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Home My WebLink About11-7317 C S ?''? ca (7' R'I M r M r U) tv c? CD Dissinger & Dissinger William C. Dissinger, Esquire 400 South State Road Marysville, PA 17053 (717) 957-3474 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW ALISON HOFF RISSER vs. NO. It- 1311 0,-tvi l T?fw COMMONWEALTH OF PENNSYLVANIA, : DEPARTMENT OF TRANSPORTATION, : BUREAU OF DRIVER LICENSING APPEAL FROM THE SUSPENSION OF OPERATING PRIVILEGES TO THE HONORABLE, THE JUDGES OF SAID COURT: AND NOW comes Petitioner, Alison Hoff Risser, who, respectfully avers as follows: 1. Petitioner, Alison Hoff Risser, resides at 1287 Kuhn Road, Boiling Springs, Pennsylvania 17007. Petitioner's Pennsylvania Operator's Number is 22755368. 2. PennDOT proposes by Notice dated August 23, 2011, a copy of which is attached hereto as Exhibit "A", to suspend Petitioner's driving privileges for a period of one (1) year, pursuant to Section 1547 of the Vehicle Code, effective September 27, 2011. 3. The withdrawal and suspension of Petitioner's operating privileges is unlawful, for the following reasons: Petitioner did not knowingly or intelligently refuse a chemical test. 4. Pursuant to 75 Pa.C.S.A. § 1550(b)(1)(I), Petitioner is retaining diver's license until final determination of the suspension of privilege. WHEREFORE, Petitioner respectfully requests that this Honorable Court allow her to take an appeal from the suspension of his operating privileges. Respectfully Submitted, Dissinger & Dissinger By William C. Dis inger, Esquire ID# 27737 400 South State Road Marysville, PA 17053 (717) 957-3474 ga.o to(o3q COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF TRANSPORTATION Bureau of Driver Licensing Mail Date: AUGUST 23, 2011 ALISON HOFF RISSER WID # 112286746520607 001 1267 KUHN ROAD PROCESSING DATE 08/16/2011 DRIVER LICENSE # 22755368 BOILING SPGS PA 17007 DATE OF BIRTH 08/10/1972 Dear MS. RISSER: This is an Official Notice of the Suspension of your Driving Privilege as authorized by Section 1547DII of the Pennsylvania Vehicle Code. As a result of your violation of Section 1547 of the Vehicle Code, CHEMICAL TEST REFUSAL, on 0712612011: ¦ Your driving privilege is SUSPENDED for a period of 1 YEAR(S) effective 09/27/2011 at 12:01 a.m. COMPLYING WITH THIS SUSPENSION You must return all current Pennsylvania driver's licenses, learner's permits, temporary driver's licenses (camera cards) in your possession on or before 09/27/2011. You may surrender these items before, 09/27/2011, for earlier credit; however, you may not drive after these items are surrendered. YOU MAY NOT RETAIN YOUR DRIVER'S LICENSE FOR IDENTIFICATION PURPOSES. However, you may apply for and obtain a photo identification card at any Driver License Center for a cost of 413.50. You must present two (2) forms of proper identification (e.g., birth certificate, valid U.S. passport, marriage certificate, etc.) in order to obtain your photo identification card. You will not receive credit toward serving any suspension until we receive your license(s). Complete the following steps to acknowledge this suspension. 1. Return all current Pennsylvania driver's licenses, learner's permits and/or camera cards to PennDOT. If you do not have any of these items, send a sworn notarized letter stating you are aware of the suspension of your driving privilege. You must specify in your letter why you are unable to return your driver's license. Remember: You may not retain your driver's license for identification purposes. Please send these items to: EXHIBIT If A ?? 112286746520607 Pennsylvania Department of Transportation Bureau of Driver Licensing P.O. Box 68693 Harrisburg, PA 17106-8693 2. Upon receipt, review and acceptance of your Pennsylvania driver's license(s), learner's permit(s), and/or a sworn notarized letter, PennDOT will send you a receipt confirming the date that credit began. If you do not receive a receipt from us within 3 weeks, please contact our office. Otherwise, you will not be given credit toward serving this suspension. PennDOT phone numbers are listed at the end of this letter. 3. If you do not return all current driver license products, we must refer this matter to the Pennsylvania State Police for prosecution under SECTION 1571(a)(4) of the Pennsylvania Vehicle Code. PAYING THE RESTORATION FEE You must pay a restoration fee to PennDOT to be restored from a suspension/revocation of your driving privilege. To pay your restoration fee, complete the following steps: 1. Return the enclosed Application for Restoration. The amount due is listed on the application. 2. Write your driver's license number (listed on the first page) on the check or money order to ensure proper credit. 3. Follow the payment and mailing instructions on the back of the application. Please note: Paying the restoration fee DOES NOT satisfy the requirement to acknowledge your suspension/revocation. If you have not acknowledged your suspension/revocation, please follow the instructions listed under "Complying with this Suspension/Revocation". 112286746520607 APPEAL You have the right to appeal this action to the Court of Common Pleas (Civil Division) within 30 days of the mail date, AUGUST 23, 2011, of this letter. if you file an appeal in the County Court, the Court will give you a time-stamped certified copy of the appeal. In order for your appeal to be valid, you must send this time-stamped certified copy of the appeal by certified mail to: Pennsylvania Department of Transportation Office of Chief Counsel Third Floor, Riverfront Office Center Harrisburg, PA 17104-2516 Remember, this is an OFFICIAL NOTICE OF SUSPENSION. You must return all current Pennsylvania driver license products to PennDOT by 09/27/2011. Sincerely, 4j?w ?-- - Z W, vt) Janet L. Dolan, Director Bureau of Driver Licensing INFORMATION 8:00 a.m. to 5:00 p.m. IN STATE 1-800-932-4600 TDD IN STATE 1-800-228-0676 OUT-OF-STATE 717-412-5300 TDD OUT-OF-STATE 717-412-5380 WEB SITE ADDRESS www.dmv.state.pa.us VERIFICATION The undersigned hereby states that the statements made in the attached Appeal of Suspension are true and correct to the best of my knowledge, information and belief. The undersigned understands that the statements in the attached Appeal are made subject to the penalties of 18 Pa.C.S. Sec. 4904 relating to unsworn falsification to authorities. Alison Hoff Wsser 1287 Kuhn Road Boiling Springs, PA 17007 V trl? C?? =:M 11A Dissinger & Dissinger William C. Dissinger, Esquire r? - -, 400 South State Road r :77 Marysville, PA 17053 (717) 957-3474 ._-, - IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW ALISON HOFF RISSER VS. NO. 11-731'] ?? iv?tTerMA COMMONWEALTH OF PENNSYLVANIA, DEPARTMENT OF TRANSPORTATION, BUREAU OF DRIVER LICENSING ORDER OF COURT +14 2011, upon AND NOW, this ? day of consideration of the attached Petition for Review of an Order of the Department of Transportation suspending Appellant's operating privilege, a hearing de novo is granted to determine whether the action of the Department of Transportation in recalling Petitioner's operator privilege should be set aside. Hearing in the above captioned matter is scheduled for the day of 2011, at 14- o'clock 10;30 y, in Courtroom No. of the Cumberland County Courthouse, Carlisle, Pennsylvania. Pending hearing, this Order shall serve as a supersedeas, as provided in 75 Pa.C.S.A. § 1550(b)(1)(I). Petitioner is directed forthwith to serve a notice of the appeal and copies of the Appeal from suspension of operating privileges and Order for hearing on the Department of Transportation at the address shown in the Department's notice of entry of order, by certified mail, return receipt requested. BZYT URT, J. qiw opehief Gourd Qenn Lot L-SsirTr 4 ?issir?er 0006 9/a../fl od ALISON HOFF RISSER, Petitioner V. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF TRANSPORTATION, BUREAU OF DRIVER LICENSING, Respondent IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 11-7317 CIVIL, TERM LICENSE SUSPENSION APPEAL ORDER OF COURT AND NOW, this 21st day of November, 2011, by agreement of the parties, the record shall remain open for two weeks for counsel to submit a stipulation as to the availability of a blood alcohol test performed at the Harrisburg Hospital prior to the Trooper's request. If such a test is available, we will sustain the appeal pursuant to the Rohrer case. If such a test is not available, the appeal will be is dismissed. By the Court, Edward E. Guido, J. William C. Dissinger, Esquire Attorney for Petitioner ? Phillip M. Bricknell, Esquire M JII-'p, A f d ttorney or Respon ent srs r'e'f < CD S%'' - r r? 4x X SV F!1LED- CF EICE t,Ra? nq c;, CUM ER ?.NlD Cup;;,; Y EI IdS'r'L?` ;7 A Dissinger & Dissinger William C. Dissinger, Esquire 400 South State Road Marysville, PA 17053 (717) 957-3474 ALISON HOFF RISSER, Petitioner Vs. COMMONWEALTH OF PENNSYLVANIA, DEPARTMENT OF TRANSPORTATION, BUREAU OF DRIVER LICENSING, Respondent : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY, : PENNSYLVANIA CIVIL ACTION - LAW NO. 11-7317 CIVIL TERM MOTION FOR RECONSIDERATION AND NOW comes Petitioner, Alison Hoff Risser, who, through and by her attorneys, Dissinger & Dissinger, moves the Court as follows: 1. On September 22, 2011, Petitioner filed with this Court an "Appeal from the Suspension of Operating Privileges." 2. A hearing was held November 21, 2011 before the Honorable Edward E. Guido. 3. As a result of that hearing the following order was issued: "AND NOW, this 21St day of November, 2011, by agreement of the parties, the records shall remain open for two weeks for counsel to submit a stipulation as to the availability of a blood alcohol test performed at the Harrisburg Hospital prior to the Trooper's request. If such a test is available, we will sustain the appeal pursuant to the Rohrer case. If such a test is not available, the appeal will be dismissed. By the Court," 4. Petitioner on November 22, 2011, submitted a request for records and release to Pinnacle Health, in the form of an "Authorization to use or Disclose Protected Health Information - General." 5. Star - Med, agent for Pinnacle Health invoiced Petitioner the sum of $49.06 which was received by Petitioner on December 8, 2011. Said invoice was paid on December 9, 2011. 6. On December 9, 2011, this Court issued the following order: "AND NOW, this 9th Day of December, 2011, after hearing the appeal is dismissed and the action of the Department of Transportation is ratified and affirmed. BY THE COURT" 7. Subsequently, the records, a copy of which is attached hereto marked exhibit "A" and made a part hereof by reference thereto, where received by Petitioner. 8. The records show blood tests performed and reported at 14:30 with an alcohol level of 0.46. 9. Trooper Hoffman, testified at hearing on this matter that he did not arrive at the Harrisburg Hospital until 14:35 and that the alleged "refusal" by the Petitioner Fifteen (15) minutes later. This occurred after blood had been withdrawn from Petitioner and tests, including blood alcohol level, performed and the results of those tests reported and available. 10. Concurrence of opposing counsel was sought. Opposing counsel does not oppose the receipt by the Court of the information contained in Exhibit "A" but may dispute the relevancy or effect of such information. WHEREFORE, Petitioner, respectfully requests the Court reconsider its decision in this matter and issue an Order sustaining Petitioner's appeal. Respectfully Submitted, Dissinger & Dissinger By: //< William C.' Dissing`er, E/uire ID# 27737 400 South State Road Marysville, PA 17053 (717) 957-3474 STAR*MED Bill To: DISSINGER AND DISSINGER ATTORNEYS AT LAW 28 NORTH THIRTY SECOND STREET CAMP HILL, PA 17011 P.O. Box 4356 Wilmington, DE 19807 PH: 302.235.5757 FAX: 302.235.0702 TAX ID #; 56-2283680 Patient Information Prepay Invoice Invoice #: PA-51-1321927 Facility: PA-51 Patient Name: RISSER, ALISON Request No.: KB2637644 Date Request Recv'd: 12/1/2011 Pages: 20 AMOUNT DUE:: Description Amount Medical record copies Amount Duet 1149 Medical records ww ue sent upon receipt of payment in iun A $15.00 cancellation fee will be applied to all requests for medical records that are cancelled A $30.00 fee will be applied to all returned checks A late fee will be applied to all unpaid invoices after 30 days Please include invoice number on remittance Please send payment to: S'T"A R*M E D P.O. Box 4356 Wilmington, DE 19807 PH: 302.235.5757 FAX: 302.235.0702 TAX ID #: 56-2283680 Invoice # PA-51-1321927 Please write on your payment EXHIBIT Payment ce. a DISSINGER DISSINGER at Law November 22, 2011 VIA FAX (717) 782-3671 and HARD COPY PinnacleHealth Harrisburg Campus PO Box 8700 Harrisburg, PA 17105 RE: Alison H. Risser Dear Sir or Madame: -119 Please be advised that I represent Alison H. Risser (SS# 200488036). I enclose an "Authorization to Use or Disclose Protected Health Information - General" executed by Ms. Risser. On July 26, 2011 Ms. Risser was transported to the Harrisburg Campus emergency room after an automobile accident which occurred at 12:53p.m. on July 26, 2011. She was in the emergency room approximately two hours and released. Please provide all records in regard to treatment, diagnosis and procedures during that emergency room visit. Of particular interest is any record showing the withdrawal of blood from Ms. Risser, the time of such withdrawal and the results of any test or tests performed on the blood withdrawn. If you have any questions, feel free to contact me at my office. Very truly you William C Dissinger NOY .30 2011 Attorney at Law WCD:drs Encl: 1 Cc: Alison Risser File: 4-1.1-161 28 North ThirtySecond Street • Camp Hill, Pennsylvania 17011 e 717.975.2840/voice • 717.975.3924/fax 400 South State Road • Marysville, Pennsylvania • 17053 717957.34741voice • 717.957.2316/fax V\, Medical Record/Social Security 2c, o L/ v y Patient Name: ? Date of Birth: 0 Phone #: 7J -7 ' YaS- Q 1. 1 authorize the use o (disclosure of the above named individual's health information as described below. 2. The following individual or organ Address: is authorized to make the use or disclosure: 3. The type and amount of information to be used or disclosed is as follows (include dates where appropriate): `ilk History & Physical, Discharge Summary, Consult, Progress Note, Operative Report, X-rays, Lab Dates: ? Entire Record l _ Dates: ffi Other (specify) Dates: 30 4. 1 understand that the information in my health record may include information relating to sexually transmitted disease, acquired immunodeficiency syndrome (AIDS), or human immunodeficiency virus (HIV). It may also include information about behavioral or mental health services, and treatment for alcohol and drug abuse. However, the recipient may be prohibited frorn disclosing substance abuse information under the Federal Substance Abuse Confidentiality Requirements. The following information is protected by State and Federal Law. If this information applies to you, please indicate if you would like this information released/or obtained (include dates where appropriate,) Alcohol, Drug, or Substance Abuse Records_ Yes No Dates: 1 ?;' =ELI HIV Testing and Results Yes _ No Dates: La Mental Health or Psychotherapy Records I? Yes No Dates: 5. This information may be disclosed to and used by the following individual or organization: 6. 1 understand that I have a right to revoke this authorization at any time. I understand that if I revoke this authorization I must do so in writing and present my written revocation to the Health Information Management Department. I understand that the revocation will not apply to information that has already been released in response to this authorization. I understand that the revocation will not apply to my insurance company when the law provides my insurer with the right to contest a claim under my policy. This authorization is effective as of the date set forth below. Unless otherwise revoked, this authorization will expire on the following date, event, or condition: If I fail to specify an expiration date, event or condition, this authorization will expire 120 days from the date that I sign it. I understand that authorizing the disclosure of this health information is voluntary. I can refuse to sign this authorization. I understand that Pinnacle Health Hospitals may not condition treatment on whether I sign this authorization. I understand that I may inspect or copy the information to be used or disclosed, as provided by federal patient privacy regulations. I understand that any disclosure of information carries with it the potential for information disclosed pursuant to this authorization to be redisclosed by the recipient and no longer be protected by federal patient privacy regulations. If I have questions about disclosure of my health information, If I have questions about disclosure of my health information, I may contact the Compliance and Privacy Officer at Pinnacle Health, P.O. Box 8700, Harrisburg, PA 17105 or by phone (717) 231-8211. I understand the nature of this authorization. T federet p ivacy regulations referred to in this document may be found at 45 CFR 160 and 164. .2/ 4?2,::,? hy. Signature of Patient r Personal Representative Date If Signed by Personal Representative, Describe Personal Representative's Authority PINNACL.EHEALTH AUTHORIZATION TO USE OR DISCLOSE PROTECTED HEALTH INFORMATION - GENERAL PATIENT IDENTIFICATION Form 7181-150 (0607) NIR (PM) STAR?MEZY P.O. Box 4356 Wilmington, DE 19807 Phone: 302-235-5757 Pax: 302-235-0702 Dear Requestor; Star-Med has been retained by the Health Information Management Department of Pinnacle Health - Harrisburg Hospital to fulfill requests for health information. Enclosed are the reproduced medical records authorized by the patient or his/her legal representative. If you have any questions on your request, please call 302-235-5757 and a Star-Med Team Member will be happy to assist you. This information has been disclosed to you from medical records that may be protected by Federal Law and State Law. The Code of Federal Regulations (42 C.F.R., Part 2) prohibits you from making any further disclosure without the specific written consent of the person to whom it pertains, or as otherwise permitted by such regulations. A general authorization for the release of medical or other information is not sufficient for this purpose. Thank you. If you would like to learn more about our services please visit our website at www.Starmedllc.com or call us at 302-235-5757 RISSER, ALISON H-Enc #120029125-OPT-HER-7/26/2011 Facesheet -- 7/26/2011 - 1 pg *****PinnacleHealth Outpatient Facesheet***** Patient Name: RISSER ALISON H Patient No: 120024125 Nurs Sta: Room/Bed: Med Rec No: 200488036 Hosp Svc: HER Admit Date: 07/26/11 Pt Status: ET Pt Type: E Areas: Patient Infc: S S N : Address: Marital Sts Fin Class: Patient Emp Empr Name: Address: State: 200-48-8036 1287 KUHN RD M Sex: F A lover Info: NOT EMPLOYED Zip Cd: Guarantor Info: Name: RISSER ALISON Address: 1287 KUHN RD State: PA Zip Cd: 17007 Guarantor Employer Info: Empr Name: NOT EMPLOYED Address: State: Zip Cd: Emergency Co ntact Info: Name: RISSER BRIAN Address: 1287 KUHN RD State: PA Zip Cd: Home Phone: 717-218-0279 Insurance In formation: Ins Code: X99 Priority: Subscriber: RISSER ALISON Group #: Employer: AUTO UNKNOWN Ins Code: Priority: Subscriber: Group #: Employer: Ins Code: Priority: Subscriber: Group #: Employer: Ins Code: Priority: Subscriber: Group #: Employer: Adm Date: 07/26/11 Time: Adm Dr No: 00193 Complaint: MVA/LEG ABRASIONS Birthdate: 08/10/1972 Age: 38 City: BOILING SPRINGS State: PA Zip Cd: 17007 Phone No: 717-218-0279 Religion: CAT Race: C Occupation: City: Phone: - Patient Rel: S City: BOILING SPRINGS Phone: 717-218-0279 Occupation: City: Phone: Patient Rel City: 17007 Work Phone: 1 Description Policy #: Precert #: Description: Policy #: Precert #: Description: Policy #: Precert #: Description: Policy #: Precert #: 13:45 Adm Source: Adm Dr Name Comments: Resp Party: 717 - 245-1526 Y BOILING SPRINGS 717 - 986-5521 AUTO UNKNOWN 200488036 OU EMERGENCY ROOM ASSOC INFO FROM PT/NCS/AUT HALEXA 17:15 07126111 FROM @020,ZPPRADFI Page 1 of 1 RISSER, ALISON H-Enc #120029125-OPT-HER-7/26/2011 ED Facesheet - 7/28/2011 - 1 Pg ?? D lArN ??®? 07/26111 200488036 120024125 ?1 , Harrisburg Hospital Front St 111 S RISSER,ALISON H F 08/10/1972 y?; ??15 , ?. , . . . Harrisburg PA 17101 EMERGENCY DEPARTMENT MDRO: NO MDRO A e Date of Birth ?? Sex Date g38 08/10/1972 i LL_j 07/26/11 (1 ( Primary Care Phys: rx- ?th h?l S N Chief Complaint: 200488036 MVAILEG ABRASIONS Dr. Time In L7 Medical Command Date/Time Accident: Police Notified: Oyes ?No By: Chief Comp: Hx, cunt: HPI: Social: Location: Tobacco: Drugs: ETON: Quality/Severity Living Situa tion: Timing/Duration PE: BP ! P R T Context: SP02 VYt Q see nurse's rate - reviewed Modifying Factors: Assoc Symptoms: Const: ROS: Unable to obtain balwasO Const: Psych: EYES: ENT: Resp: CV: GI: GU: MS: Integ: Neuro: Endo: Hem/Lymph: All/Immun: ? 'All other systems negative" l'] See nurse's note - reviewed Hx: Allergies: Meds: __Z_&4 Medical: I'C' ,,244 01). Family: Mental Status/Psych: EYES: ENT: Head/!Neck: Resp: CV: G1: GU: Integ: Neuro: MS: Lymph: ED Course: Test Interpretation: Procedures: p Time out procedure completed: Patient Identification and procedure confirmed identified correct sidetelte; correct position; special equipment and requirements Ox: / t / 14-IvQ-- CC Minutes: Dictated Service Bed Type Follow-U eferral Consult ? Condition on Discharge hr obs pAdmission 0723 OTransfer POischarge O Med/Burg ?Telemetry OCritical Care ? Psych CP Name: ime: tffStable ? improved Other E.D. Physician Physician's AssistanU Mid-level Practitioner FORM 531 IMNYII11B111? 167 ER Triage Physician MEDICAL RECORD 1§111011111111 Page 1 of 1 RISSER, ALISON H--Enc #120024125-OPT-HER-7/26/2011 ED Nursing Assessment - 7/28/2011 - 4 pg i? a z 0 S z V ?Aai risburg ? CGOH Acuity ? 1 ? 2 ? 4 ? 5 Tim Date: 01.20-1 I 1 e: Age: r71 Sex: Wt. (kg): ?r Vital Sipne Level Of ConeeloutxTess; Ventilation Circutatlon Chief Comp hl I _... , . . . Alert ? Olear u i Temp. pq , /? ?Obstructed (alts) I t pT spverbet • C] Pain , - .resent O absent -7 Pules l ebored n ? regular ? Irregular O Unresponsive ? Apneic Rasp: yy _ C31rthNbated ? strong ? weak PeRYtetttvMN: ?4 V^ ` t . ea arUn,Scala 0-10 LMP: • (]N!A l aatetlon O N/A O Y ON ? ? True Nuise Mode of Arrival: Patl em Die n: ? Am# Wafting Room PRE-HOSPITAL CARE UNIT: 'v`??`r""' \ El BLS C3 ALS Arrived with: Child Vital Signs BP: P: ?V R14 ? Wheelchair ?No Identified Needs Z. 1 ? Ambulator eaks No English ? S icious•marks ? Unu Va s Loss of ? No _ ? Yes y ? Carried p Language: sua p u ? Sexual Abuse Consciousness Airwa ? Oral ? Nasal ? Er Tube ? Translation By: ? Domestic Violence y Size: IMMUNIZATIONS ? Safe Referral Oxygen ? NC I/m ? NRM vm TETANUS: PSH / Social ? Suicide Risk Pulse ox RA' E Oxygen Childhood Plan: thm H t Rh ? UTD ? Not UTD f J?' y ear CPR Started C] No ? Yes Time Triage Protocols/ Interventions: AED ! O No ? Yes Time Medications IV Therapy Gauge Site Solution I f T 1 J D t ti k i k k {? M / dl M / dl ex roa c c Medications Administered Pre-h " Si nature of Provider: Tft" ! rse: Time: 'no" NEURO ?ORIENTED Rm DENIES ?NA GU DENIES ?NA SYMMETRICAL 6 UNLABORED E ?DISORNENTED AREA:, O TION ?INEFFECTIVE AIRWAY CLEARANCE AR CL ? LABORED ? GLASCOW COMA SCALE QlaBty: R?atbn: ?DYSURIA ? FOLEY ? INEFFECTIVE BREATMNG PATTERN ? WHEEZING ? L ? R ?HEADACHE D IMPAIRED GAS EXCHANGE ?RALES/RHOIVCH ?l ?R ? STIFF NECK SEVERITY (0.10) GYN DENIES ? NA O FLUID VOLUME DEFICIT ? pMMSHEO ? L ? A gym'' EEDING B ? ? C] RETRACTIONS ? DIZZINESS VAGINAL L ALT. BODY TEMP Gt?DB;NtES ?NA ? NORMAL FLOW ?ASNOR ALFLOW ? ALT. T V$%. * PERFUSION ULM10N ERATNE EMOTIONA :_ PERIPHERAL/CARDIAC/CEREBRAL PULSES (9iht) RAMVE ? UNCOOPERATIVE O NAUSEA ? VOMITING ? IMPAIRED SKIN INTEGRfi1• ENT ?ABSENT ?AN%IOUS ?DIAARHEA ?CONSTIPATION ?DISCHARGE: TROO ? WEAK k I ? FLAT AFFECT ? DARK STOOLS /]z ? ?N: ACUTE /CHRONIC ? IRREGULAR EIIJ LAR ? AVOIDS EYE CONTACT EEJW[U DENIES ? NA ? IMPMREO MO&UTY ? EDEMA:. O BABY ?ABDOMEN ?NA VISUAL ACUITY: ? INEFFECTIVE COPING ?JVD ? CAPILLAAV' REFILL: A MA ? SOFT ? FIRM QCORRECTED ? NOT CORRECTED ? OTHER: ? Q SEC ?>2 SEC TR U ? ABRASION: ? DISTENDED OU: ? LACERATION: ? TENOER: OD: NK ()RACE ?ECCHYMOSIS: ?BOWELSOUNDS: OS: JC 0DIAPHORETIC ?DEFORMITY. ?PRESENT ?ABSENT ?EPISTAxIS ?R ?L YANOTIC ? BURNS: ? EARACHE ? R ? L ?JAUNDICE ? SEE BODY DIAGRAM (ON SACK) ? SORE THROAT PRIMARY NURSE SIGNATURE: k7'4- TIME: EMERGENCY NURSING PINNACLEHEALTH ASSESSMENT SHEET HOSptais i 1 ? Iii iili liii ill iili ili?il 1 • Form INV 7482 (021" MR ED2505 Ihl) DATICNIT INFf1gMATION W"'488036 CASE:120024125 _ RISSER ,ALISON H F DATE: 07126/11 DOB: 08/10/1972 Ph #: AGE: 38 OR: Page 1 of 4 RISSER, ALISON H•-Enc #120024125-OPT-HER-7/26/2011 ED Nursing Assessment - 7/28/2011 - 4 pg ANTEPAOR F"iT LEFT QOMRIOR gODY IM KJUF lES CODE O NA ON A - AV - AVULSION H-SU M C- SON 0 - DEFORMITY L - LACEPJMO P - PI!? SW - STAB VOU14D S - gyyEwNG AMP • AMPUTATION GLABC•OW COMA SCALE BEST MOTOR SW' BEST VET R? EYE OPEN 4SPO?ffANEWg 00o Q-Gt?IENTt? PA1 3 -10 SPEECH 4 YrITHD N 3 *AM* WOROS 2 - TO PAIN Fw" 2 • INCOW SW"'* NOME 2 - ABN EMNSON 1 . NONE I -HONE PUPIL S12E 1 p 3 I S ! T ! Y A. frj4TW 0"00.09 LEFT KA ANTERIOR P0S1ERlOR ftlGW HAND ANTMW p0g(ERtOR 4 I.111 MR: *"`488038 RISSER ,AUSON H DATE; 07126M I Ph#: DR; CASE:120024126 006;0811011972 AGE: 38 ''Y Patient Name. PatlBnt S.S.W. Page 2 of 4 RISSER, ALISON H--Enc #120024125-OPT-HER-7/26/2011 ED Nursing Assessment - 7/28/2011 - 4 pg • • • • Pane I of- Procedures Medications [] A DATE/TIME DRUG DOSE ROUTE SITE INT : U Cl ECG: Labe; EIX-Ray; ? BCx2 BCI: BC2: CT. [I u/s: 0 ABG; IV Solutions DATEMME BRE SIZE SOLUTION / VOLUME RATE INIT 1 Dateffime OP P R Spo• O. L::::11 Pain to - 10) Narrative Vik 0 i 041"MM)A r ?4a3 tuiv d ow litrbm- FN . Rte Lixt• Worv fb06 0. UYI u10t4 6 K iv rIvi U )IL I600 tl. rOVilk v WS1U' Cy f if • tIL No i f6 ?k• 441f hn b vld CAA. nbri t`4 1 6 111n t b s v>'t- 11 (tVi v c lYilw rn, L- 0. o i PCP. Mil u?ulf,+lht'I ?n V lh lON tiXl b YtS VV1 li(ot- Q?tt,lF. Admit ted Disposition Assessment Initials / Signature 0 Admit O 23* hr CBS Time: 1111 B/1?? R: T Attending:- Bede: P in. (0 - 10) Discharged OTransferred Mi _ Report called by: (see Ttansfer form) To: Time: i M In the care of tI d I Mlli li t di f Pt/F il b d d on tor To Bed:- D Yes 0 No y ver un ers ng o am a ze an D/C Instructions Mode: 0 W/C 0 R*ritten Instru i rvQp by: Stretcher Advanced Directives Discussed 0 ?0 Mode: Ambulatory0 W/O 0 Helicopter Copy available 0 O E S .0 Carried 0 Crutches RN RN PINNACLEHEALTH F OW SHEET NURSING I vili ionig S CONTINUATION CASE: 120024125 * 488036 MR: * * Ilil I IWU 1111111 I 111111111111 PASSE o,A2 /11 H DOB: 08110/1972 Ph#: AGE: 36 Farm INY 7-4W p2/ta) MR ED25o6 Ono) DR: Page 3 of 4 01 RISSER, ALISON H-Enc #120029125-OPT-HER-7/26/2011 ED Nursing Assessment - 7/28/2011 - 4 pg 0 Urinalysis Reference Ranges: Protein Negative Glucose Negative Bilirubin Negative Ketones Negative Blood Negative Nitrates Negative Leukocytes' Negative Urobilinogen Normal pH 5.0-8.0 Specific Gravity ; 1.003-1.030 Blood Glucose Monitor:. i _ Reference Range: - 74=118 mg/dL- Troponin I Reference Range: <0.03 ng/mL - 0.49 ng/mL 0 L-1 MR: OEM CASE: 120024125 RISSER,ALISON H DATE: 07/26/11 008: 08/10/197 2 Ph#* AGE: 38 DR: • Page 4 of 4 RISSER, ALISON f(--Enc #120024125-OPT-HER-7/26/2011 ED Patient Instruction Sheet - 7/28/2011 - 1 pg 4 --jZ 'Harrisburg ED 782-3297 Please note that the instructions circled or checked below pertain to • • 0 You have been discharged with the diagnosis of 1`'l1Wr K` &/?-jt A, M[' 7_ AJ;0l/t?Z4KA L . The examination and treatment you have received in the Emergency Department have been rendered on an emergency basis, and not Intended to be a substitute for ongoing care provided by a primary care physician or specialist. Not all of your medical problems may be known, diagnosed and/or treated at this visit. It is important for you to follow up with your physician and to return to the Emergency Department if you become worse in any way. Qt )Instni-dons SuRplemental Instructlon Sheet ? Yes Rest for ? Medication(s) Off work/. school from to Return to work on Light duty for Regular duty ? Cautian- . Medications may cause drowsiness. Eallow•uo CareCare: - No alcoholic beverages. 1. If for any reason you feel you need medical attention before Do not drive, operate machines, or perform your follow-up appointment, please return to this Emergency risk taking activities. Department. 2. Emergency Department on ? 'k * You have had IV contrast for a radiology study. Do not 3. Family Physician take Glucophage (metformin) or Glucophage containing 4. See Dr:. on medications until you see your primary care provider in at AM / PM. 2.3 days and he/she tells you to resume this medication. 5. Call the following clinic within one business day for an appointment I hereby acknowledge receipt of these instructions, i will to be seen In -day(s): arrange for follow-up care as I have been instructed. _Hamlhon Health Center, 1821 Fulton Street 232-9971 1 will lake the medic tion I?y physician. Community Health Center nV1? //J 7 ____.Chlldren & Teen Center, 2nd FI 782-4650 -women's Outpatient, 3rd FI 782.4700 Signature of Patent or Responsible Person Dale Kline Health Center, Landis Bldg. 2nd Floor. Discharge Patlent From Emergency D partment. --;-Orthopedic Clinic 782-2142 _Sixglcal Clinic 782-2100 R.N. Signature Physician signature 6. If you smoke you are advised to stop. Please call 717-221-6250 . or access www.elnnaclehealth.or- for more information on Attending Pl Iden (Primed) smoking cessation. X-Ray Instructions Radiology Studies - Including plain X-rave. T/MRI Scans and Ultrasounds'Your Radiology Studies have been reviewed by an Emergency Physician, Physician's Assistant or Radiologist. A final Radiologist's Interpretation will be reported and you or your doctor will be notified of any abnormalities which require follow-up. PINNACLEHEALTH Hospitals Emergency Department Pat lent Instruction Sheet I IIII?H IIIII IIII IIIII IIIII HIII IIII III) tamer Fam INV 29001 (210) MR (PM) 4*.* PINNACLEHEALTH . Hospitals Emergency Department P.O. Box 8700 Harrisburg, PA 17105-8700 Date Harrisburg - I& 11?J Substitution Permissible M.D., D.O. IN ORDER FOR A BRAN AME PRODUCT TO BE DISPENSED, THE PRESCRIBER MUST WRITE'BRAND NE SARY' OR'BRA. S PACE MM Miss MAY REFILL TIMES MR: * * *488036 CASE: 1200Y4 i 25 PA Lic A ~ RISSER AUSON H DATE: 07/26/11 F DE9• o. DOB: 08!10/1972 Ph#: PRINT PHYSICIAN NAME. DR: AGE: 38 LABEL ALL PRESCRIPTIONS First copy -Patlent Second copy - Medical Records Third W - E.0, Record Page 1 of 1 RISSER, ALISON H-Enc #120029125-OPT-HER-7/26/2011 ED Physician Orders - 7/28/2011 - 1 pg r- L a Date, Time LEVEL O INTENSITY LOI : (Pieria complete a Level of Intensity Oder Form for any Lot N-V) 7INIIII I&M Allergies: Procedures / Su Iles Lab Time: initials Drug Levels Cultures Radiology ? Cardiac Monitor O ABG O Glucose O Acetaminophen D Blood x Time: O ECG ? Acetone O Hepatic Panel D Aspirin O Chlamydla Initials: ? Nasogestric tube O Amylase ? H&H ? Carbamazepine ? GC ? Foley Catheter O ALT/AST O Lactic Acid D Digoxin ? GC/ChlamYd!a Portable: ? C-spine El Straight Catheter D Ammonia O Lipase O Lithium (gene amp) O CXR O Pelvis O IV: ? BMP D Magnesium ? Phenobarbital p Herpes Spine: ?c ?T OuS ? Cardiac O Myoglobin O Phenytoin D Sputum O Ankle L R BNP O PT/INR ? ophylline O Stool • ?CXR LPM O 02 O CK - Total O CK - MB O PTT D Qua[ HCG Urine Tox. Valproic acid O Stool - C-dill ? Elbow L R _ - O Pulse Oximetry O CK - Index D Quant HCG D Throat/strep D Urine ? Facial ? Femur L R O Non-invasive roponin 1 CBC w/auto dill O Rpt Cardiac O CK - Total Blood Bank ? Type & Cross O Wound: O Finger L R COHbg b O CK - MB O T e & Screen ? Foot L R O Peak Flow 9 yp ? Forearm L R El Neb Treatment: p Met Panel F ? CK -Index ? Rh Factor d L R D H CR O Troponin I an ' O D-Dimer (DVT) O TSH Bedside Testing ? Hip L R ectrolyte O Sed rate BGM D Humerus L R OH Zt O Urinalysis ? Qual HCG (urine) ? Nasal NT O Troponin 1 O Knee L R e O KUB If ST Elevation MI O Thrombolysis (Order sheet) ? Ob Series AMI D Pelvis Orders ? STAT Cardiology Consult with (PreCath orders) O Ribs L R ASA 328 mg po O STAT, O Given PreHospital, ? Taken at Home ? Shoulder L R ? Skull Acute ? Vital Signs q 15 minutes O IV: 0.9 NSS @ 50 mL/hour ? BGM ? Stroke Alert Team ? lb/Fib L R Stroke Orders ? Strict NPO until dysphagis evaluation called Q Time: O wrist L R Symp ? Aspirin 300mg PR x 1 dose ? Notify physician if: SBP >18D, DBP >105, change in neuro status. T: ? ED Abdominal Pain Protocol initiated Q ED Asthma Protocol Initiated C S ED Protocols O ED Chest Pain Protocol Initiated O ED Fever Protocol initiated D US: ? ED Pain Management Protocol Initiated O Venous Doppler: Date Time Additional Orders: O MRI: O V-Q Scan _ ? Other: 01 Physician Signature Printed Name sl na (printed) PINNACLEHEALTH Hospitals EMERGENCY DEPARTMENT PHYSICIAN ORDERS Form WV 30741FJU e)MR ED2502 (In) II Patient Idenfifice4on 151111611111111 M' is `48803+5 CASE: 1 200241 2 5 Ri SSER ,AL/SON H F DATE: 07128111 DOS: 08/10/1972 Ph #: AGE: 38 Dr. k Page 1 of 1 RISSER, ALISON H-Enc 0120029125-OPT-HER-7/26/2011 ED Report - 8/3/2011 - 1 pg RISSER, ALISON H RM#: MRN: 200488036 PI N NAC LE H EA LT H CASE: 00120024125 DOB: 08/10/1972 P.O. Box 8700 ADM: 07/26/2011 Harrisbur , PA 1 71 05-8 700 Emergency Department PinnacleHealth System P.O. Box 8700 Harrisburg, PA 17105-8700 EMERGENCY DEPARTMENT Time seen is 1400. Collaborating physician is Dr. Heidi Commins. CHIEF COMPLAINT: MVA. HISTORY OF PRESENT ILLNESS: This is a 38-year-old female brought in by West Shore EMS who is involved in a motor vehicle accident. She was the restrained driver, hit another car, rear-ended head on, had gone through a traffic light. The other driver was not injured. The driver of this vehicle pulled off to the side of the road. They found her slumped over in the passenger side with noticeable beer cans, 3 beer cans in the car. She is obviously intoxicated. They boarded her and collared her and brought her in. Police have been here already. She does arouse to her name, but her speech is garbled due to being intoxicated. She denies having injury anywhere. She does not recall the events. She does not state that she is intoxicated. REVIEW OF SYSTEMS: Otherwise negative. I just cannot get a good history on her based on her intoxication. PAST HISTORY: SHE HAS NO ALLERGIES. They do say that she is on Zoloft she takes for a history of depression. She has no medical history otherwise. No surgical history. Primary care provider is Dr. Paul Curtain. FAMILY HISTORY: Noncontributory. PHYSICAL EXAMINATION Vital signs: Temperature is 36.9, blood pressure is 116/80, pulse is 110, respiratory rate is 18. She is 94% saturated on room air. Constitutional: This is a 38-year-old female, highly intoxicated lying on the bed. Boarded and collared. Speech is garbled. Eyes are PERRLA. Conjunctivae are clear. Sclerae is white. Tympanic membranes are pearly gray with no fluid levels. No pain on palpation across the facial area. She has full range of motion to the jaw. Oral cavity reveals teeth that are patent. She has no pain on palpation. I do not see any abnormalities of the inside of her mouth. Her head is normocephalic, atraumatic. Palpation from the neck down palpate her extremities. Her chest, abdomen and pelvis lower extremities, she has no pain on palpation. I do put her through a full range of motion of the upper and lower extremities. She does not complain of Page 1 of 3 Page 1 of 3 RISSER, ALISON H-Enc #120024125-OPT-HER-7/26/2011 ED Report - 8/3/2011 - 1 pg RISSER, ALISON H RM#: MRN: 200488036 PI N NAC LE H EALTH CASE: 00120024125 DOB: 08/10/1972 P.O. Box 8700 ADM: 07/26/2011 Harrisbur , PA 17105-8700 Emergency Department anything. Rolled onto the side she has no complaints of neck pain, thorax pain, lumbar, sacral discomfort. She has good radial pulses, good pedal pulses. Brisk capillary refill. Her lungs are clear without any rates, rhonchi or wheezing. No pain on palpation over the ribs, scapula or clavicular area. Regular rate and rhythm without any murmurs, gallops or rubs. No pain on deep palpation of the abdomen. It is soft. No masses palpable. I do not see any significant trauma to her skin. Some abrasions to her lower extremity. She has no facial contusions. EMERGENCY DEPARTMENT COURSE: But because of her intoxication, I felt the need to do a CT of her head and spine just to make sure those were okay. Also sent some blood work including urine tox and alcohol level. In the interim, the patient did wake up and took her C-collar off. She was seen walking around the ER department. EMERGENCY DEPARTMENT PHYSICIAN TEST INTERPRETATION: She did go for CT of head and neck and it was negative for any acute abnormalities. CBC, BMP revealed relatively normal studies with an alcohol level of 0.46. DISPOSITION: At this point, the patient wants to go home. She has been walking around the ER using the bathroom. She did lose her flip-flop at one point. She has been making numerous phone calls to find a ride home. I did instruct her if she could find a ride home, she could go home, but with her alcohol level being 0.46, her other option was she would have to stay until she had a normal alcohol level. The police have already been here. They have gotten the paperwork that they need to charge her with a DUI. She does find a family friend who is able to take her home and they come in approximately a little after 5, family and friends. She was discharged home with them. They said they were going to be taking her home and someone was going to be staying with her tonight. The patient was discharged in stable condition. DIAGNOSTIC IMPRESSION: 1. MVA. 2. Alcohol abuse. Patient: Alison Risser cc: PAUL D. CURTIN, DO Dictated by: KATHLEEN HINDERMYER, CRNP KATHLEEN HINDERMYER, CRNP Page 2 of 3 Page 2 of 3 RISSER, ALISON H-Enc #120024125-OPT-HER-7/26/2011 ED Report - 8/3/2011 - 1 pg RISSER, ALISON H R M#: MRN: 200488036 PI N NAC LE H EALTH CASE: 00120024125 DOB: 08/10/1972 P.O. Box 8700 ADM: 07/26/2011 Harrisburg, PA 17105-8700 Emergency Department DD:07/27/2011 DT:08/03/2011 /kjr D#:3156095 Signed by HINDERMYER CRNP, KATHLEEN on 03-Sep-2011 12:32:58 -04:00 Page 3 of 3 Page 3 of 3 RISSER, ALISON H-Enc #120024125-OPT-HER-7/26/2011 Lab Results - 7/29/2011 - 1 pg 07/29/2011 Page 23:46 1 PinnacleHealth Hospitals James A. Piper, M.D., Medical Director Harrisburg, PA Phone: (717)782-5564 Fax,: (717)782-5958 H# : 200488036 Loc : HER Name: RISSER,ALISON H BD/Age: 08/10/1972 38Y Sex: F Acct: 120024125 Admit: 07/26/2011 Discharge: 07/29/2011 Phys. 1: EMERGENCY ROOM ASSOCIATES Phys. 3: TEST: UNITS: LO-HI: 07/26/11 R1430 TEST: UNITS: LO-HI: 07/26/11 81430 +++++.+++++++++++++++++++ Routine Chemistry ++++++++++*++*++++++++++++ Sodium Potassium Chloride C02 Anion Gap BUN Creatinine MMO'i,/L MMOL/L MMOL/L MMOL/L MG/DL MG/DL 137-147 3.3-5.1 97-108 20-30 6-18 0-20 0.6-1.3 ---------------------------------------------------------------------- 131 3.7 93 * 22.8 15.2 1 U.5 ========================= Routine Chemistry ======_=======___========= GFR Glucose Calcium Alk Phos ALT Total Bili Total Protein ML/MIN/1.73 SQM MG/DL MG/DL U/L U/L MG/DL GM/DL 74-118 8.9-10.3 30-136 24-65 0.4-2.0 6.1-7.9 ---------------------------------------------------------------------- 146.8 (a) (b) (c) (d) (e) (fl (gl (hl 85 8.7 * 42 59 0.8 6.7 --- FOOTNOTES --- (a) IF PATIENT IS BLACK/AFRICAN AMERICAN (b) MULTIPLY RESULT BY 1.21 (c) CHRONIC KIDNEY DISEASE <60 ML/MIN/1.73 SQ.M. (d) RENAL FAILURE <15 ML/MIN/1.73 SQ.M. (e) THE ESTIMATED GFR IS DESIGNED TO BE (f) USED AS AN ESTIMATE OF RENAL FUNCTION. (g) IT IS NOT TO BE USED TO ADJUST DOSAGE (h) OF MEDICATION. OP Medical Records Copy Final CONTINUED Page 1 of 5 RISSER, ALISON H-'Enc #120024125-OPT-HER-7/26/2011 Lab Results - 7/29/2011 - 1 pg 07/29/2011 Page 23:46 2 PinnacleHealth Hospitals James A. Piper, M.D., Medical Director Harrisburg, PA Phone: (717)782-5564 Fax: (717)782-5958 H# : 200488036 Loc : HER Name: RISSER- ALISON H BD/Age: 08/10/1972 38Y Sex: F Acct: 120024:125 Admit: 07/26/2011 Discharge: 07/29/2011 Phys. 1: EMERGENCY ROOM ASSOCIATES Phys. Routine Chemistry TEST: Albumin AST Alcohol UNITS: GM/D1; U/L %W/V LO-HI: 3.5-4.8 ----------- 0-40 ---------- 0 ----------- ---------------- ------------ ----------- 07/26/11 R1430 4.2 133 0.46 ++++++?+++ ++++++*++++++++.++** Hemogram +*+++++*+++***++++*+++++++++++ TEST: WBC RBC HGB HCT MCV MCH UNITS: K%UL M/UL G/DL % FL PG LO-HI: 3.9-9.5 ---------- 3.87-5.01 11.7-15 --------------------- .1 34.5-43.7 --------------- 82.5-96.8 ------------ 26.8-33.8 ------------ 07/26/11 P. 1430 2.97 * 3.69 12.9 35.4 95.9 35.0 RANL RANL RANL ADJ Hemogram TEST: MCHC PLT RDW MPV UNITS: G/DL K/UL a FL LO-HI: 31.5-36.7 ----------- 129-366 --------- 11.0-15.3 ------------ 6.5-12.2 --------------- ------------ ------------ 07/26/11 81430 36.4 147 13.1 9.1 RAN,'., RANL --- FOOTNOTES --- ADJ ADJUSTED FOR NUCLEATED RBC'S RANL ANALYSIS REPEATED (i) 1.2 % NRBC'S PER 100 WBC'S OR Medical Records Copy Final CONTINUED Page 2 of 5 RISSER, ALISON H-Enc #120024125-OPT-HER-7/26/2011 Lab Results - 7/29/2011 - 1 pg 07/29/2011 23:46 Page 3 PinnacleHealth Hospitals James A. Piper, M.D., Medical Director Harrisburg, PA Phone: (717)782-5564 Fax: (717)782-5958 H# : 200488036 Loc : HER Name: RISSER;ALISON H BD/Age: 08/10/1972 38Y Sex: F Acct: 120024/25 Admit: 07/26/2011 Discharge: 07/29/2011 Phys. 1: EMERGENCY ROOM ASSOCIATES Phys. 3: *********************** Manual Differential ************************* TEST: NEUT NEUT BAND BAND LYMPH LYMPH MONO MONOS EOS UNITS: $ % % % % % % % % LO-HI: 50-70 --------- 50-70 ------- 0-10 -------- 0-10 -------- 25-45 25-45 2-10 ----------------------- 2-10 ---------- 1-5 ----- 07/26/11 R1430 50.0 DD 3.0 DD 29.0 DD 13.0 DD 2.0 Manual Differential ====- TEST: EOS BASO BASOS NEUTROP LYMPH MONOS EOS ABSOLUT E ABSOLUTE ABSOLUTE ABSOLUTE UNITS: % % % % % % LO-HI: 1-5 --------- 0-1 ------- 0-1 -------- 1.8-7.4 -------- 0.6-3.9 0.0-0.1 ----------------------- 0.0-0.7 ---------- ----- 07/26/11 R1430 DD 3.0 * DD DD DD DD DD ========= ======= ======== Manual Differential TEST: BASOS ABSOLUTE UNITS: % LO-HI: 0.0-0.1 --------- ------- -------- -------- ----------------------- ---------- ----- 07/26/11 R1430 DD --- FOOTNOTES --- DD DUPLICATE DIFFERENTIAL OP Medical Records Copy Final CONTINUED Page 3 of 5 RISSER, ALISON H-Enc #120024125-OPT-HER-7/26/2011 Lab Results - 7/29/2011 - 1 pq 07/29/2011 Page 4 23:46 PinnacleHealth Hospitals James A. Piper, M.D., Medical Director Harrisburg, PA Phone: (717)782-5564 Far.: (717)782-5958 H# : 200486036 Loc : HER Name: RISSEP.;ALISON H BD/Age: 08/10/1972 38Y Sex: F Acct: 120024125 Admit: 07/26/2011 Discharge: 07/29/2011 Phys. 1: EMERGENCY ROOM ASSOCIATES Phys. 3: ***+*****+******** RBC, WBC and Platelet Morphology **************+*** TEST: R B C Morphology UNITS: LO-HI: ----------------------------------------------------------------------- 07/26/11 81430 (j ) (k) --- FOOTNOTES --- (j) ANISOCYTES +1 (k) POIKILOCYTES +1 (1) OVALOCYTES +1 OP Medical Records Copy Final CONTINUED Page 4 of 5 RISSER, ALISON H-Enc #120024125-OPT-HER-7/26/2011 Lab Results - 7/29/2011 - 1 pg 07/29/2011 Page 23:46 5 PinnacleHealth Hospitals James A. Piper, M.D., Medical Director Harrisburg, PA Phone: (717)782-5564 Fax: (717)782-5958 H# : 200488036 Loc : HER Name: RISSEP,ALISON H BD/Age: 08/10/1972 38Y Sex: F Acct: 120024125 Admit: 07/26/2011 Discharge: 07/29/2011 Phys. 1: EMERGENCY ROOM ASSOCIATES Phys. 3 ++++.++++++++++++++++++++ CANCELLED TESTS ++++++++++++++++++++++++++ 07/26/11 R1430 CANCELLED: AUTO DIFF REASON: MANUAL DIFF ORDERED 07/26/11 1400 CANCELLED: DRUG SCREEN ABUSE (URINE MEDICAL) REASON: NO SPECIMEN RECEIVED +++++++*+++++:**+++*++*+++++ OTHER TESTS ++++++++++++++++++++++++++++ 07/26/11 R1430 WBC DIFF NEUTROPHILS ABSOLUTE *1.57 LYMPHOCYTES ABSOLUTE 0.86 MONOCYTES ABSOLUTE *0.39 EOSiNOPHILS ABSOLUTE 0.06 BASOPHILS ABSOLUTE 0.09 NEUTROPHILS ABSOLUTE *1.57 LYMPHOCYTES ABSOLUTE 0.86 MONOCYTES ABSOLUTE *0.39 EOSINOPHILS ABSOLUTE 0.06 BASOPHILS ABSOLUTE 0.09 OP Medical Records Copy Final END OF REPORT (1.8-7.41 K/ul [0.6-3.91 K/ul (0.0-0.11 K/ul [0.0-0.71 K/1al (0.0-0.11 K/al Page 5 of 5 RISSER, ALISON H.-Enc #1120029125-OPT-HER-7/26/2011 Radiology Report - CT CERVICAL W/O CONTRAST 72125 - 7/26/2011 - 1 pg PINNACLEHEALTH System Radiology Imaging Report MR#: 200488036 SSN: 200488036 ADM: 000120024125 DOB: 08/10/1972 AGE: 38Y BED: HER- PTCLAS S: E HER NAME: RISSER, ALISON 1287 KUHN RD BOILING SPRINGS, PA 17007 ORD DR: HINDERMYER, KATHLEEN ORD#: 90010 ATT DR: EMERGENCY ROOM, ASSOCIATES PCP: CURTIN, PAUL REASON: mva, alt loc COMMENTS: ***Final Report*** HARRISBURG CT DEPARTMENT PROCEDURE: CTS - 4578 - CT CERVICAL W/O CONTRAST 72125 PROCEDURE DATE: Jul 26 2011 2:39PM ACCESSION#: 6824281 EXAM: Unenhanced CT of the cervical spine HISTORY: Pain after an MVA RESULT: Routine unenhanced axial images were obtained. Sagittal and coronal reformatted images were developed. Alignment: The alignment of the cervical spine is within normal limits. Vertebral Bodies: There is no evidence of loss of vertebral body height or definite fracture. Disc Spaces: There is no evidence of disc space narrowing. Visualized Soft Tissues: Unremarkable. Other: Limited cuts through the lung apices are unremarkable. The findings are confirmed on the sagittal and coronal reformatted images. IMPRESSION: 1. There is no evidence of malalignment or fracture. 2. Cervical spine CT is unremarkable. DICTATED: (07/26/2011 02:49PM) TRANS: (PSC/PS) ON: 07/26/2011 14:52 INTERPRETED AND REVIEWED BY: RICHARD P. MOSER, JR., M.D., FACR ELECTRONICALLY SIGNED: 07/26/2011 14:52 Radiation Exposure Information: This CT scan was performed using dose reduction protocols. Age / weight strategy and / or automatic tube current modulation was used for the purposes of limiting radiation exposure. The specific techniques and exposure value for the exam are recorded as part of the Scan Data Page in Pinnacle's PACS. In the event of any questions regarding this report, a Quantum Radiologist can be reached by phone at 932-8030. Study interpretation provided by Quantum Imaging & Therapeutic Associates. If you have received this document by facsimile, the information contained in this transmission is privileged and confidential. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution, or copy of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately at: 1-717-782-3240. Printed: July 26, 2011 2:55 PM Page 1 of 2 RISSER, ALISON H-Enc #120029125-OPT-HER-7/26/2011 Radiology Report - CT CERVICAL W10 CONTRAST 7 125 - 7/26/2011 - 1 pg PINNACLEHEALTH System Radiology Imaging Report MR#: 200488036 SSN: 200488036 ADM: 000120024125 DOB: 08/10/1972 AGE: 38Y BED: HER- PTCLASS: E HER NAME: RISSER, ALISON 1287 KUHN RD BOILING SPRINGS, PA 17007 ORD DR: HINDERMYER, KATHLEEN ORD#: 90010 ATT DR: EMERGENCY ROOM, ASSOCIATES PCP: CURTIN, PAUL REASON: mva, alt loc COMMENTS: Study interpretation provided by Quantum Imaging & Therapeutic Associates. If you have received this document by facsimile, the information contained in this transmission is privileged and confidential. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution, or copy of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately at: 1-717-782.3240. Printed: July 26, 2011 2:55 PM Page 2 of 2 RISSER, ALISON H--Enc #120029125-OPT-HER-7/26/2011 Radiology Report - CT BRAIN W/O CONTRAST 70950 - 7/26/2011 - 1 pg PINNACLEHEALTH System Radiology Imaging Report MR#: 200488036 NAME: RISSER, ALISON SSN: 200488036 1287 KUHN RD ADM: 000120024125 BOILING SPRINGS, PA 17007 DOB: 08/10/1972 AGE: 38Y ORD DR: HINDERMYER, KATHLEEN BED: HER- ORD#: 90010 PTCLASS: E HER ATT DR: EMERGENCY ROOM, ASSOCIATES PCP: CURTIN, PAUL REASON: mva, alt loc COMMENTS: ***Final Report*** HARRISBURG CT DEPARTMENT PROCEDURE:: CTS - 0450 - CT BRAIN W/O CONTRAST 70450 PROCEDURE: DATE: Jul 26 2011 2:39PM ACCESSION#: 6824280 EXAM: Unenhanced cranial CT HISTORY: Altered mental status after an MVA RESULT: Routine unenhanced images were obtained from the skull base to the vertex. Paranasal Sinuses: There is mild mucosal thickening in both maxillary sinuses. Otherwise, the visualized paranasal sinuses are clear. The mastoid air cells are well pneumatized and are bilaterally symmetric in appearance. Atherosclerotic Calcification: There is no evidence of atherosclerotic calcification at the base of the brain. Bone Windows: There is no evidence of fracture. Ventricles: The ventricles are within normal limits in size and configuration. Periventricular White Matter: There is no evidence of periventricular white matter hypoattenuation. Hemorrhage: There is no evidence of subdural, epidural, or intracerebral hematoma. Midline Shift: None. Other: There is no significant abnormality noted otherwise. IMPRESSION: 1. There is no acute intracranial hemorrhage or midline shift. 2. The unenhanced cranial CT is unremarkable. DICTATED: (07/26/2011 02:47PM) TRANS: (PSC/PS) ON: 07/26/2011 14:49 INTERPRETED AND REVIEWED BY: RICHARD P. MOSER, JR., M.D., FACR ELECTRONICALLY SIGNED: 07/26/2011 14:49 Radiation Exposure Information: Study interpretation provided by Quantum Imaging & Therapeutic Associates. If you have received this document by facsimile, the information contained in this transmission is privileged and confidential. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution, or copy of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately at: 1-717-782-3240. Printed. July 26, '2011 2:52 PM Page 1 of 2 RISSER, 139 ALISON H.-Enc #120024125-OPT-HER-7/26/2011 Radiology Report - CT BRAIN W/0 CONTRAST 70450 - 7/26/2011 - 1 PINNACLEHEALTH System Radiology Imaging Report MR#: 200488036 NAME: SSN: 200488036 ADM: 000120024125 DOB: 08/10/1972 AGE: 38Y ORD DR: BED: HER- ORD#: PTCLASS: E HER ATT DR: PCP: REASON: mva, alt loc COMMENTS: RISSER, ALISON 1287 KUHN RD BOILING SPRINGS, PA 17007 HINDERMYER, KATHLEEN 90010 EMERGENCY ROOM, ASSOCIATES CURTIN, PAUL This CT scan was performed using dose reduction protocols. Age / weight strategy and / or automatic tube current modulation was used for the purposes of limiting radiation exposure. The specific techniques and exposure value for the exam are recorded as part of the Scan Data Page in Pinnacle's PACS. In the event of any questions regarding this report, a Quantum Radiologist can be reached by phone at 932-8030. Study interpretation provided by Quantum Imaging & Therapeutic Associates. If you have received this document by facsimile, the information contained in this transmission is privileged and confidential. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution, or copy of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately at: 1-717-782-3240. Printed: July 26, 2011 2:52 PM Page 2 of 2 Dissinger & Dissinger William C. Dissinger, Esquire 400 South. State Road Marysville, PA 17053 (717) 957-3474 ALISON HOFF RISSER, Petitioner Vs. COMMONWEALTH OF PENNSYLVANIA, DEPARTMENT OF TRANSPORTATION, BUREAU OF DRIVER LICENSING, Respondent : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY, : PENNSYLVANIA CIVIL ACTION - LAW : NO. 11-7317 CIVIL TERM CERTIFICATE OF SERVICE The undersigned hereby certifies that on , 2012, I caused to be mailed by regular mail, postage prepaid, a copy of the Motion for Reconsideration, and all attachments, to: Philip M. Bricknell, Esquire Department of Transportation Office of Chief Counsel Vehicle and Traffic Law Division Riverfront Office Center 3=d Floor 1101 South Front Street Harrisburg, PA 17104-2516 Date: 2012 By: ' William C. D' s'nger, squ' e ID# 27737 400 South State Road Marysville, PA 17053 (717) 957-3474 ALISON HOFF RISSER, Petitioner V. COMMONWEALTH OF PENNSYLVANIA, DEPARTMENT OF TRANSPORTATION, BUREAU OF DRIVER LICENSING, Respondent IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2011 - 7317 CIVIL TERM ORDER OF COURT AND NOW, this 7TH day of MARCH, 2012, a Rule is issued upon Respondent to Show Cause why our order of December 9, 2011, should not be vacated and Petitioner's appeal sustained. Rule returnable twenty (20) days after service. -the Court,, r Edward E. Guido, J. I/William Dissinger, Esquire _ . .ry /Philip M. Bricknell, Esquire m? rnr Pa. Department of Transportation = ? u' > i inn :sld P -S , ??.C?ed 1'7/,? (3\1Y ALISON H. RISSER, IN THE COURT OF COMMON PLEAS Petitioner CUMBERLAND COUNTY, PENNSYLVANIA V. No. 11-7317 CIVIL TERM COMMONWEALTH OF PENNSYLVANIA, : CIVIL ACTION - LAW DEPARTMENT OF TRANSPORTATION, LICENSE SUSPENSION APPEAL BUREAU OF DRIVER LICENSING, Respondent ORDER AND NOW, this V - day of Yn "Op. 2012, the orde@d t11tiet De artment of Trans ortation's Motion to Quash is GRANTED and it is hereb , p p y Co Petitioner's Motion for Reconsideration is QUASHED. _U z r M :: U1 C)O 7" n Z -- BY THE COURT: p c7 J. Distribution: ?Philip M. Bricknell, Esq., Department of Transportation, Riverfront Office Center- 3rd Floor, 1101 South Front Street, Harrisburg, Pennsylvania 17104-2516 ?William C. Dissinger, Esq., Dissinger & Dissinger, 400 South State Road, Marysville, PA 17053 ?pl t'S AVi fed 319 f lj 4L,