HomeMy WebLinkAbout04-28-15 : IN THE COURT OF COMMON PLEAS OF
7� �e. : COMBERLAND COUNTY, PENNSYLVANIA
Bra�don Kuhn : ORPHAN'S COURT DIVISION
cv : CNILACTION—ADJUDICATIONOF
`o � � i— '��. ; INCOMPETENCY AND APPOINTMENT OF A
w � S `�� � : GUARDIAN OF THE YERSON AND A
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� '� E c . � � : GUARDIAN OF THF.F.STATE
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i;P�r'J'1'Fi�N OF ST�PHANIE KUHN LOGAN KUHN AND NICHOLAS FIORF.LLO
�s SUPI�RTING ADJUDICATION OF INCAPACITY AND APPOIN'CMENT OF A
GOARDIAN OF THE PERSON AND A GUARDIAN OF 7'HE ESTATE OF BRANDON
KUHN AN INCAPACITATED INDIVIDUAL,PURSUANT T020 PA.C.S. CH. 55
TO THE HONORABLG JUDGES OF SAID COURT:
Thc Petitioners, Stephanie Kuhn, residi�� at 1 R Sinclair Road, Mechanicsburg,
Pennsylvania, 17055; L,ogan Kuhn, residi�g at 18 Sinclair Road, Mechanicsbi�rg,Yc�nsylvania,
17055; and Nicholas Fiorello,residing at 9760 N W 58'h Court, Parkland, Tlo�ida 33076-1826
depose and say:
1. Stephanie Kuhn, Logan Kuhn, and Nicholas Fiorello are the namcd Petitioners in the
above titled civil eause of action and Drandon Kuhn (B �andon) is the allegedly
incapacitated person.
2. This petilion is instituted to aid and be�e£t B�andon.
3. Stepha�ie Kuhn is the mother of IIrandon, Logan Kuhn is the younger brother of
I3randon, and Nicholas Fiorello is [he firs[ cousin of Brandon.
4. All petitioners are over cighteen (18) yeazs of age. Logan Kuhn is twenry-one (2l)
ycars old and Nicholas Piorello is twrnty-three (23)years old.
5. This petition is to inform the Court as to the incapacity of Rrandon, to uppoint
i
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Stcphanie Kuhn as p�imary plenary guardian of the person and primary plenary
guardian of the estate �br Hrandon. ro uppoint Logan Kuhn as secondary plenary
guardian of the pers-on zod secondai}° plenary guardian of the cstxte lbr Bra�doa and
to appoint Nicholus Fiorcllo as tcniary plenary guardian o( the person and teniary
plenary guardian of the estatc for Brandon.
6. No othec guardian of the perso� of Brandon has been appointcd by any court.
7. Stephanie Kuhn has power of atrorney Ibr Brundon. There is no trust. special needs or
olherwise, benclitting Brandon.
8. l3randon Kuhn, born Deccmbcr 3. 1991. is twenty-two (22) ycars old, has nevcr bcen
mar�ied. and resides at home with his mother, Stephanic Kuhn, at 18 Sinclair Road,
Mechanicsburg, Pennsyivanin, U05�.
9. Brandun docs not heve any children
10. 6randon livcs wi[h his mother, Stephanic Kuhn, and thcrelo�c docs nol currenily
submit to any residcntial services or i�stitutiuns.
I l. The name and address otBrandon's care and s-en�ice provider is:
Keysto�e Autism Scrvices
134 Yinc S�rect
Harrisburg. PA 17101
12. �Chc namc and address of Hrandon`s pediatrician is:
Dc Mario Sangillo
IDC Nediatrics
3025 Technology Narkway. Suim 108
Mcchanicsburg, PA 17050
13. The name and eddreas of Brandods general piactitionec is:
Dr. Charles Lydeckcr L,owe
310 Lambs Gap Road
Mechanicsburg PA 17050
14. Brandon receives mental health and psychiatric treatment from:
Dr. Counney F. Baker
Holy Spirit Hospital
503 N 21" St.
Camp [Iill, PA 17011
Dr. Michael A. Fueyo
Philhaven Rehavioral Healthcare
1884 Rohrerstown Rd.
Lancaster, PA 17601
I5. Brandoo rcccives ncurologic trextment from:
Dr. Vivia� C. Fai�cloth
WeIlSpan Gettysburg Hospital
147 Gettys Street
Getrysbucg, PA 17325
16. Brandon's pediatrician, Dr. Sangillo, is i� agxccment with this petition. Dr. Sarigi0o
treated Brandon for eighteen years and is familiar with his condition. Dr. Snugillds
a�ticipated testimony will show that Brandon has bccn diagnosed with autism,
intelleetual disability, obsessive-wmpulsive disocder, cpilepsy, and brain trauma; thal
Brandon is unable to make decisions conceming his pe�soq pmperiy, fivances,
health. welfare, and safcry; and that Stephanie Kuhn is the best pe�son to serve as
Bra�dods guardian.
17. Brandods ncxt oC kin is his fathe�, Michael E. Kuhn, who resides at 515 E. Berlin
Rd., York Springs, Pc��sylvania. 17372. He is divorced from Stephanie Kuhn.
Michael E. Kuhn vecbally expressed his agreement with this petition to decermi�e
Brandon incapacitated, [o appoin[ Stephanie Kuhn as B�andods primary gua�dian of
the person and the estate, to appoi�t Logan Kuhn as secondary guardian of the person
and the estate, and to appoint Nicholas Fio�ello as tertiary guardian of the person and
the estate. However, Michael E. Kuhn has not signed a eonsent to appointment oCa
guardian. Michael E. Kuhn has been served with a copy of this petition as an
interested pany, should he wish to intervene o� challe�ge.
18. Guardians-hip of the person and of thc estate is being sought because Brando� suffcrs
from severe cognitive dysf�netion as a result of autism, intellectual disability,
obsessive-cotnpulsivc disorder, epilepsy, and brein trauma. His IQ is not testable but
is approximately below 70 points. He is u�able to communicare by t�aditional means.
Brandon is able to communicate to a limited degree using sign language, a wocd
board, o� an iPad. However, hc does not always understa�d the question and his
ability to respond is very inconsiste�t.
l9. 6randods wo�sening condition impaies his capaciry m make decisions. Beeause of
Bcandods mental and physical deficiencies, he is unable to make responsible
dccisions conceming his person, property, finences, hcalth, wclfare. and satety. He is
unable to communicate his needs, tend to his persoual hygiene, medieate himselt, and
provide for his personal safcty. Rrandon is not able to make medical decisio�s lhat
afCect his gencral health and well-being. Ile is unable to make lire-altering decisions,
such as conse�ting to necessary surgeries or othe� emergency procedures, because he
cannot fully comprehend thc cffects of his medical decisions.
20. Brandon receives a small amount of income primarily in the form of child support
and Supplemental Security Income (SSI), but he is unable to ma�age his personal
finances or makc Fnancial decisions.
2 L Rrandon receives child support in the amount of$325.00 pe[ month and SSI presently
in the amount of $234.00 per month. Brandon also works for Center for Industrial
T�aining (CI`f) as pnr� of a sheltered workshop for disabled persons and receives a
small amount of income usually ranging from $40A0 to $60.00 per month. Brandon
does not havc any savings. I-lis nct incomc from all sourccs totals approximatcly
$609.00 per mon[h o� $7,308.00 per year.
22. Poc the reasons listed above, Pctitioner alleges that Brandon Kuhn is a legally
incapacitnted person under 20 Pa.C.S.A. § 5501 as he is "an adult whose ability to
receice and evaluate information effectivcly and eommunicate decisions in any way,"
and "impaired to such a significant exte�t that he is partially oc totally unable to
manage his financial resourees or to meet essential �equirements for his physical
health and safety."
23. The Petitioners have made efforis to allow Brandon ro retain as much autonomy as
possible. Ilowevec, he continues to be dependent upon othe�s to assist him in his
personal care.
24. The namre of Stcphanie Kuhn's rclationship with Araodon is that of a mother and
caretaker. Stephanie Kuhn has been the sole provider of eaee for Brandon since 1999
and has primury physical custody of him.
25. Ma Kuhn has extensive knowledge in Brandon's idiosyncratic behaviors and his
prior behavioral iraining received at Johns Hopkins Ken�edy Kriegcr Ce�tec She
intimately understa�ds Brandon's needs and wants thcough years of caring fo� he�
son.
26. Allowing 13randon m slay in his own home �+�ith his mother as his guurdian is the least
restrictive mezms by which he can maintain some independence. [3ecame Brandon
requires i�tcnsive carc and supervision. either Ms. Kuhn or a ftdl-time care scrvice
would be best suited to provide for 13czndon's needs. Ms. Kuhn is immediately
rcady.. willing, and able to act as Brandon Kuhn's guardian.
27. All less restrictive altcrnativcs to thc appointment of a guardian of the person have
been eonsidemd. 'I'he Petitioners believe that such alcernutives witl be ineffective.
38. All Pctitioners are qualilied to be I3randon's guardian because they arc interested in
his wcltare and have no intcrest adverse to his. 'I�hc consems oi' the proposed
guardians of�he person are xttached to the petirion.
WI IF,RGCORE, Pctitioners respectfully roqucs� ihat this Couri adjudicatc Brandon Kuhn
an incepacitated person, assign to Petitioner Stepha�ic Kuhn primary powers of guardianship of
the person ; if Ms. Kuhn becomes unwilling, unable,or unavnilablc. assign to Petitioner L,ogan
Kuhn secondary powers of guardian ol�the person and the estate of I3randon Kuhn:and if both
Ms. Kuhn and Mc Kuhn bccomc umsilling, imablc. or unavailable, assign to Pctiiioncr Nicholas
1'iurcllo teitiary powcrs of guardianship o(the person and the estare of Brandon Kuhn.
Detc: �� •�`�� •�P�S _ . _
- [)cre-lr Smith
Certifed l,egal intem
l ll-�/rl � '�:iGb ,t.(f��t
Megam�iesmeycr %
Supercis'i�ig Attorncy
Thc Community Law Clinic
45 North Pilt Street
Cadislc. PA 17013
(717) 243-2968
V G,RIFICAl'ION
I vcrify that the statcments made in the forcgoing PETITION SUPPORTING
ADJODICATION OF 1NCAPACITY AND APYOINTMF.NT OF A GUARDIAN OF TIiE
PF.RSON AND A GUARDIAN O FTHE ESTATE azc true and correct, to the best of my
knowledge, i�formation and belief. I understand making x falsc statemcnt would subject me to
the penalties of 18 Pa.C.S. § 4904,relatiug to unsworn falsifications to authorities.
Datc: 7,-30 -I �'
e anie Kuhn
Petitio�cr
Date: � `�0� � "� ��� --
Loga� Kuhn
Yctitioner
Dale: I 10�,��� �C'����
Nicholas Fiorello
Petitioner
: IN TH� COURT OF COMMON PLEAS OF
[n re: : CUMBERLAND COLJNTY, PENNSYLVANIA
Brandon Kuhn : ORPHAN'S COURT DIVISION
: CIVILACTION—ADJUllICATIONOF
: INCOMPEI'Y:NCY AND APPOINTMF.NT OF A
: GUARDIAN OF THE PIiRSON ANU A
: GUARDIAN OF 7'li8 ESTATE
NO.
CONSENT OF INll1VIDUAL TO APPOINTMENT AS GUARlliAN
I, Stephanie Kuhn, hereby consent to my appointment as primary pleuary guardian of the
person and primary plcnary guardian of the estate of 6randon Kuhq an alleged incapacitated
persoq and certify that:
I. I am 18 years of age or older.
2. I reside at 18 Sinclair Road,Mechanicsburg, Pennsylvania, 17055.
3. My occupatiou is pe�sonal earegiver fo�the alleged ineapacitated person at issue.
4. ] speak, read, and write thc Bnglish language.
5. I am a citizen of thc United States.
6. I do not have any inte�est adverse to the alleged incnpacitated person.
7. I am not e fiduciary, o�an officcc o� employec of a corporate fiduciary, of nn estate in
which thc alleged incapacitated person has an intcrest, or a surety, or an officer or
employce of a corporate surety, of such a fiduciary.
8. I am the biological mother of the alleged incapacitated person.
l�ate: �� -�jU — �`-f ,^^k `^—J
l� Step anie Kuhn
Petitioner
: IN THE COUKT OF COMMON PLEAS OF
In rc: : CUMBERLAND COUNTY, PENNSYLVANIA
Brandon Kuhn : ORI'HAN'S COURT DiVISION
: CIVILAC�PION—ADSUDICATIONOF
: INCOMPE'TF.NCY AND APPOINTMENT OF A
: GUARDIAN OF 1'H� PERSON AND A
: GUARUTAN OF 7'HF. F.STATF.
NO.
CONSEN'f OF INDIVIDUAL TO APPOINTMENT AS GUARDIAN
I, Logan Kuhn, hc�cby consent m my appointment as sccondary plenary guacdian of the
person a�d secondary plenary guardian of the es[atc of Brandon Kuhn, an allcged incapacitated
person, and certify that:
]. L am 18 ycars of age o�older.
2. I reside at 18 Sinclair Road, Mechanicsbucg, Pennsylvania, 17055.
3. My oeeupation is college student.
4. I spcak, �ead, and write the English languagc.
5. 1 am a citizen oP the Unitcd States.
6. 1 do not have any intecest adverse to the alleged incapacitated person. �
7. 1 am not a fiduciary, or an officer or employee of a eorporate fidueiary,of an estate in
which the alleged incapacitated person has an interest, or a sueety, or an oftice�or
employce of a corporate surety, of such a fidueiary.
8. I am ihe biological brother of the alleged incapacitated person.
llatc: � q � �
Loga Kuhn
Yctitioner
NOTARIZED
COMMONWEALTH OF PENNSYI,VANIA .
COUNTY OF CUMBERLAND . SS.
On this, the �0� day ot /�(�e/✓Jhe� ,2014, before me, ^l .,linal , a
Notary Public of the Commonwealth of Pennsylvania, thc u�de�signed o ficer, personally
appeared Stcphanie Kahq known[o me(or satisfactocily proven) to be the person whose name is
subsc�ibed to the within Verificatioq and aeknowledge that she exeeu[ed the same for the
purposetherein contai�ed.
IN WITI�ESS WH�REOF, I have se[ my hand and notarial seal.
(scal) —
co�Mor+ws=�-� �F oer�Hsvw�nu [ary ublic
� vo:aria' sea��—�
�I i05_�,p1' P.. Slp3qo JL, hotdry f401k �i .
I .�, sc��-; r«o.. ��Tc�na�c cc����+ry My Commiss�on Expires: i � r �3�����'
My Cnmm�issdon Esqires Jen. 13, 101! � UdYC
...e.s. :;.�.s...,,,�.,,"_u _:r n„_.i_u
COMMON WftALTH OF PENNSYLVANIA .
COUNTY OF CUMBERI.AND . SS.
� 1�rM�iP/
On this, the �� day of � , 2014, before me, � / a���%C , a Notazy
Public of the Commo�wealth of Pennsylvania, the unde�signed 1Ticex, perso�ally appeared
Logan Kuhn, known to me (or satisfactorily proven)to be the person whose name is sabscribed
to the within V erification, and acknowledge that she exee�ted the same for the purpose therein
contained.
IN WITNESS WHEREOP', I have set my hand and notarial sea.l.
(seal) �
✓
coHnom,v�<�.1: oF ==nNsriv�a[� ary ublic
n ta a >a
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I }oseR 4 [ o r.. Noary >uEd, �4
c.i+,; � r �.,�5 ,�a�� �;�,�, My Commission Expires � a,.� /I 20��
�i Mr �mm ss o� E G�as en. 13, IO1B I 3SC
: IN THE COURT OF COMMON PLEAS OF
In re: : CUMBERLAND COUNTY, PENNSYLVANIA
BrandonKuhn : ORPHAN'SCOURTDIVISION
: CIVILACTION —ADJUllICATIONOF
: INCOMPETENCY AND APYOINTMLNT OF A
: GUARDIAN OF 'fHE PERSON AND A
: GUARDIAN Of THE ES"PA"1'E
NO.
CONSENT OF INDIVIDUAL TO APPOINTMENT AS GUARDIAN
I,Nicholas Fiorello, hereby wnsc�t to my appointment as teriiary plenazy guardian of the
person and tertiary plenary guardian of the estate of Brandon Kuhn, an alleged incapacitated
persoq and certify [hat
1. i am I 8 years oC age or olde�.
2. I reside at 9760 NW �8`�' Coun, Pazkland, Flocida 33076.
3. I recentty gcaduated with a degree in environme�tal engincering and am i� the
process of seeking employmcnt.
4. I speak, ccad, and write the English language.
5. [am a citizen of thc United States.
6. 1 do not have any interes[ adverse to [hc ulleged incapacitated person.
7. I am not a fiducia�y, or an officer or employee of a corporate fiduciary, of an estate in
which the alleged incapacitated person has an interest, or a surety, or an office�o�
employee oC a corporate surety, of such a fiduciary.
8. I am the first cousin of the alleged incapacitated person.
Uate: � I o� I�J /�r`- !�
Nicholas Fiorello�
Petitionec
S'CATE OC FLORIDA .
COUNTY OF BROWARD . SS.
On this, the 11�day of �Cd.17 ,201�before me,�l� ✓,p,�R �J�� a Notary
Public of fl�C ���y, _ 4t�� � - �a�a,-[he undersigned officer, personalty appeared
Nicholas Fiore`��ofl��k, no�n��o me or satisfactocily proven) to be the person whose name is
subscribed to the within Verificatioq and acknowledge that she executed the same for the
purpose therein contained.
IN WI"11�ESS WHh;REOF, I have set my hand and notarial seal.
(seul) ---�--
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�"��„-;, sweeTa eieeu Notary Public
Nolary�uGli[�Sla�¢o�FloriOa
; MY Lomm.E*piies Au9 24.P015
�,�,� �ommisson k EE �2483] My Commission 6xpires: � la- �'{"J�.S
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Intalce Asaesament 7 Eligibllity$eport
Ideatifyiag Informatioa:
Name::EC�anKvltta
DnMe of Sirth: 12/U3/1�991
Date of Inierview: 1713l2012
Age:21
Geeder:Mele
Rece: Ceuegsien
.48d[ea9: 1$Siac�air Rofld �
Mecl�mucsbivg,Pa 77035
��� County: Cumbeflsnd �
�� Goaidian/Power of Attomey: Stephaaie RUhtt,-his mottier,liaspowei or attomey aud is laoking
ta getlegelguardisnship
Community Syartems: Attends C�m,ibedanfl Velley Hz$h Schoal,wrnks 2 days a week at CTT,
� � used w 6eve CommuniEy Services GrovP's BHR5 sernices,un[il he aged out of the program.
5onrcee ofIriformsKan:
STB-R
Psttntal Saess Scale
Quality of[rie Assessmmt
PsychosociaLlnterview
Treatment Pleu ixom CSd
kEP from C`ntnirerland Valley Schonl Diy¢ict
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b3/04/2015 13:03 7172201727 KEVSTONE AUTISM SER PAGE BS/39
I�.,,$�EfieYhg:
BSeadop?s family reporis his Stteagths are that h�s a loving persoa to those he�is close to,he can lie
� � die big liiottiei to lii9 tw0 yrovt6et bmthets whm he needs to be,end is helpfiil m!u5 famity.TLe3'als°
rep4+rthe�follnws ditectlons wtlt ead has avery Boofl�6em°rY.$esmdaa's mother slso added�t she
thinks be isa good ar6st;he is self-suffiaent witlt some�oaanin8,and tekihS his'medicalions.Fie is land
andgoad wifh the fmnily pca.as well.She states bis pe[saveTeace�is a shen6th berau9e Coen tkoaBh 6e
cannot spaefi pe coutint�en to hS'artd does aoY Bn'e�up.The interviewei observed BtendoU fol[ow his
aktttnoe¢�io�ina He was indapendent'nm choesiaB thiil�gs he wanted Ko do dming hie breaks.
p,cceidiagw the$ffi•Et,Beandou's s4engtlss�are his mo�Wr skitls�bodi fime md goss;�
�:Bra¢don has]imited to vc�'limited sklls ia Urisacea.
�r-�
'Btstidott's femily feds the m'eas of concetn for Hrsndon s1�en acxass fhe baerd.Heis ia1 need of
help veidh Ids�speecla and his mefi�odCs)of cowtunication iio others.Bzandoe's fkm7Y note�ottier Yhan.
school md CIt;Brandon d6�s tmf see attY�e�x��u'p�ly�lii n eucist siti�ation.Brandon has
uevte been invited to a pazty or after school activity typlcal of s�eone:his-age.Ii'is femily would like to
see 1Pis�cwek�and.independent livinB sldll aontinue to be devtloped wi"th speeific sitention dixected to
handlinB moety md commtmitY.safety.
Acco:diz�g'ta the SIB-R Bmndort's ateas o#needs Suclude socialRomtnupic�on�
��°°mmuoity living��,.�d Petsonal living��
HisSTB•Rsupportscatewas seHectiveotneediagfteqtteets �
�� behoviaes.inthe
�... Du'Yingtfle SIR-R essessment the folkowinB item's aeze notated as sbal.le�Ygin&
category. of destrucfion M pmperty ik was despibed..as hitling nut of 5v;a'ahan,Tn the cateEmS�
dismptioe behavior We fam?IY identified'mteemptin&3'ellin�g and scteamm8�and lavglting�widwvt ie8sou
as behaviors.7n ihe section of umisnal or xcpetitive bei�aviors 9re fam!1Y notated be ivvUs lile sldn for�
sensorY 3Cm+ffa'ti.ou ersd he has nervous tics tl�at he emgeges ia. Foz socially ofknsive behavior k wes
!de¢tified thst 8randoaetruBB�es wiih peesenal apace and his pmximitY to People with whom�his�is
�&mB�@or is mnund. Btandoa vrill sometimes show little intaest ot cmacenhatiouon a task and
someumes also disp]aYs�aetY bY meaus of xe£usinB m Bo Placas with tiis family Hia fadulY noted tirty
saw the liehavior ofte£Vsals m go placav�es�ihc tneret concem�n6•
F�Brnndoa cuereutly lives at home�witlt his mdtliet�Stephanie Kulm,snd YaunB��ther,.Dylan
Kvhn.gcandoa Les anoflcayotut�bmtLet who is i¢cokege mid only home far holidays ahdbreaka
Bs�tlden h�ao current celadMsship or contect witli 3vs bialogical fatba.Mom hss a friedd th�is ova
� fie�itcntlY>Terri Taylor-.Mrs.Kuhv hes tecentl9 been diaBoosed es Lav3ng dep+esaion md m�a as�well�
as t�d1U.Btandaa's youagest bmthtt hes elw Ueen diagnosed with depreysi�.Paremal hisiory is
� udcnmvn and was aoY discloseA at the time of t8e i�ervibw.
$d.rmtinn&L�'mrtloVIDeA.t:
Biandnn has l�een a pazt of'tLe Cumbeilead Valley Sch�ool DisEriet for lds.eattre schoot rateec.
�i� `, M�.IGuffi tcpo�fs B�euddan.teally fell behind the othet students�academi�aLly ia 5fllt�'ade.Sht stgted
`-'' wlule'hz.wu sacial,�1�ad sume etten6mi Pi°blems,In 20Q5 he wss sentw Kem�edy TCriega and'm 2003
hb was sent to Suutk VJood.At the time of the iarerview irtam said dlero wtte no papers io disasss 1ris
03/B4/2015 13:03 7P22b7�27 KEYSTONE AUTISM,SER PAGE 66/38
I �
_.., sWys them. Both pincemenCs,<ach of which las[ed over six mdnths,aze believed ta�5flve odcurred d¢e ro
� ��behavieral concmis..
.- H�mdon is chrtendy in the higlt schoal Iife skills progam tbmu�t6e�Cwnberland VaJley Sehool
�atrict. Mts.ICuha.stated he ased to 6e ia ibe Avtism SupporG room butthat he no loagei aeeQed those
snpports azrd aaspvt iMo his cutrent progem. She statcs naav''ff somtoae i�iitiahs i.he�.socielaetivity�he
wiA en&a�e bubeven still the engegemwt miFhtbe Iibrited.8ehavioxallY,.M�s.Y,uYw rePorts-inbi.gh
seiwol he is maa'e eompliant aad thete are not a lot of issurs Nt school or thc CIT pmg[am.She did
mention tiowevec thet he still ststg�lrs wS[17 petsunal sPa�e�sua.a°a geltwg t�°f doimg t6ings or not
waxitiag to do tliings in�hooL Btmmdon will giaduste this hme and reCeive lris certificste of attendance
5rom tb.e sdtool distriM,
Biandon hes no current e�ploqmeM 2rtstoty es he is anly morking tLrnugh CTT 2 duys e week w3th
ttie schobl Life Sldlls progcam.IvJrs.Kuhn stated she was goingto woxk on setting up a cese tLraugh
6VR
�CtimmuniYw_
Mzs,Rvtin sta[q fot right new she is satisfied ok,with the living azrengemenYs�'or Bcandan. S7ie
mentirnrs tliai it is JifFicolt to do things sometimes becevse slte csnaot.leave ldm aloae withont
s¢pervision and relis+on her Respite Worlcees or soa to watcfi him.fiequentlY.B�atidan is c�me�tly�t
involved in any commimiiy activ[Gits orclubs bovxver mem stetefl thet he enjoys boarling,sv+immi[t&
eutside activitias and eaimals•For}us feis¢e time et bome�,Bxandott completes ptiales,plays on tb.e
cof�puiet,doCs his artwofk,wetcAes videos on YauTube,or watches TV.
Brandun does nM.wUmteer enywhere,hawever fii.e mothet brlieves that if ffie right place was
foued he amuld enjoy it.Bmnden aHeads ehurch almost every Sunday vfiYh his family�d dves.well there.
�, .� PcecRelatiov.sk�P:
Bcendon does not initiate or mainta'vi any sacialrelaYionships.Ei'is famiiy notes tfiet this is a goal
they have.for ldm.Standon's only socisl intefections ieclude his fe[tuly end l�is steff,either aehool or
BH25(TSSYBSCJ.
prup 9nd AlcoSol:.
Mts.Kuhn.smtes thaz tbere is�no tistory of dntgs m�a[colwl a6asa with Brand'on ar wzthin her
femily.She cusenfl.y does aot see this asa prohlem.
MedicaYDewelenmmf6l:
DevelopmMattl:
B�andon was bom eazly at 37 weelcs gestatioa.FGs metl�swtas there we�?¢o�camplisations
durieg ptegnnncy.LDiaing Eae 18 hwYlabor Br�doa failed to pzo$�ess.and the doctor usedfocceps to help
lum.. Dutitkg the.aeon8tai cotuse Brandon wes wlioky.had jaund'ice;,end was hospiteli�far asthma
eitecks,ev6admlly usiag nebuliztt teatm�ts:
Forhis developmetAaL mi7estoaes,Bsandon setained all motoc mil.estones ea vme.Foz his leuguage
skiqs they were eIlarnmel until he wss abotd 11 monr6s nl3 Brnndon wei the bed vav7 he was 8 or 10
years ald aud hed conlcol of�is bowels at 5 peers old.Brsndan met all thenoimal mi�estones for self-help
incLud'mg sa6flg etYd dttessiug.Biandan's mothei estimates ffiat he�has gc+od eogniti've.abilide5 but ceq,��*Pc
more repetitidas t�n sbmeoiher people for bim w Seera Chings.
r. �
`'-, Medicel:.
03/04/2015 13:83 7P2201�27 KEYSTONE AUTISM SER PAGE 07/38
When Bra�xlon was.fast bom he was b.v5pitsli�ed for asthma etmcks re�ui.riag aebuli�g
r .�}rpg}meMs. 9Thcn he was approximately 13 moztths�old lie had a seizucc that lest for a tatal of 96 tnlnut?s.
�� � As a result sevexal seotions of Isis btain wete tln�Ylaged.He wes�eoentually dsagtos�sed with an Jntetleetual
Disebility;ho++!avc bfis.Ku4m does.aot remember the exact timinS cf flaat In 199�4 he was slso
diaghosised withAulislit IJisurder. Btandoa is cunently on Kepptx two times e day for seizure cmitrat,.
Lvretadine one time pcc dsy for allergies,Gonazepm Uuee times a daY for h's atixietY.Sirattera one time
a day�of atte¢dvenecs,snd Trazadonevne tinte per day for steep.Mrs. Kuhn.states that curtently$tandoa
is in good health
Hxsndoh sleeps through tNe n'tg�xt with�the help�ofthe TYazadone.Mrs. Kuhn stat�tt�lus appctife
is good he is just pichy aboni what he eats.Brendon does.not cia�te�ly participate in any exetoii9e athet
thaa whxt he rcceives st sehbol tluougti 4he modified Phqsical Fducation Progrsm.2vtrs.Ku4w meaf'aoned
at his last docrof s:appoimmettt his cholesteml was high end they wovld li1:e to try and get thaz down but
he was htlt glaeed�on any medicffions�at that time.
kstrrLoseciil3nforntatioa:
Bretadop is cuaently single and livjng with his f�1y.While fGs mother idmtified drat he was
hospitalized fm'sigeificent IengtLs of time in 2005 e¢d 20D7,she coald pot give any Paperwork for those
limes iitiring the interview.The interviewer ilid contact liis school district frn copics o�his eval�tibn
repvct,whwi he was fustdP'P^^+^Pd fo need epecial educatdan as weA as e copy of Ri�most recent review
of t3�ie�xeport,howevet hes not bu¢contacted baelc withenY iufiotmation.
Btsndon cvtrentlq only sees his�primazy cate phSski�,hi$denh'8���''d psychie'h�isL AA mher
services iucluding amployment auppoR and speech ate delivaed tluough the school dist[iet
Itwas reported tUat Brandon 6ss a hismry of elopement behaviots,hoa'evtt mam lias
( . ..� slated thstY]�s behavio�ih tbe hose has not heen seea lattly,end thst the only time it Lappens for her
�.. wifliiti flae cby,�nwnity ia if Ite has¢a go to the bathmnm..
Htatidan'S symptoms oPAutistic Diso�der ere�quite appetent erid'mclude impaitrueatS�-in
cotmmunication.as 6e is non•vuhal aad does nat elweys vse the.assistive devieas.ar sigi]aa���e to
atuwa ar respand ro saother petsoa Stendoa's sacial tesipzocity is impain3 as well as his wdetstaedittg
of sociial and physical pttilcimities to othet peaple.Bxendon's engages in stereotqpScal md sensory�seeking
6etaviars�stich ss rockiag,h�ming, as well as tovchia�objxts wlv7e he is walking.etound.
Trangla H'.stary;
gianduawas wimess to dochrsdevialence whw he was 1�years dd,fiis matherstated thatihare
was a situation witt+his 6iological fathet that msuked in�Lim%riaelauQ ba.Braedba as well as]usqbueger
brot6er wimessed the incideat.Brendon hes auffered the traumetic]oss oPltic fa�er who 6as cut ties with
his previous fzmily aftc[the divace u vrell as his maumal gteat grrmdum[ber mid�rendmotlre[.Mis.
Kuhn also befieoes tbat the loss efthe femily dog, 6unly,tias affected Staedon.The dag used io sleop at
9iandun°s feet sad it took a while forBtendon to�sroop�looking for the dogat night.
Btandoa has sti�'eced no ather trauma aa;ording�tw his mothe�r draing the intet¢iewprocess.
LeEul:
'I'heie ax eurreetly�no legal issues or conceros regardiqg Bran6on at rthe time of this inierview.
Servitx EGstorv:
T7tk'ovgh the schuo]disltict Brandoa has teceived OT a�[PT services in fhe pesL Hais cvr�endy
� �.� still-rer.ei.ting speech tlie�aPY t}am�gki Uiem as we11.In hie achool IEP he is getting vwatioml keiriing at
` CTT lsvo days a wtek.Fiia tpothex wbuld like m see that chmige ro five daYs a sveek when hc gtaduates in
Suae.Brandoawas ceceiving TSS mid BSC services up untiL his twernq-&isi birtbd8y. His mother also
03/B4/2815 13:03 7ll22B7�27 KEVSTONE A�TISM SER PAGE 9H/38
I (
u���p��C p�orkcrs{pr when there are tivngs sIu needs to do or�accomplish and there is no one
�� 'home to w�h&endoa.
I°�i�: �el fa fbe wr�tber.
For all Une mterview sessioos Htandod appeazed clean snd'dse@sed aPProPn Y
Hrandun's moad was eam thniughout Slt.the swsions.Htendon wcrte��Br�����°^d�
m ieq�rests�fram�his mottier detttonsttating Lis�heaxin8 and IislenSA6
bummi�pod tUckitiB('Isuughaui t�e entire�session each timc and wotild perin�ticelly rub�las fiagers
togethet.B7mtlon used�mostlY si�d�n'ieg the iiReiviewb Mtt did auempt ta say aHello"and^6ondq Bye„
P^^h.time the in�xviewer left.BTandnn did a puzzle and wetched TV d�iiing e9ch intetviz°v se�sion.At
one point the�vmteiv5eaxi get ort the'flaar with Hiaadott m ettemPt asaci�l interaaion While Braadan
would take dmoffeted purzle pieee when�oHe�ed,hut did nat mgage with the i�ervi�`��+'�g n"kpB
was czlled ax he was aalced e quesfion d�aing r3sie'urte�aMion.
Smnmarv aud Recam��etion
Bmndo¢'s symptoms of etutistic D'�sotder ere Quiu�aPParedt a°d iuclnde impeirmeirts in
ctlmmVn�cation es he im naa�vex17e1 an&doesaoi al'MaYS use 4ie assistive devices ot sig[leaguegt to
ansaer m respond to another pCson.Biiandon'§eocial i+zci.yrocity is anp�ed as.well asfiis undefstmtdinB
of socisl�dpLysicW pi-mrimities to other peaple.Brnndan's��es in stereotypical and sensary seek�nB
behaviozs such as iotkv�8,b�tmm�nS�as we�°$touching ob,jeetswiule he is wa�kin6 erouud•
Bzaadan's�eiees�for supp�rt indude all of the above as v.ell as��dependent Gviag skills and commnniry
saCery slfills.
Ihuiag the SIB-R essessmetitthe following items were notated as challanginS�bchavi.ms.In the
{ � .caeegory of r]estrtiction to propert]'it was�desmbed as hit�B°�of frustcffiian. In the�cazegory of
�-� �dimtpuvp behavior ffie family identified interruptinE,Y��S�g��Ilgs����°°g��out reason
ea I�nbsviots.tn the section of unvsual or ropetifivs behaviors the family nutatid lhat he mbA his sldn fbr
srnstlYy stimtfletion end th8t hie has aoivotYs tics t�E0.'he enBs$os in. For sociallyvflensive behavier it wac
iden"etted ftiat Bkandon sttuggles with pe'sonal space and b%s proximify to patlple with whom his is
eagsBng os is etonnd. BranBon will somatoves.show little intetest or cancetdcationon a rask:nnd
someGmes��also displaya�ery by means of reiusingto gu placeswith kus fmnily 'nis famify narated that
ihey saw the behavioc of ret�sals to go places as the mast conea^^;n .
Aespect�fittty submideQt
f
�
.�aiT� ��
Sama�fl:ia,C.Hiacfioy
ACAP Behaviaral A eaaGst
Revtewed and�apgroved by:
c-'�"'""'>'.�.-�,--�.
nmw,�M.xdrm��Ms
! . Licensed Psychologi�
l�.-' GlimcalD'u�ectorACAP
B3/04/2015 13:03 7ll22Bll27 KEVSTONE AUTISM SER PAGE B9/39
��
Primnry DemygraprykF
FintNome: KUFiN,BR,INDONM
RegiSbGion CmMlylJoindcc CumbarlonNPerry
bam OFBiNc 12N711991
Gender: hUlc
CovnryOfResidencr. CnmlqdMd
R1oTc'PhD�C.
Work Phoirc:
MobilePhane: ]V59996G0
Othel Phone�
�.ConFldential: No
ConfiAm[inl Ocbila:
Sutu�: Ac[iw
RcasonSrmus: NcwReFerzal
Atltlren
Adtlrcas Typc: RcsidcnlielllVfaiGng
AdErcse Lincl: I9 SMCLAI0.ROAD
Addrets Linc7:
Rdtlrcss Linc3�.
City: MGCHANICSBURG
$MR: PmnsYlwnia
ZN I]O55
Gmail:
Additianal Nnt4:
rrrRe�od�R��o,,m�, oaasrzooa
Gff¢tivc[ntl Daa;
AllernatclD
iticntifierTypr. IdenHder: Elfee6ye8cpinOa�e: ERmHveEod6vk:
DS!] 2110D10480 IVBI/f995
M� 31�1161160 12l03/1991
MCI 3'l012bIi6 OL77R004
MeEkeid
03/64/2815 13:83 7P22BP27 KEYSTONE AUTISM sER PAGE 1B/38
MedicniG(MAJNtmibvr. GA"�'�w'AY
1'rovider: GA'�WAY
ProadCtTypc;
ProvidcrPaFcyNumbm 3I06507i
Avirmnuwosp�w�dA'mepplyin6tor N
MA7:
MNicnid Gli�ibility[RechveHegin Dace: IL03/1991
MWiraidLiiyitiility H(fxiiv!HnG Date:
�
Plan Hegin Oute: 1/12019
Plnn Gnd Dalc:
ri�n s�am.� nnn�wcd
VIa�CazC([ury' [rificalRcvieion
PIa�IsatUpdvadDnk� 9292UI4
Likc&Admhe
W Iw[du��eo Ic likc aed Mmis rl�ev[the mdiviAoal7
Bmnden's faiviLy m.DoeR his urcngihe rm thnt Ix is a loving penan ro thom M1<ie clax to,he eM 6c Ihc biR brotherw dis
iwo youngcr bmthcrswhrn hc nmb 4 M1c,and�s hclpfiA N h'n hmily.Frendnn'v hmtlrcr mpnmKl thvl 8nndon lovd him
anwminiomelty. Thcy¢leo rc{wrt hc Pollw.s dimction.wcll unJ h�s e very goaa memory_Hnntlon'e motlxr alao atldcl Na�
eLe tAink<hc is n good nrtlet,hc i5 eclT-m�etent wi�h wme graoming nndmkia6 hrs m�cn[ions.He is 6ind wd go0d wilh
die t§mily pen as wcll.She steta�ie persevennce ia a stten6�h��eaasc cven Mwgli hc caimot spcnk hc wvNmm W ay and
doev nm give vp.The inMrvitlwce obamicd 6m�don Pollow hiz aRemoon routina lie was intlepe�Ment in ehooeing things he
wnnMd lo do during hie bReks.
C�1'swR smtpi Bnndon's errcnglhs arc his apubiliry of tleing goM woik,cicmn nnd nwt clothirtg end hygiene,and
nttendoncc.
Know&➢o
Wlmt tlocv�he cenevmerKnmily fiink mmcone nutlx fo Imow m provitle sippon9
Fhnndan mrtently IivcE et homc wi�h his mothcc S¢phsnic Ruhq end ymi�a�bro�1+n,Dql¢n Kvlm.BreMOn Mot tnothn
ye�mgerbmEhnximixincollcgcaa�onlyhemeferlwliduysan�bmnke. Hmn�onM1asneeurtenlmintieneMipareonNel
wRh Ms bialoFiu�l Gtlmr.
Brnntlon srndueved Rom Llnnberlena Vvlley Nigfi Sehool in luee 201],ond is cumemly nttrnding CTf Mondvy,Wednuduy,
end indny.
6randon usa nn iPad nnd siym langvage ro eommaniea�e,nnd is vMmpiing ro vu more reebal langnnge�hraugh speeeh end
mvsi<thenpy. He wn say hello,a�d attemph oEmr amds.
Rrnm�on b�'es praim antl hsving hie scheAuleplwmed out so hc Fsows wMtto expcU.
P�ge 1 of 2i
03/04/2015 13:03 7172201�27 KEYSTONE AUTISM sER PAGE 11139
� �
Dc�rtN Aetiritin
WMt prc the eciivitiea J�a�ihc IntliWdual would like m pMiciraCc in ar czpioce7
Ae mpOrtM by ilis motheq Bnndon rnjoys bowlin6•��mminy�,being mttdaocs,purtin$pti�i¢s logetFeq Wemhing VoqTube
M1GDienGymoties,�end peinting.
Brondon'.mnN�saye she would bkc Bren���o mnke Crirntls[hav hc cfln spe�M lime wiN.
�rartdan'v mnthCr rtmuW also likc w Fegin looking into housing q�tjone fm B2ndon.
BrMBon wnmUy voluNecra nt New Hope Minivhia end Pcico,and atumtlR GTRA,music therapy,oceupntia�d tM1er�py,
.ndnpe¢hlherryq. HrvntbnaboisnGendingo6-weckenclu avdGxmekbowli�g�gr�mbothchmughtlie6nsterSmis, �
uiA btnRmporb hc scemm W nally cnj%ba�h ecVvitics.
Imporhnt Ta
impmm�ttolndlNduvl Pdodty
pc�mgmHnMon4mnth=r,y¢�cory SnoaglyDc�imd
br aks.atlendi�CR,nrt,wnkhins
v�depy,uid Wia time.
AaoNitlgro�nndoa'smothcr,Feving Pssenlinl
hie i4m1,n�hucmrod echednlc,and
pamPtin6.
WM1at Meke 9enec
WlmaePer�eHlve NM1niM�ke�3enee Wh��Doc:NotMukeSen�e
BmndO��'.cmOtM[ ForBmndonialaeephiswM1edWp Fm6nndonto6cdnncethomearin
eu�+idingClT, AorBmnMnmcomlimc.IM1ewmm�mitytl�erom4fyconccrns.
�e live a�home m�til nPProPruR Aousing.
isfountl_
MMicarinnf/Snpplemenh
DiageoRis N!A
MedirntioNSnpplemcvlNome Clanezepem
�Ja3AgC �mg
Frequcncy T10
ftoutt gy Mou1M1
Bieetl WarkRequirod xo
IFYcs,Aow FryucntlyT
�oeatbePeraonSeltMedica�e7 Yes
NxmcOftlmVfbettiithingpoctoe ViNanFSiRla�h
Page 9 ot Y]
03/04/2015 13: 03 7P2201727 KEVSTONE AUTISM SER PAGE 12/38
SFecielinemactionslPrtcantio�u BmmGonamzinitiallypeexribodCimmmpamforewitchingandpoamringni
hix fece,M1ul his mm6cr eptes now It is for anxiety.
Bmndon'ematherpu6shismedia[ionainaweeklyptlld'rvidc[. Brn�Con
ihen tnkec his mcdiwfiam independenfly aLcn hie mofhmpomts et 17m box.
biagnwsis ADFiD
Mediwlion75u{rylanenlName $cfehC�a
DosnSe k0 mg
Fmqurn=y Q�
Roum By Movth
BlmdWurkRcqUiecd No
IFYcs,NowF�uenHy7
DoceiheP�npnSelfMedicnh? Yev
NnneofthePCe.aCribiegDocmc SiivcrCreekFxmilyPreetia
Speci6llnsinmtions/i'oecemions Bmndmismo[herpacluhiRmedicati0nsinaweeklypilltlivider. Bmndon
thcn mkcn his mMiarions intlependrnUy wtrcn h'u morha poinu nt fhe box.
D�epnmis N!A
MulirallonBuryplancnlNeme Tvaatlanc
Dosngc 100 mg
Frcqurncy HS
Renh Sy Mwth
RleodWo�IcAeqnired Na
t(YG,Haw FmqurnOy?
OvcstlmPcrxrmSclfMcdiuim? Ycs
NumeofthePrescribinpWemr: HotySpintBehaofomlHealtB
Specinllnx�vuctianRNreenntions 9rendtmi<p���dTrnxnOonefhrslecP Btxndon'smotfierpeeiuhia
mmAir�anony in n wccklypill tlivi6ec RnnEon thCn takn hie mcEicefinro
itldepetl�en�ly whon his molher poinu¢nhe bo�.
Diegnosis N/A
MeAicoiinNSupplcmemNomc Fhrvoxmninc
Dosagc 100 mg-r 200 mg
F'vcqurnry B1�
Rn�itc �y MaueF
Blood Wak Raqui[eA No
IFYcs,Hi�w Frav�ucntiy"
�acsihePcrsonSc�fMa�icnh7 Yq
Nnmc oftbc Prcecrihing Oiicton HOIy Spirit Bchrvia[fll Hee�ch
Page 4 vt Zf
B3/B9/2015 13:83 7172201?47 KEVSTONE AIJTISM �FR PAGE 13/38
I I
SpttialIIuuvetioeuli'recavtionz HmeabniepmcnbwlFluvosxmine(oronxiety. 9rendontakeel00mgin
ihemomingnnd29omgindiccvenir�g. Hrentlon'smatherp¢ckshis
mcdkuionsinuweel:lypilldi.idec BranEonthcnmkeshumeAitttions
iMcpcnAcntly whee hic moNcr palnLt ut�Mc ypn,
Diagnosic Anfl�
McdlntioMSup➢Icmm�Nomc Addenn
�oevgc I(1 mg
Frcqurncy QO
Rome By Mauth
81brclWprkR�vinE Na
If Bm,Haw Frryuen[ly?
Dxs[M1aPersonSeVMedicex7 Yn
NemeofMcPwcribingDxlor: Hn�ySpi^tBehavionlPcaltp
SOttial tnsm¢tions/1'¢wutions Hrandon'P motherpaoks hie mep�caliona in naecktypill tlivider. �irm0an
Nen pkw his medicatio�a inticpendently w�m hie matha poinE el the 6ax.
Riaenwie Alkrgia
MedicetiaVSupplemrntName LoramEine
Dmrtgc I p mg
Frequency QD
Roulc By Mputh
blootl Wmlc RrquireA No
tf Yce.HOw PrcqucnHy!
OocstlxPcrsonSClfMcJiutc.^ Yv
NameotthePrcneribingDocroc $ilvttCmekFomilyPmctice
SpeciallnftruclionslPrccautinnq BnndonPmotlmtpaikshiamedicnfiomineweeklypilidivider. Brondon
[hen�akes hie mNieaionn in�epenArntty whrn his motha'prnms at[hc hoz.
Oirgnosis Scizmca
Mediurti�nlgnDPlemrntName Kep�n
Dosngc 2000 mg
F[N��cmcy HID
RonR By Mouth
AloodwarkRcqnircA Na
IfYce,HowFrtpven[Iyn
IkcstlmPcrtsanSclFMcdicn�c7 Vcs
NamcofNePmseribingppcioc HolySyiritBehaviornlHcailh
5pwiallnstmetiort/Praanuave BrwMONsmothcrpackshu.medicefionsineweekly➢��Idividet Rmntlon
then I.kCa hie meJicetions inAepuidmNy wbrn hie mother peims nt tl¢box.
Allcrgien
Paga 5 ef 2�
B3/B4/2815 13:83 7P220'^27 KEYSTONE AUTISM �ER PAGE 14/38
KnmmAtlerky Rcatbn ReqUtredRo�ponec
NIA N/A N!A
He+IfA @valaxtlom
Type of Appaieol O[hrr
zfTy��a^onmr',s��rr AllcrgyTc+[ing
SPecie�iatTypc AIIc:Riat
Medicvl Contnd 11r,RoL•ert tuckemun
WasUinlsemvMnnaguncntConriAmad7 No
I{�'es"�6nmr Dcaile
Oe�eotAppnliml(MAA/D�/1'YYY) 09/1p2a14
FrcqnroayafAppmi9nl Asnc�dcd
PcrsonRaponsi6l�forA�ranging/Cwno�^�ieg Providcr
IfRcspo�trihle Person is"O�Ner",epecify
TypcnfAppni_aal pNcr
I!'I}ry�c ie"Othor",specify Occupa[iorml TTmxpy
Spcciatis�Typc Dccu�mtmnalThcmDuc
McdicelCantnct ScmibcrPMieinas
Wm Diabeles Mnnagc.�rcnt Camidcrcd? No
If"Yes".Bntcr Aebils
pnk ofAPPmisal(MM/D�lYYYn 09/Il/2019
�rcqurnry of M1p�tainvl Wxkiy
penonResports�blclorArtangin�Campleti�g PrndAer
If Auponsibk Penon is"Othcr",spmify
TypcafAp�naiaal PhYsical
Speeie(istT�pe PCP
McdicNConnct ChvlcxlAwc
Was DiabemsManegcmcnlConaide�ed? No
OnMnfAppMienl(MMI�bKYYS') llN820U
Froqucncy oMOPraivl Ycerly
Penw+0.upnmiMcFarArtnnging/Completing Fnmily
r��arn��a�..� o�n��
IfTypeiY"OtlicY',specify Ncuro�Ogy
SOecinlisll}Te Ncvmiogist
MedicnlConhct VivinnFaircluih
Pag!e of 27
03/04/2015 13:03 7172201'47 KEVSTONE AUTISM.OER PA6E 15/38
l
WmAixbemaManagcmrnKancidemd? No
I["Ycs",Fn¢rOemllc
bele of Appniml(MM�O�/YCY» 07)012014
Ffe�mncynfApp2unl Asnee�ed
Penan RespaneblcfmArrangiog7Complebng Family
if Rcaponfble Pehon�6"OthM,spcnty
TypcafAppmisnl Vision
IFTypc is"OfheP,�pncify
Spaialia�Ty� Optomeviet
Mcdiql.Cantxt PrcmicrEyeGr04mup
WxaUinbokeMevgemenlC'onE�demA? No
lf Wep",E�tcrDetnilc
DateofApprnisel(MM10�/1'Yl'Y) 66/13(2013
FrcqurncyofApprnisel Yeurly
Pcnan Rcaponziblc foMrtnnginp�Cam�lttin6 Pmvidcr
If Re9portPible Penan is"Othn",speciEy
Typc of Appraisol Othcr
ifTypcis"Other".speeify MueieThwaoY
S�rc.cielistTyP� MueicTimnpixt
MeAicnlConMct ]oann�%nms
WvsDiaMmsMsnnyemencConritltted7 No
li"'Yce",EnlCr bcmilc
DekofAppmigal(MM/�D/YYYV� 09212014
Frcquencyofnppnietl Weckty
Pcrson ResMinsble for Artonging/Complenng Pro�ider
If Reryo�siblc Persai iv"O�hef,specify
iypcofAppiaisal Psychiatnc
lf Typc Is"Otha",speci%
SpecialiefTypc Paychianis�
McdicalCuntui MichaelFneya
WUDiebcxzManebmmcCo�iticrcd" No
tf"YCs",Enxr Dedi6
�6m OTApp1318II1(h�Ntl4,n/}ry'}'Y) �9�0$/1014
Frtqumcyofnpprniml Qumtnly
PcrsenAcnponaibhCoMrrnnginglGbmplceing Foviticr
Paar 7 0!Z1
03/04/2815 13:03 717228��27 KEVSTONE AUTISM SER PAGE 16/39
1
If Rmpom�bl�p�cwn is"Othet',epecify
TypeafAppreiml Ot�cr
If Typc js"OtM1cr",sproity Sbccch Therapy[veluntltm
SpcchlistTypc SpeeehThempist
Medlcel Conbct Gayle Goepfert
WasD�ebexoMmagcmrntConsiderod? Nn
ir^we�^.Gnrcr ocnils
DatcofAppmisil(MM/DD/YVL'l� 09122f1014
Frtquen�qofAppreisei AEncwial
Pcnon Rcsponsiblc foMmm,ging/Complating ProWdcr
l�Rcspensblc Perso�is"Other",spcclFy
TypcofApprnisnl Dakl
IfType is"Clthcr",apceiry
SPELIJ�I6IT`nIC DCf1�15I
Medlevl Conmct Thomas Cens6igler
WnsDia6clesMana6emen[Co�9ldcrod7 No
If"Yce".F.nmr @lailre
DaleoCAyp2is¢I!�/t?D/YVYh 09/IP/'1�16
Prequenryoi�pproi.aal LvcrylMondts
PersanRqponyihlefoMrtnngin�Comple[ing Providc<
If2pponsil.lc Pcnon is"Ochcr",xpecify
Medlcnl GnnMefa
Pint Namc
Lael Wame
MidAlc Initiel:
C��O�C: $OhYCl�lo[]�('dl'J11�C6
Speciali��1'ype', Ocaipadanul TlxnPist
Addmen Linc h 625 Gomrminity Wrty
AdArca.c Linc 2_
AAdrcsa 4��c 3:
C�ry: Lenaslcr
Sk[e: Pemirylvania
7ip: 1]bp3
PhnnclV: 91]•393-0-025
FeMI:
Page 8 of 2]
B3/B4/2815 13:83 717228]'^7 KEVSTONE AUTISM��PR PAGE 17/38
FirslNemc Timma¢
[a3fNnma Grnsbigler
Mitltilc Inilia4 -
GHnie; Wes[Shom Fnmily Drntisttp
specialittTypc: np�nae
hddress Line L 4d N.36th Strtct -
ABdrenA t.ipc 2:
Add�snLinc 1:
City' Cnmp Hip
Sm2: Pennsy�vnniv
z�r: nau
PlmneN: I�I'n 737-432t
Pasp:
FiretNAmc�, RObM
LaslName Znckevmvn
Mitldletni[ial:
Climc: Allcrgy mE Aathma Speeivlien of[i�rcisW rg
Speeinlirt Type; Alleegct
AlLlrcss LiM I' 115t Linglesmwn Rd.,Sut�e I fi0A
Adtleexf I,loc 1:
Addrcss Line 3:
Gry: HnrtiRbnrg
sbs: ron�srir�i,
z��: i�uo
PhOneH'. (717)541•80G6
Foxp'.
Fvsl Nemc' fiaylc
LaetNamc: Gncpfert
MidQlc Initivl�.
Clinic:
Spccialist Typc' Sp cch ThcmPia�
Atltlra5 Lin¢ �; 47I Eort Chowlale Avenuc
Addeoea�Lh�o 2:
Addease I.inc 3:
City: Hershry
Peg�9 of 2)
03/B4/2815 13:83 7P220��27 KEVSTONE A�TISM SER PAGE 1813H
j
� $tP�c: PrnnsYlvunie
],ip: I7033
Mioncp: (717),533-1916
Fina:
FintNamc: MicMel
Last Namc: Fmya
Middle Initinl:
Clinic', Cmmefor Antism vnd DcvclopmcnmlDitabtlitira
Spccialisi Tpre�, PryihixMst
Addre�Linc I: 18A6 Rohrorn4wtt R�d
AJAmgs Linc 2�.
Addrt.a Linc3:
Ciry: L�rtcasrcr
Surc: Prnneylvnnin
Zip: 17G01
PhpneN: (71])735-14E0
Faxll:
Firs�Nnme:
Lost Nxme:
�Mitltlle tni�inl:
Clinic: Pmmin Eyc Cerc Group
Speunlisl Type: Optomehixt
Address Linc 1: 3145 N.F�t Strcel
�Adtlmxs Linc 2:
Addmc t,inc 3:
City: Harrisburg
5¢m: Pcnneylvwda
ZiO: 1I110
Phnnee: p171236-4757
FAl[M:
FintNamc: Joanne
I.a.�Nvmc Kams
Middlc Inival:
Clinic:
SpccialkiT;Te; MiuieTAcrapix[
Pd9e10 M 2]
B3/04/2015 13:03 7P22B�'27 KEVSTONE A�TISM. sER PAGE 19/38
nadreas�.inc 1: 3808 M�ke�Sercn
fHidicse Line 2
Mtliesa LiM 3:
Ciry�. Gmp(till
Stme� Prnnrylva�ria
Tp: 170I1
Phonok: (]I9)99i5681
Fe�H:
Firet N&mr. �/ivinn
LaetN¢me: Fnimloth �
MidAlc lnitlal:
Clinic: � WCI15pen
SpccinliaoTYOe: Ncmola6is�
Atldme64�nc I' 22A 5[Chorles Wpy
AddresoLine 2:
Atld�ess Line 3:
Ciry: Pork
Swh�, Pcnryrylvania
Lin: 17M2
Fnonek: (7i7)051-5503
Fpx!};
FirntName:
L�t Neixw:
Mlddle lnitiel�.
Clinic� Sil�cr Crcck F'amily Prnmicc
Speclnliet Type: PCP
Adtlrces f Fna h 310 I.nmha Gnp Rmd
Addrets Lane 2:
Addmvs Line]:
Ciry: McchenicebU�
Sfntu: Pcnnsylrnma
yip; I]O5D
Phonc#: p17)591-7425
iexM
Fvge N o(R
03/04/2615 13:03 71722b"27 KEVSTONE AUTISM sER PAGE 20/38
Cvm[M HevIM$pfus
Gment HealtM1 Szme
Bmndon he6lmd no haspiRlimliom,Ngujry,or ncw di�gnwes within the pun 12 maMh� 8nndan iF curten0y heal[hy,
nawacr at h„���ynyy�Ca4 M1ln I'CT nmed mat hie cbals�taol ane�i{gh end wenmd BmnAon ro q ro M;ng.i[doum tlirougfi
h�9 diel beNrc prexcribi�g eholeftecol mcdicnimi.
Dfv¢IopmcnMl Lhformatlon
DevclopinrnGi IrtfomuHon
Brendon wa.bom eaAy et 3'!wecb gmnton,His mother slama thcre were na wmpl�catians auriag peegunry.During Ihe
I 8 hou�lebpr Bnndon hiiN m progxss ana ihe da�pr used fo�a m hclp him. Dunng the neona(al mtvse BreeMon uae
mlicky,hnd ja�mdim,apd was hpapitatiza�l{m utinnA etlecka,cvcnNnlly using nebiilizcr pcntmcnb.
Fm his dwdopmcnml milaslonw,HraiMon atuined all��milqc�pnw onMmc.Frn hix Ixn�uge skills they wmc all
norm¢I wEf M1e was about I I montlis old Whrn he ave apP�osimn�ely f 3 menMs old he had a xia�rc fhet iau fm i mtnl of
90 minums.Ae e resvlt ecvcml mctiom ot hin bnin were dnmayed. Brnndon wct thc bnl until he was-R or 10 yean old nnd
Imd connpl nfhis bowele nl5 ycan old.BmMon met ell tho normal milommee Fm nclf•help i�iqdin6��^8 wnd dre.e�ing.
Brarvdnn'g mothn�matrs ihaehc han good cpgnitive nhiliNee Fu[requires mom rop�Gfioiu ehnn eome oNerFmpie for him
tolc�mthinge,
Accmding M D� Baka at Aoy Spiti�Beliavienel p¢alth,9rendan is dingniwcA wi�h Aufi.�fe Disorler,M1is mom rcpord,as
of1994. Accord'mgtoChnrleaLowcatSilverCrcekFnmilyP�yMice,BronEpnisnlsodi�gnmcdwithApHD,OCO,avd
Complex pertint seizures. Bnntlon'�mo[hm alp0 sL[ed he wW diegnmuM aidi In�elteew¢I Delay os n ehiid.6Ut Coul�f nM
mmember n�ahvt nge.
Payclwwcixl Intnmindon
PsywhMociel Inronnalion
8romlan hes lud no eignlficantbehe.fo�al,menM 6enith,or p.tychiemc issun,or now diegnoxs wi[I�in Me ptlSk 12 montln.
Brando¢is prcembv6 Tmiadone ta sleep thmugM1 tNe nfght.
In?005�e wes srnt b Kennedy KAcscr end in 2009 he wve ycnt ro Smith W ootl tm pryr,hiahic hoepiRlization.BOM
placemenrs,raN of which LvttW over six monNe,am bclieved ro haw���mN dve to hhnviorui concerns,
BranA�x�y wime9�W damesne violencc whrn hc wea 10 yenrs old. 8�*ndon M1m nuRe�M Ilic[numotic fwss of hn(ather,
who lus rntfia,M Wcil xs U+e tlea[6s ofMa mammel grnt grandmolher nnd gmndmoU�cv Mrs,Kuhn nleo belicves thnt Ihe
los¢ofeim(¢mily Log M1as e%ecmtl HmiMon.The dOg vaxl m alcep at 9mndon's fecl nnd i�tpok a while Por Hmndmi tn efop
looklos PortM1c dog al�t
During[he S78-R esscumrnuhc f011owing ikms wem.wle[etl es chalk�ing 6ehnvion.In Me rnfegory of<metion b
�xaperty it woe dc�cribed s hit4vg out of fissg�tion.in the aMgory oFdismptive behrvioo the Amily identifiatl inlerivpting,
Y���+�F��d saeaming,end laughing without mawn az behaviors.In iNc ecction ofummvnl w repe�i�iv�behavimc the frmity
trommdhcrvbshisakirtForunsory stlmula5ortandheMsnervoustieelhp�ry�engagesin. FarvxiellyOAmtivebehaWoNt
was itlenfi0ed tla�Bnntlon slrugaip wtth penonnl spam nntl his proximity b prople with whom his is engaging pr is
emumi_ Hrondoewillsometimmshowli¢Icintematarmncentrariononatukamlwmetimcsalseaixplxysanxferybymcena
ofreNnngiogoplacaswilli6i�fumily Hiefmilynored O�cysa.wtl�eyohnviorMreAsnLtWgopfhcesnsthemon
concem4ng. &anaon's mother curtemty usw s"Brantlan'e WryMot➢nndau's Way"raM,as aell 05 a weigh�etl va�for
Brentl�m, AC�Pwillaffcearha�e.bciaoiorcendslaffrzsranemAunngNe60.DnyF6A.
Pbysiml Aexasmrne
�Y�Are+ DescNptinn
V is10n i3rmdon weah cnrteetiw Irnm.
YeBe 12 oF2]
B3/04/2815 13:03 7P22B"?7 KEVSTONE A�TISM-�ER PAGE 21/38
i
Gmeral HenlNi n��l$�(�ty Rrsks
Ccnerol Heo��h nnd Sufety rt��ka
Bnndon's moCier fills hi�weckiy gill divider,md Bvantlon m@q his mediotlons indepenaeiHly whan his mothcr poims vtthE
boz
6mAdOn has hatl da 9ai0u9 injvAc9 or eccitlrnca in[he past yur.
Brondbn uo0otrnll9l�tlhc Io bia ucry IimiRd verbal lxnguage
BrniMmi'e mmha amtetl h�doca orme�ionally cloye fmm thc home m go lo thc locxl Orc h�uye.W�only when hc is nat
supervi�M.
13nntlon`a mothcr handle.r nIl of his flnancce.
PireSartty
Firc SnRry
9mndon rnnnM InAcprndently evaryeq�n nae of a firc,nrtd wonitl roqnirc pmmpting�e evoeueM.
TrnRe
Tmffic
e�snEon is not nwaM of tnffic wfery antl mqt�iros fupemsion wNile in�he commun6y.
CnnWng Applianao Osc
COOkinplAOP��nncellec
�Hmndon epn indepeiMrntly use n miuvwgvc and roexkq but wonld raprim Rvpmivion using any MFtt caoling nppliuncen.
Ouhloor Applivnem
Ontdvo�Appliar¢ce
Bm�Non dncy no[have expeNCnce uaing any ou4loor applianme,end wwld requirc aupervieion b ieam M1ow to mfrly nae
dmm.
Water Safety
Water S�Fcty(InchMing Tempemh�RegulnEon)
Brentlnn tan indCpentlmtly rcguleh his wnttr kmpernurc for tinNing and showering, 9mndau Aoev hew a hisrory ot
sci�nims,wNleh rtro�o�cnrrently anix,eml Nso rtquira sipervLsion around poois m oWer botli�s of waler,u h�aill go roo
(nr out inro mcw�rcr.
5afety Prtcnnlien.
Sntetq Prec¢vean�
Brendov rnn intlqsndrnNy mc cimning xnd prnonol hy�[icnc proAuctR,andrnn�wd precaulion lAbCis.
Page/3 of t1
B3/04/2815 13:03 717220!�'27 KEVSTONE A�TISM SER PAGE 22/38
ICnowietlge of SdFldenNfymg Info
Knowlepyc of SdGldrn[ifying InPormatmn
Beeotlon uv inticprntlrntlymc hin Txd Orwrirc hie eelf-iAcn[itying iNmmntion WBGn azk�. Brantltm's mothtt mcemly gd
a neW ccll phonc,rnd HNnEon is ftill wotkins on Icami�g her new mlmbcr. ➢ruidan Nfis 9 pPow 1D,but ea�not alwaye
cerryitwithM1im.
Strnn¢cr Awsrenna
Stl'AARO�lLWIfCRF9
IirnndonS motha'sNicd Bmndon is romplckly unawarc o[tlenyer,end is mrt�cntly ulwqvs aupervi6CQ et homc m6 in tlm
canmumty.
Scneory Cme.rns
SCII60IY C.q11CCIM1IP
arundan ip gensiFx tn cmwds and brigh2lighu,n�d witl wver his hec. Rnndon engagee in smreotyp�wl avd unmry
.aeel<ing ne�uvion svch�s meking,humming,ns wcil u rouching objeeu white h�{�wniking avovod.
Mexb F�rtinq
Mc�Js�Fntins
BranAon is�mnsitive ro fead mxYuros,x�A pas e limimd tlic[ BrenJon tlocs mmclimC ca[ma fest,but not enonFh to ercnrc n
choki�g nak.
9upervqMn Cxre Needa
3upervieianC+renccdTypc FlomeSupervisi��
NumGxofhmirsofsupervisian B
�csenptien Hrendon isNweye xiq�aviecA in Ihc fiomc.
fsintrn5iveevpervisionrequimdinIDuecuing? Vea
Si�evvlaionCmm�ccvlTypc CammnnitySssprnisio�
NumMot'hwnafsnpervison R
Deseviption Brnndon Is alwnyx auperviud in ohe mininuniry.
{simm�uivcsuperv�fonreqnimAinthiasnnng? vcs
S�perviyionCmm�ccdType DnySupervuion
Nnmbnofhounnfsupervislvn e
Deseripnon Brnndon issnpmised atCumhcrla�a We11cy�sh Sc6aolond CIT.
Lv{nkasircg���virionmqnircdintM1iseeMn�? Yn
Re�itlOv for IntrnsWe Swmng
Ammoa for InlmNve SURing OtM1er Reaeon Plan for Redhdng Inlensive Ctaffing
9upporte Snpporb:
Elopeinrn�risk
Vnablc�o evacue[c I�dcprnArnoly
Pa9e 14 of 2i
B3/BG/2015 13:03 7172201'27 KEYSTONE A�TISM..SER PAGE 23/38
� � i
AnIH�Qre
Namc oEDe�n¢mdPcnllM1 3uppon Pc�snn: 5tepnamp KuAn
Addmax Line 1�, 18 Sindnir Rovd
nddrw,a I.inC 2:
AAdiqa Lint i:
Ciry; Mxlwniphry
SLLk�, Pennrylwnie
Zip: I7055
Phone: 717.599-9P60
Pasev TMm4cr.
Ss the in6ivido�l¢bIc M meke hwlth cac decisi0n5? No
Is[herc gn pd+anCe dimetive in plea? Ne
itN0.�t pm7u wilt h takm m assut the permn b Brnndoe was given infirmalian cegercling nn xJvnnce directive upon
rompte[cenaeveneedirccfive7 enrollrorni
RlhefadlviAunlcxnnoYmakcheNthdxuimu,hasa Yca .
subatieu�o dCoision maker bmn idrnEificd7
�f BV65Gxuh dccision maka is itlrntif¢d,ix i[a Fnmily Mcmber
Nmnq Conmtt informefion oi'decision maker SkpM1enic Kuhn
Addmes 185incleirRmd
Gry. Mmhanicayvrg
Stnic Prnvylvmio
Zip: n055
Phane� 71]-599-9R60
Lf subsaNh tlecuion m�kv is not iArntHied,�hcn
whvt aleps will bc Celcc te identify a wibsHt�rte
ticciaium m�kcr mid 6y when7
Ncalth Promokions
Phpeienl Devclepmpnl
Phy.vicni Devciopmen�
Brmdenk�atl�hcr sWhd tLnt efthiogh Brnmlon ic awkward he is nol aignipwntly eh.11rngcd in the araa af fne or pross
moroe ekill<.
Advptfvd5elf Help
AdnpfivelSclfFlelp
Brondon's mothcr sdtal rhmBnnEon aa�MYhe md drcsc Mmvel(Mrtsometima nced�e�uiflxnw in picking om clorhes Ihnc
arcw�there0�n�n�� BmMoneenmmpletchnnscholdehmeawiihprmnpling, �mndonennu.cdmmicro��mmund
toas2r.
Paga 15 et 2'/
03/04/2015 13:83 7172201�27 KEYSTONE A�TISM sER PAGE 24/38
Lnrn�ng�CngeiNon
4enrnmg/Cagnician
BIINdan's�valFer s[aled he cam�M rzcognin pi¢ed or corntq howeva when Me d�p�ope,6e gxv m IAe 1d�heninbucg
fiiP hVax� Sltc CUNd ehc Win16Irc rofiy 6c ablc ro Icrq[,tli>A pOOpk wham hc knotW wcll D['SCes attcn. Hrend011's matllcr
stetMBfandanwnlmmmhsmadelcdFochim,Wtslmgglqwiqi�direc[ionSafmurcthnnafawaeNs. Bnnd`m'nmNher
and bmlha siafed Brmdon hav n gppi mcmory,especially with puYales tdnem once he pub it toytlher once.he knowe wTere
every picee bdangs.
CommurtieHfon
PtlmoryMnneoff.nmmunierFon; CammnnicnNonDchila:
Dtlmr
Bmndon UUB 0.mixWEe Msign lengiiege,LL9ing his iPnd,
wriling,end limfrcd vubxl cowhu�icatmn m commaoicah.
Bmndon's mo�he[Makd Bandan u umbic b undcr9and m
med nny nm•ver6al cemmuq{cerion. Hnndon's spmpbma of
/vrtisnc Dimrdcr mc quim epperwt eM inclWc impainnenp
in wmmunintion aa hc is nonwerbBl md dm.a no[Slways
use the nvuHw deviera or aign lu�eun@e ro answw rn
rwprond ro xnother persan.HnnEen:'s eadel reulp`eciry ie
impaimC a well as Ais wdetshnding of nocid nnd phyeiaal
�rcaxim¢ioe m ofha people.
SocfoVEmntionnl infarmation
SocialBmononalinfwmeton
Hrendon datt nnl ini[ietc nr maindin xrry eaeial mlxnonahips.Hie fnmily noros thxt thic ic a gwl Ncy Arve for liim.b�lon't
only mcid intttnnions inclutle hie flm+ily and hie,ntT, Bmndon daa sbew empathy,as reported by hi�mMhtt. When b�s
brothtt�A�Cryin&Hmndoo wenl into M1ix ErothcM�room,got n fis�oc,and wipcd hu bcothn4 Man.
EdurnlionalNuca[ien�I InForm�tion
Page i6 of]T
B3/B9/2015 13:03 7172281'�7 KEVSTONE A�TISM sER PAGE 25/38
SNJcnc No
Fmqucnry: Pulitimc
Curmnt&IucqNonnlSUWp; GnMrlcd NK 2013
Schonl: CmnbcrlanA VeIlcyHigh Schoei
Mdmsi Linc 1: 6]dfi Cndisle Pikc
Addrcns Linc 2
���y' Mechanicy6urg
S�utt: Prnnsylvnnia
Zip: 17�50
Phonc: (]I]Jfi9'I-A7(I
OVR Glient: Nn
O�R Cauneefor Name:
OVA GouneclwPhortc:
Doc.tFi9co�sn�ncrhawt�ining goala4: Na
Usllmininggoxla:
Commenu: (iradun¢d Iune 20 U.
� Anmding CIT Mondey,WCC�day,nnd Feiday
9rendon's mirtha is hying�o gm him ml-up with OVft.
EmploYmenlNalunleer Infarmatien
Work 5tatus�. Volumar
FrcqumcY: Pad-timc
Polition�. Volune%r
empinyet/Orgnnlzetion: New Fope Minierc�cs
Addms Line❑ 5226 L Trindlc Road
City: Meehnnics6urg
S�nm: Pennnylvunix
Zin: 17055
m�one (9i9)76a-7337
�oestl�ivcanwmerhnwemploymenJwlnntecr Yes
@bals?:
Lis�GmpinymcnVvoluntccrgoxlx: brun0onwillfocusonihe0ieceveryphaxroORTarcPore�d
Mhance skiflc For cMnpeCtive enMioymrnL
WOrkScnmx: Volnnmcr
� Frcquerycy�, PamryinC
POei[ion: Voluncccr
Employer/Or�nivarion: P��
Page 1)of 11
03/B9/2015 13:83 7P2201227 KEVSTONE AUT?SM SER PAGE 26/38
l
Atldrcas Linc 1: W 16 Cadisic Ake Stc J00
nJe,co tincz: � .
Ciryv Mecl+nnieaburg
SVtte: Pctmrylvm�ie
�m nass
Miana ('!1]�7963604
�x9thistonsimcrhawomploymrnfhrolunhc Yw
go�ls?:
Liot FmplornenVwlvnkcrgwl.r. 9mndon wi➢Fows on�he Discov�y yha¢ro pre�rpM for and
enhanee skillrirrcompetirive employmeni.
Cammend:
Work SNmv�, Valuemer
Frq�urnry: P.h-tlmc
Pasitiom. Vo7mrtccr
8mploqcr/Orgimzotitm; Crn4al Pennsylvan'ro Food Benk
Atltleer.5 LinC 1: 3908 Comy ROA�
Addmss LIm i:
City: tlorciabiRp
Smm: P�nnsylvania
],ip: I71D9
Phonc: 717-564�1]00
Docs�hieEenmmcrhnrsemploymcnVvolvnkcr Ycn
goelsT,
Lis[[mplaymenOvolUmecrgonls: BrandonwillfocusohUmRiBCMeryphasero�rzeppreforand
enhnrm ekiila for oompetitive cmploymrnt
CommentR'
Work Suma: Volv�far
Freqacncy: Pnrtdimc
rvsi<ion: votumar
Gmploycr/Oigenintimi: G4TM
ntldrcsv 4inc h Po BOR)39
Addrus Lihc 2:
Ciry� �mnrvilk
Snm: Pmnryl•anla
Zlp: ]7028
PLonc: 777�bfi9�]5�7
Daosthiero�iMcthnVccmploqmcnthrolumm Pex
gmis7,
I,is�Pmp�nymenUvp��rnleerqnele: Be¢ndonwillfacuew�helli5eoveryplmseropropamfarmd
cnhancc etil le Fat comj2Mtivic eMplvymm�t
ve9C 1E OY 2I
b3/04/2015 13:03 7P22BP27 KEYSTONE AUTISM SER PAGE 27/38
i
ICmmvona: I
UndcnMnEinp CommanRsflan
WhmthiaisM1appening...: Bm�donitukulnq�q�ion
ThCintlividueltlacn...: BmndonEoesnotalweyereplyimmOdiTtNy
WeNinkitmeans...: Bnndonhmapmneesirt�dclny
We.hduld...: Cnve BrenCnn 6me b�rtoeeu tAe question�o anawer rnrte tly
� ��
Gavl Phnuc: lndepenErnt Li�ing Skl11s
Gnel SMICNme Brendryn wil I inawm his nkille UuH wMribute[a hie obility to mom cftatiwly
end connillCntfy mce[Aix oem dnily IivinS�eeds.
Coal Smrt Derc(MMi9P7YYY): I/12013
Goal Cnd 1�te(MM/DD/pyYYJ:
Concere(sJ Relvted To Gonh Bmndon waa in Ne life ekilis progrem rt Cum6edend Vallcy Hi6h Sehool.
Thcse goele we�c etlnpkd fivm his ILT m help eonti�ue tl�cir pm6eam for him
and allnw for continuky�a M1c haiuitioned ro ACAP.
ObJective.r.
Objtt[ivc W�+ee oot in Ihc wmiminiry ned mnking e p�rchese.Brnndtln will sive
Ifie cartat emount af money ncedetl[o compfem the pu�chase,m ihe
next larges[tlolloq end aBi�For Ihe cfiange m be givrn k him,tWicc ptt
wcckwHhlnalhan5pmmptz95%oTthchialf emlingRl712014.
Condi[ion When out in t�c commutfity AnE meking a pvrchaxe,
BeLa.iar Onndon wil l give the cortecf wannnt of inimey necded in axnp(ero the
pmcFese,w Nc Mac Inrget[tloflor,6M wai[Polihe ehange m 6e given
m1vm,
Crimria miaperweckaithlessthan5prompLc7SYeo(d�eaiale wrtfing
�uavzo�a.
Objcctivc (Acivptivc AcHvjry)When welking In MCu�mmuniry,i3nnAon vnll
comectly d�ansmm safety ewarrneec imlvding aeing sidewelkc,
cmivwalkn vnd look'u�bofh wn}�for mrs wiqi no morv thae 3 O�omMS
on 75%olnpporwniNrr observed ending 12/31114.
CoMition When welking in�he commnniry
8ehavinr Brzndon will coRcctly dcmonnrnm 5nkty awaicncss inclndingvnng
eidcwalks,crox�welln end laaking 6eN Wrya for cnrs
CrAcrin with�m mrrcc thnn 3 pmmpts an"15%of oppnrNni�ics o6xrvctl rnAi�g
I4pVl a.
@mmcnt
Objecnve When eooking at home,Hnndon wiil absme uppropnam kitcM1eo
ufeiy pMHe(nat walking+wey from the nwe,kniR sofery,c�t)o0
75We of o�o�mnibnv hy 12lilll4.
Condition WNemcooking at hamc
9ehavior 9nndon wel pb�mm approprlam�i'mhen sdery skills(notmlNng
awny(rom ciro smvc,kniR safrry,cc[J
Paga t9 af 31
03/B4/2015 13:83 7172201�27 KEVSTONE AUTISM SER PAGE 2B/38
Cri�rie on�5%o�o�ottonitics by f2/11/I4.
Cmnmmi.
ObjttBw When prcpvnng to trvneirian benvxn ac���iHes,Braidae will finish vr
ee[a<idc his evrteN Wk aadcomplem Poc hnNition ro the neM.ctivity
witli 9 or Powcrpnrtpuby 12I3tF14.
ConAinon When�repuing ro trerei[ion between ncN�vitic
Bch•�ior Binndon will flvie6 or ut exitic hie mrtenl[ask end complert thc
mn.viHon W the neiaeeriviry
Cnrcna with 3 ar fewer pmmpu Iry 12q I/14.
Commrnl
Objeetive When compfeting hie�hommg hyF�cnc roska,Hnndo�will 6msh his
tccth,usc mouth woxM1 flnd pU[On dcodman4 He will da this cach
moming on 90°/.oCnromit�p Ny 13/31/Id.
Condirian WheTaomPle[ing M1is mpming hYKiena tasks
BChP+ib[ 6centlon will 6NSh Mi3 R[lh,dSC f0euth we5h pTd QIIC on dendoYM[
Cnlerie Hc will do thia coch moming o�90h of mominge by I741/I a.
Commc�
06jective Whrn cooking et home,Arendon w%I D�-V�r meal(ar himsclilwicc
per weck by 12/31/1a.
(bnditio� Whcn caalnn6 0�homa
9chvvioc Bnndon will pcpare e mcal for himetlf
Cnterle twicc per weck by l2/]l/la.
Commeirt
DhjecRve (Adnpnw Ae6.dty)Whm conryle[ing choru et homq Bmndon will
choose at IraR14 ehorep end complete ihe ehosen Kskc on 70%of
op0o�nities by 1}l]1/14.
Condition WIIC�COT�IC[in$cllOMi d�ADNC
Behwior RMndon will choose et leae[A eHmes 3nd ebinpleM the choneo mnke
Crimrin an 90°F,ofopparmneie9 bY 11/J V14.
Cnmmcnt
ONjeetive Whro aeketl penoul informetion quesrione,Brnndon wiil eommunica[e
the following inform¢fipn: PoII mmc,commlem addrccu, yhanc
��mbee.Axte of birtG,idme�fy�hrt hc lma s�Miam end doa noe ve�bally
cnmmonicate, 80%ofNetrialy withlessthan5promplocndi�G
I]/Si201d.
Condilinn When askee peeienal inFemnnHon 9uestiona,
9chn�ior O�nAon wiil wmmunium thc PnIIOwSnS��forma[ian',tnll nvmc,
eomplctc xddreaa,mam's phone nur�ber,date of binb,idrnti£y OmtRo
hce auH.m nnd Aecs nm vmhally comm�oima.
Crikrio BP%n(thc triaL with Ica.v than 5 prampce mAing�pf11/2014,
Commena
Cwl Phrmc: Cmnmunirztinn
GooISG�lemem; Brendonwill£urtherAevelaphiswmmunicationxkills.inoMenobeaermce(
hin nee�L.nnd i�rtcna cfTalivcly with o�hers.
(inal Siatl Dah(MM/DDIYYYI�: 1/I20 i l
Pa9e d0 ct 2l
B3/04/2015 13:03 7P22B1�?7 KEVST�NE AUTISM.GER PA6E 29/3H
I �
Gnel Ehd Date(NQd/DOlYYYl�: I
COfICCfI1�P�RCIpICATO C04I' BfiI1fA0�M.f��MGIIEE 6I(1�I6PM1Ig1B111Y[CIITDLRId11A VdIIL)'A�g115LhUd.
Thae goals wcre edapieA hom hisTGP b help fmninue thmr prcgmm(m Inm
wnd Wlaw tor wntinuity af 6e vonsifionetl m ACAP.
bb)ectivia:
06jooMvc 0.Ten aaked rt yes mno qvenripn,Hrsndon Mill nsc hie iPxd,�ign
InnFunpe.vocnlimtiat or dry eroa¢M+¢rd to amwer tAe qnestion m�M1
yes,no 0��donYlmow with no merc fhvn 4 pmmpts on BD%af
omesion66y 17/7lli6.
Condition When nakcd r ym aroe qnrstion
Behavio� Brnndon will vm hie iPad,sign lang�¢ge,voeulivqHon,aY dry crosc
boacE fo mswcr the quGetion wiN yes,no or I elmi't know
Cnmr'v, wiM na mmc than 4 prompu an 80%oTocnations by]2/31/l4.
Comment
Gae7Phram: Cammimitylnvolvemrn�u�Aenvirici
Goe�Stptemeno: BnndonwiilceplorctliE[erentvo�umttrtryporwnitiumdettrtninehowhc
cxn conttibuCe m dif(ertni voltmmer�rgani�wNens.
GW I SUh Dam(hAf/O�/YYYY): 7I V2013
GoalEnd Dnm(MMRJOlVYYY): 9AUI2014
Coecem(n�AcletedToCoal: Bnntlonheypiffav@ywilhpenannlapeceantlboundnrien,Rcwillphysinlly
mo�or mke Aold of somemm m yret W o pm.krcdaetivity insaM ofnsmy�
oNa�secielly appppnvh mclhads ofcommunicaGan.
CaelPhmtc Phy4�elHcalihandWcllncss
Co915intcmonn Rren�lon w'ill impmvc his overefl physirnl M1calt�aml wcllna+�.
GoalS+xrtDaro(MMIODNYvh: Mi2013
Coo16nA�ak(MMI�DNYYY): �
Covecm(s)&IaredToGnel: HrnnAonatHin�ieinanive,negabvelyimpsciin6hisdhqeicnlhenithand
wcilneu,
Objeetrcrex: �
Objtttivc �Advptiw Actiaity)While living at htlmc,Brarrclvn will c�age in I S
minums ofexerviee a+70Yo of dry�ending 1213VI4,
COndition Whilc living at hnmc,
9elmvior Bmndon will ettgnge in l5 minupr Of cacrtisc
Cntcria on t0°/af dnys anAing 12f3111 d.
Commrnt
GodlThress Sv�odaCemdinrtion
Goal Staemrnr TI4s scrvice will p�ovide Iniunl Plen peretbpmcm oteu IiMivitlual Su�en
Plaq cop�dlnallon aFanlhorixed mrviem,vntl on�i�mani�ovingofall
accviue for tMne who ere srned lryKeystone Au�ivm Sarvirn.
CiaalSru�Oa¢(MMIDDR'YYY)' 7/12�14
Gael Gnd Dnrc(MM/DDIYYYY)r
Conam(s)RetaleQTOCwaI'. Na
Ya9e Y1 of 2T
B3/B4/2815 13:03 7172207'27 KEYSTONE A�TISM.GER PAGE 30/38
Objectives:
Objccp�t Wring xcrvicc pIm meetinEx,B[nMon will work with the tmm m
idemify neulal and dairtd mrviczq end fie Svppnrp('qpr4invmr wJl
en�ure ehnt Ihecalnpmhensive Individuol�Sappory Pipp is crtfilished
eiN mainmined,(qUartcrly/onnu¢71y).
Ce�d�lion DuHng aervkc pl+n meetings,
BCMavior Iinndon will wark wiN the tc6m m idrntlTy neWed md desirc�
servecec and thc SYipytlrlf fwNinetoren7l mmrc Mn Me
COItIPI'CMEIIFiVC�1141vIdV��$Ilp�rt P101119 tltd�l�IShv`.�9Tfl tn0�11N111C�.
Cnttne [9uMcrIY/enmoally).
Commem ry/�
Obja[ivc Quencrty,Brnndon win wprk with thc tcmn ca gafn acccs.s w all
vutlq�ieed scivias inciuding ncuicd medicxl,demnl,wicieL
edueationtl,and o[Irtr�crviccs.SV7iyott9 Coottlinemrwill providt
optlMYx,nRtisNnce,nnA coordinAlian la enwro emas m avMorinE
smi�.9mrrcr4Y.
C�ndition Q�urtttly,
Bchavior B�andon will aock wiM the kam m gein aomsf b cll suthorizcd
xrvices inclutling ne�dcd metliael,denml,Fociel,WucirtionN,and o[hef
scrviccs.Snppork Gmdinstor will pmvidc nptioK,�uisHnx,and
caardination�o rnFum awess ro nNhonmd eervicq,
CHzria qvnrtcrlY.
Commrnt N/A
Objeeeivc Monfily,8raidon will mmmurtia4 wiGi�he Svp�ord GwMircaror m
provide feedbuck an nntiefaetion. Svpports Coordinarer wrn e�quec
pnRicipant cAoicc by provi0ing inT.�rpµhpn�ry�IP him/ficrin making
fiilly infprmW dccisions�cgiNing servicp.as thcy art
approvcdheepmme�dW throvgliKAS/AGF MWiral Nacsstty
ProCC15.
CwldiOan MonlNly,
➢chovmr Bnndon wili wmmuniwm wilh thc Supports Caordirtnmr M prov�tic
2etlWek m setvfaclioe, 3upperuCoetdinarorwill ensuc pnnici}mnt
choiw by providing informeuon m help hiMhor in maNng fvlly
inPortrtW dttieium rcgaMing secvices,
Crirorin - aelhrye�ceppmvedlrecwnmendedthroughKAS7'ACAPMcAienl
Necexsiry prqqsa.
CnmmeM1t NIA
Gonl Phrnse: Pre-Vocntionel Servicev
GafllStfl[ttnrne Thieemieewill�xovideineere.alensskillussessmrn¢,enrecrplannmgcarcer
expinis�ion throu�Me discovery prnce9s.basic carcn aaitmrnty�cpamtian
vistnne�,ynR skilh traini�.ona joF xnRh aesisbnce for ihpau who arc
r.rved by Kcystone mniam Scrvieu.
GoNS4rtDatc(MM/DD/YVYV): '!/12o14
Gml Gnd Dem(MM/ODHYVY)�
Cen�em(s)RclalcdTOGoe1: '�icgwla�ohclpparticipant�tainmaning[�ilemployimntlhmuRh
dwclopin hie Skilla,
oi�jcenvca:
Paga 22 or a9
03/04/2015 13:03 717220ll?7 KEVSTONE A�TISM sER PAGE 31/38
Objztive Ounng eryc cmploymmt y�mce�s,Bmnda�wili idmnfy,obtai�nnE
'eain6mploymatt, Volunmer. HducatioryanElorWotklncentiveq,by
thc 17/71/14.
ConE�<�pn D�r�qB the emplvymcn�Pmcess,
Bchavior Bcxn�onwillideality,obNinrvndreminF.mploymatt, VoluNar,
Edvcmion,.nd/arWoAcln�entives,
Cmenn Iry t1i<12lJ I/14.
Commcn[ N/A
GoalPhrefc: Hchnviaml5upport
Ooo�Sutemmtt: Thiexrviecwillpcovitleclinicnlweeaiy+�q�Qy{�pnceRndenllobOrotionforall
scrv�rss icceived Rn tho9�wha arc.verved hy Kryrtm�e AuliFm 9erviccs
Oaal$tmiDote(INMYI1Dh'YYY): 9/12014
GOeI End�Dnte(MM/0➢NYYYf,
Concem(s)RclnmdToGoal: N!n
ObjecNves:
Objective When rcceiving Behpviot SnOPott Serviee5,etmppn will inereax
ndaptive beAetiars ar dcvclop replxcemene beheWArs vdxled lo iLS,
Comrtmnidtion,Socicliratioq and PFI&W,W rnhantt hia quoiiry of
lifc.
Co�itFon Whrn remiving 6chnvior Support Se[vic�,
9ehpvio� HnnEon will increaee adaptive bcryw�oC9 eY develop�eplecemeni
behnviun rolemA W 1L5,Communieetion,SncaGmtion and PH&W,
Cnmri� ro cnhence hia qualiry 9f Iitc.
COrtTRnt WA
Gml Phreac: Suppnrted 5mploymnn
Gnnl Stnmmcne BrnnOoo Will foevs an the Discpvery phme m pmpaa far nnd rnhnnee skills
for eompetiN.e cmpivyment.
rmoisnnoa�M�o,�rwvg ioiirzoia
Gwl End�atqMM/DD/YYYY)�
Conwm(e)Rclamd To Gonl: ➢rondon rnmntly rtuinniiu aeveral vol�mmer ai�ea vM goep ro CIT bui cun
display low Ie.cls of rngnydnem�n Mc,.c tnsks.
OLjeeliv¢9;
Objective WNen e�g¢g{�g in rolnntterwwk.Bnndon wifl0erticipete In a
wlunteer netivity et lcas[3 tim2 per wcck(or 45 minulee per pccasion
Hc will Qo ihis on�of wmkE yy 13/71/14.
f.ondition When engaging in wlumm�wo�k
Bchoviar Brandon will pMicip�k in� wlnn[eer aeuvity 0�knat i pjrp�s.per
wcck for 65 minuas pc ocwsion.
G7rte+ie Fic will do fLis on 90°/.of wccko bY V131/14.
Camment
pMlPhrnx:. Sociaii�auan
Cmai 3utement 9randon wdl innez¢his rcpertoiro of sacial skills in otder ro b�imrmeet Ms
ncetls an�imrncc ctFccHwly wi�E eth�n,
Page R3 of 4]
03/04/2015 13:83 7R22B1'�7 KEVSTONE AUTISM GER PAGE 32138
i
GmISG�rt Dare(INM/DUKYYY�: l0llf2ol4
Oaal 0nd Dett(Mt�A/DDii'VY1��,
Conmm(sJRclercdTeCve1, Hmndanhesdiifirnitywithm_vpcctingpc�mnvlapaeeendwi0physiwity
movc orhkc Mltl Of gomw�l^l0 ezpre.�s hic exds inxtead pFMiu&A more
soci0tly nppmriaa me�hptl pf iRWroMion.
Objeeevev:
Objcc[ivc WMIe arouM otherR,BwHio�will ren�ecttM1eperxrm¢I hnundnries af
athen by emping an nmP.length�ny from oWem with I:ss Nnn 3
pmmpu ending 12()I/I4.
Condition Nhile ar000d othen
Behuvia B�ndan wi11 rcspect the per9onal bonndaries of othere by 9�aying av
nrm'a icngth away from oficre
Cnlerie wiM Ics ihan 2 pmmpu rnding I I/31/74.
Commrnt
�
Dey3rod �p�IqVlO�O�t[DIII¢:
1.Hypothesb
CandUon-�CscnbclM1eavironmeo[entl InthewmmunityorpubticmvsiowhichBrxndo�istravellingwiNt
lecmnth�uy{�icxl4ycontriboawNe someoneelxbyvchicic.
problcmaAe TeMofm; �
QeMvior-DceeribcGspmblcm¢Eebnhnvion HmndanwillreRnerogetovoaithevehiele.
FunCtion-Descfl6ethemeDnlheindividuolis IlinXypotheaizcdthnHhisishnvoiEnewmoonymferted
6splxyingtNCF�blemnricbchnvim: simationNarii.iri�mnneietyrclatedmtNeunlA�Atipne,lorniiwam
ucNJities.
7.HeNeeioh�l Outcomc
Cenditi(n-OexrbcYneenvivonmrntend [n[M1eeammunftyoopubliearcasinwhiehBrnndanuhnvellingxMh
facrontliatshmildFcinplammmpportHrc saneoneel.atry.ch��le,
desimd belmWpr
Behaviar-➢uaibethedceimdbehev�m BnnAonwillgnmeohhcwrindieeom.m�nity,
ou[camc:
CrimAa�-DCscribchowsumtaewillk P�uGncydah.wi�IbecollecmdonQmb<hn�iorsofgettinpOvtofthccarin
meamrotl h1NCQ to�h<daired bchvvior. [he enmmuniry end rcfiisnls ro get rvut af the cev in the cemmunity
3.Anleeedml Stnkgic:
Prev'mw locotion,.ilux[ion;mtl eUivino going m
(Fer cFoicu of Iwatloia or eetiviva
Pair�on-prcter[e0 Ipcations witfi preFettaV ectivitite.nov-pxfrned activities witli prctercCtl lonntioos.em.
1.imilNmcmcdin mppMnyatiorv7ocetlen
/.RlpIPC¢mMlmAttemetive5trnleglec
Mekc mqucnt to wvN ar go 9omcwhme else Qnslud ofxim{�ly mNsin@ ta gel mrt of nrJ
Utilize distmction-mke ipnE Fm gnoes,Nc.
Paga 1�af 2�
03/04/2815 13:83 7P22B1�27 KEYSTONE AUTISM. SER PAGE 33/38
I � �
5.Cemeqnmee Slmmgipy:
VeTntyreiee
RCfleG 6uec¢hlta
Vthnl�cdireciion
6.Me.m ofManMring:
DesrnLp ihebehavim fpr which dam iA Frequrney�q will be collectey on tLe behetion afgetling nm oFtpc urirt
collecmd: {M1ecvmmunity�ndrcNsnlsmgetoutoffienrinlPecmnmuniry; In[enry
maY be monimrW nf we11 Ihow long doC9 il t+ke him m gat auc of cer)
Ty�pfmCnsurtment', FrequeneylC+�cn[count
If O�her,SPaify: Is�nry/time m get put mY N aigage in x�vicep
Frc�uwryafde�emnmlitlntion: Weokly
IfOMier,3pecify�
Pape 25 M 3i
B3IB4/2815 13:03 7P22B]'^7 KEVSTONE AUTISM �°ER PAGE 34/_'�H
7.Behov'mr ProQreee Ilp�lqa:
Variablc TMnd Attien OMeofReriew
6irtoringC�ecomm�miry Flat/MaiMvininST�d $Ldfwillprompt 09292018
Bnmdan fo vmtniNtln
from his rnrtrnf[uk
�othc Wkin Ne
commuMrybyming
vcrbal aetl wnfko
prompk
Varixble '[rcnd AMipn IJeteofRMcw
Ln[ennginkthccommunity FfaUMainieininghend S[BRmillpmmp[ 06/792014
9rendon ro en[cr the
rnmmuniry md we e
whiCebearL ifvc'6eT
prm�[ing i.c nM
cRccBvc.
V�risble Trcea Ac4o� Dateo[Revlow
Enkring�fiecemmu�iry incrcneingTrcnA Smt£milipromp�antl 03I2Hl2014
rcdircct Brendon ro
cnttt the wmmuniry
Sbff will use n whim
boarJ iCvttbnl
prompnng is oot
cfkefive.
Wri�ble Trcnd Acflon D�tevfheviea
Gnrori�glhcwmmunity lncru�singTrcnd Brmdoncon4�ucs�o UI/162014
. sLow pro�on
cntcring[he .
commmiid.
VariaMe Tre�W Ac�ion DemoBeview
5ntcmgllicwmmuniry IncrczsingTicnd Bnndvn�onfinwxro I�i10/2013
sNaw proaRs9witfi
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B3/04/2815 13:03 7172201�27 KEVSTONE AUTISM SER PAGE 3B/38
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i
WeIlSpan Neurology
228 St Charles Way Suite 200
York, PA 17402
(717) 851-5503
. 03/02/2015 229PM
Patient Copy. This document includes confdential information from your medical
chart and brief highlights of today's visiL To access your labs and more, visit
http:!/mywellspan.orq . Please contact our offce if you have questions or concerns
about your health, or if you have not received the results of any tests within the
timeframe you were given. Thank you for allowing us to partner in your care.
Patient BRANDON M. KUHN
MRN 002061756
Birth Date 72/03l1991
Encounter: Oct 22 2014 S:OBAM
Message
Recorded az Tazk
Date: 10/212014 08:56 AM,Created By:Pnnce,Ashley
Task Name:Call Back
Assigned To:Newo-A,Tnage Group
Regazding Pe[ien[:KUHN,BRANDON M, Sta[us�.Active
CommenC
Aince,Ashley-21 Oct 2014 8:56 AM
TASK CREATED
Caller: STEPHAI4IE-,Call Back',599-9860
DR.FAII2CLOTH:
P['s mother Stephanie is celling regazding pt Stephanie states pt haz had an ivIRI which was abnoimal and had
"chian".
Mom is very wncemed as pt hzs been expenencing the foliowing intermittently for the laz[6 months�
P[has been regressing lately end Mom feels pt is going bxk m child hood.
P[is having blank stares,forgettmg what he is doing andjust stops and stands. P[is unable to follow simple
commands such as islce a shower or put yow shou oq but then the nea[day would 6e able to follow the command.
PC's OT,speech therapist,riding therapist and music therapist have no[iced sip,vifcant changes in the last two weeks.
P[was soheduled for a CT et 7 30PM last week but was afreid pt would not be coopera¢ve sfnce it wes so late and
they live an how away Mom was unable to heve this dore.
Mom would like testing and Far pt to be admined today.P[has been pointing and holdi�g his head lately.
Mom is very concemed and would like m speak with someone ASAP. Plcasc call Mom,S�ephanie,at 599-9860.
Thank you
Bahn,Li�da-21 Oc12014 10 22 AM
TASR EDITED
Mofher reports she a�d all}us iherapis6 aze noticing a cha�ge in pTs behavior,an incrcuc in pmcessmg time. Siis
and stares[o process a command,lakes 20 minutes.
Sleeping 10.15}vs day.
Aegessive behaviar has sropped since decreasing TPX dose,bu[now is having headaches egairi.
At music lherapy,he does not remember how to play his ivstrinnent arrymore.
Alert int¢[mittenUy dils AM
Mother fivs[rated She reed abou[symptoms of Chian and dunks[his may be getting worse.Can tes[ing be done to
find ow?
Pleese go lo xww.rtryxells0en.arg�o enrdl in mr patel entl 9ein eccess�o yaurlab results,X-Reyrepotls,entl medicel recoMs.
EXHIBIT
� �
I
WeIlSpan Neurology
228 St Charles Way Suite 200
York, PA 17403
(717) 851-5503 �
03/02/2015 229PM
Patient BRANDON M. KUHN
MRN 002061756
Birth Date 12/03/1991
Encounter: Od 22 2014 8:OSAM
He continues ro have trouble swallowiing(eating one meal per day),dizry,headaches,and cloudy.
Pleue advise. Vu inApril.
Fairclo[h,Vivian-21 Oct 2014 121 PM
TASK REPLIED TO:&eviously Assigned To Faircloth,Vivian
Thc tcsting tn be done Car Chiari wo=sening is brain MI2I
Bahn,linda-21 Oct 2014 2:17 PM
TASK IDITED
is Dr.Faircloth ordering the brain MRI?If so,cari you take caze of this pleau?
Robinson,Tyra-21 Oct 2014 222 PM
TASK EDITED
IDK?Order is not en[ered if order s in questions can be aaswered and sent to pre-auth.
BuchanaqCrystal-21 Oct?A14 5:03 PM
TASK EDITED
Are you ordenng an MRI of the b�sin?
If so please enter the order.
Robinson,Tyra-22 Oct 2014 8�91 AM
TASK EDITED
FYI,there's another fask s[ating the patiem's motha wants a sedaced CT.
Faircloth,Vivian-22 Oct 2014 8 09 A'vI
'IASK REPLIED TO:Previously Assigned To Fauclo[h,Vivian
ordued sedated MRI-that is the STUDY OF CHOICE
Buchaz�u�,Crystal-22 Oct 2014 I 1:05 AM
iASK EDI'IED
I spoke with mom she is very concemed a6out Brandon because all of Itis therapist aze calling hs with wncems
about his cha�ges in bchavior and loss oC abili¢es.
She a willirig to have sedated'✓AI of brain done. N7�at leve]of uigency is this MRI?
Eazlier you ordered e CT of Ma�ullary Sinuses is Lhis s[ill necessary sirae getting NiRI?
Mother told a creatwne will be�eeded and she will call back with fax number for labslip.
Favcloth,Vivian-22 Oct 2014 12:09 PM
'IASK REPLSED TO:Previously Assigned To Feucloth,Vivian
sooner is better
if he looks ill,h should be taken to ED �
Buc}�ar�aqCrysfal-22 Oct 2014 12'32 P;vf
TASK EDITED
Is CT of Maxillary Sinuses still needed since orderir�g MRI of brain?
FauclothVivian-22 Oct 2074 127 PM
TASK REPLIED TO:Previously Assigned To Fairclo[h,Vivian
no
BucheneqCrysfaL 22 Oct 2014 1:48 PM
TASK EDITED
Spoke wi�h mother she is awaze that we are just orderirig the MRI,CT is no lm�ger needed according to
WeIlSpan Neurology �
228 St Charles Way Suite 200
York, PA 17403
(717) 851-5503
03/02/2015 229PM
Patient BRANDON M. KUHN
MRN 002061756
Bidh Date 12/03(1991
Encounter: Od 22 2014 8:08AM
Dr.Favcloth.
Mother wes told she will hear&om someone in a few deys regazding appt for MRI.
BuchanaqCrystal-22 Oct 7A14 1'.54 PM
TASK EDITED
Also advised mofher to feke him to the ID if she feels he is dl or requires emergency evaluation.
Buchanan,Crysfal-22 Oct 7A14 1 S4 PM
TASKIDIPROGRESS
Hettle,Deenah-22 Oct 2014 L59 PM
TASK EDITED
R's mom,Stephanie,rewmed call m provide fac#for Holy Spint lab.Fa<it: 717-920-?b75
Thank you.
Buchanan,Crystal-22 Oct 7AI4 2:05 PM
TASK EDITED
La6slip has been(axed[o Holy Spidt.
Signature
Electretically signed by :Crystal L Buchaoan L.P N.; 10/22/2014 2:06 PM EST.
i !
WeIlSpan Neurology
228 St Charles Way Suite 200
York, PA 17402
(717) 857-5503
03/02/2015 229PM
Patient Copy. This document includes confidential information from your medical
chart and brief highlights of today's visit. To access your labs and more, visR
http://mvwellspan.orq . Please contact our office if you have questions or concems
about your health, or if you have not received the results of any tests wdhin the
timeframe you were given. Thank you for allowing us to partner in your care.
Patient BRANDON M. KUHN
MRN 002061756
Birth Date 12l0311991
Encounter: Oct 82014 3:45PM
Message
Oct 08,2014
Mario Sangillo,MD
Iones Daly Coldren&Associates
2025 Technology Pazkway Sui�e 108
Mechanicsbwg,PA]7050
Deaz Dr.Sangillo:
I had the pleas�se of seeivg BR4NDON KiII-A7 for a neurology follow-up on Oct O8,2014. BRANDOR is a 22
- ycaz-old with aNism and seizwes. He has had some headaches improved on 7PM 25 mg SID. At lilgher dose TPM
he gets aggressive. He�is on Keppra XR SODmg 200�mg BID with good seizure controL MRI of brein no=mal
except sinus disease.
PE'. normal
Imp: CPSsecondazilygenerali�ed
Autism
Rec: Check CT of head�sinuses
Continue cuirerd doses TPM/Keppra/Klonipin
. F/Ci in 6 mon[hs
Pleue see�he defzils of his visit below.
'Ihank you for allowmg me to share in BRANDONs caze.
Sincerely yours
—Vivian Faircloth.
Assessmeo[
Abnolmal bzain scan(794.09)(R94.02).
Headache (784.0)(R51)-
Localization-relamd sycnp[omatic epilcpsy and epileptic syndromes with complex partiat seinaes,not mtraclable,
Please go to xww.mywellspen.org to enrdl in cur portel entl gein ecross�a your leb resups,X-Rey repMs,entl medicel recores.
I
WeIlSpan Neurology
228 St Charles Way SuBe 200
York, PA 17403
(717) 851-5503
03/OZ/2015 229PM
Patient BRANDON M. KUHN
MRN 002061756
Birth Date 12/03/1991
Encounter: Oct 82014 3:45PM
with sta[us epilepticus(345 40)(G40201).
Orders
CT MAXILLOSAUS WO CONTRA57;Requested fot 08 Oct 2014.
Renew ClonazePAM 1 MG Oral Tablet(KlonoPll�;TAKE 1 TABLET THREE 7'IMES DAILY;Q[y90',R3',R�c.
Renew Keppra XR 500 MG Oral Tablet Eatended Releue 24 Hour(LevETIRAcetam ER);Take 4 tablets in ihe
mommg and 4 ta6lets in the evening;Qty720',Rl;R�c.
Renew Topilama[e 25 MG Oral Tablet,TAKE ONE T.4BLET BY MOi1TH TWICE DAILY;Qty 180;Rl;R�c.
Coun/Edu
Coimseli�g/Coordinalion oC Caze: Greater than 50'/0 of the visit wu spent in cowseling or coordinalion of care.
Total visit was 30 minutes. Counseled regarding 7PM side effects and improvements of headaches. Discussed
seizure observation and emergency treatment.
Team Notes
PatienI reNms for a follow-up for epilepsy,autian,migtaines.
The medication list was vea£eNc]adFed with the patie�Ps mothu over the phone.
Refills are needed of all medications.
This p[ocess revealed the following med chenges/discrepancies:
Flwoxaroine IOOmg 1 am 15 pm
TPXlamlpm
Allelgy shots
He repoits fhe following az pofential medication side ellecis: Fone.
Other visits/testir�since last appoiniment EN'I requesting CT scan bain and neck abnorsnal MRI
HPI
Brandon is s 22 y/o young mari with a Mstory of complex partial seizures secondanly generalized and autisv. He
hu reported headaches as well but these seem m be well controlled on Topam�25 milligrams twice a day.
Incre"'g the dose ot Topamax resul�cd i�aggression.
His seizures are relatively well conVolled on Kcppa XR 2000 milligams hvice a day. He is also on Klonopin one
millig�[hrcc tunes a day.
Brandon at[ends C[T Mo�day lYednesday and Fnday. He has commurtity support professiona]w work with hun
before and aftcr he goes to Cencer for Indushial Tainirig. He also gces to therapeu4c horse back riding. He
voluntcers at[he food bank and New Hope ministnes. He has art cluscs,music and speech fherapies.
Allergies
Rec:080ct2014. ListReconciledandAeviewed.
Dilantin CAPS.
Current Meds
Adderall XR 10 MG Oral Capsule E�tended Release 24 Hour(Amphe[amine-Dextroamphet ER);TAKE 1
CAPSULE TWICE DAII.Y.;RPT
1 �
WeIlSpan Neurology
228 St Charles Way Suite 2D0
York, PA 17403
(717) 851-5503
03/OZ/2015 229PM
Patient BRANDON M. KUHN
MRN 002067756
Birth Date 12l03/1991
Encounter: Od 8 2014 3:45PM
Straaera 80 MG Oral Capsule',TAKE 1 CAPS[JI.E DAILY.;RPT
Loratadine 10 MG Ocal Tab1e�TAKE 1 TP.BLET DAII.Y.;RPI'
PriLOSEC 40 MG Ornl CapsWe Delayed Release(Omeprazole)',TAKE 1 CAPSlJLE DFlD.Y.;RPT
FlwozaMINE Mzleace 100 MG Oral Tablet,Take 1 tablet in the�n and 2 table4 in the pm.;RPT
TraZODorie HCl-50 MG Oral'1 ablet;Take 12 is6(25 mg)q pm;RPT
ClonazePAM 1 MG Oral Tablet(K1o�oPII�;TAKE 1 T.4BLE'I THREE TIMES DAII,Y.;Rx
Topiramate 25 MG Oral TabletTake one ta6let in the AM and 2 ta6lets in ihe PM. (25-50)TDD.75mg;RY
Keppca XA 500 MG Oral Tablet Extended Releue 24 Hois(LevE'LLR4cetem ER)',Tal:e 4 tablets in the morttirig
and 4 tableLs in the eve^^a;R�
ROS
BEYOND WHAT MAY SE MEnTIONED IN HPI_
GENERAL:.Derues azry problems wi[hin category
EYES: Deriies axry proble[ns wi4tin category.
EARS/NOSFJl'F3ROAT'. Deniesanyproblemswitluncategory.
RESPIRATORY: Denies any pmblems withi�category.
CARDIAC: Denies auy problems witlrin category.
MOSCiJLOSKEI.ET.4L: Denies arry problems witl�in ca�egary.
GASTROINTES'IINAL: Denies any prahlems wifliln wtegory.
PSYCHOLOGICAL: Denies any pmblems wi[hm category.
NEUAOLOGICAL:involuntary movements,/nvitches during sleep,headaches.
ENDOCRINE- Deniesanyproblemswithincategory.
GEATTOURINARY'. Denies any pmblems within category.
P�MMATOLOGIGLYbfPHATIQ Denies any problems witliln category.
Patiem's mother decreased 1PX�e to eggessive behzvior.
Vi[al Signs
Adult Vitals Recorded by Robinson,Tyra on Octaher 08,2014 03'.56 PM
Height 73.5 in,Weight 1941h,BMI:2525,BSA:2]3
BP: 128/87 mmHg LUE Sitting
HR-110 b/min ;
Physical Esam
Gcn.:Awake and eler[. Sitting cnmforta6ly with iPad on lap. Makes intennittent eye contact. Says"hi" arid waves.
HEENT:The head is nolmocep}alic and atrauma4a The pupils are equa➢y raund and reactive to IighL There are
Cul]extraocular movements without nystagmus. The visual fields are fdl by co�frontational[esting. The oplic disks
are flat. Spontaneous venous pulsations aze seea The oropharynx is pink and mois[. The Tympariic membranes are
cleaz.
Neck The neck is supple. No camtid bruiLc aze ausculfated. No]ymphadmopathy oi}hyromegaly on palpatio�.
Lwgs'. Clear ro auscultation bilateally. No wheezes,rales or rhonchi.
Heaz[:Regular rate and rh�4hm. No m�mnurs,rubs or gallops.
WeIlSpan Neurology
228 St Charles Way Suite 200
York, PA 17403
(717) 851-5503
03/02/2015 229PM
Patient BRANDON M. KUHN
MRN 002061756
Birth Date 12l03l7991
Encounter: Od 6 2014 3:45PM
Abdomen:No�mal active bowel sounds,no hepacosplenomegaly.
Eatremities:No joint deformilie;cyanosis or edema.
Skin:No ashes or neurocutaneous stipnata.
Neurologic
Mental status:NonverbaL Recent andremde memory aze unahle to be assessrd.
Crartial nerves'.Crartial nerves II through}{II aa intact with the pupils equally roimd and reactive to IigM,full eatra
formovemenis,visualacuiTyinlacL Heanngisgrosslyintacl. Facesymmevicwithregardmmotoractivityand
sensation. 'Iongue and wula midline.
Motor'_Jiotor strength is 5 out oF 5 in the upper eactremities prwcimal arid disceL Motor strength is 5 out of 5 in
]owec erzhemities prmcimal and distal. Motor tone is nozmal t}uoughout Muscle bulk is no�mal for age.No
ah�oisal involuntary movements.
Sensmy:Sensadon is defesed.
Deep tendon reflexes:Reflexes in the upper estremities aze 3+out of 4 a�d symmetnc. Lower eatremity reflexes
aze 3+ou[of 4 and s}rtnmetric.
Coordinatlon'.Finger to nose testing end heel-to-shv�tes[ing showed no dy9netria. Romberg is defesed.
Gait and Slation:Surow baud with no evidence o[atar.ia. Heel and toe wallc are defecred.
Pazt Meds
Discontinue Lorafadine 10 MG Oral Tablet.
Discont'vme Pn7.OSEC 40 M(i Oiel Capsule Delayed Releasc(Omeprewle).
Signature
Electrmtically sip�ed by '. Vivian Favcloth MIJ; 10/082014 SOS PM EST.
' WeIlSpan Neurology /
228 St Charles Way Suite 200
York, PA 17402
(717) 857-5503
03/OZ207 5 229PM
Patient Copy. This document includes confidential information from your medical
chart and brief highlights of today's visit. To access your labs and more, visit
http://mVwellspan.orq . Please contact our office if you have questions or concems
about your health, or if you have not received the results of any tests within the
timefreme you were given. Thank you for allowing us to partner in your care.
Patient BRANDON M. KUHN
MRN 002061756
Bidh Date 12/03/1991
Encounter: Jul 18 2014 2:52PM
Message
Recorded as Task
Date'.07/182014 1250 PM,Crea�ed By:Henze,Lori
Task Name'.Acute Illness
AssignedTo:Ne�so-A,Taage Group
Regarding Patient�.KUI-IN,BRANDON M, Status�.Active
Comment:
HenzyLon- 18 Ju12014 12:50 PM
TASK CREATED
Caller:Bethany,Paren[;Ac�ae Illness;(71'n599A860(Home)
DRFaircloth
It hac been yrs since pt has had e seizwe but he has hed several iri the past few days. Pt recently had}tis Keppra
levels cked avd they were fine. Lh Iiang did add ropamax fm HA's.
Rewntly pPs behavior has heen off[he walL He has hecome very aggessive toward�he staff and his mom. His
pvpils will dilate ard go back to nonnal and dila4 again wit}tin minutes.
Pleue call mom at home,717-599-9860 to discuss
thar�ks
Bahn,Linda- 18Iu12014 2:04 PM
TASKINPROGRE55
Bahn,linda- 18 Ju12014 2:16 PM
"1'ASK EDITED
IJr. Favcloth is out of the office this week.Yt seen by you also.
Mo�her reports pt wu at[he ENI'o(f ce this AM.Had an episode[hal EhT thought i[laoked like a seizure.
Screamed sqwnting hzrd,held head,uppex body 4embiing x 20 secs.
Had another episode at 830PM He was watching dis�ey movie that had flashing Gghis. Same sx's. Screamed,
trembliog,held head x 20 secs.
Also had same episode last Wed after seeir�g allergist for allergy shot.
Continues meds-.Keppra 2000-2000,TPX 25-25,and Klonopin lmg TID.
Getting over a cold.
On TPX x 2 ma�[hs.
Decreased appe[ite.
Mofhec would lilce[his taken caze of before nest weeke�. She is havirig respite care,b/c she is going away.
Pleese goto www.myrvellspen.ag to enrdl in cur O�el and gein eccess�o yaur leb results,X-Reyrepats,entl medical rerortls.
( �
WeIlSpan Neurology
228 St Charles Way Suite 200
York, PA 17403
(717) 8515503
03/02/2015 229PM
Patient BRANDON M. KUHN
MRN 002061756
Birth Date 12/03/1991
Encounter: Ju1182014 2:52PM
f/u app[with IJr Faircloth in OcWber.
Pleue advise.
SiangFengjun-18 1d 2014 2'.18 PM
TASK REPLIED TO'.Previously Assigned To Jiang,Fengjun
not clearly seinaes,but may increase TPX w 25-SOmg.
Bahn,Linda- 18Iu12014 2:52 PM
TASK EDITED
Mofher, Stcphanie is awaze.TPX RX sen[to her phazmxy.
Orders
Renew Topuamate 25 MG Oral Tablet;Take o�e tablet in the AM and 2 Wble6 in the PIvL(25-50)TDD:75mg;
Qty270;R3;Rzc Amended By:Iiang,Fengun 07/18/2014 15'.13:42 PM EST.
SigoaW re
Elutronically sigried by :Linde R Bahn L.PN.;07/18/2014 2:52 PM EST.
Electronically sip�ed by :Fengjw Siang NID;07/182014 3'.13 PM EST.
Electrmtically signed by :Linda RBahn L.P N.�,07A 8/2014 436 PM EST.
i �
WeIlSpan Neurology
228 St Charles Way SuRe 200
York, PA 17402
(717) 851-5503
03/OZ2015 230PM
Patient Copy. This document includes confidential information from your medical
chart and brief highlights of today's visit. To access your labs and more, visit
http�//mywellspan.orq . Please contact our offce if you have questions or concerns
about your health, or if you have not received the results of any tests within the
timefreme you were given. Thank you for allowing us to partner in your care.
Patient BRANDON M. KUHN
MRN 002061756
Birth Date 12/03/1991
Encounter: Jun 18 2014 3:30PM
Message
Iw 18,2014.
Assessment
Headeche(784.0)(R51).
Autism(799.00)(F84.0).
Noctumal eruuesis(7883�(N39.44).
Localization-related symptomabc epilepsy and epileptic syndromes with complexpaztial seizures,not mtractable,
with srztuc epilepdcus(345.40)(G40 201).
Orders
LE VETIItACETAM LEVEL;Requested for' 18 Sim 2014_
TOPIRAMASE;Aequested for'. 18 Jun 2014.
CMP,CO'dPREHr.r.NSIVE METABOLIC PANEL, [COMP]',Requened for: 18luri 2014.
CHC V✓ITH DIFF[CBC]{Requested for 18 Jun 2014.
1.blood work sce order.
2.supervise Iwv with taking his medicaation to ue if the bcdwening continues.
3.you have follow up scheduled with Dr.Favcloth.
Coun/Fdu
Counseling/Coordvation of Caze: Grea[er than 35 minutes of the visit was spent in couaseling or coordmation of
caze. Tatal visit was 40 minutes.Discusssed enwesis,wuses,reviewed MRI of brain images,blaod work nest
steps.
Chief Complaint
•BRANDON is a 22 year oldmale with complainLs oCEpilepsy&Au[ism/medical f/u
Team Notes
The medication Gst fhe patientthe caregiver
This process revealed the following med changes/disc¢pancies' He has weaned doum form Tra�adone]00 mg to
25 mg q hs.
He reports the following az pocenlial medication side effects: None.
O[her visiu/testing since las[appoinnnert:I�one.
HPI
no deCwtive seizure.However,mom is concemed about noctumal enuresis.Happened almost�tly,ihen for past
two nights,mom reduced Trazodone ta 25 mg and he did not wet his bed Durmg o�e oChis bedwettmg,mom
noticed some facial twitchir�g.71eft side.
Headaches are beker.Tolerating TPX well. On 25 mg bid.Also lost 5 Ibs.
Pleese go�o wuw.mywellspen.ag�o enrdl in aur partal entl gein ecwss[oyour leb resutts,X-Rey reparts,end metlicel recoMs.
i � �
WeIlSpan Neurology
228 St Charles Way Suite 200
York, PA 17403
(717) 851-5503
03/02/207 5 230PM
Patient BRANDON M. KUHN
MRN 002061756
Birth Date 12l03l1991
Encounter: Jun 182014 3:30PM
Had MRI of bcairt Images reviewed with mmn. Cere6ellar Wnsil slightly low but there is p1enTy of space in
postedor fosse. Mom feels relieved that MRI of bmin is benign.
Had blood wak. Somehow,LEV level from lut week was ahout 1/2 the]evel&om March.Timing of spmimen
collection wac compaza6le.Mom knows that the most recent one was a We trough level. She is not enlvely s�se if
the one from March was a trough level,evev though it wes reques[ed m be a trough level. She dces�ot have faith in
fhe wregiver that day.We also diuussed potential change in manufacNre.We called his pha[macy,and confumed
with phaanacist thet Brandon hes been taki�g brand name Keppra XR
We will repeat LEV level.Discussed seeing wologis[.Discussed limit wafer intake.Brandon seems ro drink a lot oE
water.He was on DDAVP in the past for bed wettlng then efter he stopped bed wetting mom stopped DDAVP.
PMH
HSstory of hyperlipidemia(V7229)(Z86 39)
Hislory of mrntal retazdation(V11.8)(Z86.59)
Hiamry of seizure disorder(V 72A9)(Z86.69)
Stering spell(780-39)(R56.9)-
Allergies
Rec: 18hm2014. ListReconciledandReviewed.
Dilantin CAPS.
Current Meds
Rec' 12Mn2014. List Reconciled and Reviewed.
Adderall HI2 10 MG Orzl Capsule Eztended Releue 24 Hour(Amphetamme-Dexiroamphet ER);TAKE 1
CAPSULE'I WICE DAII.Y.;RP7
Strattera 80 MG O`sl Capsule',TAKE 1 CAPSUi.E DAII,Y.;RPI
Lorafadine 10 MG Oral Tabkt;TAKE 1 TABLEI DP.II,Y.;RP7'
PriLOSEC 40 MG Oral Capsule Deleyed Release(Omeguole);TAKE 1 C.4PSiILE DAII,Y.;RPT
FluvoxaM�SE Mzleate 100 MG Oral Tablet;Take 1 tablet in[he am�td 2 ta6lets in the pm.�,RPT
ClonazePAM 1 MG Oral Tablet(KlonoPII�;TAKE 1 TABLET IHREE TIMES DAII.Y.;Rx
Keppre XR 500 MG Otal Tablet Extended Releese 24 Hour(LevE'1TRAcetam ER);TAKE 4'IABS IN THE AM
A�-D 4 TABS IN THE PM.;Rx
Topuamate 25 MG Oral Tablet,TAKE 1 TP.BLET TWICE DAII,Y;IM
7rzZODone HCl-50 MG Oral Tablet;Take U2 tab(25 mg)q pm;RPI'.
Family Hz
Family lilstory of migainc headaches:Mother(V172)(Z82.0).
ROS
BEYOND W'HAT MAY BE MEN'IIONED IN HPI:
GINERAL:He has calemd down since last visi[.
EYES: Denies arry problems widun wtegory.
EAAS/NOSE/THROAT: Deniesanyproblemswilluncategory.
RESPIR4TORY'. De�ies any problems witiiln category.
CP.RDIAC IJenies any problems wit}nn wtegory.
M[JSCilI.OSKELET4L: Denies any problems withiri category.
GASTROINTESTINAL: Deniesanyproblemswithvicategory.
WeIlSpan Neurology
228 St Charles Way Suite 20D
York, PA 17403
(717) 851-5503
03/02l2015 230PM
Patient BRANDON M. KUHN
MRN 002061756
Birth Date 12l03l1991
Encounter: Jun 182014 3:30PM
PSYCHOLOGiCAL'.
NElJROLOGICAL: involumarymovemenLs,/twirchesdunngsleep headaches-havedecreasedby50%smce
TPX was increased..
Eh�OCRINE: Denies any problems witiiln category.
GENITOORINARY: Deniesanyproblemswiiltincategory.
I-IEIv1ATOLOGIGLYMPHATIC: Denies any problems within ca[egory.
Vi[al Signs
Rewrded by Collier,Lisa M ov 18 Iun 2074 03:51 PM
BP:118/78, LL-E, SSning,
HR:89 6/min,
Height 73.5 us Weight 20016,BMI'.26 kg/m2,
BMI Calculated:26.03,
BSA Calculated:2.16.
Physical Exam
Non verbal.Pmmpted by mom,use his ipad m ask simple questions,6ut does not seem to wmprehend answers,and
does�o[have back and forth dialogue.
Resuks
N62I BRAIN W WO CON'IR4ST 11 J�m 2014 09:12 AM
- MRI BR1IN W WO CONTRAST
MRI BRAIN WITH AI�"D WITHOUT CONTRAST
IMPRESSION:
1.No xute ilil.raclanial infarction,hemolrhege or mass.
2.Fo evidence of intraaanial etiolagy for seizure.
3. Small mucous retention cysLS or polyps.
4.Borderline Chiazi I malformation with some crowding of the
posterior fossa.
IND OF IIvIPRtiSSION-
INIJICATION'.Aistory of autism.�pilepsy. Headaches. Some facial
droop.Difficulry swaRowing.
TECFINIQLE:MRI brain with and without contrast with mul[iplanar Tl,
T2,FI..4IR and diliusion weipJrted seque�ces.
CONTRAST'. 20m1 of MAGNEVIST administered IlJTRAVGNOUS
FIELD STRENGTH: LS 7'esla magnet.
COMPARISON:none available.
l �
WeIlSpan Neurology
228 St Charles Way Suite 200
York, PA 17403
(717) 8515503
03/02/2015 230PM
Patient BRANDON M. KUHN
MRN 002061756
Birth Date 12l03l1991
Encounter: Jun 182014 330PM
FINDINGS:
No sciIIe intracranial infarction,hemoahagy sass,mess effect,
midline shif5 e#ra-�aa]fluid collecfion oc hydcocephalus is
noted. Basilar cistems aze patent.No suspicious wttite maner lesion
of the brain is noted.Slight motion a[[ifacfs limit assessment.
Small mucouc retcnlion cyst or polyp is noled in the left ma�llazy
si�ut.
Major intracruual vazculaz flow voids aze mamtained.Intemal
auditory canals appearunremarkable. Tympanomastoid cavilies are �
imopxifed. Orbits appear unremazkzble.Small mucous retention cy3
or polyp is noted in the right aspect of the sphenoid sinus.
No suspicious intracranial enhancing mass lesion is visual'uzd.
Bilarcral hippocampal femetions are grossly unremarkable.No
suspiciouc evidence of inesial[empoal lobe sclerasis is noted'Jo
evidence of gray matter hetcrotopia is noted. Selle appears
unremarlmble.
Cerehellar tonals descend app[oximately 5 mm below the foramen
magmnn wid.mild aowding of[he pos[erior fossa consisterR with
Chian I malCcema[ion.
This mport was created using Voice Recognition soRware.Thank you
for allowing us[o participete m the wre of your paRen[.If you
have any questions conceming itus repor[please call fhe following
phone numbers:YorkHospitalIma�jng' 717-851-2217;Yrnk Hospital
Women's Imagfng-7ll-851-1901;Gettysbu�g Im=gg^g:717339-2015.
Signature
Electro�iwllysignedby :Fengjw Iiang IvID;06i18/20146:02PMEST.
�
WeIlSpan Neurology
228 St Charles Way Suite 200
York, PA 17402
(717) 857-5503
03/02/207 5 230PM
Patient Copy. This document includes confidential information from your medical
chart and brief highlights of todays visit. To access your labs and more, visit
http://mywellspan.orq . Please contact our offce if you have questions or concerns
about your health, or if you have not received the resutts of any tests within the
timefreme you were given. Thank you for allowing us to partner in your care.
Patient BRANDON M. KUHN
MRN 002061756
Birth Date 12/03/1991
Encounter: Apr282014 1:43PM
Me�sage
Recorded az Tazk
Date:04/28I2014 10:53 Ab1,Created By:Ren&qlisa
Tuk Name:Medication Inquiry
AssigriedTo:Ne�ao-A,Tnagc Group
Regarding Pavent KSJI-IN,BR4VDON M, Siatus:Active
Cenmeril:
Renfro,Lisa-28 Apr 2014 10:53 AM
TASK CREATID
Caller:stephanie,Parent,Miscellar.eous;(71"�599-9860(Day)
jiang
mom had m call over the weeke�d 6c pt was being very aggessive and pt was at the hospital so[he hospital called
drjie�g and it was suggested for pt ro smp ttis topimax
he was taking 2 tahlets a day
mom deaeued him to one a day and that seemed[o be better_now today she is going to give him the 2 a day agavi.
It really seems to help w his headaches.IS ths okay7 pls call back.
Bahn,Linda-28 Apr 2014 1233 PM
TASK EDITED
Non strucmre during last week. Back to routine t}tis week.
S[ill HA's and twitching.
"Too much,too fas1,[oo saon".Awake 34hrs.
Finally slept with OTC meds and Alivan O.Smg of hers-helped calmed down.
TPX 25mg at 4 PM Slept well,but wet bed this AM
Seems]ilce HA's have calmed down.
She is giving hun 1PX Bff1 wtil seen on Thursday,b/c it seems[o be helping the HA's.Bu[if he comes home[oda}'
very aggitated agaiq she will go back to TPX once daily.
She also mendoned pt will not He sfill long enough fo�MRI with only Afivari.
Mother feels like the VEEG wac all for nothing.Fo ariswers.
7iang.Fengjw-28 Apr 2014 138 PM
TASK REPLIED TO:Rcviously Assigned To Iiang,Fengjun
Lisa already azldressed[his,and Lisa spoke ro Stephanie arowd 12'.00 noon today.
Signature
ElecGonically signed by:Linda R Bahn L.P.N.;0428/2014 1�45 PM EST.
Pleese Bobwxw.myuellspen mq[o enrdl in aur partel antl gein ecwss ta ymrle�msulis,X-Rey repMs,entl metlicel mcortls.
i
WeIlSpan Neurology
228 St Charles Way SuRe 200
York, PA 17402
(717) 851-5503
03/OZ2015 230PM
Patient Copy. This document includes confidential information from your medical
chart and brief highlights of today's visit. To access your labs and more,visit
http://mywellspan.orq . Please contact our o�ce if you have questions or concerns
about your health, or if you have not received the results of any tests within the
timeframe you were given. Thank you for allowing us to partner in your qre.
Patient BRANDON M. KUHN
MRN 002061756
Birth Date 12/03l1991
Encounter Apr1420144:10PM
Message
Recorded as Task
Dace�. 04/14/201411:56 AM,Created By:Ro]dan,Ruth
Task Name�. Call Hack
Assip�ed To:Ne�o-A,Clinical Fa'vcbth
Regarding PavenL Ki7FIN,BRANDON M,Staws:In Progress
Commerd:
RoldaqRuth-74 Apr 201 A 11:56 AM
I'ASK CREA'IED
Caller: Stepharue,Mother,Ca1lBack;(7l7)599A860(Day)
Favcloth-Pts mother is calling to check sfatus of EEG appt. Stephanie states fhat the p[is rni[ching is ge[ting
worse and migraines. Please call S[ephanie at 599-9860,Thank you
RobinsoqTyra- 14 Apr 2014 12'.47 PM
TASKINPROGRESS
RobinsoqTyra- l4 Apr 2014 12'.49 PM
IASK EDITED
LMOM for patie�Ps mother to retum call.
Order infavnetion waz sen[to HMC for the doc[or to review.Tesk wu deferred by the ISC for 2 weeks.
RobinsoqTyra- 14 Apr 2014 220 PM �
TASK EIJITED
U.Favcloth,
I spoke with the patlenYs mother again in regards m the referral to HMG She advised she took[he patien[to NY this
weekend to visit family arid he was complaining of a headache. She slept witli him through ihe night arid the
[wiNhi�g is more aggressive and thc mouth pos[urivg is more noticable. She also wavted you fo know that ihe
Keystove Autism Services hzs been nolicing theu s)znptoms az well and will be calling with av update.7hey
advised that his pupils also seem ro enlazge and then he will have the mou[h posnaing and a laughing spell.
She dces�ot warII to add ano[her med wtil the[es['vig is completed. She is willing[o wti[for FIIvIC m reply i(you
believe he will be ok wtil theq bW she feels he may have a breakthrougp seizure.I(anything,she is wondering if
you can ivcrease his Klonopin in the sean[ime.He is cucrently still taking 1 mg TID.
She is also wondenng if we can set fhis sNdy up at York Hospital if he could get in sooner.
� Robinson,Tyre- 14 Apr 2014 227 PM
Pleeu golo wxw.myuellspen.ag to enrdl in our partel entl gein ecress to yaur le�resNts,X-Ray reports,end meEicel reco�tls.
1 l
WeIlSpan Neurology
228 St Charles Way Suite 200
York, PA 17403
(717) 857-5503
03/02/2015 230PM
Patient BRANDON M. KUHN
MRN 002061756
Birth Date 12l03/1991
Encounter: Apr 14 2014 4:10PM
TASK EDITED
I just tallced m Tammy BazcGft and she can get him in on Monday at York Hospital. She will need to obiain the auth
[oday.
Fsrzcloth,Vivian- 14 Apr 2014 2:50 PM
TASK REPLiED TO:Reviously Assip�ed To Fafrc]oth,Vivian
OK forYork
Can incrcase Klonipin to 1 mg 4 x a day
RobinsoqTyra- 14 Apr 2014 2:53 PM
TASKINPROGRESS
Ro6inson,7yra- 14 Apr 2014 3:09 PM
TASK EDITED
I reached the patienPs mother,b�a the call was dropped.I hied calling back,but went snaight to VM
RobinsoqTyra- 14 Apr 2014 4'.10 PM
iASKEDTTED
I spoke with the patienYs mo[her and she advised it is ok Eor�he appt on Monday. She will cal]back[ommrow fo
follow-up on status as she will need to cavicel a train ticket.
She is awaze m inaeue Klonopin to 1 mg 4 x per day.
Signature
Electr�fcallysignedby:'fyta Robu�son;04Q4/20144�10PMEST.