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HomeMy WebLinkAbout09-8853ANGINO & ROVNER, P.C. David L. Lutz, Esquire Attorney ID# : 35956 4503 North Front Street Harrisburg, PA 17110-1708 (717) 238-6791 FAX (717) 238-5610 Attorneys for Plaintiff(s) E-mail: dlutz@angino-rovnerxom KIM and FRANK TUSCHAK, Plaintiffs V. KATHLEEN MARSHALL, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA NO. ?? ?'k S3 ?l l?, T.-l rm CIVIL ACTION - LAW 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 A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. ORIGINAL 427281 IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. Pennsylvania Lawyer Referral Service Pennsylvania Bar Association, P.O. Box 186, Harrisburg, PA 17108 TELEPHONE 1-800-692-7375 AVISO USTED HA SIDO DEMANDADO/A EN CORTE. Si usted desea defMarshalle de las demandas que se persentan mds adelante en las siguientes pdginas, debe tomar accion dentro de los proximos veinte (20) dias despuds de la notificacion de esta Demanda y Aviso radicando personalmente o por medio de un abogado una comparecencia escrita y radicando en la Corte por escrito sus defensas de, y objecciones a , las demandas presentadas aqui en contra suya. Se le advierte de que si usted falla de tomar accion como se describe anteriormente, el caso puede proceder sin usted y un fallo por cualquier suma de dinero reclamada en la demanda o cualquier otra reclamaci6n o remedio solicitado por el demandante puede ser dictado en contra suya por la Corte sin mds aviso adicional. Used puede perder dinero o propiedad a otros derechos importantes para used. USTED DEBE LLEVAR ESTE DOCUMENTO A SU ABOGADO INMEDIATAMENTE. SI USED NO TIENE UN ABOGADO, LLAME O VAYA A LA SIGUIENTE OFICINA. ESTA OFICINA PUEDE PROVEERLE INFORMACION A CERCA DE COMO CONSEGUIR UN ABOGADO. SI USED NO PUEDE PAGAR POR LOS SERVICIOS DE UN ABOGADO, ES POSIBLE QUE ESTA OFICINA LE PUEDA PROVEER INFORMACION SOBRE AGENCIAS QUE OFREZCAN SERVICIOS LEGALES SIN CARGO O BAJO COSTO A PERSONAS QUE CUALIFICAN. Pennsylvania Lawyer Referral Service Pennsylvania Bar Association, P.O. Box 186, Harrisburg, PA 17108 TELEFONO 1-800-692-7375 427281 ANGINO & ROVNER, P.C. David L. Lutz, Esquire Attorney ID# : 35956 4503 North Front Street Harrisburg, PA 17110-1708 (717) 238-6791 FAX (717) 238-5610 Attorneys for Plaintiff(s) E-mail: dlutz@angino-rovner.com KIM and FRANK TUSCHAK, Plaintiffs V. KATHLEEN MARSHALL, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA NO. t)q; c N, I CIVIL ACTION - LAW JURY TRIAL DEMANDED COMPLAINT 1. Plaintiffs Kim and Frank Tuschak are adult individuals and citizens of the Commonwealth of Pennsylvania who reside in Dillsburg, York County, Pennsylvania. 2. Defendant Kathleen Marshall is an adult individual and citizen of the State of Virginia who resides at 9073 Falcon Glen Court, Bristow, Virginia, 20136. 3. The facts and occurrences hereinafter related took place on or about February 3, 2008, at around 3:30 p.m. at the exit ramp from S.R. 581 onto S.R. 15 South, Lower Allen Township, Cumberland County, Pennsylvania. 4. At that time and place, Mrs. Tuschak had been operating a Chevrolet Malibu, traveling south on S.R. 581. Mrs. Tuschak was merging her vehicle onto S.R. 15 South. 5. At the same time and place, Defendant Marshall was operating a Volkswagen, licensed and registered in the State of Maryland. 6. Defendant Marshall was operating her vehicle, traveling south on S.R. 581, and was also merging her vehicle onto S.R. 15 South. 427281 r j 7. Defendant Marshall permitted the front of her vehicle to collide into the rear of Mrs. Tuschak's vehicle. 8. The foregoing accident and all of the injuries and damages set forth hereinafter sustained by Mrs. Tuschak are the direct and proximate result of the negligent, careless, wanton, and reckless manner in which Defendant Kathleen Marshall operated her motor vehicle as follows: a. failure to keep alert and maintain a proper watch for the presence of other motor vehicles on the S.R. 581 exit ramp to southbound S.R. 15; b. failure to stop her vehicle within the assured clear distance ahead; C. failure to brake before colliding into the rear of Mrs. Tuschak's vehicle; and d. driving her vehicle upon the highway 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. Kim Tuschak v. Kathleen Marshall 9. Paragraphs 1 through 8 of the Complaint are incorporated herein by reference. 10. Plaintiff Kim Tuschak sustained painful and severe injuries, which include but are not limited to chronic low back and neck pain, a herniated disc at C5-C6 and C6-C7, and left shoulder and left arm pain and numbness. 427281 11. By reason of the aforesaid injuries sustained by Mrs. Tuschak, she was forced to incur liability for extensive medical treatment, medications, therapy, 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, Mrs. Tuschak has been advised and, therefore, avers that she may be forced to incur similar expenses in the future, and claim is made therefor. 13. Mrs. Tuschak has undergone and in the future may undergo physical and mental suffering, inconvenience in carrying out her daily activities, loss of life's pleasures and enjoyment, and claim is made therefor. 14. Mrs. Tuschak 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. CLAIM II Frank Tuschak v. Kathleen Marshall 15. Paragraphs 1 through 14 of the Complaint are incorporated herein by reference. 16. As a result of the aforementioned injuries sustained by his wife, Plaintiff' Kim Tuschak, Plaintiff Frank Tuschak has been and may in the future be deprived of the care, companionship, consortium, and society of his wife, all of which will be to his great detriment, and claim is made therefor. 427281 WHEREFORE, Plaintiffs Kim and Frank Tuschak demand judgment against Defendant Kathleen Marshall in an amount in excess of Fifty Thousand Dollars ($50,000.00), exclusive of interest and costs and in excess of any jurisdictional amount requiring compulsory arbitration. ANGINO & ROVNER, P.C. 7v- - Dav> . Lutz I.D. No. 35956 4503 N. Front Street Harrisburg, PA 17110 (717) 238-6791 -phone (717) 238-5610 - fax dlutz@angino-rovner. com t Attorney for Plaintiffs Date: ? ' V l 427281 VERIFICATION We, Kim and Frank Tuschak, Plaintiffs, have read the foregoing COMPLAINT and do hereby swear or affirm that the facts set forth in the foregoing are true and correct to the best of our knowledge, information and belief. We understand that this Verification is made subject to the penalties of 18 Pa.C.S.A. Section 4904, relating to unsworn falsification to authorities. 1 I i s v - Kim Tuschak Frank Tuschak Dated: L,-'// y1 427281 U ?;y,? lutz "' J ? ?U?N Cl1, ANGINO & ROVNER, P.C. David L. Lutz, Esquire Attorney ID# : 35956 4503 North Front Street I-Iarrisburg, PA 17110-1708 (717) 238-6791 FAX (717) 238-5610 Attorneys for Plaintiff(s) E-mail: dlutz@angino-rovner.com OF TH?APff ? OTAkY 2010 JAN -b PM 3: 42 CUWIBE:_-:;. k. Z GOUN TY PENNSYLVA"41A, KIM and FRANK TUSCHAK, IN THE COURT OF COMMON PLEAS Plaintiffs CUMBERLAND COUNTY, PA V. I NO. 09-8853 CIVIL KATHLEEN MARSHALL, I CIVIL ACTION - LAW Defendant JURY TRIAL DEMANDED ACCEPTANCE OF SERVICE I, John Ninosky, Esquire, counsel for Defendant Kathleen Marshall, hereby accepts service of the attached Complaint filed in this action on behalf of Defendant Kathleen Marshall and hereby verify that I am authorized by my client to accept service of the Complaint. ad, X A'??a Jo R. Ninosky, Esquire Johnson, Duffle, Stewart & Weidner 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 Dated: 428589 ?RIGINAt CERTIFICATE OF SERVICE I, Mary T. Geraets, 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 the ACCEPTANCE OF SERVICE upon defense counsel via postage prepaid first class United States mail addressed as follows: John R. Ninosky, Esquire Johnson, Duffle, Stewart & Weidner 301 Market Street P.O. BOX 109 Lemoyne, PA 17043-0109 Attorney for Defendant Mary T. raets Dated: 428588 FILED-+3i i`CE OF THE Pr y' I-'Q'N!JTARY JOHNSON, DUFFIE, STEWART & WEIDNER By: John R. Ninosky, Esquire I.D. No. 78000 301 Market Street P. O. Box 109 Lemoyne, PA 17043-0109 Phone: (717) 761-4540 E-mail: jrn@jdsw.com KIM AND FRANK TUSCHAK, Plaintiffs 1010 JAN 13 PH 3: 40 CUPvI ,< Nr;y Counsel for Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 09-8853 Civil Term CIVIL ACTION - LAW KATHLEEN MARSHALL, Defendant JURY TRIAL DEMANDED PRAECIPE FOR ENTRY OF APPEARANCE TO THE PROTHONOTARY: Please enter the appearance of the undersigned on behalf of Defendant Kathleen Marshall in the above-captioned matter. Date: January 12, 2010 388538 Respectfully submitted, JOHNSON, DUFFIE, STEWART & WEIDNER 91 By: 4??z ,''1 Jolth R. Ninosky, Esquire Attorney I.D. No. 78000 301 Market Street P. O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Counsel for Defendant CERTIFICATE OF SERVICE I hereby certify that a copy of the foregoing Praecipe for Entry of Appearance has been duly served upon the following counsel of record, by depositing the same in the United States Mail, postage prepaid, in Lemoyne, Pennsylvania, on January 12, 2010: David L. Lutz, Esquire Angino & Rovner, P.C. 4503 North Front Street Harrisburg, PA 17110 JOHNSON, DUFFIE, STEWART & WEIDNER By e4- a"6 J hn R. Ninosky ~~ F~~irG-.~~,;- 1 I :. 1 7i9~~~~ Cv FI is 49 ~ ~,, ~~4~ ~~: - ANGINO & ROVNER, P.C. David L. Lutz, Esquire Attorney ID# :35956 4503 North Front Street Harrisburg, PA 17110-1708 (717)238-6791 FAX (717) 238-56]0 Attorneys for Plaintiff(s) E-mail: dlutz@angino-rovner.com KIM and FRANK TUSCHAK, Plaintiffs v. KATHLEEN MARSHALL, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA NO.09-8853 CIVIL CIVIL ACTION -LAW JURY TRIAL DEMANDED PLAINTIFFS' REQUEST FOR ADMISSIONS TO DEFENDANT - SET NO. 1 To: Defendant Margaret Kathleen Marshall, by and through counsel, John Ninosky, Esquire Please take notice that you are hereby required, pursuant to Rule 4014 of the Pennsylvania Rules of Civil Procedure (Federal Rules of Civil Procedure 36), to serve upon the undersigned within thirty (30) days from service, your response to the admissions} requested herein: 1. Do you admit that on February 3, 2008, at approximately 3:30 p.m., you were operating a Volkswagen when involved in a motor vehicle accident at the exit ramp from State Route 581 at the entrance of State Route 15 South? Admit Deny -w. ORIGINAL 2• Do you admit that before the subject motor vehicle collision, you had been operating a Volkswagen south on State Route 581 and planned to proceed south on State Route 15 South? Admit Deny -~ • Do you admit that the front of the Volkswagen you were operating came into contact with the rear of a Chevrolet Malibu? Admit Date: ~. ~ c~-~,~'~ \~ Deny ANGINO & ROVNER, P.C. Davi .Lutz I.D. No. 35956 4503 N. Front Street Harrisburg, PA 17110 (717) 238-6791 -phone (717) 238-5610 -fax dlutz@angino-rovner. com Attorney for Plaintiffs 432997 CERTIFICATE OF SERVICE I, Mary T. Geraets, 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 the PLAINTIFF'S REQUEST FOR ADMISSIONS TO DEFENDANT -SET NO. 1 upon defense counsel via postage prepaid first class United States mail addressed as follows: John R. Ninosky, Esquire Johnson, Duffie, Stewart & Weidner 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 Attorney for Defendant Dated: ~ ~ ~ ~' ~~ 1 --.. I ~~ Mary T, eraets 432997 ~ ., r F~ -" ""'_ ?010 MAR -2 PM 2: ~ g ~~~~~ ~~ . ~:~.va .JOHNSON, DUFFIE, STEWART 8c WEIDNER By: John R. Ninosky, Esquire I.D. No. 78000 301 Market Street P. O. Box 109 Lemoyne, PA 17043-0109 Phone: (717) 761-4540 E-mail: jrn@jdsw.com KIM AND FRANK TUSCHAK, Plaintiffs v. KATHLEEN MARSHALL, Counsel for Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 09-8853 Civil Term CIVIL ACTION -LAW Defendant JURY TRIAL DEMANDED NOTICE TO PLEAD TO: Kim and Frank Tuschak and their counsel, David L. Lutz, Esquire YOU ARE REQUIRED to plead to the within Answer with New Matter within 20 days of service hereof or a default judgment may be entered against you. JOHNSON, DUFFIE, STEWART &WEIDNER By: /2 J n R. Ninosky, Esquire Attorney I.D. No. 78000 Date: March 10, 2010 Counsel for Defendant • ~ •._, JOHNSON, DUFFIE, STEWART ~ WEIDNER By: John R. Ninosky, Esquire I.D. No. 78000 301 Market Street - P. O. Box 109 Lemoyne, PA 17043-0109 Phone: (717) 761-4540 E-mail: jrn@jdsw.com KIM AND FRANK TUSCHAK, Plaintiffs v. KATHLEEN MARSHALL, Defendant NO. 09-8853 Civil Term CIVIL ACTION -LAW JURY TRIAL DEMANDED DEFENDANT'S ANSWER WITH NEW MATTER TO PLAINTIFFS' COMPLAINT AND NOW, comes the Defendant, Kathleen Marshall, by and through her counsel, Johnson, Duffie, Stewart & Weidner, P.C., who files this Answer with New Matter to Plaintiffs' Complaint by respectfully stating the following: 1. Denied. After reasonable investigation, the answering Defendant is without sufficient knowledge or information to form a belief as to the truth of the averments contained in this paragraph. The same are therefore denied, and strict proof demanded at the time of trial. 2. Admitted. 3. Denied. The averments contained in this paragraph are denied pursuant to Pa. R.C.P. 1029(e). 4. Denied. The averments contained in this paragraph are denied pursuant to Pa. R.C.P. 1029(e). 5. Denied. The averments contained in this paragraph are denied pursuant to Counsel for Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Pa. R.C.P. 1029(e). 6. Denied. The averments contained in this paragraph are denied pursuant to Pa. R.C.P. 1029(e). 7. Denied. The averments contained in this paragraph are denied pursuant to Pa. R.C.P. 1029(e). 8. Denied. The averments contained in this paragraph are denied pursuant to Pa. R.C.P. 1029(e). CLAIM I Kim Tuschak v. Kathleen Marshall 9. Defendant incorporates herein by refere nce the answers to paragrap hs 1 through 8 above as though fully set forth herein at length. 10. Denied. The averments contained in this paragraph are denied pursuant to Pa. R.C.P. 1029(e). 11. Denied. The averments contained in this paragraph are denied pursuant to Pa. R.C.P. 1029(e). 12. Denied. The averments contained in this paragraph are denied pursuant to Pa. R.C.P. 1029(e). 13. Denied. The averments contained in this paragraph are denied pursuant to Pa. R.C.P. 1029(e). 14. Denied. The averments contained in this paragraph are denied pursuant to Pa. R.C.P. 1029(e). CLAIM II Frank Tuschak v. Kathleen Marshall 15. Defendant incorporates herein by reference the answers to paragraphs 1 through 14 above as though fully set forth herein at length. 2 16. Denied. The averments contained in this paragraph are denied pursuant to Pa. R.C.P. 1029(e). WHEREFORE, Defendant, Kathleen Marshall, respectfully requests that Plaintiffs' Complaint be dismissed with prejudice and that judgment be entered in her favor. NEW MATTER 17. Plaintiffs' Complaint fails to state a claim upon which relief may be granted. 18. Plaintiffs' claims and/or alleged losses may be barred by their comparative negligence. 19. Defendant's negligence, which is expressly denied, was not a substantial factor in causing any harm to the Plaintiffs. 20. Plaintiffs' claims and/or alleged losses may be barred by the limited tort doctrine. WHEREFORE, Defendant, Kathleen Marshall, respectfully requests that Plaintiffs' Complaint be dismissed with prejudice and that judgment be entered in her favor. Respectfully submitted, JOHNSON, DUFFIE, STEWART & WEIDNER By: Joyin R. Ninosky, Esquire V Attorney I.D. No. 78000 301 Market Street - P. O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Date: March 1, 2010 Attorneys for Defendant 3 VERIFICATION I, KATHLEEN MARSHALL, have read the foregoing Answer and New Matter, and hereby affirms that it is true and correct to the best of my personal knowledge, or information and belief. This Verification and statement is made subject to the penalties of 18 Pa. C.S. §4904 relating to unsworn falsification to authorities; 1 verify that all the statements made in the foregoing are true and correct and that false statements may subject me to the penalties of 18 Pa. C.S. §4904. Ka teen arsha Date: 386246 CERTIFICATE OF SERVICE I hereby certify that a copy of the foregoing Answer with New Matter has been duly served upon the following counsel of record, by depositing the same in the United States Mail, postage prepaid, in Lemoyne, Pennsylvania, on March 1, 2010: David L. Lutz, Esquire Angino & Rovner, P.C. 4503 North Front Street Harrisburg, PA 17110 JOHNSON, DUFFIE, STEWART & WEIDNER By J hn R. Ninosky ~, Johnson, Duffle, Stewart & Weidner By: John R. Ninosky, Esquire I.D. No. 78000 301 Market Street P.O. Box 109 Lemoyne, Pennsylvania 17043-0109 717-761-4540 Attorneys for Defendant F3~r. J~(. ~ PM ~'•~ ~ 1R ri r_ ._~'`j i`f CUiv~~r. . jrn@jdsw.com KIM and FRANK TUSCHAK, Plaintiffs v. : KATHLEEN MARSHALL, Defendants IN THE COURT OF COMMON PLEA$ O CUMBERLAND COUNTY, PENNISYLVANIA NO. 09-8853 CIVIL CIVIL ACTION -LAW JURY TRIAL DEMANDED CERTIFICATE PREREQUISITE TO SERVICE OF A SUBPOENA PURSUANT TO RULE 4009.22 As a prerequisite to service of a subpoena for documents and things pursuant to Rule 4009.2, Defendant hereby certifies that: (1) A Notice Of Intent To Serve A Subpoena, with a copy of the subpoena attached thereto, was faxed or delivered to each party; (2) A copy of the Notice Of Intent, including the proposed subpoena, is attached to this Certificate; (3) There is no objection to the subpoena and the twenty (20) day rule has been waived, therefore there is no delay in serving the subpoena; (4) A copy of an a-mail from Plaintiffs attorneys, confirming that there are no objections to the subpoena and the twenty (20) day notice has been waived, is attached to this Certificate; and (5) The subpoena to be served is identical to the subpoena attached to the Notice Of Intent. Respectfully submitted, JOHNSON, DUFFIE, STEWART & WEIDNER By: 7/~7 ~~ J n R. Ninoslry, Esquire Page 1 of 2 Susan M.Ladeda From: John R. Ninosky Sent: Thursday, June 03, 2010 8:44 AM To: 'Lutz, Dave' Cc: Marcy L. Brymesser, Geraets, Mary T. Subject: RE: Tuschak v. Marshall Will do. Thanks. From: Lutz, Dave [mailto:dlutz~angino-rovner.com] Sent: Thursday, June 03, 2010 7:48 AM To: John R. Ninosky Cc: Marcy L. Brymesser; Lutz, Dave; Geraets, Mary T. Subject: RE: Tuschak v. Marshall John- my guess is that it would be faster to subpoena the documents from the agent. I will waive the 20 day rule and please provide me with the documents you get in response. thanks David L. Lutr, Esquire [maiito:DLutr~angino-rovner.coml Angino 8~ Rovner, P.C. 4503 North Front Street Harrisburg, PA 17110 Phone: (717) 238-6791 ~ Fax: (717) 238-5610 7/21/2010 Johnson, Duffie, Stewart & Weidner By: John R. Ninosky, Esquire I.D. No. 78000 301 Market Street P.O. Box 109 Lemoyne, Pennsylvania 17043-0109 717-761-4540 jrn@jdsw.com Attorneys for Defendant KIM and FRANK TUSCHAK, Plaintiffs v. KATHLEEN MARSHALL, Defendants IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 09-8853 CIVIL CIVIL ACTION -LAW JURY TRIAL DEMANDED NOTICE OF INTENT TO SERVE SUBPOENA TO PRODUCE DOCUMENTS AND THINGS FOR DISCOVERY PURSUANT TO RULE 4009.21 To: David L. Lutz, Esquire Angino ~ Rovner 4503 North Front Street Harrisburg, PA 17110-1708 PLEASE TAKE NOTICE that Defendant intends to serve a subpoena identical to the one that is attached to this notice. Per the a-mail of June 3, 2010, between David L. Lutz, Esquire, attorney for Plaintiffs, and John R. Ninosky, Esquire, attorney for Defendant, you do not have any objections to the subpoena and have waived the twenty (20) day waiting period prior to service of the subpoena. Respectfully submitted, JOHNSON, DUFFIE, STEWART & WEIDNER lp By: J n R. Ninosky, Esquire Date: 7 ~7~~D COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND KIM and FRANK TUSCHAK, IN THE COURT OF COMMON PLEAS OF Plaintiffs CUMBERLAND COUNTY, PENNSYLVANIA NO. 2009-8853 CIVIL TERM v. KATHLEEN MARSHALL, CIVIL ACTION -LAW Defendant SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: Jack M. Panas Insurance Inc. (Name of Person or Entity) Within twenty (20) days after service of this subpoena, you are ordered by the court to produce the following documents or things: Declaration page for auto policy of Kim and Frank Tuschak. Jr., policy # Q02 0208349 H ~ for the policy period covering February 3. 2008 . at Johnson. Duffle. Stewart 8~ Weidner. 301 Market Street. P.O. Box 109. Lemoyne, PA 17043. You may deliver or mail legible copies of the documents or produce things requested by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You have the right to seek in advance the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by this subpoena within twenty (20) days after its service, the party serving this subpoena may seek a court order compelling you to comply with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON: NAME: John R. Ninoskv. Esquire . ADDRESS: 301 Market Street Lemoyne. PA 17043 TELEPHONE: 717-761-4540 SUPREME COURT ID #: 78000 BY THE COURT: ry/Clerk, ivil Division Deputy DATE: 01 Seal of th Court (Eff. 7197) CERTIFICATE OF SERVICE I hereby certify that I served a copy of the foregoing document upon the person(s) indicated below by depositing a copy of the same in the United States mail, postage prepaid, at Lemoyne, Pennsylvania, on the ~hday of ~ , 2010. David L. Lutz, Esquire Angino & Rovner 4503 North Front Street Harrisburg, PA 17110-1708 JOHNSON, DUFFIE, STEWART & WEIDNER By. /'~- J hn R. Ninosky, Esquire CERTIFICATE OF SERVICE I hereby certify that I served a copy of the foregoing document upon the person(s) indicated below by depositing a copy of the same in the United States mail, postage prepaid, at Lemoyne, Pennsylvania, on the a`~~ day of ~ , 2010. David L. Lutz, Esquire Angino & Rovner 4503 North Front Street Harrisburg, PA 17110-1708 JOHNSON, DUFFIE, STEWART & WEIDNER By: /~ Joh R. Ninosky, Esquire cA/A~- PRAECIPE FOR LISTING CASE FOR ARGUMENT (Must be typewritten and submitted in duplicate) TO THE PROTHONOTARY OF CUMBERLAND COUNTY: (List the within matter for the next Argument Court.) CAPTION OF CASE (entire caption must be stated in full) KIM AND FRANK TUSCHAK, C Plaintiffs ~ ~? ~ , -~ ~; vs. ,.... ~. ~..~. i "~ KATHLEEN MARSHALL, rC t:::a s~ ~ ~,.~ ~ : T~ ~.~ -~ Defendant 5;0 ~ ~~rn No. 09-8853,~vil T~m ~ ~,. 1. State matter to be argued (i.e., - plaintiffs motion for new trial, defendant's demurrer to complaint, etc.): Defendant Marshall's Motion for Summary Judgment 2. Identify counsel who will argue cases: (a) for plaintiffs: David L. Lutz. Esquire. Angino & Rovner. P.C.. 4503 North Front Street Harrisburo. PA 17110 (Name and Address) (b) for defendant: John R. Ninoskv. Esouire: Johnson Duffle: 301 Market Street P.O. Box 109 Lemoyne. PA 17403 (Name and Address 3. I will notify all parties in writing within two days that this case has been listed for argument. 4. Argument Court Date: October 6, 2010 / ~/ Sign ure John R. Ninoskv Print your name Attorney for Defendant Marshall Date: September 2, 2010 INSTRUCTIONS: 1. Two copies of all briefs must be filed with the COURT ADMINISTRATOR (not the Prothonotary) before argument. 2. The moving party shall file and serve their brief 12 days prior to argument. 3. The responding party shall file their brief 5 days prior to argument. 4. If argument is continued new briefs must be filed with the COURT ADMINISTRATOR (not the Prothonotary) after the case is relisted. JOHNSON, DUFFIE, STEWART 8 WEIDNER By: John R. Ninosky, Esquire I.D. No. 78000 By: Andrew J. Petsu, Jr., Esquire I.D. No. 206495 301 Market Street ~ P. O. Box 109 Lemoyne, PA 17043-0109 Phone: (717) 761-4540 KIM AND FRANK TUSCHAK, Plaintiffs v. KATHLEEN MARSHALL, Defendant JURY TRIAL DEMANDED DEFENDANT'S MOTION FOR SUMMARY JUDGMENT AND NOW, comes the Defendant, Kathleen Marshall, by and through her counsel, Johnson, Duffle, Stewart & Weidner, P.C., who files this Motion for Summary Judgment by respectfully stating the following: 1. This matter arises from an automobile accident that occurred on February 2, 2008. See, Plaintiffs' Complaint attached hereto as Exhibit A. 2. The accident happened when Defendant's vehicle struck the rear of Mrs. Tuschak's vehicle, while Defendant was merging onto S.R. 15 South from S.R. 581. 3. At the time of the accident, Mrs. Tuschak had selected the "Limited Tort" option on her personal automobile insurance policy with Erie Insurance. See, a copy of the applicable ,.. ~.~~ .. -~ A'~ g; 58 J .,s,.; i",~UPftY Coun~~~~:~fdaht IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 09-8853 Civil Term CIVIL ACTION -LAW Declarations Page is attached hereto as Exhibit B. 4. Defendant asserted in her New Matter that Plaintiffs' claims and/or alleged losses are limited or barred by her selection of the Limited Tort option. See, Defendant's Answer with New Matter filed on March 2, 2010 attached hereto as Exhibit C. 5. An individual who selects the Limited Tort option is precluded from recovering non-economic damages unless an injury causes a serious impairment of a body function. See, 75 Pa.C.S.A § 1705. 6. "The 'serious impairment of body function' threshold, which must be met for limited tort elector to maintain action for non-economic loss arising from motor vehicle accident asks (1) what body function, if any, was impaired because of the injuries sustained in a motor vehicle accident, and (2) was the impairment of the body function serious." Washington v. Baxter, 553 Pa. 434, 719 A.2d 733 (Pa. 1998). 7. "Several factors must be considered to determine if the claimed injury is a "serious injury" for purposes of limited tort option threshold for recovery of non-economic damages: (1) the extent of the impairment; (2) the length of time the impairment lasted; (3) the treatment required to correct the impairment; and (4) any other relevant factors. Graham v. Campo, 990 A.2d 9 (Pa. Super. 2010). 8. At the time of the accident Mrs. Tuschak was, and currently is, employed at the West Shore YMCA as the YMCA Director. Mrs. Tuschak claims that she suffered no loss of occupational duties as a result of the accident. See, Plaintiffs' Answers to Defendant's Interrogatories Numbers 1 and 21 attached hereto as Exhibit D; and Tuschak Deposition attached hereto as Exhibit E, pp. 7-8. 9. Prior to the accident, Mrs. Tuschak testified she was running approximately thirty (30) miles per week. See, Exhibit E, p. 14. 10. After the accident, Mrs. Tuschak was treated at Olivetti Chiropractic from February 6, 2008 to May 21, 2008, where she experienced steady improvement in her condition. See, medical records from Olivetti Chiropractic attached hereto as Exhibit F. 11. On February 6, 2008, Dr. Olivetti noted that she had minimal interterence with her daily activities and her prognosis was good. See, Exhibit F. 12. Mrs. Tuschak was then referred to Jaclyn Dotter, DPT for physical therapy between the dates of May 22, 2008 and August 15, 2008. See, medical records from Jaclyn Dotter, DPT attached hereto as Exhibit G. 13. By June, 13, 2008, Mrs. Tuschak was able to run/walk for five miles in one hour. See, Exhibit G. 14. According to Mrs. Tuschak's medical records, by July 7, 2008, she was able to run two miles and jog two miles; and on July 10, 2008, she was able to run five miles. See, Exhibit G. 15. By the end of her physical therapy on August 15, 2008, Mrs. Tuschak returned to all recreational activities, hobbies and ADL's, pain-free, and without increased symptoms or difficulty. See, Exhibit G. 16. According to her medical records, by August 15, 2008, Mrs. Tuschak made complete progress with physical therapy, achieving all long term goals. She was discharged from physical therapy due to returning to pre-morbid functional status. See, Exhibit G. 17. Since the time Mrs. Tuschak's treatment ended, she has not been on any medication for injuries related to the accident and she has not been put on any medical restrictions. See, Exhibit E, p. 29. 18. At the time Mrs. Tuschak answered Defendant's Interrogatories, she was jogging with a little walking between fin+enty (20) and thirty (30) miles per week. See, Plaintiffs Answer to Defendant's Interrogatory Number 21, Exhibit D. 19. Any reduction in the miles Ms. Tuschak runs is not due to the injuries she sustained in the accident. See, Exhibit E, p. 32. 20. In Murrav v. McCann, 658 A.2d 1223 (Pa. Super. 1995), the plaintiff was struck by a motorist and the court found that she did not suffer a "serious impairment" of a bodily function. The plaintiff was able to perform all her daily activities fully, she did not have to take breaks from work for pain, her doctor stated that she would lead a normal life, albeit with a "measure" of pain, and she ceased medical intervention after eight months. Plaintiffs bodily impairment was not "serious," when the plaintiff suffered neck and back pain that required a few months of physical therapy, did not interfere with the ability to perform daily activities, and could be treated with ibuprophen. 21. In Dodson v. Elvev, 665 A.2d 1223 (Pa. Super. 1995), the plaintiff was found not to have suffered a "serious impairment of body function," where four months after the accident he was released to work with full range of motion in his arm, and no restrictions, he remained gainfully employed and received no treatment or medication for pain, and there was no serious interference with his daily life. 22. Due to Mrs. Tuschak's treatment and improvement in her condition as stated above, It is submitted that the injuries she allegedly suffered do not demonstrate a serious impairment of bodily function. 23. Pennsylvania Rule of Civil Procedure 1035.2 governs Motions for Summary Judgment: ...any party may move for summary judgment in whole or in part as a matter of law (1) whenever there is no genuine issue of any material fact as to a necessary element of the cause of action or defense which could be established by additional discovery or expert report, or (2) If, after the completion of discovery relevant to the motion, including the production of expert reports, an adverse party who will bear the burden of proof at trial has failed to produce evidence of facts essential to the cause of action or defense which in a jury trial would required the issues to be submitted to a jury. Pa. R.C.P. 1035.2 (1996). 24. The standard of review under Rule 1035 normally requires the Court to deny summary judgment unless the case is clear and free from doubt. Redland Soccer Club v. Department of Armv. 548 Pa. 178, 696 A.2d 137 (1997). 25. Moreover, summary judgment is generally warranted if, on review of the entire record, the trial court determines that there is no genuine issue of material fact. Snyder v. Specialty Glass Products. Inc.. 441 Pa. Super 613, 658 A.2d 366 (1995). 26. It is submitted that Mrs. Tuschak cannot recover non-economic damages in this case, because she has not suffered an injury which has caused a serious impairment of a bodily function. (See, attached documents). 27. Here, reasonable minds cannot differ on the issue of whether a serious injury has been sustained. In light of the above, Mrs. Tuschak has not sustained a serious injury; therefore, she has no claim for economic damages and summary judgment is appropriate in this case. WHEREFORE, Defendant respectfully requests that this Honorable Court grant her Motion for Summary Judgment and that Plaintiffs' cause of action be dismissed with prejudice. Respectfully submitted, JOHNSON, DUFFIE, STEWART 8 WEIDNER By: Jo R. Ninosky, Esquire Attorney I.D. No. 78000 Andrew J. Petsu, Jr., Esquire Attorney I.D. No. 206495 301 Market Street P. O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Attorneys for Defendant Date: September 2, 2010 410342 C~ ~'' - .~~ _ ~ (_~~ T Q ~til .~-. _. ':7 :.ate `-r=~ -;~ ;; . ~ _ ;~ f..r ...._ ,~` .. r 'Ya ~ ~- ~ ANGINO & ROVNER, P.C. David L. Lutz, Esquire Attorney ID# : 35956 4503 North Front Street Harrisburg, PA 17110-1708 (717)238-6791 FAX (717) 238-5610 Attorneys for Plaintiff(s) E-mail: dlutz@angino-rovner.com KIM and FRANK TUSCHAK, IN THE COURT OF COMMON PLEAS Plaintiffs CUMBERLAND COUNTY, PA ~C~, ~~ 5.3 ~l~d~ v. NO. KATHLEEN MARSHALL, I CIVIL ACTION -LAW Defendant 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 A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. 427281 IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. Pennsylvania Lawyer Referral Service Pennsylvania Bar Association, P.O. Box 186, Harrisburg, PA 17108 TELEPHONE 1-800-692-7375 AVISO LISTED HA SIDO DEMANDADO/A EN CORTE. Si usted desea defMarshalle de las demandas que se persentan mas adelante en las sguientes paginas, debe tomar accion dentro de los proximos veinte (20) dies despues de la notificacion de esta Demanda y Aviso radicando personalmente o por medio de un abogado una comparecencia escrita y radicando en la Corte por escrito sus defenses de, y objecciones a , las demandas presentadas aqui en contra suya. Se le advierte de que si usted fella de tomar accibn como se describe anteriormente, el caso puede proceder sin usted y un fallo por cualquier suma de dinero reclamada en la demanda o cualquier otra reclamacion o remedio solicitado por el demandante puede ser dictado en contra suya por la Corte sin mas aviso adicional. Used puede perder dinero o propiedad u otros derechos importantes pare used. LISTED DEBE LLEVAR ESTE DOCUMENTO A SU ABOGADO INMEDIATAMENTE. SI USED NO TIENE UN ABOGADO, LLAME O VAYA A LA SIGUIENTE OFICINA. ESTA OFICINA PUEDE PROVEERLE INFORMACION A CERCA DE COMO CONSEGUIR UN ABOGADO. SI USED NO PUEDE PAGAR POR LOS SERVICIOS DE UN ABOGADO, ES POSIBLE QUE ESTA OFICINA LE PUEDA PROVEER 1NFORMACION SOBRE AGENCIAS QUE OFREZCAN SERVICIOS LEGALES SIN CARGO O BAJO COSTO A PERSONAS QUE CUALIFICAN. Pennsylvania Lawyer Referral Service Pennsylvania Bar Association, P.O. Box 186, Harrisburg, PA 17108 TELEFONO 1-800-692-73 75 427281 ANGINO & ROVNER, P.C. David L. Lutz, Esquire Attorney ID# :35956 4503 North Front Street Harrisburg, PA 17110-1708 (717)238-6791 FAX (717) 238-5610 Attorneys for Plaintiff(s) E-mail: dlutz@angino-rovner.com KIM and FRANK TUSCHAK, Plaintiffs v. KATHLEEN MARSHALL, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY,. PA NO. CIVIL ACTION -LAW JURY TRIAL DEMANDED COMPLAINT 1. Plaintiffs Kim and Frank Tuschak are adult individuals and citizens of the Commonwealth of Pennsylvania who reside in Dillsburg, York County, Pennsylvania. 2. Defendant Kathleen Marshall is an adult individual and citizen of the State of Virginia who resides at 9073 Falcon Glen Court, Bristow, Virginia, 20136. 3. The facts and occurrences hereinafter related took place on or about February 3, 2008, at around 3:30 p.m. at the exit ramp from S.R. 581 onto S.R. 15 South, Lower Allen Township, Cumberland County, Pennsylvania. 4. At that time and place, Mrs. Tuschak had been operating a Chevrolet Malibu, traveling south on S.R. 581. Mrs. Tuschak was merging her vehicle onto S.R. 15 South. 5. At the same time and place, Defendant Marshall was operating a Volkswagen, licensed and registered in the State of Maryland. 6. Defendant Marshall was operating her vehicle, traveling south on S.R. 581, and was also merging her vehicle onto S.R. 15 South. 427281 7. Defendant Marshall permitted the front of her vehicle to collide into the rear of Mrs. Tuschak's vehicle. 8. The foregoing accident and all of the injuries and damages set forth hereinafter sustained by Mrs. Tuschak are the direct and proximate result of the negligent, careless, wanton, and reckless manner in which Defendant Kathleen Marshall operated her motor vehicle as follows: a. failure to keep alert and maintain a proper watch for the presence of other motor vehicles on the S.R. 581 exit ramp to southbound S.R. 15; b. failure to stop her vehicle within the assured clear distance ahead; c. failure to brake before colliding into the rear of Mrs. Tuschak's vehicle; and d. driving her vehicle upon the highway 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. CLAIM I Kim Tuschak v. Kathleen Marshall 9. Paragraphs 1 through 8 of the Complaint are incorporated herein by reference. 10. Plaintiff Kim Tuschak sustained painful and severe injuries, which include but are not limited to chronic low back and neck pain, a herniated disc at CS-C6 and C6-C7, and left shoulder and left arm pain and numbness. 427281 11. By reason of the aforesaid injuries sustained by Mrs. Tuschak, she was forced to incur liability for extensive medical treatment, medications, therapy, 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, Mrs. Tuschak has been advised and, therefore, avers that she may be forced to incur similar expenses in the future, and claim is made therefor. 13. Mrs. Tuschak has undergone and in the future may undergo physical and mental suffering, inconvenience in carrying out her daily activities, loss of life's pleasures and enjoyment, and claim is made therefor. 14. Mrs. Tuschak 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. CLAIM II Frank Tuschak v. Kathleen Marshall 15. Paragraphs 1 through 14 of the Complaint are incorporated herein by reference. 16. As a result of the aforementioned injuries sustained by his wife, Plaintiff Kim Tuschak, Plaintiff Frank Tuschak has been and may in the future be deprived of the care, companionship, consortium, and society of his wife, all of which will be to his great detriment, and claim is made therefor. 427281 WHEREFORE, Plaintiffs Kim and Frank Tuschak demand judgment against Defendant Kathleen Marshall in an amount in excess of Fifty Thousand Dollars ($50,000.00), exclusive of interest and costs and in excess of any jurisdictional amount requiring compulsory arbitration. ANGINO & ROVNER, P.C. Date: ~ a"~ " ~ l David'L. Lutz I.D. No. 35956 4503 N. Front Street Harrisburg, PA 17110 (71 T) 23 8-6791 -phone (717) 238-5610 -fax dlutz@angino -rovner. com Attorney for Plaintiffs 427281 VERIFICATION We, Kim and Frank Tuschak, Plaintiffs, have read the foregoing COMPLAINT and do hereby swear or affirm that the facts set forth in the foregoing are true and correct to the best of our knowledge, information and belief. We understand that this Verification is made subject to the penalties of 18 Pa.C.S.A. Section 4904, relating to unsworn falsification to authorities. ,(~ ~ v Kim Tuschak ,~.~ r.. 9 , ~ ~ /~C Dated: ~~~ 7~ Frank Tuschak 427281 BLGRPP ..........................::::..::,.::::.:.:::,:.:.::.::. _::::............. q Erie ERTF INSURANCE EXCHANGE ,° di Insurance ~ FAMILY AUTO POLICY ~~ Group ~ CONTINUATION NOTICE 100 Erie Ini PL Erie, PA 16530 AA7982 JACK M. PANAS INS. INC. 02/02/09 TO 02/02/10 Q02 0208349 H FRANK TUSCHAK,JR & KIM TUSCHAK '' 4 N SEASONS DR DILLSBURG PA 17019-9519 AGENT - JACK M. PANAS INS. INC. 725 N. US HIGHWAY 15 ~**** AGENT PHONE- (717) 432-5595 DILLSBURG PA 17019 1616 ************************************************************ * CONGRATULATIONS! A PIONEER EXPERIENCE RATING CREDIT HAS * BEEN APPLIED TO YOUR POLICY PREMIUM. ************************************************************ ITEM 4. AUTOS COVERED AUTO YR MAKE VIN ST TER PHY LI OT RATING CLASS DDP 1 98 GMC SIERRA1500 1GTEC14W7WZ524672 PA lU 8 11 11 A1BL-M MM56 2 07 CHEV SILVERADO 3GCEC14X57G255484 PA lU 7 07 16 ALAS-M FM52 3 08 CHEV EQUINOX 2CNDL43F086291257 PA lU G 07 19 A2AL-M FM52 ITEM 5. INSURANCE IS PROVIDED WHERE A PREMIUM OR INCL, IS SHOWN FOR THE COVERAGE. COVERAGES, LIMITS AND ANNU~IL PREMIUMS ARE AS FOLLOWS- M EQUALS THOUSAND $ #1 #2 #3 - THE LIMITED Z LIABILITY PROTECTIC BODILY INJURY 3C PROPERTY DAMAG~ FIRST PARTY BENEFI~ MEDICAL EXPENSE UNINSURED MOTORIST BOD INJ ~300M/PEP UNDERINSUR D MOTORI BOD INJ $300M/PEA PHYSICAL DAMAGE COV *****GOOD DRIVER RATES APPLY***** ORT OPTION APPLIES TO ALL PRIVATE PASSENGER VEHICLES. --- N- OM/P RSON $300M/ACC 59 42 53 100M~ACC 61 44 55 5M_ 19 ~ 17 ~ 19 /ACC-UNSTACKED S- ACC-UNSTACKED COMPREHENSIVE - $250 DED COLLISION - $500 DED TOTAL ANNUAL PREMIUM FOR EACH AUTO 8 9 45 50 69 84 $ 924 267 TOTAL ANNUAL POLICY PREMIUM ITEM 6. APPLICABLE POLICY ENDORSEMENTS EXCEPTIONS ALL AUTOS - FAP 03/07, AF~FO1 03/07, AF1~A03 10/08*. AUTO 1 - AFPU01 03/07. AUTO 3 - AFPU01 0307. 9 50 149 375 TO DECLARATIONS ITEMS ANTI-THEFT DISCOUNT APPLIES-ALARM AUTO 2 ANTI-THEFT DISCOUNT APPLIES-ALARM AUTO 3 AUTO~HOME MULTI POLICY DISCOUNT APPLIES PASS VE RESTRAINT DISCOUNT APPLIES - DUAL AIRBAGS AUTO 1 PASSIVE RESTRAINT DISCOUNT APPLIES - DUAL AIRBAGS AUTO 2 PASSIVE RESTRAINT DISCOUNT APPLIES - MULTIPLE AIRBAGS AUTO 3 ANTI-LOCK BRAKE DISCOUNT APPLIED AUTO 1 ANTI-LOCK BRAKE DISCOUNT ,APPLIED AUTO 2 ANTI-LOCK BRAKE DISCOUNT APPLIED AUTO 3 PAY PLAN DISCOUNT APPLIES *~r**********************>~********************~r********************* * FIRST ACCIDENT FORGIVENESS APPLIES. THE FIRST SURCHARGE FOR A * FUTURE AT-FAULT ACCIDENT WILL BE WAIVED. * ******************************************************************* 027003 ^ Yn wF S n i /n ~ /n a ~- 2p{~ MpR -~ PM 2~ 19 C ~-~~ ~~ =~~:u .IOHNSON, DUFFIE, STEWART 8~ WEIDNER By: John R. Ninosky, Esquire I.D. No. 78000 301 Market Street P. O. Box 109 Lemoyne, PA 17043-0109 Phone: (717) 761-4540 E-mail: jrn~jdsw.com Counsel for Defendant KIM AND FRANK TUSCHAK, IN THE COURT OF COMMON PLEAS OF Plaintiffs CUMBERLAND COUNTY, PENNSYLVANIA v NO. 09-8853 Civil Term CIVIL ACTION -LAW KATHLEEN MARSHALL, Defendant JURY TRIAL DEMANDED NOTICE TO PLEAD TO: Kim and Frank Tuschak and their counsel, David L. Lutz, Esquire YOU ARE REQUIRED to plead to the within Answer with New Matter within 20 days of service hereof or a default judgment may be entered against you. JOHNSON, DUFFIE, STEWART &WEIDNER By: J n R. Ninosky, Esquire Attorney I.D. No. 78000 Date: March 10, 2010 Counsel for Defendant JOHNSON, DUFFIE, STEWART 8c WEIDNER By: John R. Ninosky, Esquire I.D. No. 78000 301 Market Street - P. O. Box 109 Lemoyne, PA 17043-0109 Phone: (717) 761-4540 E-mail: jrn@jdsw.com KIM AND FRANK TUSCHAK, Plaintiffs v. KATHLEEN MARSHALL, Defendant Counsel for Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 09-8853 Civil Term CIVIL ACTION -LAW JURY TRIAL DEMANDED DEFENDANT'S ANSWER WITH NEW MATTER TO PLAINTIFFS' COMPLAINT AND NOW, comes the Defendant, Kathleen Marshall, by and through her counsel, Johnson, Duffle, Stewart 8~ Weidner, P.C., who files this Answer with New Matter to Plaintiffs' Complaint by respectfully stating the following: 1. Denied. After reasonable investigation, the answering. Defendant is without sufficient knowledge or information to form a belief as to the truth of the averments contained in this paragraph. The same are therefore denied, and strict proof demanded at the time of trial. 2. Admitted. 3. Denied. The averments contained in this paragraph are denied pursuant to Pa. R.C.P. 1029(e). 4. Denied. The averments contained in this paragraph are denied pursuant to Pa. R.C.P. 1029(e). 5. Denied. The averments contained in this paragraph are denied pursuant to Pa. R.C.P. 1029(e). 6. Denied. The averments contained in this paragraph are denied pursuant to Pa. R.C.P. 1029(e). 7. Denied. The averments contained in this paragraph are denied pursuant to Pa. R.C.P. 1029(e). 8. Denied. The averments contained in this paragraph are denied pursuant to Pa. R.C.P. 1029(e). CLAIM Kim Tuschak v. Kathleen Marshall 9. Defenda nt incorporates herein by refere nce the answers to paragrap hs 1 through 8 above as though fully set forth herein at length. 10. Denied. The averments contained in this paragraph are denied pursuant to Pa. R.C.P. 1029(e). 11. Denied. The averments contained in this paragraph are denied pursuant to Pa. R.C.P. 1029(e). 12. Denied. The averments contained in this paragraph are denied pursuant to Pa. R.C.P. 1029(e). 13. Denied. The averments contained in this paragraph are denied pursuant to Pa. R.C.P. 1029(e). 14. Denied. The averments contained in this paragraph are denied pursuant to Pa. R.C.P. 1029(e). CLAIM II Frank Tuschak v. Kathleen Marshall 15. Defendant incorporates herein by reference the answers to paragraphs 1 through 14 above as though fully set forth herein at length. 2 16. Denied. The averments contained in this paragraph are denied pursuant to . Pa. R.C.P. 1029(e). WHEREFORE, Defendant, Kathleen Marshall, respectfully requests that Plaintiffs' Complaint be dismissed with prejudice and that judgment be entered in her favor. NEW MATTER 17. Plaintiffs' Complaint fails to state a claim upon which relief may be granted. 18. Plaintiffs' claims and/or alleged losses may be barred by their comparative negligence. 19. Defendant's negligence, which is expressly denied, was not a substantial factor in causing any harm to the Plaintiffs. 20. Plaintiffs' claims and/or alleged losses may be barred by the limited tort doctrine. WHEREFORE, Defendant, Kathleen Marshall, respectfully requests that Plaintiffs' Complaint be dismissed with prejudice and that judgment be entered in her favor. Respectfully submitted, JOHNSON, DUFFIE, STEWART 8~ WEIDNER By: Jo n R. Ninosky, Esquire Attorney I.D. No. 78000 301 Market Street - P. O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Date: March 1, 2010 Attorneys for Defendant 3 VERIFICATION I, KATHLEEN MARSHALL, have read the foregoing Answer and New Matter, and hereby affirms that it is true and correct to the best of my personal knowledge, or information and belief. This Verification and statement is made subject to the penalties of 18 Pa. C.S. §49U4 relating to unsworn falsification to authorities; I verify that ail the statements made in the foregoing are true and correct and that false statements may subject me to the penalties of 18 Pa. C.S. §4904. r at leen arsha o~,e 23 U 386246 CERTIFICATE OF SERVICE I hereby certify that a copy of the foregoing Answer with New Matter has been duly served upon the following counsel of record, by depositing the same in the United States Mail, postage prepaid, in Lemoyne, Pennsylvania, on March 1, 2010: David L. Lutz, Esquire Angino & Rovner, P.C. 4503 North Front Street Harrisburg, PA 17110 JOHNSON, DUFFIE, STEWART 8~ WEIDNER By J hn R. Ninosky c- .r`, p- ~ ~ / r- ~E~~ ~ z Soto J~H~~wS~~ ~UFFlE JOHNSON, DUFFIE, STEWART & WEIDNER By: John R. Ninosky, Esquire I.D. No. 78000 301 Market Street P. O. Box 109 Lemoyne, PA 17043-0109 Phone: (717) 761-4540 E-mail: jrn@jdsw.com KIM AND FRANK TUSCHAK, Plaintiffs Counsel for Defendants C~~ ~ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA v• NO. 09-8853 Civil Term CIVIL ACTION -LAW KATHLEEN MARSHALL, : Defendant JURY TRIAL DEMANDED PLAINTIFFS' ANSWERS TO DEFENDANT'S INTERROGATORIES Date: June 21, 2010 ANGINO & ROVNER, P.C. utz PA I.D. No. 35956 4503 N. Front Street Harrisburg, PA 17110 (717) 238-6791 -phone (717) 238-5610 -fax dlutz@angino-rovner.com Attorney for Plaintiffs JOHNSON, DUFFIE, STEWART 8c WEIDNER By: John R. Ninosky, Esquire I.D. No. 78000 301 Market Street P. O. Box 109 Lemoyne, PA 17043-0109 Phone: (717) 761-4540 E-mail: jrn@jdsw.com KIM AND FRANK TUSCHAK, Plaintiffs Counsel for Defendants IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA v• NO. 09-8853 Civil Term CIVIL ACTION -LAW KATHLEEN MARSHALL, Defendant JURY TRIAL DEMANDED DEFENDANT'S INTERROGATORIES DIRECTED TO PLAINTIFFS TO: David L. Lutz, Esquire Angino & Rovner, P.C. 4503 North Front Street Harrisburg, PA 17110 PLEASE TAKE NOTICE that you are hereby required, pursuant to Pennsylvania Rules of Civil Procedure No. 4009 to serve upon the undersigned, within thirty (30) days after service of this Notice, the following documents. Date: May 20, 2010 401886 JOHNSON, DUFFIE, STEWART &WEIDNER By: John R. Ninosky, Esquire Attorney I.D. No. 78000 301 Market Street P. O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Attorneys for Defendant INTRODUCTION SCOPE. -- These standard interrogatories approved for use in all matters subject to Rule 4001 of the Pennsylvania Rules of Civil Procedure. DEFINITIONS. -- The following definitions are applicable to these standard interrogatories: "Document" means any written, printed, typed, or other graphic matter of any kind or nature, however produced or reproduced, including photographs, microfilms, phonographs, video and audio tapes, punch cards, magnetic tapes, discs, data cells, drums, and other data compilations from which information can be obtained. "Identify" or "Identity" means when used in reference to: (1) A natural person, his or her: (a) full name; and (b) present or last known residence and employment address (including street name and number, city or town, and state or county); (2) A document: (a) its description (e.g., letter, memorandum, report, etc.), title, and date; (b) its subject Matter; (c) its author's Identity; (d) its addressee's identity; (e) its present location; and (f) its custodian's identity; (3) An oral communication: (a) its date; (b) the place where it occurred; (c) its substance; (d) the identity of the person who made the communication; (e) the identity of each person to whom such communication was made; and (f) the identity of each person who was present when such communication was made; (4) A corporate entity: (a) its full corporate name; (b) its date and place of incorporation, if known; and (c) its present address and telephone number; (5) Any other context: a description with sufficient particularity that the thing may thereafter be specified and recognized, including relevant dates and places, and the identification of relevant people, entities, and documents. 440914 "Incident" means the occurrence that forms the basis of a cause of action or claim for relief set forth in the complaint or similar pleading. "Person" means a natural person, partnership, association, corporation, or government agency. STANDARD /NSTRUCTlONS. -- The following instructions are applicable to these standard interrogatories: (1) Duty to answer. -- The interrogatories are to be answered in writing, verified, and served upon the undersigned within 30 days of their service on you. Objections must be signed by the attorney making them. In your answers, you must furnish such information as is available to you, your employees, representatives, agents, and attorneys. Your answers must be supplemented and amended as required by the Pennsylvania Rules of Civil Procedure. (2) Claim of privilege. -- With respect to any claim of privilege or immunity from discovery, you must identify the privilege or immunity asserted and provide sufficient information to substantiate the claim. (3) Option to produce documents. -- In lieu of identifying documents in response to these interrogatories, you may provide copies of such documents with appropriate references to the corresponding interrogatories. 440914 1. Personal information. -- State: a.. Your full name; b. Each other name, if any, which you have used or by which you have been known; c. The name of your spouse at the time of the accident and the date and place of your marriage to such spouse; d. The address of your present residence and the address of each other residence which you have had during the past five years; e. Your present occupation and the name and address of your employer; f. Date of your birth; g. Your Social Security number; h. Your military service and positions held, if any; and i. The schools you have attended and the degrees or certificates awarded, if any. ANSWER: a. Kim Elaine Tuschak b. Same as above c. Frank Tuschak d. Four North Seasons Drive, Dillsburg, PA 17019 e. YMCA Director -West Shore YMCA, 410 Fallowfield Rd, Camp Hill, PA 17011 f. August 8, 1956 g. 202-42-5523 h. None i. Cedar Cliff High School Slippery Rock University - B.S. in Health, Physical Ed and Recreation 440914 2. Insurance. -- If you are covered by any type of insurance, including any excess or umbrella insurance, that might be applicable to the incident in this matter, state the following with respect to each such policy: a. The name of the insurance carrier which issued the .policy; b. The named insured under each policy and the policy number of each policy; c. The type(s) and effective date(s) of each policy; d. The amount of coverage provided for injury to each person, for each occurrence, and in the aggregate for each policy; and e. Each exclusion, if any, in the policy which is applicable to any claim thereunder and any reasons, if any, why you or the carrier claim the exclusion is applicable. ANSWER: See Plaintiffs declaration sheet previously provided and included in Plaintiffs' Responses to Defendant's Request for Production of Documents. 440914 3. Expenses. -- List and describe all expenses and losses that you have incurred because of the incident. ANSWER: Plaintiff is responsible for co-pays since her first party medical benefits have exhausted. See Plaintiffs medical bills previously provided and included in Plaintiffs' Responses to Defendant's Request for Production of Documents. 440914 4. Facfual basis for claims and defenses. -- State with particularity the factual basis for each claim or defense you are asserting in this case. ANSWER: See Complaint and medical records previously provided and included in Plaintiffs' Responses to Defendant's Request for Production of Documents. 440914 5. Witnesses. -- a. Identify each person who Was a witness to the incident through sight or hearing and/or Has knowledge of facts concerning the happening ~of the incident or conditions or circumstances at the scene of the incident prior to, at the time of, or after the incident. b. With respect to each person so identified, state that person's exact location and activity at the time of the incident. ANSWER: Joe K. Tuschak, son was in the passengers seat. No other witness stopped at the scene. 440914 6. Statements. -- If you know of anyone that has given any statement (as defined by the Rules of Civil Procedure) concerning this action or its subject matter, state: a. The identity of such person; b. When, where, by whom, and to whom each statement was made, and whether it was reduced to writing or otherwise recorded; and c. The identity of any person who has custody of any such statement that was reduced to writing or otherwise recorded. ANSWER: See Kathleen Marshall, Kim Tuschak and Robert Redding statements previously provided and included in Plaintiffs' Responses to Defendant's Request for Production of Documents. 440914 7. Reports of incident. -- Identify documents (except reports of experts subject to Pa. R.C.P. No. 4003.5) which describe the incident or the cause thereof. ANSWER: Plaintiff is not aware of any reports that describe the incident. 440914 8. Licensure -- If you were required by law or regulation to be licensed for the activity in which you were engaged at the time of the incident, state: a. The type of license required; b. The date you first obtained such a license; c. The dates of issuance and expiration of your current license(s); d. The identity of the authority that issued your license(s); e. The number of your license(s); f. The nature and duration of any revocation or suspension of Your license(s); g. The special restrictions, if any, imposed on your license. ANSWER: a. drivers license b. 1972 c. 10/7/08 8/9/12 d. Pennsylvania e. 17084654 f. None g. None 440914 9. Demonstrative evidence. -- If you know of the existence of any photographs, motion pictures, video recordings, maps, diagrams, or models relevant to the incident, state: a. The nature or type of such item; b. The date when such item was made; c. The identity of the person that prepared or made each item; and d. The subject that each item represents or portrays. ANSWER: None. 440914 10. Trial preparation material. -- If you, or someone not an expert subject to Pa. R.C.P. No. 4003.5, conducted any investigations of the incident, identify: a. Each person, and the employer of each person, who conducted any investigation(s); and b. All notes, reports or other documents prepared during or as a result of the investigation(s) and the persons who have custody thereof. ANSWER: None. 440914 11. Trial witnesses. -- Identify each person you intend to call as anon-expert witness at the trial of this case, and for each person identified state your relationship with the witness and the substance of the facts to which the witness is expected to testify. ANSWER: Plaintiff has not yet determined who will be called as witnesses at trial. Upon completion of Discovery or when a determination has been made, the answer to this Interrogatory will be seasonably supplemented. 440914 12. Expert witnesses. -- Identify each expert you intend to call as a witness at the trial of this matter, and for each expert state: a. The subject matter about which the expert is expected to testify; and b. The substance of the facts and opinions to which the expert is expected the testify and a summary of the grounds for each opinion. (You may file as your answer to this interrogatory the report of the expert or have the interrogatory answered by your expert.) ANSWER: Plaintiff has not yet determined who will be called as expert witnesses at trial. Upon completion of Discovery or when a determination has been made, the answer to this Interrogatory will be seasonably supplemented. By way of further response, Plaintiff reserves the right to call any of her several treating physicians. 440914 13. Tria! exhibits. -- Identify all exhibits that you intend to use at the trial of this matter and state whether they will be used during the liability or damages portions of the trial. ANSWER: Plaintiff has not yet determined what exhibits will be used at trial. Upon completion of Discovery or when a determination has been made, the answer to this Interrogatory will be seasonably supplemented. 440914 14. Books, ma4azines, efc. -- If you intend to use any book, magazine, or other such writing at trial, state: a. The name of the writing; b. The author of the writing; c. The publisher of the writing; d. The date of publication of the writing; and e. The identity of the custodian of the writing. ANSWER: Plaintiff has not yet determined what exhibits will be used at trial. Upon completion of Discovery or when a determination has been made, the answer to this Interrogatory will be seasonably supplemented. 440914 15. Admissions, -- If you intend to use any admission(s) of a party at trial, identify such admission(s). ANSWER: See Plaintiffs' Request for Admissions to Defendant Margaret Marshall Set No. 1 and Defendant's Response to Plaintiffs' Request for Admissions. 440914 16. Injuries and diseases alleged. -- Identify all injuries or diseases that you allege you suffered as result of the incident. ANSWER: See Complaint and Plaintiffs medical records previously provided and included in Plaintiffs' Response to Defendant's Request for Production of Documents. 440914 17. Prior or subsequent injuries or diseases -- If, either prior to or subsequent to the incident, you suffered any injury or disease in those portions of the body claimed by you to have been affected by the incident, state: a. The injury or disease you suffered; b. The date and place of any accident, if such injury or disease was caused by an accident; c. The identity of hospitals, doctors, or practitioners who rendered treatment or examination because of such injury or disease; and d. The identity of anyone against whom a claim was made, and the tribunal and docket number of any claim or lawsuit that was filed in connection with such injury or disease. ANSWER: None. 440914 18. Medical treatment -- If you received medical treatment or examination (including X- rays) because of injury or disease you suffered as a result of the incident, state: a. The identity of each hospital at which you were treated or examined; b. The date on which each such treatment or examination at a hospital was rendered, and the charge by the hospital for each; c. The identity of each doctor or practitioner by whom you were treated or examined; d. The date on which each such treatment or examination by a doctor or practitioner was rendered. and the charge for each; and e. The identity of any document(s) (except reports of experts subject to Pa. R.C.P. 4003.5) regarding any medical treatment or examination, setting forth the author and date of such document(s). ANSWER: See Plaintiff s medical records previously provided and included in Plaintiffs' Response to Defendant's Request for Production of Documents. 440914 19. Earnings before the incident -- For the period of three years immediately preceding the date of the incident, state: a. The name and address of each of your employers or, if you were self-employed during any portion of that period, each of your business addresses and the name of the business while self-employed; b. The dates of commencement and termination of each of your periods of employment orself-employment; c. The nature of your occupation in each employment orself-employment; and d. The wage, salary, or rate of earnings received by you in each employment or self-employment, and the amount of income from employment and self- employment for each year. ANSWER: Plaintiff is not making a claim for work loss. 440914 20. Earnings after the incident. -- If you have engaged in one or more gainful occupations subsequent to the date of the incident, state: a. The name and address of each of your employers or, if you were self-employed at anytime subsequent to the incident, each of your business addresses and the name of the business while self-employed; b. The dates of commencement and termination of each of your periods of employment orself-employment; . c. The nature of your occupation in each employment or self-employment; d. The wage, salary, or rate of earnings received by you in each employment or self-employment, and the amount of income from employment and self- employment for each year; and e. The date(s) of any absence(s) from your occupation resulting from any injury or disease suffered in this incident and the amount of any earnings or other benefits lost by you because of such absence(s). ANSWER: Plaintiff is not making a claim for work loss. 440914 21. Limitation of duties and activities after the incident -- If, as a result of this incident, you have been unable to perform any of your customary occupational duties or social or other activities in the same manner as prior to the incident, state with particularity: a. The duties and/or activities you have been unable to perform; b. The periods of time you have been unable to perform; and c. The identity of all persons having knowledge thereof. ANSWER: No loss of occupational duties. February 2008 -February 2009. Social/training runs: stopped running with my girlfriends weekends and weekdays. Walked with them on occasion. Stacey Pietras, Sue Shuter, Barb Walton, Terri Neyhart and Pam Maloney. Prior to February 2008 I was running 25-30 miles a week to maintain a fitness level to start marathon training, should I decide to run a fall or winter marathon. After the accident I was unable to run and started therapy and treatment with the chiropractor. After being released from physical therapy I began a slow progressive training program with the goal of 25-30 miles a week. This would include walking (5-6 miles) three times a week, stair stepper 4-5 miles two times a week and weight training (lower body, eventually working light upper body (no neck). Over time approximately 10-12 months I increased walking with jogging. Currently I am jogging and a little walking 5 miles 4-6 times a week. This program keeps me at a comfortable fitness level. 440914 22. Substance impairment. -- If you consumed any alcoholic beverage, sedative, tranquilizer, marijuana, cocaine, hashish, or other drug, medicine or pill during the eight hours immediately preceding the incident, state: a. The nature, amount, and type of item consumed; b. The amount of time over which consumed; c. The identity of any and all persons who have any knowledge as to the consumption of those items; and d. The identity of the physician or medical practitioner or other person who gave, purchased or prescribed any of said items, if any. ANSWER: None. 440914 23. Physical or mental disability -- If you were under any physical or mental disability at the time of the incident, explain the disability. ANSWER: None. 440914 24. Motor vehicle information -- With respect to all motor vehicles involved in the incident, state: a. The identities of the owner(s) and. operator(s) of each vehicle; b. The identity of the passenger(s) in each vehicle, if any; and c. The make, model, and year of each vehicle; ANSWER: a. Robert Redding b. Kim Tuschak and her son Joey c. 2004 Chevrolet Malibu 440914 25. Mofor vehicle damage. -- With respect to any vehicle you owned that was involved in the incident, state: a. The nature of any damage existing prior to the incident; b. The identity of any person who performed repairs to the vehicle following the incident; c. The total amount of the repair bill(s), or if not yet repaired, the total estimated cost of repairing the vehicle or the estimated value of the damages to the vehicle (include the identity of the person furnishing any such estimate); d. The date and place of last state inspection prior to the incident and identify the person making said inspection; and e. The nature of any defect in or problem with the vehicle and the length of time such defect or problem existed. ANSWER: Plaintiff does not own the vehicle. The owner was her father Robert Redding. a. None b. Lawrence Chevrolet c. $3,000.00 d. do not know e. No defect 440914 26. Motor vehicle operation. -- With respect to the vehicle you operated or in which you were a passenger, state: a. The destination and the point and time of departure of the vehicle; b. The purpose of the trip or journey in the vehicle; c. The time and place of all stops and departures between the commencement of the trip or journey and the time of the incident; d. Whether the operator of the vehicle was familiar with the surrounding area of the incident; and e. The weather conditions at the time of the incident, including visibility and roadway conditions. ANSWER: a. My song and I were on our way home to Dillsburg after dropping off my sister, Kathy in Marysville. We were returning from Reading, PA at which my song was a participant in a football camp. Departure from Reading was between 12-1 p.m. b. Football Camp c. Dropping off Kathy Young my sister in Marysville, PA. d. yes, 53 years familiar. e. Beautiful day, roads clear. 440914 27. Motor vehicle accident causation. -- State in detail the manner in which you assert that the incident occurred, specifying the speed, position, direction and location of each vehicle involved during its approach to, at the time of, and immediately after the collision. ANSWER: My car was stopped as I was looking over my left shoulder with left hand on the wheel. Traffic on Route 15 South was stop and go due to the heavy flow and red lights. I had to stop to let the traffic through. As I was looking back to see that it was clear, I heard and felt a loud "boom". I never looked in my rearview mirror until that point. I was surprised and confused. I drifted the car forward to clear the lane at which time 1 got out of the car to talk to the other driver. It was avery -brief discussion, exchanging insurance information. 440914 CERTIFICATE OF SERVICE I hereby certify that a copy of the foregoing Interrogatories has been duly served upon the following counsel of record, by depositing the same in the United States Mail, postage prepaid, in Lemoyne, Pennsylvania, on May 20; 2010 David L. Lutz, Esquire Angino & Rovner, P.C. 4503 North Front Street Harrisburg, PA 17110 JOHNSON, DUFFIE, STEWART & WEIDNER By John R. Ninosky 440914 VERIFICATION We, Kim and Frank Tuschak, Plaintiffs, hereby verify that the facts set forth in the foregoing document are true and correct to the best of our knowledge, information and belief. We understand that any false statements therein are made subject to the penalties of 18 Pa.C.S.A. Section 4904, relating to unsworn falsification to authorities. _- J9.~~~ Witness Witness Dated: lv ~7~b Kim Tuschak - .~ ~~'~~ Frank Tuschak 417884 CERTIFICATE OF SERVICE I, Mary T. Geraets, 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 the PLAINTIFFS' ANSWERS TO DEFENDANT'S INTERROGATORIES upon defense counsel via postage prepaid first class United States mail addressed as follows: John R. Ninosky, Esquire Johnson, Duffle, Stewart & Weidner 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 Attorney for Defendant Dated: ~ - ~ ~ _ `(~ 428588 EXHIBIT "E" IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA No. 09-8853 Civil Term JTD CA-Law ---------------------------x RIM AND FRANR TUSCHAK, Plaintiffs - vs - KATHLEEN MARSHALL,. Defendant. ---------------------------x Deposition of RIM TUSCHAR 4503 North Front Street May 25, 2010 Harrisburg, PA 9:30 a.m. IT IS HEREBY STIPULATED and agreed that the sealing of the within transcript is waived; IT IS FURTHER STIPULATED and agreed that all objections except as to the form of the question are reserved to the time of trial. ERSA COURT REPORTING 30 North 17th Street, Suite 1520 Philadelphia, PA 19103 ti (215) 564-1233 Fax (215) 564-1225 ORIGINAL KIM TUSCHAK 2 APPEARANCES: ANGINO & ROVNER 4503 North Front Street Harrisburg, PA 17101 BY: TODD GETGEN, ESQ. (717) 238-6791 For the Plaintiffs JOHNSON, DUFFIE, STEWART & WEIDNER 301 Market Street 1 Lemoyne, PA 17043 BY: JOHN NINOSKY, ESQ. (717) 761-4540 For the Defendant ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES KIM TUSCHAR 3 I N D E X WITNESS EXAMINATION BY PAGE Kim Tuschak Mr. Ninosky 4 Mr. Lutz 35 ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES KIM TUSCHAK 4 1 PROCEEDINGS 2 KIM TUSCHAK, having been duly sworn 3 by Gwen. A. Leary, Notary Public, was examined and 4 testified as follows: 5 6 EXAMINATION BY MR. NINOSRY: 7 Q My name is John Ninosky and we have 8 just been introduced. I'm an attorney who 9 represents Ms. Marshall on a case that you and 10 your husband instituted against her for an 11 accident that happened, I believe on February 3, 12 2008. 13 We are here for your deposition. 14 Have you ever gone through a deposition before? 15 A No. 16 Q It is a chance for me to meet you 17 and to ask you some questions. You have been 18 sworn in to tell the truth, just as you would in 19 a courtroom. I don't expect this to be very 20 long; but if at any point you need a break, let 21 me know and we can certainly accommodate you. 22 Okay? 23 A Yes. 24 Q You are not going to get a grade 25 today; so if you don't know something or if you ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES KIM TUSCHAK 5 1 don't remember something, please tell me that you 2 don't know or you don't remember. I don't want 3 you to guess. And I am sure Mr. Lutz doesn't 4 want you to guess at anything. Okay? 5 A Okay. 6 Q You can give me an estimate, but go 7 ahead and tell me that it is an estimate. All 8 right? 9 A All right. 10 Q If you don't hear me or don't 11 understand me, let me know and I will restate it 12 or rephrase it for you. 13 A Okay. 14 Q If you answer, I am going to assume 15 that you heard it, you understood it, and that 16 you answered it to the best of your ability. Is 17 that fair? ', 18 A Yes . 19 Q And you are doing a good job of 20 letting me finish before you respond, so it makes 21 a nice clean record. All right. 22 What is your current address? 23 A 4 North Seasons Drive, Dillsburg, 24 PA. 25 Q How long have you lived there? ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES KIM TUSCHAK 6 1 A 25 years. 2 Q Who do you live with now? 3 _P_ Frank Tuschak and my son, Joe 4 Tuschak. 5 Q How long have you been married to 6 Frank? 7 A Twenty years. g Q Any other marriages? 9 A Yes. 10 Q I am sure it was a long time ago -- 11 A Yes. 12 Q But to whom and when? 13 A Jeff Shellcross, 1979 -- 1984. 14 Q Did it end in divorce? 15 A Yes. 16 Q Which county, do you remember? 17 A Cumberland County. 18 Q Okay. Do you have any children, 19 other than Joe? 20 A No. 21 Q How old is Joe? 22 A Seventeen. 23 Q Is he a junior or senior this year? 24 A Junior. 25 Q And I think we just -- we were ., ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES FCIM TUSCHAK 7 1 talking, it is Northern High School? 2 A Correct. 3 Q Can I have your educational 4 background? 5 A Cedar Cliff High School, graduated 6 1978 and Slippery Rock University, 1978 -- Cedar 7 Cliff was 1974. 8 Q And what did you graduate the Rock 9 with? 10 A 1978. 11 Q What degree? 12 A Health and physical education, 13 Bachelor of Science. 14 Q Do you have a job? 15 A Yes. 16 Q Where do you work? 17 A The Harrisburg area YMCA West Shore 18 Branch. 19 Q What do you do there? 20 A I am a director. 21 Q As a director what are your 22 responsibilities? 23 A Administrative supervision, 24 supervise wellness center, staff, programs, 25 onsite programs and offsite programs. ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES KIM TUSCHAK 8 1 Q How long have you been a director at 2 the YMCA? 3 -~ A Fifteen years. .. 4 Q So at the time of the accident, that 5 was your job? 6 A Yes. 7 Q And was that also your 8 responsib ilities, then at the time of the 9 accident, as they are now? 10 A Pretty much, yes. 11 Q Any difference? 12 A No. I have actually been a senior 13 director for ten years with them. It was just a 14 higher level administration. 15 Q How close are you to the top of the 16 pyramid? 17 A Associate executive director. There 18 is an exe cutive director and then me. 19 Q Okay. So you are almost at the top? 20 A Almost. I like where I am at. 21 Q Have you had any other lawsuits, 22 other tha n this one, where you were a party? 23 Have you sued anybody else? 24 A Yes. Yes. 25 Q Okay. What type of case and when? ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES RIM TUSCHAK 9 1 A It was a dog bite. And it was in -- 2 probably ten years ago. 3 Q Were yeu the one who was bitten? 4 A Yes. 5 Q Did it end up in a trial or did it 6 resolve? 7 A It did go to trial. 8 Q Which -- Cumberland County or Berks 9 County? 10 A Cumberland County. 11 MR. LUTZ: I will be a little 12 technical. It was probably arbitration 13 as opposed to a jury trial. 14 MR. NINOSRY: Did you represent her? 15 MR. LUTZ: Yes. Was it the old 16 courthouse, on the second floor? 17 THE WITNESS: I don't know. 18 MR. LUTZ: The old courthouse as 19 opposed to the new? 20 THE WITNESS: It was square. 21 BY MR. NINOSRY: 22 Q Did you remember a jury sitting 23 there or three lawyers sitting up front? 24 A There were lawyers. 25 MR. LUTZ: I might add that there ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES RIM TUSCHAK 10 r 1 was no insurance involved. There was an 2 award and then we had trouble collecting 3 i t . ~ ~~• 4 BY MR. NINOSRY: 5 Q Other than that, any other lawsuits? 6 A No. 7 Q Have you ever been sued? 8 A No. 9 Q Any workers' compensation claims? 10 A No. 11 Q And I ask this of everybody, don't 12 be offended. Have you been convicted of any 13 crimes? 14 A No. 15 Q You don't look like a hardened 16 criminal, but I have to ask. 17 And my guess is you were living with 18 Frank and-Joe at the time of the crash? 19 A Yes. 20 Q Okay. Currently, who is your family 21 physician? 22 A Dr. Laurel Bailey. 23 Q Where is Dr. Bailey located? 24 A Silver Creek. 25 Q And how long has she been .your ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES KIM TUSCHAK 11 1 physician? 2 A Thirty years. 3 Q - So you are going to make this 4 deposition so much faster. Working for the some 5 place 15 years and same doctor for 30 years. 6 A Very predictable. Typical Central 7 Pennsylvania gal. 8 Q I don't know how typical that is 9 from what Mr. Lutz and I hear. 10 A Conservative Pennsylvania. 11 Q So my guess is Dr. Bailey, you are 12 going to have for probably at least the next year 13 or so? 14 A Yes. 15 Q Is there any other physician or 16 healthcare provider that you treat regularly for 17 maybe orthopedic problems? 18 A No. 19 Q You don't have a chiropractor or 20 anything? 21 A Dr. Olivetti. I have seen him on 22 occasion. 23 Q Did you see him before the crash at 24 all? 25 A I had seen him one other time for a ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES KIM TUSCHAK 12 1 series of adjustments. 2 Q Neck, back, what was he adjusting 3 before the crash? 4 A Before the crash it was just an 5 overall manipulation, which he does adjust the 6 neck and back and stretches my legs. 7 MR. LUTZ: Tell him why. 8 MR. NINOSRY: That was going to be 9 my next question. 10 A For running. I am a marathon -- gym, 11 was, a marathon runner. 12 Q How many have you run? 13 A Eighteen. 14 Q Oh, my. When was the last one? 15 A 2006. 16 Q So after you would have a marathon, 17 you would go and get some treatment with Dr. 18 Olivetti? 19 A Yes. Uh-huh. 20 Q Anyone other than Dr. Olivetti that 21 you would seek treatment? 22 A No. 23 Q And again, I am just talking about 24 orthopedic issues. 25 A Right. No. ELECTRONIC REPORTING STENOGRAPHIC~AFFILIATES KIM TUSCHAK 13 1 Q You ever see an orthopedic surgeon 2 for either neck or back problems? 3 - A No. 4 Q Prior to this incident, I should 5 say? 6 A No. 7 Q How long of courses of treatment 8 would you have with Dr. Olivetti when you would 9 see him? Was it weeks, months? And again, on 10 average. We can get the records. 11 A On average, maybe a month. 12 Q Would it be after a marathon or what 13 would spark the need to see Dr. Olivetti? 14 A Yeah. I would run maybe two 15 marathons a ~~ar; so it would be in between those 16 two marathons. 17 Q Which gets me to -- we're talking 18 about before the accident. What types of hobbies 19 and activities did you like to do? 20 A Running. 21 Q Okay. 22 A Gardening, cooking, spending time 23 with my son's sporting events. 24 Q What sports does Joe play? 25 A Football and baseball. ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES RIM TUSCHAK 14 1 Q And it is my understanding he was a 2 varsity baseball player. Was he also a varsity 3 football player this past year? 4 A Yes. 5 Q Okay. Any other activities that you 6 can think of that you would do on a regular basis 7 prior to the crash? 8 A Weight training. That's it. 9 Q On average, what was your running 10 routine before the crash? And it might vary on 11 whether you were training for a marathon, I take 12 it. 13 A On average, 30 miles a week if 14 running five, give or take, days a week. 15 Q So you do five or~six miles a clip? 16 A Yes. 17 Q How about the weight training? 18 Describe for me what the weight training routine 19 was. 20 A Twice a week, high reps, light 21 weights. 22 Q Would it be Nautilus? Would it be 23 free weights? What type of apparatus would you 24 use? 25 A Typically Cybex. ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES KIM TUSCHAK 15 1 Q What type of gardening did you like 2 to do? °3 A Vegetable gardening. 4 Q Bow big? 5 A I would say it's probably 40 by 40. 6 Q What types of vegetables did you 7 like to plant? 8 A Anything that my husband puts in the 9 ground, anything and everything. You name it, we 10 grow it. 11 Q Okay. 12 A Not corn. 13 Q In my household, we will plant 14 anything and everything. Now, whether it grows 15 is a~different story. 16 A He plants it. I harvest it. 17 Q And would that require you to go out 18 and do weeding and those types of things? 19 A He does the weeding. I do the 20 picking of the vegetables. He tries to get me to 21 weed, but -- 22 Q And how about the cooking? Was this 23 gourmet or routine cooking? Describe it for me. 24 A I would say routine cooking with a 25 flair of gourmet. I like to think so, anyway. ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES KIM TUSCHAK 16 1 Q And my guess is your son's 2 activities kept you hopping, at least, several 3 days a week, year-round? 4 A Year-round, definitely. Travel 5 baseball. 6 Q What is the name of his travel team? 7 A Well, at that time it was- the 8 Capitals and now it is the Mid-Atlantic Rookies. 9 Q Now, I would like to talk about the 10 accident, if we could. And it is my 11 understanding it was February 3, 2008. Is that 12 correct? 13 A Yes. 14 Q Where did the accident happen? 15 A At the ramp-from 581~going onto - 16 Route 15 South. 17 Q Camp Hill? 18 A Yes. 19 Q My guess is living in Dillsburg, you 20 are very familiar with that area? 21 A Yes. 22 Q What was your game plan? Were you 23 going home? 24 A Yes. My son and I were traveling 25 home. ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES KIM TUSCHAK 17 1 Q Do you remember what time the 2 incident happened? 3 A It was in early afternoon, I 4 believe, or mid afternoon. 5 Q Do you remember what day of the week 6 that would have been? 7 A That was Sunday. 8 Q What type of vehicle were you 9 driving. 10 A A Chevy Malibu. 11 Q And it's my understanding that was 12 owned by your dad? 13 A Yes. 14 Q Was that a vehicle that you would 15" operate on a regular basis at that time? 16 A We had borrowed it. They live in 17 Florida over the winter months. It gets better 18 gas mileage. 19 Q And it is a way to keep that vehicle 20 moving, so your parents don't come back to a dead 21 car? 22 A Yes. 23 Q And was Joe your only passenger? 24 A Yes. 25 Q Was he in the front seat? ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES KIM TUSCHAK 18 1 A Yes. 2 Q Were you both wearing your 3 seatbel.ts? 4 A Yes. 5 Q Does that vehicle, if you know, have 6 air bags? 7 A I assume it does. 8 Q What were the traffic conditions 9 like as you were approaching the off ramp? 10 A There was traffic. It wasn't 11 completely -- it wasn't your typical after work 12 hour backups, but there was some traffic. 13 Q Moderate traffic? 14 A Moderate, yes. 15 Q What was the weather like? 16 A It was nice. It was sunny. 17 Q Roads were dry? 18 A Yes. 19 Q Clear? 20 A Uh-huh. Yes. 21 Q Tell me what happened. 22 A I was coming up the ramp, slowed 23 down to turn my head left to look for oncoming 24 traffic. And the next thing I knew, I got rear 25 ended. ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES KIM TUSCHAR 19 1 Q Were you the first car in line -- my 2 assumption is you came to a stop at a red light? 3 A No . T~iere i s. ~o red light . I t i s a 4 yield. 5 Q Okay. And so you were looking for 6 oncoming traffic. You had yielded to see if 7 there was oncoming traffic? 8 A Yes. 9 Q Did you come to a complete stop? 10 A Yes. 11 Q Did you have any awareness of the 12 vehicle coming behind you, prior to the impact? 13 A No. 14 Q Can you describe the force of the 15 impact for me? 16 A It was forceful. It moved the car 17 forward a couple feet. We were surprised. We 18 heard a loud noise. 19 Q And I think I asked you this. There 20 was no vehicle in front of you. Correct? 21 A Right. 22 Q You were surprised. What happened 23 after that? 24 A I felt immediate -- I had my left 25 hand on the steering wheel. And as soon as -- ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES KIM TUSCHAK 20 1 upon impact, I felt a tingling sensation, like a 2 latent bolt go down my -- from my next to my 3 _t-1ZUmb and my fingers . And I -was a little , ,, 4 surprised. I pulled my car off the road to clear 5 traffic and got out of the car. And the gal got 6 out of her car and we looked at our cars. 7 The trunk was lifted up. I tried to 8 push the trunk down and it would not latch. And 9 we exchanged insurance information. I got my 10 insurance card out. 11 Q Did she apologize or anything to 12 you, that you recall? 13 A Yes, she did. 14 Q All right. And I interrupted you. 15 You exchanged insurance information, I believe? 16 A Yes. 17 Q Anything other than that? 18 A I called my husband to get advice 19 from him. We decided not to call the police, 20 because the car was running and I knew I could 21 drive it home. 22 Q Did you think you needed medical 23 attention at that point? 24 A At that time I was shook up, but I 25 didn't feel that I needed to go to the hospital. ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES KIM TUSCHAK 29 1 Q How about Joe, how was he? 2 A He was shook up, too; but he seemed 3 fine at the time . 4 MR. NINOSKY: Dave, was there a 5 claim for the boy? 6 MR. LUTZ: No. 7 MR. NINOSKY: Okay. 8 THE WITNESS: Actually, he did go 9 see the chiropractor for one treatment. 10 I forget, maybe it was two weeks later or 11 a week later he felt something in his 12 neck. I took him to the chiropractor, 13 but o ther than that -- 14 MR. NINOSKY: 15 Q That was it for him? 16 A Yes. 17 Q Okay. And as you were getting ready 18 to leave the scene, were you feeling any 19 discomfort? You told me you were shaken up; but 20 any pain, di scomfort at that point? I am trying 21 to break it into time segments. 22 A Uh-huh. Not that I remember. 23 Q So the plan was to go home? 24 A Yes. 25 Q Did you go home? ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES KIM TUSCHAK 22 1 A Yes. 2 Q What happened next, after you got 3 home? 4 A I know I had called the insurance 5 company. I believe I left a message for them, 6 because it was a Sunday afternoon. 7 Q And it is my understanding your 8 insurance company is Erie. Correct? 9 A Yes. 10 Q Okay. And what happened? You 11 called the insurance company. Did you give a 12 statement to them? 13 A Yes. 14 Q And it is my understanding there was 15 a recorded statement. Is that correct? - 16 A Yes. 17 Q What happened next? 18 A A couple days later I started -- the 19 tingling w as coming back in my arm. 20 Q A couple days later? 21 A Yes. 22 Q So before the tingling came back, 23 you were n ot feeling any pain or discomfort? 24 A I don't remember. I think I was, 25 but it was n't enough to really act on. ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES KIM TUSCHAK 23 1 Q I should ask you this. Back at the 2 time before the accident, were you taking any 3 medications-at the time of the crash?. 4 A No. 5 Q Okay. What did you do then when you 6 started to feel the tingling? 7 A I decided to go to Dr. Olivetti, the 8 chiropractor. 9 Q And again, this tingling is on your 10 left side? 11 A Yes. 12 Q What did Dr. Olivetti do for you? 13 A He evaluated my neck and started a 14 treatment plan. 15 Q What was that plan, from-your 16 recollection? 17 A I know there was some heat, 18 manipulation, I guess you could say, of the 19 shoulders. 20 Q Both or just the left side? 21 A I know he concentrated on the left, 22 but typically he tries to balance both sides out. 23 Q Was there any adjustments of the 24 neck that you can recall as part of his plan? 25 A I can't say for sure. ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES KIM TUSCHAK 24 1 Q Again, we have the records. We can 2 check that. 3 A Okay. .- 4 Q Were you having any discomfort, 5 pain, tingling, anywhere else, other than having 6 the tingling going down your left arm? 7 A No. 8 Q How long did you have a treatment 9 plan with Dr. Olivetti? 10 A I believe I saw him three months. 11 Q Did your symptoms get any better or 12 any worse during that three-month period? 13 A They got -- they started to get 14 better, then they got worse. Never completely -- 15~ L,constantly had the tingling, which it-got 16 worse. 17 Q And it was a constant tingling that 18 you felt? 19 A Yes. 20 Q Even without activity? 21 A Right. 22 Q And you said -- 23 A And neck pain, too. I should 24 mention that. 25 Q When did the neck pain start? ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES KIM TUSCHAK 25 1 A That went along with the arm 2 tingling. 3 ~- Q Okay. So you had neck pain..at the .- 4 time that you were having the arm tingling? 5 A Yes. 6 Q And after -- was there anything that 7 changed that you said things were starting to get 8 a little better and then it got worse? Was there 9 anything that happened? 10 A No. 11 Q You have had no other accidents, 12 falls or anything? 13 A No. 14 Q What did you do then as things got a 15~ little bi t worse--under Dr. Olivetti's care? 16 A We started to discuss further 17 treatment. And we talked about getting an MRI. 18 Q How did it get worse? The severity 19 of the symptoms or what? 20 A Yes. The neck pain, the discomfort 21 when I lay flat. I couldn't lay flat on my back. 22 Q So was there back pain or is it 23 still all focused on the neck and shoulder area? 24 A Yeah, neck and ,shoulder. 25 Q And was an MRI performed? ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES RIM TUSCHAK 26 1 A Yes. 2 Q And was that at the request of Dr. 3 Olivetti? 4 A I went to see my family physician 5 and she recommended that. 6 Q Did she make any other referrals, 7 other than for an MRI? 8 A Yes, to OIP for evaluation of the 9 MRI. 10 Q Do you remember which. physician you 11 saw at OIP? 12 A Is it Dailey, I believe, Dr. Dailey. 13 Q How many visits did you have at OIP? 14 A Just the visit with him, when he 15~ read the MRI to me . -- - -- 16 Q Do you remember -- or what is your 17 understandin g as to what he told you about the 18 MRI? 19 A Yes. He saw two herniated disks and 20 some stenosi s. I believe it was at disk 6 and 7 21 or 5 and 7, something like that. 22 Q Did he recommend any sort of 23 treatment for you at that point? 24 A Continue with the physical therapy 25 and gave me some medicine, Prednisone, if I ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES KIM TUSCHAK 27 1 needed it, which I didn't take. 2 Q Had you had any physical therapy at 3 that poin t by the time you had._seen_him?..- 4 A Yes. 5 Q Who had prescribed the physical 6 therapy? 7 A Dr. Dailey. 8 Q At the time that you had gone to 9 OIP, do y ou remember how long you would have had 10 physical therapy, either weeks, months, days? 11 A I am guessing a few weeks. 12 Q Had you stopped the chiropractic 13 treatment and then you went on to the physical 14 therapy? 15 A Yes.... . . 16 Q Okay. Where was the physical 17 therapy? 18 A Drayer, Trindle Road. 19 Q Close to work? 20 A Yes. 21 Q Altogether, how long did you have 22 physical therapy? 23 A Three to four months. 24 Q And generally, what types of things 25 did they do for you over that three- to ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES KIM TUSCHAK 28 1 four-month period? 2 A Traction, massage, muscle 3 stimulation and-eventually exercise. ' 4 Q So it is my understanding, and I am 5 just trying to get the list of the healthcare 6 providers. You would have seen Dr. Olivetti. 7 You would have seen your family physician. You 8 had one visit with OIP. And you had physical 9 therapy with Drayer? 10 A Yes. 11 Q Correct? 12 A Yes. 13 Q Anyone other than those physicians 14 that you treated with for injuries related to the 15 accident? 16 A No. 17 Q Have you -- when was the last time 18 you had any treatment for injuries you contend 19 are related to the accident? 20 A It would have been October 2008. 21 Q Is that the end of the physical 22 therapy? 23 A Yes. 24 Q Or give or take? 25 A Yes. ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES KIM TUSCHAK 29 1 Q So there would have been about seven 2 or eight months of active treatment. Is that a 3 fair statement? ~~ 4 A Yes. 5 Q Okay. Any discussions of surgery of 6 any sort? 7 A Drayer -- not Drayer, Dailey 8 mentioned that if it would get worse, that could 9 be a potential future thing. 10 Q But he didn't recommend -- 11 A No. He didn't recommend -- at this '12 time, no. 13 Q Any injections or anything along 14 those lines? 15 A No . .. 16 Q Have you been on any medication 17 since October 2008 for injuries related to the 18 accident? 19 A No. 20 Q Since October 2008, have you been 21 put on any medical restrictions? 22 A No. 23 Q And my guess is, you don't have any 24 appointments with any physicians for injuries 25 related to the accident either? ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES RIM TUSCHAK 30 1 A No. 2 Q Okay. Are you still having 3 symptoms? 4 A Slight. 5 Q Describe for me what you are feeling 6 and when. 7 A On occasion I still have the 8 tingling in my index finger. 9 Q And again, the left index? 10 A Yes. And stiffness in my neck. I 11 don't have quite the mobility that I had at one 12 point -- prior to. 13 Q But no medications to address this? 14 A No. 15 ~ Q Are you seeing Dr. Olivetti at all? 16 A No, I have not. 17 Q Any other chiropractor? 18 A No. 19 Q Is there anything that kind of 20 precipitates the stiff neck or the tingling? 21 Working in the yard or whatever? 22 A Not that I am aware of. 23 Q Are there things that you don't do 24 now that you did before the accident? 25 A Run marathons. ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES KIM TUSCHAK 3] 1 Q I think you had told me the last one 2 you had run before the accident would have been 3 in 2006. Did I write that..~,own correctly? 4 A That sounds about right. 5 Q And you didn't do any in 2007? 6 A No. 7 Q Why not? ~' 8 A Time. It takes a lot of time to run 9 marathons. 10 Q And did you have any plans or 11 anticipate running any in the calendar year 2008? 12 And the crash happened in February. 13 A I was going to run the Pittsburgh 14 Marathon, but I forget what year it was. Plans ~15 to run the Pittsburgh Marathon either-that year 16 or the following year, which is in May. 17 Q So either in 2008 or 2009 you were 18 going to do the Pittsburgh Marathon? 19 A Let's say 2009 or 2010. 20 Q Okay. Why didn't you run it in 21 2009, any marathon in 2009? 22 A Time. 23 Q Which is really my question. Are 24 you not running the marathons because of the 25 injuries you sustained or is it just because Joe ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES KIM TUSCHAK 32 1 is busy and all those types of things? 2 A Right. It's that, not because of 3 _- the injury. .. .:.. 4 Q Is there anything that you are not 5 doing now as a result of the injuries you 6 sustained that you did before the crash? And I 7 had written down that you would be running about 8 30 miles a week, give or take? 9 A Right. 10 Q Are you still running 30 miles a 11 week? 12 A 25, 20 or 25. 13 Q Again, was the reduction due to time 14 or due to your neck and shoulder? 15 A Time and motivation-: - 16 Q You are really a slacker now? 17 A Yeah. I am feeling it. 18 Q Still have the garden? 19 A Yes. 20 Q And your responsibilities in the 21 garden are the same now as what they were at the 22 time of the crash? 23 A Yes. 24 Q And how about in 2008, when you were 25 going thr ough the physical therapy and treatment, ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES KIM TUSCHAK 33 i 1 were you still out in the garden? 2 A Probably not as much. 3 Q When dra. you think -- how was your 4 activity level affected by your injury and your 5 treatment , during that six- to eight-month 6 period? 7 A I wasn't running or weight lifting. 8 I eventua lly got back to walking. Stretch, I do 9 a lot of stretching. 10 Q But you were still able to do the 11 gardening ? 12 A I don't remember. 13 Q Okay. Were you still able to go to 14 your son' s activities? 15 A Yes . ___ 16 Q And still doing -- semi-gourmet 17 cook? 18 A Yes. 19 Q And how about just in the household, 20 prior to the accident, how did you and your 21 husband divide responsibilities for keeping up 22 with the house? Sounds like you were the cook? 23 A Yes. 24 Q How about laundry, grass cutting, 25 you know, that type of stuff? ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES KIM TUSCHAR 34 1 A I made due. I don't really remember II 2 how much of an effect it had. 3 - Q Before the crash, would you be in -- 4 you were in charge of cooking? 5 A Yes. 6 Q Were you in charge of laundry? 7 A Yes. 8 Q How about grass and those types of 9 outside s tuff? 10 A No. 11 Q Was that your husband's 12 responsibility? 13 A Yes. 14 Q Okay. And today is it kind of back 15 to normal, that you are still doing the cooking 16 and he is doing the outside things? 17 A Yes. 18 Q Are you back to the same weight 19 training regimen of a couple days a week with the 20 high reps on the Cybex? 21 A Yes. 22 Q Is there any other way you think 23 this accident has adversely impacted you, that we 24 have not already talked about? 25 A No. ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES KIM TUSCHAK 35 1 Q Do you have any out-of-pocket 2 expenses, anything that wasn't covered by 3 insurance? .,. 4 A Just the deductibles. 5 Q Do you have any sort of an idea how 6 much that was or is? And I am sure Mr. Lutz can 7 .tell me later. 8 A No. 9 Q Okay. Are we talking about hundreds 10 or thousands? 11 A I don't know. 12 Q Okay. We can track that down. 13 MR. NINOSRY: Ma'am, those are all 14 of the questions that I have for you. 15 Thank you. 16 THE WITNESS: All right. 17 MR. LUTZ: I'm actually going to ask 18 some questions. 19 1120 EXAMINATION BY MR. LUTZ: 21 Q Mrs. Tuschak, I want you to focus on 22 the year before the accident. February 1, 2007, 23 to February 1, 2008. Are you with me? Say yes. 24 A Yes. 25 Q During that year period, were you ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES KIM TUSCHAK 36 1 running approximately 30 miles a week? 2 A Yes. 3 Q Would you run ev~r~.day or did you 4 take some days off? 5 ~ A I would take a day or two off a 6 week, yes. 7 Q Mr. Ninosky asked you earlier, you 8 think you were averaging about five or six miles 9 a day when you would run? 10 A Yes. 11 Q Okay. Why were you running so much? 12 A I always want to keep a training 13 plan ready if I decide to do a marathon, keep my 14 mileage up. 15 - Q Have you been running pretty much 16 all your adult life? 17 A Yes. 18 Q If you were not in this accident, 19 would you h ave run the Pittsburgh Marathon either 20 May of 2009 or May of 2010? 21 A Possibly. 22 Q But at the time of the accident, you 23 had, I thin k you testified, had done 18 24 marathons? 25 A Yes. ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES KIM TUSCHAK 37 l 1 1 Q Just so we are all clear, how long 2 is a mara thon in terms of miles? 3 A - 26.286 miles. 4 Q Now, after the accident, I. 5 understand from your answers to Mr. Ninosky's 6 questions there was a period of time you did not 7 run at al l? 8 A Correct. 9 Q In fact, I think you said you had to 10 start wal king to build up your endurance, I 11 think? 12 A Just because it was painful to run. 13 Q How did you feel about not running 14 for that period of time after the accident? Y5 ' ~ A . ~-Streased. - 16 Q Why? 117 A Because it is my lifestyle. It is X18 my stress reliever. 19 I Q Okay. Can you tell me approximately ~20 when you started walking after the February 1, 21 2008, acc ident? 22 A June. 23 Q June of 20.08? 24 A Yes. 25 Q Can you tell me when you started to ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES RIM TUSCHAK 38 1 try to resume some type of running after the 2 accident, if you know? 3 A Maybe, I am guessing, the beginning 4 of September. 5 Q Did you start out slow? 6 A Yes. 7 Q How many miles did you start out, if 8 you remember? 9 A It was more of a walk/run, as many. 10 miles as I could get in at the time, probably 11 three I am guessing. 12 Q And I think you testified that you 13 now run about 25 miles a week? 14 A Yes. 15 Q Do you know how long yourhave-been 16 doing about 25 miles a week, if you know? 17 A 25 years. 18 Q Well, my question was a bad one. 19 There was a period of time after the accident, it 20 sounds like, you didn't run at all; and then you 21 started to walk; and then you started to build up 22 your running a little bit. 23 So my question to you is, do you 24 know when you started to run. 25 miles a week 25 after the accident? ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES KIM TUSCHAK 39 1 A Well -- 2 Q If you know. .?. A It probably would have been ., 4 November, winter. 5 Q And do you run even when it is cold 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 out? A Yes. Q Do y ou run inside or outside? A If I can run outside, I go outside. Q And if it is below 32 degrees, do you still run out side? A Yes. MR. LUTZ: All right. Very good. Thank you. Mr. Ninosky may have some ---- questions, based on my questions. MR. NINOSRY: No. I don't. Thank you. T8E WITNESS: You're welcome. (Deposition adjourned at 10:13 a.m.) ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES KIM TUSCHAK 40 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 C E R T I F I C A T E I, Gwen A. Leary, the officer before whom - ~. the within deposition(s) was taken, do hereby. certify that the witness whose testimony appears in the foregoing deposition(s) was duly sworn by me on said date and that the transcribed deposition of said witness is a true record of the testimony given by said witness; That the proceeding is herein recorded fully and accurately; That I am neither attorney nor counsel, nor related to any of the parties to the action in which these depositions were taken, and further that I am not a relative of any attorney or counsel employed by the parties hereto, or financially interested in this action. 20 Gwen A. Leary, Reporter 21 Notary Public in and for the Commonwealth of Pennsylvania 22 23 My .commission expires September 1, 2010. 24 25 ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES KIM TUSCHAK 41 1 2 " °` 3 4 5 6 7 8 9 10 ~ 11 C E R T I F I C A T E I, Gwen A. Leary, the officer before whom the within deposition(s) was taken, do hereby certify that the witness whose tes`~imany appears in the foregoing deposition(s) was duly sworn by me on said date and that the transcribed deposition of said witness is a true record of the testimony given by said witness; That the proceeding is herein recorded fully and accurately; That I am neither attorney nor counsel, nor related to any of the parties to the action in which these depositions were taken, and further that I am not a relative of any attorney or counsel employed by the parties hereto, or financially interested in this action. 12 13. 14 15 16 17 18 19 20 21 22 23 24 25 Gwen A. Leary, R orter Notary Public in and for the Commonwealth of Pennsylvania My commission expires September 1, 2010. ELECTRONIC REPORTING STENOGRAPHIC AFFILIATES EXH/BI T "F" ti~~~~~ CHIROp~~~h O~ rn ~; ~:.. z; y9~l SBURG Q e z` ~~ E~~S~ Mark T. Olivetti, D.C. 856 Century Drive, Suite C Mechanicsburg, Pa 17055 717-697-7058 September 9, 2009. To whom it may concern: Re: Kim Tuschak Date of Birth: August 8, 1956 Accident Date: February 3, 2008 Mrs.Tuschak was first examined and treated on February 6, 2008. She had sustained injuries from a motor vehicle accident dated February 3, 2008. On the day of the exam, Mrs. Tuschak complained of neck pain and sore shoulders. Additional complaints of mid back pain and left arm are noted. At the time of her exam, her current pain level was graded at a 4/10 with 10 being unbearable pain. Her symptoms were present 51-75% of the time. She had minimal interference with her daily activities. With examination and review of the case history, the following diagnoses were produced: 847.0 C/S S/S, 847.1 T/S S/S, and 847.2 L/S S/S, 723.1 Neck Pain. Treatment consisted of chiropractic ir~aiiipulation, manual therapies, and ultrasound. Mrs. Tuschak was initially seen.twice a week for treatments. Progress was made, and a decrease in frequency to once a month was decided on Apri19, 2008. However, Mrs. Tuschak's paresthesia of the left arm and hand gradually returned and worsened. At this point, a medicaUorthopedic evaluation was requested. Symptoms appear to be permanent at this point in her treatment. Mrs. Tuschak was last seen on May 21, 2008. She had not made any notable progress since the previous visit. She continued to have pain in the neck increased by forward movement and radiating pain in her left shoulder. It was agreed that physical therapy could be of benefit. MRI had been scheduled for the cervical spine and physical therapy sessions had been scheduled also. At this point in the treatment chiropractic was palliative and not curative. Other treatments were considered and addressed with her medical doctors. At the time of the last evaluation, Mrs. Tuschak's injuries appeared permanent. Mrs. Tuschak's prognosis is fair. Chiropractic manipulation and manual therapy techniques have proved to be palliative for Mrs. Tuschak's condition. Symptoms gradually returned. Supportive care for Mrs. Tuschak will involve tia~~~l CHIROpR9o~ O~ •~ ~;~ z ,. ~ 9 9~~cSeuRC, PEr'~'`' Mark T. Olivetti, D.C. 856 Century Drive, Suite C Mechanicsburg, Pa 17055 717-697-7058 chiropractic manipulation, manual therapies and/or therapeutic exercises. Office visits consisting of chiropractic manipulation and therapeutic exercises will be billed at $70 per visit. I would estimate 24 visits a year to properly manage exacerbations. Mrs. Tuschak did not have these symptoms prior to her accident. There is a reasonable degree of medical certainty that all of Mrs. Tuschak's injuries and the treatment that was provided is directly related to the clients automobile accident. Please refer to the MRI that was scheduled to be taken after I released Mrs. Tuschak from care. This may show further medical evidence of trauma. Sincerel , Mark T Olivetti, DC Patient Name: Tuschak, Kim suprespinatus muscle area revealed myofascial trigger point with radicular pain into the left upper arm region. There is myofascial trigger point in the rhomboids muscle area. A posterior subluxatian was found at Ct3. T1 was revealed to have a left maalignment. Assessment: Today's evaluation of Ms. Tuschak's condition shows approximately a 8% improvement since her previous visit. The current treatment plan has reduced the intensity of the patient's symptoms. Patient attempted withdraw! from care and symptoms have gradually worsened. Requested an orthopedfGmedical examination. Syptoms appear to be permanent. Mrs. Tuschak did not have these symptoms prior to the accident.. Plan: The patient will be treated every other week for 1 month. The patient also continues to be instructed to perform spedfic exereses and use a cold pack while at home. Chiropractic manipulation was performed to the following areas: Cenical, Thoracic, and Jumbo-sacral region. 5/21/2008 Subjective: On today's visit, Ms. Tusdtak stated her pain in the left region of the neck which is increased by {onward movement is feeling about the same as her prior visit. Ms. Tuschak also indicated her radiating pain into the left shoulder and hand is feeling about the same as her previous visit. Additionally, the patient indicated her pain in the left mid back is feeling about the same as her previous visit. Paraesthesia is still present, however chiropractic treatment is palliative. Objective: Discomfort of a mild level was revealed during palpation at Ct3. L5 was revealed to have a mild level of tendemess when evaluated by, palpation. A mild level of tendemess was found upon palpation of the patient's spinal tissues at T4. Evaluation of the supraspinatus muscle area revealed a trigger point with pain with radiation to the left upper arm region. A trigger point was revealed with pain in the fiomboids muscle area. C6 was revealed to be subluxated posterior. A misalignment was revealed, T1 left. Assessment: No notable progress since the previous visit was evident during today's assessment of the patient's condition. Ms. Tuschak will begin Physical Therapy nextweek. A re-exam will be done after 4 weeks of Physical Therapy. An MRI has been scheduled.. Plan: The patient will be treated 1 time per week for 1 month. Therapy on the left upper arm region today included trigger point therapy for 10 minutes to restore normal spinal biomechanics. To increase the effectiveness of Ms. Tuschak's treatment, she continued today to perform specific exercises and use a cold pack whife at home. Chiropractic manipulation was performed to the following areas: Cervical, Thoracic, and Jumbo-sacral region. Olivetti Chiropractic Office 717-697-7058 Mark T. Olivetti, DC Fax: 717-697-1700 Patient Name: Tuschak, Kim Plan: The patient will be treated every other week for 1 month. Therapy on the shoulder region today inducted trigger point therapy and ultrasound to restore normal spinal biomechanlcs. To increase the effectiveness of Ms. Tuschak's treatment, she continued today to use a cold pads while at home. Chiropractic manipulation was performed to the following areas: Cervical, Thoradc, and Jumbo-sacral region. 4/9/2008 Subjective: On today's visit, Ms. Tusdtak stated her pain in the left region of the neck which is Increased by forward movement remains unchanged since her previous visit. Additionally, the patient stated her radiating pain into the left shoulder and hand remains unchanged since her previous visit. The patient also stated the severity of her pain in the left mid back improved noticeably since her last visit to 3/10. Radiating pain continues to decrease. Objective: Tendemess of a mild degree was revealed during palpation at Ct3. A mild degree of pain was revealed upon palpation of Ms. Tuschak's spinal area at L5. T4 was found to have a mild degree of tendemess when evaluated by palpation. Evaluation of the supraspinatus muscle area revealed a trigger point with pain with radicutar pain into the left upper arm region. There is myofascal trigger paint in the rhomboids musde area. A posterior maalignment was found at Ct3. T1 was revealed to have a left subluxation. Assessment: Overall, the patient has shown approximately a 9% improvement since her previous visit. Ms. Tuschak is responding positively io her treatment thus far and has shown a reduction in the intensity of her condition. Continue at home posture exercises.. Plan: The patient viii be treated every other week for 1 month. Therapy on the cervical region today included therapeutic exerdses performed for 10-15 minutes to restore normal spinal biomechanics. The patient also continues to be instructed to perform specific exerdses and use a cold pack while at home. Chiropractic manipulation was performed to the following areas: Cervical, Thoradc, and Jumbo-sacral region. 5/7/2008 Subjective: Ms. Tuschak stated that on today's visit her pain in the left region of the neck which is increased by forward movement has not noticeably changed since her previous visit. Additionally, the patient stated the severity of her radiating pain into the left shoulder and hand has increased since her previous visit to 4/10. Additionally, Ms. Tuschak stated her pain in the left mid back is feeling about the same as her last visit. The paraesthesia of the left hand and arm that is Increased with flexion of the cervical spine gradually returned. The paraesthesia is now worse than the previous visit. Objective: A re-examination was performed today. Ct3 was found to have a mild degree of pain and discomfort when evaluated by palpation. Palpation of the spine at L5 results In mild tendemess. Pain and discomfort of a mild degree was revealed during palpation at T4. There is myofasdal trigger point in the supraspinatus musde area with radiation to the left upper arm region. Palpation of the rhomboids musde area revealed myofasdal trigger point. C6 was found to have a posterior misalignment. T1 was revealed to be subluxated, left. Palpation revealed normal (grade +5) musde strength of the upper extremities. Assessment: The patient seems to be tolerating the treatment as expected but has shown no notable change since the prior visit. Patient attempted withdraw) from care and symptoms have gradually worsened. Requested an orthopediGmedical examination. Syptoms appear to be permanent. Mrs. Tuschak did not have these symptoms prior to the acddent.. At this time, the patient is in a rehabilitative stage of care and has a fair prognosis. Plan: The patient will be treated every other week for 1 month. Ms. Tuschak also continues to be instructed to perform spedfic exercises and use a cold pads while at home. Chiropractic manipulation was performed to the following areas: Cervical, Thoracic, and Jumbo-sacral region. 5N8/2008 Subjective: The patient stated that on today's visit her pain in the left region of the neck which is increased by forwaM movement is feeling about the same as her previous visit. The patient also reported the severity of her radiating pain into the left shoulder and hand improved modestly since her fast visit to 3/10. In addition, she also indicated her pain in the left mid bads remains unchanged since her last visit. Paraesthesia is still present, however chiropractic treatment is palliative. Objective: C8 was found to have a mild degree of pain and discomfort when evaluated by palpation. A mild degree of discomfort was revealed upon palpation of the patient's spinal tissues at L5. Palpation of the spinal tissues at T4 causes mild discomfort. Palpation of the Olivetti Chiropractic Office 717-697-7058 Mark T. Olivetti, DC Fax: 717-1397-1700 Patient Name: Tusdtak, Kim with a reduction in the intensity of her condition. Ms. Tuschak is in a relief/repair phase of care and has a good prognosis. Plan: The patient will be treated 1 time per week for 2 weeks. Treatment consisted of chiropractic manipulation and therapy on the shoulder region today included trigger point therapy and ultrasound to restore normal spinal biomechanics. The patient will also continue to use a cold pack while at home. 2/27/2008 Subjective: Ms. Tuschak stated that on today's visit her pain in the left region of the neck which is increased by'iorward movement has not noticeably changed since her previous visit. Additionally, the patient stated her radiating pain into the left shoulder and hand remains unchanged since her last visit. Furthermore, the patient indicated her pain in the left mid back is feeling about the same as her prior visit. Objective: Tendemess of a mild degree was revealed during palpation at C6. A mild degree of pain was revealed upon palpation of Ms. Tuschak's spinal area at L5. T4 was found to have a mild degree of tendemess when evaluated by palpation. Palpation of the suprespinatus musde area revealed myofascial trigger point with radiating pain into the left upper arm region. Palpation of the rhomboids muscle area revealed myofasciai trigger point. CB was found to have a posterior malalignment. T1 was revealed to be misaligned, left. Assessment: An assessment of the patient's current condition as compared to their prior treatment shows no substantial improvement. At this time, the patient is in a relief/repair stage of care and has a good prognosis. Plan: The patient will be treated 1 time per week for 2 weeks. Therapy on the shoulder region today inducted trigger point therapy and ultrasound to restore normal spinal biomechanics. To increa"se the effectiveness of Ms. Tuschak's treatment, she continued today to use a cold pack white at home. Chiropractic manipulation was perforated to the tollowing areas: Cervical, Thoracic,-and Jumbo-sacral region. 3152008 Subjective: On today's visit, Ms. Tuschak stated her pain in the left region of the neck which is increased by forward movement remains unchanged since her previous visit. Furthermore, the patient stated the severity of her radiating pain into the left shoulder and hand improved modestly since her prior visit to 2110. Furthermore, the patient stated her pain in the left mid back is feeling about the same as her last visit. Objective: C6 was found to have a mild level of discomfort when evaluated by palpation. Palpation of the spinal area at L5 produces mild tendemess. A mild level of discomfort was found upon palpation of the patient's spinal area at T4. A trigger point was present with pain in the supraspinatus musde area with radiation to the left upper arm region. Palpation of the rhomboids muscle area revealed myofasdal trigger point. C6 was sound to have a posterior subluxation. T1 was revealed to be malaligned, left. Assessment: Upon evaluating Ms. Tuschak's response to her treatment thus far, her condition has improved Hearty 10°k from her prior treatment. Treatment thus far has proved to be favorable and the patient is responding favorably with a reduction in her overall symptoms. The patient's phase of care is relief/repair and her prognosis is good. Plan: The patient will be treated every other week for 1 month. Treatment consited of chiropractic manipulation and therapy on the shoulder region today included trigger point therapy and ultrasound to restore normal spinal biomechanics. To increase the effectiveness of Ms. Tuschak's treatment, she continued today to use a cold pack white at home. 3N 9/2008 Subjective: Today, Ms. Tuschak reported that she has had a decrease in the frequency of her pain in the left region of the neck which is increased by forward movement from intermittent to constant since her prior visit. Ms. Tuschak also indicated her radiating pain into the left shoulder and hand has not noticeably changed since her previous visit. The patient also indicated the severity of her pain in the left mid bads has increased since her last visit to 4110. Objective: Palpation of the spine at C6 induces mild discomfort. Palpation of the spine at L5 induces mild discomfort. Tendemess of a mild degree was revealed during palpation at T4. There is myofasciat trigger point in the supraspinatus muscle area with redlcular pain into the left upper arm region. Evaluation of the rhomboids muscle area revealed a trigger point with pain. A posterior subluxation was found at C6. A subluxation was revealed, T1 left. Assessment: Today, the patient seems to be accepting the treatment well, but has shown little progress since the prior visit. Olivetti Chiropractic Office 717-897-7068 Mark T. Olivetti, DC Fax: 717-687-1700 Patient Name: Tuschak, Kim Plan: The patient will be treated 2 times per week for 2 weeks. Treatment consisted of chiropractic manipulation and therapy on the shoulder region today induded trigger point therapy to restore normal spinal biomechanics. To increase the effectiveness of Ms. Tuschak's treatment, she continued today to use a cold pads while at home. 2/15/2008 Subjective: Today, Ms. Tuschak reported that she has had an increase in the frequency of her pain in the left region of the neck which is increased by forward movement from occasional (2t3 to 50% of awake time) to frequent (51 to 75% of awake time) since her prior visit. Ms. Tuschak also indicated her radiating pain into the left shoulder and hand has not noticeably changed since her previous visit. The patient also indicated her pain in the left mid bads has not noticeably changed since her last visit. Objective: Ct3 was found to have a mild degree of tendemess when evaluated by palpation. Pain of a mild degree was found during palpation at L5. Palpation of the spine at T4 induces mild tendemess. Evaluation of the supraspinatus musde area revealed a trigger point with pain with radiation to the left upper arm region. There is myofascial trigger point in the rhomboids muscle area. A posterior malalignment was sound at Ct3. A misalignment was revealed, T4 anterior. Assessment: No notable progress since the previous visit was evident during today's assessment of the patient's condition. Plan: The patient will be treated 2 limes per week for 2 weeks. Treatment consisted of chiropractic manipulation and therapy on the shoulder region today induded trigger point therapy and ultrasound to restore normal spinal biomechanics. The patient will also continue to use a cold pack while at home. 2/18/2008 Subjective: On today's visit, Ms. Tusdtak reported she has had a decrease in the frequency of her pain in the left region of the neck which is increased by forward movement from frequent (51 to 75°k of awake time) to intermittent (0 to 25°~ of awake fime) since her prior visit. She also reported that the severity has somewhat improved to 2110. Furthermore, Ms. Tuschak indicated her radiating pain into the left shoulder and hand continues to be about the same as her previous visit. Ms. Tuschak also stated her pain in the lest mid back is feeling about the same as her previous visit. Objective: Ct3 was found to have a mild degree of pain and discomfort when evaluated by palpation. A mild degree of discomfort was revealed upon palpation of the patients spinal tissues at L5. Palpation of the spinal tissues at T4 causes mild discomfort. Palpation of the supraspinatus musde area revealed myofascal trigger point with radicular pain into the left upper arm region. There is myofascial trigger point in the rhomboids muscle area. A posterior subluxation was found at CB. T1 was revealed to have a left malalignment. Assessment: Today's evaluation of Ms. Tuschak's condition shows approximately a 21 % improvement since her previous visit. The current treatment plan has reduced the intensity of the patient's symptoms. Plan: The patient will be treated 2 times per week for 2 weeks. Treatment consited of chiropractic manipulation and therapy on the shoulder region today induded trigger point therapy and ultrasound to restore normal spina{ biomechanics. Ms. Tuschak will also continue to use a cold pads white at home. 2122!2008 Subjective: Today, the patient reported that her pain in the left region of the neck which is increased by forward movement is feeling about the same as her prior visit. Furthermore, Ms. Tusd-ak reported her radiating pain into the left shoulder and hand continues to be about the same as her prior visit. Furthermore, Ms. Tuschak reported the severity of her pain in the left mid back improved mildly since her previous visit to 2/10. Objective: A mild level of pain and discomfort was found upon palpation of the patent's spine at Ct3. Discomfort of a mild level was found.< . during palpation at L5. Palpation of the spine at T4 results in mild pain and discomfort. There is myofascial trigger point in the supraspinatus musde area with radicular pain into the left upper arm region. There is myofascial trigger point in the rhomboids muscle area. C6 was revealed to be misaligned posterior. A subluxation was revealed, T1 left. Assessment: Since the prior visit, the patient has improved nearly 9% .The patient's response to her current treatment has been favorable Olivetti Chiropractic Office 717-697 7058 Mark T. Olivetti, DC Fax: 717-697-1700 Patient Name: Tuschak, Kim 21612008 Subjective: On today's visit, Ms. Tuschak reported she is having frequent (51 to 75°k of awake time) pain in the left region of the neck which is increased by fonnrard movement. She estimated the severity 4/10 on a 1 to 10 visual analog scale with 10 being the most severe. Additionally, Ms. Tuschak reported she has frequent (51 to T5% of awake time) radiating pain into the left shoulder. She rated the severity 4110. Additionally, the patient reported she is experiencing frequent (51 to 75% of awake time) pain in the left mid back. Ms. Tuschak graded the severity 4/10. Objective: A mild level of pain was found upon palpation of the patient's spinal tissues at C6. Discomfort of a mild level was found during palpation at L.5. A mild level of pain was found upon palpation of the patient's spinal tissues at T4. There is myofasclal trigger point in the supraspinatus muscle area with radiation to the left upper arm region. A trigger point was revealed with pain in the rhomboids muscle area. C6 was revealed to be misaligned posterior. T4 was revealed to have a anterior subluxation. Evaluation of the patlent's muscle strength revealed the upper extremities to be normal (grade +5). Evaluation of the patient's musculature revealed the trapezius musculature to have a rigidity (grade +1) degree of hypertonicity. Evaluation of the patient's musculature revealed the neck flexors musculature to have a rigidity (grade +1) degree of hypertoniclty. Orthopedic evaluation: Valsalva for disk occlusion negative bilateral. Max. Compression for cervical nerve root compression negative bilateral. Jackson's Comp. for nerve root compression negative bilateral. Assessment: The patient is in a relieflrepair phase of care and has a good prognosis. Plan: The prescribed treatment plan for the patient is 2 times per week for 2 weeks. Treatment consisted of chiropractic manipulation and therapy on the shoulder region today included trigger point therapy to restore normal spinal biomechanics. 2/8/2008 Subjective: Today, the patient stated the severity of her pain in the left region of the neck which is inueased by forward movement improved somewhat since her last visit to 3110. Additionally, the patient indicated the severity of her radiating pain into the lest shoulder improved somewhat since her prior visit to 3110. The patient also reported the severity of her pain in the left mid back improved slightly since her prior visit to 3110. Objective: A rrxld degree of tenderness was found upon palpation of Ms. Tuschak's spine at C6. Discomfort of a mild degree was found during palpation at L5. Discomfort of a mild degree was revealed during palpation at T4. A trigger point was found with pain in the supraspinatus muscle area with radiating pain into the left upper arm region. There is myofascial trigger point in the rhomboids muscle area. CB was revealed to be maaligned posterior. A subluxation was revealed, T4 anterior. Assessment: Today's evalration of Ms. Tuschak's condition shows approximately a 14% improvement since her prior treatment. The patient is responding favorably to her treatment thus far and has shown a reduction in the intensity of her condition. Plan: The patient will be treated 2 times per week for 2 weeks. Treament of the cervical, thoracic, and Jumbo-sacral region today included chiropractic manipulation to restore normal spinal biomechanics. Additional therapy today included trigger point therapy to restore normal spinal biomedtanics in the shoulder region. 2/11/2008 Subjective: The patient raported that on today's visit she has had a decease in the Irequency of her pain in the lest region of the neck which is increased by forward movement from frequent to constant since her last visit. Furthermore, Ms. Tuschak indicated she has frequent radiating pain into the left shoulder and hand. Ms. Tuschak did report that she is now experiencing radiating pain into the left shoulder and hand instead of the radiating pain into the left shoulder previously reported. The patient also indicated she has had a decrease in the frequency of her pain in the left mid bade from frequent to occasional since her previous visit. Objective: Palpation of the spinal tissues at C8 induces mild discomfort. Pain and discomfort of a mild degree was found during palpation at L5. T4 was found to have a mild degree of discomfort when evaluated by palpation. Palpation of the supraspinatus muscle area revealed myofascial trigger point with radicular pain into the left upper arm region. A trigger point was reveafecf with pain in the fiomiwids muscle area. C8 was found to have a posterior misalignment. T4 was revealed to be malaligned, anterior. Assessment: Today's evaluation of Ms. Tuschak's condition shows approximately a 33% improvement since her prior treatment. Today, the patient seems to be accepting the treatment well, but has shown little progress since the prior visit. The patient's phase of care is relieflrepair and her prognosis is good. Olivetti Chiropractic Office T17-697-7058 Mark T. Olivetti, DC Fax: 717-697-1700 INTERIM REPORT 5/712008 Attn: Erie Insurance Comp Re: Kim Tuschak 1 D #: SSN: DOI: 02/03/08 Claim: To whom it may concern, As you are aware, Ms. Tuschak has been under care at this office for an automobile injury which occurred on 02!03!08. A re-evaluative examination was performed on 5R/2008 to evaluate the status of her health as well as the effectiveness of the previously prescribed treatment regime.. An update in subjective and objective data is necessary to properly address Ms. Tuschak's future health needs. The findings from this examination are as follows. Ms. Tuschak's below symptoms were reported as of the date of this exam. Subjective Complaints: Ms. Tuschak stated that she is experiencing: 1: Intermittent (0 to 25% of awake time) pain in the left region of the neck which is increased by forward movement. She rated the pain 2/10 using a visual analog scale with 10 being extreme pain. 2: Occasional (0 to 25% of awake time} radiating pain into the left shoulder and hand. She rated the pain 4/10. 3: Occasional (0 to 25% of awake time) pain in the left mid back. She rated the pain 3110. Objective Findings: (As of 517/2008) Deep Tendon Reflex Testing: Ail DTRs normal. Sensory Perception: Areas of hypoesthesia were noted within the dermatome areas corresponding to the nerve root levels of C6 on the left. Areas of hyperesthesia were noted within the dermatome areas corresponding to the nerve root levels of CB, C7 on the left. Coordination Testing (Proprioceptive System): Rhomberg test was performed normal. Finger to nose test was performed normal. Finger to finger test was performed normal. Heel walking was performed normal. Toe Walking test was performed normal. Orthopedic Svaluatian: Valsalva for disk occlusion negative bilateral Max. Compression for cervical nerve root compression negative bilateral. Jackson's Comp. far nerve root compression negative bilateral. Palpation: Tenderness: G6 mild; L5 mild; T4 mild. Trigger Points: Supraspinatus +1 with radiation into left upper arm. Rhomboids +1. Subluxations were found at C6 posterior; T'l left; L5 posterior. Muscle Strength: Upper extremities normal (grade ~-5}. Cervical R.O.M. testing: l/lexian: (Norma! = 50°} 50° due to dull pain at mid back and into the left hand. Left lat. flex: (Normal = 454) 40°. Rotation: {Normal = $0°) 55° inflammation at neck. Diagnosis: 847.0 Hyper. exteriorlFlex. Injury {Cervical} 847,1 Thoracic Sprain /Strain 847.2 Lumbar Sprain /Strain 723. i Neck Pain Prognosis: The patient's prognosis is fair. Remarks: Ms. Tuschak is currently not medically stationary. Based on the above subjective complaints and objective findings, Ms. Tuschak will receive the following treatment plan: The patient wilt be seen every other week for a period of 1 month. The patient`s Treatment program will include a Diversified, Constead, and Sacral-Occipital adjus#ive techniques along with manual therapy techniques and eventually therapeutic exercises. The patient has been instructed to perform specific exercises and use a cold pack while at home. If my office can be of further assistance regarding Ms. Tuschak`s condition, please do not hesitate to eon#act me. Sincerely, Mark T. Olivetti, DC INTERIM REPORT ti27/2aos Attn: Erie Insurance Comp Re: Kim Tuschak ID #: SSN: DOI: 02103!08 Claim: To whom it may concern, As you are aware, Ms. Tuschak has been under care at this office for an automobile injury which occurred on 02103/08. A re-evaluative examination was performed on 2/27/2008 to evaluate the status of her health as well as the effectiveness of the previously prescribed treatment regime. An update in subjective and objective data is necessary to properly address Ms. Tuschak's future health needs. The findings from this examination are as follows. Ms. Tuschak's below symptoms were reported as of the date of this exam. Subjective Complaints: Ms. Tuschak stated that she is experiencing: 1: Intermittent (0 to 25% of awake time) pain in the left region of the neck which is increased by forward movement. She rated the pain 2/10 using a visual analog scale with 10 being extreme pain. 2: Occasional (0 to 25% of awake time) radiating pain into the left shoulder and hand. She rated the pain 3110. 3: Occasional (0 to 25% of awake time) pain in the left mid back. She rated the pain 2/10. Objective Findings: (As of 2/27/2008) Sensory Perception: Areas of hypoesthesia were noted within the dermatome areas corresponding to the nerve root levels of C6 on the left. Coordination Testing (Proprioceptive System): Rhomberg test was performed normal. Finger to nose test was performed normal. Finger to finger test was performed normal. Heel walking was performed normal. Toe Walking test was performed normal Orthopedic Evaluation: Valsalva for disk occlusion negative bilateral. Max. Compression foe cervical nerve root compression negative biiatera{. Jackson's Comp. for nerve root compression negative bila#erat. Palpation: Tenderness: C6 rnild; L5 mild; T4 mild. Trigger Paints: Supraspinatus +1 with radiation into left upper arm. Rhomboids +2. Subluxations were fiound at C6 posterior; T1 left; L5 posterior. Muscle Tone: Trapezius rigidity (grade ~1); Neck flexors rigidity (grade -~1). Muscle Strength: Upper extremities normal (grade +5). Cervical R.d.M. testing: Lift lat. flex: (Normal = 45°) 40°. Rotation: (Normal = 80°) 55° inflammation at neck. Diagnosis: $47.C? Hyper. ex#erior/Flex. Injury (Cervical) 847.1 Thoracic Sprain /Strain 847.2 Lumbar Sprain 1 Strain 723.1 Neck Pain Prognosis: The patient's prognosis is good. Remarks: Ms. Tuschak is currently no# medically stationary. Based on the above subjective complaints and objective findings, Ms. Tuschak will receive the following treatment plan: The patient will be seen 1 time per week for a period of 2 weeks. The patient's treatment program will include a Diversified, Gonstead, and ,Sacral-Occipital adjustive techniques along with manna{ therapy techniques and eventually therapeutic exercises. Therapy will include trigger point therapy and ultrasound on the shoulder region to restore normal spinal biomechanics. The patient has been instructed to use a cold pack vrhile at home. if my office can be ofi further assistance regarding Ms. Tuschak's condition, please do not hesitate to contact me. Sincerely, Mark T. Olivetti, DC AUTO ACCfDENT INITIAL EXAMINATION/EVALUATION REPORT 2/6/2008 Attn: Erie insurance Company P.O. Box 2013 Mechanicsburg, Pa 17055 Re: Kim Tuschak ID# ; SSN: DOI: 02/03/2008 Claim: 010170962619 To whom it may concern: Following is a report respectfully submitted with the permission of the above-named patient with regard to an automobile accident sustained on 02103!2008. Due to persistent symptomotology, this patient sought care at this offrce on 02/0612008. The following is the information I have on file relative to her condition. Mechanism of Onset: This injury is the direct result of a motor vehicle acadent. History of Injury: Ms. Tuschak was the driver in an automobile accident. She was driving a full size car at the time of the accident. She was at a complete stop just prior to the collision. The impact of the accident was caused when Ms. Tuschak was struck by another vehicle. The point of impact on Ms. Tuschak's vehicle was on the rear. Just prior to the impact the other vehicle was merging into traffic. The other vehicle's point of impact was on the front. Ms. Tuschak was wearing a full lap and shoulder restraint at the time of the accident. Her vehicle did have a head rest which was adjusted in the lowest position. Air bags were not deployed on Ms. Tuschak's vehicle as a result of the impact. She stated that she was completely surprised by the accident. Her head and neck were in a position rotated to the left at the time of impact. During the accident, Ms. Tuschak's body whipped violently forward and backward. She was not rendered unconscious but was shaken and disoriented. She did not receive medical attention at the scene of the accident. Ms. Tuschak was taken home immediately following the accident. Subjective Complaints: Ms. Tuschak stated that she is experiencing: 1: Frequent (51 to 75% of awake time) pain in the left region of the neck which is increased by forward movement. She rated the pain 4110 using a visual analog scale with 10 being extreme pain. 2: Frequent (51 to 75% of awake time) radiating pain into the left shoulder. She rated the pain 4/10. 3: Frequent (51 to 75% of awake time) pain in the left mid back. She rated the pain 3/10. Physical Examination Height: 5'7" Weight: 140 lbs. The patient's movements seem to be normal. Minor's Sign was found to be negative. Deep Tendon Reflex Testing: All DTRs nomnal. Sensory Perception: Areas of hypoesthesia were noted within the dermatome areas corresponding to the nerve root levels of C6 on the left. Cranial Nerve Testing: Examination of the cranial nerves revealed the following: A normal sense of smell. There was a normal response to both direct and indirect light as well as accommodation reflexes. All extraoccular movements, including superior and inferior recti, the two oblique muscles and the medial and lateral recti, were intact with no evidence of any diplopia or scatomata. The frfth cranial nerve (trigemina!) revealed no abnormalities. The patient was able to perform the normal range of facial movements, no asymmetry or other abnormalities were noted. The tuning fork test showed the eighth cranial nerve (acoustic) to be normal. Examination of the throat revealed no abnormality of the pharyngeal musculature. Examination of the throat revealed the laryngeal musculature to be normal. The shoulder shrug was performed well revealing the eleventh cranial nerve to be normal. Examination of the throat revealed no deviation, atrophy or asymmetry of the tongue. Coordination Testing (Proprioceptive System): Rhomberg test was performed normal. Finger to nose test was performed normal. Finger to finger test was performed normal. Heel walking was performed normal. Toe Walking test was performed normal Orthopedic Evaluation: Valsalva for disk occlusion negative bilateral. Max. Compression for cervical nerve root compression negative bilateral. Jackson's Comp. for nerve root compression negative bilateral. Palpation: Tenderness: C6 mild; L5 mild; T4 mild. Trigger Points: Supraspinatus +1 with radiation into left upper arm. Rhomboids +2. Subluxations were found at C6 posterior; T4 anterior, L5 posterior. Muscle Tone: Trapezius rigidity {grade +1); Neck flexors rigidity (grade +1). Muscle Strength: Upper extremities normal (grade +5). Cervical R.O.M. testing: Flexion: (Normal = 50°) Extension: (Normal = 60°) Left lat. flex: (Normal = 45°) Right lat.. flex: (Normal = 45°) Rotation: (Normal = 80°} Right Rotation: (Normal = 80°) Lumbosacral R.O.M. Testing: Flexion: (Normal = 60°) Extension: (Normal = 25°) Left lat. flex: (Normal = 25°) Right lat. flex: (Normal = 25°) Left Rotation: {Normal = 30°) Right Rotation: (Normal = 30°) 50°. 60°. 40°. 45°. 55° due to inflammation at neck. 80°. 60°. 25°. 25°. 25°. 30°. 30°. Diagnosis: 847.0 Hyper. Ext./Flex. Injury (Cervical) 847.1 Thoracic Sprain /Strain 847.2 Lumbar Sprain /Strain 723.1 Neck Pain Prognosis: The patient's prognosis is good. Treatment Plan: After completing an initial examination and evaluation of Ms. Tuschak, I have selected a plan of treatment that should return this patient to a pre-injury status and minimize the possibility of future residuals. The patient's treatment program will include a Diversified, Gonstead, and Sacral-Occipital adjustive techniques along with manual therapy techniques and eventually therapeutic exercises. Discussion: We have a 51 year old, female, who sustained an automobile injury on 02/03/2008 and is experienang continuing trauma. Medical care: Treatment in this office will consist of conservative chiropractic spinal correction, chiropractic physical therapy and observation at the interval stated above under Treatment Plan and decreasing in frequency as the patient's condition allows. Permanent disability factors for consideration: Along with the subjective complaints by the patient, objective observance includes the pain and tenderness as indicated and the decrease of function in the areas noted. I currently feel it is too early to determine whether this patient will have any residuals of permanent disability. If my office can be of further assistance regarding Ms. Tuschak's condition, please do not hesitate to contact me. ..~r.•.vr _.. .~ .• •~ ~ ^. 1 rT1J~1(3ts +Jr •f t12f cl}')QUGC r.;~.~r.I !~iw~ ~ tiSCHA!~, KIM -:?a ;;:J MARK T OLII+ETf! ~C rut;::,-;. ~• 1. ^~-S~i1VE•MtN 4 b'l~l1ira •J.. ... tl.~ ~.. Sul ~. l' i.C ~:r .JJI\~ 1.'1.. .'iYiS C~77~ ... ~ a8'08%1 ySc ~ ..:,~~e r2:ri0 ~~K.7ir' :~(-Jr•~JI(~`~! S~Ife~' ~iEflC?5 -+~stc(•~ Nec~: pain and f~`r< arm aa~r, fa?io:~::~1g rno;^r •,eh!~•le a: C,+~~nl ~ ~.r,~~'k.~ ~G~: K'es~,,t: fit,er~ a« ,i., :;U~'i1Gc~ttSC.~n ax~tr~s _ TIiE~ CPCVIt:c~I F~fi$ 15 ~~faiv!' ~!` ~ ~?.('hC:}`• ~~r'.,'.iCE•l"~ (1~.5'.t;C3^ r7, ~UiS.llf3i~i iti 0iil~r'•IJI`SE' niJ!""ir~Jl. •"~~ verteb~'a! boa} 1'1e;gnt:~ ~iG",]i'85f:!VErtl 'r.•.rE!F':,'?"Q~B!d(~ `~2~@fl~i3t Yz J:SC' C~5~35? 3t C;S-mot:. Pith d~sr, grace -13frcMl~~g 3t~:" iJS!E'OfJhjfi@ ':)"!!l3t:Q.^.• ~i ;f.t° y rn~1d cse~e;te-atl`~a disc Cli~;aa_.5E? ~3; CFA-C~''. 7rtsre ;; n `r~S~t~_~ ~r s~~~uxdcur rho !'@~Sf~1 tJti~rf;.!~~3 are ~+s1t8"'R fJ'1 `f`.u Ccl~que V'w~h•: "rl~. Sr_:tt t! ;;ltP~a 3(? r'.G~"'LEI ''nCf~S5i0r1: J-w•b ~t1C ~Y.rG7 t~P.L~1~'~'vVG G~5r. w':°~a3~. "vC el~l:t~ .~5?Oi: 4~;r~Grrr~ilty. I _ =.~I-~~ JOtiATHaN C3 S~cF'HE;~tSOAf. fflCf ::~i'_:,:4~•~ ..~~,:. ~ r"~'~;'~;. ;_,_ • . _.'=<;t ~'~.:: -J0~1ATH.~N i? 5?'FPHENSO!~ (J~D . _ _..':;;- ~. r ,b.. ..~~ DRAYER® Physical Therapy ]nstitute Eroding the Way m Cood Hcalth Discharge Summary 8!1 S/08 RE: Kim Tuschak DOB: 8!8/56 Dear Dr. Bailey, Thank you for the referral of Kim Tuschak to Drayer Physical Therapy Institute for therapy for the diagnosis of C-Spine Pain. Kim Tuschak was seen in our facility for 36 visits between the dates of S/22/08 and 8/15/08 for therapy consisting of functional activities, strengthening, neuro re-ed, balance/coordination, posture, manual therapy, mobilization, A/AA/PROM, flexibility, HEP, spine stabilization, McKenzie Program, job skills, taping, traction, a-stim and hot/cold pack. Initially, Kim Tuschak presented w/pain, l'd function, j'd ROM, ,~'d strength, j,'d mobility and j'd flexibility. At the time of discharge, Kim Tuschak had attained: Pain: Cturent: 0/10 Worst: 0110 with no radicular symptoms. ROM: C-spine ROM full flexion and extension ecjual. Side bending and rotation slight pull at end range. Strength: Shoulder ABD and flexion to 4+/5 w/o compensation, ER/IR 4+/S w/o compensation, biceps/triceps to S/S w/o compensation, MT to 4+/5 w/o compensation and LT to 4/S w/o compensation. Function: Patient returned to all recreational activities, hobbies and ADL's painfree w/o T'd symptoms or difficulty. Kim Tuschak made complete progress w/physical therapy achieving all Iong term goals. Kim Tuschak was discharged due to returning to premorbid functional status. Kim Tuschak was discharged on 8/1 S/OS w/ instructions to continue (I) w/given HEP. Thank you again for the opportunity to provide therapy to Kim Tuschak. Please feel free to contact me w/ any questions or concerns regarding her care. Sincerely, ~ ~~~~ Jaclyn otter, DPT PT-019215 Tx: KA Patient Name: Kim Tuschak Mechatticsburg Center 5108 E. Trindle Road ~ Suite 200 ~ 143echanicsburg, PA 17050 ~ PHONE: 717.790-9920 • Fix: 717-790-9923 DRAYER® AU6 0 7 2U88 Physical Therapy Institute Leading the Way ro Good Henlth Re-Evaluatio n Patient Name: Kim Tuschak Date: 7/15/08 Date of Birth: 8/8/56 Sex: F Date of Evaluation: 5/22/08 Dia nosis: Cervical S ine Pain Date of Onset: 213/08 Referrin Physician: Dr. Bailey Total # of Visits: 24 # Cx: 1 # NS: 0 Sur ical Procedure: None Date of Sur er :None Re-Certi ccation Period E ective Date: From: 7/19/08 T/:rough: 8/17/08 SUBJECTIVE STATUS/PROGRESS: Current Complaints/Functional Limitations: Patient presented to Drayer Physical Therapy Institute on 5/22/08 2° cervical spine pain referred by Dr. Bailey.. Patient reports a 24% on functional disability score w/ 26% at initial evaluation. Patient reports chief c/o numbness/tingling of (L) UE, mostly wrist and hand. Patient reports a 90% improvement since beginning physical therapy w/ symptoms currently intermittent. Patient j'd numbness and tingling, T'd mobility w/ ~''d ROM w/ cervical spine painfree. Patient is able to sleep t/o the night better w/ j'd toleration of ADL's, overhead activities, and better able to liffilcarry objects > 10 lbs. Patient reports signs and symptoms ~''d greatest at work or while standing at sink, especially if counter is too low or high and prolonged neck flexion. Patient reports occasionally difficulty sleeping at night and seldom difficulty preparing meals and running or jogging. Pain Rating: Best: 0 / 10 Worst: 3 / 10 Current: 0 / 10 At I.E.: Best: 2/10 Worst: 8/10 OBJECTIVE AND FUNCTIONAL STATUS/PROGRESS: objective Prior Current Goal Goal Met Measurement/Functional Limitations/S ecial Tests Measurements .Measurements Yes No MMT: Shoulder Flexion 4/5 w/o coin 4+/5 w/ com 4+/5 w/o com X ABD 4/5 w/o com 4+/5 w/com 4+5/ w/o com X ER 4/5 4+/5 4+/S w/o com X IR 4+/5 5/5 4+/5 X Bice s 4+/5 5/5 5/5 X Trice s 4+/5 5/5 5/5 X Cervical ROM Flexion Full w/o pain unless excess use upper cervical to obtain ROM Full w/ERP especially w/capital flexion w/ min mid cervical motion Full w/o ERP w/o ?'d X Extension Full w/o 'd ain Full w/o T'd ain Full w/o j'd ain X Side Bending (B) 75% w/ stretch w/o ain (B) 75% w/ stretch w/o pain Full w/o r'd pain X Rotation (R) 75% (L) SO% w/ mild ain (B) 75% w/pain on (R) w/ (B) Full w/o r'd pain X Posture Forward rounded shld w/ cervical protract w/ excesssca rotract J.'d round shld w/ improving cervical retraction w/ mild scap win in Good posture X MT/Rhomboid/Scap MMT. 4-/5 4-/5 4/5 X LT NT 3+/5 4-/5 X Patient Name: Kim Tuschak ... .-^_^ - ----.._ .,....,~ .. ........ ..... n,o qnn noon ASSESSMENT OF STATUS/PROGRESS: Rationale for Need to Continue Skilled Therapy Services Including Goals Not Met and Why: Patient presently seen for 24 visits at Drayer Physical Therapy Institute. Patient demonstrates improvements w/ T'd painfree ROM, T'd strength and j'd tolerance to ADL's. Patient would benefit from continued skilled physical therapy to J,'d compensation w/ ADL's, j'd strength/stability, painfree ROM and address work tasks flexion w/ possible work site evaluation if needed to return to function and perform ADL's and IADL's, Rehabilitation Prognosis/Potential: Good Updated Objective Short Term Goals (to be achieved in 4 weeks): 1. J, pain to 1/10 at worst. 2. r ROM painfree cervical flexion and full. 3. T strength to 4+/5 scapular stabilizers. 4. T UE strength to grossly 4+/5. 5. (I) w/ HEP. Functional Goats to be Achieved by Next Progress Report (to be achieved in 4 weeks): 1. T functional ability to drive 30 minutes w/o )''d symptoms. 2. T functional ability to go 1 week w/o difficulty sleeping. 3. T functional ability to squat/lift w/o compensation 25 lbs painfree. 4. T functional ability to perform functional activities w/o UT compensation or winging. 5. T functional ability to sit at computer w/o signs or symptoms. 6. T functional ability to work %2 day w/o T'd symptoms. 7. T functional ability to return to running/jogging routine. 8. J, functional disability score to 20/95. PLAN: Treatment Plan: Functional activities, strengthening, neuro re-ed, balance/coordination, posture, manual therapy, mobilization, A/AA/PROM, flexibility, HEP, spine stabilization, McKenzie Program, job skills, taping, traction, a-stim and hotJcold pack. Treatment Frequency of: 3 times per week Treatment Duration of: 4 weeks ! hove discursed the nbave findings, «rsersment, revised [rentment plna, and rxpecred outcomes with the pmient. He/She it mwre ojthe diagnosis mul prognosis and voluntnrily ngrces ro ronlinue p/u irticip«tio« is Therapist's Signature: License: PT-019215 Date: 7/15/08 Jacly~Dotter, DPT ' Re-Cenificruion: !hereby certify dmt rehnbilitntion servicrs ore medicn!!y necessary jor then a etUioned pntiud. /also uuderslnnd tha! my signnture signifies ngreement wide die Updalnd Plan ojCnre, estimated jrulummy and rlurntion, as established by the licensed lhernpist. I wulerstnntl this PI ojCnre becomer effeetlve on rbe dgtewoteJ and runniru effective jor the duration ojtrenlment outlined bt the Physician's Comments: Physician's Signature: Date: Tx: KA Please Return This Progress Repon ro Ornyer PJrysicnl 7Yieropy Patient Name: Kim Tuschak ,. __ ® .I~~ ~ 8 Z~~r DRAPE R Physical Therapy Institute Leadir4g the Way to Good Health Re-Evaluation Patient Narne: Kim Tuschak Date: 6/19/08 Date of Birth: 8/8156 Sex: F Date of Evaluation: 5/22/08 Dia nosis: Cervical S ine Pain Date of Onset: 2/3/08 Referrin Ph sician: Dr. Baile Total # of Visits: 12 # Cx: 1 # NS: 0 Sur ical Procedure: None Date of Sur er :None Re-Certi ccation Period E ective Date: From: 6/20/08 Throu h: 7/19/08 SUBJECTIVE STATUS/PROGRESS: I Current Compiaints/Functional Limitations: Patient presented to Drayer Physical Therapy Institute on 5/22/08 2° cervical spine pain referred by Dr. Bailey. Patient reports a 27% on functional disability score w/ score at initial evaluation at 26%. Patient reports intensity of tingling 1 UE j'ing, noting mid j'd cervical pain w/ centralization of signs and symptoms w/none---min pain 1 UE. Patient reports turning to look over shoulder while driving and performing recreational activities causes T`d discomfort occasionally. W/ sleeping, looking up into cupboard and performing overhead activities causes T'd pain seldom. Patient reports looking ~, only causes pain if she is not cautious. Patient has difficulty sitting on bleachers or sitting for prolonged amount of time. Pain Rating: Best: 0 / 10 Worst: 3 - 4 / 10 Current: 0 / 10 At I.E.: Best: 2/10 Worst: 8/10 OBJECTIVE AND FUNCTIONAL STATUS/PROGRESS: Objective Prior Current Goal Goal Met Measurement/Functional Limitations/S ecial Tests Measurements Measurements Yes No MMT: Shoulder Flexion 4+/5 4/5 w/o com 4+/5 w/o com X Abduction 4+/5 4/5 w/o com 4+/5 w/o com X External Rotation NT 4/5 4+/5 X Internal Rotation NT 4+/5 4+/5 X Bice s 4/5 4+/5 4+/5 X Trice s 4/5 4+/5 5/5 X Cervical ROM Flexion 25% w/ pull on the (L) Full w/o pain unless excessive use of upper cervical s ine to obtain ROM Full w/o i''d pain X Extension 75% w/ ain on the L Full w/o 'd ain Full w/o 'd ain X Side Bendin R 75% (L 25% wi ain 75% w! stretch w/o ain Full w/o 'd ain X Rotation (R) 70% (L) 25% w/pain (R) 75% (L) 50% w/mild ain Full w/o T'd pain X Cervical Retraction NT ERP, j'd sxs upon return to centralized sxs No ERP X Posture NT Forward rounded shld w/ cervical protraction w/ excessive scapular rotraction Fair + to good positive X Sca ular Stren h NT 4-/5 4+/5 X *Patient reach overhead w/ scapular winging, UT compensation, spine compensation and poor scapulohumera! rhythm. *Cervical retraction occasionally centralizes signs and symptoms and rotation to (R) w/ flexion occasi nally centralizes signs and symptoms. ` ~~ Patient Name: Kim Tuschak ii n 0 8 20~• ASSESSMENT OF STATUS/PROGRESS: Rationale for Need to Continue Skilled Therapy Services Including Goals Not Met and Why: Patient presently seen 12 visits at Drayer Physical 'Therapy Institute. Patient demonstrates improvements w/ physical therapy w/ centralization of signs and symptoms and improving posture and strength w/ ring ROM. Patient would benefit from continued skilled physical therapy to improve signs and symptoms, painfree ROM, strength and posture to improve functional ability o perform ADL's and IADL's. Rehabilitation Prognosis/Potential: Good Updated Objective Short Term Goals (to be achieved in 4 weeks): 1. J, pain to 1/10 at worst. 2, j ROM to painfree rotation of cervical and flexion. 3. T strength to 4+/5 of UE strength w/o compensation. 4. T scapular stabilization strength to 4+/5. 5. (T) w/ HEP. 6. j scapular winging w/ UE movements. Functional Goals to be Achieved by Next Progress Report (to be achieved in 4 weeks): 1. T functional ability to sit t/o baseball games w/o r'd pain. 2. T functional ability to look up into cupboard w/o T'd pain. 3. T functional ability to sleep w/o T'd pain. 4. T functional ability to return to running w/o T'd pain. 5. J, functional disability score to 22%. 6. j functional ability to sit at computer for 1 hour w/o T'd pain. Treatment Plan: Functional activities, strengthening, neuro re-ed, balance/coordination, posture, manual therapy, mobilization, A/AA/PROM, flexibility, HEP, spine stabilization, McKenzie Program, job skills, taping, traction, a-stim and hot/cold pack. Treatment Frequency of: 3 times per week Treatment Duration of: 4 weeks I have dlscnrsedlhe above firdt»gs, assessment, revised treatment plan, and expected outcomes with the patient. He1She is aware ojthe diagrraris and progruuia and voluntarily agrees to mnlimre par~icrpalinn in /~ l/oacu JiorwL~herapy eer+rices Therapist's Signature: / ~~~+'' ' ense: PT-019215 Date: 6/19/08 Jaclyn Dotter, I hereby certify that rehuhilttatiar servicw• are medically ne jor the abovr mur!!on rent. I also vnderslwd that my sigrnhrre y and duratirur, ar established by the ltcenredlheraptsl. / vn stand this Plgn•o mes q~'ectlve on the date Holed and remairrs i Physician's Comments: Physician's Signature: Tx: KA Plea.re Re!::rn !F.ts Progress /?eper! !o L~r ;per Physical Therapy agreement with the Updated Plan ojCare, Orclm or the dnmtion of trealman outlined in t~je Plmr Date: Patient Name: Kim Tuschak ~d= DRAYER® Physical Therapy Institute Leading the Way to Good Health soy. ~ f ~n~ Plan of Care Patient Name: Kim Tuschak Date of Evaluation: 5/22/0.8 Date of Birth: 8/8/56 Sex: F Date of Onset: 2/3/08 Dia nosis: Cervical S ine Pain Sur ical Procedure: None Referrin Ph sician: Dr. Baile Date of Sur er :None Initial Cerfi cation Period E ective Date: From: 5/22/08 7'hrou 1:: 6!20/08 ASSESSMENT: Treatment Rationale/Impairments that Justify the Medical Necessity of Skilled Therapy Services: Patient is a 51-year-old female referred to Drayer Physical Therapy Institute by Dr. Bailey for cervical spine pain. Patient presents w/pain, j'd function, j'd ROM, j'd joint mobility and flexibility, j.'d strength and j.'d postural awareness. Patient would benefit from skilled physical therapy to return to recreational activities and hobbies and work w/ J,'d symptoms and painfree, 1 ROM, strength, joint mobility, flexibility, postural awareness and j,'d pain to improve function. Rehabilitation Potential: Good Short Term Objective Goals: (to be achieved in 4 weeks): 1. j pain to 5/10 at worst. 2. (I) w/ HEP. 3. Patient to report j.'d episode of waking tlo the night 2° pain. 4. Patient to sit at computer w/proper posture for 20 minutes w/ T'd symptoms. 5. 1 cervical spine ROM by 25%. Long Term Objective Goals: (to be achieved in 8 weeks): 1. 1 pain to 0/10. 2. T ROM to full and painfree. 3. j strength by 1 MM grade of the middle and lower trapezius, bicep and tricep. 5. Patient to sit at the computer 1 hour w/o T'd symptoms. 6. Patient to squatJlift and carry 25 lbs w/ proper mechanics w/o j'd symptoms. 7. Patient to drive 30 minutes w/o T'd symptoms w/ cervical spine rotation. 8. Patient to T grip strength by 10 lbs. Long Term Functional Goals: (to be achieved in 8 weeks): 1. Patient to improve serratus strength to ,~ scapular winging w/ activities. 2. Patient to return to work w/o difficulty or T'd symptoms. 3. Patient to return to running routine w/o j'd symptoms. 4. Patient to report no difficulty w/ overhead activities. 5. Patient to report sleeping t/o the night w/o awakening 2° pain. 6. Patient to demonstrate improved posture and maintain w/o verbal or manual cues. Patient Name: Kim Tuschak Treatment Plan: Functional activities, strengthening, neuro re-ed, balance/coordination, posture, manual therapy, mobilization, A/AA/PROM, flexibility, HEP, spine stabilization, McKenzie Program, job skills, taping, traction, a-stim and hot/cold pack. Treatment Frequency of: 3 times per week Treatment Duration of: 8 weeks / /urwe discrrxsed the abcrve Endings, asressmun, revised lreannen! plmy and expec(ed ox(crunes with the palien(. HNShe is mvare of the dingnnsls wul/xogrwsis• arul i»/nnlarily agrees 1n rnnlinne parlicipnlinn in /~ physlenllncnrpnllaral lhernpy .rerrices. Therapist's Signature: ~ ~ ~~~ '~ License: PT-019215 Date: 5122/08 Ja ~ yn Dotter, DP CertlflrnNorc /hereby certify dxc(rehabiGla(iar serWces arc medically nec jor the abai>e mnillane Ilent /also tnw'erslaml !ha! my estinwfed jreque(xy and duraNal, as erlab/fished Ay the /icatsed (h~i(!, caul lhk /nilta! Plmt Care s~rpersedes the Lrstrrrcflons o Physician's Comments: Physician's Signature: __ / Tx: KA the Prcscrip!!nn !ha( in!(ia(ed rehnhililu(!ar Date: Patient Name: Kim Tuschak -~: eoQZ ~_o ~nr- ~_~_ D RAPE R® Physical Therapy Institute Leading the Way to Goad Health Initial Evaluation Patient Name: Kim Tuschak Date of Evaluation: 5/22/08 Date of Birth: 8/8/56 Sex: F Date of Onset: 2/3/08 Dia nosis: Cervical S ine Pain Sur ical Procedure: None Referrin Ph sician: Dr. Baile Date of Sure :None SUBJECTIVE HISTORY: Subjective History: Patient is a 51-year-old female referred to Drayer Physical Therapy Institute by Dr. Bailey for cervical spine pain s/p an MVA on 2/3/08. Patient was rear-ended while at a stop. Patient reports that at the time she was holding the wheel w/her (L) UE w/ her cervical spine rotated to the (L) looking at oncoming traffic. At the time that she was rear-ended she felt a warm burning sensation down her (L) UE and in the (L) side of her cervical spine. Patient reports that she initially sought treatment from a chiropractor. The chiropractor j'd her pain and tingling; however, tingling remained in her (L) UE. The radicular symptoms have become more frequent and more intense. The patient has had an T in pain over the past 2 weeks. She has pain in her (L) cervical spine to her (L) shoulder w/tingling to her 15` and 2"d finger of her (L) UE. She reports awaking 3 times a night. She sleeps supine 2° T'd pain. She is unable to sleep prone. Patient is (R) hand dominant. On 5/23/08, the patient is"scheduled for an MRI. Plain films taken on 2/3/08 showed DJD. The patient has had no prior occurrences of this condition and has sought no other treatment other than chiropractic care. Current Complaints: Pain and tingling radiating from the (L) side of her neck down to her fingers and numbness in her hand. She reports that rest makes it better and that laying on her stomach, sitting at the computer and daily activities makes it worse. Function: The patient reports a 26% disability on the cervical spine functional questionnaire reporting frequently having difficulties sleeping t/o the night due to her injury and occasionally having difficulty driving such as when turning her head to look over her shoulder and seldom having difficulty w/ daily tasks due to dizziness or LOB related to her injury and difficulty looking up to perform overhead activities. Pain Rating: Current: 5 /10 Worst: 8 /10 Best: 2 /10 Patient reports that she has no T'd pain w/ carrying objects such as laundry and groceries. She is able to sit at the computer for ~ 15 minutes before T'd pain. Occupation/Work Status: Patient is a YMCA director and is presently working full-time. She reports that her job is mainly administrative. She does computer work and is up walking around performing office tasks. Social History/Interests/ Living Environment: Patient lives at home w/ her spouse w/ 1 flight of stairs and a handrail. Patient reports that her interests and hobbies are affected by her symptoms. She used to run 25 - 30 miles a week, and she had replaced running w/ walking, however, she is now having r'd pain walking after ~ 10 minutes. She also enjoys gardening, cooking.and other forms of exercise. PMHx: Patient classifies herself in good general health. PMHx is significant for allergies and intolerance to cold and heat. Medical Precautions/Contraindications: Patient does not feel that there are any factors that will complicate her ability to participate in therapy and has not fallen within the past 12 months. Medications: Please see chart. Patient was prescribed Naproxen yesterday per MD and has not yet seen any changes. Patient's Goals for Therapy: To have full ROM, painfree. OBJECTIVE FINDINGS: , . .... _ Cervical Spine Flexion 25% w/ a pull on the (L) Extension 75% w/pain on the (L) Side Bending (R) 75% / (L) 25% w/pain Rotation (R) 70° / (I.,) 64° w/pain Patient Name: Kim Tuschak Strength.' "' Right Left Upper Trapezius 4+/5 4+/5 Middle Trapezius 4/5 4-/S w/ signifcant UT substitution Lower Trapezius 3+/5 w/ significant UT substitution 3+/S w/ significant UT substitution Shoulder Abduction 4+/5 4+/5 Flexion 4+/5 4+/5 w/pain Biceps 4/5 4/5 w/pain Triceps 4/5 4/S Grip Level 2 65 lbs, 60 Ibs, 70 Ibs SS Ibs, S8 lbs, 521bs w/ T'd tingling Observation/Inspection: Patient demonstrates a willingness to move w/ good upright posture w/slight forward head and cervical spine flexion. Patient is tender to palpation at C5. Patient demonstrates (B) scapular winging in sitting w/ ,~'d thoracic spine kyphosis. Neurological: i.'d light touch sensation along the CS dermatome on the (L) UE. ,i'd pain w/distraction, and J.'d tingling intensity after repeated cervical spine distraction. Pain w/ cervical spine retraction both manually and actively. Patient demonstrates ~''d pain w/cervical spine capital flexion. The alx~ve infrnmatiat reprrsrnls cell s !o Orcr)er Physics! T Therapist's Signature: Tx: KA r1lvd and ohjeclive fitxlings. Plemr refer !o the utclosed Plan oJCare jw my assessmertl, lrealmrn! grxr/.r, mx! trea(men! plmt. Pha~ro sign wx/rehrrn the Plan wish, make a copyJor your records. Thank yon for this referral. 1 will keep ysu it formed ojmry changes in the patlenr's slohrs or the treatment plai4 ~~ _ ~ 0 License: PT-019215 Date: 5/22/08 Jacl Dotter, DP Patient Name: Kim Tuschak f~ f .t t f ~} RAYE R'' ('I»~ica) ThCrai+Y to:[Rote tnr~fhy(rAa 1{h, a G4sx! fM`1rM1 p i s c f2 a rg e S u CTt [`1Z a ry Patient Naive: _--- G~aK- Date: ~ ~ `~ t~~ Date of Discharged i ~ ~ j ~ ~ Y t ~ Total # Visits: ~ Cx: 2 NS:,.>( ,~,:~V.`i+E: 3:r "Y~'#'*+': .F~. 1 ~!~`--:-ar-* :n**~;tB~:r~°t:~"~. _~;a~'%sa? - ~3°~t~a °~Y ..i ~r Y+cc.?+.'~s'v?k3. F•.nr: _ }U'='.~i._, Objective SEatus at lime of D~isc~ha[rj~'e: ~ ~~ ~ ~ (} / Pain: a.p,~n~ ©'~~ ,1~1V~ °'T~ b~~ ~ ~ ~ ~~lJv` ` '~1/l'~~ t/ ! l ~~ 1_ ROM:. /, 4~.~'~1 l ~j~~ 1'Z~ 'strength: ~~ ~~~. Q ~~ ~ ~~~ 5' C~ --- `°` 1Jjl~ y~..~- ~,l e t ~i ~'~ ~-~v~t Function: ~ ~'~ f ~S ~ ~~ ! ~'~ ~ ~~~~ ~ C-t3~w~D ~l ~,~ Other: S ~ ~ ~~ 1. _ang Term Treatment goats were: Ait met Partially Met: % Met Not Met Other: Explanation of why goats not met (if needed}: Discharge rationale: .~ Patient returned to premarbid functional status Patient achieved maximal beneft from therapy Treatment was discontinued by the physician Patient choice to dtscontinue therapy ~ MD contacted Patient noncampltance , MD contac#ed Other: Discharge instructions: ditiona! Comments: H EP: ~_,~nYrr ou7s ~ r~ ~, Participation in Wellness program Follow up with PT/OT; Other: { ~~~ I License #: OIL/OLIS Dafe: Therapist signature: IDRAY~R P'iiY~ICAi,TifiFRAPYII~iS'I"iTTJTE Evalua tion Time Based fJfodalities -Direct Contact Required _ _Other Proced_ ures lSupplie s . __ ____ . ,_ Description i CPT UNITS 59 Description ~ CPT UNITS 59 Description ~ CPT UNITS iitial Evaluation-PT 97001 Ultrasound (ea.15min) 97035 ; TENS Instruction 64550 e-evaluation-PT 97002 lontophoresis {ea.15min} 97033 Orthotic Mgmt Training (ea.15 min) 97760 iitial Evaluation-OT ~ 97043 E-Stim Attended (ea.15min) 97032 Orthotic Checkout (ea.15 min) 97762 e-evaluation-OT 97004 Servtce Based ProceduresfftM1odafities -Direct Contact Not Required Prosthetic Training (ea.15 min) 97761 hysical Performance TestlMeas 97750 Hot/Cold Pack , 97010 Electrodes (per pair) A4556 .C.E. Functional Drills-ea.15min) ~ Mechanical Traction (97012 , Splint: Time 5ased Procedures -Direct Contact Required E-Stim Unattended 97014 Splint: ~erapeuticActivities (ea. m' 97530 Vasopneumatic 97016 Supplies: ierapeutic Procedures (ea.1 ) 97110 Paraffin Bath 97018 :uromuscular Re-ed (ea.1 97112 WhirlpoollFluidotherapy 97022 TracKing Med icare Non=Medics anual Therapy (ea. 15 min) 97140 Infrared 97026 Time In sit Training (ea.15min) 91116 Group Therapy 97150 Time Out assage (ea.15min) 97124 Biofeedback 90901 Total Treatment Time iuatic Therapy (ea. 15 min) 97113 Wound Gare . Total Service Based Time --- >If Care/Home Management 97535 Wound-Selective 5 20SO. CM 97597 Total Time Based Time ~mmunity/Work Reintegration 97537 Wound-Selective > 20S0. CM 97598 Total Time Based Units ~gnitive SkiIIslTraining 97532 Wound-Non Selective 97602 Total Units (SB + TB) ~~ m ~ i v • ~ . ~'~~~~~• CBflVICAL PAIN 723.1 NS R/S Date ibjective: Patient's perceived changes/progress toward functional goals: tient's chief complaint: her: ~jective: Please refer to this patient's flow sheet for detail pecific to the procedures/modalities and specific exercises utilized during today's treatment. :atment progression: ~M: THE H: GIRTH: ier (Function, Special T nsa i r ~essment: Patient's p ress towards functional STG/L G: _ er: n: Progress/modify current treatment _Achieve by next visit /week Other: Total # visits rapist Signature t GUARANTOR t~~,ME AND PUSCHAK, KIN B ~' 1 NORTH SBA50NS DRIVB IILLSBURG, PA 17019 Brief Re-evaUProgress Report next visit D!C patient FED. I.D. # 75-3050291 Cx Reason: /~ ~ i y License # F ~t ~~~ PATIENT NO. PATIENT NAME DOCTOR NO. DATE 38 406621 T SCHAK KIN B 27 330p DATE OF TELEPHONE INSURANCE BIRTH NO. CODE DESCRIPTION CERTIFICATE N0. 8 08/56 717 32 2575 9@@ A TO INSURANCB T[cket;I 140159@6S N COPRY PTYpe;€ 40 II1~AY~R PIiYSICAL TI~LItAPY INSTITUTI~; FED. I.D. # 75-3050291 l ~ / Evaluation lescription CPT UNITS 59 Time Based Modalities -Direct Contact Required Description CPT UNITS 59 Other ProcedureslSupplies Description CPT UNITS iitial Evaluation-PT 97001 Ultrasound (ea. 15 min) 97035 TENS Instruction 64550 ;e-evaluation-PT 97002 lontophoresis (ea. 15 min) 97033 Orthotic Mgmt Training (ea.15 min) 97760 ~itial Evaluation-OT 97003 E-Slim Attended {ea.15min) 97032 Orthotic Checkout (ea,15 min) 97762 ;e-evaluation-OT 97004 Service Based Procedureslh7adalities • Direct Contact Not Required Prosthetic Training (ea.15 min) 97761 hysicaf Performance Test/Meas 97750 Hot/Cold Pack 97010 Electrodes (per pair) A4556 ~.C.E. Functional Drills~a.15 min) Mechanical Traction 1 97012 I Splint: 1"ime F3ased Procedures -Direct Contact Required . E-Slim Unattended j 97014 Splint: herapeuticActivities(ea., i) 97530 Vasopneumatic 97016 Supplies: ierapeutic Procedu 97110 Paraffin Bath 97018 euromuscular Re-ed (ea ~i) 97112 Whirlpool/Fluidotherapy 97022 Tracking ~ Medicare Non-Medics 'anual Therapy (ea. 15 min) 97140 Infrared ~ 97026 Time In sit Training (ea. 15 min) 97116 Group Therapy 97150 Time Out S assage (ea. 15 min) 97124 Biofeedback 90901 Total Treatment Time auatic Therapy (ea. 15 min) 97113 Wound Care Total Service Based Time 'If Care/Home Management 97535 Wound-Selective 5 20SQ. CM 97597 Total Time Based Time ~mmunityNVork Reintegration 97537 Wound-Selective > 20SQ. CM 97598 Total Time Based Units ~gnitive SkillslTraining e 97532 ~ . Wound-Non Selective 97602 ~ ~ • o Total Units (SB + TB) CERVICAL PAIN 123.1 Cx NS R/S Date Reason: ttient's chief complaint: her: ~jective: Please refer to this patient' flow =.atment progression: STREN the pGoceduresdmmdalities treatment. GIRTH: ier (Function, Special Tests, ier: in: Progress/modify current treatment plan -Achieve by next visit /week Other: . Brief Re-eval/Progre Report next visit D/C patient -Total # visits . :rapist Signature ~ ~~ License # C/ " ~~~~ GUARANTOR NAME AND ADDRESS PATIENT NO. PATIENT NAME DOCTOR NO. .DATE TIJSCHAK, KIN E 4 NORTH SEASONS DRIVE 3B 4@6621 T SCHAK KIN E 27 33@p DATE OF TELEPHONE I NSURANCE DILLSBURG, PA 11@19 BIRTH NO. CODE DESCRIPTION CERTIFICATE NO. B 08/56 117 _32 2575 9@@ A N TO IN5DRANCE COPAY Tickets 140159064 PTypeP 40 I)RAY~~ PHYSICAIL THI;R.APY INSTIY UTP FED. I.D. # 75-3050291 ~tJ _... __ _..... 6calua fiCan___..__.. _ ._._.._ -.....Time Based Modalities -Direct Contact Required-- _ Other ProcedureslSupplies Description CPT UNITS 59 Description CPT UNITS 59 Description CPT UNITS ~itial Evaluation-PT 97001 Ultrasound {ea.15min) 97035 ~ TENS Instruction 64550 :e-evaluation-PT 97002 , loniophoresis (ea.15min) , 97033 ~ Orthotic Mgmt Training (ea.15 min) 97760 ~itial Evaluation-OT 97003 I E-Stim Attended (ea.15 min) ~ 97032 ~ i Orthotic Checkout (ea.15 min) 97762 e-evaluation-OT 97004 Service Based Procedures/fl4odalities -Direct Contact Not Required Prosthetic Training (ea.15 min) 97761 hysical Performance TesUMeas 97750 Hot/Cold Pack 97010 Electrodes (per pair) A4556 :.r•,F. F~~r,rn;~~ai nrin~_ea 15 m~nl Merhanical Tr~rtion 47012 .Splint: Time 3ased Procedures -Direct Contact Required E-Stim Unattended , 97014 Splint: herapeuticActivities (e . )~ 97530 Vasopneumatic ' 97016 ~ Supplies: ~ ierapeutic Procedures (ea. ) 97110 ~ Paraffin Bath 97018 euromuscular Re-ed (ea. ') 97112 3 WhirlpoollFluidotherapy 97022 Tracking Medicare Non-Medics lanual Therapy (ea. 15 min) 97140 ~ Infrared 97026 Time In ~3 sit Training (ea. 15 min) 97116 Group Therapy 97150 Time Out `f lassage (ea. 15 min) 97124 Biofeedback 90901 ~ Total Treatment Time quatic Therapy (ea. 15 min) 97113 Wound Care Total Service Based Time ---~ elf CarelHome Management 97535 Wound-Selective 5 20SQ. CM 97597 Total Time Based Time omniunitylWork Reintegration 97537 Wound-Selective > 20S0. CM 97598 Total Time Based Units ognitive SkiIIslTraining e 97532 ~ ~ o Wound-Non Selective 97602 ~ • ~ Total Units (SB + TB) C&RVICAL PAIN atient's chief complaiht: they: (~' ~l bjective: Please ref to this -eatment proctression~f`~ flow sheet for details 723.1 Cx Reason: exercises NS R/S Date tq~lay's treatment. RTH: ther (Function, Special Tests, Sensation): they: an: Progress/modify current treatment plan _Achi e by next visit /week Other: rie Re-evaUProgres Report ne t visit D/C patient -Total # visits ierapist Signatur License # _ ~t ~'-'`"' GUA ~ NTO NAME, ND ADDRESS ATIENT NO. PATIENT NAME DOCTOR N0. DATE TUSCHAK, KIf4 1's 38 4@6621 T SCHAK KIN 1's B/11/0 21 330p 4 NORTH SEASONS DRIVB DATE OF TELEPHONE INSURANCE BIRTH NO. CODE DESCRIPTION CERTIFfCATE NO. ~~ f)ILLSHURG, PA 17@19 8 08/56 117 .32 25T5 900 A N TQ INSURANCE COPAY Ticketa% 14@159215 FTypeB 4@ Al12AVli'.R PlrTVST[`AT.TNT+:RAPV TNSTiTTJT~ FED. I.D. # 75-3050291 ~~ Evaluation Time Based Modalities -Direct Contact Required Other Procedures(Supplies, , __.__. __ )escnption -CPT UNITS 59 Description CPT UNITS 59 Description I CPT UNITS ~itial Evaluation-PT 97001 Ultrasound (ea. 15 min) 97035 TENS Instruction 64550 te-evaluation-PT 97002 lontophoresis (ea.15min) 97033 Orthotic Mgmt Training (ea.15 min) 97760 ~itial Evaluaton-OT , 97003 ~ E-Brim Attended (ea.15min) ~ 97032 ~ Orthotic Checkout (ea.15 min) 97762 e-evaluation-OT 97004 , Servtce Based ProcedureslModalities -Direct Contact Not Required Prosthetic Training (ea,15 min) 97761 97750 hysical Performance TestlMeas Hot/Cold Pack 97010 Electrodes (per pair) A4556 ~.C.E. Functional Drills-ea. 15 min) ~ Mechanical Traction 97012 Splint: 'time Based Procedures -Direct Contact Requtred E-Brim Unattended 1 97014 _ _ _ Splint: herapeuticActivities (ea. 5 i) 97530 Vasopneumatic 97016 Supplies: ierapeutic Procedures (ea. t ) 97110 Paraffin Bath ~ 97018 euromuscular Re-e e k 97112 WhirlpoollFluidotherapy 97022 I Tracking Medicare Non-Medics anual Therapy (ea.15 in) 97140 Infrared 97026 Time In sit Training (ea. 15 min) 97116 Group Therapy 97150 Time Out assage (ea. 15 min) ' 97124 Biofeedback 90901 Total Treatment Time auatic Therapy (ea. 15 min) 97113 Wound Care Total Service Based Time -----~ ;If Care/Home Management • 97535 Wound-Selective 5 20SQ. CM 97597 Total Time Based Time ~mmunitylWork Reintegration 97537 Wound-Selective > 20SQ. CM 97598 Total Time Based Units ~gnitive SkiIIslTraining 97532 Wound-Non Selective 97602 Total Units (SB + TB) '(p CER9ICAL PAIK 723.1 Cx Reason: NS R/S Date ibjective: Patienirs er ived changeslp ogr ss tows d functional goals: V,.~[:.t~ ~'- ~. { e- 1~~~ ~j~,g,~j! ~~ ~ (~ -~~ client' hief complaint: her: ~jective: Please refer to this aatment progression: utilized )M: 1 STRENGTH: 'G~IR~T~H~: ~ .~ _ ier (Function, Special Te~fshSi sessment: I~tient's progress n: ~_Progress/modify current treatment plan _Achieve by next visit /week V ~ ~ C Brief Re-eval/Progress Report ne t visit D!C patient Other: _Total # visits rapist Signature ~ // License # l 11 ~ ~i 1 ~~ GUARA R NAME A ADDRESS PA TENT NO. PATIENT NAME DOCTOR NO. DATE SJ06/@ tUSCHAK, KI(d B 38 406621 T SCHAK KIf{ E 27 330p 4 NdflTH SEASONS DRIVE DATE OF TELEPHONE INSURANCE BIRTH NO. CODE DESCRIPTION CERTIFICATE NO. IILLSBUR~, PA 17019 _ 8 @8/56 71T 432 2575 9@0 A TO INSURAKCE Tlctetl 14@15T851 N COPAY PType4 40 DiaAYER PHYSICAL TIiEIZAPY INS1'iTUTE towels Evaluation Time Based Modalities - Direct Contacf Required Other ProcedureslSupplies )escription CPT UNITS- ~ 59 Description CPT ~ UNITS ss Description CPT UNITS iitial Evaluation-PT 97001 Ultrasound (ea. 15 min) 97035 TENS Instruction 64550 te-evaluation-PT 97002 lontophoresis (ea. 15 min) 97033 Orthotic Mgmt Training (ea.15 min) 97760 iitial Evaluation-OT 97003 E-Slim Attended (ea.15min) 97032 Orthotic Checkout (ea.15 min) .97762 ie-evaluation-OT 97004 Service Based Procedures/Modalities • Direct Contsct Not Required Prosthetic Training (ea.15 min) 97761 'hysical Performance Test/Meas 97750 Hot/Cold Pack 97010 Electrodes (per pair) A4556 =.C.E. Functional Drills-ea. 15 min) Mechanical Traction 97012 Splint: I Ime Based Procedures -Direct Contact Required E-Slim Unattended 97014 ~ Splint: herapeuticActivities (ea. 15 ) 97530 ~ Vasopneumatic 97016 Supplies: ~erapeuGc Procedures(ea.1 ~) 97110 Paraffin Bath 97018 euromuscular Reed (ea. 97112 ? WhirlpooVFluidotherapy 97022 Tracking Medicare Non-Medlca lanual Therapy (ea.15 m) 97140 Infrared 97026 Time In ~ ail Training (ea.15min) 97116 Group Therapy 97150 Time Out 'assage (ea. 15 min) 97124 Biofeedback 90901 Total Treatment Time ~uatic Therapy (ea.15min) 97113 ~ Wound Care Total Service Based Time -~'-? ~If Care/Home Management 97535 Wound-Selective 5 20S0. CM 97597 Total Time Based Time ommunity/Work Reintegration 97537 _ Wound-Selective > 20S0. CM 97598 Total Time Based Units ~gnitive SkiIIs/Training 97532 Wound-Non Selective 97602 Total Units,(SB + TB) ' .. h. ` ~ ~ o ~ ® ri CERVICAL FAIN 723.1 Cx NS R/S Date Reason: ~ ~ ~r o I ~} objective: Patient's perce'ved ch nges/progress toward f nc~io~~aoals: f/"~ ~ - t~ itient's chief complaint: ~jecttve: Please refer =atment progression:- specific to the GI ier (Function, Special Tests, sEsssm~nt: Patient's uroore ier: in: Progress/mo -Achieve by next visit/ -Other: -Total # visits '' .., :rapist Signatur current treatment FED. I.D. # 75-3050291 ~~ Brief Re-eval7fsrogress Report next vi~it DfC patient AND ADDRESS GUARANTOR TUSCHAK, KIN B 4 NORTH SEASONS DRIVE DILLSBURG, PA 11019 ,t, , ~~-'L~--" - License # V USwy~ PATIENT NO. PATIENT NAME DOCTOR NO. DATE 36 406621 T SCHAK KIN S 2T 330p DATE OF TELEPHONE INSURANCE BIRTH NO. CODE DESCRIPTION CERTIFICATE NO. 0 08/56 717 432 23T5 900 A TO INSURANCE T1clsetK 140151850 N COPAY PTypeK 40 DRAYER PIiYSICAL TIIERAPY I1~ISZ'J(TUTE FED. I.D. # 75-3050291 ~ r•• l ', Evalua fion Time Based t~4odalities -Direct Contact Required ~ Other Proceduresl5upples lescription CPT UNITS 59 Description CPT UNITS 59 Description CPT UNITS iitial Evaluation-PT 97001 Ultrasound (ea.15min) 97035 TENS Instruction 64550 ;e-evaluation-PT 97002 lontophoresis (ea. 15 min) 97033 i Orthoiic Mgmt Training (ea.15 min) 97760 iitial Evaluation-OT 97003 E-Stim Attended (ea. 15 min) 97032 Orthotic Checkout (ea.15 min) 97762 :e-evaluation-OT 97004 Service Based Procedures/A~odallties -Direct Contact Not Required Prosthetic Training (ea.15 min) 97761 hysical Performance TestlMeas 97750 HotlCold Pack 97010 ~ Electrodes (per pair) A4556 ~.C.E. Functional Drills-ea. 15 min) ~ Time Based Procedures -Direct Contact Required Mechanical Traction E-Stim Unattended 97012 97014 ~ .Splint: Splint: herapeuticActivities (ea. iln) 97530 Vasopneumatic 97016 ~ Supplies: ierapeutic Procedures (ea.15min) 97110 Paraffin Bath 97018 euromuscular Re-ed (ea. m} ~ 97112 Whirlpool/Fluidotherapy 97022 Tracking Medicare Non-Me;dica lanual Therapy (ea.15 m n 97140 Infrared 97026 Time In ~ gj ait Training (ea.15min) 97116 Group Therapy 97150 Time Out lassage (ea.15 min) 97124 Biofeedback 90901 Total Treatment Time quatic Therapy (ea.15min) 97113 Wound Care Total Service Based Time ----- elf Care/Home Management 97535 Wound-Selective 5 20SQ. CM 97597 Total Time Based Time ommunity/Work Reintegration 97537 Wound-Selective > 20SQ. CM 97598 Totai Time Based Units ognitive Skills/Training ~ 97532 ® Wound-Non Selective 97602 ~ ~ ~ Total Units {SB + TB) CERVICAL FAIN Cx NS R/S Date 123.1 .Reason: ha~ng~es/p rog{~e t a functio}~al go~ LS• ~~~ ~' ~J 1 V~~....3G~~~~.~~/d 7"!~,) r.~,v ~'~ ~ !/7 U~'f .~ . n n r a ,. l ~.~•P A / ~ r7,'L, i vw ~ chief complai Cher: bjective: Please refer to this eatment oroaression: to the proced res/modali 'es and e i i eF xercises utilized during today's treatment. :her (Function, Special Tests, her: ~\ A// f I '~ an: ~,~Progress/modify current treatment I -Achieve by next visit /week Other: -Total # visifs - erapist Signature GUARANTD NAMEAN ADDRESS TUSCHAK, KIK E 4 NORTH SEASONS DRIVE DILLS9URG, PA 17019 GIRTH: Brief Re-eval/Progress Report next visit D/C patient ~' ~ '" ' License # ~ ~r~" PAT NT NO. PATIENT NAME DOCTOR NO. DATE 8/04/0 38 406621 T SCHAK KIH E 21 330p DATE OF TELEPHONE INSURANCE BIRTH N0. CODE DESCRIPTION CERTIFICATE NO. S @8/56 717 _32 2575 9@0 A TO INSURANCE Ticket# 140157849 N COPAY PType# 40 DRAYER l'~~IYSICAL T~IRRAPY IIiTSTITUTL FED. I.D. # 75-3050291 Evalua tion Time Based Modalities • Direct Contact Requited Ofiher ProcedureslSupplies tescription CPT UNITS 59 Description CPT I UNITS I59 Description CPT UNITS ~itial Evaluation-PT 97001 . Ultrasound (ea. 15 min) 97035 TENS Instruction 64550 ;e-evaluation-PT 97002 lontophoresis (ea.15min) 97033 Orthotic Mgmt Training (ea.15 min) 97760 iitial Evaluation-OT 97003 E-Slim Attended (ea.15min) 97032 Orthotic Checkout (ea.15 min) 97762 ;e-evaluation-OT 97004 Service Based Proceduresltblodalities -Direct Contact Not Required Prosthetic Training (ea.15 min) 97761 'hysical Performance TestlMeas 97750 HotlCold Pack 97010 ~ Electrodes (per pair) A4556 ~.C.E. Functional Drills-ea. 15 min) I Mechanical Traction-- 97012 ~ Splint: Time Based Procedures • 'rect Cohtact Required __ __ E-Slim Unattended T 97014 Splint: herapeuticActivities (ea. 15 mi 9 530 Vasopneumatic 97016 Supplies: herapeutic Procedures (ea.15min) 97110 I ~ Paraffin Bath 97018 !euromuscular Re-ed (ea. 15 mi 112 Whirlpool/Fluidotherapy 97022 Tracking Med icare Nori-Media ianual Therapy (ea. 15 min) 7140 Infrared 97026 Time In ~ ; fait Training (ea.15min) 97116 Group Therapy 97150 Time Out lassage (ea,15min) 97124 Biofeedback 90901 Total Treatment Time quatic Therapy (ea. 15 min) 97113 Wound Care Total Service Based Time elf CarelHome Management 97535 Wound-Selective S 20S0. CM 97597 Total Time Based Time ommunitylWork Reintegration 97537 Wound-Selective > 20S0. CM 97598 Total Time Based Units ognitive SkiIIs/Training 97532 Wound-Non Selective 97602 Total Units (SB + TB) • ~ • ~ s o CBRVICAL PAIN 123.1 Cx _ Reason: NS R/S Date ubjective: Patient's perceived changes/progress toward functional goals: atient's chief complaint: ether: objective: Please refer to this pa ' n 's fl heel for it pe fit ~(~~o e res/modalities and specific exercises utilized during today's treatment. reatment progression:~r~!~ • ~ ~, Ild . !5 ~S OM: STRENGTH: GIRTH: they (Function, Special Tests, Sensation): ssessment: Patient's progress towards functiona! STG/LTG: ther: i ~l G Ian: Progress/modify current treatment plan -Achieve by next visit /week Brief Re-eval/Progress Report next visit D/C patient Other: -Total # visits ierapist Signature License # C~ii~~ GUARANTOR NAME AND DDRESS PATIENT NO. PATIENT NAME DOCTOR NO. DATE TUSCHAK, KIH li 38 4@6621 T SCHAK KII{ B 2T 1@45 4 NORTH SEASONS DRIVE DATE OF TELEPHONE INSURANCE DILLSBURG, PA 17@14 BIRTH NO. CODE DESCRIPTION CERTIFICATE NO. 8 @8/96 TIT 32 2575 4@@ A TO INSURANCE Ticket# 14@19T@44 N COPAY PTypeB 4@ FED. I.D. # 75-3050291/ III~2AY~It PIiYSICAL TIrIERAPY INSTITUTE Evalua tion - - Time Based Modalities -Direct Contact Required -- Other Procedures/Supplies )escription CPT UNITS 59 Description CPT I UNITS ~ 59 Description CPT UNITS iitial Evaluation-PT 97001 Ultrasound (ea. 15 min) 97035 TENS Instruction 64550 te-evaluation-PT 97002 lontophoresis (ea. 15 min} 97033 Orthotic Mgmt Training (ea.15 min) 97760 iitial Evaluation-OT 97003 E-Slim Attended (ea. 15 min) 97032 Orthotic Checkout (ea.15 min) 97762 ;e-evaluation-OT 97004 Service Based Procedures/Modalities -Direct Contact Not Required Prosthetic Training (ea.15 min) 97761 'hysical Performance Test/Meas 97750 Hot/Cold Pack 97010 Electrodes (per pair} A4556 ^C.E. Functional Drills-ea. 15 min) Mechanical Traction 97012 Splint: ___ _ _ _ Time Based Procedur s - Direct Contact Required E-Slim Unattended ~ 97014 ~ . Splint: herapeuticActivities (ea. 15 97530 Vasopneumatic 97016 Supplies: ierapeutic Procedures (ea.15 '~ 97110 ~ Paraffin Bath 97018 euromuscular Re-ed (ea. 1 97112 , WhirlpooUFluidotherapy 97022 Tracking ~ .Med icare iVon-Medici lanual Therapy (ea. 15 min 97140 Infrared 97026 Time In (, ail Training (ea.15min) 97116 Group Therapy 97150 Time Out "•~ lassage (ea. 15 min) 97124 Biofeedback 90901 Total Treatment Time J quatic Therapy (ea.15min) 97113 Wound Care Total Service Based Time ~If Care/Home Management 97535 Wound-Selective 5 20SQ. CM 97597 Total Time Based Time ommunityANork Reintegration 97537 Wound-Selective > 20SQ. CM 97598 Total Time Based Units ognitive SkillslTraining 97532 Wound-Non Selective 97602 ,. };,,};,~; f;,i , e • o ~ • e Total Units (SB + TB) Cx NS R/S ate l:1SHV1l;AL PAlN atient's chief complaint: 723,1 ~jective: Please refer to this patient's flow sheet for details eatment progression: ~M:_ ~ .. her (Function, Special Tests, rn: _~ Achieve -Total # visits :rapist Signature TUSCHAK, KIM E 4 NOATH SEASONS DAIVE DILLSSUAG, PA 17019 procedu~ s/~Qdalities ar~d specific exercises utilized during today's treatment. GIRTH: License # L.-1~~ ~ ~ / INSURANCE CERTIFICATE NO. Tjcket~ 140157852 PType~ 40 I?g2AYIJR PHYSICALTf~IRRAPY Il'~I~~~ITUTR FED. I.D. # 75-3050291 / Evaluation Time Based Modalities -Direct Contact Required Other ProcedureslSupplies ' lescription ~ CPT UNITS 59 Description CPT UNITS 59 Description CPT UNITS titial Evaluation-PT 97001 ' Ultrasound (ea. 15 min) 97035 TENS Instruction 64550 ;e-evaluation-PT 97002 ~ lontophoresis (ea.15min) 97033 Orthotic Mgmt Training (ea.15 min) 97760 ~itial Evaluation-OT 97003 E-Stim Attended (ea. 15 min) 97032 Orthotic Checkout (ea.15 min) 97762 ;e-evaluation-OT 97004 Service Based ProcedureslModalities -Direct Contact Not Required Prosthetic Training (ea.15 min) 97761 'hysical Performance Test/Meas 97750 HotlCold ck (1 97010 Electrodes (per pair) A4556 = C.F. Funrtional Drills-ea. 15 mint Mechani , I Traction /7 l 97012 _ i Splint: Time Based Procetj res - Direct Contact Required E-Stim U att ed + 97014 Splint: ~ herapeuticActivities (ea. 1 i )~ 97530 Vasopneumatic 97016 Supplies: herapeutic Procedures (ea.1 n) 97110 ~ Paraffin Bath 97018 Ieuromuscular Re-ed (ea. )1 97112 WhirlpooUFluidotherapy 97022 Tracking ~ Med icare Non-Medic lanual Therapy (ea. 15 mr 97140 Infrared 97026 Time In Jam' t fait Training (ea.15min) 97116 Group Therapy 97150 Time Out lassage (ea. 15 min) 97124 Biofeedback 90901 Total Treatment Time ,quatic Therapy (ea.15min) 97113 Wound Care Total Service Based Time •elf CarelHome Management 97535 Wound-Selective 5 20S0. CM 97597 Total Time Based Time ;ommunitylWork Reintegration 97537 Wound-Selective > 20S0. CM 97598 Total Time Based Units ;ognitive SkillslTraining 97532 Wound-Non Selective 97602 e ~ • rr oe CERVICAL PAIN T23,1 Total Units (SB + TB) Cx NS R/S Date Reason: r - r s ~ubjec ' P nt's perceived h n progress~a_r~i un 'o al go s: ~ ~ - • ~ L~ 'atienYS curet comprarnt: v-' >ther: tbjective: Please refer to this patient's flow sheet for gtails reatment progression: 0 IOM: to the today's treatment. rther (Function, Special Tests, Sensation): v ~ ~ ° ~" ~ .sses~mznt: Patient's Drpgre~s to~rards,~¢uncYional STG/LTG: _ '_- ~theri Ian: _~Progress/modify current treatment -Achieve by next visit /week Other: Total # visits herapist Signatu R NAi~I,~ AND ADDRESS TUSCHAK, KIH E 4 NOATH SEASONS DRIVE DILLSHURG, PA 17019 next visit ~ D/C patient ~~ ! License # `-~' ~~r PATIENT NO. 38 4@6621 T SCHAK DATE OF TELEPHONE BIRTH NO. 8(@S/56 717 X32 2575 PATIENT NAME DOCTOR NO. DATE 7/29/@ KIH E 27 300p INSURANCE CODE DESCRIPTION CERTIFICATE NO. 900 A TO INSURANCE Ttcket4 140197042 N COPAY PType;t 40 ~ DRAYEI2 PHYSICAL THERAPY INSTiiTUTE FED. I.D. # 75-3050291 __ ._ __. __-__.____... Evalua fion__._________._ _._TlmeBased,Modalities.-Direct.ContactRequired Other ProcedareslSupplies__ Description CPT UNITS 5s Description CPT UtJiTS ss Description cPT uNtrs iitial Evaluation-PT 97001 Ultrasound (ea.15min) 97035 . TENS Instruction 64550 e-evaluation-PT '97002 lontophoresis (ea.15min) 97033 Orthotic Mgmt Training (ea.15 min) 97760 iitial Evaluation-OT 97003 E-Stim Attended (ea. 15 min) 97032 Orthotic Checkout (ea.i5 min) 97762 e-evaluation-OT 97004 service eased Procedureslfdodalities -Direct Contact Not Required Prosthetic Training (ea.15 min) 97761 hysical Performance Test/Meas 97750 H tlCold Pack ~ 97010 Electrodes (per pair) A4556 r. E. Functional drills-ea. 15 mint ~ echanical Traction i 97017_ A : Solint: ~ Time Based Procedures - ^' ect Contact Required - tim Unattended 97014 Splint: herapeutic Activities (ea. 15 mi 9 30 asopneumatic ' 97016 Supplies: ierapeutic Procedures (ea.15 n ~ Paraffin Bath 97018 euromuscular Re-ed (ea. 15 min) WhirlpoollFluidotherapy 97022 Tracking Medicare ~ Non-MedEcF lanual Therapy (ea. 15 min) 140 Infrared 97026 Time In aif Training (ea.15min) 97116 Group Therapy 97150 Time Out lassage (ea. 15 min) 97124 Biofeedback 90901 Total Treatment Time quatic Therapy (ea.15 min} 97113 Wouhd Care Total Service Based Time ~ elf CarelHome Management 97535 Wound-Selective S 20S0. CM 97597 Totai Time Based Time "'j ommunity/Work Reintegration 97537 Wound-Selective > 20S0. CM 97598 Total Time Based Units ognitive SkiIIs/Training r 97532 ~ a Wound-Non Selective 97602 Total Units (SB + TB} 6~ s e CERVICAL PAIN ubjective: Patient's atiant'c rhiaf rmm~laint• ther: changes/progress toward functional 723,1 Cx Reason: Qln NS R/S Date bjective: Please refer to this patient's flow sheet for details specific to the ~eatment progression: ~ ther (Functioih, Special Tests, Sensation):. TG: GI treatment. :her. ~ - - ...- ....~. t t an: Progress/modify current treatment plan -Achieve by next visit /week -Other: '~ P~l'g Re-eval/Progress Report next visit D/C patient /` ~ ~Q Total # visits ~~ ~s ` (~ ~ ierapist Signature J ~J y ~ _ __ - n r~ ~`'~ License # V c .~ l ~~I GUARANTOR NAME AND ADDRESS P TENT NO. PATIENT NAME DOGTOR NO. DATE TUSCHAK, KIH E 38 4@6621 SCHAK KIN E T/26/@ 2T 815 4 NORTH SEASONS DRIVE DATE OF TELEPHONE I NSURANCE BIRTH NO. CODE DESCRIPTION CERTIFICATE NO. [IILLSBURG, PA 17@19 8 @8/56 71T _32 25T5 9@@ A N TO INSURANCE COPAY Ticket;( 140157385 PT e~ 40 DRAY~R PHYSICAL THI';RAPY IlVS~ITUTI+r FED. I.D. # 75-3050291 Evaluation Time Based Modalities • Direct Contact Required Other Procedures/Supplies ~eSCClption CPT I UNITS 59 Description CPT UNITS ' Ss Description CPT UNITS iitial Evaluation-PT 97001 Ultrasound (ea. 15 min) 97035 TENS Instruction 64550 :e-evaluation-PT 97002 lontophoresis (ea.15min) 97033 Orthotic Mgmt Training (ea.15 min) 97760 iitial Evaluation-OT 97003 E-Slim Attended (ea. 15 min) 97032 Orthotic Checkout (ea.15 min) 97762 :e-evaluation-OT 97004 f Service Based Procedureslh7odalities -Direct Contact Not Required Prosthetic Training (ea.15 min) 97761 hysical Performance TestlMeas 97750 Hot/Cold Pack 97010 ~ Electrodes (per pair) A4556 ~_C.E. Functional Drills-ea.15min) Mechanical Traction 97012 ~ Splint: Time Based Procedures -Direct Contacf Required E-Slim Unattended 97014 Splint: herapeuticActivities (ea. t5 min) 97530 Vasopneumatic 97016 Supplies: ierapeutic Procedures {ea.15min) 97110 Paraffin Bath 97018 euromuscular Re-ed (ea. 15 min) 97112 Whirlpool/Fluidotherapy 97022 Tracking 6Redicare ~ Nbn-Medic lanual Therapy (ea. 15 min) 97140 Infrared 97026 Time In ail Training (ea. 15 min) 97116 Group Therapy 97150 Time Out lassage (ea.15min) 97124 Biofeedback 90901 Total Treatment Time quatic Therapy (ea. 15 min) 97113 Wound Care Total Service Based Time elf Care/Home Management 97535 Wound-Selective 5 20SQ. CM 97597 Total Time Based Time ommunity/Work Reintegration 97537 Wound-Selective > 20S0. CM 97598 Total Time Based Units ognitive SkiIIslTraining 97532 Wound-Non Selective 97602 Total Units (SB + TB) CBAVICAI, PAIN 723,1 I Cx ~ NS R/S Date Reason: ~.f.11~'~-~ objective: Patient's perceived changes/progress toward functional goals: atient's chief complaint: they: bjective: Please refer to this patient's flow sheet for details specific to the procedures/modalities and specific exercises utilized during today's treatment. ~eatment progression: OM: STRENGTH: GIRTH: they (Function, Special Tests, Sensation): ssessment: Patient's progress towards functional STG/LTG: _ _ _ _ __ lher: an: Progress/modify current treatment plan -Achieve by next visit /week Brief Re-eval/Progress Report next visit D/C patient Other: -Total # visits ierapist Signature License # GUARANTOR NAME AND ADDRESS PATIENT NO. PATIENT NAME DOCTOR NO. DATE 7/25/ TUSCHAK, KIN B 38 406621 T SCHAK KIH B 27 33@p 4 NOATH SBASQNS DAIVB DATE OF TELEPHONE I NSURANCE DiLLSBUAG PA 17019 BIRTH NO. CODE DESCRIPTION CERTIFICATE NO. , 8 09/56 ~ 717 32 2575. 900 A TO INSUAANCB Ticgetik 140155881 N COPAY PType~ 40 h~F2 AV~.,'t? P~i~.~.Tf' A T . TNTi.R A PY iNC'ti' (TTTTT+'. T23.1 _ _._. _______ -Evalua tioa_.__ _.___- : _.. _..__ __. _. ?ime Based Modalities -Direct Contact Pequired ----_. _ Other Procedures/Supplies escription CPT UNITS ss Description CPT UNITS 5s Description CPT UNITS iitial Evaluation-PT 97001 Ultrasound (ea. 15 min) 97035 TENS Instruction 64550 e-evaluation-PT 97002 lontophoresis (ea.15min) 97033 Orthotic Mgmt Training (ea.15 min) 97760 iitial Evaluation-OT 97003 E-Stim Attended (ea.15min) 97032 Orthotic Checkout (ea.15 min) 97762 e-evaluation-OT 97004 rvice Based ProcedureslA9odalities -Direct Contact Not Required Prosthetic Training (ea.15 min) 97761 hysical Performance Test/Meas 97750 Hot? old Pack ~ 97010 Electrodes (per pair) A4556 C ~ r~ ^,^'icr_! Dr!!!s-ea. 15 m!n) : chanica( cfion 97012 )______ _ Splint: _ Ttme Based Procedures • Direct Contact Required E-Stim Una ended ~ 97014 Splint: herapeutic Activities (ea.15 nrj 97530 Vasopneumatic 97016 Supplies: ~erapeutic Procedures (ea.1 ' id) 97110 Paraffin Bath 97018 euromuscular Re-ed (ea. 1 97112 Whirlpool/Fluidotherapy 97022 Tracking ilRed icare Non-Media lanual Therapy (ea.15min) 97140 ~ Infrared 97026 Time In gait Training {ea. 15 min) 97116 Group Therapy 97150 Time Out lassage (ea. 15 min) 97124 Biofeedback 90901 Total Treatment Time quatic Therapy (ea, 15 min) 97113 Wound Care Total Service Based Time elf Care/Home Management 97535 Wound-Selective S 20S0. CM 97597 Total Time Based Time ommunitylWork Reintegration 97537 Wound-Selective > 20SQ. CM 97598 Total Time Based Units ~ognitive SkiIIslTraining 97532 Wound-Non Selective 97602 Total Units (SB + TB) ~ ~ ~ • o CB1tVICAL FAIN subjective: ?ther: >s ~rv5ard f4r~ ti nal goals: ~~T~~TTIIL.. ~=~-- Objective: Please refer to this patient's flow sheet for details sp c'fic to the procedu es/modalAy sand specific exercises utilized during today's treatment. 'reatment progression: n~ ~ ~ f tOM: STRE~' NG H: GIRTH: C) )they (Function, Special Tests, Sensation): assessment: Patient's progress tcvrards functional STG1L TG: ~ i~ y ~, )than plan: gress/modify current treatment F -Achieve by next visit /week Other: Total # visits -herapist Signature GUARANTOR NAME AND ADDRESS TUSCHAK, KIN B 4 NORTH SBASONS DflIVB DILLSBUIZG, PA 1T014 C FED. I.D. # 75-3050291 ~`. Cx Reason: NS R/S Date ,,1-~. Brief R~eval/Progress Report next visit D/C patient n 1 -. A ~ r ~r ~ ' License # ~l t t G, (-~ PATIEN N0. V PATIENT NAME DOCTOR NO. DATE T/24/0 38 406621 T SCHAK KIH B 27 330p DATE OF TELEPHONE INSURANCE BIRTH NO. CODE DESCRIPTION CERTIFICATE NO. B 08/56 11T 32 25T5 900 A TO INSUaANCB Tlcket4 140155880 N COPAY PType'4 40 I ~RAY~?`2 PI~YSICAL TFIERAPY II~iSTi1TUTR FED. I.D. # 75-3050291 ~~~ _ Evaluation ._, ----------- _ .. ----- __;__TimeBasedModatities:~_DirectContactRequired_ __ _....__-Dfher.ProcedureslSupplies__._____:_.._. Iescription CPT i UN[TS 5s Description CPT UNITS 59 Descri tl0n P CPT UNITS ~itial Evaluation-PT 97001 Ultrasound (ea. 15 min) 97035 ~ TENS Instruction 64550 ;e-evaluation-PT ` 97002 lontophoresis (ea. 15 min) 97033 Orthotic Mgmt Training (ea.15 min) 97760 iitial Evaluation-OT 97003 E-Stim Attended (ea.15min) 97032 Orthotic Checkout (ea.15 min) 97762 ;e-evaluation-OT 97004 Service Based Procedureslf~fodalities ~ Direct Contact Not Required Prosthetic Training (ea.15 min) 97761 hysical Performance TesUMeas 97750 HoUCoI Pa ~ 97010 Electrodes (per pair) A4556 ~.C.E. Functional Drills-ea. 15 min) Mecha : ical Traction 97n19 Splint; Time Based Procedures -Direct Contact Req fired E-S im a ed 97014 Splint: herapeuticActivities (ea. 15 m t 97530 asopneum 'c 97016 Supplies: ierapeutic Procedures (ea.15 i )~ ~ ` 97110 Paraffin Bath 97018 euromuscular Re-ed (ea, 15 97112 Whirlpool/Fluidotherapy 97022 Tracking Medicare. ~Nori-Media anual Therapy (ea. 15 n ( 97140 rated 97026 Time In ,(3 ait Training (ea. 15 min) 97116 Group Therapy 97150 Time Out assage (ea. 15 min) 97124 Biofeedback 90901 Total Treatment Time auatic Therapy (ea.15min) 97113 Wound Care Total Service Based Time alf Care/Home Management 97535 Wound-Selective 5 20SQ. CM 97597 Total Time Based Time p. ~mmunityNUork Reintegration 97537 Wound-Selective > 20SQ. CM 97598 Total Time Based Units ~gnitive Skills/Training ® 97532 • Wound-Non Selective 97602 ~ • e Total Units (SB + TB) CERVICAL FAIN abjecti F itient's chief Cx NS R/S Date Reason: 723.1 :her: ~jective: Please refer to this patient's flow sheet 5 detail s ecific to the satment progression: )M: STR t GTH:~ IRTH: per (Function, Special Tests, Sensation): `~' sessn-ien ~ tP~ti~nt's pro s' vvards unctio STG/l,TG: ier: '., ln: ~ Broaress/modifv current treatment elan -Achieve by next visit /week -Other: -Total # visits ;rapist Signature TUSCHAK, KIl[ B 4 NORTH SEASONS DRIVE DILLSBURG, FA 17019 ~, i ' Report next visit ~ D/C patient License # ~'~/•TJ~J PATIEN NO. PATIENT NAME DOCTOR NO. DATE 38 4066 T SCHAK KIH ~ E 27 330p DATE OF TELEPHONE INSURANCE BIRTH NO. CODE DESCRIPTION CERTIFICATE NO. B 08/56 717 32 2515 900 A TO INSURANCE Ttcket;r` 140155879 N COFAY PTypeK 40 fTlr?AVF.R P~TV~T(''AT,TTTT+'.14APVTNSTiTITTT+, FED.I.D.#75-3050291 ' ! 1 - - .._._ ____ ______~.Ev_olua tion_ __ Time Based Modalities -Direct Contact Required Other ProcedureslSupplies ' escription CPT UNITS 59 Description CPT I UNITS 59 Description .CPT UNITS itial Evaluation-PT . 97001 Ultrasound (ea. 15 min) 97035 TENS instruction 64550 e-evaluation-PT 91002 lontophoresis (ea. 15 minj 97033 Orthotic Mgmt Training (ea.15 min) 97760 ~itial Evaluation-OT 97003 ' E-Stim Attended (ea. 15 minj 97032 Orthotic Checkout {ea.15 min) 97762 e-evaluation-OT 97004 Service Based ProcedureslModalities • Direct Contact Not Required Prosthetic Training (ea.15 min) 97761 hysical Performance Test/Meas 97750 Hot/Cold Pack G) 97010 ' Electrodes (per pair) A4556 _ y E Fer:^t'^~~~ n^I!~-na 1.5 m~nl I Mechanical Trac~td~if 97012 Splint; _ Time Based Procedures -Direct Contact Required _ __ Stim Unattended f7 ~ 97014 Splint; herapeuticActivities (ea. 15 } 97530 sopneumatic 97016 Suppiies: herapeutic Procedures (ea.15 h 97110 Paraffin Bath 97018 leuromuscular Re-ed (ea. 15 ' }~ 97112 , ~ WhirlpoollFluidofherapy 97022 Tracking Medicare Non Medic Qanuai Therapy (ea.15 min 97140 infrared 97026 Time In 3ait Training (ea.15min) 97116 ~ Group Therapy 97150 . Time Out Aassage (ea. 15 min) 97124 Biofeedback 90901 ~ Total Treatment Time aquatic Therapy (ea.15min) 97113 Wound Care Total Service Based Time 2,,..'~- >elf Care/Home Management 97535 Wound-Selective 5 20SQ. CM 97597 Total Time Based Time ;ommunitylWork Reintegration 97537 Wound-Selective > 20SQ. CM 97598 Total Time Based Units ;ognitive SkillslTraining e 97532 ~ at Wound-Non Selective 97602 a oe Totai Units (SB + TB) CERVICAL PAIN 723.1 Cx NS R/S Date Reason: Subjective: P ie t' e Patient' ~c ie complaint: Other: Objective: Please refer to this patient's flow sheet for Treatment progression: ~~ .-.. .... ~. .....-,.. _..~ _r__. ~. .__._, __..___. _..~._ Asse~st~ent: Patient's progress towards fu ~--- is o t pro dures/ dalit'es and specific exercises utilized during today's treatment. NGT GIRTH: Other: - V Plan: rogress/modify current treatment plan _Ac eve by next visit /week rief a-ev I/Prog ss Report next visit D/C patient Other: Total # visits _ (mil v ( ~ ~~~ Therapist Signature License # GUA ANTOR NA AND ADDRESS PATIENT NO. PATIENT NAME DOCTOR NO. DAT! 7JiTJ0 TUSCHAK, I(IK S 38 406621 T SCHAK KIN S 2T 345p 4 NORTH SEASONS DAIVB DATE OF TELEPHONE INSURANCE BIRTH NO. CODE DESCRIPTION CERTIFICATE NO. ' DILLSHUAG, PA 170!9 ' S 0SJ56 717 32 2575 990 A TO INSURANCE Tlcket~ 140154777 N COPAY PType4 40 T)RAVT~,R PNV~TC'AT,TAtiaRAPV iRT4TTTTITF, FED. I.D. # 75-3050291 ~ , Evaluation T(me Based PJlodalities -Direct Contact Required Other P.rocedure_s!$upplies, _ ..... ~ .__ _ _ .-- lescription CPT uNtTS ss Description CPT I UNITS ~ 5s Description CPT UNITS iitial Evaluation-PT 197001 Ultrasound (ea.15min) 97035 TENS Instruction 64550 ;e-evaluation-PT j rf ~ -" 97002 ( ontophoresis (ea.15min) 97033 Orthotic Mgmt Training (ea.15 min) 97760 iitial Evaluation-OT t 97003 E-Slim Attended (ea.15min) 97032 Orthotic Checkout (ea,15 min) 97762 :e-evaluation-OT 97004 Service sed ProcedureslModalities -Direct Contact Not Required Prosthetic Training (ea.15 min) 97761 hysical Performance Test/Meas 97750 Ho old kt . 97010 Electrodes (per pair) A4556 .C.E. Functional Drills-ea.15min) ~ Me hanical Tractio ' 97012 __)_ ___ Splint: _ _ 1-ime Based t~rocedures -Direct Contact Required E- im U a rlded _ _ 97014 Splint: ~erapeutic Activities (ea. 15 min) 97530 f asopn atic 97016 Supplies: ierapeutic Procedures (ea.15min) 97110 \ araffin Bath 97018 I auromuscular Re-ed (ea. 15 min) 97112 \ irlpooVFluidotherapy 97022 Tracking ~ Medicare Non-Medica anual Therapy (ea. 1 97140 Infrared 97026 Time In ~ L ail Training (ea.15min) 97116 Group Therapy 97150 Time dut assage (ea. 15 min) 97124 Biofeedback 90901 Total Treatment Time - iuatic Therapy (ea.15min) 97113 Wound Care Total Service Based Time 'If CarelHome Management 97535 Wound-Selective S 20SQ. CM 97597 Total Time Based Time r~ ~mmunityM/ork Reintegration 97537 Wound-Selective > 20SO. CM 97598 Total Time Based Units ~gnitive Skills/Training 97532 Wound-Non Selective 97602 Total Units (SB + TB) C15flVICAL PAIN ibjective: Patient's perceived changes/progress toward functional tient's chief complaint: ~-~-~ per: 123,1 Cx NS R/S Date Reason: ~jective: Please refer to this patient's flow sheet for details specific to the procedures/modalities and'specific exercises utilized during today's treatment. ~atment progression: +M: STRENGTH: GIRTH: ier (Function, Special Tests, Sensation): ~essment: Patient's progress towards functional STG/LTG~ __ er: n: Progresslmodify current treatment plan _Achieve by next visit /week Brief Re-eval/Progress Report next visit D/C patient Other: Total # visits _ rapist Signature , ,~ License # ~I rrC X; GUARA OR N ~ E AN ADDRESS PATIE NO. PATIENT NAME DOCTOR NO. DATE 7/15(@ PIlSCHAK, KIK & 38 406621 T SCHAK KIK S 27 330p ! t30&TH SgASONS D&IVIs' DATE OF TELEPHONE [NSURANCE BIRTH NO. CODE DESCRIPTION CERTIFICATE NO. IILLSBQ&G, FA 17019 8 @8/56 711 32 2575 9@@ A TO IAfSU&AHCS Tlcket~ 14@154776 N COPAY PType~ 40 DRAYEFZ PHYSICAL THERAPY I1o1STYTUTR FED. I.D. # 75-3050291 f ~~ Evaluation )eSCflptlon CPT UNITS I ss Time Based fJiodalifies -Direct Contact Required Description CPT UNITS 59 Other Procedures/Supplies Description CPT UNITS iitial Evaluation-PT 97001 Ultrasound (ea. 15 min) 97035 TENS Instruction 64550 ;e-evaluation-PT ~itial Evaluation-OT ;e-evaluation-OT hysical Performance Test/Meas 97002 97003 97004 97750 lontophoresis (ea. 15 min) 97033 E-Stim Attended (ea. 15 min) 97032 ~ Service Based ProcedureslModafities -Direct Contact Not Required Hot/Cold Pack ~ t 97010 Orthotic Mgmt Training (ea.15 min) Orthotic Checkout (ea.15 min) Prosthetic Training (ea.15 min) Electrodes (per pair) 97760 97762 97761 A4556 ' ~.C.E. Funaional Drills-ea.15min) Mechanical T action ~ ~ t 197012 ~ Splint: lime Based Procedures -Direct Contact Re aired. -Stim Unat end dp ~ ~ 97014 ~ Splint: herapeuticActivities (ea. 15 min) 97530 Vasopneumatic 97016 Supplies: ierapeutic Procedures (ea.15min) 97110 Paraffin Bath 97018 euromuscular Re-ed (ea. 15 min) !anual Therapy (ea ~ 97112 97140 hirlpool/Fluidotherapy __ Infrared 97022 97026 Tracking Time In Medicare Non=Medico ait Training (ea. 15 min) 97116 Group Therapy 97150 Time Out assage (ea. 15 min} 97124 Biofeedback 90901 Total Treatment Time ~uatic Therapy {ea. 15 min) 97113 _ ' Wound Care Total Service Based Time a ;If Care/Home Management 97535 Wound-Selective < 20SQ. CM 97597 Total Time Based Time ~mmunitylWork Reintegration 97537 Wound-Selective > 20SQ. CM 97598 Total Time Based Units ~gnitive Skills/Training 97532 Wound-Non Selective 97602 Totaf Units (SB + TB) Cx NS ___ R/S Date Clst{UiCAL FAIN ~ itient's chief complaint: 123.1 Reason: ~jective: Please refer to this :atment progression: details itilized during today's treatment. GIRTH: - - - --' r.. .,y. ~ ~.,~ ~ i u u. ~ L v J- 7y. lJ ier: ( ~n: Progress/modify current treatment plan _Acliieve by next visit /week -Other: Bri rogress a visit D/C patient -Total # visits :rapist Signature License # y t ((~'~ GUA ANTOR AME D ADDRESS ~ PATI~ NT NO. PATIENT NAME DOCTOR NO. DATE TUSCHAK, KIK B 36 4 N4flTH S&ASONS DflIUg 406621 T SCHAK KIH 6 1/14/0 27 330p DATE OF TELEPHONE INSURANCE DILLSBUflG 'PA 17019 BIRTH NO. CODE DESCRIPTION CERTIFICATE NO. , S 08/56 1i1 432 2575 900 A N TO INSUflANCis COPAY Ttcket4 140154775 PTypeN 40 her: I~RAY~R PI3YSICA]L T~I~RAPY I1~1S~~Y'rU'r~ FED. I.D. # 75-3050291 '/~}S( Evaluation Tirne Based Modalities -Direct Contact Required Other ProcedureslSupplies )escription CPT I lJNITS 59 Description CPT UNITS 59 Description CPT UNITS iitial Evaluation-PT 97001 Ultrasound (ea. 15 min) 97035 i TENS Instruction 64550 te-evaluation-PT 97002 ~ lontophoresis (ea.15min) 97033 Orthotic Mgmt Training (ea.15 min) 97760 ~itial Evaluation-OT 97003 E-Stim Attended (ea.15min) i 97032 ~ Orthotic Checkout (ea.15 min) 97762 te-evaluation-OT 97004 a ice Based Procedures/Modalities - Direcf Contact Not Required Prosthetic Training (ea.15 min) 97761 'hysical Performance TesUMeas ` 97750 Hot/ old Pack` 97010 I ) Electrodes (per pair) A4556 =.C.E. Functional Drills-ea. 15 min) ~ ~ Time Based Procedures -Direct Contacf Required chanical Tracti ~ `~,,,.- , ~E-Stim Unattended ~ ' 97012 97014 ~ i Splint: Splint: herapeutic Activitie ( 97530 Vasopneumatic . 97016 Supplies: herapeutic Procedures (ea. 15 7110 ~ Paraffin Bath 97018 leuromuscular Reed (ea. 1 97112 ~ iripool/Fluidotherapy 97022 Tracking ~ Medicare Nori-Medici 1anual Therapy (ea.15 97140 Infrared 97026 Time In fait Training (ea. 15 min) 97116 Group Therapy 97150 Time Out . ~" lassage (ea. 15 min) 97124 Biofeedback 90901 Total Treatment Time quatic Therapy (ea.15 min) 97113 Wound Care Total Service Based Time 1 elf Care/Home Management 97535 Wound-Selective 5 20S0. CM 97597 Total Time Based Time - gmmunity/Work Reintegration 97537 Wound-Selective > 20SQ. CM 97598 Total Time Based Units ognitive SkiIIs/Training s. 97532 ~ o Wound-Non Selective 97602 e • a Totai Units (SB + TB) CEIIVICAL PAIN objective: Patient's C atient's chief comp) dher: Cx NS R/S Date Reason: 723,1 bjective: Please refer to this patient's flow sheet for det ' ecifi tot a procedur odalities~a_ d specific exercises utilized during today's treatment. ~eatment progression: ~ ~ ~ ^~ ~ ~'"'~ OM: STRENGT GIRTH: -{~ ~. they (Function, Special Tests, Sensation):~~ 5~ ~ C. Q ~ y..- ~~ ~ ~ t ssessment: p.ogr ss towards fu ctional STG/LTG: - ~ 1 ~. ~) ~-t_,• ~, Cher: an: v i Achieve b e _Othe r: Tt o al # visits ierapist Signature GUARAI fiUSCHAK, KIFI E 4 Nb1tTH SEASONS DRIVE DILLSBUBG, PA 17019 current AND ADDRESS Brief Re-evaUProgress Repdrt next visit C3/C patient ~~I~ I License # ~ ~~'~ '~ PATIENT NO. PATIENT NAME DOCTOR NO. DATE 7/10/0 38 406621 T SCHAK KIt{ E 27 33@p DATE OF TELEPHONE INSURANCE BIRTH NO. CODE DESCRIPTION CERTIFICATE NO. S @B/56 117 32 2575 90@ A TO INSURANCE Ticket0 140154572 N C6PAY PType~ 4@ DRAYEI2 PHYSICAI, TIIEItAPY INS1`ITUTI~J FED. I.D. # 75-3050291 '// Evaluation Time Based Modalities -Direct Contact Required Other Procedures/Supplies lescriptlon CPT UNITS ss Description cPT untlTS ss Description CPT uNlrs iitial Evaluation-PT 97001 Ultrasound (ea. 15 min) 97035 TENS Instruction fi4550 :e-evaluation-PT 97002 lontophoresis (ea.15min) 97033 Orthotic Mgmt Training (ea.15 min) 97760 ~itial Evaluation-OT 97003 E-Stim Attended (ea. 15 min) 97032 Orthotic Checkout (ea.15 min) 97762 e-evaluation-OT 97004 Service Based Procedures/h7odalities - Qirect Contact h'ot Pequired Prosthetic Training (ea.15 min) 97761 hysical Performance TestlMeas 97750 old Pack 1 ~/ 01 / Electrodes (per pair) A4556 ~.C.E. Functional Drills-ea. 15 min) Mechanical Traction ! 2 ( Splint: Time Based Procedures • Direct Contact Required ~ E- tim Unattended ,J Splint: ~ ~erapeutic Activities (ea. 15 min) 97530 ~ I Vasopneumatic 97016 Supplies: ierapeutic Procedures (ea. 15 min) 97110 Paraffin Bath 97018 euromuscular Re-ed (ea. 15 min) 97112 ~ 'pool/Fluidotherapy 97022 Tracking Medicare: Non'-Medic 'anual Therapy (ea. 15 min) 97140 I Infrared 97026 Time In alt Training (ea.15min) 97116 Group Therapy 97150 Time Out 5/, ~ S assage (ea. 15 min) 97124 Biofeedback 90901 Total Treatment Time auatic Therapy (ea. 15 min) 97113 Wound Care Total Service Based Time elf Care/Home Management 97535 Wound-Selective S 20S0. CM 97597 Total Time Based Time ~mmunityNVork Reintegration 97537 Wound-Selective > 20SQ. CM 97598 Total Time Based Units ~gnitive SkiIIs/Training 97532 Wound-Non Selective 97602 ~ ~ e ~ rig Total Units (SB + TB) Cx NS _ R/S ? ' Date ClillVll;AL YAllt 723.1 Reason: utsjective: Patient's perceived changes/progress toward functional goals: `~- ~ r+~•r.~.-- /~E~ ~tr1 --. F-~ ~ s ~icxk~'i-'wc, ~~ , r ~h C.~..c-....,. ~ atient's chief complaint: ther: sjective: Please refer to this patient's flow sheet for details specific to the procedures/modalities and specific exercises utilized during today's treatment. eatment progression: ~~~ ~,~ ,E,,,~('!-r ~M: STREN~,'f H~ _ GIRTH: o r ~i~_ l rtiicli'Gee1'.rh-• a_v .+n ~•.~~ '*^ -rT l~ 4~if f X7f' " S t.rrOill t i r tittJ -i her (Function, Special Tests, Sensation): L° rsessment: Patient's progress towards functional STG/LTG: `v~. < < ..._. c~c A~ d..n ~- r~~ s~+~...a-iro-ins ~--~r.~ her: sn: _~Progress/modify current treatment plan~.~- ~ .~L. -Achieve by next visit / vveek Brief Re-evaUProgress Report next visit D/C patient -Other: -Total # visits Ztr n ~ / erapist Signature f •f,/L~.~Z• ~ ~'~ License # ~/~/~(t GUARANTOR NAME AND ADDRESS PATIENT NO. PATIENT NAME DOCTOR NO. DATE TUSCHAK, KIN @ 4 NO&TH S@ASONS DflIV@ 360406621 KIN @ ~ 2T 338p I DATE OF I TELEPHONE INSURANCE DILLSBURG, PA 17019 BIRTH I NO. CODE DESCRIPTION CERTIFICATE NO. 08/56 TiT 432 2575 190Q N~TCOPAYUBANC@ I TPc~Yp~t~ 140404571 ~ a~2A5~~R ~'~IYS~CAI, T~iE~.ZAF'ft INg t`i'1'UT~ FED. I.D. # 75-3050291 ~„j~ J Evaluation Time Based Modalities -Direct Contact Required Other Procedures!$upplies I@SCflptlon I CPT UNITS 54 Description CPT UNITS 59 Description CPT UNIT$ ~itial Evaluation-PT 97001 Ultrasound (ea. 15 min) 97035 TENS Instruction 64550 ,2-evaluation-PT 97002 lontophoresis (ea. 15 min) ' 97033 i ~ Orthotic Mgmt Training (ea.t5 min) 97760 iitial Evaluation-OT 97003 E-Stim Attended (ea. 15 min) 97032 , ~ Orthotic Checkout (ea.15 min) 97762 :e-evaluation-OT 197004 Service Based Procedures/IJlodalities -Direct Contact Not Required Prosthetic Training (ea.15 min) 97761 'hysical Performance TestlMeas 97750 ~ Ho old Pack t 97010 Electrodes (per pair) A4556 =.C.E. Functional Orills-ea. 15 min) Time Based Procedures -Direct Contact Required Mechanical Traction j'~ r E-Stim Unattended ~ 97012 97014 I ~ ~ Splint: Splint: herapeuticActivities (ea• i~4) 97530 Vasopneumatic 97016 Supplies: herapeutic Procedures (ea. 15 min) 97110 Paraffin Bath 97018 euromuscular Re-ed ea. 15 min) 97112 Whirlpool/Fluidotherapy 97022 Tracking Medicare Non-Medica lanual Therapy (e 97140 Infrared 97026 Time In gait Training (ea. 1 min) 97116 Group Therapy 97150 Time Out lassage (ea. 15 min) 97124 Biofeedback 90901 Total Treatment Time quatic Therapy (ea. 15 min) 97113 ~ Wound Care Total Service Based Time ~ elf CarelHome Management 97535 Wound-Selective 5 20S0. CM 97597 Total Time Based Time r'J ommunitylWo~k Reintegration 97537 Wound-Selective > 20SQ. CM 97598 Total Time Based Units ognitive SkiIIs/Training ~a~tt t ~~>, _,.ti d ~ ~e Y 97532 ~ o Wound-Non Selective 97602 e e e Total Units (SB + TB) •h CERVICAL PAIN atient's chief compla~,in~t: they: , f°f I 723,1 Cx NS R/S Date Reason: bjective: Please refer to this patient's flow sheet for details specific to the prop~edur /m,,o(dalities and specific exercises utilized during today's treatment. -eatment progression: ~~ (~'~~ ~~~ry ~j~~,Q~, OM: /!-1 ~~„~~~~, ~ STRENGTH: GIRTH: ~~~ an: rog ss/modify current treatment plan _Ac ieve ~ y t visit /week Brief Re-eval/Progress Report next visit D/C patient Other: -Total # visits (~~' ierapist Signature { License # _ _~ ~~ t ~~ GUARANT NAME ,it D ADDRESS PATIENT NO. PATIENT NAME DOCTOR NO. DATE 1/0T/0 TUSCHAK, KIN E 4 NORTH SEASONS DRIVE DILLSRURG, PA 17019 38 DATE OF TELEPHONE INSURANCE BIRTH NO. CODE DESCRIPTION CERTIFICATE NO. 8 08/56 T17 32 25T5 900 A TO INSURANCE Ticket;? 140I54ST0 I I3I2AY~Id ~IiYSICAL TIiLRAPY INSTI'-1'tJTE FED. I.D. # 75-3050291 ~ Evalua tion Time Based frfodalities -Direct Contact Required Other ProcedureslSuppiies )escription CPT uNirS ss Description cPT UNITS ss .Description cPT untlTs nitial Evaluation-PT 97001 Ultrasound (ea. 15 min) 97035 TENS Instruction 64550 fie-evaluation-PT 97002 ~ lontophoresis {ea. 15 min) 97033 Orthotic Mgmt Training (ea.15 rnin) 97760 nitial Evaluation-OT 97003 E-Stim Attended (ea. 15 min) 97032 Orthotic Checkout {ea.15 min) 97762 fie-evaluation-OT 97004 .Service Based Proceduresll~lodatitles • Dlrect Contact Not Required Prosthetic Training (ea.15 min) i 97761 'hysical Performance Test/Meas 97750 ~Wot% old ~ k O 97010 f Electrodes (per pair) A4556 F.C.E. Functional Drills-ea.15min) Time Based Procedures -Direct Contacf Required Mechanical Tractio 1 ?. -Sf ,Unattended ~ 97012 97014 , Splint: Splint: I 'herapeutic Activities (ea, 15 min) 97530 i asopneumatic 97016 ~ Supplies: 'herapeuGc Procedures (ea.15min) 97110 Paraffin Bath 97018 Jeuromuscufar Re-ed (ea. 15 min) 97112 irlpool/Fluidotherapy 97022 Trac(cing Medicare ~ Non-Medic. danual Therapy (ea.15min) p 97140 Infrared 97026 Time In 5 5 gait Training (ea. 15 min) 97116 Group Therapy 97150 Time Out ,~~ passage (ea. 15 min) 97124 Biofeedback 90901 Total Treatment Time aquatic Therapy (ea.15min) 97113 Wound Care Total Service Based Time ielf CarelHome Management 97535 Wound-Selective S 20SQ. CM 97597 ~ Total Time Based Time ;ommunityMlork Reintegration 97537 Wound-Selective > 20S0. CM 97598 Total Time Based Units ;ognitive Skills/Training - ~ 97532 ~ Wound-Non Selective 97602 D ~+. Q @ Total Units (SB + TB) a ~ -c :. CERVICAL PAIN subjective: Patient's pe ~~ 'atient's chief complaint: Cx NS R/S Date Reason: r n 723.1 ether: ibjective: Please refer to this patient's flow sheet for details specific to reatment progression: ' ~~ OM: _ S ENGT I ther ther: ~ ~ "" Ian: Progress/modify current treatment plan ' -Achieve by next visit /week Other: Brief Re evaVProgress Report next visit D/C patient -Total # visits ierapist Signature r. GUARANTOR NAME AND ADDRESS TUSCHAK, KIH B 4 NORTH SEASONS DRIVE DILLSBURG, PA 17@19 and specific exercises utilized during today's treatment. GIRTH:. ~•~ ti ~ License # ~ t -t~~~ P TENT NO. PATIENT NAME .DOCTOR NO. DATE 38 4@6621 T SCHAK KIN E 7/@3/@ 27 1@45 DATE OF TELEPHONE I NSURANCE BIRTH NO. CODE DESCRIPTION CERTIFICATE NO. 8 08/56 717 32 2575 9@@ A N TO INSURANCE COPAY Ticketai 14@15322@ PType# 4@ ssessment; Patient's progress„towards functional STG/LTG:_ N~ l%~~ ~ ~ ,/~ ®.~.-l __ "~/lz ~~. .~.. ,.,~...a~',,__ ,, e ,~ ]DI:AYLIi PT3YSICAL TI-ILRAPY Il`15TI''"rUTL FED. I.D. # 75-.1050291 ~' 1 . ____. __-...____._ ~ygtualiun__ ._ _. " ______. __ __.).tme rsaseg rvtoaal~[ies - vireo co ----- ntact Kequlrea _ ". _ utner_Nrocequreslsupplies " _ )escription CPT UNITS 59 Description ~ CPT UNITS 159 Description I CPT UNITS nitial Evaluation-PT 97001 Ultrasound (ea. 15 min) 97035 TENS Instruction 64550 fie-evaluation-PT 97002 ~ lontophoresis (ea. 15 min) 97033 ; Orthotic Mgmt Training (ea.15 min} 97760 nitial Evaluation=OT j 97003 E-Stim Attended (ea. 15 min) 97032 Orthotic Checkout (ea.15 min) 97762 2e-evaluation-OT 97004 Service Based ProcedureslModalities -Direct Contact Idot Required Prosthetic Training (ea.15 min) 97761 'hysical Performance Test/Meas 97750 `Cold Pack (~ 97010 ( :Electrodes (per pair) A4556 I F.C.F. Fpnctinnal Drills-e~. 15 mint Mechanical Tracti n r ~. 97012 I .Splint: i ~ Time Based Procedures • Direct Contact Required i ~ Unattende Gr? 97014 Splint: 'herapeutic Activities (ea. 15 min) 97530 i asopneumatic 97016 Supplies: "herapeutic Procedures (ea. 15 min) 97110 Paraffin Bath 97018 Jeuromuscular Re-ed (ea, 15 min) 97112 irlpool/Fluidotherapy i 97022 Tracking Medicare Non-Medics Aanual Therapy (ea.15min) 97140 Infrared 97026 Time In ~ ~ fait Training (ea. 15 min) 97116 Group Therapy 97150 Time Out ° ~~ Aassage (ea. 15 min) 97124 Biofeedback 90901 Total Treatment Time aquatic Therapy (ea.15min) 97113 `Wound Care Total Service Based Time ielf Care/Home Management 97535 Wound-Selective S 20S0. CM 97597 Total Time Based Time $- ;ommunity/Work Reintegration 97537 Wound-Selective > 20S0. CM 97598 Total Time Based Units :ognitive SkiIIslTraining e 97532 ~ o Wound-Non Selective 97602 a e ~ Total Units (SB + TB) CERVICAL FAIN ~ubjectiv :Patient's r ~ 'atient's chief com lai )they: 723.1 Cx NS R/S Date Reason: )bjective: Please refer to this patient's flow sheet for deta'Is specific to the procedures odalities,.a d specifi exercises utilized during today's treatment. ~_:.. reatment progression: ~ n - IOM: STREN H: GIRTH: ether (Function, Special Tests, Sensation): SSess:nent: Patient's prCgCBSS tolR~ardS f! nCtlOnal STG/LTG: ~ --~ .n.~C- .~ [~~ fY~ i -- a - ~ther: Ian: Progress/modify current treatment plan _ i~ r -Achieve by next visit /week Brief Re-eval/Progress Report next visit D/C patient -Other: -Total # visits ~~ i ~y ~erapist Signature ~ ~-' ~ License # ~ZC ~ GUARANTOR NAME AND ADDRESS PATIENT N0. PATIENT NAME DOCTOR NO. DATE 7/@2/0 TUSCHAK, KIN E 3B 4@6621 T SCNAK KIN E 27 330p 4 NORTH SEASONS DRIVE DATE OF TELEPHONE INSURANCE BIRTH NO. CODE DESCRIPTION CERTIFICATE NO. DILLSBURG, FA 17019 S @8/56 717 432 2575 900 A TO INSURANCE T[cl;et~ 140153219 N COPAY FTypeIR 4@ DItAYI1R PHYSICAL, TH~~APY INSTI'1'UTU FED. I.D. # 75-3050291 f a.( ...-___ __ ._. _ _ __ Evalua tion-_._. _: _.______ _ time_Based l,Rodalities-Direct Contact Required ___ ____._.__ __ -Other Procedu. reslSupplies _._ _, -- - _ _ ?escription ~ CPT UNITS 59 Description CPT UNITS 59 'Description CPT I UNITS nitial Evaluation-PT 97001 Ultrasound (ea. 15 min) 97035 TENS Instruction 64550 2e-evaluation-PT 97002 ~ lontophoresis (ea. 15 min) 97033 Orthotic Mgmt Training (ea.15 min) 97760 nitial Evaluation-OT 97003 E-Stim Attended (ea. 15 min) 97032 Orthotic Checkout (ea.15 min) 97762 2e-evaluation-OT 97004 ~ ice Based Procedures(Modalitles -Direct Contact Not Required Prosthetic Training (ea.15 min} 97761 'hysical Performance TestlMeas 97750 ot/ old Pack ~ 97010 Electrodes (per pair) ~ A4556 ~~.E.~~^.`.i~.",~Inr:!!S~g~.lg!`I!^) ~ ~A.,P.rhaniralTrarfjnn •~7,i g7n1~ ~ ~ $rlint: ~ I Time Based Procedures -Direct Contact Required -Stim Unattended p 97014 i Splint: 'herapeuticActivities (ea. 15 min) 97530 Vasopneumatic 97016 Supplies: 'herapeutic Procedures (ea. 15 min) 97110 Paraffin Bath 97018 Jeuromuscular Re-ed (ea. 15 min) 97112 Whirlpool/Fluidotherapy 97022 Tracking Medicare ~ Non-Med'ica Aanual Therapy (ea. 15 mi 97140 ,~ Infrared 97026 Time In gait Training (ea. 15 min) 97116 Group Therapy 97150 Time Out ~} Aassage (ea. 15 min) 97124 Biofeedback 90901 Total Treatment Time lquatic Therapy (ea. 15 min) 97113 Wound Care Total Service Based Time ,.'~ lelf CarelHome Management 97535 Wound-Selective 5 20S0. CM 97597 Total Time Based Time ~j ~' ;ommunitylWork Reintegration 97537 Wound-Selective > 20S0. CM 97598 Total Time Based Units ~- ;ognitive SkiIIs/Training Y 97532 ~ 0 Wound-Non Selective 97602 i '' ® 6 Total Units (SB + TB} ~ . n..'..• CERVICAL PAIN 723.1 Cx _ Reason: NS R/S Date tubjective; Patient's perceived chan es/progress toward functional goals: ?'~~ -"t C'~'~~ Zf __ ~~L(.1"~ '~,1\rt'..r iJt~ ' (.p , 'atient's chief complaint: '\ ~ ~~ .r. (~ b 'Y~ru ~- ~Lt'e4't . )ther: I )they: 'Ian: P gress~rnodify current treatment plan h' !r Y -Achieve by isit /week ~` Brief Re-eval/Progress Repott next visit D/C patient Other: Total # visits nn herapist Signature ~ License # ~~"t2~ 5 GUARANTOR NAME AND ADDRESS PATIENT NO. PATIENT NAME DOCTOR NO. DATE 6/30/0 TUSCHAK, KIN B 38 4@6621 T SCHAK KIN E 2T 4@0p 4 NORTH SEASONS DRIVE DATE OF TELEPHONE INSURANCE BIRTH NO. CODE DESCRIPTION CERTIFICATE NO. DILLSHURG, PA 17@19 8 @8/56 117 32 2575 4@@ A TO INSURANCB Tickets 140153218 N COPAY PType;j 40 )bjective: Please refer to this patient's flow sheet for details specificlto the procedur /rmond~alities and specific exercises utilized during today's treatment. _ 'reatment progression: t ~.,~k`~~ ~',~ ~UVV ~j~Q11,'~ ~37~~}C.o~ t ~ d G-Jj O UL~AYIIt 1~IIYSICA)L TI~IRAPY IP~15TI'I'UT~ 723.1 -- -- -. _ _ . _...- Evaluation- _: -_-- ---_ _ _ - _ --.-,-- --_-_--Time Based fE7odalities-- Dtrect Contact Required ----- - ---- ------Other-Procedures/Supplies - )escription I CPT ~ UNITS 159 Description CPT UNITS 59 'Description CPT UNITS nitial Evaluation-PT 97001 Ultrasound (ea. 15 min) 97035 i TENS Instruction ; 64550 ~ Ze-evaluation-PT 97002 • lontophoresis (ea. 15 min) 97033 Orthotic Mgmt Training (ea.15 min) 97760 nitial Evaluation-OT 97003 E-Slim Attended (ea. 15 min) 97032 Orthotic Checkout {ea.15 min) 97762 Ze-evaluation-OT 97004 Service Based ProcedureslModalities -Direct Contact Not Required Prosthetic Training (ea.15 min) 97761 'hysical Performance Test/Meas 97750 H ot/C old Pack 97010 ~ Electrodes (per pair) , A4556 f.V.C. 1 ~III:IIVIIUI VIItiJ-Gd. IJ IIIII I' 1 I I i ,, ~ / 141~riIlUIII~Ji TI :J..t•JIi 07012 °~'~~` r.a... Time Based Procedures • Direct Contact Required E-Slim Unattended 97014 Splint: Therapeutic Activities {ea. 15 min) 97530 Vasopneumatic 97016 Supplies: "herapeutic Procedures (ea.15 min) 97110 Paraffin Bath 97018 leuromuscular Re-ed (ea. 15 min) 97112 Whirlpool/Fluidotherapy 97022 Tracking Medicare Non-Medice Aanual Therapy (ea.15min) 97140 Infrared 97026 . Time In 3ait Training (ea. 15 min) 97116 Group Therapy 97150 Time Out Aassage (ea. 15 min) 97124 Biofeedback 90901 Total Treatment Time aquatic Therapy (ea.15min) 97113 Wound Care Total Seance Based Time self Care/Home Management 97535 Wound-Selective 5 20S0. CM 97597 ~ Total Time Based Time ;ommunity/Work Reintegration 97537 Wound-Selective > 20SQ. CM 97598 Total Time Based Units ;ognitive Skills/Training m 97532 ~ o Wound-Non Selective 97602 ~ ~ o Total Units (SB + TB) C;SAVICAL FAIN subjective: Patient's perceived changes/progress toward functional goals: 'atienYs chief complaint: t~lrnvt-~. ~~ ( 'c ~~4 1 ~~ai~ ~ )ther: -bjective: Please refer to this patient's flow sheet for details specific to the procedures/modalities and specific exercises utilized during today's treatment. reatment progression: iOM: ` S~TQRENGTH: ` GIRTH: i rtYil k'(a 1/ .~°•7 '(~ .-C 4 I ( ~7--~`~ (`~ - ~ F~C~~"t-Q' ~--- ~~~ t'ai~ '-~( ~~~`i~tir>~~ b P ~1 ~~~ ether (Function, Special Tests`, Sensation): ssessment: Patient`s progress towards functionai STGi~TG: rt_~~~'~,~~~~,•,c'~~4 ~ ~~~'-{~a ~'i- ~ ""~" Ither: pan: rrogressimooity current treatment -Achieve by next visit /week Other: -Total # visits `~~ FED. LD. # 75-3050291 ~ Cx NS Reason: Re-eval/Progress Report next visit D/C patient herapist Signature ~ / (~~• r yVi,(~~l~Q,{~ .~ License # ~Z `~ GUARANTOR NAME AND ADDRESS PATIENT NO. PATIENT NAME DOCTOR NO. DATE 6/21/0 TUSCHAK, KINK 38 406621 T SCHAK KIN B 21 41Sp 4 NORTH SEASONS DAIVB DATE OF TELEPHONE INSURANCE BIRTH NO. GODE DESCRIPTION CERTIFICATE NO. DILLSBURG, PA 17019 B 08/56 717 32 2515 900 A TO INSURANCB Tlt:ket4 140153484 N COPAY PType~ 40 I t ~F2 A VF'.R E~E~V ~T('' A T . TTfTF.T2 A PY T14TSTTTTTTT: FED. I.D. # 75-3050291 /~ - - --- _ -- -- -~_-- Evahiation -- ------ -- - --Time Based-62odaiitiesr Direct-Contact Required_ -.__-___ -___ Qther_Procedures - lSu . lies--„ . _ ____ _ --pp - )escription cpr CENITS 58 'Description CPT UNITS 59 Description CPT UNITS nitial Evaluation-PT 97001 ~ Ultrasound (ea. 15 min) 97035 TENS Instruction 64550 fie-evaluation-PT 97002 ~ lontophoresis (ea.15 min) 97033 Orthotic Mgmt Training (ea.15 min) (97760 nitial Evaluation-OT 97003 E-Stim Attended (ea. 15 min) 97032 Orthotic Checkout {ea.15 min) 97762 2e-evaluation-OT 97004 .Service Based Proceduresltdodalities • Direct Contact Not Required Prosthetic Training (ea.15 min) 97761 'hysical Performance TestlMeas 97750 Hot/Cold Pack ~ (97010 l Electrodes (per pair) A4556 F.C.E.I-uncnonaiuritls-ea. iominj I iY~c„~~u~~l,.~l ~&c,..: ~- 0._ m' Time Based Procedures -Direct Contact Required. E-Stim Unattende ~ 97014 Splint: therapeutic Activities (ea. 15 min) 97530 ~ Vasopneumatic 97016 Supplies: - f ~~ ~ S , ~ i herapeutic Procedures (ea. 15 min} 97110 Paraffin Bath 97018 neuromuscular Reed (ea. 15 min) 97112 'L'Vhirlpool/Fluidotherapy 97022 Tracking ~ Med icare Nan-Medic, J~anual Therapy (ea. 15 mi) ' 97140 Infrared 97026 Time In '~ ; 3ait Training (ea. 15 min) 97116 Group Therapy 1 97150 Time Out ~ vlassage (ea. 15 min) aquatic Therapy (ea. 15 min) 97124 97113 Biofeedback ) 90901 ~ Wound Gare Total Treatment Time Total Service Based Time ~ ~ Self Care/Home Management 97535 ~ Wound-Selective 5 20SQ. CM 97597 Total Time Based Time ~ ~., ~ommunitylWork Reintegration 97537 Wound-Selective > 20SQ. CM 97598 Total Time Based Units cognitive SkiIIslTraining e 97532 ~ • Wound-Non Selective 97602 ® ® s Total Units (SB + TB) .{-`.~ CERVICAL PAIN 723,1 Cx N5 Reason: 5u jective: Patient's perceived changes/progress toward functional goal: - ~' 1~' ~~ \ ~~~ \~ v• r Patient's chief complaint: Other: Objective: Please refer to this patie~'s-flow sheet for detail s cific tot a procedures/modalitie ands c' 'c exercis s utiliz~d during today's treatment. Treatment progression: ''_ ~ / ~'" • ~ ~' ROM: TRENGTH: GIRTH: f t'Tt a,c;' Ib, t\nc~.t~k~~c ~ M )-Pac~4, -- ~, Other (Function, Special Tests, Sensation): Assessment: Patient's progress towards functional STG/LTG: ~" ~ ' "'"~~ 7 ~ ~ ~ (~thar• ___ Plan: rogress/modify current treatment F -Achieve by next visit /week Other: Total # visits Therapist Signatur ~ GUARANTOR N E AND ADDRESS TUSCHAK, KIf4 E 4 NORTH SEASONS DRIVE DILLSBURG, PA 17@19 Brief w5 uate C~ Report next visit D/C patient \ ~ " License # CJ ~ PATIENT N0. PATIENT NAME DOCTOR NO. .DATE 6/25/@ 38 406621 T SCHAK KIFt E 27 93@ DATE OF TELEPHONE INSURANCE. BIRTH. [JO. CODE DESCRIPTION CERTIFICATE NO. 8 08/56 717 32 2515 9@@ A TO INSURANCE Ttcket4 140152699 td COFAY PTypeK 4@ I}HAY~Id PHYSICAL T~IERAPY I1~iSTITUTE FED. I.D. # 75-3050291 ~ / Evalua tion Time Based f~lodalities -Direct Contact Required Other Procedures/Supplies )escription CPT UNITS 59 Description CPT UNITS 59 pescription CPT UNITS nitial Evaluation-PT 97001 Ultrasound (ea. 15 min) 97035 TENS Instruction 64550 fie-evaluation-PT 97002 ' lontophoresis (ea. 15 min) 97033 Orthotic Mgmt Training (ea.15 min) 97760 nitial Evaluation-OT 97003 E-Stim Attended (ea. 15 min) 97032 Orthotic Checkout (ea.15 min} 97762 fie-evaluation-OT 97004 Se, ice Based ProceduresMiodalities -Direct contact Not Required Prosthetic Training (ea.15 min) 97761 'hysical Performance Test/Meas 97750 otl old Pack ~ 97010 Electrodes (per pair) A4556 F.C.E. Functional Drills-ea. 15 min) ~ Mechanical faction ) 'f ~ 97012 t ,Splint: Time Based Procedures • Direct Contact Required E-Stim Un tten ~ ' 97014 Splint: 'herapeutic Activities (ea. 15 min) ' 97530 Vasopneumatic 97016 Supplies: , ~' Gq herapeutic Procedures (ea. 15 min) 97110 Paraffin Bath 97018 leuromuscular Re-ed (ea. 15 min) 97112 'rlpool/Fluidotherapy 97022 Tracking 'Medicate Non-Medic danual Therapy (ea. 15 mi 97140 Infrared 97026 Tirne In 7 gait Training (ea. 15 min} 97116 Group Therapy 97150 Time Out 4assage (ea. 15 min) 97124 Biofeedback 90901 Total Treatment Time ,quatic Therapy (ea.15min) 97113 Wound Care Total Service Based Time - ;elf CarelHome Management 97535 Wound-Selective 5 20SQ. CM 97597 Total Time Based Time ~ :ommunity/Work Reintegration 91537 Wound-Selective > 20SQ. CM 97598 Total Time Based Units :ognitive SkiIIs/Training ~:~ .~r, . ,' ., . e 97532 ~ s . Wound-Non Selective 97602 Q ®' a Total Units (SB + TB) ., t;151tV1(;AL YAlN 723.1 Cx NS R/S Date Reason: functional atient's chief complaint: they: bjective: Please refer to this 'ent's flow sheet for tail specific to the procedures/modalities and specific exercises 4tilized during ~eatment progression: , ~ - ~ -~ c~~ OM: RENG _ GI TH: , c t? .k 'S :her (Function, Special Tests, Sensation): ~ ssessment: Patient' progress towards functional STG/LTG: r~ l ~ v ~ ~' ~ i _ ~ ` ~ 'her: ' an: ~ rogress/modify current treatment plan -Achieve by next visit /week -Other: ~ ~ - a B ief Re-evaVProgress Report next visit D/C patient -Total # visits erapist Signature __. License # G~,~~fl GUARANTOR NAME D ADDRESS PATIENT NO. PATIENT NAME DOCTO DATE TUSCHAK, KI({ E 4 NORTH SEASONS DAIVE 38 406621 T SCHAK KIH E 27 415p DIL DATE OF TELEPHONE INSURANCE LSBUAG, PA 17019 BIRTH NO. CODE DESCRIPTION CERTfFtCATE NO. 8 6 717 3 2575 9 C T cketk 152 9 PType# 40 TZR AVTi'R PTTVCTf AT.'i'ITF.RAPV TIiT~'li ~ rrTT~+', FED. I.D. # 75-3050291 ~ J~~ _ .__-_-_ -_ _ _._ __- Evafuation._ Iime_Based IlRodalitigs _Di[ect.Confact Required-- _ -_ ___ ---Other Procedur_eslSupplies lescription CPT UNITS 59 Description CPT I UNITS ~ 59 Description CPT UNITS iitial Evaluation-PT 97001 Ultrasound (ea.15min) ~ 97035 ~ TENS Instruction 64550 ;e-evaluation-PT 97002 lontophoresis (ea.15min) 97033 Orihotic Mgmt Training (ea.15 min) 97760 iitial Evaluation-OT 97003 E-Slim Attended (ea. 15 min) 97032 Orthotic Checkout (ea.15 min) 97762 ie-evaluation-OT 97004 Service Based ProcedureslModalities -Direct Contact hot Required Prosthetic Training (ea.15 min) 97761 'hysical Performance Test/Meas 97750 Ho Cold Pack ~ ) Electrodes (per pair) A4556 "C 5 F;:rc:iccc! Drl!e 15 mi^) I pA?rhaniral TrRrtinn t2 ` 97012 ~~ Splint: -- -- - _--_--_- Time Based Procedures -Direct Contact Required E-Slim Unattended 97014 Splint: herapeutic Activities (ea. 15 min) 97530 Vasopneumatic 97016 Supplies: ~ Pd`~ - herapeutic Procedures (ea. 15 min) 97110 Paraffin Bath 97018 leuromuscular Re-ed (ea. 15 min) 97112 WhirlpoollFluidotherapy 97022 Tracking Med icare Nan-Medic danual Therapy (ea.15min) 97140 Infrared 97026 Time In i!U : (7 gait Training (ea. 15 min) 97116 ~ Group Therapy 97150 Time Out '• ~ passage (ea. 15 min) 97124 Biofeedback 90901 Total Treatment Time aquatic Therapy (ea. 15 min) 97113 Wound Care Total Service Based Time oZ ~ >elf Care/Home Management 97535 Wound-Selective 5 20SQ. CM 97597 Total Time Based Time ;ommunityM/ork Reintegration 97537 Wound-Selective > 20SQ. CM 97598 Total Time Based Uniis ;ognitive SkiIIs/Training 97532 Wound-Non Selective 97602 Total Units (SB + TB) a ~ i • ' 0 6 CERVICAL PAIN ;objective: Patient's perceived changes/progress toward functional 'atient's chief complaint: 723.1 als: J ~ ~--~~--- CX Reason: /.~. ~ N5 Fi/5 Uate )ther: )bjective: Please refer to this patient's flow sheet for details specific ~ -reatment progression: .U iOM: STRENGTH:, and specific exercises utilized during today's treatment. G )they (Function, Special Tests, Sensation): lssessment: Patient's progress towards functional STG/LTG: ' '~" -"' n - )ther: 'fan: rogress/modify current treatment plan .~-~ -Achieve by next visit /week c ~ Brief Re-eval/Progress Report next visit D/C patient Other: -Total # visits f~ l~ ~/ License # ~~~/ -herapist Signature GUARANTOR NAME AND ADDRESS PATIENT NO. PATIENT NAME DOCTOR DATE TUSCHAK, KIN S 38 4@6621 T SCHAK KIN 6 27 1@@@ 4 NOflTH SEASONS ORIVS DATE OF TELEPHONE INSURANCE OILLSBURG, PA 17@19 BIRTH NO. CODE DESCRIPTION CERTIFICATE NO. 8 8 5 717 432 2575 9 A 0 INSURANCE T cket# 14 152696 PType# 4@ I I~RAY~Ia P~IYSICAL'I'I-I~RAPY INSTI1i'UT~ FED. I.D. # 75-3050291 ~~ I --- - - --- ---Evaluation------- -------------__ - ____--.Time Based f~odalities • Direct Contact Required - - - _ Other Procedures/Supplies--------- lescription Cpr UNITS 59 pescription CPT UNITS 59 'Description CPT UNITS iitial Evaluation-PT 97001 Ultrasound (ea. 15 min) ' 97035 ~ TENS Instruction 64550 '.e-evaluation-PT p ~ 97002 lontophoresis (ea. 15 min) 97033 Orthotic Mgmt Training (ea.15 min) 97760 iitial Evaluation-OT 97003 ~ E-Stim Attended (ea. 15 min) 197032 Orthotic Checkout (ea.15 min) 97762 te-evaluation-OT 97004 Service Based Procedures/Modalities -Direct Contact Not Required Prosthetic Training (ea.15 min) 97761 'hysical Performance TestlMeas 97750 HoUCold Pac 97010 Electrodes (per pair) A4556 - ^ ~ ;"urc.iooal Cr~l~ ~ 15 r;i. ; ! i ! ~ h^ech~ ^! TM^^t`cn ~' ' yV ! ^'01 ~ ~ ~p!int: Time Based Procedures- Direct Contact Required E-Stim Unatt ,d 97014 Splint: herapeutic Activities (ea. 15 min) 97530 Vasopneumat j 97016 ~ Supplies: ,~ herapeutic Procedures (ea.15min) 97110 P raffin Bath 97018 leuromuscular Re-ed (ea. 15 min) 97112 irlpoollFluidotherapy 97022 Tracking Medicare ~ Nan-tl4edic~ 4anual Therapy (ea. 15 m l 97140 , Infrared 97026 Time In fait Training (ea.15min) 97116 Group Therapy 97150 Time Out 3 1assage (ea. 15 min} 97124 Biofeedback 90901 Total Treatment Time .quatic Therapy (ea. 15 min) 97113 Wound Care Total Service Based Time elf CarelHome Management 97535 Wound-Selective <_ 20S0. CM 97597 Total Time Based Time ommunity/Work Reintegration 97537 Wound-Selective > 20S0. CM 97598 Total Time Based Units ognitive SkiIIs/Training ®~ 97532 ~ Wound-Non Selective 97602 e ~a Total Units (SB + TB) CERVICAL PAIN Cx NS R/S Date Reason: 723.1 ubjective: Patient's perceived changes/progress toward functional goals: atient's chief complaint: ether: tsjective: Please refer to this patient's flow sheet to s specific to the procedu •eatment progression: OM: STRENGTH: ities and specificexercises utilized during today's treatment. GIRTH: they (Function, Special Tests, Sensation): sse~sment: Patient's progress to:~~ards functiona! STG/LTG: they: an: Progress/modify current treatment plan _nci neve ~y next visit ~ Other: -Total # visits ierapist Signature Brief Re-eval/Progress Report next visit D/C patient GUARANTOR NAME AND TUSCHAK, KIH E 4 NORTH SEASONS DRIVE DILLSBURG, PA 17019 ~vf- License # ~iyJ~~ PATIENT N PATIENT NAME DOCTOR NO. DATE 38 406621 T SCHAK KIN E 2T 1130 DATE OF TELEPHONE INSURANCE BIRTH NO. CODE DESCRIPTION CERTIFICATE NO. 8 OB/66 711 432 2575 900 A TO INSURANCE Tickets 140152624 PType~ 40 D~2AY~~ ~'frIYSICAi~ TII~~aAI'Y 1-NS1 Y'rUT~ FED. I.D. # 75-3050291 --- --_._.__. Evaluation- ____ ____._.IimeB_ased_Modalities.•_Qirect Contact Required _.._._ ___ _i___ Other ProcedureslS~plies__________.____ lescription CPT UNITS 59 Description I CPT I UNITS 159 . Description CPT UNITS iitial Evaluation-PT 97001 Ultrasound (ea. 15 min) 97035 I TENS Instruction i 64550 e-evaluation-PT 97002 ~ lontophoresis (ea.15 min) 97033 ~ Orthotic Mgmt Training (ea.15 min) 97760 iitial Evaluation-OT i 97003 ( E-Stim Attended (ea. 15 min) 97032 Orthotic Checkout (ea.15 min) 97762 ;e-evaluation-OT 97004 .Service Based ProcedureslModatities -Direct Contact fdoE Required Prosthetic Training (ea.15 min) 97761 'hysical Performance TestlMeas 97750 HotlCold Pack ~ 97010 I Electrodes (per pair) A4556 : r c ~~nrti~n?,I n~p~_ea. 15.p;n1 lutarhenical Traetinn ~ 97012 I Splint: Time Based Procedures -Direct Cotrtact Required E-Stim Unattended 97014 Splint: j herapeuticActivities (ea. 15 min) 97530 Vasopneumatic 97016 Supplies: herapeutic Procedures (ea.15min) 97110 Paraffin Bath 97018 leuromuscular Re-ed {ea. 15 min) ~ 97112 Whirlpool/Fluidotherapy 97022 Tracking ~ Medicare Non-Medics 9anual Therapy (ea. 15 min) 97140 Infrared 97026 ~ Time In fait Training (ea. 15 min) 97116 Group Therapy 97150 Time Out lassage (ea. 15 min) 97124 Biofeedback 90901 Total Treatment Time ,quatic Therapy (ea. 15 min) 97113 ~ Wound Care Total Service Based Time elf Care/Home Management 97535 Wound-Selective <_ 20SQ. CM 97597 Total Time Based Time ~ommunitylWork Reintegration 97537 Wound-Selective > 20S0. CM 97598 Total Time Based Units ognitive SkiIIs/Training .~ . ' 97532 Wound-Non Selective 97602 Total Units (SB + TB) CERVICAL FAIN 723.1 Cx ~,f NS R/S Date ~~`~l Reason: ~'~ ~ G~`!l~'Y~~~7.r`~~ subjective: Patient's perceived changes/progress toward functional goals: 'atient's chiet complaint: tther: ibjective: Please refer to this patient's flow sheet for details specific to the procedures/modalities and specific exercises utilized during today's treatment. reatment progression: OM: STRENGTH: GIRTH: ether (Function, Special Tests, Sensation): SSeSSi'i'ient: Pate@nt'S pr6greSS tOwardS fL'i~CilOnal STG/LTG: ether: Ian: Progress/modify current treatment -Achieve by next visit /week Other: Brief Re-evaUProgress Report next visit D/C patient Total # visits herapist Signature License # GUARANTOR NAME AND ADDRESS PATIENT NO. PATIENT NAME DOCTOR NO. DATE TUSCHAK, KIN E 38 4 NORTH SEASONS DRIVE 406621 T SCHAK KIN E 6 18/0 27 1030 DATE OF TELEPHONE INSURANCE DILLSBURG FA 17019 BIRTH NO. CODE .DESCRIPTION CERTIFICATE NO. , 8 08/96 717 32 2579 900 A TO INSURANCE TjcketR 140152282 PType4 40 FED. I.D. # 75-3050291 11 D~AYER PHYSICAL THERAPY INSTITUTE I --- - ----Evalua tion---------- --- -;----Time-Based-Modal'sties_-.DirecsrContact.Required-.__ ....._..... Other. Proced~lr_esl~.u~plies lescription CPT UNITS 5s Description CPT UNITS 5s Description CPT UNITS nitial Evaluation-PT ' 97001 Ultrasound (ea.15min) 97035 ~ TENS Instruction 64550 te-evaluaiion-PT 97002 lontophoresis (ea. 15 min) 97033 i Orthotic Mgmt Training (ea.15 min) 97760 , nitial Evaluation-OT 97003 E-Stim Attended (ea. 15 min) 97032 Orthotic Checkout (ea.15 min) 97762 te-evaluation-OT 97004 ~ Service Based Procedures/Modalities -Direct Contact Not Required Prosthetic Training (ea.15 min) 97761 j 'hysical Performance TesUMeas 97750 Hot/Cold P,3c C 1 97010 ~ Electrodes (per pair) A4556 i .. ~c _ f~~ F.C.C.1-unctior~s~Crils . ~,,;~i~~~~ , ~ /r. ~„~~ ~ o~nnn . C ~ ~ P.,.,ch:..•,....Tr,: q7 17 0._ 1 I Cnlinh Time Based Procedures -Direct Contact. Required E-Stun U : att nod 97014 Splint: 'herapeuticActivities (ea. 15 min) 97530 Vasopneumatic 97016 Supplies: °' ~ - 'herapeutic Procedures (ea.15 min) 97110 Paraffin Bath 97018 leuromuscular Re-ed (ea, 15 min) 97112 Whirlpool/Fluidotherapy 97022 t Tracking Medicare ~ Non-Media Manual Therapy (ea. 1 'r t 97140 ~ -tn raved 97026 Time In ,~ gait Training (ea. 15 min) 97116 Group Therapy 97150 Time Out 4assage (ea.15min) 97124 Biofeedback 90901 Total Treatment Time aquatic Therapy (ea.15min) 97113 Wound Care Total Service Based Time >elf CarelHome Management 97535 Wound-Selective 5 20SQ. C~4 97597 Total Time Based Time ;ommunity/Work Reintegration 97537 Wound-Selective > 20SO. CM 97598 Total Time Based Units ;ognitive Skills/Training ® 97532 ~ o Wound-Non Selective 97602 e ~ ~ Total Units (SB + TB) , •}-~~. CERVICAL PAIN T23.1 )they: Cx NS R/S Date _ Reason: ibjective: Please refer to this patient's flow k~ t ~or dexails specific to the ro ed s/modali ie and spe ific exercises utilized during today's treatment. 'reatment progression: ~ ~,i V~~C--- 1n~ .~ -~`•. ~ ~ ~ <~~~.~ ,~ ..... tOM: f ST ENGTH: GIRTH: )ther (Function, Special Tests, Sensation): ~sse ment: Patient's progress Iowa ds i STG/LTG: 'Ian: ~_..•-progress/modify current treatment plan Achieve by next visit /week .. -•~ Brief Re-eval/ _ Progress Report next visit D/C patient -Other: ~=~ ~ ` ,-•\ Total # visits herapist Signature GUAE~AI TU5CHAK, KIEd E 4 NORTH SEASONS DRIVE DILLS9UAG, PA 17019 AND ADDRESS PA71 NT NO. PATIENT NAME DOCTOR NO. DATE 6/16/0 38 406621 T SCHAK KIH E 27 345p DATE OF TELEPHONE INSURANCE BIRTH NO. CODE DESCRIPTION CERTIFICATE N0. 8 08/56 717 .32 2515 900 A TO INSURANCE TtcketK 140151943 PType~ 40 I)RAYER PHYSICAL THERAPY INSTITUTE f FED. I.D. # 75-3050291 Evaluation Time Based Modalities -Direct Contact Required Other Procedures/Supplies )escriptioit CPT ~ UNITS 59 pescription CPT UNITS 159 Description CPT UNITS ~itial Evaluation-PT 97001 Ultrasound (ea.15 min) 97035 TENS Instruction ' 64550 Ze-evaluation-PT + 97002 lontophoresis (ea. 15 min) 97033 Orthotic Mgmt Training (ea.15 min) 97760 iitial Evaluation-OT 97003 E-Stim Attended (ea.15min) 97032 j Orthotic Checkout (ea.15 min) 97762 te-evaluation-OT 97004 ~ rviee Based Procedures/Modalities -Direct Contact Not Required Prosthetic Training (ea.15 min) 97761 'hysical Performance TesUMeas 97750 0 old Pack 97010 ( Electrodes (per pair) A4556 =.C.E. Functional Drills-ea. 15 min) M_ anlcal Traction ~ ~,,. , 97012 ~ ~ Splint: Time Based Procedures -Direct Contact Required E-Stim Unattended 97014 ___ __ ~ ~ _ Splint: herapeutic Activities (ea. 15 min) 97530 Vasopneumatic 97016 ' Supplies: herapeutic Procedures (ea. 15 min) 97110 Paraffin Bath 97018 leuromuscular Re-ed (ea. 15 min) , 97112 Whirlpool/Fluidotherapy 97022 Tracking Medicare Non-Medics 4anual Therapy (ea.15min) 97140 Infrared 97026 Time In 9' fait Training (ea.15min) 97116 Group Therapy 97150 Time Out 0~ dassage (ea.15min) 97124 Biofeedback 90901 Total Treatment Time f.~ +quatic Therapy (ea.15min) 97113 Wound Care Total Service Based Time ~- ~elf CarelHome Management 97535 Wound-Selective 5 20S0. CM 97597 Total Time Based Time 5 2. :ommunity/Work Reintegration 97537 Wound-Selective > 20SQ. CM 97598 Total Time Based Units :ognitive SkiIIs/Training ~ 97532 • Wound-Non Selective 97602 e • c Total Units (SB + TB) CERVICAL PAID! - 723,1 Cx NS R/S Date Reason: _ subjective: P Tent's perceived changes/progress toward functional gpals: S t~ ~ ~ U`~.~t'1'~ -S ' t ~- ~. ~S n p c>I~ 'atients chief complaint: Ither: Ibjective: Please refer to this patient's flow sheet for details specific to the procedures/modalities and specific exercises utilized during today's treatment. reatment progression: L~-~l'fi ~iY f'~~v S~?,P.~~ .OM: STRENGTH: GIRTH: ~ x~~ e r s v - +ther (Function, Special Tests, Sensation): 1 ~~,Q ` (( ssessment: Patient's progress towards functional STG/LTG: Y~ e. f r ether: Ian: _Ach ieve -Other: _ odify current treatme -an /week ~ Brief Re-evaVProgress Report next visit D/C patient -Total # visits (0 nerapist Signature • ~~ NAME AND TUSCHAK, KIM 1s 4 MORTH S6ASOHS DRIVB DILLS9URG, PA 17019 License # ~j! ~~ PATIENT NO. PATIENT NAME DOCTOR NO. DATE 6/13/0 39 406621 SCHAK KIM B 27 330 DATE OF TELEPHONE INSURANCE BIRTH NO. CODE .DESCRIPTION CERTIFICATE NO. 8 06J56 717 432 2575 90@ A TO IHSURANCI3 Tickets 14015@554 PTy e~ 4@ FED. I.D. # 75-3050291 DRAYEIt PHYSICAL THERAPY INSTI TUTE ' - ~----- --Evafua tiorr------------------ =-- -Time-Basedf}7odalities-~DirectGontact-Required-- ---.-.--_.Other.Prncedures lSup{~lies __ )escription CPT ~ UNITS 59 Description ~ CPT UNITS 5s Description ~ CPT j UNITS nitial Evaluation-PT 97001 Ultrasound (ea.15min) ~ 97035 TENS Instruction 64550 i te-evaluation-PT 97002 ~ lontophoresis (ea.15min) j 97033 Orthotic Mgmt Training (ea.15 min) 97760 nitial Evaluation-OT i 97003 E-Stim Attended (ea. 15 min) 97032 Orthotic Checkout (ea.15 min) 97762 j te-evaluation-OT 97004 j Service Based ProceduresltJlodalides -Direct Contact Not Required Prosthetic Training (ea.15 min) 97761 'hysical Performance TestlMeas 97750 ~ Hot/Cold t j 97010 Electrodes (per pair) A4556 r.u.E.runciiunai utilis-ea. i5iiiiu) i , L,.-i .-I Trn ~a;•r 2 n7 ~7 Mecuui~~ ui ~~,.~~~~i ; .0.~ ~ ~ .~' iin}• p,.... Time Based Procedures -Direct Contact Required E-Stim na bd ; 97014 Splint: 'herapeutic Activities (ea. 15 min) 97530 Vasopneu atic ~ 97016 Supplies: herapeu6c Procedures (ea. 15 min) 97110 Paraffin Bath j 97018 leuromuscular Reid (ea. 15 min) 97112 hirlpooVFluidotherapy 97022 j Tracking Med icare Non-Medici Manual Therapy (ea.15min) 140 ~ Infrared 97026 Time In I 3ait Training (ea.15min) 9 116 Group Therapy 97150 Time Out Aassage (ea.15min) 97124 Biofeedback 90901 j Total Treatment Time j b aquatic Therapy (ea.15min) 97113 tNourid Care Total Service Based Time I ielf CarelHome Management 97535 Wound-Selective S 20SQ. CM 97597 Total Time Based Time l ~C ~~y}-- ~ Y ;ommunity/Work Reintegration 97537 Wound-Selective > 20SQ. CM 97598 Total Time Based Units ~ ;ognitive Skills(Training 97532 Wound-Non Selective 97602 Total Units (SB + TB) j ~ ~ e • ^ CERVICAL PAIN ;objective: Patient's perceived changes/progress toward functional 123.1 /` Cx Reason: NS R/S Date 'atient's chief complaint: )ther: )bjective: Please refer to this patient's flow sheet for details specific to the pro du s/modalities and specific exercises utilized during today's treatment. 'reatment progression: iOM: STRENG? H' GIRTH: )ther (Function, Special Tests, Sensation): }ssessrnent: P tie is pr es towar~.functional STGi G: ~ ~ )thee ,' ifan: Progress/modify current treatment plan ~ ' -Achieve by next visit /week Bri Re-evil/Progress Report next visit D/C patient Other: -Total # visits herapist Signature ~" ' ~ License # / i~~ GUARANT AME AN ADDRESS PATIENT NO. PATIENT NAME DOCTOR NO. DATE 6/11/8 iUSCNAK, KIM E 38 486621 T SCNAK KIM E 27 330p 4 NORTN SEASONS DRIVE DATE OF TELEPHONE INSURANCE BIRTH NO. CODE DESCRIPTION CERTIFICATE NO. DIILSBURG, PA 11619 i3 08/56 711 432 2515 988 A TO INSURANCE Ticketik 146156553 Piype# 40 rn .-vr, n nuVeT~ A T T77TD A DV TllTCTTTTTTii FED. I.D. # 75-3050291 ~~ ~,~..~a~.a~ s as a..._...._ - -- -------Evalua _. _~~----- - - ~- tion--------------- -----i'imeBased[dodalities-Direct ContactiZequired-. ___Other_Pr_ocedureslSupplies____..___,___ )ascription CPT I UNITS 59 Description CPT UNITS 59 Description CPT UNITS nitial Evaluation-PT 97001 ~ Ultrasound {ea.15min) ' 97035 TENS Instruction 64550 te-evaluation-PT 97002 lontophoresis (ea. 15 min) 97033 Orthotic Mgmt Training (ea.15 min) 97760 nitial Evaluation-OT 97003 E-Stim Attended (ea. 15 min) 97032 Orthotic Checkout (ea.15 min) 97762 te-evaluation-OT 97004 Service Based PtocedureslMadalities -Direct Contact Not Required Prosthetic Training (ea.15 min) 97761 'hysical Performance TesUMeas 97750 HoUCold P ck 97010 Electrodes (per pair) ~ A4556 F.G.E. I=uncoonal Unlls-ea. 'i5 min) I ~ o~ ~ni a wCuvn ` ~' ^701'_ ,. Time Based Procedures -Direct Contact Required. ` E-Stun na ed 97014 Splint: 'herapeuticActivities (ea. 15 min) 97530 Vasopn atic 97016 Supplies: -herapeutic Procedures (ea. 15 min) 97110 Paraffin Bath 97018 Jeuromuscular Re-ed (ea.,15 min) 97112 WhiripoollFluidotherapy 97022 j Tracking Med icare ~ Non-Medic. danual Therapy (ea.15 ~ 97140 Infrared 97026 Time In 3ait Training (ea.15 min) 97116 Group Therapy 97150 Time Out Aassage (ea.15min) `,quatic Therapy (ea.15min) 97124 97113 Biofeedback 90901 Wound Care Total Treatment Time Total Service Based Time ~- ielf Care/Home Management 97535 Wound-Selective 5 20SQ. CM 97597 Total Time Based Time :ommunitylWork Reintegration 97537 Wound-Selective > 20SQ. CM 97598 Total Time Based Units ;ognitive SkiIIslTraining ~ 97532 ~ ~ Wound-Non Selective 97602 e • ~ Total Units (SB + TB) CERVICAL PAIN Subjective: Patient's perceived change/s//progresstnward 'atient's chief compla' I'/,~.~., ~,G~ G Gx Reason: rz3.1 NS rv~ uate Other: Objective: Please refer to this patient's flow sheet for details specific to the procedures/mo alities an pacific exercises utilized during today's treatment. treatment progression: 3OM: STREN H: GIRTH: Other (Function. Special Tests, Sensation):. I ~ccaccmon+• Patient's nrnnracc tnwarric functional STG/LTG: --.._. plan: ~gress/modify current treatment -Achieve by next visit /week Other: -Total # visits _ therapist Signature GUARANTOR NAME AND ADDRESS TUSCNAK, KIN E 4 NORTN SEASQNS DRIVE DILLSBURG, PA 17019 Brief Re-evaVProgress Report next visit D/C patient ~~%~ nse # L~%/ t~ PATIENT NO. PATIENT NAME DOCTOR NO. DATE 9 3B 406621 T SCHAK KIM E 2i 1145 DATE OF .TELEPHONE INSURANCE BIRTH NO. CODE DESCRIPTION CERTIFICATE NO. B 08/56 11i 432 2515 900 A i0 INSURANGE TicketB 140150699 PTypeK 40 D~iAY~R PHYSICAL, TH~ItA&'Y INSTITUTE FED. I.D. # 75-3050291 ! _ _. -_..._ . __ _. ______Evaluafion---~- ~ ---------- __ -- -- -Time Based Modaiities-- Direct Contact Required ,-- ------ - ---Other-ProcedureslSupplies - ------ )escription t CPT uNtTS 5s Description cPT utmTS ss Description ~ cPT unllTs nitial Evaluation-PT 97001 Ultrasound {ea. 15 min) 97035 TENS Instruction 64550 fie-evaluation-PT 97002 ~ lontophoresis (ea. 15 min) 97033 Orthotic Mgmt Training (ea.15 min) 97760 nitial Evaluation-OT 97003 E-Stim Attended (ea. 15 min) 97032 Orthotic Checkout (ea.15 min) 97762 2e-evaluation-OT 97004 Servtce Based ProcedureslModallties -Direct Contact Not Required Prosthetic Training (ea.15 min) ; 97761 'hysical Performance Test/Meas ~ 97750 ~ old Pack 97010 . ( Electrodes (per pair) A4556 F.C.E. Fu ctior-! C~!I° . t5 rin) ~ hleGhaniczl Traction "- 97012 ~ '~Nliid: Time Based Procedures -Direct Contact Required E- m, attended r}- 97014 ~ Splint: "herapeutic Activities (ea. 15 min) 97530 Vasopneumatic 97016 ~ Supplies: herapeutic Procedures (ea. 15 min) 97110 Paraffin Bath 97018 leuromuscular Re-ed (ea. 15 min) 97112 Whirlpool/Fluidotherapy 97022 Tracking Medicare Non-Media 3anual Therapy (ea.15 mi 97140 Infrared 97026 Time In , p~ gait Training (ea.15min) 97116 Group Therapy 97150 Time Out - 4assage (ea. 15 min) 97124 Biofeedback 90901 Total Treatment Time aquatic Therapy (ea.15 min) 97113 Wound Care Total Service Based Time elf CarelHome Management 97535 Wound-Selective 5 20SQ. CM 97597 Total Time Based Time :ommunitylWork Reintegration 97537 Wound-Selective > 20SQ. CM 97598 Total Time Based Units Agnifive SkillslTraining ~ 97532 • . Wound-Non Selective 97602 ~ o ~ Total Units (SB + TB) CERVICAL PAIN ubjective: Patien't'^s perceived ~~~~ atient's chief complaint: ~. 123.1 Cx Reason: NS R/S Date ther: bjective: Please refer to this patient's flow sheet for details specific to the, edures/modalities and specific exercises utilized during today's treatment. ~eatment progression: r~ OM: RENGTH: GIRTH: ~ } 7 f',~111 'i~r~c_ L 6 :her (Function, Special Tests, ~sessment: P ~...~- TG: an: ~LProgress/modify current tment plan -Achieve by next visit /week -Other: ~ ~ Brief Re-eval/Progress Report next visit d/C patient -Total # visits ~ , ' ~ i ~ erapist Signature 9 ~ZZ~'/G ` /~/~ -' ~ License # ~~~" GUARANTOR NAME AND ADDRESS PATIENT O. PATIENT NAME DOCTOR NO. DATE TUSCHAK, KIM E 4 NORTH SEAS6NS DRIVE 38 406621 T SCHAK KIM E 21 800 DATE OF TELEPHONE INSURANCE DILLSBURG, PA 11419 BIRTH NO. CODE DESCRIPTION CERTIFICATE NO. B 0D/56 711 32 2515 900 A i0 INSURANGE . Tickets 140150646 PTypeB 40 T)RAVFR PNV~Tf'AT,TATi'.RAPV TNSTTTCTTF, FED. I.D. # 75-3050291 - -- ----- Evalua tion------- ------Time Based Modalities --Direct Contact Required-- -- ----------. Other RrocedureslSupplies._ __.________ Description CPT UNITS 59 Description CPT UNITS ~ 59 Description CPT i UNITS Initial Evaluation-PT 97001 Ultrasound (ea. 15 min) 97035 ~ TENS Instruction 64550 Re-evaluation-PT 97002 • lontophoresis (ea. 15 min) 97033 Orthotic Mgmt Training (ea.15 min) 97760 initial Evaluation-OT 97003 E-Slim Attended (ea. 15 min) 97032 ~ Orthotic Checkout (ea.15 min) 97762 Re-evaluation-OT 97004 ~ Service Based ProcedureslModallties -Direct Contact Not Required Prosthetic Training (ea.15 min) 97761 Physical Performance TesUMeas 97750 old Pack /'Z r 0 Electrodes (per pair) A4556 ;F.C.E. Fuo~,~onel D,iils-ea..G rein) I "~lcchcnicc! Trcction r' ` ~ n70.1~ °"lint: i I Time Based Procedures- Direct Contact Required E-Slim Unattended ~ •z' ( Splint: Therapeutic Activities (ea. 15 min) 97530 Vasopneumatic 97016 Supplies: Therapeutic Procedures (ea.15min) 97110 Par Bath 97018 Neuromuscular Re-ed (ea. 15 min) ~- irlpoollFluidotherapy 97022 Tracking Medicare Non.-Medic, Manual Therapy (ea. 15 min) 9 Infrared 97026 Time In ~ _ ~ 3ait Training (ea. 15 min) 97116 Group Therapy 97150 Time Out 1 Massage (ea.15 min) 97124 Biofeedback 90901 ~ Total Treatment Time ;~,' ~ 4quatic Therapy (ea.15min) 97113 Wound Care Total Service Based Time Self CarelHome Management 97535 Wound-Selective 5 20SQ. CM 97597 Total Time Based Time L 3ommunity/Work Reintegration 97537 Wound-Selective > 20SQ. CM 97598 Total Time Based Units cognitive SkiIIs/Training ~ 97532 ~ s Wound-Non Selective 97602 e s ~ Total Units (SB + TB) :s CERVICAL PAIN subjective:,, Patient's perceived 'atient's chief complaint: Cx 123.1 Reason: ~ -• ~ functional coals: _ v S ` NS R/S Date _ ~~®~~~ I.~ to (L)1-~ ether: objective: Please refer to this p tient's flow she t for details specific to the procedures/modalities and specific exercises utilized during today's treatment. treatment progression:, C~I S S~Lt:Ei-s 30M: STRENGTH; GIRTH: c. 1 ~ ~-~IQ,~~ ~- ~z ll~x G,~vr ether (Function, Special Tests, Sensation): assessment: Patient's progress towards functional STG~`LTG: ~ ~s 'r-c' far-~a.~~ 9s~~- . ether: plan: Progress/modify current treatment plan ~ ~~--~:-~~ -Achieve by next visit /week Brief Re-eval/Progress Report next visit D/C patient Other: - Total # visits ~p 1 -herapist Signature ~ ~ License # d/~7 ~; GUARANTOR NAME AND ADDRESS PATIENT NO. PATIENT NAME DOCTOR NO. DATE 6/05/0 TUSCNAK, KIM E 38 406621 T SCNAK KIN E 2I 345p 4 NORTN SEASONS DRIVE DATE OF TELEPHONE INSURANCE DILLSBURG PA 11019 BIRTH NO: CODE DESCRIPTION CERTIFICATE NO. , 8 08/56 111 432 2515 900 A TO INSURANCE Tickets 140150550 PTypet 40 DItAYER PHYSICAL THERAPY II'dSTITUTE FED. I.D. # 75-3050291 "1~ Evaluation - - Time Based Modalities -Direct Contact Required Other Procedures/Sup lies )escrlptlo CPT UNITS 59 Description CPT UNITS 59 Description cPT UNITS nitial Evaluation-PT 97001 Ultrasound (ea. 15 min) i 97035 TENS Instruction ~ 64550 2e-evaluation-PT 97002 lontophoresis (ea. 15 min) 97033 Orthotic Mgmt Training (ea.15 min) 97760 nitial Evaluation-OT 97003 E-Slim Attended (ea. 15 min) 97032 Orthotic Checkout (ea.15 min) 97762 te-evaluation-OT 97004 Service Based ProceduresfModalities • Direct Contact Not Requ ired Prosthetic Training (ea.15 min) 97761 'hysical Performance TesUMeas 97750 HoUCold Pack ~ 97010 Electrodes (per pair) A4556 =.C.E. Functional Drills-ea. 15 min) ~~- I - Mechanical btioh ~ 97012 _-.- . .....-- - -- --- ~ - Splint: ----- -- - - - -- - Time Based Procedures -Direct Contact Required E-Slim Unattended I 97014 p S lint: 'herapeutic Activities (ea. 15 min) 97530 t Vasopneumatic 97016 Supplies: J~ '~ herapeutic Procedures (ea. 15 min) 97110 Paraffin Bath 97018 leuromuscular Re-ed (ea. 15 min) 97112 ~ WhirlpooUFluidotherapy 97022 Tracking Medicare Non-Media lanual Therapy (ea. 15 97140 Infrared 97026 Time In gait Training (ea.15min) 97116 Group Therapy 97150 Time Out ~ G lassage (ea.15min) 97124 Biofeedback 90901 Total Treatment Time quatic Therapy {ea. 15 min) 97113 Wound Care Total Service Based Time ~ '] elf Care/Home Management 97535 Wound-Selective 5 20S0. CM 97597 Total Time Based Time ommunity/Work Reintegration 97537 Wound-Selective > 20S0. CM 97598 Total Time Based Units ognitive Skills/Training ~ 97532 ~ Wound-Non Selective 97602 ~ • ~ Total Units (SB + TB) .F CEflVICAL PAIN -Patient's pe of codnnlaint: Cher: toward functional 723.1 Cx NS R/S Date Reason: ~ w Lf _ 'i Vll~ VYIa•~inut bjective: Please refer to this patient's flow sheet or details specific to the procedures/modalities and specific exercises utilized during today's treatment. eatment progression: ,~, ~M: ENGTH: GIRTH: i a ~~ ,v ' 't~-l ~~ e~~~Y~- `1-~yw -~ ~ '' ~1 ~ ~ .~~_ ~' i, 1 1 /I ~I -~' (~ l ~l f 9'1i.(fyl ltt~ 5 -i~hi her (Function, Special Tests, Sensation): _ ~,,,I, :sessment: Patient's progress towards functional STG/LTG: u her: in: gress/modify current treatment plan_~~ -Achieve by next visit /week Other: Brief Re-evaUProgress Report next visit t D/C patient -Total # visits -~ =rapist Signature _~C7- y! GUARANTOR N/ TUSCHAK, KIN E 4 NO&TH SEASONS DRIVE DILLSBUAG, PA 17019 AND ~~ License # ~`I Z~ 5 PATIENT NO. PATIENT NAME DOCTOR NO. DATE 6/03/0 406621 SCHAK KIN E 21 345p DATE OF TELEPHONE INSURANCE .BIRTH NO. CODE DESCRIPTION CERTIFICATE NO. 08J56 711 432 2575 900 TQ INSURANCE Tlcket~ 140150311 FType~ 40 ilRAVT'.R F~NVCTf'AT.TAT+'.RAPVTNCTTTTTTF. FED. I.D. # 75-3050291 ._:_.-_: ,_. _ _ __.__:__Exalu~ tion _::_____ . _ , .--Time Based Modalities • Direct Contact Required Other Procedw•eslSuppiies }escriptlon CPT UNITS 59 Description CPT UNITS ~ 59 Description CPT UNITS nitial Evaluation-PT 97001 Ultrasound (ea. 15 min) 97035 TENS Instruction 64550 te-evaluation-PT 97002 lontophoresis (ea. 15 min} 97033 Orthotic Mgmt Training (ea.15 min) 97760 nitial Evaluation-OT 97003 E-Slim Attended (ea. 15 min) 97032 Orthotic Checkout (ea.15 min) 97762 te-evaluation-OT i 97004 Service Based ProcedureslModalities -Direct Contact Not Required Prosthetic Training (ea.15 min) 97761 'hysical Performance TestlMeas 97750 Hot/Cold Pack 97010 Electrodes (per pair) A4556 Fc F F~i~rtinoal nrills-Pa.15 mini ' Time Based Procedures - Direct Gontact Required ~ Mechanical Traction ~ E-Slim Unattended 97012 97014 _____ _ Splint: _ Splint ~ ~ ~ 'herapeutic Activities (ea. 15 min) 97530 I Vasopneumatic 97016 Supplies: I 'herapeutic Procedures (ea.15 min) 97110 Paraffin Bath 97018 Jeuromuscular Reed (ea. 15 min) 97112 Whirlpool/Fluidotherapy 97022 Tracking Med icare ~ Non-Media Aanual Therapy (ea. 15 min) 97140 Infrared 97026 Time In ~ •Ot' gait Training (ea. 15 min) 97116 Group Therapy 97150 Time Out _ Aassage (ea. 15 min) 97124 Biofeedback 90901 Total Treatment Time !quatic Therapy (ea.15min) 97113 Wound Care Total Service Based Time - ~elf Care/Home Management 97535 Wound-Selective S 20SQ. CM 97597 Total Time Based Time ;ommunity/Work Reintegration 97537 Wound-Selective > 20SQ. CM 97598 Total Time Based Units ;ognitive Skilis/Training ~ 97532 ~ • Wound-Non Selective 97602 ~ ~ • ~ Total Units (SB + TB) CBRVICAL PAIN 723.1 Cx NS R/S Date Reason: >ubjective: Patient's perceived changes/progress toward functional goals: 'atient's chief comolaint• ~ ^ y U~ ~ f ~ ~ ~ y r ww a•u .,, + )thee / . _ __ ,~ L _ fn.. .., /_ 1 ~ )ther (Function, Special Tests, lssessment: Patient's progress towards functional STG/LTG: , hher ..~ '~~ ct 'Ian: Progress/modify current treatment plan -Achieve by next visit /week Brief Re-eval/Progress Report next visit D!C patient Other. Total # visits "herapist Signature /~-~ ~j~ ~l a-! License # GUARANTOI~NAME AND ADDRESS PATIENT NO. PATIENT NAME DOCTOR NO. DATE S/2ti/ 8 TUSCHAK, KIN 6 38 4@6621 USCHAK KIN !3 27 8@0 4 O ~ N RTH SBASONS DRIVB DATE OF TELEPHONE' INSURANCE DILLSBURG PA 17@19 BIRTH NO. CODE .DESCRIPTION CERTIFICATE NO. , 8 @8/56 717 432 25T9 9@@ TO INSURANCE Ticket$ 14@148894 PType~ 4@ )bjectlve: Please refer to this patient's flow sheet for details specific to the procedures/modalities and^specif~~xer_cises utilized during today's treatment. "reatment progression: (~- ~~~~ iOM: i • _ ___~ __ - _~` _ STRENGTH: GIRTH: nn ~ vr~r~ r~uverr A r TrXTi'A s vv TllTCTY•f'T TTFi' 123,1 -- - - - -----° --Evatua tiorr-- ----- --- -- Time Based-Modalities--Direct Contact Required----- --------- -.Other.Procedures/Supplies-- . .________ )eSCCIpt1011 CPT UNITS 59 Description CPT i UNITS 59 Description CPT I UNITS nitial Evaluation-PT 97001 ~ Ultrasound (ea. 15 min) 97035 I TENS Instruction 64550 fie-evaluation-PT 97002 lontophoresis (ea. 15 min) 97033 I Orthotic Mgmt Training (ea.15 min) 97760 nitial Evaluation-OT 97003 E-Stim Attended (ea, 15 min) 97032 ~ Orthotic Checkout (ea.15 min) 97762 2e-evaluation-OT 97004 Service Based ProcedureslModalities • Direct Contact Not Required Prosthetic Training (ea.15 min) 97761 'hysical Performarice TestlMeas 97750 Hot/Cold Pack f 5' 97010 ~ I Electrodes (per pair) I A4556 F.C.t. Func[ionai Urilis-ea. i5 min) I I T ,.,a•_. ,., iY1C1.11G111(..a 1 rGl.l~Ul I L ~ 7 ,•, L j c lent: Time Based Procedures -Direct Contact Required ' E-Stim Unattended 9701 I Splint: j iherapeuticActivities(ea.l5min) 97530 asopneumatic 97016 Supplies: herapeutic Procedures (ea.15min) 97110 Paraffin Bath 97018 deuromuscular Re-ed (ea. 15 min) 97112 WhirlpooUFluidotherapy 97022 Tracking Med icare Non-Media Manual Therapy (ea. 15 min) 97140 Infrared 97026 Time In 3ait Training (ea.15min) 97116 Group Therapy 97150 Time Out ,' -2.7 Massage (ea. 15 min) 97124 Biofeedback 90901 Total Treatment Time Z aquatic Therapy (ea.15min) 97113 Wound Care. Total Service Based Time ielf Care/Home Management 97535 Wound-Selective <20SQ. CM 97597 Total Time Based Time ;ommunitylWork Reintegration 97537 Wound-Selective > 20S0. CM 97598 Total Time Based Units ;ognitive SkiIIs/Training 97532 Wound-Non Selective 97602 Total Units (SB + TB) ~ ~ • o ~ ~ CERVICAL PAIN >atient's chief ether: 3bjective: Please refer to this patient's flow sheet for details specific to the procedures/modalities and specific exercises utilized during today's treatment. treatment progression: ~~~ 3OM: _ STRENG~Fd: r., r GIRTH: ether (Function, Special Tests, Sensation) 4ssessment: Patient's oroaress towards c >lan: _;,~P gr ss/modi urrent treatment plan t.+'~-"~ - o t ~~ v - i r i ~ w ~ v r v ~ w~ ~ ~ --- r - _Achieve b t visit / ee ~ C ~ Brief Re-eva Progress eport next visit D/C patient Other: ' -Total # visits s therapist Signature O License # O t ~~I GUARANT R NAME AND ADDRESS PATIENT NO. PATIENT NAME DOCTOR N0. DATE 5/24/ 8 TUSCHAK, KI6f E 38 406621 USCHAK KIH E 2T 800 4 NORTH SEASONS DRIVE DATE OF TELEPHONE INSURANCE BIRTH NO. CODE DESGRIPTION CERTIFICATE NO. OILLSBURG, FA 17019 8 08/56 TiT 432 2575 9@0 UTO INSURANCE Tlcket~ 140148893 PTypeB 40 FED. I.D. # 75-3050291 Gx Reason: NS rti~ uare n~ ~v~'t~ puVCTf' A T TuFR APV TraCTT'7~f fTF. ~ ecific to the procedures/mod lities and STRENGTH: ------- -- -- -------- --Evaiuatiarn --------= -- -- - ----Tame-Based Modalities _Dicect.ContactRequi~ed____ - ....______--_Other.ProcedureslSupplies ____....._ . )ascription CPT UNITS 59 Description CPT I UNITS 59 Description CPT UNITS ~itial Evaluation-PT 97001 Ultrasound (ea. 15 min) 97035 TENS Instruction 64550 te-evaluation-PT 97002 lontophoresis (ea. 15 min) ~ 97033 Orihotic Mgmt Training (ea.15 min) ; 97760 iitial Evaluation-OT 97003 E-Stim Attended (ea. 15 min) 97032 Orthotic Checkout (ea.15 min) 197762 te-evaluation-OT 97004 I `Service Based ProcedureslModalities • Direct Contact Nof Required Prosthetic Training (ea.15 min) ~ 97761 'hysical Performance TestlMeas 97750 Hot/Cold Pack ~ 97010 ) Electrodes (per pair) A4556 ~.~.~. rur~cGonal Grillo-s~. t~ rair ~ ; h.~och~nic~l Tr~c6cn , ~ v 9701? I S;!lir?t: Time Based Procedures -Direct Contact Required E- tim Unattended ~j 97014 Splint: ` ,ot) 'herapeuticActivities (ea. 15 min) 97530 ~ Vasopneumatic 97016 Supplies: herapeu6c Procedures (ea.15min) 97110 Paraffin Bath 97018 leuromuscular Re-ed (ea. 15 min) 97112 WhirlpooUFluidotherapy 97022 Tracking Med icare Non-Media danual Therapy (ea. 1 ~ 97140 4 Infrared 97026 Time In '• ~ gait Training (ea. 15 min) 97116 Group Therapy 97150 Time Out ( ~ 4assage (ea.15min) 97124 Biofeedback 90901 Total Treatment Time aquatic Therapy (ea.15min) 97113 Wound Care Total Service Based Time pelf Care/Home Management 97535 Wound-Selective 5 20SQ. CM 97597 Total Time Based Time ;ommunity/Work Reintegration 97537 Wound-Selective > 20SQ. CM 97598 Total Time Based Units ;ognitive SkillsfTraining ~ 97532 ~ • Wound-Non Selective 97602 o ~ o ~ Total Units (SB + TB) . -{- I 'atient's chief complaint: )ther: Cls -P~ ~ r~~-Z . STG/LTG: R/S Date Ibjective: Please refer to 'reatment progression:- IOM: )ther (Fu cti ec'~I Tests,~Se sat assessment: Patient's progress tow ether:. ~. ~ 'Ian: Prog ss/ , ify current -Achieve by next visit /week Other: l Total # visits herapist Signat i GUARANTOR ~ ME AND TUSCHAK, KIM E 4 NOATH SEASONS OAIVE t1ILLSBUAG, PA 17@19 FED. I.D. # 75-3050291 Cx _ Reason: G VProgress Repot next visit ~ D/C patient ^~~v~~U 1 i 1./~ License # ~~~~1~ PATIENT N0. ~ I PATIENT NAME DOCTOR NO, DATE 5J23J 8 64@6621 USCHAK KIM E 27 845 DATE OF TELEPHONE INSURANCE BIRTH NO. CODE .DESCRIPTION CERTIFICATE NO. '@B/56 71T 432 2975 9@0 UTO INSURANCE TicketK 14@148892 PType~ 4@ nn ~ vin nEiVCT!"~ A Y 'TltIT`72 A PV T1lTQ'i'TTIf TTTi'. FED. I.D. # 75-3050291 ~~ -- --- - ------Evaiuation- --=---- --Time.Based_Modalifies=-Dire-ctContactgequired___ _.-_______._ Other Pro_ce__d_u_reslSupplies )escription I CPT UNITS 59 Description CPT UNITS 59 Description CPT UNITS iitial Evaluation-PT 97001 l Ultrasound (ea. 15 minj ; 97035 TENS Instruction 64550 ;e-evaluation-PT 97002 lontophoresis (ea. 15 min) ~ 97033 Orthotic Mgmt Training (ea.15 min) 97760 iitial Evaluation-OT 97003 E-Slim Attended (ea.15min) 97032 ~ Orthotic Checkout (ea.15 min) 97762 te-evaluation-OT 97004 ' e Based ProceduraslModalities -Direct Contact Not Required Prosthetic Training (ea.15 min) 97761 'hysical Performance TesUMeas 97750 oUC d Pack 97010 Electrodes (per pair) ~ A4556 - ~ ~ - ~• • ~ •r -•- -.l..t. runGtWlldl L71111S-CG. w Od.,) I ~ ~ an'ral T a t' ~"~ i ~ ~.. .., !..-... r-CJOn ;_ 97(112 ~! $pllnt: Time Based Procedures:- Direct Contact Required E-Slim Unattended 97014 Splint: -hers peutic Activities {ea. 15 I 97530 Vasopneumatic 97016 Supplies: 'herapeutic Procedures (ea.15min) 97110 Paraffin Bath 97018 neuromuscular Re-ed (ea. 15 min) 97112 WhirlpooVFluidotherapy ~ 97022 Tracking Med icare Non-Medica Aanual Therapy (ea.15min) 97140 ~ ,,~ Infrared 97026 Time Ih 3ait Training (ea. 15 min) 97116 Group Therapy 97150 Time Out Aassage (ea. 15 min) 97124 Biofeedback 90901 Total Treatment Time aquatic Therapy (ea.15min) 97113 Wound Care Total Service Based Time >elf CarelHome Management 97535 Wound-Selective 5 20SQ. CM 97597 Total Time Based Time ;ommunityllNork Reintegration 97537 Wound-Selective > 20S0. CM 97598 Total Time Based Units ;ognitive SkiIIs/Training 97532 Wound-Non Selective 97602 Total Units (SB + TB) ~ ~ ~ ~ • ~ (~ //~~ ~ ~;Q P l~ ~ ~ ~ ~~'-` ~ C Cx NS _ R/S Date Reason: 1 ~ ~ • i C..M:entivn• P~+icnt'c ncrrai«wr~ rtha nnaR/Nf1(11'P.RR I'OWArCt fnnCtlOrlat dOdIS: ~ 1 /il J ~ ~ - • j ~ ., ~ 'atient's chief co ' t: ether: objective: Please refer to this patient's flow sheet for details specific to the treatment progression: ~nnn• STRENGTH: a~ pecific exercises utilized during today's treatment. GI ether (Function, Special Tests, 4ssessment: Patient's progress towards functional STG/LTG: Jther: ?Ian: Progress/modify current treatment plan -Achieve by next visit /week Briet Re-evaUProgress Report next visit D/C patient -Other: Total # visits therapist Signature AND ADDRESS... 7PATIENT NO. TUSCHAK, KIN B 38 4@6621 USCHAK 4 NOATH SEASONS DAIVE DATE OF TELEPHONE DILLSBUAG, FA 17@19 BIRTH N0. S @S/56 111 432 2575 License# lJf ~~~ PATIENT NAME DOCTOR N0. DATE 5/22/ 8 KIN E 21 315p INSURANCE CODE .DESCRIPTION 9@@ UTO INSURANCE CERTIFICATE NO. Ticket# 140148764 FTypet 4@ [ - {, , ... ,. D RAPE R® Physical Therapy Institute Leading the Way to Good Health Patient Name: _ '~R~r~T-MINT FLOW _S-~~E'~' Dates ~_ ~~-L~_. ~-0,3~~ .z~-G~ tU~ tdr ~ ~rGd ~v ~ '.n (.'~ ~~~ _y j ~i uy~ C i I ~ ~' S ~j'~t t 1 C~j I ~' V'- l C ~~~ '~, ~6"" N V ~ tW~rv, f Z ~~....r- 1 t ~./~ ~~ s ]~' ~ ~l of [Sb ~, ~ ` ha[~ .._-_. ._._-- 5 ~' c L (0~ ~~ ~ ~6 ~ ~~ ~ ~~~t Z~~I D`~ ,Z ~~f~'~ tt 11 ~~IC1 ` ~, '1~ io ~~~4~~ ~ ~( ~Dt~ r~ ~~ ~ Ur~~ ;b;c T~. L ~ ~ k~~,i ~7 ~! ~J "~-.~ a ~v1 r-E- I'zI a, ~ i'L'[415 1 ~,1o I ~ ' t~ ~ 8 ~ 3 ' ~ ~\$ lS S ~~8' i ~~ ~ '~~ ~tv~J r hold ~ rest ~~'~, Zu 21,3o1~v~ ?,R'~ i7~ 30~~ n~0\3=~ 3v~~ ~t~~yd 2j ~ ~~ 1 ;~ Signature/Credentia/s /nitia/s /nitia/s Signature/Credentials Siq ature/Credentia/s /nitia/s -tom ~t I ~,.. _---- -~ - ' - TREATMENT FLOW-SHEET ___ DRAYER® Physical Therapy Institute ~ S ~~~ ~- Leading the Way to Good liealih Patient Name: (~~rr~ ~ _ ~ Dates _ ` ~ _ ~ ~li~l-fir ~ 1'-T~G~ ~~ ~ 1~``l~ `~ ~~ 13p~~ ;ih~~' ~1C7f If1~~~ ~ibi J1/~ i r ~ ~ ~ to ZJ 2< Ib ~~~ ~o z-CJX \O 251 ~~` ~~Oit ,` JO / ~~~ ~~ ~ ' ~ you ' C . l Self ~ ~ 1D~1o`` 1c~nty l~xto~ ~ 1uk~ ,~ loxio ~ laX/n ~ ^~" ~ ~o,l o`` o ~,~ ~- ) o~ ~n~ ~ dK ~ o t~ ~20y~ ~ ,~ Z~ ~ ~~ ~. a a ,~ ~~ 1 ~ o ~ `f~ ~ ~ l ~ ~ (Sx~ is 15 x -. ~`,.~~' f 1 ~i ~i~3 r ~~ ~ '~~~li)} t-lot~~~Z ~1~;1~,L 'i~~,~,y - ~~}I~i~ ~( ~-D~2 u0~~~`7~ ~L L~ ~U~}v,~ .~ Signature/Credentia/s /nitia/s Signatur Credentia/s /nitia/s Signature/Credentia/s /nitia/s i. ------ ~~rr~ «~ - D RAPE R® Physical Therapy Institute Leading the Way to Good Health TREATMENT--FLOW- SHEE-T- Patient Name: Xi ~l 1 u~-~chnk I~ D~ `~ ~ 02S l ~ U ~ 5 0 ! l CYS (G~ e L r 4 -mil r u (~l}~ c -FC _C( ~`~.' to ~ ~ ~ jr,~~' ~ cam,,,, /UI ~~(`~'~ lbt ~ d~ -' ~~ ~~ ~ q l ~'3 ~~ ~0 3 1 t 0 t) L{ 2©~~ vt ~~3 1~ `~ i( 2~ 3 gca re c-ac.~ c1s % Set-F - ~ 'dot ~~tU" '~ l~" 30~ tit to Ivy " ~ ~~i Oilb~ ~ ~ o`t e cam' lad ~' 3~~ ~d (Ol(b'~ :~ oxio ~b~~~`` xc0 tbxrp ~X(~ 1GNo~~ J F7-v~/ ~~~5 a~t5 ~~+15 Zxc ~~~ G~I~~ ~~~~ a 2 --. t ~-m_ ~ ~ l x ~. ~` ~! ~~ - x z~ t. a sx c`ry' an rowl ex 1 `~ i ~x 15~ ~' tZ ~ ~ ~) ~~:< ~S Z .~'~~ e h ~ Yl S ~ ?~2 yc ~' ~~ ' ~y~ ~ ` `~ I a ~ Z~ d-\ ~' I ~ ~~ ~ ~ ~ ~ ~ m x ~'n~n S-~ r1- lY>~`~~3 (~'$3 t~'lP3 ~~l,x)3 ~yrg~3 Ik~~13 )°b~~~3 -S gj3 ~~( ~ r hold 'L~~4~~1u ,~ ~ 1 D v. aid°~~ ~ ~ ~a-I~b1~ ~ y au ~ CSI `'~ ~) ~~ 1 ~' ~~ ;~ ;3~ /nitia/s nature/Credentia/s Signa uie/Credentia/s /nitia/s Signature/Credentia/s /nitia/s (~ fJ I~ J ..,:.. __ __ _ -_ -- - DRAYER Physical Therapy Institute Leading the Way to Good Health Patient Name -- T-REATMEN-T--FLOW- SREET--- - --- -- Dates _ ~. ?i~~t~l~ ~, ~' i"' o 1_. ., u~ U C! I,.) ~ ~ V J ~-,~ a i.(') d~ i~? ~. ~/ i !~ ~I, i,.,,, v W V' <r1~,lhc~ : I l l u b r-~.,`, 1\\ vim. ~-.~ +clr~~ cat l ~ l~ ~ ~n ~~ ~ ~ ~ ~~ m l ~ ~ v i d ~~- ~ ~~~ ~>~~ ~ ~z ~~ ~l ~j~ X23 3` ~ ~ ~ ,~! ~ ~D 1~ x ~! ox~ ~~'~j`l X ~ X 3~i 2~~.~ `' 3`\~ ~,.~ 3'' 3a;c3" ~ vrt.. ~ ~© Ol ~, '~k~o - u ~~ ~\ "'©XiD ll 3~7xta ' Ux tb~ 0 ~a ~o Id oxtrJ`~ ~ C ~ ~ S 1~ C i.. ~'-ofi / ~ `' lox iv' ;i ~~~ 1~ p lOxl~ ~ tox(d 1Q~14~1 ~v ! 1o xi~~ red aox o~Gx ~x ,~ ~' 3~~ 30~ t:~x ~~ ~ ~2x-5 ~~ ~~-~ XIS ~~~s ~t`,~ ~Ii~ ax,~ ~xts ~ _ r ~ a~X ~ ~ X '~ ~ a~ ;~ ~ X ~~~ `~ l' f t~ c~ t ~ ~ X ~^ . 15~ a». ~ h ~~.~ f ~ is .~P x, ~ a~ a a ~r P ~ ~x - fi~x~ 1. ~ a~ lu to ~ l~ ~x1c~ .~~~a x(~ a a ~~~~`` ~~xto ,, l~ ~~ti U? b 2~(fl ~ (~ ~-~~(~ .3X~o ~l~ ~ xto ~xr~ ` r1 l r ~ a''~ II.J ~ f V l ~Xr~ a ~Q ~ ~ (~ CYX~~ D~X~~ ~ilV~ ~x ' `3xlS XIS ~I-S Xt~j ? ( ' bn L 'X 1 X~ ~~ `~ L i x-F ~ e~be,w. i 1 x -~' . ~ ~ ~ - ,~G ,t,1 `~~ro ~ pia Ixo ~ x tr7 ax ~~ c, P ~ ~~P 36 Ita ~~'I~b ~ x~o ~ 1 1~ ~' S `C ~ Slc. ~ tSx `'`` 3~a S 1 U ~ tf G ~C -~~G _ .~. _ - - - ~ . ~ Q; e1 ~ 2` 1 ~ - ~ h~lr~ ~~ hG~~ . ~~ -~ ~ 1~~1~13 -~1~13 ~ ~ ld , rer ~ ~~~~~ 2~~~ ~~ ~~,`~~ io C~ Ste- ~ ~~ .-.- ~' - ~-- ~i~ 4 Si nature/Credentia/s /nia/s Signa re/Credentia/s /nitia/s Signature/Credentia/s /nitia/s ,. ~~ v CERTIFICATE OF SERVICE I hereby certify that a copy of the foregoing has been duly served upon the following counsel of record, by depositing the same in the United States Mail, postage prepaid, in Lemoyne, Pennsylvania, on May 20, 2010: David L. Lutz, Esquire Angino & Rovner, P.C. 4503 North Front Street Harrisburg, PA 17110 JOHNSON, DUFFIE, STEWART & WEIDNER By J n R. Ninosky 3,5 PEtiivS ?`lV%?IA ANGINO & ROVNER, P.C. David L. Lutz, Esquire Attorney ID# : 35956 4503 North Front Street Harrisburg. PA 17110-1708 (717) 238-6791 FAX (717) 238-5610 Attorneys for Plaintiff(s) E-mail: dlutz'a?angino-rovnerxom KIM and FRANK TUSCHAK, Plaintiffs V. KATHLEEN MARSHALL, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA NO. 09-8853 CIVIL CIVIL ACTION - LAW' JURY TRIAL DEMANDED PLAINTIF'FS' RESPONSE TO THE DEFENDANT'S MOTION FOR SUMMARY JUDGMENT AND NOW COMES the Plaintiffs, Kim and Frank Tuschak, by and through their counsel, Angino & Rovner, P.C., and files the Plaintiffs' Response to the Defendant's Motion for Summary Judgment as follows: 1. Denied as stated. This matter arises from a motor vehicle collision that occurred on February 3, 2008. 449170 2. Admitted. 3. Admitted, although Exhibit B is not the applicable declaration page. 4. Admitted. 5. Admitted. 6. Admitted. ORIGINAL 7. Admitted. The extent of the impairment, the length of time the impairment lasted, and the treatment required to correct the impairment in Mrs. Tuschak's case is set forth, to some extent, in the medical treatment summary listed below: A. Olivetti Chiropractic Mrs. Tuschak first saw Mark Olivetti, D.C., on February 6, 2008. Mrs. Tuschak was experiencing neck pain, pain radiating from her left shoulder to her left arm, and pain in her mid back. Dr. Olivetti prescribed a treatment plan consisting of chiropractic manipulation, therapy on her shoulder region, and trigger point therapy to restore normal spinal biomechanics. By her April 9, 2008, visit with Dr. Olivetti, Mrs. Tuschak's pain level had decreased somewhat and Dr. Olivetti decided to reduce her treatments to once a month. Despite her monthly treatments, Mrs. Tuschak's paresthesia of her left arm and hand gradually returned and worsened. Dr. Olivetti arranged for an orthopedic evaluation. Mrs. Tuschak last visited Dr. Olivetti on May 21, 2008. He reported that her symptoms had not improved and appeared to be permanent. Dr. Olivetti noted that Mrs. Tuschak continued to have pain in her neck radiating into her left shoulder. Dr. Olivetti scheduled an MR[ of her cervical spine and recommended physical therapy. See, Dr. Olivetti's September 9, 2009, report, as well as his office notes is attached to the Defendant's Motion for Summary Judge as Exhibit F. B. Silver Creek Family Health Center - Holy Spirit Hospital On May 21, 2008, Mrs. Tuschak saw her family physician, Dr. Laurel Bailey. Mrs. Tuschak was experiencing left arm pain, squeezing, numbness, tightness in her left shoulder, and tingling in her left fingers. Dr. Bailey noted Mrs. Tuschak's cervical spine x-rays showed C5, C6, and C7 degenerative discs. Dr. Bailey diagnosed Mrs. Tuschak with a cervical neck injury due to the motor vehicle accident on February 3, 2008. Dr. Bailey prescribed a course of 449170 2 physical therapy, cervical traction, and an MRI. Attached as Exhibit A are copies of the relevant medical records from Dr. Bailey at Silver Creek Family Health Center. C. Orthopedic Institute of Pennsylvania Mrs. Tuschak saw Dr. Stephen Dailey, an orthpedic surgeon, on July 21, 2008. She was experiencing persistent left upper arm pain, numbness, and tingling; that radiated into her left hand. Dr. Dailey reviewed her x-rays and MRI. Dr. Dailey diagnosed Mrs. Tuschak with significant spondylosis at C5-6 and C6-7. Dr. Dailey noted her MRI showed significant foraminal stenosis at C6-7 on the left with a disc herniation. Dr. Dailey prescribed Mrs. Tuschak a Medrol dose pack and continued physical therapy. Dr. Dailey also suggested epidurals to Mrs. Tuschak if her symptoms did not improve. Attached as Exhibit B are copies of the medical records from Dr. Dailey at Orthopedic Institute of Pennsylvania. D. Drayer Physical Therapy Institute On. May 22, 2008, Mrs. Tuschak was seen for an initial physical therapy evaluation. After performing an examination, her treatment plan included electrical stimulation, neuromuscular re-education, active and passive range of motion, manual therapy, strengthening exercises, hot/cold pack, functional activities, taping, traction, spine stabilization, and McKenzie Program. Her sessions occurred three times per week for eight weeks. Mrs. Tuschak was re-evaluated on June 19, 2008. Her overall pain rating had decreased from the date of her initial evaluation. However, Mrs. Tuschak reported she was still experiencing tingling in her left arm, and pain in her mid cervical spine area. Mrs. Tuschak had not met her physical therapy goals and the physical therapist recommended another course of treatment consisting of the exercises listed above, three times a week for four weeks. 449170 3 Mrs. Tuschak was re-evaluated on July 15, 2008. Mrs. Tuschak still reported numbness and tingling in her left arm through her wrist and hand. Again, Mrs. Tuschak had not reached her therapy goals and the physical therapist recommended another course of treatment consisting of the exercises listed above, three times a week for four weeks. Mrs. Tuschak was finally discharged from her therapy program on August 15, 2008. Mrs. Tuschak underwent 36 physical therapy sessions at Drayer Physical Therapy Institute. The Drayer Physical Therapy records are attached to the Defendant's Motion for Summary Judgment as Exhibit G. 8. Admitted. 9. Denied as stated. Mrs. Tuschak testified that she was running 30 miles per week on average, unless she was training for a marathon. See, Plaintiff Kim Tuschak's deposition transcript at p. 4, attached to the Defendant's Motion for Summary Judge as Exhibit D. 10. It is admitted that Mrs. Tuschak treated with Dr. Mark Olivetti and he prepared a report dated September 9, 2009, confirming that Mrs. Tuschak's "symptoms appear to be permanent at this point in her treatment." Dr. Olivetti emphasized that his treatment was "palliative and not curative" and that Mrs. Tuschak's "prognosis is fair." See, Dr. Mark Olivetti's September 9, 2009, report attached to the Defendant's Motion for Summary Judgment as pant of Exhibit F. 11. It is admitted that when Dr. Olivetti first examined Mrs. Tuschak on February 6, 2008, Mrs. "Tuschak was experiencing neck pain and sore shoulders, mid-back pain, and left arm pain. Dr. Olivetti noted that her "symptoms were present 51 to 75% of the time." At that time, Dr. Olivetti noted that Mrs. Tuschak had not yet experienced significant interference with her activities of daily living (this evaluation was 3 days after the accident). See, Dr. Mark Olivetti's September 9, 2009, report attached to the Defendant's Motion for Summary Judgment as part of Exhibit F. 449170 4 12. It is admitted that Mrs. Tuschak's physical therapy records document that she attended physical therapy at the Drayer Physical Therapy Institute for 36 visits between May 22, 2008, and August 15, 2008. 13. It is admitted that the physical therapy note dated June 13, 2008, appears to indicate that "PT was able to run/walk 1 hour (5 miles)." 14, It appears that the physical therapy note dated July 7, 2008, indicate that "PT ran 2 mi jogged 2 mi yesterday." The July 10, 2008, physical therapy note seems to indicate that Mrs. Tuschak had been jogging and her neck pain increased during the jog. Moreover, a physical therapy note (with a bate stamp of June 5, 2008), provided as follows: The patient reports a 26% disability on the cervical spine fiinction questionnaire reporting frequently having difficulties sleeping t/o the night clue to her injury and occasionally having difficulty driving such as when turning her head to look over her shoulder and seldom having difficulty w/daily tasks due to dizziness or LOB related to her injury and difficulty looking up to perform overhead activities. 15. through 17. It is admitted that Mrs. Tuschak was highly motivated to complete her physical therapy and medical treatment and thereafter, she attempted to return to her activities of daily living. After all, Mrs. Tuschak was extremely active before the subject collision. Besides weight lifting, gardening, cooking, housework, and attending her son's high school sporting events, Mrs. Tuschak was a marathon runner. See, Plaintiff Kim Tuschak's deposition transcript at pp. 13, 14, and 15, attached to the Defendant's Motion for Summary Judge as Exhibit D. Before the subject motor vehicle collision, Mrs. Tuschak had run 18 marathons. See, Plaintiff Kim Tuschak's deposition transcript at p. 36, attached to the Defendant's Motion for Summary Judge as Exhibit D. Typically, she would run two marathons a year. Before the collision, on average, Mrs. Tuschak would log 30 miles per week, 5 to 6 miles for each run. See, Plaintiff Kim Tuschak's deposition transcript at pp. 32 and 33, attached to the Defendant's Motion 449170 5 I'm Summary Judge as Exhibit D. This was in addition to t?vice a week weight tnvining with a COex machine. See. Plaintiff Kim Tuschak's deposition transcript at p. 34, attached to the Dciendant's Motion for Summary Judge as Exhibit D. Shove ri on the next two pages are several photograpt-?s of Mrs. Tuschak ;und her friends. other marathon runners. Attached as Exhibit C is Mrs. Tuschaks training jolrrnal log. This trainin,(2: jourral was used for a Boston Marathon. 449170 6 449170 Mr. and Mrs. Tuschak reside in Dillsburg. They maintain a large vegetable garden. Therefore, in addition to doing the housework, Mrs. Tuschak would harvest vegetables that she would use of cooking. See, Plaintiff Kim Tuschak's deposition transcript at p. 15, attached to the Defendant's Motion for Summary Judge as Exhibit D. Mr. and Mrs. Tuschak's son, Joseph, played quarterback for the high school football team and also plays year-round travel baseball. See, Plaintiff Kim Tuschak's deposition transcript at p. 14, attached to the Defendant's Motion for Summary Judge as Exhibit D. Much of Mrs. Tuschak's time is devoted to her son's sporting activities. Sec, Plaintiff Kim Tuschak's deposition transcript at p. 16, attached to the Defendant's Motion for Summary Judge as Exhibit D. During the period after the motor vehicle collision, Mrs. Tuschak did not run. See, Plaintiff Kim Tuschak's deposition transcript at p. 37, attached to the Defendant's Motion for Summary Judge as Exhibit D. Due to her neck pain and discomfort, she would lay flat on her back. Mrs. Tuschak underwent chiropractic treatment, medical treatment and physical therapy in an effort to minimize her pain. Since the accident, Mrs. Tuschak has not run marathons as it takes a lot of time to prepare to run a 26 mile marathon. See, Plaintiff Kim Tuschak's deposition transcript at pp. 30 and 31, attached to the Defendant's Motion for Summary Judge as Exhibit D. Eventually, Mrs. Tuschak started to resume some of her activities, first walking and stretching, and then running at a slower pace and less distance. See, Plaintiff Kim Tuschak's deposition transcript at pp. 37 and 38, attached to the Defendant's Motion for Summary Judge as Exhibit D. Additionally, Mrs. Tuschak's other activities of daily l=iving, such as housework, gardening, cooking, etc., were diminished. See, Plaintiff Kim Tuschak's deposition transcript at p. 33, attached to the Defendant's Motion for Summary Judge as Exhibit D. 449170 8 Mrs. Tuschak has been a runner all of her adult life. See, Plaintiff Kim Tuschak's deposition transcript at p. 36, attached to the Defendant's Motion for Summary Judge as Exhibit D. She had always run approximately 30 miles a week in order to lay the foundation for a marathon. See, Plaintiff Kim Tuschak's deposition transcript at p. 36, attached to the Defendant's Motion for Summary Judge as Exhibit D. Obviously, running is a passion. Mrs. Tuschak was unable to run after the accident because it was simply too painful. See, Plaintiff Kim Tuschak's deposition transcript at p. 37, attached to the Defendant's Motion for Summary Judge as Exhibit D. As such, Mrs. Tuschak felt stressed because she could not engage in running which had become a major part of her lifestyle and a stress reliever. See, Plaintiff Kim Tuschak's deposition transcript at p. 37, attached to the Defendant's Motion for Summary Judge as Exhibit D. Mrs. Tuschak started walking approximately June 2008 and then it was not until September 2008 that she started to run at a very slow pace. See, Plaintiff Kim Tuschak's deposition transcript at pp. 37 and 38, attached to the Defendant's Motion for Summary Judge as Exhibit D. In fact, it was more like a "walk/run." 18. It is admitted that at the time Mrs. Tuschak answered the Defendant's Interrogatories, no. 21, she listed the following limitations of duties and activities after the subject motor vehicle collision: No loss of occupational duties. February 2008 - February 2009. Social/training runs: stopped running with my girlfriends weekends and weekdays. Walked with them on occasion. Stacey Pietras, Sue Shuler, Barb Walton, Terri Neyhart and Pam Maloney. Prior to February 2008 I was running 25-30 miles a week to maintain a fitness level to start marathon training, should I decide to run a fall or winter marathon. After the accident I was unable to run and started therapy and treatment with the chiropractor. 449170 9 After being released from physical therapy I began a slow progressive training program with the goal of 25-30 miles a week. This would include walking (5-6 miles) three times a week, stair stepper 4-5 miles two times a week and weight training (lower body, eventually working light upper body (no neck). Over time approximately 10-12 months I increased walking with jogging. Currently I am jogging and a little walking 5 miles 4-6 times a week. This program keeps me at a comfortable fitness level. 19. Denied as stated. Mrs. Tuschak testified in discovery depositions that she had not run in the 2009 Pittsburgh Marathon due to "time." More specifically, Mrs. "Tuschak testified that given her desire to follow her son's high school football and baseball games, she did not have time to train for a marathon. See, Plaintiff Kim Tuschak's deposition transcript at pp. 31 and 32, attached to the Defendant's Motion for Summary Judge as Exhibit D?. 20. In Murray v. McCann, 658 A.2d 404 (Pa. Super. 1995), there was a question of fact whether the Plaintiff sustained a serious impairment of bodily function. The Plaintiff, Melinda Murray, unlike Mrs. Tuschak, "did not engage in vigorous physical exercise because she suffered from athletic asthma." Murra , 658 at 405. Additionally, Ms. Murray's medical records confirmed that she did not sustain a permanent injury. In a non-jury trial, the trial court determined that Ms. Murray did not sustain a serious impairment of bodily function and the Superior Court affinned. 21. Admitted. 22. Denied. Your Court must review the record in light most favorable to Mrs. Tuschak, the non-moving party and all doubts as to the existence of a genuine issue of material fact must be resolved against Defendant Kathleen Marshall, the moving party. In fact, only where there is no genuine issues as to any material fact and it is clear that Ms. Marshall as the moving is entitled to summary judgment as a matter of law, should Your Court grant Ms. Marshall's Motion for Summary Judgment. Pappas v. Asbel, 768 A.2d: 1089 (Pa. 2001). 449170 10 23. Admitted. 24. Admitted. 25. Admitted. 26. and 27. Denied. It is respectfully submitted that there is a question of fact whether Mrs. Tuschak sustained a serious impairment of bodily function. For example, in Leonelli v. McMullen, 700 A.2d 525 (Pa. Super. 1997), the Superior Court reversed the trial court's summary judgment ruling in favor of the Defendant. See also, Piwonski v. Choe, 806 A.2d 474 (Pa. Super. 2002) (Superior Court held the trial court erred in determining that the Plaintiff did not sustain a serious impairment of bodily function as there was a question of fact for the jury). Your Court must review the record in light most favorable to Mr. and Mrs. Tuschak, and all doubts as to the existence of a genuine issue of material fact must be resolved against the Defendant. Given the record before Your Court, the Plaintiffs respectfully request that the Defendant's Motion for Summary Judgment be denied. ANGINO & ROVNER, P.C. Date: f David L. Lutz PA I.D. No. 35956 4503 N. Front Street Harrisburg, PA 17110 (717) 238-6791 -phone (717) 238-5610 - fax dlutz ,angino-rovner.com Attorney for Plaintiffs 449170 11 V'? ? ??`??,? ( 1 PROB# SOAP DATE/PROGRESS NOTES juy f) 02f TELEPHONE MESSAGE BATE: l k t. b TIME: r DR: d 1NiT:i? t PATIENT: I(iL ?v'\ / Li yt.?j Gt PHONE /#1: PHO E ##Z: CALLER:_'1 L 7? PHARMACY: PHONE #: ONSET: HEAD CHEST ABDOMEN _FEVER _ CO!)Cilt NO-PRODUCTIVE __PAFN ____NOSECOL.OR ___CRESTPAIN ___DIARRHEA SORETHROAT ---SOB __NAUSEA EAR PAIN TVOM2.irrfNG HFADACIM C/C T _fL Y ] I o C- 42?-_ J[t/ L,?` ?'? l? C. t ?^ ` cif -- 20 t U ? t J ra+i t .t ??. ( f (?.. `Iri ?7 . G u*t c rP.? 7o i --r_- ors (J It NOLYSMI HOSPITAL SUN 14M FAMILY HEALTH CENTER pnoomm "Diu ?+- . ? b . tOB OA T .- TUSCHAK, KIM 5/21108 LPB S: Arm pain, squeezing, numbness, tightness in her shoulder and tingling in her fingers- Seems to start in the back of her neck and run the whole way down her arm. It happened after an accident where she was rear-ended. She had a seat belt on but at the time, she was looking left and it came as a surprise, so her neck jerked back as she was turning her head at the same time, and it had been hurting a lot on the left side of her neck. She went to a chiropractor and had treatments done. Had tenderness on his note, in the supraspinatus and the rhomboids and trapezius and neck rigidity. She was treated for the muscle spasms and alignment of the spine but continued to have paresthesias in her hand after the chiropractor treatment and he appropriately evaluated her for x-rays and to come into my office. She's been using Advil 4 tablets once or twice a day- She stopped running and she's a runner, because the chiropractor told her to maybe stop for a week or two. She states she doesn't think that running would bother it. Doesn't seem like anything really makes it better or worse. It just sort of stays the same as far as the discomfort in the arm. Cervical spine x-rays showed C5, C6, CT degenerative disc, otherwise normal. She doesn't feel weak in her upper extremities. Q: Physical exam reveals range of motion of the neck is very good. She doesn't really have pain with moving her neck up or down or left to right. She doesn't have any c--spine tenderness but the paraspinal muscles on the left side are slightly tender as well as the trapezius. She's able to hold her arms up against pressure without any difficulty and biceps tendons and grip strength, everything is normal. Her sensory deficits are apparent on exam with just some tingling but she does have feeling everywhere. A: 1. Cervical neck injury due to car accident early February. P: Start a course of PT and cervical traction to see if that would help reduce the paresthesias and Y an MRI scan. Follow up with me in a couple weeks. Anaprox DS bid. .? L__? 4 o d o o ? r ?? cnAF DATEIPROG RESS Nt}TE5 do) I n W.Va CREW FPAWY WAL O-r u- - - - - - - - - - - - - - 000% 01 C ORT] ..PEDIC INSTITUTE OF PENNSYi.., ANIA (717) 761-5530 Patient: Kim E. Tuschak Chart #: 28649001 DOH: 08/08/56 SSN: 202 42 5523 Page # 1 ------------------------------------------------------ ------------------------- 7/21/2008 STEPHEN W. DAILEY, M.D. OFFICE VISIT 3399 Trindle Road Cffice CHIEF COMPLAINT: Kim Tuschak was seen in consultation at the request of Laurel Bailey, M.D. for evaluation of her cervical spine. HISTORY OF COMPLAINT: Kim is a 51 year old female wtio was near-ended by a car February 2008. She had neck pain at that time. She went to the chiropractor with some relief. Now she has persistent left- upper extremity pain, numbness and tingling that radiates into the hand. She is going to physical therapy and is improving. She has been in therapy for about 6 weeks. She had x-rays and a MRI which is consistent with significant spondylosis at C5-6 and C6-7. The MRI also shows significant foraminal scenosis at C5-'/ on the left with a disc herniation. She says over all. she is improving at this point. REVIEW OF SYSTEMS: Review of systems, past medical history, family history and social history have been recorded and reviewed. PHYSICAL EXAM: She is a well developed, well nourished female in no acute distress. She is alert and oriented times three. Shc is cooperative, and a goud historian. She moves about the room with normal attitude and posturing of the head. There is no midline, paraspinal muscle or periscapular tenderness- There are no palpable muscle spasms or masses. There is full range of motion nf the neck. Sensory, motor and reflex examinations are normal in both upper extremities. There is no hyperreflexia in the lower extremities. There are no skin lesions in the cervical spine area. DIAGNOSIS: Cervical spondylosis with disc and cervical sprain, recently. PLAN: She will continue with therapy- She was given a Medrol dose pack if she needs it. If she calls and would like to proceed with epidurals if her symptoms do not continue to improve, we can schedule that. She would lake to return to scc me as needed. SWD/slf Dictated but not read. LTR-DR DAILEY CONSULT LETTER (Ref) BAILEY M.D. LAUREL `7-aI-d? D -E ?+ izrte Patient Name L4C Address ` 'r ?f,4ffice ` Doctor` 1?3? Chart # ?;LT(C:2Y0 cly.aw e Phone: Home SSN Employer 19 Work Ext. Cell L5Z(o .- $7,2(n D W ?S?Age Sex ]wl tal Stat M Occupation SWm- try, zip Spouse Q,A /Y,?, DOB Cell Employer Telephone# 41-13 -7Ext Mother/Guardian Employer Father/Guardian Employer AlternateMOA/Telepbone # Address (if POA) Injury DOI a - 3 - D1A Sports Acci Description Address # POECy # Subscriber's Name e43 Address Telephone# Ext auto what state_&- work Related Address ?r Croup # __ 1 a a S orr Policy # Subscriber's Name Address n Family Dr. Referring Dr. ? Address Address Send letter to: Family Dr. Referring Dr. Neither _ Send letter to another doctor: Nam Address - (1 at ?-?.?d Appointment comments: 1?C' yVl 10 DOB Cell Telephone# Ext DOB Cetl INSURANCE I Primary secondary I_ __ n Item: CMQ Ortho Institute cf BA .all s0 2008 {12:07} User: a1f001 Dictatic¢1 worklist Page No: 1 Chart # : 28649001 Patient ZUSCHAK, KIM $. Social 9ecuri.ty.4: 202-42-5523 Addr-Pa : • NORTH SEASONS DRIVE Date of Birth 8/06/56 Howo Telephvno #: WLLSSLTRC PA 17019 work Telephone t: - . _ _ - _ _ _ - A L r. r R u t G S _ - - - _ - _ _ - _ - _ _ - _ - - _ _ . - - (Needs to be addressed) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - DaLW Drug same Strength Form Dispensed Refilla Sig stop narc. seatua Pharmacy Yrcnrider Remarks ----------------------- --------------------- --------------- ----------------------------------------------------------------------- 07/21/2008 PRWNLSOKB (VAR) OR TARS 5 21 0 AS DIRECTED ACfIVF. MED1CAT2 MG DAILEY, M. D.. 5, SLED/samples S m y y 7 Cx1 Cd d C7 p y x Q c+ v' o o 5 w a m ao Q n CL. N cr to $ G £1 ?" a a 4v3' cam. Q L b D 7' p" ro d? f F1 G ID r OQ n r O CLI 0 -It ?{ ? { 2 tp ?y( ?... ?? L • Sl! ..rr .Y n tro a ? yr ? ""' .? ?.? '? r, ?? ? ? ? ....+ ""? ?-"? ? ~ ? .? 4 p.q T'^ ?...+ R r., r` r".' r^ ? ? Al- >4 tt s a un bh- N .+ -+ a ?' a '+' cn ro n G P Q ro N N o c °° v} "' n n"51 3 "' c a 14 W N a P a w N ?c?4yY 1? A p S G_ t b t QQ 5L ?'' `? ? a• ? ? rb a. o ? vroi ?'?t+ 4?s " to 'd n ro ?'y h c? gO77J cyoC a s n O [? q <?°. d to H C o° 1 d ry% m `x .a _ Z 0 CO co ?c ? C SA- a r n 0 .? p d 6 p Oyy ~ o ? T R d c!? r d G+ a ' z) N T? }? y a ? u t1 g r M c F a .? V G O • i ? u r" _ G r 7 n b e Y r. V 0 0 ? P ? E 8 0 C V O a+ 'Z 4 s =a O 3 t r ?s Z ? c .m Yt N i ? rte". /?, .r u U a 0O aTi ? ~ ro J '13a"Jent Name: Tuschak, Kim Exam Date: May 23 2008 M I C MAGNSTIG IMAGING 0EN7E01 1t'ix•r? Ina{cw is C'wn fuss{. Patient: Tuschak, Kim Ref. Dr.: Laurel P. Bailey MD MRN: 6292 DOB: 08 Aug 1956 Date of Exam. 23 May 2008 FINAL Diagnostic Imaging Report Accession Study Clinical History 8258 MRI CERVICAL SPINE W/O CONTRAST Neck pain. Report Exam: MRI cervical spine. History: 51-year-old female. Neck pain. MVA injury. X-ray exam January 7, 2008. Pain radiates to left upper extremity. Result: MRI at 3.0 tesla. Sagittal T1 and T2. Transaxial COSMIC and MERGE. The atlantoaxial articulation is normal. Sagittal imaging includes portions of the posterior fossa and do not demonstrate abnormality. Disc level C2-C3 is normal. Disc level C3-C4 is normal. Disc level C4-C5 shows a minimal central disc protrusion, transaxial image 23 series 7. There is no frank disc herniation. There is no foraniinal or central canal stenosis. Disc level C5-C6 shows marked narrowing with marked disc margin hypertrophy. There is a prominent disc osteophyte complex across the entire disc space which is eccentric, greater toward the right side. There is moderate central canal stenosis and mild forarnir_al stenosis. There is no disc extrusion. Disc level C6-C7 shows disc narrowing and disc margin hypertrophy. There is a prominent disc herniation at the left lateral recess and into the left neural foramen, sagittal images 3 and 4. The left neural foramen is obliterated. There is edema of the left nerve root. There is moderate stenosis of the central spinal canal, transaxial image 10. Disc level C7-T1 is normal. Disc level T1-T2 is shown on sagittal imaging and is normal. Cervical cord is posteriorly displaced at both levels C5-C6 and C6-C7. No signal abnormality is seen within the cervical cord. There is no mass intrinsic to the cervical cord. There is no signal abnormality 4665 Trindle Road Mechanicsburg PA 17050 717.975.0444 Fax 717.731.9165 www.miemri.com 'atient Name. Tuschak, Kim Exam Date: May 23 2008 of the bone marrow co npw ;nts. Impression: There is advanced spondylosis at C5-C6 and C6-C7. There is moderate central canal stenosis. Disc osteophyte formation bridges the posterior margin of C5-C6. There is a focal disc herniation or disc extrusion at the left lateral recess of C6-C7 with obliteration of the left neural foramen and edema of .he left nerve root. Reported by George Durisek on 23 May 2008 at 04:59 p.m Electronically signed by George Durisek on at 04.59 p.m 4665 Trindle Road Mechanicsburg PA 17050 717.975.0444 Fax 717.731.9165 www.miemri.com PATIENT NAME: TUSCHAK, KIM REFERRING: MARK T OLIVETTI DC PROCEDURE: C-SPINE-MIN 4 VIEWS 405 St. John's Church Road. Suite 102 Camp Hill. AA 17411 (717) 761-747D Fax: (717) 761-6291 www.gita.com Mpio: 21874 Dos: 00!0811856 F ss*: 202-42-0523 Code: 72050 Dos: 02/16108 EYAM ID#: E-00289447 Exam: Cervical spine series History: Neck pain and left arm pain following motor vehicle accident 2 weeks ago. Result: There are no comparison exams. The cervical spine is held in a slightly flexed position. Alignment is otherwise normal. The vertebral body heights are preserved. There is moderate degenerative disc disease at C5-C6, with disc space narrowing and osteophyte formation. There is mild degenerative disc disease at C6-C7. There is no fracture or subluxation. The neural foramina are patent on the oblique views. The soft tissues are normal. Impression: C5-C6 and C6-C7 degenerative disc disease. No acute osseous abnormality. DICTATED: JONATHAN D STEPHENSON, MD 02115/2008 ELECTRONICALLY VERIFIED: JONATHAN D STEPHENSON, MD 0211512.008 Exam #. E-00289447 TUSCHAK, KIM Page 1 1'; ?? RUNUMERIS NRORLO' A daily dose of motivation, training tips and running wisdom for every kind of runner-from fitness joggers to competitive racers By the Editors of Runner's World Magazine with an introduction by Amby Burfoot ny. k ?J v 61?, `-t- LL [. ° 7 c+ 44 1. 1 S ? :D J, -- j- 'JJ N a o o y W Z F LL vi = O t o LLI a D ?+ w ? y ? w z w Q Q o a? oS o = f' 4 0 w Z - w ? { a ? z Q Li N ? Q w cG - w F ; ? ' U (] I- > LLj Z ° o o z y C L,L O 4,n J L) a' w LL. cj O C> C) S F? - O O O U T ?` ,f. r ?= w w w z 4 O ? o U w O }? L}? .}J J C LL7 F Z 0 C O n Q) y-- b4 O o i a' a cca Q C" G 45 cu M E a) O O ? ? ITT ? Q? ? ? ? d 't a 2 Q F J ?G w i W. 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O O Yl G 7 I Q W H Q D ' Q H D w Q F ? Q cNn p J ? n ? o a / a - 1 I U Q F z _z Q H N'i o L ? N z ? p a z L J U Q 7 z Q 1- vii o J L N O J Q O -? W W O H W V. W Q LL ° o -U- - ~ N ° o U -° N o i ~ -- - 'llllIIIIIIIIIIIIIfIltlll 1 t ? J ?J _? Z G v ;? z W Z O W 1 :D U z Q Cn n o Li -_ Z C) o W > W > U z Q H V) N o LWL - 2 C7 o W W U z Q (1) V7 V) o ? - - _ C.7 o - _ W F- U z Q of N v o LL LIJ C7 o CC G U S' ?' U 02 H 0 U OS F=- I- J o S I- (if 0 T O O H C C 'O 41 D Q ?/ Y ?' ? ? ? O b4 Q a W A W o0 `" W o cn z a LL `m o 2 E c u !^ 3~ - Y ++ cc o p? m E ?Y m p o? ` v ? L w. ? I O .p W m m a c n x N Y a - u w c .o 0 2 .. F H m O ? .°'. c ? o s CERTIFICATE OF SERVICE I, Mary T. Geraets, an employee of the law firm of Angino & Rovner, P.(-., do hereby certify that I am this day serving a true and correct copy of the PLAINTIFFS' RESPONSE TO THE DEFENDANT'S MOTION FOR SUMMARY JUDGMENT upon defense counsel via postage prepaid first class United States mail addressed as follows: John R. Ninosky, Esquire Johnson, Duffie, Stewart & Weidner 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 Attorney for Defendant Mary T. Geraets Dated: U, 449170 KIM AND FRANK TUSCHAK, PLAINTIFFS V. KATHLEEN MARSHALL, DEFENDANT {N THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA 09-8853 CIVIL TERM IN RE: DEFENDANT'S MOTION FOR SUMMARY JUDGMENT BEFORE GUIDO. J. AND MASLAND. J. ORDER OF COURT AND NOW, this ~~ day of October, 2010, the motion of defendant for summary judgment, IS DENIED. By the Court, David L. Lutz, Esquire For Plaintiffs John R. Ninosky, Esquire For Defendant saa ~ >iS' rn~. lv ~s'l rv `~'.~ Albert H. Masland, J. d ~, -~~ -~ ~~, ~ ~ ~, ~ ~ ~ ~ ~,~ ~~ n ° ~ ~~ ~ xb ~ h O -1 O ~' ~ ~D ~ KIM AND FRANK TUSCHAK, PLAINTIFFS V. KATHLEEN MARSHALL, DEFENDANT IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA 09-8853 CIVIL TERM IN RE: DEFENDANT'S MOTION FOR SUMMARY JUDGMENT BEFORE GUIDO. J. AND MASLAND. J. OPINION AND ORDER OF COURT Masland, J., October 13, 2010:-- This matter stems from a motor vehicle accident that occurred on February 3, 2008, when Kimberly Tuschak (plaintiff) was attempting to merge her vehicle onto S.R. 15 south from S.R. 581 at which time she was struck in the rear by a vehicle driven by Kathleen Marshall (defendant). At the time of the accident plaintiff had an automobile insurance policy with Erie Insurance and was covered under the "limited tort" option on her policy. Procedurally, the action was commenced with plaintiffs' filing a complaint on December 28, 2009. Defendant filed an answer with new matter on March 2, 2010. Plaintiffs filed an answer to defendant's new matter on March 4, 2010. The pleadings and relevant discovery are closed. Defendant has filed a motion for summary judgment asking that all claims asserted against her be dismissed with prejudice by virtue of the fact that plaintiffs' insurance coverage was pursuant to a limited tort option. Our esteemed colleague, President Judge Kevin A. Hess, addressed the identical issue in the case of Tomsa v. Conklin, No. 09-4681 Civil in an opinion dated September 21, 2010. Inasmuch as the defense counsel and conclusion of the court are the same in both cases, we will not belabor the point. In "limited tort" cases, the issue is whether "serious impairment of body function" has occurred. The Pennsylvania Supreme Court has set forth the threshold inquiries: (1) what body function, if any, was impaired because of injuries 09-8853 CIVIL TERM sustained in a motor vehicle accident; (2) was the impairment of the body function serious. Washington v. Baxter, 719 A.2d 733, 740 (Pa. 1998). Our Superior Court has elucidated several factors that must be considered to determine if the claim of injury is "serious:" (1) the extent of the impairment; (2) the length of time the impairment lasted; (3) the treatment required to correct the impairment; and (4) any other relevant factors. Graham v. Campo, 990 A.2d 9, 16 (Pa. Super. 2010). Most importantly, as President Judge Hess made imminently clear, our Supreme Court has directed that the ultimate determination as to whether a limited tort elector has sustained a serious injury should be made by a jury in all but the clearest of cases. Washington, 719 A.2d at 740. As the court was satisfied in the Tomsa case, we are satisfied in the case sub judice that reasonable minds on the jury could disagree as to whether plaintiff's injuries constitute a serious injury. Although defendant claims that plaintiff has made a 100 percent recovery, viewing the record in the light most favorable to the plaintiff and resolving all doubt as to the existence of a genuine issue of material fact against the defendant, we are constrained to find otherwise. Distilling the facts to their fundamental essence, prior to the accident, plaintiff Kimberly Tuschak was the figurative if not literal poster child for the President's Council on Physical Fitness. As noted in plaintiffs' brief, "besides weightlifting, gardening, cooking, housework, and attending her son's high school sporting events, Mrs. Tuschak was a marathon runner." (Plaintiffs' brief at 4). Having run 18 marathons in her lifetime, the fact that she had to stop running for six months suggests a level of physical impairment a reasonable jury could determine to be serious. This is not to discount the other facts proffered by plaintiff with respect to the seriousness of her injuries; however, the court is satisfied that when an individual who is clearly more active than 99 percent of America suffers an injury that -2- 09-8853 CIVIL TERM relegates her to being merely more active than 80 percent of America, the threshold of serious impairment has been crossed and must be determined by a jury. Accordingly, we will enter the following order: ~ ORDER OF COURT AND NOW, this t ~ day of October, 2010, the motion of defendant for summary judgment, IS DENIED. By the Court, Albert H. Masland, J. David L. Lutz, Esquire For Plaintiffs John R. Ninoslcy, Esquire For Defendant :saa -3- ~,. 7.~- ~-~~.~__ `.fin ~-~~, i I ~~ i 3 t f.. r ,.~ F,. , q } r ea 1 ~~ i ~~~ i\~;~:*ii.J lr~~.~ a x{^. j ANGINO & I~ VNER, P.C. David L. Lutz,;. squire Attorney ID# :''; 35956 4503 North Fr t Street Harrisburg, PA 17110-1708 PHONE: (717 238-6791 FAX: (717) 2 8-5610 Attorney for Plaintiff: E-mail: dlutz an ino-rovner.com Kim and Frank Tuschak KIM and F NK TUSCHAK, IN THE COURT OF COMMON PLEAS Plaintiffs CUMBERLAND COUNTY, PENNSYLVANIA v CIVIL ACTION -LAW KATHLEE MARSHALL, NO. 09-8853 CIVIL Defendant JURY TRIAL DEMANDED PETITION FOR APPOINTMENT OF ARBITRATORS TO THE H' NORABLE, THE JUDGES OF SAID COURT: Davfd L. Lutz, Esquire, counsel for the Plaintiffs in the above action, respectfully represents that: 1. The above-captioned action is at issue. 2. The claim of the Plaintiffs in the action is $50,000. The counterclaim of the Defendant in the action is $0. The following attorneys are interested in the case(s) as counsel or otherwise disqualified to sit as arbitrators: 'John R. Ninosky, Esquire ~~ .00 i'~ A~'t'`~ c~ S~.~y ~~ asooa9 4523SS WI-$EREFORE, your Petitioners pray Your Honorable Court to appoint three (3) arbitrators to whom the ~ase shall be submitted. Date: jb i\~ ANGINO & ROVNER, P.C. Davi L. Lutz PA LD. No. 35956 4503 N. Front Street Harrisburg, PA 17110 (717) 238-6791 -phone (717) 238-5610 -fax dlutz@angino-rovner.com Attorney for Plaintiffs 452355 ~! CERTIFICATE OF SERVICE I, 111'Iary T. Geraets, an employee of the law firm of Angino & Rovner, P.C., do hereby ,~ certify that ~1 am this day serving a true and correct copy of the PETITION FOR APPOINTMENT OF ARBI~'RATORS upon defense counsel via postage prepaid first class United States mail addressed ~ follows: John R. Ni osky, Esquire Johnson, D ffie, Stewart & Weidner 301 Market Street P.O. Box 1 9 Lemoyne, A 17043-0109 Attorney f ' Defendant i Dated: ~ ~ ~'~? J,~ t M T. erae 452355 .~ KIM and FRANK TUSCHAK, Plaintiffs v. KATHLEEN MARSHALL, Defendant ~'~ ~i=(=1c~ u~- ~ Ht . --. , ~;4~ ~ ~a ~ ~ Zoia~p~ ~ ~°~ ~.;: ~~~ cur~,~~E~ , ,' ,r ~~~~: y OCT222010 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -LAW NO. 09-8853 CIVIL JURY TRIAL DEMANDED ORDER OF COURT AND NOW, this lAtday of `}?.r~~~j~,/ , 2010, in consideration of the foregoing petition, .~~ ~%f~th~ ,Esq. ~ 6tdl~, Es . q and ~ Esq. are appointed arbitrators in the above- captioned action as prayed for. BY THE COURT: ' ~'7' /~ J. ~c~.s' m~~+ r ~1.. ~Z, ~~~I.f f . Ni;uvs t~ ~.~lU -T/~~ 452355 kl'14? Plaintiff Defendant In The Court of Common Pleas of Cumberland County, Pennsylvania No.?- 74 Civil Action - Law. Oath We do solemnly swear (or affirm) that we will support, obey and defend the Constitution of the United States the Constitution of this-Commonwealth and that we will discharge the duties of our office with f elity. Signature gnature ?.tJ ?i the 5'54,?- A/ ? avt s Name (Chairman) Name Law Firm Law Firm 1?aw Firm Address Address A# i? 70/? OAS c 1-_p city, Zip city, Zip city, /1-7/7 ao?/ -19- /,2926 Award ` 11 We, the undersigned arbitrators, having been duly appointed and sworn (or affirmed), make the 1/1`? following award: (Note: If damages for delay are awarded, they shall be separately stated.) r Date of Hearing: / (Chairman) Date of Award: / // Notice of Now, the -13tk day of J. 20 at 11:;2,7 , _ff.M., the above award was entered upon the docket and notice thereof givers by mail to the parties or their attorneys. Arbitrators' compens6tion to be'prlid upon appeal: S -250, .6 By: Deputy Address dissents. (Insert name i applicable.) FILED-O 4= iC E PR 0 I'lfit,' x.f, ZO11 JAN 13 AM I 1 2 > MBE LAND E OU"I' , PEWISYLVANUA cop es 04 ? . ? IQ4 t-,.t J. l i;;omk,. ya?i, ' ..?:?i ?yA s . y:. i ?-'?. '• -y?,1 9r . _ a ?+ 6 ?. #, ? ? ::..? t tj •? ,,.,,f•'y?.' I r E iI..ED-D+ F ICS , 4. a? ROT13DPI+lTAh { t1ll I FEB 15 FM UUMBERLAND COUNT`" PENNSYLYAWIA JOHNSON, DUFFIE, STEWART & WEIDNER By: John R. Ninosky, Esquire I. D. No. 78000 301 Market Street P. O. Box 109 Lemoyne, PA 17043-0109 Phone: (717) 761-4540 E-mail: jrn@jdsw.com KIM AND FRANK TUSCHAK, Plaintiffs V. KATHLEEN MARSHALL, Defendant Counsel for Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 09-8853 Civil Term CIVIL ACTION - LAW JURY TRIAL DEMANDED PRAECIPE TO ENTER JUDGMENT TO THE PROTHONOTARY: PLEASE enter judgment in favor of the Defendant and against Plaintiffs based upon the Award of Arbitrators entered in the above-captioned matter on January 13, 2011. JOHNSON, DUFFIE, STEWART & WEIDNER x4fslsl.D°?d By: e3s?sl ZU J An R. Ninosky, Esquire Ra55a1Y Date: February 14, 2010 Attorney for Defendant 1Vp?,ce ?la:fP? JUDGMENT Judgment is entered pursuant to the Award of Arbitrators in favor of Defendant and against Plaintiffs. Dated: - I S _/ 431209 By: 1 I Prothonotary CERTIFICATE OF SERVICE I hereby certify that a copy of the foregoing Praecipe to Enter of Judgment has been duly served upon the following counsel of record, by depositing the same in the United States Mail, postage prepaid, in Lemoyne, Pennsylvania, on : David L. Lutz, Esquire Angino & Rovner, P.C. 4503 North Front Street Harrisburg, PA 17110 JOHNSON, DUFFIE, STEWART & WEIDNER By 44 XZVa?? John R. inosky _ irk ? 7 i?2.?i' l ' s ?,1. / Plaintiff Defendant In The Court of Common Pleas of Cumberland County, Pennsylvania No.O? - Civil Action -Law. Oath We do solemnly swear (or affirm) that we will support, obey and defend the Constitution of the United States the Constitution of this,Commonwealth and that we will discharge the duties of our office with f elity. Signature 'gnature ?itJ ?uhp ?? Al. ayt tr Name (Chairman) Name uh-D' ?tisOw ??.. N B?po is, y. Law Firm Law Firm Law Firm j j ? 5,_ 6?, -7gov Address Address 170// Off' City, Zip City, Zip City, tip 102826 / a0/A a a /7 '. ?,? We, the undersigned arbitrators, having been duly appointed and sworn (or affirmed), make the 1?1'y ^ following award: (Note: If damages for delay are awarded, they shall be separately stated.) 7'? l Date of Hearing Date of Award: Notice of (Insert name if applicable t Now, the day of 20 at _1/:;Z7 , _&.M., the above award was entered upon the docket and notice thereof giver by mail to the parties or their attorneys. Arbitrators' compensation to be,pAid upon appeal: $_R5O,,e,A By: Deputy l '- ----s- 407 Address