'it ( ) Trespass DORIS E. TIMMONS, ~XX) Trespass (Motor Vehicle) SUSAN L. (Plaintiff) vs. FLICKINGER, (Defendant) VS. ( ) (other) The trial list will be called on ~ and --' Trials commence on July ]2~ 2004* Pretrials will be held on ~une 23, 2004 (Briefs are due 5 days before pretrials.) (The Party listing this case for trial shall provide forthwith a copy of the praecipe to all counsel, pursuant to local Rule 214-1.) *Plaintiff's counsel is not available on July 15, 2004. No. 03-2837 Civil Term Indicatetheattorneywho willtrycasef°rthepartywh°filesthispraecipe:C°unsel Briqid Q. Alford, Esquire (Supreme Cou~ ID ~38590) 315 N, F~ont St., Harrisburg, PA 17101 (717) 236-9377 indicatetrialcounselforotherpartiesifknown: C~un~] f~ P]~: Richard A. Badlock, Esquire 4503 N. Front ~t.~ ~a~r~hur~ PA ~7~1~-17~R (!~7) 2~R-~791 x~ for Defendant: This case is ready for trial. Date: April 12, 2004 Signed' L ~ 2 ,{~.-V~ Print Name:_~~ Alfo~, Esquire Attorney for: Defendant Flickinqer__ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DORIS E. TIMMONS, Plaintiff SUSAN L. FLICKINGER, Defendant CIVIL ACTION - LAW NO. 03-2837 CIVIL JURY TRIAL, DEMANDED NOTICE OF INTENT TO OFFER DOCUMENTARY EVIDENCE PURSUANT TO RULE 1311.1 To: Defendant Susan L. Flickinger, by and through her attorney Brigid Q. Alford, Esquire Plaintiff, by and through their attorneys, Angino & Rovner, P.C., intend to offer the documents attached hereto at the trial of the appeal from the Award of Arbitrators, in the manner provided by Rule of Civil Procedure 1311.1. The following documents are attached: 1. Report of Peter Giesswein, M.D. dated April 13, 2004 (Exhibit A); 2. Records from Peter Giesswein, M.D. (Exhibit B); 3. Records from Holy Spirit Hospital (Exhibit C); and Records from Holy Spirit Hospital Rehabilitation Services - Departmem of Occupational Therapy (Exhibit D). Doris E. Timmons Name of Plaintiff ANGINO & ROVNER, P.C. ~!ont Stree Harrisburg, PA 17110 (717) 238.-6791 Counsel for Plaintiff Date: April 26, 2004 273466.1~SWiLB Giesswein Plastic Surgery Peter Giesswein, M.D. Center for Cosmetic ~ Reconstructive Surgery 5 Brookwood Avenue, Suite I * Carlisle, PA 17013 890 Poplar Church Road. Medical A.,ts Bid§., Suite 204 * Camp Hill, PA 17011 Phone: 717-249-2424 · Fax: 717-249-4S34 April 13, 2004 Richard A. Sadlock, Esq. Angino & Rovner, P.C. 4503 North Front Street Hamsburg, PA 17110-1708 RE: Doris Timmons (DOB 01/31/28) Dear Attorney Sadlock: This letter is a response to your inquiry from April 5, 2004. It pertains to my treatment of your client and my patient, Mrs. Doris Timmons. Mrs. Timmons is a delightful 76-year- old Caucasian female who I first saw in July 2000. She was treated for fight carpal tunnel syndrome. At that time the patient was complaining about pain in her right extremity, particularly her hand. The EMG study showed mild carpal tunnel syndrome. The patient also had arthritis in the basilar joint of the same. hand involving her thumb. Both conditions were treated at the same time by doing a carpal tunnel release in addition to a right thumb basilar joint arthroplasty. The patient was initially placed in a cast and then later underwent hand therapy. Her recovery was rather slow with lingering aches and pains. In April 2001 the carpal tunnel release on the right was repeated and scar tissue was removed. She recovered faster than after the first operation. I released the patient from my care on May 10, 2001. On November 5, 2002 the patient presented again to me with pain in her right thumb after a MVA on November 2, 2002. She also wanted me to evaluate two skin lesions on her right temple area. The patient had fairly good use of her hand at that time although she had findings consistent with tendinitis. I injected the area with some Kenalog. During the following months her swelling diminished, her ROM imtproved and so did her pain. She continued to wear her splint during more strenuous activities. The two excision sites on her temple area from November 19, 2002 healed uneventfully. Her hand discomfort, however, lingered despite slight improvements after the injection of the steroid and conservative hand therapy. Certified by: The American Board of Surgery ° The American Board of Plastic Surgery Member Page 2 Doris Timmons April 13, 2004 Although her finger mobility initially was limited, it then continued to improve. I discharged Mrs. Timmons from my care on February 10, 2003 after I was able to have her move the fingers and thumb in a normal fashion. The para over the dorsum of her hand had greatly improved. Mrs. Timmons was instructed to call me if any further problems arose. I saw the patient for a new problem on March 1, 2004. A mass on the tip of her nose was identified. This new growth was removed and turned out to be a nodular basal cell carcinoma. The entire lesion was excised. She is healing well. Her last visit was on April 8, 2004. At that time she was still complaining about her arthritic thumb and about pain over the dorsum of her right hand. She was able to use her hand freely. I will not be able to predict what future treatments will be necessary for Mrs. Timmons' hands. Her hand problem seems to be posttraumatic, but also influenced by her chronic hand arthritis. At the present time I recommended to Mrs. Timmons to just use some OTC non-steroidal anti-inflammatory medicines. I am unable to give a prognosis in this case secondary to the progressive nature of degenerative joint diseases. With regard to my previous statements I also will not be able to estimate the cost for future treatment. Finally, I can state with a reasonable degree of medical certainty that Mrs. T/mmons' return visit to my office on November 5, 2002 was related to a MVA several days prior. If you have any ~a~er questions or if I can be of any future sen, ice to your client, please do not hesitat; contact me. My federal tax identification number is 25-1857164. Very tmly~ur_s, . [~F BIRTHD PAGE Important: Please date and initial every entry. Doris Timmous 11/05/02 S: Pain, right thumb after MVA on November 2, 2002 and formation of two lesions in the fight temple area. O: The patient has swelling over the MP joint and the second metacarpal on her hand. The swelling is located orr the dorsum- She has some localized pain at the base of her second metacarpal and also in the radial aspect of her MP joint I. It appears to be a syaovitis. The patient brought some X-rays which I reviewed with her. The patient had previous surgery on this thumb and the incision of this pre~ious surgery has healed very nicely. There is some~____~ also over the areas of the para. The patient also shows me at this appointment two facial lesions which are unrelated to the [vIVA. Both are located on the fight temple. Oae has a nodular appearance and it measures about 2 x 1.3 cm. The other one appears to he an irritated seborrhea keratosis. I talked to the patient in great length about these finding.q P: For the hand, I would recommend some kenelog i~ iection which we did today. For the nnc,t do today, but I descfihed face, I would recommend some excision which we c benefits, risks and alternatives and we will make the trrangements for the near future. I also recommended for the hand the use of some ha~ patient will do this. I will see her again in about tw, which case she knows to call me before. PG/nar therapy and some splinting. The weeks unless there's a problem in Doris Timmons 12/03/02 S: The patient feels better, but she still has some pain over the previously treated hand areas. O: The swelling over the hand areas have diminished. She has full ROM. She has good gross motor strength Sensation is f'me and so is capillary refiU to the distal fingertips. She still has some pain on palpation on the base of the second metacarpal and at the radial aspect of he;/hMP joint, but it is much less than before. She is wearing her splint. The temple areas~e h.,,ealing very nicely. P: I explained to [firs. Timmons that [ would coutimae the present care. If there should be any change, she l~6ws to call. Otherwise, I would like to see her back in about four weeks. PG/nar/~ t'roaar ss DATE iRTHD 'TE . PAGE Important: Please date and initial every entry. Doris Timmons 01/14/03 S: The patient still has some pain in the right hand, but less than before. O: The tendonitis-synovitis has improved. She still has one area on the dorsum of her fight hand, which does cause some pain on palpation. She would like me to inject it aga, in. She has full ROM ofa~l digits and good extension. She has good capillary refill ana sensation distally. The l~wer grip is fine. I injected tbe spot that we identified with 1 ¢¢ ofkenelog 10 and the pj~tient tolerated this well. P: I ~vill release Mrs. Timmfins fi.om my care, but she kno~ to call ~e iftbere should be any further problems. Ifh~r~overy, however, continues then I don t necessarily have to see her back. PG/nar/// l I -- Doris Timmons 02/10/03 S: Mrs. Timmons is doing much better with her fight hand. O: She indicates that she is not able to ~read the second and third digits on her right hand, but I can actually make her do it/I do not understand wbere she got the impression that she would not be able to do so. T~bere is much less pain over the dorsum of bet hand. P: I will release Mrs. Timmons from/by care. She knows to ,call me if there should be any problems or cOncerns. PG/nar ~/ DATE JPAGE Important: Please date and Initial every entry. r~^. ~, ,, ~ ...... '~-~F_SS~VE~N PLASTIC SUR~I=H, pETER GIESSWEIN, M.D. CENTER F-OR COSMETIC & RECONSTRUCTIVE SURGERY 3.514 TRINDLE ROAD 5 BROOKWOOD AVE., SUITE 1 CAMP HILL, PA 17011 CARLISLE, PA 17013_ ADDRESS _ P ~ LABEL / REFILL' 0'1'2' 3'4'P~N / / ' ' SUBSTiTUTiON pERMISSIBLE ~4~V~' x ., M.D. NAME R DUCT TO BE DISPENSED, THE PRESCRIBER MUST HAND- IN ORDER FOR A BRAND -~ ..... "~LY NECESSAR~ IN THE SPACE BELOW. W~ITE "BRAND NECESSAR~ ONFiDEE,;L ( ONFIDENTIA/ TELEPHONE: (717) 249-2424 DEA #. FAX: (717) 249-4534 LIC. #MDO40737L GIESSWEIN PLASTIC S[JRGERY PETER GIESSWEIN, M.D. CENTER FOR COSMETIC & RECONSTRUCTIVE SURGERY 5 BROOKWOOD AVE,, SUITE 1 3514 TRINDLE ROAD CARLISLE, PA 17013 CAMP HILL, PA 17011 ADDRESS / DATE ev,,.I.. ¢-f'x' O.T./ I'-I LABEL / REFILL- O- 1- 2- 3- 4- PRN ~1// ~ ~ ~' IN ORDER FOR A BRAND NAME PRODUCT TJ~ BE DISPENSED, THE PRESCRIBER MUST HAND- WRITE "BRAND NECESSARY" OR "BRAND hIEDICALLY NECESSARY" IN THE SPACE BELOW. ADM. DATE: 11/02/2002 CHIEF COMP~LAINTIHISTORY OF PRESENT ILLNESS: The patient is a 74-year-old female who was in a motor vehicle accident. She was at a complete stop and was hit from the back. The patient denies any injury, loss of consciousness, nausea, or vomiting, but because her hands were on the wheel, she injured her right hand from being hit from the back. She now complains of pain in the right thumb area. She denies any tingling, numbness, or weakness. The patient has a history of right wrist reconstruction in the past:. PHYSICAL EXAMINATION: CONSTITUTIONAL: The patient is in no distress. VITAL SIGNS: Per nursing notes. EXTREMITIE~i Right Hand: There was some mild tenderness and swelling over the first carpometacarp, al joint, with range of motion of the thumb painful and slightly limited. Iqeurovascular status of the right hand was normal. There was a scar from previous surgery on the right wrist. Range of motion of the wrist was also slightly painful and limited. ASSESSMENT: Fracture, dislocation, right first carpometacarpal region. PLAN: The X-rays were read by the radiologist as positive for fracture and dislocation. Mr. Horner was paged and he will be in to see the patient for further management. RS/Ih DOC #: 286139 D: 11/02/2002 T: 11/04/2002 2:23 P 003840 Signed RANJANA SHARMA, MD 11/1112002 10:26 RANJANA SHARMA, MD Page 1 of 1 HOLY SPIRIT HOSPITAL NAME: Timmons, Doris E Camp Hill, PA MR#: 441034 17011 ROOM# ER3 EMERGENCY ROOM REPORT COPY '. ~SD ALS~ Other[~''~ T pL~__~..~_~·_ R~ p~e~HoSPit~ c PMH Checklist: None[] MI[] HTN~CAD [] CH"F'g, ASTHMA [] CANCER [] STROKE [] NiDDM"~ IDD~r~ "~ ' Surgeries ~ Other [] Latex Allergy Yes[] No[] Immunizations: UTD [] Not UTI:) [] Tetanus LMP _ Medicat o~i HOHr~ ~ Yes[] Nog Medications: Treatment @ Triage__ MT [] Medic,[~ List,~,ottles [] Patient [] info obtained by: -- Dos~e ~~ Meds. Meds Meds Unknown [] Injury: Place Occurre~.~ ~H~_~Workr-i Body: "'~"~"~ ~ Log In: Triage: /"~' ~ Room: _ ed Directives No[] Attach~,.~_ Yes[] .,~o L~, Exposure to n'~e~.~sles, chxn pox, TB? Yes[] No~ Location ~ Scale q /10 Wong Baker [] Character: Ache [] Dull [] Pressure [] Burning [] Throbb' Radiating []!.~ Duratio~' F req u an c'j~v~.~ What relieves Pain? ~ Triage Notes: Dose Cool [] No• Distal Pul~,,. Edema: Yesr% No~.,,_ Deformity: Yes [] No ~ Ecchymosis: Yes [] No~ Triage to Radiology at Holy Spirit Hospital Camp Hill, PA 17011 John R. Dietz ECU Nursing Assessment CHART COPY Initial Lab & X-Ray Orders: · Labs [ ] Acetamidophen [ ] DOAS [ ] Acetone (SACE) [ ] ESR ,; [ ] A~cohol (ALCO) [ i Glucose [ ] Amylase/Lipase [ ] HCGS [ ]AP'rr [ ]HIV [ ]BBH [ lLiver [ ] Blood Cultures Profile [ ]BMP [ ]Lyres [ ] CBCP [ ] CMP [ ] CRP1 [ ] DIgoxin [ ] Dilantin Radiology [ ] Abd/Obstr. Series [ ] Ankle R L [ ] Clavicle R L [ ] Cerv. Spine Rt. / Let. [ ] Chest Rtn. / Por~ / TPA -2" [ i Elbow R L [ ] Facial [ ] Femur [ i Finger .-- [ ] Foot [ ] F/drean'n [J/J H~nd [ ] Hip ] Humerus ] Knee ] Other: REASON:. [ ] Thrornbdlyflc Labs [ ] Tox Semen [ ] Urine Tox Screen [ I TSHR [ ] Type&Cross __ # of units (BOR) [ ) Type & Screen [ lUA;[ ]DIP[ ID[AG- [ ]Phenobarb [ ]UrineC&S [ ]PTP [ ]UrineHCG [ ] Salicylate [ i WC Breath AlCO Test [ ]Th? [ ]WCDrugScreen [ ] Other: [ ] KUB [ ] L/S Spine [ ] Mandible [ ]Nase. I [ I Orbit R L [ ] Pelvis [ ] Pyelogram IVP R L . i[~]Ribs R L R t~ p~] Shoulder R L R k~ [ ]Skull /~ L 17 [ i T/Spine R L [ 1Toe R L R L { ] Wrist R L Special Procedures: Ultrasound: CT: (W=With contrast; WO=Without) [ ] Abdomen [ I Abdomen/Pelvis w WO [ ] VQ S~an [ ] Duplex Doppler [ ] Brain/Head W WO [ i Echo- [ ] Gallbladder [ ] Chest W WO cardiogram [ ] pelvic/ [ ] Spiral chest for PE Transvaginal [ ] Other: REASON: Specimens/Cultures [ ] Beta Strap AG Rapid [ ] Cervical/Genital [ ] Chlamydia [ ]GC Culture [ ] Monospot (rapid) [ ] Sputum C & S [ ] Stool C & S [ ] Stool O & P [ ] Stool c. Difficile [ ] Trichomonas [ ] Wound C & S [ ] Other:. pHYSICIAN CHARGE [ ] Level I [' ] Level Il [ ] Level Ill [ ] Level IV [ ] Leval V Billing Classification: FACILIT~ CHARGE [ ] Level I [ ] Accident [ ] Leval II [ ] Mbdical [ }Levellll [ }Case1 [ ] Level IV [ ] Extended Hrs. [ ] Level V Holy Spirit Hospital Camp Hill, PA John R. Dietz Emergency Center Physician Order Sheet Cardiac Respiratory [ ! Monitor [ ] ABG's [ ] EKG [ ] Peak Flows Before/After Resp. Tx. [ 102 L/Min. [ I Respiratory Tx.. { ] 02 Saturation Medications / IV's / Additional Orders Date/Time/Int. )ate/Time IV: NSS/D5W/LR/DS/.45NS/D5.9NS WO/KVO/Infuse at . mis/hr [ ] Obtain old records [ lTd ,[ ] Protoco~ initiate~ for.'. '~ r:/? initials: ,~___-'/Slgna ,u re: ~/__ ""- ~ ./~/ RN/MA Initials:',__ Signature: Dictated: Half [ ] Completed [ Diagnostic Impression: CRITICAL CARE: RN/MA hrs. Consulting/Admitting physician: Date: ! ~ ~ Time: ' ~'31~ L C~J~LRI~E St ER3 ; Appearance: ~.-' / Me-j~l Status: R~espiratory: Gastrointestinal [;~fl'/A Trauma_r~NIA ~emaciated Ocyanofic ~d~ ~talkafive Operson Response td Stimuli ~wheezing L I R Last BM ~bums: ~ productive Neuro~NiA GU I GYN ~/A Cardiovascular ~Chest p shies ~ Monltor/rh~hm: area; EYES MOTOR RESPONSE VERBAL 4 S~ · * ' iented E es Ears Nose ~ Throat NURS NG ASSESS~NT~//~ ~ ''~ ~g ......... Proi~l Initla~ed: '~ La~ doled-ray done~ ~ C~I[ bell ~~ - within reach ~Sid~~~ ~ p~dure expla'ned ~~ Dat~ ~ ~t ~ So~u~on ~ Site Rate ~ Affemp~ Cond. Inl~al ~e Drag ~ime Notes ~ ~ ~ ~ Time ~otes · / ~arged ~pani~ by:~ ~a~lato~ ~wlc Qambulan~ to:~ome ~nursing home QAMA Qpat{ent Qfamily Qparent Qother: Qve~alized unders~nding of d/c ins~u~ons QRe~ ~lled ~to ~old re~s sent to fl~r ~clothing sh~t done ~transfe~djo~ ~ ~nsent signed Conditio~ ~afisfa~o~ ~C~c~eceased to morgue Qlmpmved pain~/ ~ I~ John R. Die~ ECU C;~A~bL~55U~G ~ lTZO[ ' NurslngAssessmen~Notes (~ ' G,I~,/,~-~ Zb3-13~8 ' .~ EMERGENCY CENTER URGI CENTER DISCHARGE INSTRUCTIONS : OLY SPIRIT HOSPITAL · (717) 763-2316 (717) 763-2424 ('" .~ ' ~' The examination ami treatm~m you have received in the Emergency Center have been rendered on an emergency basis only, and are not inl*nded to be a subedmte for or an effort to provide complete medical care. ff you develop new problems or complications contact your physician or the Emergency Center. FOLLOW ~ INSTRUCTIONS CHECKED BELOW. Patient Information: Patient Information sheets contain important information to review and keep. ( )Abdomifisi pain · ( )Comesi abrasionJforsign body ( ) Alcohol reaction ( ) Croup/bronchifis ( ) Allergic reaction ( ) Crutch walking ( ) Asthma ~ ( ) Diarrhea and Vomiting/Pad. Vomiting ( ) Back pain ( ) Dislocation ( ) Bites-Human/AnimaFInsect ( ) Drug/Alcohol a~use/addiction ( ) Sum ( ) Febrile Convulsior ( ) Chest Pain ( ) Fever/Pad. Fever ( )Conjunctivdis ( ) Fit ( )COPD ( ) Fracture WOUND CARE ( } May gently wash over wound in 24 hours with soao ano water or peroxide· Do not soak in water. · ( ) Change dressing times daily. Redress with Bactirasin/Neosporin and stadia dressing, ( ) Keep wound clean, dry, covered. ( ) Tetanus/Diptheda Booster gigen. SPRAINS, STRAINS, BRUISES, FRACTURES ( ) Elevate the injured part for days to reduce swelling· f (,.~Apply ice packs intermiffenify for .~days to reduce swelling. ( } Ace wrap Ior support for__days. ( ) Wear splint (,) At all fime_s until follow-up. ( ) For activity as needed· ( ) Use sling for support. ( ) Use crutches: ( ) As needbd, weight beating as tolerated· ( )At all times. NO WEIGHT BEARING NECK/BACK ( ) Wear cervical callar for support for days. ( ) Rest, avoid bending, lifting, strenuous a_ctivity for dsys. ( ) Apply mo[st heat for minutes times daily beginning in hours. ADDITIONAL INSTRUCTIONS I ) Off workJschool from to ( ) Return to work on' ( ) Light Duty until: Restrictions: ( ) No gym/sports until ( } Follow instmctfons on Workmen's Compensation Fon'n .... ( )Wear eye patch for hours· ( ) If nose bleed recurs, pinch nose firmly for 5 minutes continuously, return if bleeding not controlled, ( ) The prescribed antibiotic may reduce the effectiveness of medication you are currently taking. Check package instructions or consult with Pharmacist. ( ) The interpretation of your X-Rays are pralimlnary reading. Your films w~ll be revfewed by a radiologist. You or your ( ),Headache, ( )Pain Management · ( ) Head Injury ( ) Pediatric Head Injury ( ) Hypertension · ( ) Pediatric URI ( ) Immunizationffetanus ( ) PID/STD ( ) Kidney Stones ( ) Pneumonia ( ) Lablycthitis ( ) Rash ( ) Laceration ( ) Seizure ( ) Neck Strain ( ) Sore Throat ( )Nosebleed ( I Sprains and Strains ( )Otitis Media { )Suture Care & Removal MEDICATIONS ( ) Continue Dreserd medications excsor ( )Threatened Miscarriage ( ) Toothache ( ) URI and CGIds ( ) UTI and Pyelonephritis ( ) Wound Recheck ( )24 hr. Pharmacies ( ) Other ~'~se Advil ([buprofen} or Tylenol as neede~., fever according to package instructions for age, wsign[. ( ) Use the following mad :ines according to package instructions: ( }The following medicines may cause crewsiness: DO NOT DRIVE OR OPERATE MACHINERY WHILE TAKING: FOLLOW-UP This is our recommendation for follow-up, if your nsurance [HMO) requires a physician referral for specialty =onsultation. 13' IS YOUR RESPONSIBILITY TO OBTAIN THE NECESSARY APPROVAL. ( ) Follow-up with: ( ) Urgi Center ( ) Family Doctor m days for: { ) Fo[Iow-up ( ) Suture removal ( ) Call as soon as possible for appointment ( ) Pick up your X-Rays from me Radiology Department ptior to your follow-up appointment. Call 763-2696 to have films ready. [~)'~ee youl physician o~ne~h~"w'd i~fl~ _..,/' ( ) Return to Emergency Center if you feel your condition is worsening, especially if the, pain Increases despite pain relief medication. ( ) Your blood oressure was elevated. Please have it rechecked by your physidan. ( ) Test resuRs have been g~ven to you. ~rake them with you to the fo[Iqw-up appoirdment. Test resuifs grven: [~CBC ~CMF~ I~EKG I- X-RAY COPY -IBMP C]RECORDS COPY CHART ~GLUC. physician will .be contacted if there is a change in the .... A copy'o~ your d~clated Emegency Reon~ Re~3o~s ~ilaj~le~'~;~ur diagnosis, physician from M~'lical Records (763-2660), if not already sent. Additional Inst~t~ ..~ ~ i hereby acksowledge mseipt of thsoe instructions and unde~s{and them- -~ . I understand that I have had emergency ~reabnent only and that I may ~ ~ · . be_released before all~f my medical problems are known ~r treated._ .~ ~ .. . ~'~ ~>'~ ~,~'~-° ~ -~ * * :-' I wtil arrange for f~llow-up care as I have been Instructed. It Js your _ ' . - -. .... r ......... responsibility to rmUfy~your prknm7 Care Phystsia~ of this vls~---- -. _ J'~J:~TIENT VEBJBALIZE$?NDERSTANDINO -; '- --_- .... "7 ~- U>'.' HOLY SPIRIT HOSPITAL'EMERGENCY CENTER . ~ ' ' .- · - , ' · - · ~03 NORTH 21ST STREET- CAMP HILl., PA 17011-2288 (717) 763-2316 .....- ~" ~'~- ~-" '~ · ~- ·" ) Vanitha Abraham. M.D. 038840L .... ( ) Jon Dubin, D.O. OS 006991L .... ( ) lawrence Paul. M.D. 039524-L ) Thomas Aldous. M.D. 017075E ( ) Marlys Hasson. M.D. 072553L - ( ) Howard Rudnic~.M.D: ) Salvatom Alfano, M.D. 025502E ' ( ) John P. Judson. M.D. 038368-E , ( ) Rm~jana Sharma, M.D. 031265-E ._ _~;, ) Glen Daughtxy,.D.O. 05006776E :- ( ) Phillip Maguim, M.D~3-E - - - la ) Da,ad Zimmennan; . . . ) Nicolau DaCosta. M.D. 053288-L .... (-) Pushpa Mu~_~.MJD. 051514D ~ ~ ~ ........ .. '~- _ SPRAINS, STRAINS, BRUISES, FRACTURES ' 1: _ - ..... - . ()Elevatatheinjuredpartfor.~._daystoreduceswelling. '~-' : --~- 2: (t~pply i.ce packs ntermittently for.~days to reduce s_wal[ing. ._ .:~:_ 7-3 -'_ ( ) Ace wrap for support for__ days ........... ( ) The following medicines thay-ca~ drowsiness: ( ) Wear splint (.) At ail times until follow-up. .......... DO NOT DRIVE OR OPERATE MACHINERY WHILE TAKING: ( ) For activity as needed. ' - ( ) Use sling f~r support. - - ' ~ ~ ( ) Use crutches: ( )As needed, weight bea~eg se tolerated. ' .''FOLLOW-UP Thi~ is-o~r.recomm~ndation roi; follow-up. If your . ( )At all times. NC WEIGHT BEARING insurance (HMO) requires a physician referral for specialty NECK/BACK consultation, T IS YOUR RESPONSIBILITY ~0 ~BTAIN THE .. ........................... ..... NECESSARY APPROVA£~---- ~ ( ) Wear cprvlcal collar for support for days. .... ( ) Rest, avoid bending, lifting, strenuous activity [or days. ( ) Follow-up ,ni~: ( ) Urgi Center: ( ) Apply ~noist heat for minutes t[mas dally ( ) Fam?y Do~_!or - beginning in - - hours. . , ' ' --.- - ' ' in ' " days for: - - ( ) Foll~w-up AD0iTIONAL INSTRUCTIONS ..... ~ ......... ~ ~;(-) Suture removal- . - - . - ( ) Off wdrk~schobl from ' - - - to ~ .............. (') Call as ,,~o~n as possible fb~ apl~ointrfient ..... (-) Re~J'r~ ~-~-fl~n- -- ( ) Light Duty u~il' ' ' "( ) Pick up your X-Rays from the Radiology Department pdor to ................. your follow-up appointment[ Call 763-2696 t6' hay6 fil~s Rse~fi~ti~s: . ready ........ : - · ( ) No gym/sports until (s,,~See your physician o~e~aiad~ (' Follow instructions on Workmen's ComponsstJon Form.. 2 m~ n-~nt :~y~u ;eel- y;ur co~- iswol~e~n~g. ( )Wear eye patch for noum. ( ) Rstum t E er t ( ) If noas bleed ~ecurs, pinch nose firmly for 5 minutes c~ntinuously,/re{um if bleeding not controlled. ( ) The prescnbed antibiotic may reduce the effecgveneas of medication you are currently taking. Check package instructions or consult with Pharmacist. ( ) The interpretation of your X-Rhys are preliminary reading. Your ti[ms will be reviewed by a radh31egist. You or your physicia? will ? contacted if there is a change in the diagnosis. Additional Inst ~tion :' ' especially ff the pain Increases despite pain relief medication. ( ) Your blood pressure was elevated. Please have it rechecked by your physician. ( ) Test results have been given to you. Take them with you to the follow-up appointment. Test results given: [] CBC I-I CMP~ ~'EKG [] X-RAY COPY []BMP ~RECORDS COPY CHART F-IGLUC. A copy of your dictated Ernegency Room Report is available to your physician from Medical Records (763-2660), if not already sent. I hereby acknowledge receipt of these instructions and understand them. I understand that I have had emergency treatment onlv and that I may be released before all of my medical problems are known or treated. I will arrange for follow-up care as I have been instructed. It ls your respons!bility to r~otify YOU~' Pdmary Care Physician of this visit.. Clinical Impressions: HOLY SPIRIT HOSPITAL EMERGENCY CEN~rER 5)03 NORTH 21ST STREET CAMP I.IILL, PA 17011-2288 (717) 763-2316 (~) ..~/anitha Abraham, M.D. 038540L ( ) l~homas Aldous, M.D. 017075E ( ) Salvatore Alfase, M.D. 025502E ( ) Ramesh Arora, M.D. 016727E ( ) Glen Daughb-y, D.O. 0S006776E ( ) Nicolau DaCosta, M.D. 053285-L DATE. Jon Dubin, D.O. OS 006991L . . ( ) Lawrence paul, M.D. 0395.~-L . Marlys Hasson, M.D. 072553L ( ) Howard Rud~ck, M.D. 040862-L . Jolm P. Judson, M.D. 038308-E ( ) Ranjana Sharma, M.D. 031265-E Richard Lulcy, ~ ( ) Alan Tcplis, M.D. 030018-E ) Davld Zimmerm~m, M.D. 005636-E SIGNATURE M.D.~.O. IN ORDF~ FOR A BRAND NAME PRODUCT TO BE DISPENSED, TH~ PRESCRIBER MUST HAND WRIT~ "BRAND NECESSARY" OR "BRJdqD MEDICALLY NECESSARY" IN TH~ SPACE BELOW. DEA# REFILL TIME II11110[I$ ,DORIS E :~ - :315 [ ClIHERItI[ ST :~ ER3 ~ CHII~SERS~URG ' PI-I~Z01 .PATIENT: TIMMONS, DORIS E ';MR#: 441034 - SOC SEC: 162-22-3833 ORD DR: MARIPAT GATTER M.D. PT TYPE: E DOB: 01/31/1928 LOCATION: ER3- Holy Spirit Hospital Depart...ent of Radiology and Diagnostic .laging Camp Hill, Pennsylvania 17011 (717) 763-2600 DICTATION DATE: Nov 32002 1:41P TRANSCRIPTION DATE: Nov 32002 1:41P . ADM DATE: 11/02/2002 ARRIVAL DATE: 11/02/2002 HOSP SERVICE: F-R3 ***Final Report*** EXAMINATION: RIGHT HAND (3V) 73130 - 11/02/2002 COMMENTS: Indication: MVA. There is dislocation of the first metacarpal, carpal articulation. There is a crescent shaped bony fragment consistent with an avulsion probably from the base of the first metacarpal. Mild arthritic changes are seen at the DIP joints of the second through fifth fingers. CONCLUSION: Fracture dislocation atthe first metacarpal carpal articulation. DICTATED BY: BARBARA BRONITSKY M.D. / DAC DATE OF EXAM: 11/02/2002 SIGNED BY: DATE/TIME: BARBARA BRONITSKY M.D. Nov 3 2002 2:23P maging Services Consult~-ti~n Page 1 HOLY S'PIRIT ~,'<~$PITA,, R*mO~,OG~sT/~i~.E COPY ACCESSION ]~ARCODE 1917649 Nov 'STATUs: STAT ER3 PATIENT: TIMMON$, DORIs E $0C SEC: 162-22-3883 ORDER #: 90001 ' MED REC #: 441034 ~AGE: 74Y ORO DATE: Nov 2 2002 1:31PM OR i DR: ~,ontrast/Isotope: - ?- Pregnant'. ..... 'Nlergles: Room#:. ~-..'~,~ EXAM DATE: Nov 2 2002 1:31PM 1377 RIGHT HAND 73130 PRIORITy 2 HOSP SVC: ER3 WALK ADDRESS: 3t5 E CATHERINE ST / CHAMBERSBURG, PA 17201 PHONE: ['717} 2~3-1328 ADM #: 1986695:3 DOB: 01/31119:!8 SEX: F Total # of Teoh: 1917649 · 'COMMENTs: Oxygen: ~- IV: :, R~ING ~DIOLOGIST: TIME ~D: REPORT DICTATED: .L TOTAL P.O1 ~ November ~, 2002 Peter Giesswein, MD Giesswein Plastic Surgery 5 Bmokwood Ave., Suite 1 Carlisle, PA 17013 RE: Timmons, Doris E SS#: 162-22-3833 DOB: 01/31/1928 MR: 441034 HOLY SPIRIT HOSPITAL REHABILITATION SERVICES DEPARTMENT OF OCCUPATIONAL THERAPY (717) 972-4545 Nov 6 '02 16:47 012 ~ ~ Page(s) OK INITIAL EVALUATION 'DoHs was seen in the Outpatient Occupational Therapy Department on 11/05/02. She sustained an injury to her right d~minant hand while involved in a motor vehicle accident. Holding onto the steering wheel, she has had a hyperextension injury to the web space, as well as the pollicis, and an injury to her right index metacarpal head. Upon examination today, we find this patient to have within normal limits range of motion with a level of pain described as 7/10 on the pain scale. We will offer two solid resting postures for the phatanges involved, and also the web space and thumb. The night splint is on the volar aspect and isolating the metacarpal head, as well as the proximal and distal interphalangeal joints. A functional C-bar splint will isolata the metacarpal head of the index finger and will isolate motions at the metacarpal head of the pollicis. This can be utilized while performing tasks at her work place in writing and performing mouse and typing skBs. We have also issued a compression garment by Comfort Cool to support the surgical site of the carpal metacarpal joint. This will give a compression force across the thenar eminence and control of any extra motions into the dght dominant pollicis. We will continue to observe this patient. Doris is very astute of the use of her splinting for day and night use. We thank you for the opportunity of providing an Initial Evaluation. We will await your examination in approximately two weeks' time to reexamine Doris. Any questions pertaining to her care. please don't hesitate to contact us at 717- 972-4545. Sincerely/~ ~ Page 1 of 1 ORIGINAL November 27~ 2002 Peter Giesswein, MD Giesswein Plastic Surgery 5 Bmokwood Ave. ~Cariisle, PA 17013 RE: Timmons, Doris SS#: 162-22-3833 DOB: 01/31/1928 MR: 441034 ~ HOLY SPIRIT HOSPITAL REHABILITATION SERVICES DEPARTMENT OF OCCUPATIONAL THEPJ~,PY (717) 972-4545 Nov 29 '02 1.3.:56 DISCHARGE SUMMARY Doris Timmons was seen in the Outpatient Occupational Therapy Department t0r a reevaluation on 11/27/02. This woman sustained an injury in a motor vehicle accident to her right dominant hand. The injury upon Initial Evaluation on 11/05/02 was a level of pain of a 7/10 on the pain scale. This patient is able to report a 0/10 on the pain scale, as well as manipulating the pollicis and the dght index finger, much improved range of motion specifically to apposition and the use of the web space musculature. She has some pinpoint tanderness on the proximal metacarpal head and articulating surfaces to the carpus. She specifically has pain across the metacarpal head, proximal head, on the dorsum. It is felt that, with the Comfort Cool compression garment, she can support her wrist and discontinue the static style Thermoplasfic splint for web space control. We ask for discharge, as this patient is reporting a 0/10 on the pain scale. She has no limitations in range of motion. Neurovascularly intact. Quite able to function normally with all her activities of daily living. We thank you for the opportunity of providing outpatient Occupational Therapy to Dods Timmons. Any questions pertaining to his care, please don't hesitate to contact us at 717-972-4545. ~ EIERSCH MI~:~"', ~'I"R/L,~SHT Page 1 of 1 ORIGINAL HOLY SPIRIT HOSPITAL REHABILITATION SERVICES DEPARTMENT OF OCCUPATIONAL THERAPY (717) 972-4545 February 12, 2003 Peter Giesswein, MD Giesswein Plastic Surgery 5 Brookwood Ave., Suite 1 Carlisle, PA 17013 RE: Timmons, Doris SS#: 162-22-3833 DOB: 01/3111958 MR: 441034~ INITIAL EVALUATION: Doris Timmons is familiar to the Outpatient Occupational Therapy Department. She presents on initial evaluation of 02/12/03 with an injury that she sustained in a motor vehicle accident on 11/02/02. This patient traumatized her right dominant hand over the index metacarpal joint, as well as the second metacarpal shaft, specifically the mid shaft on the origin site of the first dorsal interossei. Notable localized enlarged swelling is apparent, although manageable in its palpation. Presentation at the present time, patient is unable to adduct the index finger away from the third digit. She is able to apply abduction to her phalanges when slightly flexed but, upon initial evaluation, findings of fingers extended is very difficult for her to initiate the voluntary motion. Volitional motions upon examination today find that this patient, from traumatizing the first dorsal interossei have completely avoiided utilizing and flaring this muscle. After examination today and finding muscle reeducation program, this patient was able to demonstrate adduction in full range of motion, although complaints of an 8/10 on the pain scale. We will continue to promote muscle reeducation, desensitization on this patient. We have integrated a home program utilizing the specific musculature of the right dominant hand in the extensor communis, the first dorsal interossei, and web space of the thumb, the musculature of the web space of the thumb, and integration of extension of the phalanges, abduction with resistance, adduction of the phalanges, as well as pincer grasp techniques. The patient is able to demonstrate excellent cylindrical grasp in her right dominant hand equal to her left at 80 pounds per square inch. Interossei musculature w~ll be reintegrated and reeducated with desensitization and a home program for massage, heat, ice, as patient toleretas. This patient is demonstrating excellent muscle reeducation and will be reevaluated in approximately two weeks' time, on 03/05/03. She has been issued a professional card to contact us if any questions during the two week time period. It is important to contact her therapist. It is felt that this patient will greatly improve by volitionally utilizing the involved traumatized area, and desensitize the area with strengthening program mentioned above. We thank you for the opportunity of providing hand rehabilitation to Doris Timmons. We will continue to follow her over the next 30 days and followup with a Progress Update and Discharge Summary in hopes to see her regain full range of motion with residual pain decreased by 50% within 30 days. Any questions pertaining to her hand rehabilitation, please don't hesitate to contact us at 717-972-4545. Sincerely, 'THOM"A-S~BI--IERSCHMITT, bTPJL, ASHT Page 1 of 1 ORIGINAL CERTIFICATE OF SERVICE I, Marcy L. Brymesser, an employee of the law firm of Angino & Rovner, P.C., do hereby certify that I am this day serving a tree and correct copy of NOTICE OF INTENT TO OFFER DOCUMENTARY EVIDENCE PURSUANT TO RULE 1311..1 on the following via postage prepaid, first class United States mail, addressed as follows: Brigid Q. Alford, Esquire Boswell, Tintner, Piccola & Wickersham 315 North Front Street P.O. Box 741 Harrisburg, PA 17108-0741 Date: April 26, 2004 arcy Li BrChesser 273466.1 hRAS~VILB 1N THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA DORIS E. TIMMONS, Plaintiff SUSAN L. FLICK1NGER, Defendant To; CIVIL ACTION - LAW NO. 03-2837 CIVIL JURY TRIAL DEMANDED STIPULATION TO LIMITATION OF MONETARY RECOVERY PURSUANT TO RULE 1311.1 Susan L. Flickinger, by and through her attorney Brigid Q. Alford, Esquire Doris E. Timmons, Plaintiff, by and through her counsel, Angino & Rovner, P.C., stipulates to $15,000.00 as the maximum amount of damage recoverable upon the trial of the appeal from the award of arbitrators in the above-captioned action. Doris E. T:[mmons Name of Plaintiff ANGINO & ROVNER, Date: April 26, 2004 4503 N. Front Street Harrisburg:, PA 17110 (717) 238-6791 Counsel for Plaimiff ulre 273465.1~RAS~vlLB CERTIFICATE OF SERVICE I, Marcy L. Brymesser, an employee of the law firm of Angino & Rovner, P.C., do hereby certify that I am this day serving a tree and correct copy of STIPULATION TO LIMITATION OF MONETARY RECOVERY PURSUANT TO RULE 1311.1 on the following via postage prepaid, first class United States mail, addressed as follows: Brigid Q. Alford, Esquire Boswell, Tintner, Piccola & Wickersham 315 North Front Street P.O. Box 741 Harrisburg, PA 17108-0741 Date: April 26, 2004 MarO L. Brim 273465.1 ~RAS\MLB Bfigifl Q. Al ford, Esqui~ Supreme Court I.D. #38590 BOSWELL, TINTNER, PICCO/A &ALFORD 315 North Front Stxeet Post Office Box 741 Hanisburg, Pennsylvania 17108-0741 Attorneys for Defendant Susan L. Flickinger DORIS E. TIMMONS, Plaintiff V. SUSAN L. FLICKINGER, Defendant : IN THE COURT OF COMMON PLEAS : CUMBERLAND' COUNTY, PENNSYLVANIA : : No. 03-2837 - CIVIL TERM .. : CIVIL ACTION - LAW : JURY TRIAL DEMANDED NOTICE OF INTENT TO OFFER DOCUMENTARY EVIDENCE PURSUANT TO RULE 1311.1 To: Doris Timmons C/O Richard A. Sadlock, Esquire Angino & Rovner, P.C. 4503 North Front Street Harrisburg, PA 17110 Susan Flickinger, Defendant, intends to offer the documents attached hereto at the trial of this appeal from the award of arbitrators, in the manner provided by Pa.R.C.P. No. 1311.1. The following documents are attached: 1. Geisswein Plastic Surgery records - subpoenaed records (#1-24) 2. Holy Spirit Hospital discharge records - 8/27/00; 11/2/02 (#25,26) Daryl White, M.D. subpoenaed records (#27-187) Respectfully submitted, By: BOSWELL, TINTNER, PICCOLA & ALFORD 315 North Front Street, Post Office Box 741 Harrisburg, Pennsylvania 17108-0741 Attorneys for Defendant Flickinger Date: DORIS TIMMONS' MEDICINE LIST A]O JULY 2000 ALLOPURINOL - 1 PER DAY, 300 MG (TO PREVENT KIDNEY STONES) PREMARINE - 1.25 MG - 1 PER DAY (FOR BONES) RANDITIDINE - 1-2X A DAY (TO DECREASE STOMACH ACID) HYLOREL - 10 MG - 1-2X A DAY (FOR HIGH BLOOD PRESSURE) ALTACE - 2.5 MG - 1 PER DAY (FOR HIGH BLOOD PILESSURE) TRIAMTERENE - 37.5/25 MO -1-MON, WED, FRI, (FLUID PILL) PRAVACHOL - 20 MO - 1 PER DAY IN EVENING (CHOLESTEROL) QUESTRAN LIGHT PDR PACKET - 5 MG - MIX & TAKE I PACKET 2 X A DAY (NO SUBSTITUTE) GLUCOTROL -5 MG -1 AFTER BREAKFAST (DIABETIC) TETKACYCLING - 1 DAILY (SKIP WEEKENDS) (FOR ROSACEA OF THE NOSE) ASPIRIN - I PER DAY (SUSCEPTIBLE TO BLOOD CLOTS) PROPOXYPHENE NAP+APAP - 100 MO, 1-2X A DAY (OR AS NEEDED FOR ARTHRITIS) ANUSOL HC CREAM - 10 MG APPLY 2X A DAY (FOR HEMORRHAGE) SUCRALFATE TABS - 1 GM (FOR REFLUX) ALLERGIES CODINE SEA FOOD ZOCOR LATEX RUBBER PENICILLIN FISH MEVACOR BETA BLOCKERS HAVE A HERNIATED DISC 3RD FROM BOTTOM OF SPINE 000001 c~..- -.-----*-i* Patient Name '"~g_'~.~' I ~ Age '~,~- eirthdate What is your reason for visit? GENERAL [] Chilis [] Depression [] Dizziness [] Fainting [] Fever [] Forgetfulness [] Headache [] Loss of sleep [] Loss of weight [] Nervousness [] Numbness [] Sweats MUSCLEJJOINT/BONE Pain, weakness, numbness in: ,~ Arms [] Hips [] Back [] Legs [] Feet [] Neck [~Hands [] Shoulders GENITO-URINARY [J~] Blood in urine [] Frequent urination [] Lack of bladder control [] Painful urination [] AIDS [] Alcoholism [] Anemia [] Anorexia ~ Appendicitis [] Arthritis [] Asthma [] Bleeding Disorders [] Breast Lump [] Bronchitis I--] Bulimia [] Cancer [] Cataracts ON IDENTIAL __Today's Date ~7~' / 7' ~6 (Confidential) Date of last physical examination Check (v') symptoms you currently have or have had in the past year. GASTROINTESTINAL [] Appetite poor ~ Bloating [] Bowel changes [] Constipation ~ Oiarrhea [] Excessive hunger [] Excessive thirst [] Gas ~ Hemorrhoids t~q indigestion [] Nausea [] Rectal bleeding [] Stomach pain [] Vomiting [] Vomiting blood CARDIOVASCULAR [] Chest pain [] High blood pressure [] irregular heart beat [] Low blood pressure [] Poor circulation [] Rapid heart beat [] Swelling of ankles [] Varicose veins EYE, EAR, NOSlE, THROAT [] Bleeding gums [] Blurred vision [] Crossed eyes [] Difficulty swallowing [] Double vision [] Earache [] Ear discharge [] Hay fever [] Hoarseness [] Loss of hearing [] Nosebleeds [] Persistent cough [] Ringing in ears [] Sinus problems [] Vision - Flashes [] Vision - Halos SKiN [] Bruise easily [] Hives ~ Itching [] Change in moles ~C~ Rash F~ Scars [] Sere that won't heal MEN only [] Breast lump [] Erection difficulties [] Lump in testicles [] Penis discharge [] Sore on penis [] Other WOMEN only [] Abnormal Pap Smear [] Bleeding between periods [] Breast lump [] Extreme menstrual pain F,~ Hot flashes [] Nipple discharge [] Painful intercourse [] Vaginal discharge [] Other Date of last menstrual period Date of last Pap Smear ~2-/._4' - ~"'~ Have you had r a mammogram? ~s Are you pregnant? Number of children Check (/) conditions you currently have or have had in the past year. [] Chemical Dependency ~] Chicken Pox [~ Diabetes [] Emphysema [] Epilepsy [] Glaucoma [] Goiter [] Gonorrhea [] Gout [] Heart Disease [] Hepatitis [] Hernia [] Herpes [] High Cholesterol [] HIV Positive [] Kidney Disease [] Liver Disease [] Measles [] Migraine Headaches [] Miscarriage [] Mononucleosis [] Multiple Sclerosis J;~ Mumps [] Pacemaker [] Pneumonia [] Polio List medications you are currently taking. [] Prostate Problem [] Psychiatric Care [] Rheumatic Fever [] Scarlet Fever [] Stroke [] Suicide Attempt [] Thyroid Problems [] Tonsillitis [] Tuberculosis [] Typhoid Fever [] Ulcers [] Vaginal Infections [] Venereal Disease OO00.O2 p~ H~,-~) ~.~ , health information about your family. Check (,/) if, your bloo,rt relatives State of Age at I Cause of Death Retgtion Age Health Death Disease Father ?~ ~o~ ~ /~A~ ~ A~hritls, Gout Mother 72 ~'~ ¢~ 5~ ~6 k~ Asthma. Hay Fever Brothers Cxd~ /¢ S~ SN ~E~ X Cancer , 6 ~ ~~~ Chemical Dependency ~ ~ ~~ ~ Diabetes ~ Hea~ Disease, Strokes Sisters ~ ~;~ .~m~ ~"~~ ~ High Blood Pressure ~ ~ ~¢:~ Kidney Disease &~ ~ Tuberculosis ~ ~ ¢¢¢~ Other Year Hospital '7? Reason for Hospitalization and Outcome ,, al< Yearof Sex ofl Complications if any Birth Bidh ,~o F .' Check (/) which substances you use and describe how much you use. Have you ever had a blood transfusion? If yes, please give approximate dates [] Yes [~No Serious Illness/Injuries Date Outcome Caffeine Tobacco Drugs Other Check (,/) if your work exposes you to the following: Stress Hazardous Substances Heavy Lifting Other Occupation I certify that the above information is correct to the best of my knowledge, l will not hold rny doctor or any members of his/her staff responsible for any errors or omissions t,h~t I may have made in the completion of this form. · Signature Date Date Reviewed By 000003 Consultation Note Patient Name: Doris Timmons Date: July 26, 2000 Chief Complaint: Right carpal tunnel syndrome. HPI: Mrs. Timmons is a 72-year-old Caucasian female who for a long time is suffering from pain in the right extremity. This pain is located in the distribution of the distal median nerve. She had undergone a carpal tunnel EMG which showed early mild carpal tunnel syndrome. She would like me to recommend treatment. PM}I: Hysterectomy, appendectomy, pulmonary embolus, crushed left wrist and childbirth. Medications: The patient is on several listed on the accompanying separate sheet. was reviewed with the patient. medications which are The health history form Allergies: She also has multiple allergies as listed on the separate sheet. FH: Is positive for cancer, diabetes, heart disease and high blood pressure. She has four sisters and all are healthy. Ail of her brothers died. She has four children of whom two have diabetes. SH: She drinks tea three times a week. She doesn't smoke and doesn't drink alcohol. She never received a blood transfusion. Examination: 72-year-old Caucasian female in no acute distress. The patient has at the day of exam no pain in her hand. However, the Tinel's sign is positive with shooting pain up and down the hand. She also has a positive Phelan's sign on the right. The hand does not show any dystrophic signs. The ROM is within normal limits. She has good capillary refill to all digits and good sensation. There is no sign of significant arthritis seen on the digits. The left hand is showing a positive: Phelan's sign, but an inconclusive Tinel's sign. The gross motor strength is well. The patient is right-handed. Impression: The patient has early carpal tunnel syndrome on the right arm. Plan: I discussed with her several treatment options including splinting versus surgical release. She does not want the splint. This will get in her way. She would like to have the carpal tunnel released. However, before I commit myself to this surgery, I told her that I will get an X-ray just to make sure that she does not have any arthritis in her wrist which could oonceivably contribute to her pain. 000004 Consultation Note Continued July 25, 2000 Doris Timmons knows to call me if she should have any concerns. er questions or PG/nar Peter Giesswein, M.D. 000005 RUN DATE: 09/01/00 RUN TIME: 1749 HOLY SPIRIT HOSPITAL, CA~P HILL, PA 17011 DEPARTMENT OF LA~ORATORYM~DiCINE STEPHENSON S.P- SWAMIDOSS, M.D., DIRECTOR pHYSICIAN GIESSWEIN, PETER MD PAGE i CONFIDENTIAL Name: TIMMONS,DORIS E Birthdate: 01/31/28 Age: 72 Room No.: OP SUnG REG CLI Sex: F Hosp. No.: 000015537178 441034 Doctor: GIESSWEIN,PETER MD Specimen Date: 08/25/00 Received Date: 08/25/00 1035 Surgeon: GIESSWEIN, PETER MD Specimen No.: S 00-6594 REPORT: Surqical Specimen Submitted 1- SCLEROTIC TRAPEZIOUS BONE RIGHT HAND Entered: 08/25/00 - 1050 BS Clinical Information Provided History and Pre-Op Diagnosis: Basalar joint arthroplasty, Right carpaltunnel syndrome Post-Op Diagnosis: Same Entered: 08/28/00 - 1033 SML Gross Description The received specimen consists of multiple irregular fragments of bony consistency, the aggrgate measuring approximately 2.5 x 2 x 1.5 cm. Dictated by: ANTHONY E. MAAS, M.D Entered: 08/28/00 - 1034 SML Microscopic Description Sections reveal fragments of sclerotic bone with overlying cartilage showing degenerative changes including focal fissuring and erosion. definite histological features of malignancy are identified. No Dictated by: CHARLES D EVANCHO MD Entered: 09/01/00 - 1654 SML Diagnosis SPECIMEN DESIGNATED SCLEROTIC TRAPEZIUS BONE RIGHT HAND, BASILLAR JOINT ARTHROPLASTY: FRAGMENTS OF SCLEROTIC BONE WITH C~RTILAGE SHOWING DEGBNERAT IVE01DictatedEntered*' bY:09/01/00CHANGEScF~RLE s.(SEE1551D MICROSCOPICEvANCHO$~L MD DESCRIPTION). CHARLES D EVANCHO MD 09/01/00 000006 Pro. qrexs ~ ~ ~/~,-" ~ CONFIDENTIAL t/al~ar IPA~ PATIENT NAME OATE Important: Please date and initial every entry. /" Pro. qrexs ]Vo./:ex 000007 PAGE PATIENT NAME DATE Important: Please date and initial every entry. Doris Timmons 08128/00 S: The patient is doing very well after the recent surgery. She has improved. However, she is still in her cast which does not give her any problems other than some irritation on the volar proximally. I, therefore, altered the cast to make it mo?e aspect comfortable. P: I will see the patient back in about: a week just to make s~, e that this irritation on the upper part has improved. PG/nar/,/ Doris Timmons 08114/00 S: The exam has not changed. The patient still has carpal tunnel syndrome complaints in the fingers and she also has complaints about numbness in the ulnar side of her hand. The exam was repeated and found to be exactly as it: was before. I also did another Grinding test on the hand and that shows some discomfort in the basilar joint of her thumb. I also went over the X-ray with the patient. We discussed benefits, :risks and alternatives of surgery. / P: We will go ahead and do a so-called Anchovy procedure where we remove the trapezium bone and replace it with aut0~nous material from the flexor carpi radialis tendon. All patien~/~uestionsl./ were answered. We will schedule the surgery. PG/nar /y /, Doris Timmons 09/07/00 S: The irritation has improved with the change of the cast. P: I will see Mrs. Timmons back in about two weeks at which point we will remove the cast. I have already spoken to Tom Beierschmitt, the occupational therapist at Holy Spirit Hospital, to coordinate the hand therapy. He is aware of wha~ is ~eeded. Mrs. Timmons will call me if there should be any ~roblems in the interim, but so far she is very happy with her recovery. There ~re no nerve compression symptoms remaining. PG/nar~. ' . PREOPERATIVE DIAGNOSIS: Severe arthritis, right basilar joint with intractable pain and carpal tunnel symptoms and symptoms of ulnar nerve compression. POSTOPERATIVE DIAGNOSIS: The same. OPERATION: Release of right carpal tunnel by open technique and release of canal through the same incision. Arthroplasty of right basilar thumb joint with excision of trapezium bone and Correll type int, erposition tendon graft with application of thumb, spica cast with thumb in position of function. SURGEON: PETER GIESSWEIN, MD ASSISTANT: DATE: 8/25/2000 ANESTHESIA: General anesthesia. Postoperative condition stable. Upper arm tourniquet set at 250 of mm of Mercury, Total tourniquet time: 85 minutes. HISTORY: The patient is a 72-year-old Caucasian female who for a long time suffered from severe intractable pain of the right basilar joint of her thumb. She also described symptoms of carpal tunnel compression at the wrist as well as compression of the ulnar nerve at the wrist. Nerve conduction study, however, only showed a mild degree of carpal tunnel compression. The patient was seen on several occasions in the office. Benefits, risks, and alternatives of the arthroplasty and release of the nerve were discussed. The patient had all questions answered before consent was obtained. The patient notes that the arthrOl:dasty is primarily designed to accomplish more comfortable use of her hand. She notes that il: might.be necessary at one stage to fuse that joint. PROCEDURE: The patient was placed in the supine position and after administration of general anesthesia, the hand was prepped and draped in the usual sterile manner. An Esmarch bandage was used to exsanguinate the hand as the tourniquet was then inflated to 250 mm of Mercury. Preoperatively, the incision was a modified Wagner st}fie and was reinforced with marking pens. The incision was opened and special care was taken not to injure any of the radial nerve branches, The radial artery was identified in the snuffbox after release of the first extensor compartments. The artery and tendons of the first compartment were retracted dorsally in order to gain access to the trapezius bone. The bone was identified by following the first metacarpal. The volar capsule was opened and the bone was dissected out of its surrounding. tissue using the Freer elevator. Some of the tissues were sharply incised. The bone was found Page 1 of 2 HOLY SPIRIT HOSPITAL Camp Hill, PA 17011 RECORD OF OPERATION NAME: Timmons, Doris E MR#: 441034 ROOM: 7EST704 02 COPY TO: PETER GIESSWEIN, M.D. 000009' NAME: Timmons, I. ,s E M R#: 441034 CONFIDENTIAL to be sclerotic and the bone was removed with the rongeur initially. The remaining half was then elevated and excised. The area was extensively irrigated. The joint surfaces of the scaphoid and first metacarpal were examined. The surfaces showed some degree of destruction but it was rather minor. The repair was then done with a piece of the extensor carpi radialis tendon. 8 cm of the tendon was harvested by splitting the tendon in half. It reached attached at its distal insertion. This tendon was formed in a ball and sutured togethe~r in a style of fashion. I used #4-0 Prolene on piecemeal for doing this. This achieved a nice cushion. This cushion was then placed wherever the trapezius bone had been located. The spacer was held in place by suturing it to the surrounding tissues. The surrounding tissues of this joint were then closed by using #-4-0 Prolene simple stitches. A nice repair wa.~; accomplished. Radial artery was checked and found to be intact. I again checked the identit~ed radial nerve branches and none of the nerve branches were cut. The repair was then donE; with simple stitches of #4-0 nylon. After closing the arthroplasty site, the palmar incision was opened according to the preoperative markings. The palmar fascia and the transverse carpal ligament was excised completely in order to free the median nerve. The entire release was checked and it was found to be complete. I then went ahead and opened the septum tow;ard the Greer's canal. The nerve was found to be not compressed in this area. No further dissec~tion was done in this area. The closure of the release was done with simple stitches of ~4-0 nylon. Bacitracin was applied to all incisions and the Xeroform. The hand was extensively padded with gauze and Kerlix. A thumb spica plaster cast was placed. This cast was surrounded with ace wrap. The tourniquet was released and good refill was reestablished to all the digits. The patient left the Operating Room in stable and satisfactory condition. She will spend some time in the post anesthesia care unit before being admitted for 23 hours observation. Directly after the procedure, I talked to her sister and gave report. PG/sz DOC #: 79619 D: 08/25/2000 T: 08/30/2000 9:15 A 001019 cc: PETER GIESSWEIN, M.D. PETER GIESSWEIN, M.D. Page 2 of 2 HOLY SPIRIT HOSPITAL Camp Hill, PA 17011 NAME: Timmons, Doris E MR#: 441034 ROOM: 7EST704 02 RECORD OF OPERATION COPY TO: PETER GIESSWEIN, M.D. 000010 CONFIDENTIAL mZ mm 000011 CONFIDENTIAL PAGE PATIENTNAME DATE Important: Please date and initial every entry. Doris Timmons S: Mrs. Timmons' wrist looks excellent. There is no sign of infection, the stitches were removed today. She was seen by Mr. Bierschmitt yesterday for a splint fabrication. The carpal tunnel syndromes as well as the ulnar nerve compression symptoms have completely disappeared. I will now take aback seat and have Mr. Bierschmitt work with Mrs. Timmons to reg~¢ good function of this hand. I am pleased that Mrs. Timmons' [~a~y is pain free. I will see her back in about two weeks. PG/naw~ Doris Timmons 10/05/00 - S: Mrs. Timmons is doing very well. She: had seen Tom Beierschmitt who initiated the hand therapy. She already has good ROM in the- joint and the comfort level is fair. At times she still has some pain ih the operated thumb, but this is not as ~/~a~-/ a problem as- was before surgery. ~ I will see Mrs. Timmons back in thr~e weeks at which point she had several sessions of hand theraCy and I would anticipate- significant improvement She knows t~call me if there should be- any problems in the interim. PG/nar L/ - Doris ?immons 10/25/00 S: Mrs. Timmons' wrist looks excellent. The discomfort at the operative site is getting less and less. She is now using her hand freely. ,~he is progressing nicely with her hand therapy. P: I wil~ see Mrs. Timmons back in about four to six weeks unless there's ~ problem in which case she knows to call me before. PG/nar )/ 00001.2 ROb PETER G~ESSWEiN, M.D. SUBSTITUTION PERMISSISLE IN ORDER FOR A BRAND NAME PR~'DUCT TO SE DISPENSED, THE PRESCRIBER MUST HANDWRrI'E SRAND NECESSARY OR BRAND MEDICALLY NECESSARY IN 'THE SPACE BELOW, 000013 PATIENTNAME DATE / CONFIDENII [ Important: Please date and initial every entry. /=CL. Doris Timmons ~/20/00 S: Mrs. Timmons is doing well, but she still has some jagging at the distal part of her palm incision. It could well be that she has a retained stitch. I explained this to her. We then explored this area here in the office, but I could not find a stitch. The incision was made about 8 mm long and under local anesthesia. The patient tolerated it well. P: I will see her back in about two weeks just to make sure that she is healing well. The thumb is doing e~cellent. She ~as good ROM and she is very comfortable. She is ~till pursuing her hand therapy for ~he next three months once a/,month appointments. I will see Mrs. Timmons back prn. PG/nar ~/ - // Doris Timmons 12/07/00_ ....... well The area that was explored in the ~ is - S: Mrs Timmons ts aotng wu, .... . ,. ' - The/:a~in,~ ,-ain has already decreased significantly. ThWpatient ts using - neanngwelt. ~ ~ ~v , · · her thumb freely~nd comfortably. I don t see any IX~Stoperative comphcatmns and I _ the atien now to go ahead and use her hand as much as she wishes. allow p. ~/r ,_ :_ _~.~,.. ,~.. ,~. iust to make sure that she continues to do - P: I will see ne~ oac~ tn aura,,, .......... th% _ well. PO/n_ar:/ Pro q r rr 000014 DATE PROGRESS NOTES CONFIDENTi;2 Doris Timmons 02/07/0z _ S: Mrs. Timmons still has some pain with a positive Tinel's sign in the right carpal tunnel release incision. It has not significantly - improved. The scarring has matured. I believe at today's visit we - are seeing a neuroma. P: I would like to address this surgically by removing the scar and - exploring the incision. I explained this to the p~tient and she is - in agreement. Benefits, risks and alternatives w~re explained and the patient would like to make an appointment t~/have it done in - the near future. An h and p was done. PG/nar~ - Doris Timmons 04/26/01 S: Mrs. Timmons is doing very well. The pressure and pain point in her palm is gone. There is no sign of infection. The patient has good ROM. The motor branch of the median nerve is functioning well. P: I will see Mrs. Timmons back in about a week for stitch removal. If there should be any problems, the patient knows to call. PG/na~ I1' Doris Timmons os/zo/ol S: Mrs. Timmons is doing very well. She has greatly improved. All the stitches are removed. The scar tissue is~ery minimal in the palm She is using her hand freely and without problems. P: I'will see Mrs. Timmons back prn. PG/nar//. ~ ~ 7 7 f ' · / oo/oi 5 CONFIDENTIAL ADM. DATE: 04/19/2001 PREOPERATIVE DIAGNOSIS: Pain, right carpal tunnel release scar with entrapped nerve. POSTOPERATIVE DIAGNOSIS: The same. OPERATION: Removal of scar tissue and release of median nerve from encasing scar tissue. SURGEON: PETER GIESSWEIN, MD ASSISTANT: DATE: 4/19/2001 ANESTHESIA: MAC plus 4 cc of 1% Lidocaine without Epinephrine infiltration. Upper arm tourniquet set at 300 mm of Mercury for 18 minute:s. Postop condition stable. History is as per office chart. Benefits, risks and alternatives of proposed procedure were explained to the patient on several occasions. All her questions were answered before informed consent was obtained. PROCEDURE: The patient was placed in the supine position on the Operating Room table. MAC was administered. The patient's hand was then prepped and draped in the usual sterile manner. The right forearm tourniquet was inflated to 250 mm of Mercury after exsanguination of the hand. The palmar incision was made according to the preoperative markings, reopening the old incision. Upon opening, a tremendous amount of scar tissue was encountered. During the procedure, some punctate bleeding was observed and the tourniquet was then increased to 300 mm of Mercury. This resulted in complete hemostasis. Under Ioupe magnification, diligent dissection of the tissues around the nerve was carried out. The scar tissue was excised. The median nerve in the distal tunnel was freed of all surrounding scar tissue making sure that the motor branch of the median nerve was not violated. The area was extensively irrigated. The patient was then asked to oppose the thumb which she was able to do indicating an intact motor branch. The closure was done with simple stitches of #5-0 nylon. Bacitracin underneath a dry dressing with apparent gauze was applied. Volar plaster splint was applied which was secured with an ace wrap. The tourniquet was released and good capillary refill was reestablished to all digits. The patient left the Operating Room in a stable and satisfactory condition. She is instructed concerning follow-up, diet, activities, and medications. She knows to call if there should be any further problems or concerns. Page 1 of 2 HOLY SPIRIT HOSPITAL Camp Hill, PA 17011 RECORD OF OPERATION NAME: Timmons, Doris E MR#: 441034 ROOM: OSR COPY TO: PETER GIESSWEIN, M.D. .000016 · NA,E: Timmons. ~.,risE ~ CONFIDENTIAl M R#: 441034 PG/sz DOC #: 138488 D: 04/20/2001 T: 04/23/2001 1:26 P 001457 cc: PETER GIESSWEIN, M.D. PETER GIESSWEIN, M.D. Page 2 of 2 HOLY SPIRIT HOSPITAL Camp Hill, PA 17011 RECORD OF OPERATION NAME: Timmons, Doris E MR#: 441034 ROOM: OSR COPY TO: PETER GIESSWEIN, M.D. 00.0017 Pro.~re~ DATE important: Please date and initial every entry.' V ') 000018 FAX: (7171 249-4534 ~SSWEIN PLASTIC SURGERY PETER G[ESSWEiN. M.D. CENTER FOR COSMETIC & RECONSTRUCTIVE SURGERY 5 BROOKWOOD AVE., SU,TE ~ C^RL,SLE, PA ~o~ ADDRESS 3514 TRINDLE ROAD CAMP HILL, PA 17011 AGE °ATE [] LABEL /, ~ ~"'~, ~' ,MD SUBSTITUTION pERMISSIBLE ~~j¢4¢ ~ '~'/~'~' , '' RDER FOR A BRAND NAME p.~t6DUDT TO BE DISPENSED, THE PRE,<~CRIBER MUST HAND- IN 0 ...... ~A~v" r')CV~'IBRAND MEDICALLY NECESSARY" IN THE SPACE BELOW. WRITE "BRANU N~UC~ .... ~'B~ ~ CONFIDENTIAL 00001_9 Operative Report CONFIDENTIAL Patient: Date: Surgeon: Doris Timmons 11/19/02 Peter Giesswein, M.D. Preoperative Diagnosis: Basal cell carcinoma, right temple and irritated seborrhea keratosis. Postoperative Diagnosis: Same. Operative Procedure: Excision and layered repair ofbas:d cell carcinoma, right temple with adjacent tissues and shave biopsy with hyfercation of irritated seborrhea keratosis, right temple. Anesthesia: 4 cc of 1% lidocaine with epinephrine infiltration. Postop Condition: Stable. History: As per office chart. Benefits, risks and alternatives were explained to the patient. Alt questions were answered before informed cot[seat was obtained. Description of Procedure: The patient was placed in a supine position. The lines of excision were outlined with marking pen. The areas were prepped and draped in the usual sterile manner and infiltrated with the above-mentioned local anesthetic. A full thickness excision nfthe nodular basal cell carcinoma was carded out. The adjacent tissues were undermined. Bleeders were electrocauterized. The tissues were rotated into the defect and secured in a layered fashion using 5-0 Vieryl for the deeper layer and 6-0 Nylon simple stitches for the skin. The second temple lesion was shaved off. The base was hyfereated. Bacitracin ointrnent underneath a dry dressing was placed for each area. The patient toterated the procedure welk Plan: The patient is informed about follow-up, diet, activity and medication and to call if there shoutd be any probl, ems or 4oncems. She is also fottowed by.me for a right hand injury which is an unrelated pro, em. / Peter Giesswein, M.D. /4 /' PG/nar / 000020 Carlisle Regional Medical Center Department o£ Pathology 246 Parker Street, Carlisle, PA 17013 ( ONFIOENTIAL Duckkyu Chang, M.D., Pathologist Henry S. Crist, M.D., Pathologist T1MMONS, DORIS E MR.N: 0001017063 DOB: 01/31/1928 Ward/Clinic: SP Age: 74 Y Sex: F Procedure Date: 11/19/2002 Received Date: I 1/20/2002 Attending: PETER GIESSWEIN, M.D. Requesting: PETER GIESSWEIN, M.D. Page 1 of 1 SP-02-8873 Surgical Pathology Report SPECIMEN: A. SKIN - Right temple CLINICAL NOTES: SPECIMEN DESCRIPTION: GROSS DESCRIPTION: The specimen received in formalin consists of a 1.5 by 1 cm, ellipse of skin with an average thickness of 0.5 cm. The central surface is raised and granular. The biopsy margins are inked. It is serially sectioned into four pieces and submitted in one cassette. (DC/vgh 11/20/02) MICROSCOPIC DESCRIPTION: Performed DIAGNOSIS: Excisional Biopsy of Skin, Temple, Right: Nodular Basal Cell Carcinoma (margins are free) Solae Elastosis Signed Out/Reported Date: 11/21/2002 DUCKKYu CHANG, M.D. (£1ectronie Signature) TIMMONS, DORIS E SP-02-8873 Ward/Clinic: SP Printed: tl/21/O2 9:57 AM ('l (3 O .(} 9. '~ Page 1 oft PATIEN~ ME DATE CONFIDENTIAL Important: Please date and initial every entry. Doris Timmons 11/05/02 S: Pain, right thumb after MVA on November 2, 2002 and. formation of two lesions in the fight temple area. O: The patient has swelling over the ~ joint and the second metacarpal on her hand. The swetling is rotated oa the dorsum She has some localized pain at the base of her second metacarpal and also in the radial aspect of her MP joint I. It appears to be a synovitis. The patient brought some X-rays which I reviewed with her. The patient had previous surgery on thi/~s ~} ,~? and the incision of this previous surgery has healed very nicely. There is somed~__~ also over the areas of the pain. The patient also shows me at this appointment two facial lesions which are unrelated to the MVA_ Both are located on the fight temple. One has a nodular appearance and it measures about 2 x 1.3 cm. The other one appears to be an irritated seborrhea keratosis. I talked to the patient in great length about these findings. P: For the hand, I would recommend some kenelog injection which we did today. For the face, I would recommend some excision which we c~nnot do today, but I described benefits, risks and alternatives and we will make the/arrangements for the near future. I also recommended for the hand the use of some hah#therapy and some splinting. The patient w/Il do this. I will see her again in about tw~ weeks unless there's a problem in which case she knows to call me before. PO/nar/1/4 Doris Timmons 12/03/02 S: The patient feels better, but she still has some pain over the previously treated hand areas. O: The swelling over the hand areas have dimin/shed. She has full ROM. She has good gross motor strength. Sensation is f'me and so is capillary refill to the distal fingertips. She still has some p,a/n on palpation on the base of the second metacarpal and at the radial aspect of he;/MPjoint, but it is much less than before. She is wearing her splint. The temple areas ~e healing very nicely. - P: I e,xplained, to,~rs. Tiromo,a.s that I would continue the present care. If there should be any Change, she l~Ows to call. Otherw/se, I would like to see her back in about folk weel~. PO/nar (q 0000 CONFIDENTIAL DATE Important: Please date and initial every entry. Doris Timmons 01/14/03 S: The patient still has some pa/n in the right hand, but less than I~fore. O: The tendonitis-synov/tis has improved. She still has one area on the domum of her right hand, which does cause some pain on palpation. She would like me to inject it again. She has fulI ROM of and sensation distally. The 1 cc ofkenelog 10 and the t P: I will release Mrs. Timm any further problems. Ifh to see her back. PG/nar ~wdig/ts and good extension. She has good capillary refill er ghp is fine. I injected ~te spot that we identified with ient tolerated th/s well. ns fi.om my care, but she knows to call me if there should be l?covery, however, continues then I don't necessarily have Doris Timmons 02/10/03 S: Mrs. Timmons is doing much better O: She indicates that she is not able to hand, but I can actually make her do that she would not be able to do so. ' P: I will release Mrs. Timmons fi.om any problems or concerns. PG/nar with her right hand. ~read the second and third digits on her right [ d.o not understand where she got the impression ere ts much less pain over the dorsum of her hand. ay care. She knows to call me if there should be 000023 Bfigld Q. Afford, Esquir~ Supreme Cot~ I.D. #35590 BOSWELL TINTNER, PICCOL~, & ALFORD Pos~ Of~cc Box 741 DORIS E. TIMMONS, Plaintiff V. SUSAN L. FLICKINGER, Defendant : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : : No. 03-2837 -CIVII_ TERM : CIVIL ACTION - LAW : JURY TRIAL DEMANDED NOTICE To Giess~vein Plastic Surgery: You are required to complete the following Certificate of Compliance when producing documents or things pursuant to the Subpoena. CERTIFICATE OF COMPLIANCE WITH SUBPOENA TO PRODUCE DOCUMENTS OR THINGS PURSUANT TO RULE 4009.23 /~;C-~l~_ .~-~-I ,certifytothebestofmyknowledge, information and beliefthat all documents or things required to be produced pursuant to the Subpoena issued on October 29, 2003 havebeenproduced. Date: 000024 HOLY '~IT HOSPITAL TIMMONS OORIS E 441034 Gender : Female Age : 72 Disposition : Home, Self Care (1) Disch Date : 08/27/2000 15544281 Medicare DRG 441 HAND PROCEDURES FOR INJURIES HCFAwt 0.9179 A/LOS 3.1 G/LOS 2.2 Principal Diagnosis *99791 COMPLICATION AFFECTING SPECIFIED BODY SYSTEM, HYPERTENSION Secondaw 3540 9974 78701 71694 73399 25000 5533 53081 E8788 E8497 Diagnoses CARPAL TUNNEL SYNDROME -DIGESTIVE SYSTEM COMPLICATIONS, POSTOPERATIVE NAUSEA WITH VOMITING ~ARTHRITIS, RIGHT BASIL.AR JOINT -SCLEROSIS. TRAPEZIUM BONE DIABETES MELLITUS WITHOUT COMPLICATION, TYPE II (NON-INSULIN DEPENDENT/NIDDM/ADULT-ONSET) OR UNSPECIFIED TYPE DIAPHRAGMATIC HERNIA ESOPHAGEAL REFLUX OTHER SURGICAL OPERATION, WITH ABNORMAL REACTION/LATER COMPLICATION, NO SURGICAL MISADVENTURE Injury or Poisoning occurring at/in residential institution ,Principal Procedure ~;t2~'*0443 RELEASE OF CARPAL TUNNEL [ Other Procedures ?~1~ ~' 8172 ~ARTHROPLASTY OF RIGHT BASIl. AR THUMB JOINT WITHOUT IMPLANT tj~'7794 -EXCISION OF TRAPEZIUM BONE O000c. -F~MERGENCY CL'~T[R URGI CL~TER DISCHARGE INSTRUCTIONS ~LY SP[~T H~PITAL (71~ 763-~16 ~ (717) 763-~ ~ . ~g' ~' e ' ~ ~' Patient In~aflon: pi~atton s~ ~nt i~o~a~on to ~ and ~p, 2: NECESSARY AP ( ) Fo~low-up with: ( ) Urgi Cente? ( ) Family Doctcr in cieys for: ( ) FollOW-Up '~-~ooe Du~im D,O. OS 00699tL ( ) Magys Hast. on, M.D. 0725~t3L 000026 Brigid Q Alford, Esquire Supreme Court I.D. #38590 BOSWELL, TINTNER, PICCOLA & ALFORD 315 North Front Street Post Office Box 741 Harrisburg, Pennsylvania 17108-0741 Attorneys for Defendant Su~an L. Flickinger DORIS E. TIMMONS, Plaintiff V. SUSAN L. FLICKINGER, Defendant : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLV.a2NIA : No. 03-2837 - CIVIL TERM : CIVIL ACTION - LAW : JURY TRIAL DEMANDED To Da:'.ry White, M.D.: NOTICE You are required to complete the following Certificate; of Compliance when producing documents or things pursuant to the Subpoena. CERTIFICATE OF CoMpLIANCE WITH SUBPOENA TO PRODUCE DOCUMENTS OR THINGS PURSUANT TO RULE 4009.23 i, bfi ch [ ~ {/-ih' 4 '~-..-, certify to the best of my knowledge, information and belief that all documents or things required to be produced pursuant to the Subpoena issued on October 29, 2003 have been produced. Date: 000027 - Chambersburg Patient: TIMIVlONS, DORIS Referring Physician: DARYL WHITE MD Date of Birth: 1/31/28 Date of Exam: April 9, 2003 MRI EXAMINATION OF THE LUMBAR SPINE . CLINICAL HISTORY: This is a 75-year-old female with a two month history of Iow back pain radiating to both hips. The patient claims having a prior herniated disc but at present the pain is much worse and lasts much longer. TECHNIQUE: TI-weighted spin-echo sagittal and axial and fast T2-weighted spin-echo sagittal sequences were performed. COMPARISONS: None. FINDINGS: A levorotoscoliosis centered at the L3-L4 level is present, there are no significant abnormalities of alignment. Degenerative/dehydrational decrease disc signal intensity is seen between L5-S1 and T11-T12 levels. Intervertebral disc space narrowing is associated at the LS-Sl level where degenerative reactive marrow changes are present inferiorly. The marrow signa~l is otherwise normal and the vertebrae are intact overall. The distal spinal cord is unremarkable. Axial images as follows: L5-S1 level: Circumferential disc bulging is present upon which is superimposed a left paracentral/lateral disc herniation measuring approximately 6 x 8.4 mm in size as best appreciated on axial T1 image #16. This is bearing upon the proximal portion of the left S1 nerve root as well as compromising the proximal neural foraminal left L5 nerve root. The findings are superimposed on bilateral facet arthropathy and left sided facet joint fluid. L4-L5 level: Circumferential disc bulging is present without measurable central spinal canal or left neural foraminal compromise. The disc bulging does extend into the right neural foramen and is in very close proximity to the exiting right L4 nerve root without definite conta~ct. The findings are superimposed on bilateral facet arthropathy and prominent facet joint effusions, left !greater than right. L3-L4 level: No disc herniation or significant disc bulging is present. Bilateral facet arthropathy and left sided facet joint fluid is present. L2-L3 level: There is no disc abnormality. Bilateral facet joint effusions of a small size are present. L1-L2 level: The intervertebral disc is unremarkable. Minor facet arthropathy and a small amount of left sided facet joint fluid are present. Continued on page 2 405 Phoenix Dr, Unit A- Charnbersburg, PA 17201- Phone: 717-263-4999 Fax: 717-263-5522 Chambersburg ;:-: Patient: TIMMONS, DORIS Referring Physician: DARYL WHITE MD Date of Birth: 1/31/28 Date of Exam: April 9, 2003 CONCLUSION: MRI EXAMINATION OF THE LUMBAR SPINE (4/9/2003) 1. L5-S1 left paracentral/proximal neural foraminal disc herniation with compromise of the left S1 and L5 nerve roots. 2. Otherwise apparent are multilevel relatively minor degenerative disc disease changes. Please see detailed segmental analysis above. 3. Facet joint degenerative changes which may also be a source of Iow back and/or radicular type symptoms. NOTE: The findings were discussed with Dr. White on 4/09/03 at 11:34 a.m. Stephen M. Blum, M.D./jes/4/9/2003-103115/ 722.73 04.09 2~30~ ~'E[~ 13:13 FAX 7172~3~222 MRI EXAMINATION OF THE LUMBAR SPINE Patient: TIMMONS, DORIS Referring Physician: DARYL WHITE MD Date of Birth: 1/31F28 Date of Exam: April 9, 2003 CLINICAL HISTORY: Th;s ~s a 75-year-old female wlth a two montl~ history of Iow back pain ra¢iating to both hips, The patient claims having a prior herniated d~sc but at present the pain is mLlfh worse and lasts much longer. TECHNIQUE: T1-weighLed spin-echo sagitta[ and axial and fast T2-weigh[ed spin-echr sagittal sequences were performed. COMPARISONS: None. FINDINGS: A !evorotoscolicsis centered at the L3-L4 level is present, there are no significant abnorrralities of alignment Degenerative/dehydrational decrease disc signal Int,~nsity is seen between Lti-S1 and T11-T12 levels. Intervertebral disc space narrowing Is associated at the LS-Sl level where degenerative reactive marraw changes are present infedorly. The marrow signal is otherwise normal and the ~ertebrae are inta~ overatl. The distal spinal cord is unremarkable. Axial images as follows: L5-S1 level: Circumferential disc bulging is present upon which is superimposed a left paracemralllateral disc herniation measuring approximately 6 x 8.4 mm in size as best appreciated on axial T1 image #16, This is bearing upon the proximal portion of the left S1 nerve root as well as compromising the proximal neural foraminal left L5 nerve root. The findings are superimposed on bilateral facet adhropathy and left sided facet joint fluid. L4-L5 level: Circumferential disc bulging is present without measurable central spinal canal or 19fl neural foraminal compromise. The disc bulging does extend into the right neural feramen and is in ~ e~/close proximity to the exiting right L4 nerve root w~thout definite contact. The findings are superimposed on bilateral facet arthropathy and prominent facet joint effusions, left greater than right. L3-L4 level: No disc herniation or significant disc bulging is present. Bilateral facet arthropathy and left sided facet joint fluid is present. L2-L3 level: There is no disc abnormality. Bilateral facet joint effusions of a small size are pres~ nt, L1-L2 level: The intervertebral disc is unremarkable. Minor facet arthropathy and a small amount of left sided facet joint fluid are present, Continued on page2 .,~ "~ 405 Phoenix Dr, Untt,~ · Chembet~Durg, PA ! Z'20'i . Phone: 717-263-4999 FSX: 71 i'.263-5522 000030 WED 13:14 FAI 7~.7263§222 ~IDE OPEN Patient: TIMMONS DORIS Referring Physician: DARYL WHITE MD Date of Birth: 1/31/28 Date of Ex,~m: April ~J, 2003 CONCLUSION: MRI EXAMINATION OF THE ~,~JMBAR SPINE (4/9/2003.1 1. LS-S1 left paracentral/pro×imal neural foraminal disc herniation with compromise of the le~ S I and L5 nerv$ foots. 2. Otherwise apparent are multilevel relatively minor degenerative disc disease changes Pleas~ see detaited segmental analysis above 3. Face[ ioint degenerative changes which may also be a source of law back and/or radicular type symptoms. NOTE: The findings were discussed with Dr. White on 4/09/03 at 11:34 a.m. Stephen M Blum, M.D,Ijes/4/g12C03.103115/ 722.73, ,~05 F~hoenix ~, ~J.it A - ¢~,ambersburg, PA 17201. Pl}or~e. 777-283.4~ F-3.~. 717-2~3.~522 00003t THE CHAMSERSBURG HOSPITAL 112 North Seventh Street Chambersburg, PA 17201 (717) 267-3000 NAME: TIMMONS,DORIS E PATIENT #: H00017186917 PHYSICIAN: Michael M Coriale M.D. ROOM/BED: SERVICE DATE: 10/28/03 MEDICAL RECORD #: H349999 PATIENT TYPE: DEP ER DOB: 01/31/1928 REPORT #: 1029-0098 REPORT STATUS: Signed CHIEF COMPLAINT: Stuck pill. EMERGENCY ROOM REPORT HISTORY OF PRESENT ILLNESS: This is a 75-year-old female who at 8:30 this evening swallowed a Pravachol pill and she says it got stuck right at the base of her neck. This is the first time it has h~appened to her. Patient has a hoarse voice as well. She is able to cough but still feels like it is stuck. Pain score 8/10. PAST MEDICAL HISTORY: Hyperchoiesterolemia and elevated blood pressure. History of kidney stones, arthritis, diabetes. She has had appendectomy, hysterectomy, left wrist surgery, cataract surgery, carpal tunnel surgery. MEDICATIONS: Were reviewed. Please see attached list. ALLERGIES: Multiple, please see attached list. PHYSICAL EXAM: Alert, oriented, normal mental status. Temperature 97.3, pulse 125, respirations 22, blood pressure 187/79, saturation 99%on room air. Head: Normocephalic. Atraumatic. Eyes: PERRLA. EOM intact. ENT: Mucous membranes moist. Pharynx not injected. No pill is visualized. Neck is supple with no stridor. Hoarse voice is noted. Chest is clear bilaterally. Heart is regular with no murmur. Slightly tachycardic. Lungs clear bilaterally. Abdomen: Soft and nontender. Extremities: No edema or rash. Neurologic: Nonfocal. No gross deficits. EMERGENCY DEPARTMENT COURSE: Patient was observed with no development of respiratory distress, stridor or dyspnea. I spoke with Dr. Dunlevy. He feels that most likely the patient has some abrasions and some mild inflammation causing the hoarseness. He feels that the pill will most likely dissolve if it is stuck, but he believes it most likely has already passed. Patient was observed in the emergoncy department and was given large amounts of water to help dissolve the pill, and she was re-evaluated at 10:30, and she would prefer to go home. DIAGNOSIS: Possible stuck pill. DISPOSITION: The patient was given Dr. Dunlevy's phone number to follow-up in the morning if symptoms persist. Return here for any sudden worsening. Continue water intake. <Electronically signed by Michael M Coriale M.D.> Dictating Physician: Michael I~1 Coriale M,D. Electronic Signature Date And Time: 10/30/03 0628 Electronic Signature Date And Time: TR NAME: LAS DICTATED: 10/28/03 2229 TR DATE: 10/29/03 0821 CC: Daryl E White M.D. Additional copy: White M.D., Daryl E, 144 S Eighth St, Chambersburg, PA 17'201 .age,of1 0000.32 DEPARTMENT: CHAMBERSBURG HIM 007-29-2C03 N:_b 08:31 A~ CHfdFF, HOSP HE~' REC3RDS THE cHAMBERSBURG HOSPITAL 112 North Seventh Street Chambersburg, PA 17201 (717) 267-3000 NAME: TiMMONS,DORIS E pATIENT#: H00017'H~6917 pHYSICIAN: Michael M Coriale M.D. ROOM/BED: SEI~VICE DATE~ FA>: liO, 7!7267~t4 MEDICAL RECO!RD #'- H349999 PATIENT TYPE: DEP "R DOB: 0113111928 REPORT #: 102~-00a8 EMERGENCY ROOM REPORT REPORT STATUS: ?, 02 CHIEF COMPLAINT: Stuck pill. HISTORY OF PRESENT ILLNESS: This is a 75-year-old female who at 8:30 this even~g swallowed a prevachol pill end she says it got stuck dghl at the base of her neck.. T~is is the flr~ time it has happened to he~. Patient has a hoame. voice aswell. ~he is able to coug~ but~l[Ifeelsiike~isstuc~' painscore 8H0. , rchO estemlemia and e evata~ blOOd pressure. Histo~ of kidney stoneS, a~hdtls, PAST MEDICAL HISTORY. ~--. ~-~terectomy, le~ wrist surge~, cataract sumaC, carpel tunnel surge~. diaries. She ~as ~a~ ~ppen~e~u.~, .~- MEDICATIONS: Were reviewed. Please ~e affached list. ALLERGIES: Multiple, ~ease see a.ach~ I1~. , PHYSICAL E~M: Ale~, o~e~e~, no.al mental stMus. Temperature 97.5, p~Lse 12~, respirations 22, bloo~ pressure ~ : ~ali~. A~aumatic. EyeS: PERR~ EOM inta~. ENT; Mu~ memories moist. ~a~ u~, ,-~ ................. ~-~a~ c Lung~ clear bilrerally. A~oman; · ' is re ular w~h no mu~ur, a Nm y t~.~ . CheSt is clear bilaterally,.. Hea~ g . eu~ol~nlc: Nonf~al. No gro~ deft its. a~d nontender. E~mm,t,cs: No edeff~a or fas.. N . EMERGENCY DEPAR~ENT COURSE: patient was obse~e~ with no development~ef res~rato~ digress, st~dot or dyspnea. I s~ with Dr. Dunlevy He feels that most likely the patient has some ab~sions anG some mild inflammation causing ~e hoar~ne~. He feels ~at the pill will moat llAely dissolve if ~ is ~ucK, but he believes it most atient wes oDse~ n the ame~enoy depa~men~ a~d w~s given large amounts of water likely has a ready pas~d. P ....... ~.~n ~ hel~disso ye the pill, a~ she was re-evatua~u m · ........... e w _ DIAGNOSIS: port,la ~uck pill. m DISPOSITION: The patient ~s given Dr. Dunlevy'S pho~a number to follow-~p in th~ morning if symptoms persist, Return hem ~or any sudden womening. Continue wats? intake. Dictating Physician: MicMael M Coril Electronic Signature Date And Time Electronic Signature Date Arid Time Page 1 of 2 ~M.D. TR NAME: LAS DICTATED: 10128/03 22~9 TR DATE: 10/29/03 0821 DEPARTMENT: CHAMBERSBIJRG HiM O000..a OC -~.~1 ~03 ~"-'D 08:31 ~M CH~iEG HO£P NEC' RECOR['$ THE cHAMBERSBURG HOSPITAL '112 North Seventh Street ChamOersburg, PA 17201 ('/17) 267-3000 NAME: TiMMONS,DORIS MEDICAL RECORD pATiENT #: H(30017186917 ROOM/BED: CC: Draft copy: ,, EMERGENCY ROOM REPORT 7~7267%t4 ~ O3 DEPARTMENT: CHAMBERSBURG HIM Page 2 of 2 000034 NEUROLOGICAL SURGERY, LTD. 920 Centu~ Drive, Mechanicsburg, PA 17055-8404 Tel.: (717) 697-5800 Fax: (717) 697-2719 www. brain?pine-st trgery, corn Cotttrnittt'~{ to e~ce[[ence itt nearostt~tical'care September 29, 2003 BARRY B. MOORE. MD. ROGER H OSTDAHL M.D. GEORGE R. ROTH, JR., MD (Retired) Daryl E. White, M.D. FAIRWAY MEDICAL ASSOCIATES !44 S. Eight Street Chambersburg, PA 17201 RE: Doris E. Timmons Dear Dr. White: I met with Doris Timmons for a follow-up visit on September 23. She remains roughly the same. She does not have a great deal of pain in her legs, but she still has quite a bit of spasm in her back. This is due to the fact that she is in the midst of nerve recovery which begins about six or eight weeks after surgery. She and her husband feel that she is much better overall and certainly does not have the back pain she had prior to the surgery. This lingering discomfort and spasm in the back is usually the last symptom to disappear once back surgery is performed, and it often takes 12 to 18 months until that occurs. Otherwise, I am very pleased with her progress. I will continue to follow her on a regular basis. Very truly yours, Barry B. Moore, M.D. BBM/ccw Brain Surgery - tumors, aneurysms Pituitary tumors Spine Surgery and Instrumentation - ruptured discs, spinal stenosis Microsurgery and Laser Surgery Carpal Tunnel Surgery Trigeminal neuralgia Stimulator Implants Ior pain Peripheral Nerve Surgery 000035 NEUROLOGICAL SURGERY, LTD. 920 Century Drive, Mechanicsburg, PA 17055-8404 Tel.: (717) 697-5800 Fax: (717) 697-2719 www. brain-spine-sttrgerY, corn Committe~[ to e~:e[fence itt nettrosu~iica[care Au§ust 7, 2003 BARRY B. MOORE, M.D. ROGER H. OSTDAHL M.D. GEORGE R. ROTH. JR, M.D. (Retired) Daryl E. White, M.D. FAIRWAY MEDICAL ASSOCIATES 144 S. Eight Street Chambersburg, PA 17201 RE: Doris E. Timmons Dear Dr. White: I recently met with Doris Timmons for her second postoperative visit on July 31, 2003. The patient has had some nerve root recovery pain with increased spasm and aching down the legs. She is presently involved in physical therapy, including aquatic therapy, and this has helped significantly. She is quite pleased with her progress and is progressing very nicely, She is coming along very satisfactorily. It will simply take several more months until all of these symptoms totally' resolve. Thank you for allowing me to see this patient in consultation. Very truly yours, Barry B. Moore, M.D. BBM/ms ./ Brain Surgery - tumors, aneurysms Pituitary tumors Spine Surgery and Instrumentation - ruptured discs, spinal stenosis Microsurgery and Laser Surgery Carpal Tunnel Surgery Trigeminal neuralgia Stimulator Implants for pain Peripheral Nerve Surge? O000cr, ~HE CHAMBERb~0RG HOSPITAL Department of Pathology 717-267-7154 PAGE: 2 Name: TIMMONS,DORIS E MR#: H349999 DR: White M.D., Daryl E Age: 75 LOC: CPFA Sex: F Room-bed: COLL: 07/10/03 0649 REC: 07/10/03 0649 PHYS: White M.D., Daryl E (0710:H00145R) Con~nents: **************************************** HEMATOLOGY **************************************** TEST ~SULT CBC HEMOGRAM WBC 5.6 RBC 3.56 HH HGB 11.0 HCT 34.5 MCV 96.9 MCH 30.9 MCHC 31.9 pLATELET COUNT 288 NEUTROPHILS % 44 LYMPHOCYTES % 40 MONOCYTES % 9 EOSINOPHILS % 7 BASOPHIL % 0 NEUTROPHILS # 2.5 LYMPHOCYTES # 2.2 MON~YTES # 0.5 EOSINOPHILS # 0.4 ~SOPHIL # 0.0 DIFF SCREEN ~uNIS~YTOSIS 1+ MACROCYTOSIS 1+ PLT ESTIMATE ~EQ L L L H L REFERENCE RANGE 4-11 K/UL 4.10-5.10 M/UL 12.3-15.3 g/dL 36-45 % 85-95 fl 27-32 32-37 g/dL 150-400 K/UL 40-70 % 20-40 % 0-10 % 0-10 % 0-2 % 2.0-7.7 K/UL 0.8-4.4 K/UL 0.1-1.1 K/UL 0-0.5 K/UL 0-0.2 K/UL ADEQUATE LABOR^TORY RESULTS [] Within Normal Limits Acceptable Lab Values Abnormal Lab Values - Notify P~t Date Recvd: FOLIXDW-UP: Date ~viewed: TI~4ONS, DORIS E Report Prin%ed: 07/10/03, 2006 PAGE: ** END OF REPORT ** 2 000037 THE CHAMBER~URG HOSPITAL .... Department of Pathology 717-267-7154 PAGE: NAME: TIb~4ONS, DORIS E PHONE#: (717)263-1328 DIAGNOSIS: ELEV CHOL BIRTH DATE: 01/31/1928 SEX: F AGE: 75 MR%~: H349999 ACCT%~: H00016269060 LOC: CPFA Ordering Physician: DR: White M.D., Daryl E 144 S Eighth St Chambersburg, PA 17201 Ordered Tests: LIVER, LIPID COLL: 07/10/03 0649 REC: 07/10/03 0649 PHYS: White M.D., Daryl E (0710:C00174R TEST LIVER TOT PROT 6.4 ALB 3.2 TBIL 0.5 DBIL 0.1 AST/SGOT 24 ALT/SGPT 18 ALK PHOS 59 RESULT REFERENCE RANGE 6.1-7.9 G/DL L 3.4-4.8 G/DL 0.3-1.2 MG/DL 0.0-0.2 MG/DL 15-41 U/L 14-54 U/L 38-126 U/L NCEP Guidelines DESIPJ%BLE BORDERL HIGH RISK Total Chol <200 200-239 >240 HDL Chol > 60 35- 59 < 40 LDL Chol <130 130-159 >160 Triglyceride <150 150-199 >200 TEST RESULT REFERENCE RANGE LIPID CHOL 195 120-200 MG/DL TRIGLYCERIDES 194 MG/DL HDL 61 MG/DL LDL 95 MG/DL ~LDL 39 H 8-32 MG/DL Ordered Tests: CBC, CBC W/O AUTO $, DIFF SCREEN LABORATORY RESULTS .Within Normal Limits Acceptable Lab Values Abno'h~ Lab Values / - Nol'i'f~ Patient ..~ \(~,ddit ional ,~)m e nt s Dat~\\\\fD ph¥~an's Initials Date Recvd: FOLLOW-UP: Date l~eviewed: TIgONS,DORIS E Report P:cinted: ** CONTINUED ON NEXT PAGE ** 07/10/03, 2006 PAGE: 000038 THE CHAMBERSBURG HOSP,, AL · 112 North Seventh Street Chambersburg, PA 17201 (717~267-7149 SUMMIT HEALTH CENTER Rhonda Brake Shreiner Women's Center Summit Diagnostic Services Departments of Chambersburg Hospital NAME: TIMMONS,DORIS E PATIENT #: H00015774912 DOB: 01/31/1928 RADIOLOGIST: Barry L Levin M.D., FACR PATIENT LOCATION: CSCLAB REPORT #: 0514-0543 MEDICAL RECORD #: H349999 PATIENT TYPE: REG CLI ROOM/BED: PATIENT PHONE: (717)263-1328 FINANCIAL CLASS: MCRE ORDER #: 0514..0083 ADMITTING DIAGNOSIS: SURG 5-30-03 AT CAMPHILL REASON FOR EXAM: ORDERING PHYSICIAN: Moore, Barry B M.D. DIAGNOSTIC IMAGING REPORT STATUS: Signed DATE OF SERVICE: 5-14-03 INDICATION: 75 year old female, pre operative. CHEST - Frontal and lateral chest radiographs are made showing the lungs well expanded with no consolidation, atelectasis or increase in the interstitial pattern. '['he cardiovascular silhouette is within normal limits. There is no pleural effusion or mediastinal widening. IMPRESSION: No active disease in the chest. V72.83 <Electronically signed by Barry L Levin M.D., FACR> Dictating Physician: Barry L Levin M.D., FACR TR NAME: DMS DICTATED: 05/14/03 1240 TR DATE: 05/14/03 2318 CC: Barry B Moore M.D.; Barry L Levin M.D, FACR; Daryl E White M,D. Family Physician's copy White M.D., Daryl E 144 S Eighth St Chambersburg, PA 17201 Page 1 of 1 DEPARTMENT: DIAGNOSTIC IMAGING 71020 .'HE CHAMBER'--_.JRG HOSPI9?AL Department of Pathology 717-267-7154 PAGE: 2 Name: TIgONS,DORIS E MR#: H349999 DR: Moore M.D., Barry B Age: 75 Sex: F LOC: CSCLAB Room-bed: COLL: 05/14/03 0735 REC: 05/14/03 0736 ** CONTINUED ** (0514:H00168F) HEMATOLOGY (cont.) .................................... TEST RESULT REFERENCE RANGE NEUTROPHILS % 49 40-70 % LYMPHOCYTES % 37 20-40 % MONOC~TES % 9 0-10 % EOSINOPHILS % 4 0-10 % BASOPHIL % 1 0-2 % NEUTROPHILS # 2.5 ~ 2.0-7.7 K/UL LYMPHOCYTES ~ 1.9 U 0.8-4.4 K/UL MONOCYTES # 0.5 0.1-1.1 K/UL EOSINOPHILS # 0.2 0-0.5 K/UL BASOPHIL # 0.1 0-0.2 K/UL Ordered Tests: PT & PTT COLL: 05/14/03 0735 REC: 05/14/03 0736 PHYS: Moore M.D., Barry B Copies sent to: White M.D., Daryl E Comraents: FAXED 0514 1035LMN. (0514: HC00089F) *** NOTICE NORMAL RANGE CHANGE, EFFECTIVE 03/23/03 *** The reagent for Prothron%bin times has been changed to a more sensitive reagent, Innovin. The PT in seconds will increase above previous values in patients stabilized on warfarin therapy but the INR will not change in most of these patients and should be used as a guide in therapy. RESULT ~EFERENCE RANGE TEST PT & PTT PT PT INR PTT 9.9 9.5-12.3 SEC 0.9 28.9 25.0-34.0 SEC Date Recvd: FOLLOW-UP: Date F~viewed: TI~4ONS, DORIS E Report Printed: 05/14/03, ** END OF REPORT ** 2007 PAGE: 000040 2 .~HE CHAMBERL~JRG HOSPITAL Department of Pathology 717-267-7154 PAGE: 1 NA~{E: TIb~4ONS,DORIS E PHONE#: (717)263-1328 DIAGNOSIS: SURG 5-30-03 AT CAMPHILL BIRTH DATE: 01/31/1928 AGE: 75 SEX: F MRna: H349999 ACCT~I: H00015774912 LOC: CSCLAB Ordering Physician: DR: Moore M.D., Barry B Neurological Surgery, Ltd 920 Century Drive Mechanicsburg, PA 17055-8404 Ordered Tests: BMP COLL: 05/14/03 0735 REC: 05/14/03 0736 PHYS: Moore M.D., Barry B Copies sent to: White M.D., Daryl E Con~nents: FA~ED 0514 1035LMN. (0514:C00221F) TEST ~SULT BMP GLU 97 BUN 22 CREA 1.1 L YTES Na 137 K 4.0 C1 101 TCO2 26 GAP 10 Ca 9.5 REFEP~NCE RANGE 70-110 MG/DL 8-20 MG/DL 0.6-1.1 MG/DL 135-145 mM/L 3.6-5.1 n~4/L 101-111 n~M/L 22-32mM/L 5-15 8.6-10.3 MG/DL Ordered Tests: CBC, CBC W/O AUTO $ COLL: 05/14/03 0735 REC: 05/14/03 0736 PHYS: Moore M.D., Barry B Copies sent to: White M.D., Daryl E Co~nents: FAXED 0514 1035LMN.@05/14/03 0925: CBC W/O AUTO $ added. RFLXG -- CBCND. (0514:H00168F) TEST Pd~SULT REFEBi~NCE RANGE CBC HEMOGRAM WBC . 5.1 4-11 K/UL RBC 3.65 L 4.10-5.10 M/UL HH HGB 11.3 L 12.3-15.3 g/dL HCT 35.S L 36-45 % MCV 97.3 H 85-95 fl MCH 31.0 27-32 ~4G MCHC 31.8 L 32--37 g/dL PLATELET COUNT 253 150-400 K/UL Date Reviewed: Date Recvd: FOLLOW-UP: TI~/~ONS, DORIS E Report Printed: 05/14/03, 2007 PAGE: ** CONTINUED ON NEXT PAGE: ** 000041 1 ~¢5:1 BP: '~%~ LMP; ~-~ %S5 Age: fl5 p: ~o~ Meds: s~ ~+ 3-27-03 S: O: Breasts-w/o dominant masses/tenderness, ABD-BS+, abd.-soft, NT. Pelvic exam. NEFG, Cx a~d ut. are surgically absent. Adnexa w/o masses. Rectovag. exam revealed no masses. Stool was hems tested and was hsme neg. A: Normal GYN exam. P: Pap smear was deferred until next yr. Stool was hems tested and was heme neg. WHI study was discussed in detail. The pt. will be slowly weaned off of the meds. We will decrease the med. to Premarin 0.9 mg. po qd. SMR/amh 4-8-03 Copy of 3-Z/-UJ v~zz: sen~ I;0 ])]~, Whi_te. SMl{/amh ,t Pt. presents ~or an *~. Pt. is w/o cio. ~'~m~- ) HEENT-WNL, Neck supple w/o thyromegaly, lungs-CTA, heart RRR w/o murmu ~- 0' ~ THE CHAMBERSBURG HOS~ .. AL 112 North Seventh Street Chambersburg, PA 17201 (717~ 267-7149 SUMMIT, ,,'ALTH CENTER Rhonda Brake Shreiner Women's Center Summit Diagnostic Services Departments of Chambersburg Hospital NAME: TIMMONS,DORIS E PATIENT #: H00014935290 DOB: 01/31/1928 RADIOLOGIST: Niteen N Sukerkar M.D. PATIENT LOCATION: CCAR REPORT #: 0207-0191 ADMITTING DIAGNOSIS: NO DX REASON FOR EXAM: ORDERING PHYSICIAN: White, Daryl E M.D. MEDICAL RECORD #: H349999 PATIENT TYPE: REG CLI ROOM/BED: PATIENT PHONE: (717)263-1328 FINANCIAL CI.J~,SS: MCRE ORDER #: 0206-0018 REPORT STATUS: Signed DIAGNOSTIC IMAGING DATE OF SERVICE: 2/6/03 HISTORY: Shortness of breath with exertion. No previous MI. Hypertension. Tc 99m Tetrofosmin Myocardial Perfusion Scan: The patient was given a 8 millicude intravenous injection of Tc 99m Tetrofosmin at rest. Spect imaging was subsequently performed. The patient was pharmacologically stressed with 33 milligrams persantine administered intravenously by drip infusioin. 30 millicuries Tc 99m Tetrofosmin were intravenously injected and, later, gated spect imaging was performed. Patient was given 75 mg. of Aminophylline IV at 9 minutes. There is no diagnostic evidence of reversible ischemia or permanent myocardial damage. Apparent decrease in perfusion involving apex is a normal variation. No focal abnormality is seen. Left ventricular wall motion is however slightly hypokinetic. This does not involve a specific segment of myocardium. Ejection fraction is 49%, decreased. IMPRESSION: Slight generalized hypokinesis, with ejection fraction of 49%. Negative for reversible ischemia or permanent myocardial damage. 786.05 Page 1 of 2 DEPARTMENT: DIAGNOSTIC IMAGING NAME: TIMMONS,DORIS E MEDICAL RECORD #: H349999 PATIENT #: H00014935290 ROOM/BED: DATE OF SERVICE: 02~06~03 REPORT #: 0207-0191 THE CHAMBERSBURG HOSPITAL 112 North Seventh Street Chambersburg, PA 17201 (717) 267-3000 REPORT STATUS: Signed DIAGNOSTIC IMAGING <Electronically signed by Robert S Pyatt M.D., FACR> Dictating Physician: Niteen N Sukerkar M.D. TR NAME: MICHELE L HILL DICTATED: 02/06/03 TR DATE: 02~07~03 CC: Dali E White M.D.; Niteen N Sukerkar M.D.; COPY TO EKG Ordering Physician's copy White M.D., Daryl E 144 S Eighth St Chambersburg, PA 17201 DEPARTMENT: DIAGNOSTIC IMAGING Page 2 of 2 000044 ~fE CPLA_MBERS~RG Department of Patholo~ 717-267-7154 PAGE: 1 NAME: TIMMONS,DORIS E PHONE#: (717)263-1328 DIAGNOSIS: ELEV CHOL DM BIRTH DATE: 01/31/1928 SEX: F AGE: 75 MR#: H349999 ACCT,: H00015283328 LOC: CPFA Ordering Physician: DR: White M.D., Daryl E 144 S Eighth St Chambersburg, PA 17201 Ordered Tests: LIVER, LIPID COLL: 03/10/03 0737 REC: 03/10/03 0737 PHYS: White M.D., Daryl E (0310:C00258R) RESULT REFERENCE RANGE TEST LIVER TOT PROT 6.4 ALB 3.3 TBIL 0.8 DBIL 0.1 AST/SGOT 24 ALT/SGPT 20 ALK PHOS 44 6.1-7.9 G/DL L 3.4-4.8 G/DL 0.3-1.2 MG/DL 0.0-0.2 MG/DL 15-41 U/L 14-54 U/L 38-126 U/L NCEP Guidelines DESIRABLE BOR/)ERL HIGH RISK Total Chol <200 200--239 >240 HDL Chol > 60 35-- 59 < 40 LDL Chol <130 130--159 >160 Triglyceride <150 150-199 >200 TEST RESULT REFERENCE RANGE LIPID ~~ CHOL H 120-200 MG/DL TRIGL¥CERIDES MG/DL HDL 74 MG/DL LDL 95 MG/DL VLDL 38 H 8-32 MG/DL Date Recvd: FOLLOW-UP: Date Reviewed: TIMMONS,DORIS E Report Printed: 03/10/03, 2006 PAGE: ** END OF REPORT ** .000045. THE CHAMBERSBURG HOSP,, AL · 112 North Seventh Street Chambersburg, PA 17201 (717~ 267-7149 SUMMIT HEALTH CENTER Rhonda Brake Shreiner Women's Center Summit Diagnostic Services Departments of Chambersburg Hospital NAME: TIMMONS,DORIS E PATIENT #: H00014932982 DOB: 01/31/1928 RADIOLOGIST: Barry L Levin M.D., FACR PATIENT LOCATION: CSCMAM REPORT #: 0304-0168 MEDICAL RECORD #: H349999 PATIENT TYPE: REG CLI ROOM/BED: PATIENT PHONE: (717)263-1328 FINANCIAL CLASS: MCRE ORDER #: 0303-0017 ADMITTING DIAGNOSIS: SCREENING MAMMOGRAM REASON FOR EXAM: ORDERING PHYSICIAN: R~schid, Sohael M M.D. DIAGNOSTIC IMAGING REPORT STATUS: Signed DATE OF SERVICE: 3/3/2003 INDICATION: 75-year-old female for screening. BILATERAL MAMMOGRAM: Views of the breasts are made in reutine projections and are interpreted with computer aided detection· The stromal pattern is the same as seen previously on 1/25/99 and 3/28/97. In the interval, there is no new three dimensional mass or calcification of concern. Breast Composition: There are scattered fibroglandular densities. IMPRESSION: Stable mammogram. CATEGORY 2 - BENIGN V76.12 ~h <Electronically signed by Barry L Levin M.D., FACR> Dictating Physician: Barry L Levin M.D., FACR TR NAME: MARCY J GOSHORN DICTATED: 03/03/03 TR DATE: 03/04/03 CC: Barry L Levin M.D. FACR; Daryl E White M.D.; Sohael M Raschid M.D, Page I of 2 DEPARTMENT: DIAGNOSTIC IMAGING 0 0 0 (~ 4 ~ NAME: TIMMONS,DORIS E MEDICAL RECORD #: H349999 PATIENT #: H00014932982 ROOM/BED: DATE OF SERVICE: 03/03/03 REPORT #: 0304-0168 THE CHAMBERSBURG HOSPITAL 112 North Seventh Street Chambersburg, PA 17201 (717) 267-3000 REPORT STATUS: Signed Family Physician's copy White M.D., Daryl E 144 S Eighth St Chambemburg, PA 17201 DIAGNOSTIC IMAGING Page 2 of 2 00004? DEPARTMENT: DIAGNOSTIC IMAGING · &Chambersbur. g- DEPARTMENT OF CARDIOLOGY IV PERSANTINE MYOCARDIAL PERFUSION PHARMACOLOGIC STRESS TEST - ~ ' - Comments Time (min) Heart Rate BP (mm Hg) Comments: ~chnicia HISTORY ~nt Chest Distress Height Wet Tobacco ~. 0 Documented O I O~H Suspected M.I. Angina Hea~ Mumur ~ , ~ype~ension Palpitations Rheumatic Fever Current Medications: Associated Symptoms Q Dyspnea. Q Ughtheadedness O Diaphoresis Q Nausea CI Radiation O Other 000048 ' · -IE CHAMBERSBURG HOSPITAL ~ 112 North Seventh Street Charnbersburg, PA 17201 (717) 267-3000 NAME: TIMMONS,DORIS E PATIENT#: H00014935290 DOB: 01131/1928 DICTATING PHYSICIAN: Michael H Palmer M.D. PATIENT LOCATION: CCAR DATE OF SERVICE: 02/06/03 ORDERING PHYSICIAN: White, Daryl E M.D. ADMITTING DIAGNOSIS: NO DX MEDICAL RECORD #: H349999 PATIENT TYPE: REG CLI ROOM/BED: PATIENT PHONE: (717)263-1328 FINANCIAL CLASS: MCRE REPORT #: 0207-0021 ORDER #: 0206-0057 DIPYRIDAMOLE NUCLEAR STRESS TEST 2/6/2003 Ordered by Dr. White Supervised by Dr. Palmer Ordered to evaluate dyspnea on exertion and occasional chest tightness. Has never smoked. History of hypertension longstanding, hyperlipidemia on medicalions. Father had coronary artery disease at the age of 70. Resting EKG shows sinus rhythm within normal limits. The patient experienced no chest discomfort, no significant ST segment shifts. Normal clinical/EKG portion. Nuclear portion of the study to be reported independently. TR NAME: MARCY J GOSHORN DICTATED: 02~06~03 TR DATE: 02/07/03 CC: Michael H PaI~.D~~-' Department Page 1 of 1 DEPARTMENT: CARDIOVASCULAR SERVICES 0 0 0 0 ~ 9 THE'CHAMBERSBURG HOSPITAL._~ 112 North Seventh Street Chambersburg, PA 17201 (717~ 267-7149 SUMM T HEA..~,-t CENTER Rhonda IBrake Shreiner Women's Center Summit Diagnostic Services Departments of Chambersburg Hospital NAME: TIMMONS,DORiS E PATIENT #: H00014935290 DOB: 01/31/1928 RADIOLOGIST: Niteen N Sukerkar M.D. PATIENT LOCATION: CCAR REPORT #: 0207-0191 ADMITTING DIAGNOSIS: NO DX REASON FOR EXAM: ORDERING PHYSICIAN: White, Daryl E M.D. MEDICAL RECORD #: H349999 PATIENT TYPE: REG CLI ROOM/BED: PATIENT PHONE: ('/'17)263-1328 FINANCIAL CLASS:: MCRE ORDER #: 0206-0018 REPORT STATUS: Signed DIAGNOSTIC IMAGING DATE OF SERVICE: 2/6/03 HISTORY: Shortness of breath with exertion. No previous Mi. Hypertension. Tc 99m Tetrofosmin Myocardial Perfusion Scan: The patient was given a 8 millicurie intravenous injection of Tc 99m Tetrofosmin at rest. Spect imaging was subsequently performed. The patient was pharmacolegicaliy stressed with 33 milligrams persantine administered intravenously by drip infusion. 30 millicuries Tc 99m Tetrofosmin were intravenously injected and, later, gated spect imaging was pert'ormed. Patient was given 75 rog. of Aminophylline IV at 9 minutes. There is no diagnostic evidence of reversible ischemia or permanent myocardial damage. Apparent decrease in perfusion involving apex is a normal variation. No focall abnormality is seen. Left ventricular wall motion is however slightly hypokinetic. This does not involve a specific segment of myocardium. Ejection fraction is 49%, decreased. IMPRESSION: Slight generalized hypokinesis, with ejection fraction of 49%. Negative for reversible ischemia or permanent myocardial damage. 786.05 Page 1 of 2 000050 DEPARTMENT: DIAGNOSTIC iMAGING T~'~ CHAMBERSBURG HOSPITAL 112 North Seventh Street Chambersburg, PA 17201 (717) 267-3000 NAME: TIMMONS,DORIS E MEDICAL RECORD #: H349999 PATIENT #: H00014935290 ROOM/BED: DATE OF SERVICE: 02/06/03 REPORT #: 0207-0191 REPORT STATUS: Signed DIAGNOSTIC IMAGING <Electronically signed by Robert S Pyatt M.D., FACR> Dictating Physician: Niteen N Sukerkar M.D. TR NAME: MICHELE L HILL DICTATED: 02~06~03 TR DATE: 02~07~03 CC: Daryl E White M.D.; Niteen N Sukerkar M.D.; COPY TO EKG Additional copy COPY TO EKG DEPARTMENT: DIAGNOSTIC IMAGING Page 2 of 2 00005i ,~E CH~-MBERS~-~G HOSPITAL Department of Pathology6 717-267-7154 PAGE: i NAME: TIMMONS,DORIS E PHONE~: (717)263-1328 DIAGNOSIS: DIARRHEA WT LOSS BIRTH DATE: 01/31/1928 SEX: F AGE: 74 Ordering Physician: DR: Bricker M.D., Samuel Q 144 S 8Th St MRS: H349999 ACCT': H00014403497 LOC: CPFA Chan%bersburg, PA 17201 Ordered Tests: CBC, CBC W/O DIFF $ COLL: 11/14/02 0754 REC: 11/14/02 0754 PHYS: Bricker M.D., Samuel Q TEST RESULT CBC HEMOGRAM WBC RBC HGB 12.8 HCT 38.5 MCV 95.3 MCH 31.7 MCHC 33.2 PLATELET COUNT 245 NEUTROPHILS % 55 LYMPHOCYTES % 32 MONOCYTES % 11 EOSINOFHILS % 2 BASOPHIL % 0 NEUTROPRILS # 3.4 LYMPHOCYTES # ,.' . , 2.0 MONOCYTES # 0.7 EOSINOPHILS # 0.1 BASOPHIL # 0.0 REFERENCE RANGE 4-11 K/UL 12.3-15.3 g/dL ...36-45 % ' 85-95 fl 27-32 MMG 32-37 g/dL 150-400 K/UL 40-70 % 20-40 % 0-10 % 0-10 % .' 0-2 % 2.0-7.7 K/UL 0.8-4.4 K/~ 0.1-1.1 K/~-L 0-0.5 K/UL 0-0.2 K/UL FOLLOW-UP: Date Revlewed= TIMMONS,DORIS E Report Printed: 11/14/02, 2006 PAGE: 000052 ~E CI~3M~BERS~.~G HOSPITAL Department of Pathology 717-2S7-7154 PAGE: NAME: TIMMONS,DORIS E PEONE#: (717)283-1328 DIAGNOSIS: ELEV CHOL DM HTN LOW BIR~{ DATE: 01/31/1928 AGE: SEX: F MR#: H349999 ACCT#: H00014140545 LOCi CPFA Ordering Physician: DR: Bricker M.D., Samuel Q 144 S 8Th St Chambersburg, PA 17201 Ordered Tests: HEMOGLOBIN A1C COLL: 10/14/02 0811 REC: 10/14/02 0811 PHYS: Bricker M.D., Samuel Q (1014:CR00035R) *************************** Central PA Alliance of Laboratories *************************** HEMOGLOBIN A1C 6.3(a) 6[ 4.3-6.1% (a) Test Performed at CPAL Date Recvd: FOLLOW-UPs Date Reviewed: TIMMONS,DORIS E Report Pri. nted: 10/15/02, 2005 PAGE: ' 1 .. oF -* 000053 dE C~L~MBERSL~G HOSPITAL Department of 717-267-7154 PAGE: NAME: TIMMONS,DORIS E PHONE#: (717)263-1328 DIAGNOSIS: ELEV CHOL DM HTN LOW K BIH~ DATE: 01/31/1928 AGE: 74 SEX= F Ordering Physician: DR: Bricker M,D.. Samuel Q 144 S 8Th St Chambersburg, PA 17201 MR#:: H349999 ACCT#:: H00014140545 LOC: CPFA Ordered Tests: CMP, LIPID COLL: 10/14/02 0811 REC: 10/14/02 0811 PHYS: Bricker M.D., Samuel Q (1014:C00238R) **************************************** CHEMISTRY ***************************************** RESULT REFERENCE R3%NGE TEST CMP BMP GLU 118 J~ 70-110 MG/DL BLrN 20 8-20 MG/DL CREA 0.9 0.6-1.1 MG/DL LYTES Na 139 138-145 mM/L K 4.0 3.6-5.1 n~M/L C1 101 101-111 mM/L TCO2 27 22-32 mM/L GAF 11 5-15 Ca 10.2 8.6-10.3 MG/DL TOT PROT 6.2 6.1-7.9 G/DL ~LB 3.4 3.4-4.8 G/DL TBIL 0.4 0.3-1.2 MG/DL AST/SGOT 30 15-41 U/L ALT/SGPT 27 14-54 U/L ALK PHOS 42 38-126 U/L ************************************** ~ipid Profile *************************************** TEST ~ ESULT REFERENCE LIPID CHOL i~o-2oo MG/DL TEZGL¥CERIDEE / S07 ] MG/DL ~L ! 48 I ~G/DL LDL ~ot valid du/ to high triglyc,_rlde. VLDL k lO/ ,~ 8-32 MG/DL NCEP GUIDELINES The highest acceptable level of C~OL varies with age, however values ~200 are associated with increased risk of CI4D regardless of ~DL or LDL ~alues. NCEP GUIDELINES: DESIRAHLE HORDERL HIGH RISK Total Chol <200 200-239 >240 I4DL Chol ~ 60 3~-59 · 40 LDL Chol ·130 130-159 ~160 Triglyceride ·150 150-199 >200 Date Recvd: FOLLOW-UP: Date Reviewed: 1 TIMMONS,DORIS E Report Printed: 10/14/02, 2005 PAGE= HEFORT -* 000054 BP: LMP:/./ /skr- Age: q2. 3-25-02 S: Pt.presents for an annual exam. The pt. has a long list of meds. which pt.~w_-- is attached. The pt. apparently was recently dxed. with diabetes by Dr. ~i~.¢~ Bricker. The pt. has had a long problem with perineal pruritis which has bee~. ~c~=, txed. with Betamethasone cream, Dr. Bricker had felt that this was a strong mad. which I tend to agree, p~rticularly if she is going to be on this for a prolonged period of time, so we will drop her down to a Lotrisone cream. O: HEENT-WNL, Neck supple w/o thyromegaly, lungs-CTA, heart RRR w/o murmurs, Breasts w/o dominant masses/tenderness, ABD-BS+:. abdomen soft and NT, Pelvic exam. revealed atrophic ext. female genitalia. Cx. and ut. are surgically absent. Adnexa were not palpable. Rectovag. exam revealed no masses. Ext. w/o~ edema. A: Normal GYN exam with some contact dermatitis/vaginitis as well as some atrophic changes. P: Pap smear was performed. Pt. will be continued on Premarin 1.25 mg. poqd. Pt. is being switched from Betamethasone to Lotrisone <:ream for her perineal pruritis to be used prn. Stool was hame tested and was hame neg. Screening mammo, is ordered. Pt. will be seen back for f/u in 1 yr. SMR/amh 3-28-~2 Copy of 3-25-02 visit sent to Dr. Bricker. SMR/amh 000055 E CN3LMBERS~G HOSPIT~,L · Department of Pathology' 717-267-7154 PAGE: i N~E= TIMMONS,DORIS E PHONE#: (717)263-1328 DIAGNOSIS: HTN DM ELEVCHOL/LFT BIRTH DATE: 01/31/1928 AGE: 74 SEX: F This report copy is for: DR: Bricker M.D., Samuel Q 144 S 8Th St Chambersburg, PA 17201 COLL: 03/28/02 0738 HEC: 03/28/02 0738 MR#: H349999 ACCT#: H00012570909 LOC: CPFA PHYS: Bricker M.D., Samuel Q (0328~CR00018R) *************************** Central FA Alliance of Laboratories *************************** GLYCATED HEMOGLOBIN 6.~(a) H 4.3-6.1% (a) Test Performed at CPAL FOLLOW-UP: Date Reviewed= TIMMONS,DORIS E Report Printed: 03/29/02, 2020 FAGE: 1 ** END OF REPORT ** 000058 THE CHAMBERSBURG HOSPITAL DEPARTMENT OF PATHOLOGY John W. Crispen, M.D. Michael J. Rupp, M.D. Medical Director Margaret M. Flanagan, M.D. Associate Pathologists Copies to: Raschid M.D., Sohael M v/Bricker M.D., Samuel Q Procedure: PAP SMEAR Source: VAGINAL Name: TIMMONS,DORIS E Account #: H00012556031 Medical Record #: H349999 Phone: (717)263-1328 Physician: Raschid M.D., Sohael M Case Number: P02-3427 Birthdate: 01/31/1928 Specimen Date: 03/25102 Receiverl Date: 03/26/02 Lo~'ation: CCOUR COMMENTS: LAST MENSTRUAL PERIOD: HORMONE THERAPY: PREGNANT: PREVIOUS HISTORY: PREVIOUS ABNORMAL PAP: REGULAR PERIODS: POST MENOPAUSAL: NUMBER OF SLIDES: ANNUAL PAP SMEAR, HYSTERECTOMY 00/00/0000 YES PREMARIN NO NO NO NO YES 1 SPECIMEN ADEQUACY: SATISFACTORY FOR EVALUATION RESULTS: NEGATIVE FOR SIL/MALIGNANCY RECOMMENDATION: QC 1 Date Screened: Screened by: Reviewed by: 03/26/02 Ellen S. Wright, C'l' (ASCP) Patient: TIMMONS,DORIS E Medical Record # H349999 Account # H00012556031 REPORT PRINTED: 03/27/02 PAGE: 1 Loc: CCOUR Case # P02-3427 Date Finalized: 03/27/02 0000,57 ] CFL~MBERS~-~G HOSPITAL Department of Pathology 717-267-7154 PAGE NAME: TIMMONS,DORIS E PHONE#: (717)263-1328 DIAGNOSIS: RTN DM ELEVCHOL/LFT BIRTH DATE: 01/31/1928 AGE: SEX: F 74 This report copy is for: DR: Bricker M.D., Samuel Q 144 S 8Th St Cha~ersburg, PA 17201 COLL: 03/28/02 0738 REC: 03/28/02 0738 MR#: H349999 ACCT#: H00012570909 LOC: CPFA PHYS: Bricker M.D., Samuel Q (0328:C00188R) TEST CMP GLU 117 H 70-110 MG/DL BUN 27 H 8-20 MG/DL CREA 1.0 0.6-1.1 MG/DL LYTES Na 139 135-145 mM/L K 4.3 3.6-8.1 mM/L C1 99 L 101-111 mM/L C02 29 22-32 mM/L GAP 11 5-15 Ca 10.4 H 8.6-10.3 MG/DL TOT PROT 6.3 6.1-7.9 G/DL ALB 3.6 3.4-4.8 G/DL AST/SGOT 26 15-41 U/L · J~T/SGPT 23 14-54 U/L ALK P~{OS 48 38-126 U/L RESULT REFERENCE R~%NGE ************************************** Lipid Profile *************************************** TEST RESULT REFERENCE RANGE LIPID CEOL 205 H 120-200 MG/DL TRIGLYCERIDES 390 MG/DL ~DL 57 MG/DL LDL 70 MG/DL VLDL 78 H 8-32 MG/DL NCEP GUIDELINES The highest acceptable level of CH(~ varies with age, however values ~200 are associated with increased risk of CHD rsgardless of HDL or LDL values. NCEP GUIDELINES: DESII~IBLE BORD~RL HIG~ RISK Total Chol <200 200-239 ~240 ~DL Chol > 60 35-59 < 40 LDL Chol <130 130-159 ~160 Triglyceride <150 150-199 ~200 FOLLOW-UP: TIMMONS,DORIS E Report Printed: 03/28/02, ** END OF REPORT ** 2020 PAGE :' 000058 NEUROSURGERY CUMBERLAND VALLEY NEUROSURGICAL CONSULTANTS 764 LINCOLN WAY EAST CHAMBERSBURG, PA 1720![-2768 PHONE 71%263-3850 NEUROLOGY A.R.V. KUMAR, MD.,F.R.C.S. (C) FAX 717-263-3379 September 25, 2001 S.E. SOLLENBERGER, D.O Sam Dricker, M.D. 1'i4.5. Eighth Street Ck,ambersburg, PA 17201 i _-': boris l'immons ~ ~.]r Sam: I ~m seeing boris Timmons in the office today. As you know', Mrs. Timmons is a pleasant 72 y/o right handed individual who has a rather interesting history. She relates that in the £.~.ring of this year she had two episodes separated by a 6-week interval that were fairly i i creofypical. 5he felt as though she had a tourniquet around her deltoid region and her arm 9at quite numb. This lasted approximately 10 minutes and cleared up. Immediately thereafter she describes what she calls a 'nervous sensation inside'. That lasted for about 15 minutes ~nd then resolvld. She went for 6 weeks without any recurrence until she had another one in June. This was basically identical to the previous one. 5he then went about two months and had two episodes of left arm 'weightlessness' with associated central scotoma and subsequent severe headache. This lasted about 10 fninutes and was followed again by the "nervous sensation inside'. This episode recurred again the following day. 5he blumed all of this on amaryl and discontinued taking it. 5he was subsequently put on some other oral hypeglycemic I think. She hasn't had any similar episodes since august She does hove episodic tingling sensations in the distribution of her ulnar nerve on the left which I think is a separate process. PMH is significant for long ~andin9 history of hypertension. She has had gout in the past and has recently been diagnosed with diabetes, (the last two years). Her medications are Alopurinol, Premarin. Zantac, HilorJ110 rags I bid, Altase 2.§ rags once daily, Trarnterene/HCTZ on Monday, Wednesday and Friday. She takes Pravacho140 rags daily,' C~lestid I gram bid, Celebrex 200 rags daily, Olucoph~e XR 500 rags at hs, Serevent and Tetracycline for rosacea, Aspirin daily and some OTC reeds far arthritic problems, ind;gestion and hemorrhoids. Al L ERGIE5: Codeine, Zocor, PCN, Mevacor, beta blockers. O000,)g T~MMON$, DO~I$ 11-14-2001 Doris is in the office today. She was intolerant of the Tegretol and stopped taking it. 5he has not had any recurrence of her spells since I saw her last'. I think we should try another anti-epileptic medication. I wrote for a Iow dose of Dilantin (200 rags at hs). I will see her back in o month. Prior to that visit we will check a CBC, LFT~s and a Dilantin level. I will see her sooner if need be. $.E. $ollenbenger, b.O. SEs/tv Cc: 5am~ricker, M.b. Enc: Letter of last OV O000GO THE CHAMBERSBURG HOSPITAL Department of Pathology (717) 267-7154 PAGE NAME: TIMMONS,DORIS E PHONE~: (717)263-1328 DIAGNOSIS: DM ELEV CHOL/LFT BIRTH DATE: 01/31/1928 AGE: 73Y SEX: F MR#: H349999 LOC: PSA ============================ PHYSICIAN COPY FOR DR: BRICKER, M.D., SAMUEL Q ================== DR: BRICKER, M.D., SAMUEL Q 144 S EIGHTH STREET CHAMBERSBURG PA 17201 COPIES SENT TO: SOLLENBERGER, M.D., T56351 COLL: 11/13/2001 10:02 REC: 11/13/2001 14:26 Test Requested: ABC,CPMP,DIFA,ESR,HAiC,LIPID HEMOGLOBIN A1C (CPAL 7.4 H [4.3-6.1] PHYS: BRICKER, % M.D., SAMUEL Q Date Recvd: FOLLOW-UP: TIMMONS,DORIS E Date Reviewed: Repo~ Printed: 11/14/2001, 20:00 END OF REPORT PAGE 1 000061 THE CHAMBERSBURG HOSPITAL Department of Pathology (717) 267-7154 PAGE 1 NAME: TIMMONS,DORIS E MRS: H349999 LOC: P5A PHONE#: (717)263-1328 ~~ DIAGNOSIS: DM ELEV CHOL/LFT BIRTH DATE: 01/31/1928 AGE: 73Y SEX: F ============================ PHYSICIAN COPY FOR DR: BRICKE] ==================~ DR: BRICKER, M.D., SAMUEL Q 144 S EIGHTH STREET CHAMBERSBURG PA 17201 COPIES SENT TO: SOLLENBERGER, M.D., T56351 COLL: 11/13/2001 10:02 REC: 11/13/2001 14:26 PHYS: BRICKER, M.D., SAMUEL Q Test Requested: ABC,CPMP,DIFA,ESR,HA1C,LIPID COMPREHENSIVE METABO GLUCOSE 137 BUN 21 CREATININE 0.9 CALCIUM 9.6 SODIUM 139 POTASSIUM 4.1 CHLORIDE 100 TC02 26 ANION GAP 13 BILIRUBIN, TOTAL 0.9 GOT 29 ALK. PHOSPHATASE 42 TOTAL PROTEIN 5.6 ALBUMIN 3.6 GPT 27 H [70-110] H [8-20] [0.6-1.1] [8.6-10.3 135-145] [3.6-5.1] L 101-111] 22-32] 5-15] 0.3-1.2] 15-41] 38-126] L [6.1-7.9] [3.4-4.8] [14-54] MG/DL MG/DL MG/DL mEq/L mM/L mM/L mM/L mM/L MG/DL U/L U/L G/DL G/DL U/L LIPID PANEL CHOLESTEROL 257 TRIGLYCERIDE 530 HDL 69 LDL, CALCULATED VLDL LIPID INTERPRETATION H [120-200] LDL NOT VALID DUE TO HIGH TRIG 10~ H [8-32] (NOTE) MG/DL MG/DL MG/DL MG/DL MG/DL The highest acceptable level of CHOL varies with age, however values >200 are associated with increased risk of CHD regardless of HDL or LDL values. NCEPGUIDELINES: DESIRABLE BORDERLINE HIGH RISK Total Chol <200 200-239 >240 HDL Chol > 60 35-59 < 35 LDL Chol <130 130-159 >160 Date Recvd: FOLLOW-UP: %TIMMONS,DORIS E Date Reviewed: Rep6rt"Printed: 11/13/2001, 20:00 CONTINUED PAGE 1 00.0062 THE CHAMBERSBURG HOSPITAL Department of Pathology (717) 267-7154 PAGE 2 NAME: TIMMONS,DORIS E PHONEY: (717)263-1328 DIAGNOSIS: DM ELEV CHOL/LFT BIRTH DATE: 01/31/1928 AGE: 73Y SEX: F MRS: H349999 LOC: P5A ============================ PHYSICIAN COPY FOR DR: BRICKER, M.D., SAMUEL Q ==================~ DR: BRICKER, M.D., SAMUEL Q 144 S EIGHTH STREET CHAMBERSBURG PA 17201 COPIES SENT TO: SOLLENBERGER, M.D., T56351 COLL: 11/13/2001 10:02 REC: 11/13/2001 14:26 Test Requested: ABC,CPMP,DIFA, ESR,HA1C,LIPID PHYS: BRICKER, M.D., SAMUEL Q LIPID PANEL LIPID INTERPRETATION (CONTINUED) Triglyceride <20C, 200-499 >500 (CONTINUED) HEMOGRAM WBC COUNT 6.2 RBC COUNT 4.17 HEMATOCRIT 39.5 HEMOGLOBIN 13.2 MCV 95 MCH 31.7 MCHC 33.4 RED CELL DIST. WIDTH 13.6 AUTOMATED PLATELET 223 MEAN PLATELET VOLUME 12.1 [4-11] K/CMM [4.10-5.10] M/UL [36-45] % [12.3-15.3] G/DL [85-95] FL [27-32] MMG [32-37] g/dL % [150-400] K/UL FL DIFFERENTIAL LYMPHOCYTE 31 MONOCYTE 8 NEUTROPHIL 58 EOSINOPHIL 2 BASOPHIL 1 ABSOLUTE LYMPHOCYTE 1.9 ABSOLUTE MONOCYTE 0.5 ABSOLUTE NEUTROPHIL 3.6 ABSOLUTE EOSINOPHIL 0.1 ABSOLUTE BASOPHIL 0.0 [20-40] % [0-101 % [40.0-70.0] % [O-lO.O1 % [o.o-2.o] % [0.8-4.4] K/UL [0.1-1.1] K/UL [2.0-7.7] K/UL [0-0.5] K/UL [0.0-0.2] K/UL SED RATE 16 [0-30] MM/HR Date Recvd: FOLLOW-UP: TIMMoNs,DORIS E Date Reviewed:. Rep~'~fint~d: 11/13/20(,1, END OF REPORT 20:00 PAGE 2 000063 THE CHAMBERSBURG HOSPITAL Department of Pathology (717) 267-7154 NAME: TIMMONS,DORIS E PHONE~: (717)263-1328 DIAGNOSIS: DM BIRTH DATE: 01/31/1928 SEX: F AGE: 73Y MRS: H349999 ============================ PHYSICIAN COPY FOR DR: BRICKER, DR: BRICKER, M.D., SAMUEL Q .- 144 S EIGHTH STREET CHAMBERSBURG PA 17201 PAGE 1 LOC: PSA M.D., SAMUEL Q ======= ............ F20839 COLL: 08/03/2001 08:43 REC: 08/03/2001 09:04 PHYS: BRICKER, M.D., SAMUEL Q Test Requested: MARU MICROALBUMIN, RANDOM ~ H mg/dL erence range: 0.0 to 2.01 Date Recvd: FOLLOW-UP: TIMMONS,DORIS E Date Reviewed: Report Prznted: 08/04/2001, END OF REPORT 20:01 PAGE 1 000064 NEUROSURGERY CUMBERLAND VALLEY NEUROSURGICAL CONSULTA-NTS 764 LINCOLN WAY EAST CHAMBERSBURG, PA 17201-2768 PHONE 717-263-3850 NEUROLOGY A.R.V. KUMAR, MD.,F.R.C.S. (C) FAX 717-263-3379 S.E. SOLLENBERGER, D.O September 25, 2001 Sam ~ricker, M.D. 144 5. Eighth Street Chambersburg. PA 17201 ..s Timmons ~ I om seeing Doris Timmons in the office today. As you know, Mrs. Timmons is a pleasant 72 y/o right handed individual who has o rather interesting history. 5he relates that in the Spring of this year she had two episodes separated by a 6-week interval that were fairly stereotypical. 5he felt as though she had a tourniquet around her deltoid region and her arm got quite numb. This lasted approximately 10 minutes and cleared up. Immediately thereafter she describes what she calls o "nervous sensation inside'. That lasted for about 15 minutes and then resolved. She went for 6 weeks without any recurrence until she had another one in .Tune. This was basically identical to the previous one. She then went about two months and had two episodes of left arm "weightlessness" with associated central scotoma and subsequent severe headache. This lasted about 10 fninutes and was followed again by the "nervous sensation inside'. This episode recurred! again the following day. She blamed oil of this on amoryl and discontinued taking it. She was subsequently put on some other oral hypoglycemic [ think. She hasn't had any similnr epiisodes since august. She does have episodic tingling sensations in the distribution of her ulr~r nerve on ?he left which [ think is a separate process. PMH is significant for long s~anding history of hypertension. ,She has had gout in the past and has recently been diagnosed with diabetes, (the last two years). Her medications are Alopurinol, Premarin. Zantac, Hilori110 rags I bid, Altase 2.§ mgs once daily, Tramterene/HCTZ on Monday, Wednesday and Friday. 5he tokes Provacho140 rags daily,'. Colestid I gram bid, Celebrex 200 rags daily, ~lucophage XR 500 rngs at hs, Serevent and Tetracycline for rosacea, Aspirin daily and some OTC mods for arthritic problems, indigestion and hemorrhoids. ALLERGIES: Codeine, Zocor, PClq, Mevacor, beta blockers. 000065 Page P,E: boris Timmons PREVIOUS ,SUI~GE~Y: Appendectomy, hysterectomy, left wrist surgery from a traumatic injury, cataract surgery both eyes, carpal tunnel syndrome and ulnar nerve on the right. ,She had a reconstruction of her wrist joint on the right os well and adhesions were Iysed in her right palm. Family history is significant for the death of her Father from a heart attack and her Mother from a stroke both at age 78. Review of systems is otherwise negative. On examination, Mrs. Timmons is a pleasant individual in no acute distress. BP: 14o/82, pulse 88, resp i6. Her mental status is intact. She is intelligent and articulate. Cranial nerves II-XII demonstrated normal function bilaterally except for some mild widening of the palpebral fissure on the left and some flattening of the left nasolabial fold. Motor examination demonstrated normal bulk, tone and power throughout. 5¢nsory examination was remarkable for sensory loss in the distribution of the ulnar nerve on the left. Gait and coordination are normal I~eflexes were present and brisk although slightly more so on the right than LUE. Both extremity reflexes were brisk and symmetric. No pathologic reflexes were elicited. sTUDIES: I reviewed an MP-I of the brain performed on 7-25-01. It shows some lacunar infarcts in the centrum semiovolle biloierally. There is a prominent one in the left occipital region and also one in the right posterior frontal region. These are in locations that could explain the symptoms she has related. bIAGNOSTIC IMPP, E55ION; I think Mrs. Timmons has had ;Focal seizures. I am going to get an EEG in her. We will disc'uss treatment options after that is done. In ~ddition, I Think she should Take an antlplatelet agent. 5he is takinc~ I aspirin e c~y and T think it might be a good idea to add Plavix to that if you don't mind. I will wait until I hear from you about ~hat. Thank you for referring this pleasant lady far evaluation. I hope she does well. Stanton E. $ollenberger, b.O. SEs/tv 000066 · Acl'ulles+ Solo UIt'rasonometer I Time: Physician: operator: ,System ti: AUe al Inenopause: _ '. :Ethnic: USA Female (Caucasian) G 2 T I I T F N IOO- .O '° FD S -N E C 68 O E X $ R S . E -4 20 40 60 UO 100 AGE (yams) Commenls: ~ -- LUNAR' I-xcellEnc,J I. Imuul.g GREATER C~IESAPEAKE HAND SPECIALIST~, P.A. 1400 FRONT AVENUE · SUITE 100 · LUTHERVILLE, MARYLAND 21093 (410) 296-6232 · FAX NO. (410) 821-5943 · 800-870-4263 (MD on~y) PROVIDING OUALITY CARE FOR DISORDERS OF 'TILE HAND, WRIST, ELBOW AND SIIOLILDER August 9, 2001 Peter C. Innis, M.D. Michael A. McClimon, M.D." J. Russell Moore, M.D. Michael $. Murphy, M.D. Keilh A. Segalman, M.D. Raymond A. Wittsladt, M.D., M.P.H. Neal B. Zimmerman, M.D. Gaylord Lee Clark, Jr., M.D*** E. F. Shaw Wilgis, M.D.** · reconstructive plastic sutge~ Samuel Q. Bricker, M.D. 144 S. Eighth St. Chambersburg, PA 17201 NAME: ~mmons-''~ NO: <~' DOV: 08/07/01 Dear Dr. Bricker: Thank you very much for referring Ms. Timmons for consultation regarding her left arm. She was seen today as per your request. As you know, she is a 73-year-old, right-hand domina.nt, customer service rep who has had a history of"attacks" involving her left upper extremity for about the last 2 to 2-1/2 months. These attacks happen spontaneously and are not exacerbated by any type of activities which she can identify. She does not note any change.,; in speech, gait pattem, or sphincter control during the episodes. She says that her arm feels "hollow", she does not have control over it, and then the symptoms abate as rapidly as they had started. She says that she has had an MRI as well as MRA testing of the brain with negative results to date. She has no persistent numbness or tingling in the hand following these episodes. She had a previous fracture of the left wrist about four years ago which was treated with an external fixator. She has a herniated spinal disc. She has also had an appendectomy, hysterectomy, bilateral cataract surgeries, carpal tunnel surgery, wrist reconstruction in 08/00, and surgery for adhesions in the right palm, 10/00. Current medications are numerous and are listed in the chart, but these include allopurinol, Altace, Pravachol, Celebrex, and Glucophage. She has multiple medical and other allergies, again hsted in the chart ami include codeine and penicillin. She does not smoke or drink. Family history is non-contributory. Review of systems for constitutional and musculoskeletal complaints is negative. The patient is a well-developed, well-nourished female in no acute distress. Peripheral pulses in both the right and left upper extremities are intact, bounding and symmetrical. The skin and subcutaneous tissues of both the right and left upper extremities are normal. Her exam is essentially normal with regard to her cervical spine. She has good range of motion and provocative maneuvers for cervical radieulopathy are negative. She has no fixed sensory deficit that I can identify. 0000 8 ELDERSBURG PASADENA (4D)) 2%-62.t2 ~T, MICHAELS WESTMIN$TER Page Two Namc: Doris E. Timmons Date of Visit: 08/07/01 She has good range of motion of both shoulders with no crepitus and negative impingement signs. Cuff strength is intact bilaterally. There is no evidence of ulnar neuropathy at the elbow or the wrist. She retains good functional range of motion in thc digits and wrists of both hands. Other than noted above, on inspection and palpation, there is no discernible misalignment, asymmetry, crepitation defects, tenderness, masses, effusions or prominence of either the right or left upper extremity including the areas of the shoulder, elbow, wrist and hand. Range of motion of both the fight and left upper extremities involving the shoulder, elbow, wrist and hand are normal, with no noted pain, crepitation or contracture. Stability of all joints of both fight and left upper extremities is normal with no noted dislocation, subluxafion or laxity. Muscle strength and tone of all joints of the right and left upper extremity involving the shoulder, elbow, wrist and hand are nom~al, with no noted atrophy or abnormal movements. IMPRESSION: I am suspicious that Ms. Timmons is suffering from transient ischemic cerebral attacks. I do not see any evidence of a peripheral compressive neuropathy in the upper extremity or a mechanical problem now. I do suggest a neumlogic consultation. I have conveyed my suggestions to the patient and asked her to contact you for a referral in your area. Thank you again for referring Ms. Timmons. I will certainly keep you closely updated ifI should have any future contacts with her. ~ Neal B. Zimmerman, M.D.,/F.A.C.S. ~~jmb ~ ..00006.9 Chan~,bersburg Patient: TIMMONS, DORIS E Referring Physician: SAMUEL BRICKER MD Date of Birth: 1/31/28 Date of Exam: July 23, 2001 4¢~ MR ANGIOGRAM EXAMINATION OF THE EXTRACRANIAL CAROTIDS CLINICAL HISTORY:This is a 73 year old woman with left arm numbness--TIA. Evaluate for a vascular cause. TECHNIQUE: Using a neck ceil, a 2-D time-of-flight MR angiogram was obtained. COMPARISONS: None. FINDINGS: Right Common Carotid: The distal right common carotid artery is normal. unremarkable. The distal right internal carotid artery is normal. The carotid bifurcation is Left Common Carotid: The distal left common carotid artery is normal. The carotid bifurcation is normal. The distal left internal carotid artery appears unremarkable. The vertebral arteries are codominant and widely patent. CONCLUSION: MR ANGIOGRAM EXAMINATION OF THE EXTRa, CRANIAL CAROTIDS (7123/2001) This is an unremarkable MR angiogram of the extracranial carotids. No vascular stenosis or flow limitation is noted on this exam. R. Craig Platenberg, MDJmb/7/23/2001-34919/ 435,8 (TIA) OO007O 405 Phoenix D~, Unit A - Charnbersburg, PA 17201 - Phone. 717~263-4999 Fax: 717.263-5522 ©PSN Chambersburg Patient: TIMMONS, DORIS E Referring Physician: SAMUEL BRI/C,I~ MD Date of Birth: 1/31t28 ~ Date of Exam: July 25, 2001 MRI EXAMINATION OF THE CERVICAL SPINE CLINICAL HISTORY:This is a 73 year old woman with left arm numbness. TECHNIQUE: TI-weighted spin-echo sagittal, fast spin-echo gradient-echo axial sequences were performed. COMPARISONS: None. T2-weighted sagittal and FINDINGS: There is degenerative disc disease at C5-6 manifested by thinning of the disc. There is a tiny posterior central disc protrusion at C4-5 without significant impingement on the thecal sac. The discs are otherwise unremarkable, without significant bulge or protrusion. There are no significant degenerative changes, and the neural foramina are patent. There is no malalignment, and the spinal canal is of normal diameter. The spinal cord is of normal size and contains no obvious areas of abnormal signal intensity. The craniovertebral junction is normal. There is slight decreased signal intensity of the posterior aspects of the C6 and C7 vertebral bodies which appears normal on the T2-weighted sequence and is either artifactual or possibly degenerative in nature. The bone marrow is otherwise unremarkable. CONCLUSION: MRI EXAMINATION OF THE CERVICAL SPINE (7/25/2001) Overall unremarkable for age, without significant compromise of the spinal canal or neural foramina. David A. Carrier, M.D.Ijcf1712612001-352401 722.4 (cervical disc degen) 000 405 Phoenix Dr., Unit A - Chambersburg, PA 17201 - Phone: 717-263-4999 Fax: 717-263.5522 Chambersburg Patient: TIMMONS, DORIS E erring Physician: SAMUEL BRICKER MD Date of Birth: 1/31/28 Date of Exam: July 25, 2001 MRI EXAMINATION OF THE BRAIN CLINICAL HISTORY:This is a 73 year old woman with TIAs. TECHNIQUE: TI-weighted spin-echo sagittal, TI-weighted axial FLAIR and fast T2-weighted spin-echo axial and T2-weighted coronal sequences were performed. COMPARISONS: None. FINDINGS: There are patchy and punctate foci of small vessel ischemic change in the periventricular and subcortical white matter. There are no other areas of abnormal signal intensity to suggest a large vessel infarct. There is no mass or extra-axial fluid collection. The CSF-containing spaces are prominent compatible with age-related volume loss. The major arteries and dural sinuses are patent. The sellar and pineal regions are normal. The extracranial tissues are unremarkable. CONCLUSION: MRI EXAMINATION OF THE BRAIN (7/25/2001) Chronic age-related changes which are overall not unexpected for the patient's age. Negative for mass or large vessel infarct. David A. Carrier, MDJjcf1712612001-352421 331.2 (senile degenerat brain) 000072 405 Phoenix Dr., Unit A - Chambersburg, PA 17201 - Phone: 717-263-4999 Fax: 717-263-5522 THE CHAMBERSBURG HOSPITAL Department of Pathology (717) 267-7154 PAGE 1 NAME: TIMMONS,DORIS E PHONE#: (717)263-1328 DIAGNOSIS: HIGH CHOL DM HTN BIRTH DATE: 01/31/1928 AGE: 73Y SEX: F MRS: H349999 LOC: P5A ====== .... ====== .... === .... = PHYSICIAN COPY FOR DR: BRICKER, M.D., SAMUEL Q =========== ....... DR: BRICKER, M.D., SAMUEL Q 144 S EIGHTH STREET CHAMBERSBURG PA 17201 F15342 COLL: 07/06/2001 07:39 REC: 07/06/2001 09:22 Test Requested: ABC,CPMP,DIFA,HA1C,LIPID HEMOGLOBIN A1C (CPAL 7.1 H [4.3-6.1] PHYS: BRICKER, M.D., SAMUEL Q % Date Recvd: FOLLOW-UP: TIMMONS,DORIS E Date Reviewed: Report Prlnted:'07/07/2C01, END OF REPORT 20:01 PAGE 1 000073 THE CHAMBERSBURG HOSPITAL Department of Patholo!~y (717) 267-7154 PAGE NAME: TIMMONS,DORIS E PHONE#: (717)263-1328 DIAGNOSIS: HIGH CHOL DM HTN BIRTH DATE: 01/31/1928 AGE: 73Y SEX: F MR%: H349999 LOC: P5A ============================ PHYSICIAN COPY FOR DR: BRICKER, M.D., SAMUEL Q ================== DR: BRICKER, M.D., SAMUEL Q 144 S EIGHTH STREET CHAMBERSBURG PA 17201 F15342 COLL: 07/06/2001 07:39 REC: 07/06/2001 09:22 PHYS: BRICKER, M.D., SAMUEL Q Test Requested: ABC,CPMP,DIFA,HA1C,LIPID COMPREHENSIVE METABO GLUCOSE 152 H [70-110] BUN 27 H [8-20] CREATININE 0.9 [0.6-1.1] CALCIUM 9.2 ! [8.6-10.3 SODIUM 137 [135-145] POTASSIUM 4.0 [3.6-5.1] CHLORIDE 101 [101-111] TC02 25 [22-32] ANION GAP 11 [5-15] BILIRUBIN, TOTAL 0.8 [0.3-1.2] GOT 33 [15-41] ALK. PHOSPHATASE 46 [38-126] TOTAL PROTEIN 6.1 · , [6.1-7.9] ALBUMIN 3.3 L [3.4-4.8] GPT 31 [14-54] MG/DL MG/DL MG/DL mEq/L mM/L mM/L mM/L mM/L MG/DL U/L U/L G/DL G/DL U/L LIPID PANEL CHOLESTEROL 266 / TRIGLYCERIDE 567 HDL LDL, CALCULATED VLDL H [120-200] HDL NOT VALID DUE TO HIGH TRIG LDL NOT~,,VALID DUE TO HIGH TRIG 113 -~ H [8-32] MG/DL MG/DL MG/DL MG/DL MG/DL Date Recvd: FOLLOW-UP: Date Reviewed: TIMMONS,DORIS E Report~rlnted: 07/06)200i, 2~:01 pA~'i -~ .......... CONTINUED 000074 THE CHAMBERSBURG HOSPITAL Department of Pathology (717) 267-7154 PAGE NAME: TIMMONS,DORIS E PHONE~: (717)263-1328 DIAGNOSIS: HIGH CHOL DM HTN BIRTH DATE: 01/31/1928 AGE: 73Y SEX: F MRS: H349999 LOC: P5A ============================ PHYSICIAN COPY FOR DR: BRICKER, M.D., SAMUEL Q =================: DR: BRICKER, M.D., SAMUEL Q 144 s EIGHTH STREET CHAMBERSBURG PA 17201 F15342 COLL: 07/06/2001 07:39 REC: 07/06/2001 09:22 PHYS: BRICKER, M.D., SAMUEL Q Test Requested: ABC,CPMP, DIFA,HA1C,LIPID LIPID PANEL LIPID INTERPRETATION [8-32] MG/DL (CONTINUED) (NOTE) The highest acceptable level of CHOL varies with age, however values >200 are associated with increased risk of CHD regardless of HDL or LDL values. NCEP GUIDELINES: DESIraBLE BORDERLINE Total Chol <200 200-239 HDL Chol > 60 35-59 LDL Chol <130 130-159 Triglyceride <2(10 200-499 HIGH RISK >240 < 35 >160 >500 HEMOGRAM WBC COUNT RBC COUNT HEMATOCRIT HEMOGLOBIN MCV MCH MCHC RED CELL DIST. WIDTH AUTOMATED PLATELET MEAN PLATELET VOLUME 7.4 4.11 39.1 12.7 95 30.9 32.5 13.8 212 [4-11] K/CMM [4.10-5.10] M/UL [36-45] % [12.3-15.3] G/DL [85-95] FL [27-32] MMG [32-37] % % [150-400] K/UL DIFFERENTIAL LYMPHOCYTE MONOCYTE NEUTROPHIL EOSINOPHIL BASOPHIL ...... ,...~ [20-40] · 10 [0-10] 58 [40.0-70.0] 3 [0-10,0] ~ ~ [0.0-2.0] ABSOLUTE LYMPHOCYTE ABSOLUTE MONOCYTE ABSOLUTE NEUTROPHIL ABSOLUTE EOSINOPHIL Date Recvd: FOLLOW-UP: 2.1 [0.8-4.4] 4.3 [2.0-7.7] 0.2 [0-0.5] Date Reviewed: % % % K/UL K/UL K/UL K/UL TIMMONS,DORIS E ' Report Printed: CONTINUED 07/06/2001,'20:01 PAGE 2 ~ Oooo 's THE CHAMBERSBURG HOSPITAL Department of Pathology (717) 267-7154 PAGE NAME: TIMMONS,DORIS E PHONE#: (717)263-1328 DIAGNOSIS: L/ELEVATED CHOL DM HTN L BIRTH DATE: 01/31/1928 AGE: 72Y SEX: F MR~: 349999 LOC: P5A =========== ..... === .... ===== PHYSICIAN COPY FOR DR: BRICKER, M.D., SAMUEL Q === .... = ....... === DR: BRICKER, M.D., SAMUEL Q 144 S EIGHTH STREET CHAMBERSBURG PA 17201 F28403 COLL: 07/28/2000 07:05 REC: 07/28/2000 09:28 Test Requested: UA,UMIC URINALYSIS TYPE VOIDED COLOR YELLOW CHARACTER CLEAR SPECIFIC GRAVITY 1.010 [1.003-1.026] PH 6.0 [5.0-8.0] PROTEIN NEGATIVE [NEG] GLUCOSE NEGATIVE [NEG] KETONES NEGATIVE [NEG] BILE NEGATIVE [NEG] BLOOD NEGATIVE [NEG] NITRITE NEGATIVE [NEG] UROBILINOGEN 0.2 [0.1-1.0] LEUKOCYTES NEGATIVE [NEG] URINE MICROSCOPIC EPITgELIAL 1 PHYS: BRICKER, M.D., SAMUEL Q MG/DL MG/DL MG/DL E.U./DL /HPF Date Recvd:. FOLLOW-UP: TIMMONS,DORIS E Date Reviewed: Report Printed: 07/28/2000, 20:00 END OF REPORT PAGE 2 00007'8 THE CHAMBERSBURG HOSPITAL Department of Pathology (717) 267-7154 PAGE 1 NAME: TIMMONS,DORIS E PHONE~: (717)263-1328 DIAGNOSIS: L/NO D BIRTH DATE: 01/31/1928 SEX: F AGE: 72Y MRS: 349999 LOC: P5A ============================ PHYSICIAN COPY FOR DR: BRICKER, M.D., SAMUEL Q ================= DR: BRICKER, M.D., SAMUEL Q 144 S EIGHTH STREET CHAMBERSBURG PA 17201 COPIES SENT TO: BRICKER, M.D., SAMUE H39059 COLL: 08/17/2000 06:42 REC: 08/17/2000 08:58 Test Requested: BUNCR,HH, LYTE PH~IESSWEIN, PETER M.D. BUN-CREATININE BUN 24 H [8-20] MG/DL CREATININE 1.1 [0.6-1.1] MG/DL ELECTROLYTES SODIUM 136 [135-145] mM/n POTASSIUM 4.2 [3.6-5.1] mM/L CHLORIDE 100 L [101-111] mM/L TC02 26 [22-32] mM/L ANION GAP 10 [5-15] HGB AND HCT HEMOGLOBIN 13.7 [12.3-15.3] G/DL HEMATOCRIT 41.4 [36-45] % Date Recvd: FOLLOW-UP: TIMMONS,DORIS E Date Reviewed: Report Printed: 08/17/21000, 20:00 END OF REPORT PAGE 1 000078 Doris E. Timmons AGE 72 315 E. Catherine Street Chambersburg, PA 17201 August 8, 2000 RJR Patient elected to cancel her appointment with Dr. Pellegrini's appointment due to a long wait and was seen by a hand specialist in Carlisle and is scheduled for surgery. CUMBERLAND VALLEY ORTHOPAEDIC ASSOCIATES, INC. Roger J. Robertson, M.D. Anthony Bruno, M.D. Robert F. Pellegrino, Jr., P.A.C. Chambersburg Medical Building, Suite 101 120 North Seventh Street Chambersburg, PA 17201 (717) 263-1220 FAX (717) 263-625~. oooo Doris E. Timmons AGE: 72 315 E. Catherine St. Chambersburg, PA 17201 March 22, 2000 RJR Patient represents for evaluation of right hand. Her numbness is improved. Basal thumb arthritis is improved to some degree but she still has significant weakness to grip and positive Tinel's over the carpal I~unnel with positive Phalen's test after 5 sec. After discussion, plan is to give i~ additional time. Basal thumb arthritis is also discussed but it is not severe enough as to warrant surgical intervention. Recheck clinically in 6 weeks. The advantages of endoscopic vs. open carpal tunnel release were discussed. cc: Samuel Q. Bricker, M.D. May 3, 2000 RJR Patient represents for evaluation of right hand. ller hand has actnally gotten worse. She has a positive Phalen's test up to 2-3 sec. With a positive Tinel's.. She is not quite ready for surgery. She does have decrease in grip aud pinch strength. Plan is to continue with the night splint bnt to try local carpal tunnel injection with 0.5 cc. of Celestone and I cc. off% Lidocaine. Recheck in one month to reassess her clinical status. CC: Samuel Q. Bricker, MD CUMBERLAND VALLEY ORTHOPAEDIC ASSOCIATES, INC. Roller J. Robertson, M.D. Anthony Bruno, M.D. Robert F. Pellegrino, Jr., P.A.C. Chambersburg Medical Building, Suite 101 120 Nodh Sevenlh Street Charnbersburg, PA 17201 (7t7) 263-1220 FAX {717) 263-6255 N N N () ~ 0 THE CHAMBERSBURG HOSPITAL RADIOLOGISTS REPORT FINAL ReqSeq~64 Name: TIMMONS, DORIS E MR#: 349999 Date Done: 03-08-2000 Read: Ordering Dr: BRICKER, SAMUEL Q Nurs Stat: O/P Faculty Dr: M.D., KEVIN M. CREGkN Room no.: Admitting Diag: CT/SINUS INFECTION Rsn for Exm: NA Patient phone: 7172631328 03-09-2000 TPD Date: 03-09-2000 Time: 1519 Transcriptionist: TMW Pat Class: 3 Date of Birth: 01-31-1928 ACCOUNT NO: 774236 *** F/C: 18 *** ** FINAL ** HISTORY: SINUS INFECTION. 3/8/2000 CT OF THE PARAlCASAL SINUSES: IMPRESSION: 1. 2. BILATERALLY. 3. LEFT. 4. NO EVIDENCE OF ACUTE OR CHRONIC SINUSITIS. PATENT OSTEOMEATAL COMPLEXES kND FRONTAL RECESSES LARGE CONCHA BULLOSA IN THE MIDDLE TURBINATE ON THE MODEP~ATE RIGHTWARD DEVIATION OF THE NASAL SEPTUM. 2 MM. CORONAL MAXILLA SCANS WERE OBTAINED OF THE PAPJkNASAL SINUSES. THE PA/{ANASAL SINUSES ARE NORMALLY AER3%TED WITHOUT AIR FLUID LEVELS OR MUCOPERIOSTEAL THICKENING. THE OSTEOMEATAL COMPLEXES AND FRONTAL RECESSES ARE PATENT BILATERALLY. THERE IS A LARGE CONCHA BULLOSA IN THE MIDDLE TURBINATE ON THE LEFT. THERE IS MODER3kTE RIGHTWARD DEVIATION OF THE NASAL SEPTUM WHICH DOES APPEAR TO RESULT IN NARROWING OF THE RIGHT HIATUS SEMILUNARES. CALCIFICATIONS ARE NOTED BILATERALLY IN THE CAVE~JOUS SEGMENTS OF THE INTERNAL CAROTID ARTERIES. DX: 000.0 170486/166375 HX: 461.9 Signed by DR. KEVIN M. CREGAN M.D. 000081. · CUMBERLAND VALLEY ORTHOPAEDIC ASSOCIATES, Roger J. Robertson, M.D. Anthony Bruno, M.D. Robert F. Pellegrino, Jr., P.A.C. Doris E. Timmons AGE: 315 E. Catherine St. Chambersburg, PA 1720i 72 Orthopaedic Surgery and Sports Medicine Chambersburg Medical Building Suite 101 120 NoAh Seventh Street Chambersburg, PA 17201 (717) 263-1220 FAX (717) 263-6255 February 23, 2000 COMPLAINT: Numbness and tingling right hand. BRIEF HISTORY: This is a 72 year old white female who presents for evaluation of her right wrist and hand. She states since Sept. it is getting progressively worse. Site is right-hand dominant. When she goes to write she can't write very well for very long. She also has occasional nocturnal awakening, clumsiness. She is an oral-controlled diabetic with Glucotrol. Denies any thyroid difficulty. Her hand feels weak. Site has pain to the midaspect of the wrist and to the hand primarily to the long finger but also to the thumb on occasion. Left hand is status post wrist fracture. Doing well except for occasional triggering of a finger. She was followed by Dr. Brtcker who had her obtain nerve sl:udies and now she presents for orthopaedic evaluation. MEDICAL HISTORY: Medications are Hylorel, Altace, Pracachol, Zantac, Allopurinol, Questran, Mazide, Glucotrol, Tetracycline, Aspirin and Premarin. Allergies are to Codeine, penicillin, Zocor and Mevacor. EXAMINATION: Exam is pertinent for the patient being 5', 137 lbs. Exam is pertinent for the right wrist which has no thenar atrophy. She does have evidence of early to moderate basilar thumb arthritis with sensitivity to direct palpation with a negative grind test. She has a positive Tinel's with positive Phalen's test, normal Allen's test. No significant thenar or hypothenar atrophy. Distal neurovascular is otherwise intact. Nerve studies performed by Dr. Cho 1/24/00 reveal that there is early mild carpal tunnel syndrome in the right arm. IMPRESSION: Early right carpal tunnel syndrome. RECOMMENDATION: Initially treat this conservatively with a wrist splint to wear at night. Supplement it with Celebrex 200 mg. po q day with food. Samples, prescription and precautions were reviewed. Recheck in one month to assess its therapeutic benefit. Call and return sooner if there is any significant difficulty. RJR:al Re~eY.~. Robertson, M.D. cc; Samuel Q. Bricker, M.D. (4) THE CHAMBERSBURG HOSPITAL Department of Pathology (717) 267-7154 PAGE 1 NA/4E: TI~94ONS,DORIS E PHONE#: (717)263-1328 DIAGNOSIS: L/DM UT BIRTH DATE: 01/31/1928 SEX: F AGE: 72Y 349999 ============================ PHYSICIkN COPY FOR DR: BRICKER M.D., DR: BRICKER M.D., S~/4~3EL Q. 144 S. EIGHTH STREET CHAMBERSBURG, PA 17201 02/14/2000 URINE CULTURE 0728 ACC: NO.: M10627 TRANSPORT TIME: SPECIME~ DESCRI~TION: URINE SPECIAL REQUESTS: KEFLEX 1.6 FINAL 02/16/2000 GRAM STAIN: 1. LN SCREEN POSITIVE, GRAM STAIN TO FOLLOW 2. OCCASIONAL WBC'S SEEN 3. 1+ GRAM POSITIVE COCCI COLONY COUNT: CULTURE: 5000 ORGS/ML., (ET: I DAY 0 HOURS) 1. NON SIGNIFICANT MIXED BACTERIAL GROWTH 1 DAY 0 HOURS) (ET: LOC: PLA SAMUEL Q. = ................. Date Recvd: FOLLOW-UP: Date Reviewed: TIMMONS,DORIS E Report Printed: 02/16/2000, END OF REPORT 20:00 PAGE 1 000083 THE CHA/4BERSBURG HOSPITAL .' Department of Pathology (717) 267-7154 PAGE N~/4E: TIMMONS,DORIS E M/R~.' 34~9 9 LOC: PHONE#: (717}263-1328 ~[~ DIAGNOSIS: L/DM UT BIRTH DATE: 01/31/1928 AGE: 72Y SEX: F ============================ PHYSICIAN COPY FOR DR: B~?iCKER M.D., SAMUEL Q DR: BRICKER M.D., SAMUEL Q. 144 S. EIGHTH STREET CH~BERSBURG, PA 17201 02/14/2000 URINE CULTURE 0728 ACC. N0.: M10627 TRANSPORT TIME: 1.6 PRELIMINARY SPECIMEN DESCRIPTION: URINE SPECIAL REQUESTS: KEFLEX GRAM STAIN: 1. LN SCREEN POSITIVE, GRAM STAIN TO FOLLOW 2. OCCASIONAL WBC'S SEEN 3. 1+ GRAM POSITIVE COCCI CULTURE: 1. PENDING 1 PLA M10628 COLL: 02/14/2000 07:28 REC: 02/14/2000 09:04 PHYS: BRICKER M.D., SA24UEL Q. Test Requested: UA,UMIC URINALYSIS TYPE CLEAN CATCH COLOR YELLOW CHARACTER CLOUDY SPECIFIC GRAVITY 1.023 [1.003-1.026] PH 5.0 [5.0-8.0] PROTEIN NEGATIVE [NEG] GLUCOSE NEGATIVE [NEG] KETONES NEGATIVE [NEG] BILE NEGATIVE [NEG] BLOOD NEGATIVE [NEG] NITRITE NEGATIVE [NEG] UROBILINOGEN 0.2 [0.1-1.0] ~ LEUKOCYTES LARGE * [NEG] MG/DL MG/DL MG/DL E.U./DL URINE MICROSCOPIC ' WBC'S 39 H [0-3] /HPF RBC'S 5 H [0-3] /HPF /HPF EPITHEAL 27 BACTERIA MODERATE * [NONE] Date Recvd: Date Reviewed: FOLLOW-UP: TIMMONS,DORIS E Report Printed: 02/14/2000, 20:00 CONTINUED .................. PAGE 1 000084 THE CHAMBERSBURG HOSPITAL Department of Patholo!~y (717) 267-7154 PAGE NAME: TIMMONS,DORIS E PHONE#: (717)263-1328 DIAGNOSIS: L/DM UT BIRTH DATE: 01/31/1928 SEX: F AGE: 72Y LOC: P5A ============================ PHYSICIAN COPY FOR DR: BRICKER M.D., SAMUEL Q. =================~ DR: BRICKER M.D., SAMUEL Q. 144 S. EIGHTH STREET CHAMBERSBURG, PA 17201 M10630 COLL: 02/14/2000 07:14 REC: 02/14/2000 09:04 Test Requested: CPMP PHYS: BRICKER M.D., COMPREHENSIVE METABO GLUCOSE 127 H [70-110] MG/DL BUN 21 H [8-20] MG/DL CREATININE 0.9 [0.6-1.1] MG/DL CALCIUM 9.8 [8.6-10.3] mEq/L SODIUM 144 [135-145] mM/L POTASSIUM 4.1 [3.6-5.1] mM/L CHLORIDE 105 [101-111] mM/L TCO2 27 [22-32] mM/L ANION GAP 12 [5-15] BILIRUBIN, TOTAL 0.9 [0.3-1.2] MG/DL GOT 30 [15-41] U/L ALK. PHOSPHATASE 60 [38-126] U/L TOTAL PROTEIN 6.6 [6.1-7.9] G/DL ALBUMIN 3.8 [3.4-4.8] G/DL SAMUEL Q. .? Date Recvd: FOLLOW-UP: TIMMONS,DORIS E Date Reviewed: Rep-ort"prf~t~d': 02/14/2000, 20:00 '-PAGE % END OF REPORTUUU~O NAME: TIMMONS,DORIS E PHONE%: (717)263-1328 DIAGNOSIS: L/DM UT BIRTH DATE: 01/31/1928 SEX: F AGE: 72Y THE CHA24BERSBURG HOSPITAL Department of Pathology (717) 267-7154 PAGE MR%: 349~C: PSA ============================ PHYSICIAN COPY FOR DR: BRICKER M.D., SAMUEL Q. ================== DR: BRICKER M.D., SAMUEL Q. 144 S. EIGHTH STREET CHA_MBERSBURG, PA 17201 02/14/2000 URINE CULTURE 0728 ACC. NO.: M10627 TRANSPORT TIME: SPECIMEN DESCRIPTION: URINE SPECIAL REQUESTS: KEFLEX 1.6 PRELIMINARY GRAM STAIN: 1. LN SCREEN POSITIVE, GRAM STAIN TO FOLLOW 2. OCCASIONAL WBC'S SEEN 3. 1+ G~AM POSITIVE COCCI COLONY COUNT: 5000 0RGS/Mi., (ET: 1 DAY 0 HOURS) CULTURE: 1. NON SIGNIFICANT MIXED BACTERIAL GROWTH 1 DAY 0 HOURS) (ET: Date Recvd: FOLLOW-UP: TIMMONS,DORIS E Date Reviewed: Report Printed: 02/15/2000, 20:00 END OF REPORT PAGE 1 oooos6, THE CHAMBERSBURG HOSPITAL Department of Pathology (717) 267-7154 PAGE 1 NAME: TIMMONS,DORIS E PHONE#: (717)263-1328 DIAGNOSIS: L/DM 272. BIRTH DATE: 01/31/1928 SEX: F AGE: 71Y ============================ PHYSICIAN COPY FOR DR: DR: BRICKER M.D., SAMUEL Q. 144 S. EIGHTH STREET CHAMBERSBURG, PA 17201 MRS: 349999 BRICKER M.D., LOC: P5A SAMUEL Q. ================== M3555 COLL: 01/03/2000 06:38 REC: 01/03/2000 09:02 PHYS: BRICKER M.D., SAMUEL Q. Test Requested: HA1C,LIPID LIPID PANEL CHOLESTEROL 207 H [120-200] MG/DL TRIGLYCERIDE 292 MG/DL HDL 55 MG/DL LDL, CALCULATED 94 MG/DL VLDL 58 H [8-32] MG/DL LIPID INTERPRETATION The highest acceptable level of CHOL varies with age, however values >200 are associated with increased risk of CHD regardless of HDL or LDL values. NCEP GUIDELINES: DESI~kBLE BORDERLINE HIGH RISK Total Chol <200 200-239 >240 HDL Chol > 60 35-59 < 35 LDL Chol <130 130-159 >160 TriGlyceride <2013 200-499 >500 Date Recvd: FOLLOW-UP: Date Reviewed:. TIMMONS,DORIS E ReP0~t Prin~ed: 01/03/2000, 20:00 END OF REPORT PAGE 1 000,08.7 REHAB MEDICINE ASSOCIATES, P.C. ,Specializing in PHYSICAL MEDICINE AND RI:~ .ffTATION lAY l, CLIO, M.D HONG S. PARK. M.D. 5124 E. Trind~e t -Mechanic~burg, PA 17055 (717) 795-7943 120 N. Seveth Street, Suite 102. Chambersburg. PA 17201 (717) 267-7735 ELECTROMYOGRAPH Palient: Doris Timmons Date: January 24, 2000 Type of Needle: Monopolar Normal Silent Full Abbr: NI: Normal Fib. : Fibrillation t : Increased ~ : Positive Wave ,~ :Decreased Fasc.: Fasciculation Interpretation: See Impression Below P0typh. : Polyphas~cs G.W. : Giam Wave Impression: The above EMG/NC test for the right upper extremity revealed: early/mild Carpal Tunnel Syndrome on right arm. Thanks, JJC/sjm % . 000088 REHAB M~DICINE A$SOCIA'T'F~S, P.C. · Special~i~ M PHYSICAL MEDICINEAND Patient: Doris Timmons Chief Complaints: [~ 5124 E. Trim:lie I:~ 'K:hanic~burg. PA 17055 JI'ATION (717) 795-7943 Ch~33~:~r.....-"~'---~sbufg, PA 1t I~oNo s. PARr,. MD [~ 120 N. Sevelh Street. Suite 102. 20~ / ROBERTA ~ GRJFF. M D (717) 267-7735 '~t ELECTRONEUROMYOGRAPH ~ I Date: January 24, 2000 Referfir~ Physican: Dr. Bricker History & Physical: Current Medicine: NERVE CONDUCTION STUDY *MOTOR NERV! CONDUCTI0 VELOCITY ~F_.~HE ~_R~.~ed i a n 2 55.8 Normal ~--~-~-..,,~O-lnar 2.0 Normal 55.4 Normal *DISTAL LATf ~CY OF SEN ~ORY NE~ RIGHT UPPER EXTR~ITY ~.~_~ %.Q~.y~ 3.12 m/sec, with 20 uV: Normal *SEGMENTAL .S ~.Q~_.QF ~. L~ ~DIA~ ........................... )alm-3rd f ~r.~.~_,_ 1.66 m/sec with 100 uV ,~ b~istr3rd inqer: . . ~,.36 m/sec ~i~ 100~/ slight Ly abnormal Interpretation: See Impression JJC/sjm Jay J.~"'Cho, M.D. Labora, Report Oia 800-825-7330 (PA) 800-825-7320 (Client Se~ice) ,.~ .:.., .:.., .) I..) ~.::l,:~., (0 (a J I i.d.[ ' ' "' Reference Range Units I::, .I..JIL:.J,,iL I'~].1. t L,(..iL .~. pii'li.[.?( .I, (. i.j.L .J.i'i ,.~ l....I t','¥[..H.,.lJl-ll.~ii:. i.~ J:. i' I I ~ .,. J. i.' .i. i'ii.:. ~, Ld.:.i'l i Ili'J .I. L~ .L Jl i.) · ~': Ebl9 [.il:: l::l{,h:.lL I:(i:~.[-~C)I:UI THE CHAMBERSBURG HOSPITAL Department of Pathology (717) 267-7154 PAGE 1 NAME: TIMMONS,DORIS E PHONE~: (717)263-1328 DIAGNOSIS: L/SM HTN LOW BIRTH DATE: 01/31/1928 SEX: F AGE: 71Y MR%: 349999 LOC: P5A ============================ PHYSICIAN COPY FOR DR: BRICKER M.D., SAMUEL Q. ================= DR: BRICKER M.D., SAMUEL Q. 144 S. EIGHTH STREET CHAMBERSBURG, PA 17201 W66920 COLL: 09/29/1999 07:55 REC: 09/29/1999 08:49 Test Requested: CPMP,HA1C HEMOGLOBIN A1C (CPAL 6.7 H [4.3-6.1] PHYS: BRICKER M.D., SAMUEL Q. % Date Recvd: FOLLOW-UP: Date Reviewed: TIMMONS,DORIS E Report Printed: 09/30/1999, 20:00 END OF REPORT PAGE 1 000091 THE CHAMBERSBURG HOSPITAL 112 North Seventh Street Chambersburg, PA 17201 (717) 267-7149 NAME: TIMMONS,DORIS E PATIENT#: H00010200046 DOB: 01/31/1928 RADIOLOGIST: Niteen N Sukerkar M.D. PATIENT LOCATION: CRAD REPORT #: 0522-0002 ADMITTING DIAGNOSIS: PNEUMONIA REASON FOR EXAM: ORDERING PHYSICIAN: Bdcker M.D., Samuel Q SUMMIT HEALTH CEN. _R, Rhonda Brake Shreiner Women's Center Summit Diagnostic Services MEDICAL RECORI~) #: H349999 PATIENT TYPE: REG CLI ROOM/BED: PATIENT PHONE: (717)263-1328 FINANCIAL CLAS,~: MCRE ORDER #: 0521-02:40 DIAGNOSTIC IMAGING REPORT STATUS: Signed DATE OF SERVICE: 5/21/01 HISTORY: 73 year old female, shortness of breath CHEST, TWO VIEWS: Lung markings are absent, due to poor inspiration. Active pneumonitis is not suspected. There is no evidence of CHF. Heart size is normal. Atherosclerotic aortic calcification is seen and no change has occurred since 2/21/01. IMPRESSION: No acute abnormalities. 786.05 <Electronically signed by Niteen N Sukerkar M.D.> DictaIing Physician: Niteen N Sukerkar M.D. TR NAME: DEBORAH J PEFLEY DICTATED: 05/21/01 TR DATE: 05/27./01 CC: Niteen N Sukerkar M.D.; Samuel Q Bdcker M.D. Ordering Physician's copy Bricker M.D., Samuel Q 144 S 8Th St Chambersburg, PA 17201 · Page'l-of 1 ............. DEPARTMENT: DIAGNOSTIC IMAGING 71020 Doris E. Timmons AGI! 73 315 E. Catherine Street Charnbcrsburg, I'A 172ul April 18, 2001 RJR Patient reprcscm'; ['or evaluation of her right hip. llcr hip is somewhat improved. Some days arc better then others bw 'd~e can now lay on it v, hereas before she couldn't. She was tolerating thc Vioxx very well. Recommendation after discussion, is to continue Vioxx 25 mga day for another 3 weeks then discontinue. Activities to tolerance. Follow-up in the future dependent on future symptomatology. CC: San'reel Bricker, CUMBERLAND VALLEY ORTHOPAEDIC ASSOCIATES, INC. Roger J. Robertson, M.D. Anthony Bruno, M.D. Michael E. Leit, M.D, M.S. Robert F. Pellegrlno, Jr., P.A.C. Chambersburg Medical Building, Suite 101 120 Nodh Seventh Street Chambersburg, PA 17201 0 0 0 2 .,220 ~ FAX (Ir'l) 263-(3255 CUMBERLAND VALLEY ORTHOPAEDIC ASSOCIATES, INC. Roger J. Robertson, M.D. Anthony Bruno, M.D. Michael E. Leit, M.D., M.S. Robert F. Pellegrino, Jr., P.A.C. Doris E. Timmons AGE 73 315 E. Catherine Street Chambersburg, PA 17201 Orthopaedic Surgery and Sports Medicine Chambersburg Medical Building Suite 101 120 North Seventh Street Chambersburg, PA 17201 (717) 263-1220 FAX (717) 263-6255 March 29, 2001 COMPLAINT: Pain right hip. HISTORY: This 73 year old white female was at home in her kitchen in high heels when she slipped and suffered an acute inversion injury to the right ankle. Fell onto the right hip. Date of injury was 3/12/01. Because of persistence of pain she presented emergently to Chambersburg ttospital on 3/14/01 where x-rays were obtained, advised to take Advil and if it was still painful to see her family physician. She subsequently saw her family physician, Dr. Bricker who referred her for orthopaedic evaluation. She has trouble with prolonged sitting. She must change positions. When she first walks she limps and then it gets better the more she is on it. It bethers her in the lateral aspect of the /'ight hip and down the right leg to some degree. It bothers her at night if she lays on it. She denies any radiculopathy. Denies any weakness. Denies any prior injur/. Has been staying the same. She has not taken any medicines, had any shots or any therapy. She does have ayrior histm7 of left sided herniated nucleus pulposus which causes left sciatica but never on the right. PAST MEDICAL HISTORY: Medications are Allopurinol, Premarin, Randitidine, Hylorel, Altace, Triamterene, Pravachol, Colestid tabs, Celebrex, Glucotrol, Tetracyclin, Aspirin, Propoxyphene. Allergies are to Codeine, Zocor, Penicillin and Mevacor, seafood, latex rubber, fish and beta blockers. PHYSICAL EXAM: Exam is pertinent for the right hip. Patient has symmetrical knee and ankle reflexes. Good lower extremity strength. No clonus. Normal Babinski. She has straight leg raising symmetrical. Excellent hip rotation without pain. No pelvic pain. She is very sensitive in the region of the right greater trochanter consistent with trochanteric bursitis. No evidence of sciatic nerve notch tenderness. X-RAYS: AP pelvis, lateral right hip, CVOA 3/14/01 is normal. IMPRESSION: Right hip traumatic trochanteric bursitis. 000094" Doris E. Timmons AGE 73 315 E. Catherine Street Chambersburg, PA 1720 ! March 29, 2001 (continued) RECOMMEDATION: Review pathology with the patient. Given a local injection of 1 cc of Celestone and 5 cc of 1% Lidocaine. Supplemented with Vioxx 25 mg. po q day with food. Discontinue the Celebrex. May continue with I Ecotrin a day. Recheck clinically in 3 weeks to assess her clinical status. RJR:ds CC: Samuel Q. Bricker, MD Roger J. Rohertson~ 000095 CHAMBERSBURG HOSPIT SUMMIT .ALTH CENTER · Rhonda B . .e Shreiner Women's Center · Sunmait Diagnostic Services RADIOLOGIST'S REPORT FINAL Name: TIMMONS, DORIS E Date Done: 02-21-2001 Ordering Dr: BRICKER, SAMUEL Q Nurs Stat: 80 Faculty Dr: M.D., DAVID R. BRILL Room no.: Admitting Diag: RESP/X/L/BRONCHITIS Rsn for Exm: NONE ~ (7lO 26~7149 MR#: 349999 ReqSeq: 999994 TPD Date: 02-26-2001 Time: 0848 Transcriptionist: DAH ]?at Class: 3 COUGH* Date of Birth: 01-31-1928 Patient phone: 7172631328 ACCOUNT NO: 582868 ~.~q%% ** FINAL ** CLINICAL HISTORY: 73-YEAR-OLD FEMJ%LE. BRONCHITIS, *** F/C: 18 *** COUGH AND DYSPNEA. 02/21/01 CHEST: A PATCHY INFILTRATE IS OBSERVED IN THE RIGHT MID ]LUNG FIELD, AND IS NEW SINCE A PRIOR STUDY OF 03/17/99. NO OTHER INFILTRATE CAN BE SEEN AND THE REMAINDER OF THE STUDY IS THOUGHT TO BE ~gREMARKABLE. IMPRESSION: PATTERN SUGGESTING AN ACUTE RIGHT MIID LUNG INFILTRATE HAS DEVELOPED. 61020 466.1/786.2/786.05 Signed by DR. DAVID R. BRILL M.D. 000096 Chambers~urg Hosplta± 'hambersburg, PA 17201 P~: DORIS TIMMONS OCC: COMPUTER ANALYST 15Y HAZARD: PHYSICIAN: BRICKER SMK HX: NEVER AGE: 73 SEX: F HT: 60.0 in PRED-COLLINS1 WT: 139.0 lb TECH: E. ZIEMBA RRT PT#: 349999 ADDL.ID: 5828686 DATE: 02/21/2001 TIME: 07:03:49 Pre-Drug* Post-Drug* NaC1 Spirometry Actual %Pred Predicted Actual %Pred %Chg FVC (L) 1.60 70 2.30 1.74 76 9 FEV1 (L) 1.34 85 1.58 1.50 95 11 FE~3 (L) 1.52 68 2.23 1.67 75 9 F~F25-75% (L/S) 1.55 79 1.96 2.36 120 51 F~Fmax (L/S) 3.94 74 5.31 4.16 78 5 F~V1/FVC {%) 84 122 69 86 125 2 Results: The FVC is reduced. The FEV1 and FEV1/FVC are normal. There is no response to inhaled bronchodilator. The flow volume loop is normal. Impressions: Mild restrictive pattern. The bronchodilator response approaches but does not reach the level of statistical significance.' There is no evidence of' airflow obstruction. ?. Jablin, MD 000097 THE CHAMBERSBURG HOSPITAL Department of Pathology (717) 267-7154 PAGE 1 NAME: TIMMONS,DORIS E PHONE#: (717)263-1328 DIAGNOSIS: RESP/X/L/BRONCHITIS COUG BIRTH DATE: 01/31/1928 AGE: 73Y SEX: F MRS: 349999 ============================ PHYSICIAN COPY FOR DR: BRICKER, M.D., DR: BRICKER, M.D., SAMUEL Q 144 S EIGHTH STREET CHAMBERSBURG PA 17201 LOC: OP SAMUEL Q ............ = ..... W80144 COLL: 02/21/2001 08:35 REC: 02/21/2001 08:41 Test Requested: ABC,CPMP,DIFA,HA1C,LIPID HEMOGLOBIN A1C (CPAL 7.0 H [4.3-6.1] PHYS: BRICKER, % M.D., SAMUEL Q Date Recvd: FOLLOW-UP: TIMMONS,DORIS E Date,~eviewed Report._p.rin~ed:~;02'~2'2~2001, END OF REPORT 20:01 000¢98 THE CHAMBERSBURG HOSPITAL Department of Pathology (717) 267-7154 PAGE NAME: TIMMONS,DORIS E PHONE~: (717)263-1328 DIAGNOSIS: RESP/X/L/BRONCHITIS COUG BIRTH DATE: 01/31/1928 AGE: 73Y SEX: F MRS: 349999 LOC: OP ============================ PHYSICIAN COPY FOR DR: BRICKER, M.D., DR: BRICKER, M.Do, SAMUEL Q 144 S EIGHTH STREET CHAMBERSBURG PA 17201 SAMUEL Q ==== .............. W80144 COLL: 02/21/2001 08:35 REC: 02/21/2001 08:41 PHYS: BRICKER, Test Requested: ABC,CPMP,DIFA, HA1C,LIPID COMPREHENSIVE METABO GLUCOSE 133 H [70-110] MG/DL BUN 29 H [8-201 MG/DL CREATININE 1.0 [0.6-1.1] MG/DL CALCIUM 9.5 [8.6-10.3] mEq/L SODIUM 140 [135-145] mM/L POTASSIUM 3.8 [3~6-5.1] mM/L CHLORIDE 103 [101-111] mM/L TC02 27 [22-32] mM/L ANION GAP 10 [5-15] BILIRUBIN, TOTAL 0.9 [0.3-1.2] MG/DL GOT 33 [15-41] U/L ALK. PHOSPHATASE 45 [38-126] U/L TOTAL PROTEIN 6.0 L [6.1-7.9] G/DL ALBUMIN 3.5 [3.4-4.8] G/DL GPT 23 [14-54] U/L LIPID PANEL CHOLESTEROL 202 H [120-200] MG/DL TRIGLYCERIDE 413 MG/DL HDL MG/DL LDL, CALCULATED VLDL HDL NOT VALID DUE TO HIGH TRIG LDL NOT VALID DUE TO HIGH TRIG 83 H [8-32] MG/DL MG/DL. M.D., SAMUEL Q FOLLOW-UP: TIMMONS,DORIS E CONTINUED PAGE-1 .-: 000099 THE CHAMBE~SBURG HOSPITAL Department of Pathology (717) 267-7154 PAGE NAME: TIMMONS,DORIS E PHONE#: (717)263-1328 DIAGNOSIS: RESP/X/L/BRONCHITIS COUG BIRTH DATE: 01/31/1928 AGE: 73Y SEX: F MRS: 349999 LOC: OP ============================ PHYSICIAN COPY FOR DR: BRICKER, M.D., SAMUEL Q ================= DR: BRICKER, M.D., SAMUEL Q 144 S EIGHTH STREET CHAMBERSBURG PA 17201 W80144 COLL: 02/21/2001 08:35 REC: 02/21/2001 08:41 PHYS: BRICKER, M.D., SAMUEL Q Test Requested: ABC,CPMP,DIFA,HA1C,LIPtD LIPID PANEL LIPID INTERPRETATION [8-32] MG/DL (CONTINUED) (NOTE) The highest acceptable level of CHOL varies with age, however values >200 are associated with increased risk of CHD regardless of HDL or LDL values. NCEP GUIDELINES: DESIRABLE BORDERLINE Total Chol <200 200-239 HDL Chol > 60 35-59 LDL Chol <130 130-159 Triglyceride .... ~ <200 200-499 HIGH RISK >240 < 35 >160 >500 HEMOGRAM WBC COUNT 6.9 RBC COUNT 4.15 HEMATOCRIT 39.2 HEMOGLOBIN 13.2 MCV 95 MCH 31.8 MCHC 33.7 RED CELL DIST. WIDTH 13.9 AUTOMATED PLATELET 224 MEAN PLATELET VOLUME 10.6 [4-11] K/CMM [4.10-5.10] M/UL [36-45] % [12.3-15.3] G/DL [85-95] FL [27-32] MMG [32-37] ~. % % [150-400] K/UL · FL DIFFERENTIAL -.LYMPHOCYTE . MONOCYTE NEUTROPHIL EOSINOPHIL BASOPHIL ABSOLUTE LYMPHOCYTE ABSOLUTE MONOCYTE ABSOLUTE NEUTROPHIL ABSOLUTE EOSINOPHIL Date Recvd: 29 ~'~ 10 59 0 2.0 0.7 4.0 0.2 FOLLOW-UP: [20-40] ......... [OLIO] ~ [40.0-70.0] [0-z0.0] ....... ~ [0.0-2.01 [0.8-4.4] [O.l-l.l] [2.0-7.7]'=~:.= [0-0.5] Date Reviewed % % % % % K/UL K/un K/UL K/UL TIMMONS,DORIS E Report Printed: '02/~i/2001, CONTINUED 20:00 PAGE 2 000100 THE CHAMBERSBURG HOSPITAL Department of Pathology (717) 267-7154 PAGE 3 NAME: TIMMONS,DORIS E PHONE#: (717)263-1328 DIAGNOSIS: RESP/X/L/BRONCHITIS COUG BIRTH DATE: 01/31/1928 AGE: 73Y SEX: F MRS: 349999 LOC: OP ============================ PHYSICIAN COPY FOR DR: BRICKER, M.D., SAMUEL Q ================== DK: BRiCKER, M.D., SAMUEL Q 144 S EIGHTH STREET CHAMBERSBURG PA 17201 W80144 COLL: 02/21/2001 08:35 REC: 02/21/2001 08:41 Test Requested: ABC,CPMP, DIFA,HAiC,LIPID DIFFERENTIAL [0-0.5] (CONTINUED) ABSOLUTE BASOPHIL 0.0 [0.0-0.2] PHYS: BRICKER, M.D., K/UL K/UL SAMUEL Q Date Recvd: FOLLOW-UP: TIMMONS~DORIS E Date ~eviewed Report Printed: 02/21/2001, 20:00 END OF REPORT PAGE 3 O0010i' OCTOBER 3, 2000 Dear Dr. Bricker: Reference my prescription, QUESTRAN LIGHT PACKETS, BRANF) NAME ONLY, unflavored. MERCK-MEDCO RX SERVICES has stated that I no longer can get ~this prescription unflavored. The unflavored only comes in QUESTRAN, not the LIGHT. Since I am diabetic I do not want more sugar. My stomach will not tolerate the .fla~,ored ki~_nd/ Is there some other kind of medicine 1 can take in place of QUESTKAN?~x~"-~ ~ ~ ~ ~'~ ~/~ ,'~'~ ~s\ DORIS TIMMONS WORK #261-1933 FROM 10:00 AM TIL 2:00 PM HOME #263-1328 000102 THE CHAMBERSBURG HOSPITAL Department of Pathology (717) 267-7154 PAGE 1 NAME: TIMMONS,DORIS E PHONE#: (717)263-1328 DIAGNOSIS: L/ELEVATED CHOL DM HTN L BIRTH DATE: 01/31/1928 AGE: 72Y SEX: F MRS: 349999 LOC: P5A ============================ PHYSICIAN COPY FOR DR: BRICKER, M.D., SAMUEL Q =================: DR: BRICKER, M.D., SAMUEL Q 144 S EIGHTH STREET CHAMBERSBURG PA 17201 F28402 COLL: 07/28/2000 07:05 REC: 07/28/2000 09:28 Test Requested: CPMP,HA1C, LIPID HEMOGLOBIN A1C (CPAL 6.8 H [4.3-6.1] PHYS: BRICKER, M.D., SAMUEL Q % Date Recvd: FOLLOW-UP: TIMMONS,DORIS E Date Reviewed: Report Printed: END OF REPORT 07/29/2000, 20:00 PAGE 1 000103 THE CHAMBERSBURG HOSPITAL Department of Patholo!~y (717) 267-7154 PAGE 1 NAME: TIMMONS,DORIS E PHONE#: (717)263-1328 DIAGNOSIS: L/ELEVATED CHOL DM HTN L BIRTH DATE: 01/31/1928 AGE: 72Y SEX: F 349999 ? ============================ PHYSICIAN COPY FOR DR: BRICKER, DR: BRICKER, M.D., SAMUEL Q 144 S EIGHTH STREET CHAMBERSBURG PA 17201 LOC: PLA M.D., SAMUEL Q .................. F28402 COLL: 07/28/2000 07:05 REC: 07/28/2000 09:28 PHYS: BRICKER, M.D., SAMUEL Q Test Requested: CPMP,HA1C,LIPID COMPREHENSIVE METABO GLUCOSE 142 H [70-110] BUN 24 H [8-20] CREATININE 0.9 [0.6-1.1] CALCIUM 9.6 [8.6-10.3 SODIUM 141 [135-145] POTASSIUM 4.1 [3.6-5.1] CHLORIDE 107 [101-111] TC02 22 [22-32] ANION GAP 12 [5-15] BILIRUBIN, TOTAL 1.2 [0.3-1.2] GOT 32 [15-41] ALK. PHOSPHATASE 46 [38-126] TOTAL PROTEIN 6.3 [6.1-7.9] ALBUMIN 3.9 [3.4-4.8] GPT 24 [14-54] MG/DL MG/DL MG/DL mEq/L mM/L mM/L mM/L mM/L MG/DL U/L U/L G/DL G/DL U/L LIPID PANEL CHOLESTEROL 189 [120-200] MG/DL TRIGLYCERIDE 300 MG/DL HDL 54 MG/DL LDL, CALCULATED 75 MG/DL VLDL 60 H [8-32] MG/DL LIPID INTERPRETATION The highest acceptable level of CHOL varies with age, however values >200 are associated with increased risk of CHD regardless of HDL or LDL values. NCEP GUIDELINES: DESI]~ABLE BORDERLINE HIGH RISK Total Chol <2110 200-239 >240 HDL Chol > 60 35-59 < 35 LDL Chol <130 130-159 >160 Triglyceride <200 200-499 >500 Date Recvd: FOLLOW-UP: Date Reviewed: TIMMONS,DORIS E Report Printed: 07/28/2000, 20:00 CONTINUED PAGE 1 000104 THE CHAMBERSBURG HOSPITAL Department of Pathology (717) 267-7154 PAGE 1 NAME: TIMMONS,DORIS E PHONE#: (717)263-1328 DIAGNOSIS: L/SM HTN LOW BIRTH DATE: 01/31/1928 SEX: F AGE: 71Y MR%: 349999 LOC: P5A ============================ PHYSICIAN COPY FOR DR: BRICKER M.D., SAMUEL Q. =================: DR: BRICKER M.D., SAMUEL Q. 144 S. EIGHTH STREET CHAMBERSBURG, PA 17201 W66920 COLL: 09/29/1999 07:55 REC: 09/29/1999 08:49 Test Requested: CPMP,HA1C PHYS: BRICKER M.D., SAMUEL Q. COMPREHENSIVE METABO GLUCOSE 133 H [70-110] MG/DL BUN 21 H [8-20] MG/DL CREATININE 0.9 [0.6-1.1] MG/DL CALCIUM 9.5 [8.6-10.3] mEq/L SODIUM 138 [135-145] mM/L POTASSIUM 4.1 [3.6-5.1] mM/L CHLORIDE 102 [101-111] mM/L TC02 25 [22-32] mM/L ANION GAP 11 [5-15] BILIRUBIN, TOTAL 0.8 [0.3-1.2] MG/DL GOT 27 [15-41] U/L ALK. PHOSPHATASE 59 [38-126] U/L TOTAL PROTEIN 6.4 [6.1-7.9] G/DL ALBUMIN 3.7 [3.4-4.8] G/DL Date Recvd: FOLLOW-UP: TIMMONS,DORIS E Date Keviewed: Report Printed: 09/29/1999, 20:00 END OF REPORT PAGE 1 000105 hilles+so,o Date: Time: Physician: Operator: System #: Achilles+ Solo Ultrasonometer R Patient Name: Patient ID: Birth Date: Weight: Age of menopause: Ethnic: S T I I FN FD NE EX S S 100 36, USA Female (Caucasian) 20 40 60 80 AGE (years) 2 0 S C O -2 R E -4 100 Comments: Follow-up: Other: Re--=.ul ts A,-hi I 1 e'---.+ Lun.aF Oot-pof-a '/~8,' i 99':~ 5RTE 6 .... TIHE ?:4'~ STIFFNE$:'-; INDEX '"-,~ ¢16E 7 SEX Fer,'~a FOOT Left REFERENCE ~. VOI.IH6 I:I[:,IJLT T S30RE -8.5 ',' ~l_~b HI:Il UHEL' Z S03RE t .4 STIFFHESS13Z INDEX 1 .... 36 "i"i",' -,~'~'~'-4 Z8486888 88 ¢16E (Years) LUNAR' Excellence in rmaging 1-See Achilles+ 2-USA reference popu ~.~[~. g~,~:--,~:: 3-Matched for age. See OOUlt.to THE CHAMBERSBURG HOSP][TAL Department of Pathology (717) 267-7154 PAGE 1 NAME: TIMMONS,DORIS E PHONE#: {717)263-1328 DIAGNOSIS: L/DECREASED K+ TYPE 2 D AGE: 71Y SEX: F 349999 ============================ PHYSICIAN COPY FOR DR: BRICKER M.D., DR: BRICKER M.D., SAMUEL Q. 144 S. EIGHTH STREET CHAMBERSBURG, PA 17201 PLA SAMUEL Q. == .......... = ..... M48926 COLL: 05/10/99 07:01 Test Requested: BMP REC: 05/10/99 09:25 PHYS: BRICKER M.D., SAMUEL Q. BASIC METABOLIC PANE GLUCOSE 126 H [70-110] MG/DL BUN 19 [8-20] MG/DL CREATININE 0.8 [0.6-1.1] MG/DL SODIUM 139 [135-145] mM/L POTASSIUM 4.6 [3.6-5.1] mM/L CHLORIDE 106 [101-111] mM/L TC02 27 [22-32] mM/L ANION GAP 6 [5-15] TIMMONS,DORIS E 05/10/99 20:00 END OF REPORT PAGE 1 000107 THE CHAMBERSBURG HOSPITAL Department of Pathology (717) 267-7154 PAGE NAME: TIMMONS,DORIS E MRS:: 349999 LOC: P5A PHONE#: (717)263-1328 DIAGNOSIS: L/TYPE 2 D ~ AGE: 71Y SEX: F ============================ PHYSICIAN COPY FOR DR: BRICKER M.D., SAMUEL Q. ================= DR: BRICKER M.D., SAMUEL Q. 144 S. EIGHTH STREET CHAMBERSBURG, PA 17201 F39848 COLL: 04/23/99 07:28 Test Requested: GLU, HA1C GLUCOSE 155 REC: 04/23/99 09:04 H [70-110] PHYS: BRICKER M.D., MG/DL SAMUEL Q. · ~o~s,~or~s E 04z23/99 20:00 PaGE I 000108 END OF REPORT " --4--'"L' ' : : :: i" THE CHAMBERSBURG HOSPITAL Department of Pathology (717) 267-7154 PAGE 1 NAME: TIMMONS,DORIS E PHONE#: (717)263-1328 DIAGNOSIS: OPS 0315 RT EYE CATARAC AGE: 71Y SEX: F MRS: 349999 LOC: POT ============================ PHYSICIAN COPY FOR DR: DR: KISKADDON, M.D., JAMES C. 144 S. EIGHTH STREET SUITE 110 CHAMBERSBURG, PA 17201 BRICKER M.D., SAMUEL Q. =================== COPIES SENT TO: BRICKER M.D., SAMUEL W36544 COLL: 03/10/99 09:35 REC: 03/10/99 10:54 Test Requested: AAA,ABC,BMP,CA,DIFA, LIPID BASIC METABOLIC PANE fk GLUCOSE ~ H [70-110] BUN H [8-20] CREATININE 0.9 [0.6-1.1] SODIUM 137 [135-145] POTASSIUM 4.1 [3.6-5.1] CHLORIDE 102 [101-111] TC02 26 [22-32] ANION GAP 9 [5-15] PHYS: KISKADDON, M.D., JAMES C. MG/DL MG/DL MG/DL mM/L mM/L mM/L mM/L CALCIUM 9.5 [8.6-10.3] mEq/L LIPID PANEL CHOLESTEROL 183 [120-200] MG/DL TRIGLYCERIDE 177 MG/DL HDL 65 MG/DL LDL, CALCULATED 83 MG/DL VLDL 35 H [8-32] MG/DL LIPID INTERPRETATION The highest acceptable level of CHOL varies with age, however values >200 are associated with increased risk of CHD regardless of HDL or LDL values. NCEP GUIDELINES: DESIPJ~LE BORDERLINE HIGH RISK Total Chol <200 200-239 >240 HDL Chol > 60 35-59 < 35 LDL chol <130 130-159 >160 Triglyceride <200 200-499 >500 HEMOGRAM WBC COUNT 7.8 RBC COUNT 4.31 HEMATOCRIT 41.2 HEMOGLOBIN 13.5 MCV 96 MCH 31.3 MCHC 32.8 RED CELL DIST. WIDTH 13.1 TIMMONS,DORIS E 03/10/99 [4-11] K/CMM [4.10-5.10] M/UL [36-45] % [12.3-15.3] G/DL [85-95] FL [27-32] MMG [32-37] % % 20:00 CONTINUED PAGE 1 000110 THE CHAMBERSBURG HOSPITAL Department of Patholo~Fy (717) 267-7154 PAGE NAME: TIMMONS,DORIS E PHONE#: (717)263-1328 DIAGNOSIS: OPS 0315 RT EYE CATARAC AGE: 71Y SEX: F MR%: 349999 LOC: POT ============================ PHYSICIAN COPY FOR DR: BRICKER M.D., SAMUEL Q. ==================~ DR: KISKADDON, M.D., JAMES C. 144 S. EIGHTH STREET SUITE 110 CHAMBERSBURG, PA 17201 COPIES SENT TO: BRICKER M.D., SAMUEL W36544 COLL: 03/10/99 09:35 REC: 03/10/99 10:54 PHYS: KISKADDON, M.D., JAMES C. Test Requested: AAA,ABC,BMP,CA, DIFA, LIPID HEMOGRAM (CONTINUED) AUTOMATED PLATELET 235 MEAN PLATELET VOLUME 11.2 [150-400] K/UL FL AUTOMATED DIFF LYMPHOCYTE 20 [20-40] % MONOCYTE 5 [0-10] % NEUTROPHIL 75 H [40.0-70.0] % EOSINOPHIL 0 [0-10.0] % BASOPHIL 0 [0.0-2.0] % ABSOLUTE LYMPHOCYTE 1.6 [0.8-4.4] K/UL ABSOLUTE MONOCYTE 0.4 [0.1-1.1] K/UL ABSOLUTE NEUTROPHIL 5.8 [2.0-7.7] K/UL ABSOLUTE EOSINOPHIL 0.0 [0-0.5] K/UL ABSOLUTE BASOPHIL 0.0 [0.0-0.2] K/UL .... · -.TIMMONS,DORIS E 03/10/99 20:00 END OF REPORT PAGE 2 000111 00o112. THE CHAMBERSBURG HOSPITAL Department of Pathology (717) 267-7154 PAGE NAME: TIMMONS,DORIS E PHONE#: (717)263-1328 DIAGNOSIS: OPS 110298 366.17 AGE: 70Y SEX: F LT E MRS: 349999 LOC: POT ============================ PHYSICIAN COPY FOR DR: BRICKER M.D., SAMUEL Q. =================: DR: KISKADDON, M.D., JAMES C. 144 S. EIGHTH STREET SUITE 110 CHAMBERSBURG, PA 17201 COPIES SENT TO: BRICKER M.D., SAMUEL F15342 COLL: 10/23/98 08:55 REC: 10/23/98 10:06 PHYS: KISKADDON, M.D., JAMES C. Test Requested: AAA,ABC,BMP,CA, DIFA BASIC METABOLIC PANE GLUCOSE 122 H [70-110] MG/DL BUN 19 [8-20] MG/DL CREATININE 0.8 [0.6-1.1] MG/DL SODIUM 138 [135-145] mM/L POTASSIUM 4.2 [3.6-5.1] mM/L CHLORIDE 101 [101-111] mM/L TCO2 29 [22-32] mM/L ANION GAP 8 [5-15] CALCIUM 9.6 [8.6-10.3] mEq/L HEMOGR2~Vl WBC COUMT 6.7= [4-11] K/CMM }~EC COUNT 4.33 [4.10-5.10] R/U~ H~TOCRIT 41.8 [36-45] % H~OGLOBIN 13.7 [12.3-15.3] G/DL M~ 97 H [85-95] FL MCH 31.6 [27-32] ~G MCHC 32.8 [32-37] % RED CELL DIST. WI~H 13.5 % AUTO,TED P~TELET 235 [150-400] K/UL M~ P~TELET VOL~E 11.1 FL AUTOMATED DIFF LYMPHOCYTE MONOCYTE NEUTROPHIL EOSINOPHIL BASOPHIL ABSOLUTE LYMPHOCYTE ABSOLUTE MONOCYTE ABSOLUTE NEUTROPHIL ABSOLUTE EOSINOPHIL ABSOLUTE BASOPHIL 33 [20-40] % 7 [O-lO] % 57 [40.0-70.0] % 2 [0-10.0] % 1 [O.0-2.0] % 2.2 [0.8-4.4] K/UL 0.4 [0.1-I.1] K/UL 3.8 [2.0-7.7] K/UL 0.2 [0-0.5] K/UL 0.1 [0.0-0.2] K/UL TIMMONS, DORIS E 10/23/98 20:00 END OF REPORT PAGE 000113 RADIOLOGISTS REPORT Name: TIMMONS, DORIS E Date Done: 10-13-1998 Read: Ordering Dr: Bricker, Samuel Q. M.D. Nurs Stat: O/P Faculty Dr: M.D., HENRY CHING Room no.: Admitting Diag: X/COSTICHARDITIS Rsn for Exm: CHEST FINAL ~ MR#: 349!)99 ReqSeq: 692099 10-15-1998 TPD Date: 10-15-1998 Time: 1141 Transcriptionist: MH ]Pat Class: 3 Date of Birth: 01-31-1928 Patient phone: 7172631328 ACCOUNT NO: 466852 ** FINAL ** *** F/C: 18 *** HISTORY: COSTOCHONDRITIS. lO/13/98 CHEST, PA AND LATERAL: EXAM IS COMPARED TO PRIOR CHEST DATED 8/28/97. THE HEART IS NORMAL IN SIZE. THE LUNGS ARE CLEAR. NO PLEURAL EFFUSION OR PNEUMOTHORAX IS SEEN. THERE IS NO DEFINITE RIB FRACTURE SEEN. BONES ARE UNREMARKABLE. IMPRESSION: NORMAL CHEST. DX: 0.00 61020 HX: 786.5 F/R: N/D Signed by DR. HENRY CHING M.D. THE CHAMBERSBURG HOSPItaL Department of PatholoG~y (717) 267-7154 PAGE NAME: TIMMONS,DORIS E MRS: 349999 LOC: P5A PHONE~: (717)263-1328 DIAGNOSIS: L/272.0 780. AGE: 70Y SEX: F ============================ PHYSICIAN COPY FOR DR: BRICKER M.D., SAMUEL Q. ==================- DR: BRICKER M.D., SAMUEL Q. 144 S. EIGHTH STREET CHAMBERSBURG, PA 17201 W5413 COLL: 08/05/98 08:30 REC: 08/05/98 09:23 PHYS: BRICKER M.D., Test Requested: ABC,CPMP,DIFA, LIPID,TSH HEMOGKAM (CONTINUED) HEMOGLOBIN 13.6 [12.3-15.3] G/DL MCV 97 H [85-95] FL MCH 31.3 [27-32] MMG MCHC 32.3 [32-37] % RED CELL DIST. WIDTH 13.2 % AUTOMATED PLATELET 235 [150-400] K/UL MEAN PLATELET VOLUME 11.3 FL AUTOMATED DIFF LYMPHOCYTE 35 MONOCYTE 8 NEUTROPHIL 56 EOSINOPHIL 1 BASOPHIL 0 ABSOLUTE LYMPHOCYTE 2.2 ABSOLUTE MONOCYTE 0.5 ABSOLUTE NEUTROPHIL 3.5 ABSOLUTE EOSINO?HIL 0.1 ABSOLUTE BASOPHIL 0.0 20-40] % 0-10] % 40.0-70.0] % 0-10.0] % 0.0-2.0] % 0.8-4.4] K/UL 0.1-1.1] K/UL 2.0-7.7] K/UL 0-0.5 ] K/UL 0.0-0.2] K/UL SAMUEL Q. TIMMONS,DORIS E 08/05/98 20:00 END OF REPORT PAGE 2 0001 5 THE CHAMBERSBURG HOSPI~%L Department of Pathology (717) 267-7154 PAGE 1 NAME: TIMMONS,DORIS E PHONE%: (717)263-1328 DIAGNOSIS: L/272.0 780. AGE: 70Y SEX: F MRS: 349999 ============================ PHYSICIAN COPY FOR DR: BRICKER M.D., DR: BRICKER M.D., SAMUEL Q. 144 S. EIGHTH STREET CHAMBERSBURG, PA 17201 LOC: PSA SAMUEL Q. ========= .......... W5413 COLL: 08/05/98 08:30 REC: 08/05/98 09:23 PHYS: BRICKER M.D., SAMUEL Q. Test Requested: ABC,CPMP,DIFA, LIPID,TSH COMPREHENSIVE METABO GLUCOSE 134 BUN 20 CRF~TININE 0.9 CALCIUM 9.6 SODIUM 139 POTASSIUM 4.1 CHLORIDE 101 BILIRUBIN, TOTAL 1.2 GOT 33 ALK. PHOSPHATASE 84 TOTAL PROTEIN 6.6 ALBUMIN 3.9 H [70-110] [8-20] [0.6-1.1] [8.6-10.3] 135-145] [3.6-5.1] 101-ill] 0.3-1.2] 115-41] '38-126] '6.1-7.9] 3.4-4.8] MG/DL MG/DL MG/DL mEq/L mM/L mM/L mM/L MG/DL U/L U/L G/DL G/DL LIPID PANEL CHOLESTEROL TRIGLYCERIDE HDL LDL, CALCULATED VLDL LIPID INTERPRETATION 225 H [120-200] MG/DL 454 H [35-160] MG/DL MG/DL HDL NOT VALID DUE TO HIGH TRIG MG/DL LDL NOT VALID DUE TO HIGH TRIG 91 H [8-32] MG/DL The highest acceptable level of CHOL varies with age, however values >200 are associated with increased risk of CHD regardless of HDL or LDL values.- ........... NCEP GUIDELINES: DESIRABLE BORDERLINE HIGH RISK Total Chol <200. 200-239 >240 HDL Chol > 60 35-59 < 35 LDL Chol <130 130-159 >160 Triglyceride <20¢, 200-499 >500 TSH 2.60 [0.49-4.67] uIU/mL HEMOGRAM WBC COUNT 6.3 [4-11] RBC COUNT 4.35 [4.10-5.10] HEMATOCRIT 42.1 [36-45] TIMMONS,DORIS E 08/05/98 20:00 CONTI~KJED K/CMM M/UL % PAGE 000116 THE CHAMBERSBURG HOSPITAL Department of Pathology (717) 267-7154 PAGE 1 NAME: TIMMONS,DORIS E PHONE#: (717)263-1328 DIAGNOSIS: L/272.0 HTN ELEV LF AGE: 70Y SEX: F MR#: 349999 ============================ PHYSICIAN COPY FOR DR: BRICKER M.D., DR: BRICKER M.D., SAMUEL Q. 144 S. EIGHTH STREET CHAMBERSBURG, PA 17201 LOC: P5A SAMUEL Q. ========= .... ====== W19595 COLL: 02/18/98 07:59 Test Requested: CPMP,LIPID REC: 02/18/98 09:13 PHYS: BRICKER M.D., SAMUEL Q. COMPREHENSIVE METABO GLUCOSE 120 H [70-110] BUN 19 [6-20] CREATININE 0.8 [0.5-1.2] CALCIUM 10.2 [8.5-10.5] SODIUM 139 [135-145] POTASSIUM 4.4 [3.6-5.0] CHLORIDE 104 [i01-111] BILIRUBIN, TOTAL 0.7 [0.2-1.2] GOT 29 [10-42] ALK. PHOSPHATASE 83 [42-121] TOTAL PROTEIN 6.7 [6.4-8.2] ALBUMIN 4.1 [3.2-5.5] MG/DL MG/DL MG/DL mg/dL mM/L mM/L mM/L MG/DL IU/L IU/L G/DL G/DL LIPID PANEL CHOLESTEROL 205 ' H [120-200] MG/DL TRIGLYCERIDE 335 H [<200] MG/DL NDL 56 [>35] MG/DL LDL, CALCULATED 82 [50-130] MG/DL VLDL 67 H [8-32] MG/DL LIPID INTERPRETATION The highest acceptable level of CHOL varies with age, however values >200 are associated with increased risk of CHD regardless of HDL or LDL values. NCEP GUIDELINES: DESIP~LE BORDERLINE HIGH RISK Total Chol <200 200-239 --- >240 HDL Chol > 60 35-59 < 35 LDL Chol <130 . 130-159 >160 Triglyceride <200 200-499 >500 TIMMONS,DORIS E 02/18/98 20:00 PAGE END OF REPORT 000 ooris E. wire=one A~: 69 / / 315 E. Catherine Chambersburg, PA 17201 October 16, 1997 RJR Patient presents for repeat evaluation of her left wrist. External fixator was removed without difficulty% X-rays with the fixator off reveal that the fracture is healing in anatomic alignment. Plan is to encourage active wrist and hand range of motion. Recheck clinically in 1~ weeks. If she is still limited then to send to hand therapy. cc: Samuel Q. Brlcker, M.D. CUMBERLAND VALLEY ORTHOPAEDIC ASSOCIATES, INC. James A. Strite, Jr., M.D. Roger J. Robertsnn, M.D. Anthony Bruno, M.D. (3) Cl~arnbersburg Medical Building, Suite 101 120 Nodh Seventh Street Chambersburg, PA 17201 (717) 263-1220 FAX (717) 263-6255 000115 Doris E. Timmons AGE: 69 ~-% 315 E. Catherine St. Chambersburg, PA 17201 August 29, 1997 l~3R SURGERY: CLOSED REDUCTION, APPLICATION OF EXTERNAL FIXATOR LEFT WRIST. Admission post-procedure for post-operative pain. September 2, 1997 RJR Patient presents for repeat evaluation status post application external fixator left wrist. Pin sites are stable. She is advised to perform local pin care with half-strength Peroxide. Complains of numbness of her thumb which she did not have post-procedure which may be secondary to swelling. It: is in the superficial radial nerve distribution area. She also complains of numbness of her left face area and is concerned that she may have a cheek fracture. Because of that she is referred to Dr. Wallick for his evaluation, treatment and expertise. She is to follow- up in this office in two weeks. X-rays of the left wrist taken in the office (2 views) 1997 reveal the fracture is healing in good alignment. cc: Peter G. Wallick, M.D. September 12, 1997 RJR Patient called requesting more Darvocet. Spoke with sister of the patient and advised to tell her that she needs to taper her Darvocet use. Called in 20 x 1 refill to Park Ave. Pharmacy, understanding that she will wean herself to Ibuprofen and Tylenol. September 18, 1997 RJR Patient presents for follow-up of her left wrist fracture. The fixator is doing well. Sutures are removed without difficulty. X-rays taken in the office 9/18/97 reveals the fracture is healing in excellent alignment. Plan is to maintain fixator. Return in three weeks for repeat x-ray. If there is significant healing then to consider fixator removal at that time. October 9, 1997 RJR Patient presents for follow-up of the fracture of her left wrist. The external fixator is fitting well. X-ray taken in the office 10/9/97 reveals that the fracture is healing in adequate alignment but is not fully bony consolidated. Plan is to maintain the fixator for one more week. Return in one week for removal of the external fixator and then x-ray subsequent to that. Call and return sooner if there is any difficulty. Continue with her local pin care. cc: Samuel Q. Bricker, M.D. CUMBERLAND VALLEY ORTHOPAEDIC ASSOCIATES, INC. (2) James A. Strite, Jr., M.D. Roger J. Robertson, M.D. Anthony Bruno, M.D. Chambersburg Medical Building, Suite 101 120 North Seventh Street Chambersburg, PA 17201 (717) 263-1220 FAX (717) 263-6255 0001 9 THE CHAMBERSBURG HOSPITAL Department of Pathology (717) 267-7154 PAGE NAME: TIMMONS,DORIS E PHONE#: (717)263-1328 DIAGNOSIS: L/INC CHOL INC T4 LOW AGE: 69Y SEX: F BRICKE ., ============DR: BRICKER144 ...... S. EIGHTHM'D"==========STREETSAMuELPHYSICIANQ' COPY FOR DR: <~.~ CHAMBERSBURG, PA 17201 MRS: 349999 LOC: P5A SAMUEL Q. ===== ...... === .... H71563 COLL: 09/25/97 11:59 Test Requested: BMP,LIPID REC: 09/25/97 14:48 PHYS: BRICKER M.D., SAMUEL Q. BASIC METABOLIC PANE GLUCOSE 82 [70-110] MG/DL BUN 31 H [6-20] MG/DL CREATININE 1.0' [0.5-1.2] MG/DL SODIUM 139 [135-145] mM/L POTASSIUM 4.6 [3.6-5.0] mM/L CHLORIDE 107 [101-111] mM/L TC02 26 [21-31] mM/L ANION GAP 6 [5-15] LIPID PANEL CHOLESTEROL 222/ H [120-200] MG/DL TRIGLYCERIDE 378' H [35-160] MG/DL HDL 39 [>35] MG/DL LDL, CALCULATED 107 / [50-130] MG/DL VLDL 76 H [8-32] MG/DL LIPID INTERPRETATION The highest acceptable level of CHOL varies with age, however values >200 are associated with increased risk of CHD regardless of HDL or LDL values. NCEP GUIDELINES: DESIraBLE BORDERLINE HIGH RISK Total Chol <200 200-239 >240 HDL Chol > 60 35-59 < 35 LDL Chol <130 130-159 >160 Triglyceride <200 200-499 >500 TIMMONS,DORIS E 09/25/97 20:00 PAGE 1 END OF REPORT 000120' PETER G. WALLLICK, MoD. PLASTIC AND RECONSTRUCTIVE SURGERY DORIS E. TIMMONS 9-3-97 INITIAL CONSULTATION FAMILY PHYSICIAN: Dr. Bl'lcker REFERRING PHYSICIAN: Dr. Robert$on CHIEF COMPLAINT: Facial numbness. HISTORY: This69-year-old female Is a customer servlce representative for BilIDowd, All State Insurance inChambersburg. On August 26, 1997 Doris fell down eight steps. When she fell down the stairs she hit a wall at the bottom of the steps. Her left arm hit the baseboard. The left side of her face went into the wall breaking the plaster. She bumped her right knee on the steps. Xer hips were bruised. She had a carpet burn on her right knee. She had some scratches on her face. She had not been wearing shoes and simply slipped on the steps. She was taken by ambulance to the ChambersburgXospltalEmergencyRoom. Xrayswere taken and showed no fracture of the hips. She crushed the forearm near the left wrist she was uncertain exactly which bones were fractured. INo xrays were taken of the face. Her eyes subsequently became quite swollen particularly on the left side of the face. She subsequently was referred to see Dr. Klskaddonwhoche~kedhereyes. She states that Dr. Kiskaddon checked her eyes for any type of traumatic in.jury or glaucoma and there was no significant finding. She had gone to see Dr. Robertsonbecause of the injury ![o the left forearm. On August 29, 1997, Dr. Robertson did surgery because of the left foreal'm fracture at the wrist. She had a three part fracture of what she describes as the radius at the wrist. She could not be treated in a cast and they needed to put her in an externalfixture to hold the position. When she talked to Dr. Robertson about numbness of the face, she was referred for plastic surgery evaluation. She complains of numbness along the left nose and left lemple area and from the eye to the upperllparea. She has bruising around both eyes. Sllehasalot of swelling on the left forehead. PAST MEDICAl. HISTORY: See office sheet for details. IAdult-pulmonaryembollsm 1975, phlebitis 1969, hypertension 1978's, kidney stone 1974, hypercholesterolemia, osteoarthritis of the hands, history of hemorroids, his![ory of lumber disk about thirty years ago. Surgery - D & C, laparoscopy, appendectomy, vaginal hysterectomy, wisdom tooth extraction. Medications - AIIopurlnol 388 mg. ! per day, Premarin i.25 mg. I per day, Zantac 158 mg. BID, Hylorel 18 rog. 2 tablets per day, Altace 2.5 mg. 1 per day, Pravachol 28 mg. i per day in evening, Questran Light PDR packet 5 mg. I packet 2 times a day, Maxzide 25 mg. take I three times a week, Aspirin I per day, Tetracycline I daily except weekends, Anusol HC cream :38 mg. 2 times a day, Darvacet ? rog. I Q 3 hours for pain, Sucralfate tabs I gm. morning and evening. Allel'gles - Codlne, Peniclllll~, Zecor, Mevacol', Beta blockers- reactions not specified, preolonged rubber contact causes skin to break out. SOCIAL HISTORY: The patlent lives alone. Her hobbles arecrafs. Denies tobacco, or drug use. Wears glasses. G4, P4. PETER G. WRLLLICK, M.D. PLASTIC AND RECONSTRUCTIUE SURGERY DORIS E, TIMMONS 9-3-97 INITIAL CONSULTATION PHYSICAL EXAMINATION: Pleasant, 69-year-old mildly .obese female. Head normocephalic. Eyes - PERRLA. EOMI. Sclera clear. Ears - no external deformity. TMs normal. Nose - mldllne septum, normal mucosa. Sinuses nontender. Oral cavity - no mass, ulceration or leukoplakla, she has a lower partial dentrue 1Plate. Salivary glands - no enlargement. Neck- no mass or thyromegaly. Lymph nodes - no cervical or supraclavlcular adenopathy. Facial bones-she has tenderness across the left lateral foqrehead region whcih seems to be slightly depressed in comparison to the opposite side but I think this Is simply due to the changes from the hematoma and the tenderness she has in that region. The left Infraorbital rim Is much more tender than the right partlcularlg along the central third and the medial third of the rim. There appeared to be a small step off deformity but this may simply be the suture line along the medial orbital rim. The left inferior maxillary wall particularly In the upper portion closer to the orbital rim les quite tender. Inclusion is class I and she states her teetfl are normal alignment. No mandibular orTMd tenderness. Zygomatlc arch is mildly tender on the left but Icannot feel any step off deformity. Facial soft tissue-left forehead has a hematoma with some echymosls more seuere on the left and the left cheek has a moderate amount of echymosis which extends down to the neck near the ceruical angle across the hyloid region with purplish discoloration extending from the mldllne to the left side including perpendicular to the left mastoid region and part of the left ear. IMPRESSION: PMH/Meds. Face-left cheek pain, left cheek Infraorlbltal nerve numbness. Forehead hematoma, perlorbltal echymosis. History of DVT/pulmonary embolism, high blood pressure, cholesterolemia, kidney stone, osteoarthritis, hemorrhoids, herniated disk. Left forearm fracture at the wrist. Left facial contusion with echymosls and pain. Left infraorbital nerve Injury-possible facial f~'acture. D I SCUSS I ON: We reviewed the significance of the Infraorbital neurocutaneous anesthesla.~Because of potential fracture a CT scan was recommended. We mad.~L arrangements to have her seen today. She did not haue any evidence of orbital floor fracture although it Is possible she could have an occult fracture impinging the nerve and contributing to the Infraorbital nerve anesthesia. Occlusion Is normal. She is able to widely open her mouth. PLAN: CT scan o~f the fa~, follow up exam tomarrow to ]~evlew the tests. PGW/dls 000' o? THE CnAMBERSBURG H,JSPITAL DIAGNOSTIC IMAGING CONSULTATION REPORT RADIOLOGISTS REPORT FINAL Name: TIMMONS, DORIS E Date Done: 09-03-97 Read: 09-03-97 Ordering Dr: WALLICK, PETER G., M. D. Nurs Stat: O/P Faculty Dr: M.D., PETER J FANG Room no.: :~L Admitting Diag T CHEEK NUMBNESS Rsn for Exm: CC DR BRICKER & ROBERTSON Patient phone: 7172631328 ACCOUNT NO: ** FINAL ** MR#: 349999 ReqSeq: 573346 TPD Date: 09-03-97 Time: 2136 Transcriptionist: MJG Pat Class: 3 Date of Birth: 01-31-1928 544024 HISTORY: LEFT CHEEK NUMBNESS. 9/3/97 CT OF THE FACIAL BONES: MULTIPLE TRANSAXIAL VIEWS WERE OBTAINED. THE FACIAL BONES APPEAR INTACT. NO EVIDENCE OF FRACTURE IS SEEN. MILD TO MODERATE DEVIATION OF THE NASAL SEPTUM TO THE RIGHT IS VISUALIZED. THE VISUALIZED PDJLkNASAL SINUSES APPEAR CLEAR EXCEPT FOR VERY MINIMAL MUCOSAL CHANGES SEEN INVOLVING THE LEFT ETHMOID SINUS. THE VISUALIZED ORBITS APPEAR UNREMARKABLE. IMPRESSION: 1. MINIMAL MUCOSAL CHANGES INVOLVING THE LEFT ETHMOID SINUS IS INCIDENTALLY NOTED. THERE IS MILD TO MODERATE DEVIATION OF THE NASAL SEPTU~ TO THE LEFT. 2. VISUALIZED FACIAL BONES APPEAR INTACT. NO DEFINITE FRACTURE IS SEEN. DX: 854 60486 HX: 854 F/R: N/D Signed by DR. PETER J FANG M.D. 000 . ,3 CUMBERLAND VALLEY ORTK AEDIC ASSOCIATES, INC. James A. Strite, Jr., M.D. Roger J. Robertson, M.D. Anthony Bruno, M.D. Doris E. Timmons AGE: 315 E. Catherine St. Chambersburg, PA 17201 69 Orthopaedic Surgery and Sports Medicine Chambersburg Medical Building Suite 101 120 North Seventh Street Charnbersburg, PA 17201 (717) 263-1220 FAX (717) 263-6255 August 27, 1997 COMPLAINT: Injury left wrist, pelvis, right knee, face. BRIEF HISTORY: This 69 year old white female slipped and fell do%m the steps suffered an acute injury. She has multiple trauma. She has significant injury to her face and Dr. Kiskaddon's office was called for him to evaluate for her eyes. She has some orthopaedic injuries to her left wrist and pelvis and right knee. Because of this she presents' and is referred for emergent orthopaedic evaluation. MEDICATIONS: Allupurinol, Premarin, Zantac, Hylorel, Altace, Pravochol, Questran, aspirin and Anusol cream. ALLERGIES: Codeine, penicillin, Zocor, Mevacor and beta blockers. EXAMINATION: Pertinent for the left wrist which has significant: silverfork deformity, moderate swelling. Distal neurovascular is intact. Her pelvis is tender to palpation with ecchymosis but no gross crepitus. Right knee has a superficial abrasion. AP pelvis taken at CH 8/26/97 is normal. X-rays of the left wrist from CH 8/26/97 reveal that there is a comminuted, impacted, shortened, intra-articular fracture of the left distal radius. IMPRESSION: Comminuted intra-articular fracture left distal radius. Facial abrasions, contusions. Rule out eye injury. Pelvis contusion. Eight knee contusion. RECOMMENDATION: Review pathology with the patient and her son. For the eye to see Dr. Kiskaddon today. For the wrist to place in AOA wrist splint, ice, elevation. To proceed on 8/29/97 with application of external fixator, left closed, possible open reduction of left distal radius on an .outpatient basis. Darvocet N 100, one po q3h p.r.n. -pain, ice and elevation. Patient and son understand the procedure, need for the procedure, accept the potential risks and complications and agree to proceed. RJR:al cc: Samuel Q. Bricker, M.D. Roger J. Robertson, M.D. (1) THE CHAMBERSBURG. 112 N. Seventh St. Chambersburg, PA 17201 3PITAL Page 1 COPY TIMMONS, DORIS E Patient #: 7017080 Treatment Date: 08/26/97 L. J. Boyler, M.D. EMERGENCY CARE UNIT (717) 267-7146 Medical Record #: 349999 Patient Type: 2 D.O.B: 01/31/28 CHIEF COMPLAINT: Multiple injuries. HISTORY OF PRESENT ILLNESS: This 69-year-old person f~ll when she lost her balance, putting her head through a plaster wall. She has pain on her forehead now and also her left wrist which she believes she broke and her right knee. Also slight low back pain. Denies neck or .chest pain. Denies any loss of consciousness. PAST HISTORY: Hypertension, herniated disc. Gout, kidney stones, thrombophlebitis. ALLERGIES: Codeine, penicillin, Zocor, beta blockers and others. PHYSICAL EXAM: On examination at 10 a.m. temperature is 96.3 °F, pulse 84, respirations 20, blood pressure 182/92. The patient is a pleasant woman who is alert and oriented and cooperative. There is a large area of swelling and tenderness over her left frontal scalp. Pupils equal and reactive. Extraocular movements normal. Neck is supple, nontender. C-collar removed. The patient is back-boarded. Chest is nontender. Abdomen is soft, nontender. Slight low back tenderness. The patient has an obvious Colles fracture left wrist, abrasion over the right patella. No bony or joint ten&mess. DIAGNOSIS: I. Fracture left wrist. 2. Multiple trauma. 3. Closed head injury. PLAN: The case was discussed with Dr. Robertson. The patient will be seen in his office tomorrow for treatment of the fracture. Will proceed with screening laboratory studies. Lm/lnj D: 08/26/97 T: 08/26/97 cc: Dr. Bricker L. J. Boyler, M.D. 0001, 5 0001~6 THE C AMBERSBURG HuSPITAL CONSULTATION REPORT .oeEar s. "YAW, M.O., O~CTO" ~-rE. J.w. F^Na. M.O RADIOLOGISTS REPORT FINAL Name: TIMMONS, DORIS E MR#: 349999 Date Done: 08-26-97 Read: 08-26-97 TPD Date: Ordering Dr: C.V.E.A, C. V. EMERGENCY ASSOC. Nurs Stat: O/P Faculty Dr: M.D., T. TOE THANE Room no.: Admitting Diag: FELL CHECK INJURIES Rsn for Exm: ~ReqSeq: 570938 08-26-97 Time: 1927 Transcriptionist: MJG Pat Class: 2 Date of Birth: 01-31-1928 Patient phone: 7172631328 ACCOUNT NO: 701708 ** FINAL ** HISTORY: 69-YEAR-OLD FEMALE WITH HISTORY OF FALL INJURING THE PELVIS AND LEFT WRIST. 8/26/97 LEFT WRIST: THERE IS COMMINUTED FRACTURE OF THE DISTAL END OF THE RADIUS NOTED WITH POSTERIOR DISPLACEMENT OF THE DISTAL FRACTURE FRAGMENTS RESULTING IN VENTRAL ANGULATION AT THE FRACTURE SITE. THE DISTAL END OF THE ULNA APPEARS TO BE INTACT. NO EVIDENCE OF FRACTURE IS SEEN IN THE CARPAL BONES. IMPRESSION: COMMINUTED FRACTURE OF THE DISTAL END OF THE RADIUS WITH POSTERIOR DISPLACEMENT AND VENTP~AL ANGULATION AT THE FRACTURE SITE. PELVIS, AP ONLY: BOTH HIPS ARE WELL ARTICULATED. THERE IS NO EVIDENCE OF FRACTURE, DISLOCATION OR DESTRUCTIVE BONY LESIONS. NO SIGNIFICANT OSTEOARTHRITIC CHANGE IS SEEN. THE BONY MINERALIZATION IS WITHIN NORMAL LIMITS. IMPRESSION: PELVIS IS NEGATIVE FOR FRACTURE. DX: 813.42 0.00 63110 62170 HX: 959.3 959.1 F/R: P/D N/D Signed by DR. T. TOE THANE M.D. 0001,. THE CHAMBERSBURG HOSPITAL Department of Pathology (717) 267-7154 PAGE 2 NAME: TIMMONS,DORIS E PHONE~: (717)263-1328 DIAGNOSIS: FELL CHECK INJURIE AGE: 69Y SEX: F ============================ PHYSICIAN COPY FOR DR: BRICKER M.D., DR: CVEA CUMBERLAND VALLEY EMERGENCY AS CHAMBERSBURG HOSPITAL EMERGENC CHAMBERSBURG, PA. 17201 MRS: 349999 LOC: ECU SAMUEL Q ........ ======= .... (CONTINUED) T67904 COLL: 08/26/97 10:37 REC: 08/26/97 10:54 PHYS: CVEA Test Requested: BCC,CPMP,DIFA,WDIF UNABLE TO DETERMINE EOS [0-10.0] % UNABLE TO DETERMINE BASO [0.0-2.0] % UNABLE TO DETERMINE STAT STAT MANUAL DIFF DIFF METHOD MANUAL BAND NEUTROPHIL 2 [0-11] SEGMENTED NEUTROPHIL 61 [50-70] LYMPHOCYTE 26 [20-40] MONOCYTE 9 H [0-6] EOSINOPHIL 2 [0-5] BASOPHIL 0 [0-2] RBC MORPHOLOGY NORMAL [NORM] PLATELET ESTIMATE ADEQUATE [ADEQ] TIMMONS,DORIS E 08/26/97 END OF REPORT 17:51 PAGE 2 000 THE CHAMBERSBURG HOSPITAL Department of Pathology (717) 267-7154 PAGE 1 NAME: TIMMONS,DORIS E PHONES: (717)263-1328 DIAGNOSIS: FELL CHECK INJURIE AGE: 69Y SEX: F ============================ PHYSICIAN COPY FOR DR: BRICKER M.D., DR: CVEA CUMBERLAND VALLEY EMERGENCY AS CHAMBERSBURG HOSPITAL EMERGENC CHAMBERSBURG, PA. 17201 349999~C: ECU SAMUEL Q. == .... ==== ........ T67904 COLL: 08/26/97 10:37 REC: 08/26/97 10:54 Test Requested: BCC,CPMP,DIFA,WDIF PHYS: CVEA COMPREHENSIVE METABO STAT GLUCOSE 147 H [70-110] MG/DL STAT BUN 24 H [6-20] MG/DL STAT CREATININE 0.8 [0.5-1.2] MG/DL STAT CALCIUM 10.2 [8.5-10.5] mg/dL STAT SODIUM 140 [135-145] mM/L STAT POTASSIUM 4.1 [3.6-5.0] mM/L STAT CHLORIDE 107 [101-111] mM/L STAT BILIRUBIN, TOTAL 1.1 [0.2-1.2] MG/DL STAT GOT 23 [10-42] IU/L STAT ALK. PHOSPHATASE 72 [42-121] IU/L STAT TOTAL PROTEIN 6.9 [6.4-8.2] G/DL STAT ALBUMIN 4.0 [3.2-5.5] G/DL STAT HEMOGRAM WBC COUNT 7.4 [4-11] RBC COUNT 4.49 [4.10-5.10] HEMATOCRIT 41.1 [36-45] HEMOGLOBIN 13.8 [12.3-15.3] MCV 92 [85-95] MCH 30.7 [27-32] MCHC 33..6 [32-37] RED CELL DIST. WIDTH UNABLE TO DETERMINE 253 [150-400] UNABLE TO DETERMINE AUTOMATED PLATELET MEAN PLATELET VOLUME AUTOMATED DIFF DIFF METHOD REQUEST CREDITED MANUAL DIFFERENTIAL ORDERED [20-40] UNABLE TO DETERMINE [o-lo] UNABLE TO DETERMINE [40.0-70.0] 08/26/97 17:51 CONTINUED AUTO LYMPH % AUTO MONO % NEUTROPHILS TIMMONS,DORIS E K/CMM M/UL % MG/DL FL MMG % % K/UL FL PAGE STAT STAT STAT STAT STAT STAT STAT STAT STAT STAT STAT STAT STAT STAT STAT STAT 1 000129 THE CHAMBERSBUR~., 112 N. Seventh St. Chambersburg, PA 17201 . SPITAL Page 1 TIMMONS, DORIS E Patient #: 6963607 Treatment Date: 07/14/97 T. E. Anderson, M.D. EMERGENCY CARE UNIT (717) 267-7146 Medical Record #: 349999 Patient Type:: 2 D.O.B: 01/31/28 COPY CHIEF COMPLAINT: Recheck toe. HISTORY OF PRESENT ILLNESS: This is a 69-year-old female who was seen here four weeks ago with a fracture to the right fourth toe which we have been tbllowing. She states it has been getting gradually better. Now she can use regular shoes. She does not have to use the postop shoe all the time. She does note it still hurts occasionally and she still cannot get into high heels without pain in the right fourth toe and some pain behind proximal to the right fourth toe. PHYSICAL EXAM: The right fourth toe has no swelling or ecchymosis. There is mild tenderness over the proximal aspect and over the fourth MP joint area. Neurovascular exam is otherwise intact. DIAGNOSIS: Recheck right fourth toe fracture. PLAN: The patient was told to expect continued improvement over the next four weeks, activities and any shoe wear as tolerated. She should be pretty much back to normal in four weeks. Recheck here if any new sYmPtoms or problems develop. TEA/stol D: 07/14/97 T: 07/15/97 cc: Dr. BrickerJ T. E. Anderson, M.D. 000130 -- THE ¢ -IAMBERSBURG F! SPITAL CONSULTATION REPORT ~eT~f.ss'~s~tm~a*~T~.?.~;:o~"c'°a RADIOLOGISTS REPORT FINAL Name: TIMMONS, DORIS E Date Done: 06-19-97 Read: 06-19-97 Ordering Dr: C.V.E.A, C. V. EMERGENCY ASSOC. Nurs Stat: O/P Faculty Dr: M.D., PHILIP J. SABRI Room no.: Admitting Diag: RECHECK FOOT Rsn for Exm: -RT 4 TH TOE BRICKER MR#: 349999 Req eq: 553194 TPD Date: 06-19-97 Time: 1116 Transcriptionist: MH Pat Class: 2 Date of Birth: 01-31-1928 Patient phone: 7172631328 ACCOUNT NO: 693112 ** FINAL ** HISTORY: RECHECK FRACTURE. 6/19/97 RIGHT FOOT: AGAIN NOTED IS,AN OBLIQUE FRACTURE THROUGH THE SHAFT OF THE FOURTH PROXIMAL PHALANX. NO SIGNIFICANT CALLUS FORMATION IS NOTED. ALIGNMENT APPEARS SATISFACTORY. IMPRESSION: FRACTURE OF THE FOURTH PROXIMAL PHALANGEAL SHAFT. NO SIGNIFICANT CALLUS IS SEEN AS OF YET. THERE DOES NOT APPEAR TO BE SIGNIFICANT INTERVAL CHANGE FROM THE 6/7/97 STUDY. DX: 826.0 63630 HX: 826.0 F/R: P/D Signed by DR. PHILIP J. SABRI M.D. oool)l, THE CHAMBERSBURG 112 N. Seventh St. Chambersburg, PA 17201 3PITAL Page I COPY TIMMONS, DORIS E Patient #: 691541 Treatment Date: 06/07/97 T. E. Anderson, M.D. EMERGENCY CARE UNIT /_ / (717) 267-7146 Medical Record #: 349999 Patient Type: 2 D.O.B: 01/31/28 CHIEF COMPLAINT: Foot injury. HISTORY OF PRESENT ILLNESS: This 69-year-old female accidentally kicked a part of the shower as she was getting out causing pain to the right fourth toe. PHYSICAL EXAM: The patient has tenderness to the base ofl:he right fourth toe, but no swelling or ecchymosis seen. Slight tenderness up over the forefoot. No ankle tenderness. DIAGNOSTIC STUDIES: X-my of the right foot shows fracture undisplaced over the proximal phalanx of the right fourth toe. DIAGNOSIS: Fracture of the right fourth toe. PLAN: Buddy tape was applied as well as a postop shoe and crotches. She is to use the crotches and the postop shoe as needed over the next two weeks, progressive weightbearing as tolerated and switch over to a comfortable shoe when tolerated. The patient will be checked here for exam and x-ray again on 6/19/97. Return sooner if any problems. TEA/et D: 06/07/97 T: 06/08/97 cc: Dr. Bricker T. E. Anderson, M.D. 000132 (,'i~. i'~.~ ~ f''u~ THE C. ~AMBERSBURG ¼,JSPITAL~ ' DIAGNOSTIC iMAGING CONSULTATION REPORT RADIOLOGISTS REPORT FINAL Name: TIMMONS, DORIS E Date Done: 06-07-97 Read: Ordering Dr: C.V.E.A, C. V. Nurs Stat: O/P Faculty Dr: M.D., PHILIP J. SABRI Room no.: Admitting Diag: INJURY RIGHT FOOT Rsn for Exm: ER PATIENT MR#: 349999 ReqSeq: 550122 06-07-97 TPD Date: 06-07-97 Time: 0905 EMERGENCY ASSOC. Transcriptionist: MJG Pat Class: 2 Date of Birth: 01-31-1928 Patient phone: 7172631328 ACCOUNT NO: 691541 ** FINAL ** HISTORY: TRAUMA. 6/7/97 RIGHT FOOT: THERE IS EVIDENCE OF A FRACTURE OF THE FOURTH PROXIMAL PHALANGEAL SHAFT. IT IS NONDISPLACED. NO DISLOC2~ION IS NOTED. DEGENERATIVE SPURRING OF THE CALCANEUS AT THE ACHILLES TENDON INSERTION IS NOTED. IMPRESSION: FRACTURE OF THE FOURTH PROXIMAL PHAL2~GEAL SHAFT. DX: 826.0 63630 HX: 959.7 F/R: P/D Signed by DR. PHILIP J. SABRI M.D. 000135 -. / THE CHAMBERSBURG HOSPITAL DIAGNOSTIC IMAGING CONSULTATION REPORT RADIOLOGISTS REPORT FINAL Name: TIMMONS, DORIS E Date Done: 03-20-97 Read: 03-20-97 Ordering Dr: Dobish, Mark P, M.D. Nurs Stat: O/P Faculty Dr: M.D., CHRISTOPHER LADD Room no.: Admitting Diag: X/ABD PAIN Rsn for Exm: 100CC OMNIPAQUE POWER INJECTED INTO RT VENTP, AL ZONE #4 BY LAB Patient phone: 7172631328 ACCOIfNT NO: 475852 ** FINAL ** MR#: 349999 ReqSeq: 528352 TPD Date: 03-20-97 Time: 1520 Transcriptionist: M~ Pat Class: 3 Date of Birth: 01-31-1928 HISTORY: 69 YEAR OLD WITH ABDOMINAL PAIN. 3/20/97 CT SCAN OF THE ABDOMEN AND PELVIS: ORAL CONTRAST WAS ADMINISTERED. 7 BY 7 MM. AXIAL SCANS WERE OBTAINED THROUGH THE ABDOMEN AND PELVIS DURING THE POWER INJECTION OF 100 CC. OF OMNIPAQUE 300. ABDOMEN: WITHIN THE ABDOMEN THERE IS A 2 CM. M3%XIMUM DIMENSION LEFT INTERPOLAR SIMPLE RENAL CYST. THE KIDNEYS ARE OTHERWISE NORM/kL IN APPEARANCE. THE APPEARANCE OF THE LIVER, ADRENALS, PANCREAS, SPLEEN, STOMACH, VISUALIZED SMALL AND I~%RGE BOWEL ~RE UNREMARKABLE. THE ABDOMINAL AORTA IS NON-DILATED. THERE IS NO ABDOMINAL MASS, LYMPHADENOPATHY, OR FREE FLUID. PELVIS: WITHIN THE PELVIS THE UTERUS IS NOT SEEN ,CONSISTENT WIT~ HYSTERECTOMY. NO OVARIAN T%SSUE IS EVIDENT. THE VISUALIZED SMALL AND LARGE BOWELARE UNREMARKABLE. THE URINARY BLADDER APPEARS NORMAL. VIEWS OF THE L%~G BASES ARE CLEAR. IMPRESSION: 1. THERE IS NO SIGNIFICANTABNORMALITY WITHIN THE ABDOMEN OR PELVIS. 2. 2 CM. MAXIMUM DIMENSION LEFT RENAL SIMPLE CYST. DX: 0.00 64160/62193 HX: 789.0 F/R: N/D Signed by DR. CHRISTOPHER LADD M.iD. 0001.34 · THE CHAMBERSBURG HOSPITAL RADIOLOGISTS REPORT FINAL Name: TIMMONS, DORIS E Date Done: 03-13-97 Read: 03-13-97 Ordering Dr: Dobish, Mark P, M.D. Nurs Stat: O/P Faculty Dr: M.D., NITEEN SUKERKAR Room no.: Admitting Diag: L/X/ABD PAIN Rsn for Exm: SEE DRS ORDERS MR#: 349999 ReqSeq: 526446 TPD Date: 03-13-97 Time: 1148 Transcriptionist: TMW Pat Class: 3 Date of Birth: 01-31-1928 Patient phone: 7172631328 ACCOUNT NO: 473284 ** FINAL ** HISTORY: ABDOMINAL PAIN. RIGHT RIB CAGE PAIN. 3/13/97 RIGMT RIBS: T~ERE IS NO EVIDENCE OF RIB FRACTURE, OR BONY DESTRUCTIVE CHANGE. THERE IS NO EVIDENCE OF UNDERLYING PULMONARY CONTUSION, PNEUMOTHORAX, PLEUl~AL FLUID, OR OTHER SIGNIFICANT ABNORMALITY. IMPRESSION: NEGATIVE RIB STUDY. THERE IS NO PNEUMOTHORAX, PLEURAL EFFUSION, OR LYTIC BONY LESION. CHEST X-RAY IS NORMAL. DX: 000.0 061101 HX: 786.50 F/R:N/D Signed by DR. NITEEN SUKERKkR M.D. 0001,' ,S THE CHAMBERSBURG HOSPITAL DIAGNOSTIC IMAGING CONSULTATION REPORT RADIOLOGISTS REPORT FINAL Name: TIMMONS, DORIS E Date Done: 02-12-97 Read: 02-12-97 Ordering Dr: Dobish, Mark P, M.D. Nurs Stat: O/P Faculty Dr: M.D., PHILIP J. SABRI Room no.: A, lmitting Diag: L X BACK PAIN R;'~n for Exm: WITH CCK [Vl.~#: 349999 ReqSeq: 518690 TPD Date: 02-12-97 Time: 1648 Transcriptionist: DMS Pat Class: 3 Date of Birth: 01-31-1928 Fatient phone: 7172631328 ACCOUNT NO: 462580 ** FINAL ** HISTORY: ABDOMINAL PAIN 2-12-97 HEPATOBILIARY SCAN WITH CCK: FOLLOWING THE INTPJ%VENOUS ADMINISTRATION OF 5 MILLICURIES TC99M MEBROFENIN VIA THE RIGHT AHTECUBITAL VEIN, SEQUENTIAL IMAGING OF THE ABDOMEN DEMONSTRATES NORMAL UPT;kKE AND EXCRETION OF THE RADIOPHARMACEUTICAL BY THE LIVER. BILIARY TO BOWEL TRANSIT IS NORMAL. THE G~LBLADDER VISUALIZED IN A NORMAL FASHION WITH ACTIVITY SEEN WITHIN IT BY 10 MJNUTES. AT ONE HOUR, 1.6 MICROGRAMS OF CCK WERE INTRAVENOUSLY ADMINISTERED SLOWLY OVER THE COURSE OF FIVE MINUTES VIA THE RIGHT ~TECUBITAL VEIN AND SEQUENTIAL IMAGING OF THE GALLBLADDER REVEALED N©PJ~AL CONTRACTILITY IN RESPONSE TO THE CCK. TME GALLBLADDER E.i~ECTION FRACTION WAS 61 PER CENT. IMPRESSION: NORMJkL HEPATOBILIARY STUDY, INCLUDING NORMAL C¢~NTRJkCTILITY OF THE GALLBLADDER IN RESPONSE TO CCK. DX: 0.00 6~223 HX: 789.0 F/R F/D Signed by DR. PHILIP J. SABRI M.D. 000136 CHAMBERSBU~G GASTROENTEROLOGY Ass ,ELATES, LTD. 120 N. Seventh Street, Suite 201, Chambersburg, PA 1720t-1795 o (717) 263-0629 Board Certified Internal Medicine/Gastroenterology JOHN G. ENOERS, M.D. ' MARK P. DOelSH, M.D. · WAYNE C. HOOVER, M.D. Samuel Bricker, M.D. 144 South Eighth Street Chambersburg, PA 17201 Dear Dr. Bricker: llay 1, 1997 E: Doris E. Timmons I saw Mrs. Timmons in the o[fice today for follow up of her recent helicobacter. ~r6'~--h~d recently prescribed Carafate which as of yet has not ~vTdEdbehefit, but it has only been taken for approximately 5 days. She has also had additional extensive evaluation consisting of an abdominal and pelvic CAT scan showing a small renal cyst. Rib xrays were also performed because of right sided rib cage pain. These were .als0._~gat.iv¢. A CC[ HIDA scan wa~ likewise negative, as was the ultrasound that you had performed previously. At this time I advised Mrs. Timmons to complete her current prescription for Carafate, but if it is not beneficial, it should not be renewed. I suspect that she may have a ~light element of acid pcpt!c disease for which she is taking ~he Zantac. I do not feel that I would intervene any further with additional studies._ I reassured her as to the benign nature of her complaints and the extensive negative evaluation to date. I have not arranged any further follow up on my part, but I would be happy to see her should there bca deterioration in her status. I did make her aware as to the long term nature og her complaints. I have enclosed copies of the pertinent records for your review. If you have any questions, please do not hesitate to cal[l. Sincerely, Mark P. Dobish, M.D. MPD/vJm 0ooi37 THE CHAMBE~,~BURG HOSPIT Department of Pathology (717) 267-7154 PAGE 1 NAME: TIMMONS,DORIS E MRS: 349999 LOC: P5A PHONE~: (717)263-1328 . '.,~SAMU DIAGNOSIS: L/HYPERCHOLESTER0 AGE: 69Y SEX: F ============================ PHYSICIAN COPY FOR DR: BRICKER M EL Q. =================~ DR: BRICKER M.D., SAMUEL Q. 144 S. EIGHTH STREET CHAMBERSBURG, PA 17201 T49972 COLL: 04/15/97 08:47 Test Requested: HDLCL,HP1 REC: 04/15/97 09:37 PHYS: BRICKER M.D., SAMUEL HEALTH PROFILE ~1 GLUCOSE ll2 H [70-110] MG/DL BUN 22 H [6-20] MG/DL CREATININE 0.8 [0.5-1.2] MG/DL CALCIU~ 10.1 [8.5-10.5] mg/dL SODIUM 140 [135-145] mM/L POTASSIUM 4.2 [3.6-5.0] mM/L CHLORIDE 106 [101-111] m~/L TCO2 27 [21-31] mM/L ANION GAP 7 [5-15] PHOSPHORUS 5.0 H [2.3-4.5] MG/DL ALBUMIN 3.9 [3.2-5.5] G/DL TOTAL PROTEIN 6.4 [6.4-8.2] G/DL ALK. PHOSPHATASE 65 [42-121] IU/L BILIRUBIN, TOTAL 0.9 [0.2-1.2] MG/DL URIC ACID 4.0 [2.6-7.3] MG/DL GPT 17 [10-60] IU/L GOT 22 [10-42] IU/L GAMMA GT 37 [7-64] IU/L LDH 135 [91-180] IU/L TRIGLYCERIDE 638 H [35-160] MG/DL CHOLESTEROL 225 H [120-200] MG/DL GLOBULIN 2.5 [2.5-3.7] G/DL CREA/BUN RATIO 0.04 [0.03-0.12] CALCULATED A/G RATIO 1.6 [1.2-2.3] TIMMONS, DORIS E 04/15/97 19:11 PAGE 1 END OF REPORT 000138 THE CHAMBERSBURG HOSPITAL CHAMBERSBURG, PA 17201 UPPER ENDOSCOPY Patient Name: TIMMONS, DORIS E. MR#: 349999CP Procedure Date: 04/03/97 Dictator's Name: MARK P. DOBISH, M.D. INDICATION FOR PROCEDURE: This patient is a 69-year-old white female who has been experiencing abdominal pain, as well as back pain. Evaluation to this point has been negative. No improvement has been noted with Zantac. An upper endoscopy is being performed at this time for further assessment. ENDOSCOPIST: Mark P. Dobish, M.D. PREMEDICATIONS: Valium 4 mg and Demerol 50 mg intravenously. PROCEDURE: After the potential risks and complications of the procedure were previously explained to the patient, her consent was obtained. She was placed in the left lateral decubitus position where she was monitored. Demerol and Valium were given for sedation. The posterior pharynx was anesthetized with topical Xylocaine. The Olympus video endoscope was inserted and passed into the esophagus. This was well visualized throughout its length and appeared normal. The gastroesophageal junction was identified. The scope easily passed through this area into the stomach where the body and antrum were well seen. In the antrum, there was noted an erosion or what appeared to be a nearly healed ulceration. There were also some other petechial hemorrhages noted in the antral area. The scope easily passed through the pylorus into the duodenum where erythema was identified in the first portion. The second portion appeared normal. The scope was then withdrawn back into the stomach and retroflexed, revealing the cardia and fundus. This did show some evidence for some petechial hemorrhages as well. The scope was straightened. Multiple biopsies of the antral area were obtained for urease testing, as well as pathology. The scope was then withdrawn back up through the esophagus and removed. The patient appeared stable post procedure. IMPRESSION: Gastroduodenitis with associated erosion with the need to rule out Helicobacter as an etiology. UPPER ENDOSCOPY Page 1 of 2 000139" THE CHAMBERSBURG HOSPITAL CHAMBERSBURG, PA 17201 UPPER ENDOSCOPY Patient Name: TIMMONS, DORIS E. MR#: 349999~O Procedure Date: 04/03/97 Dictator's Name: MARK P. DOBISH, CONTINUATION... RECOMMENDATIONS: needs. Await pathology to determine further treatment MPD/813 The MRC Group DD: 04/03/97 DT: 04/03/97 ~3538 cc: Dr. Bricker MARK P. DOBirSH, M.D. UPPER ENDOSCOPY Page 2 of 2 000140 CHAMBERSBU,.,J GASTROENTEROLOGY ASh CIATES, LTD. 120 N. Seventh Street, Suite 201, Ghambersburg, PA 1720t..1795 · (717) 263-0629 Board Certified Internal Medicine/Gastroenterology JOHN G. ENDER$, M.D. · MARK P. DoBlSH, M.D. · WAYNE C. HOOVER, M..[~)~ February 3, 1997 Samuel Brickcr, 144 South Eighth Street Chambersburg, PA 17201 RE: Doris E. Timmons Dear Dr. Brickcr: Thank you for allowing me to evaluate Mrs. Timraous for her complaints of hack pain and gassy feeling. This has been going on for approximately 6 months. There did not appear to be any precipitating events nor any change in her medications that would have caused this. She is not really experiencing significant abdominal pain. A gallbladder ultrasound had bccn unrcmarkablc and medications wcrc ineffective in resolving this. Her physical cxamination is unrcvcaling. Possible ctlologics include hclicobactcr Eastritis, acid peptic disease, as wctl as acalculus chol¢cystiti~. T"~"{-~bc p~rformin~CCKHIDA scan, as well as helicobactcr antibody testing. ~hould thcsc bc unrcmarkablc, then one will nccd to considcr an upper endoscopy. I plan on scc.ing her back aftcr thc results of these studies arc noted. I will bc keeping you informed as to my further thoughts at that time. Thank you for allowing mc to evaluate this pi[casant patient of yours. If you have any questions, please do not hesitate to call. Sincerely, Mark P. Dobish, M.D. ~°D/vjm 00014t. THE C,- AMBERSBURG H,JSPITAL DIAGNOSTIC IMAGING CONSULTATION REPORT RADIOLOGISTS REPORT FINA~ Name: TIMMONS, Date Done: 01-10-97 Ordering Dr: Bricker, Nurs Stat: O/P Faculty Dr: M.D., T. Room no.: Admitting Diag: Rsn for Exm: GB DORIS E Read: 01-10-97 Samuel Q. M.D. TOE THANE MR#: 349999 ReqSeq: 509942 TPD Date: 01-10-97 Time: 1147 ~ Transcriptionist: DP / ~ Pat Class: 3 ,~~of Birth: 01-31-1928 Patient phone: 7172631328 ACCOUNT NO: 451070 ** FINAL ** HISTORY: 68 YEAR OLD FEMALE WITH PAIN BETWEEN THE SHOULDERS RULE OUT GALLSTONES 1/lO/97 GALLBLADDER SONOGRAM: REALTIME ULTRASOUND EXAMINatION OF THE GALLBLADDER REVEALS NORMAL SIZE, SHAPE AND LOCATION OF THE GALLBLADDER. THERE IS NO EVIDENCE OF GALLSTONES OR SLUDGE NOTED. THE GALLBLADDER WALL IS NOT THICKENED. THE COPD IS NOT DILATED. NO EVIDENCE OF DILATATION OF THE INTRAHEPATIC BILIARY RADICLES IS SEEN. UPPER PORTION OF THE CBD MEASURES 4 MM. INCIDENTALLY NOTED IS A SMALL ECHO DENSITY IN THE KIDNEY MEASURING APPROXIMATELY 4.5 MM. IN SIZE WITH FAINT SHADOWING BEHIND THE DENSITY. A RENAL STONE IS SUSPECTED. PLEASE CORRELATE WITH CLINICAL FINDINGS. IMPRESSION: DX: 000.0 66705 HX: 789.0 F/R: N/D NO EVIDENCE OF CHOLELITHIASIS. Signed by DR. T. TOE THANE M.D. FORM #15 2 (REV. 9/95) Laboraf Report 15 = 3'7: 32.. 3989 003. 011 CORNING Clinical Laboratories 900 Business Center Drive - Horsham, PA 19044 (215)g57-9300 . 800-825-7330(PA) · 800-825-7320 (Client Sen, Patient Name Age Date C eilecled Time Collected ~ccession No TIMML]NS~DORIS 68 2L1/04/96 /: .28 82325336 [RICKEK~ SAMtJEI..\263-1328 11/05/9 11/05/9 FIHAL. I **.x. FAS'I'IN[3 c,',,.)fzECiME. N ...... * ~.x- (.,o 24~ HDL CS 24 (22 CHE:M) CALCIUM~ SERUM 9.2 8. ~ ]L,.c. MG/DL I.) H 0 S P H 0 R LJ S, S E R U M 4.0 c.."~ 3-4.6.. I'J[a/D L.' ..... MAbNEoIUM~ SE]RUM 1.9 1.8-2.6 MG/DL. b L. U C 0 ~ I::. 9'7 6 ~. ,L .L .~ r'l G / D L BUN 18 . / - ~:. 3 M G / D I.. CI~EAiININE, SEROM 0.7 0.6-1.b I I~/.{)L.. BUH CRE~T],NINE RATIO 26 H 7--.24 UJx.LL, AC~ED~ SEI:~UM 3.7 '_.2.-6,.8 MG/DI... CHOLESTEROl_ 201 H <200 MG/DI... 11~ ].(. I_YLE.I~ I DIz 410 H <200 IIb/Dl_ TOTAL.. Pf~C]]'E3;FI~ SERUM _ 6.6 6,, 0-'8.2 (:.i/'~ I ALBUMII,i 4. I 3.,a = "~a '=. 0 G/DL GLOBULIN 2.5 1.9-3.8 G/DL A-G RATIO 1.6 0.9-2. I G/DL BIL. IRUBIN, TOTAL 1.1 0.2-1.4 MG/DI.. [ILIkUBIN~ I)ZI:~ECT 0.3 0.0"-0~4 MG/DL ALKAL. INE PHOSPHATASE 68 25-125 U/L GAMMA GLUI'AMYI.., TRANS 45 1-45 U/L AST/SGOf 15 1-'40 U / I... A I_ I' / S G I::' 1' 20 1' -- ~;,. 0: U/' L.. LDII 145 110-250 LJ/L SODIUM, SI~I'< UM 136 134-145 MEQ/L. POI ASSIUM. SERUM 4. .... ~ ~ . ~ MEQ/L CI'IL Dk.[ DE ~ SERUM 10~ 96-107 MEQ/I_ IRON. TOI'AL SERUM ,109 29-162 MCG/DL / 'X, H DI / ':" ~ ,~2 35-80 MG/I)I_ CHOL/HDL RATIO 3.9 SEE REVER~E LDL (OALCUI_AI'ED) * < 160 MG/DI.. * UNAELE TO PERFORM LDL CALE, LLA ION I)UE TO MARKE INCF(EASE IN 1 I~ I[aL. YCLI~ I I)L. WI C 6.8 ,3.9-11.1 THOUS/LJL. Ix[ C 3.98 3.80'-5.20 M II../UL :'AGEE l: E ON'I'INUED ON PAGE 2 000 3 Labor~. ' Report & CHARLESWORTH [ H::IM[ F :<SBURG PA 1 ~ .~8 ~ 003.0~ TI MMOIqS, DORIS BRICKER~ SAM Ulii].. \ 263.... 1328 15:3'7:46 CORNING Clinical Laboratories g00 Business Center Orive . Horsham, PA 19044 (215) 957-9300 · 800-825-7330(PA) · 800'825-7320 (Client Ser 1 ~,~..cc J8~ 68 1 ]./O4/9 8:28 11/0 1.1.. 0,..,/:) F' I NAI.. "~ Test Results m,,m~a:r=..~ .,n*nna: .lll,l~ Reference Range Units * I~,~C MOI';~I::'H(]I_OGY NOF;~Mf-'IL FI~EI'I(](3L.C)B I H "~ 0 . ,: 1 c...: J. 1. ,.~ .I. ~. 7 L~/DL.. HEMATOCRIT 36.7 34.0-47.0 M C V 9 2 ~ ~ "" :~ ~ I:: I... MCFI 32.4 ~.? 7.1-34., 0 I::'G I'ICI"IC 3~. 2 '.'= , ", ,.) ,..... ~) "" ,:Y c',. 0 G / D L [ ..... 13.4 i :1.. u =~ ' 3 -" 1..~. ~ % L41ELE COUNT 174 15~--400 TI IOUS/L.II I,IE UT ~OI::'HI[ S ~3.2 38-80 B A N D S 0 0 ..- 6 I-YMI.:'HOCYTES 35. 1 1 ~"-49 % MOhlOCYTE:S .~ 8.9 E 0 S I H 0 I::'1-.I ~ L. S I 9 0'.- 13 ' 0-8 BASOPHILS 0.9 :{: ..... (-5- 2 % ~E,~. NELIT. COUNT 3618 1700-8500 /CU.MM ~BS. LYMPH COUhlT ~387 1~00-'3500 /CU. MM AB,:~. MON(] COUHT ('5~5 40-"90~ /CU.MM ABS. E.O~, COLJN"I' c.. 30-550 /CU. MM ADS. BAS(] C(.)UN"' 61 0....J. 25 /C[J,, MM * END OF F'IHAL REPORT .)6 P'cintbed on '11/05/96 at: 3: ;7 I::'M 0001 q Herman Hurwitz. MD. FC.A p, Senior Medical Director · Roh~ M I .e~e M ~ m m e m. ~ PHYSICIAN PROGRESS NOTES Date PHYSICIAN PROGRESS NOTES Date I 4260 NNN1 ~,g PHYSICIAN PROGRESS NOTES [:)ate ODO14.T %Of~~no fn o~ PHYSICIAN PROGRESS NOTES Date p 4260 000148 PHYSICIAN PROGRESS NOTES Oate ~ I"I 4260 ../ 00014'9 PHYSICIAN PROGRESS NOTES Date IOl¥ot. 0 0 0 .: 5 PHYSICIAN PROGRESS NOTES Date PHYSICIAN PROGRESS NOTES Date 000i52 PHYSICIAN PROGRESS NOTES Date PHYS ICIAN'~I~ROGRE~S ~NOTES Date 00015'4': PHYSICIAN PROGRESS NOTES Date · 4260 PHYSICIAN PROGRBSS NOTES Da te 000156 PHYSICIAN PROGRESS NOTES Date 'Il(t,-, 4260 0< PHYSICIAN PROGRESS NOTES Date 0OO158 Date PHYSICIAN PRO.G.RESS NOTES PHYSICIAN PROGRESS NOTES Date 000150 426O PHYSICIAN PROGRESS NOTES Date 53- oooifil NOTES Date NOV 0 6 '""--- P~IYSICIAN PROGRESS NOTES Date SEP o o 4260 i ZOOOud-~ - \%q nnn'~ PHYSICIA~ PROGRESS NOTES Date FEB 0 OC-- .4260 NNN1 R~, PHYSICIAN PROGRESS NOTES ,q G 0'1_ 65 Date PHYSICIAN PROGRESS NOTES P]FfSICIAN PROGRESS NOTES Oate 16.7' '" ?HY,SICIAN PROGRESS NOTES Date Zama¢ ' 000168 p 4260 Date PHYSICIAN PROGRESS NOTES PHY:SICIAN PROGRESS NOTES Date FEB ~ ~ 4260 [ cc PHYSICIAN PROGRESS NOTES SEP ~ OCT NOV ~6 NOV lB 1998 Lo~- \~, 1~98 000171 4260 PHYSICIAN PROGRESS NOTES Date HAY'O zj, 1~ p 426O 000=,2 PHYSICIAN PROGRESS NOTES Date .JlJk 15 p 4260 /o se-,-~o p.~_/~ oooJ-.?s Date ~ APR 15 1 7 t~- \%0 PHYSICIAN PROGRESS NOTES 0001%%?" ' p 4260 PHYSICIAN PROGRESS NOTES Oate JAN 0 7 000.175 p 426O PHYSICIAN PROGRESS NOTES ~A¥ 05 AUG 05 ~10¥ 0 4, ~h.~l I 4.26O Oate PHYSICIAN PROGRESS NOTES .~/~ 1~ f,~. PHYSICIAN PROGRESS NOTES Date JAN ~ 1 19~ p 4260 000~.~8 PHYS'[CIAN PROGRESS NOTES 19! PHiYSICIAN PROGRESS NOTES Date AUG 09 99~ ,000~0 426o .NOV ~ PHYSICIAN PROGRESS NOTES Date JUL g 7 lOqlTO 000182 ,Jill Provided courtesy of Mead Johnson Nutritionals, maker of Enfamil , P oSobee , Nutramigon , Pregestimil®, Poly-Vi-FIo~, and Tempra®. 0 0 0184 ..:.. ~qR.O ..',o Y (~. JIL. 2 4 I Provided courtesy o! Mead Johnson Nutritionels, maker or Enfamil®, ProSobeee, Nutrami~lene, Pregestimile' Poly-Vi-FIo~, and Tempra~. 000186 ' H~'~, cc( O002S~ CERTIFICATE OF SERVICE I do hereby certify that I have served a tree and correct copy of the foregoing Notice of Intent to Offer Documentary Evidence Pursuant to Rule 1311.1 by placing the same in the United States Mail, first class, postage prepaid, at Harrisburg, Pennsylvania, addressed as follows: Richard A. Sadlock, Esquire Angino & Rovner, P.C. 4503 North Front Street Harrisburg, PA 17110 Date: By: Bri~id ~. Alford,Xi~squi~} %4 DORIS TIM~4ONS, : Plaintiff : V. SUSAN L. FLICKINGER, : Defendant : Bayley, IN THE cOURT OF cOMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 03-2837 CIVIL TERM PRETRIAL CONFERENCE AND NOW, this 23rd day of June, 2004, before Edgar B. Judge, present for the plaintiff was Richard A. Sadlock, Esquire, and for the defendant, Brigid Q. Alford, Esquire. This claim arises out of a motor vehicle accident on November 2, 2002. Defendant rear-ended ]plaintiff's stationary vehicle. Defendant stipulates that she was negligent but challenges causation and damages. She seeks general damages for injuries associated with a dislocated first metacarpal and a hyperextension of the web space between the thumb and index There is no claim for medical expenses, lost wages or finger. loss of earning capacity. This is an appeal from arbitration pursuant to Pennsylvania Rule of civil Procedure 1311.1. Documents may be admitted into evidence pursuant to that Rule. The parties have stipulated that $15,000.00 is the maximum amount of damages she can collect. Accordingly, if the verdict is more than $15,000.00, it will be molded to that amount. The jury will not be instructed as to the cap. Estimated time of trial, one day to one and a half days. ~/~e Co · Edgar B.~6~ay±eY, =' Richard A. Sadlock, Esquire For Plaintiff Brigid Q- Alford, Esquire For Defendant 1mrs DORIS TIMMONS, PLAINTIFF : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA V. : : SUSAN L. FLICKINGER, : DEFENDANT : 03-2837 CIVIL TERM VERDICT AND NOW, this [ % day of July, 2004, following a bench trial, I find in favor of plaintiff against defendant and award plaintiff damages in the amount of $3,500. Richard A. Sadlock, Esquire For Plaintiff Brigid Q. Alford, Esquire For Defendant :sal Bythe Court,/,, ~//,~ Edgar B. Bayley,~. ANGINO & ROVNER, P.C. Richard A. Sadlock, Esquire I.D. No. 47281 4503 North Front Street Harrisburg, PA 17110-1708 (717) 238-6791 FAX (717) 238-5610 E-mail rsadlock@angino-rovner.¢om Attorneys for Plaintiff: Doris E. Timmons IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNS YLVANLA DORIS E. TIMMONS, Plaintiff V. SUSAN L. FLICKINGER, Defendant CIVIL ACTION - LAW NO. 03-2837 CIVIL JURY TRIAL DEMANDED PRAECIPE TO THE PROTHONOTARY: Please mark the above-captioned action as satisfied and discontinued. Date: August 16, 2004 Esquire ) ......~._D. No./4q281/ 4503 N.~ront S~eet // H~isb~% 17~ (717) 238-6791 Counsel for Plaintiff CERTIFICATE OF SERVICE I, Marcy L. Brymesser, an employee of the law firm of Angino & Rovner, P.C., do hereby certify that I am this day serving a true and correct copy of PRAECIPE on the following via postage prepaid, first class United States mail, addressed as follows: Brigid Q. Alford, Esquire Boswell, Tinmer, Piccola & Wickersham 315 North Front Street P.O. Box 741 Harrisburg, PA 17108-0741 Marcy ~L. ]3rym~se~'~ ~ ' Date: August 16, 2004 281940