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DANA K, POPE and YETLIN R,
POPE. hi s wife.
Plaint! ffs
26 Hoffer
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY. PENNSYLVANIA
V.
RUTH NAILOR.
Defendant
CIVIL ACTION - LAW
95-6785 CIVIL TERM
IN TRESPASS (M.V.l
l1LR.E;-.e.REIRlAL.c..OliffRENC.f
A pretrial conference was held before the Honorable
George E. Hoffer. p, J. on Wednesday. January 7. 1998.
In this automobile accident case. David W. Knauer.
Esquire. represents the plaintiff; and C, Kent Price. Esquire,
represents the defendant.
The occident happened on the Carlisle Pike near the
intersection of the Silver Springs Road, It occurred at an
intersection. The intersection is uncontrolled by any traffic
signal. The rood is five lanes wide with four in north-south
directions and 0 central turning lone for left-hand turns.
Plaintiff was driving a motorcycle south on the Pike, Defendant
was attempting to turn left from the Pike into the intersecting
rood. Defendant claims she waited until 011 automotive traffic
hod passed her and then attempted to make her turn when she was
struck on the side by plaintiff on his motorcycle.
She claims she didn't see plaintiff. Plaintiff claims
she turned in front of him and that she hod ample time to
observe him.
Although liability is not admitted by counsel at the
pretrial conference, it appears from the nature of the occident
that liability will almost be conceded in the case,
Plaintiff suffered injuries requiring only orthopedic
.
95-6785 Civil Term
Pretrial Conference
Page 2
treatment with the possible exception of his Jaw, Since the
occident. plaintiff has been to see on oral surgeon and
indicates he may hove permanent damage to his Jaw. Although any
treatment applied to this point has all been of 0 conservative
nature without any invasive procedures.
The demand is now thirty-five thousand. and while
there is on offer from the defense of fifteen thousand. the
Court stronglY encourages the defendant to obtain 0 higher offer
of $25.000.00. after hearing the nature of the case.
This is 0 Jury trial estimated to toke 0 day to 0 day
and 0 half to try with four challenges each. Counsel ore
directed to keep in touch with the court odministrator os to
trial schedule.
Each has examined the witness list of the other party
and raises no objection and indicates to the Court that each
will hove all depositions completed well before the trial time.
By the Court.
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David W. Knauer. Esquire
For the Plaintiffs
C. Kent Price. Esquire
P.O. Box 999
Harrisburg, Po. 17108
For the Defendant
Prothonotary
Court Administrator
PlainU ffs
CIVIL ACTION - LAW
95-6785 CIVIL TERM
IN TRESPASS (M.V.1
11 Hoffer
DANA K. POPE, YETLIN R. POPE,: IN THE COURT OF COMMON PLEAS OF
his wife, CUMBERLAND COUNTY, PENNSYLVANIA
V.
RUTH NAILOR,
Defendant
IN RE: PREJ.RlALt.O.NfERENC.E
A pretrial conference was held before the Honorable
George E. Hoffer, Judge, on Wednesday, June 18, 1997.
In this motor vehicle accident case, Mark Swartz,
Esquire, with David Knauer, Esquire, represents the plaintiff;
C. Kent Price, Esquire, represents the defendant.
Among other injuries plaintiff received in this
collision was a back injury. He has been treating with various
chiropractors and now indicates that he will be shortlY seeing
an orthopedic surgeon to evaluate a recent flare UP of his back
injury. That appointment is for early July. Because that
doctor may recommend 0 new course of treatment, plaintiff's
counsel are requesting the case been withdrawn from this trial
list and plaintiff's counsel will relist the case for trial when
they are readY. Defense counsel does not object to this
continuance because plaintiff waives any delay damages from this
moment an until the trial date.
By the Court,
Mark Swartz, Esquire
For the Plaintiff
C. Kent Price, Esquire
P.O. Box 999
Harrisburg, Po. 17108
For the Defendant
Prothonotary
G
Court Administrator
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FllED-OFFICE
OF TH= I'!',:m'!')'/OTARY
97 ./UN 2/, I1H 10: 14
CUMi3El:/,\) CO:;Nry
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DANA K. POPE and
YETLIN R. POPE, his wife,
Plaintiffs
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
NO. 95-6785
JURY TRIAL DEMANDED
v.
RUTH NAILOR,
Defendant
PRAECIPE FOR ENTRY OF APPEARANCE
TO THE PROTHONOTARY:
Please enter the appearance of THOMAS, THOMAS & HAFER as
counsel on behalf of Defendant Ruth Nailor, in the above-captioned
matter. All papers may be served upon the undersigned at P.O. Box
999, Harrisburg, PA 17108-0999.
THOMAS, THOMAS & HAFER
c~~e
305 North Front Street
P.O. Box 999
Harrisburg, PA 17108
(717) 255-7632
1.0. No. 06776
DATE:
-rJ'3 dcrb
ATTORNEYS FOR DEFENDANT
RUTH NAILOR
..
."
...
CERTIFICATE OF SERVICE
AND NOW, this 31st day of July, 1996, I, C. KENT PRICE,
ESQUIRE, for the firm of THOMAS, THOMAS & HAFER, attorneys for
Defendant, hereby certify that I have this day served the within
Praecipe for Entry of Appearance by depositing a copy of the same
in the United States Mail, postage prepaid, at Harrisburg,
Pennsylvania, addressed to:
David W. Knauer, Esquire
411-A East Main Street
Mechanicburg, PA 17055
THOMAS, THOMAS & HAFER
cS-~re
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"
.
DANA K. POPE and
YETLIN R. POPE, his wife,
Plaintiffs
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
NO. 95-6785
JURY TRIAL DEMANDED
v.
RUTH NAILOR,
Defendant
DEFENDANT'S PRE-TRIAL MEMORANDUM
I. FACTUAL BACKGROUND
This personal injury claim arises out of an accident involving
a motorcycle being operated by Plaintiff Dana K. Pope and a
passenger vehicle being operated by Defendant Ruth Nailor on
October 27, 1994. The accident occurred on SR 11, also known as
the Carlisle Pike, in Silver Spring Township.
Mr. Pope was
proceeding in a southerly direction in the left lane and Mrs.
Nailor was proceeding in a northerly direction.
Mrs. Nailor
entered the left turn lane, intending to turn into Silver Drive
Extended, and, after stopping to allow southbound traffic to clear,
she began to make her turn across the path of Mr. Pope. He was
unable to take any evasive action and struck the right back side of
the Nailor vehicle, causing him to be ejected over the trunk of the
car to the pavement.
II . DAMAGES
Please refer to Plaintiffs' Pretrial Memorandum.
III. PRINCIPAL ISSUES OF LIABILITY AND DAMAGES
Negligence, liability, causation and damages.
.....-
. ......
IV. LEGAL ISSUES
There do not appear to be any novel or unusual legal issues
involved that need to be addressed.
v. WITNESSES
Ruth Nailor
ft.'--1_!I!Il"" 'C' .... l_l'liOlIUQu-
11....... 12;1'1-....--
John Zeleznock, M.D.
Bruce Kent, D.D.S.
Defendant reserves the right to supplement this list with
reasonable notice to Plaintiffs, as well as the right to call any
witnesses listed by Plaintiffs.
VI. EXHIBITS
All medical records relevant to Plaintiffs' claims, including
records of Holy Spirit Hospital, East Shore Orthopedic Associates,
Herd Chiropractic Clinic, Beaudry Oral Surgery and Bruce Kent,
D.D.S. Defendant reserves the right to supplement this list with
reasonable notice to Plaintiffs, as well as the right to use any
exhibits listed by the Plaintiffs.
VII. CURRENT STATUS OF SETTLEMENT NEGOTIATIONS
There has been no demand made or offer extended to date.
Respectfully submitted
THOMAS, THOMAS & HAFER
c~quire
305 North Front Street
P.O. Box 999
Harrisburg, PA 17108
(717) 255-7632
1.0. No. 06776
ATTORNEYS FOR DEFENDANT
.
CERTIFICATE OF SERVICE
AND NOW, this 24 th day of April, 1997, I, C. KENT PRICE,
ESQUIRE, for the firm of THOMAS, THOMAS &: HAFER, attorneys for
Defendant, hereby certify that I have this day served the within
Defendant's Pre-Trial Memorandum by depositing a copy of the same
in the United States Mail, postage prepaid, at Harrisburg,
Pennsylvania, addressed to:
David W. Knauer, Esquire
411-A East Main Street
Mechanicburg, PA 17055
THOMAS, THOMAS &: HAFER
~~~
C. Kent Price, Esquire
..., ..' .. .... ,.,'-r_',,_~____
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
DANA K, POPE and
YElliN R. POPE, his wife
Plaintiffs
CIVIL ACTION. LAW
v.
No. 95-t??'f ~~
RUTH NAILOR
JURY TRIAL DEMANDED
Defendant
NOTICE TO DEFEND AND CLAIM RIGHTS
YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set
forth in the following pages, you must take action within twenty (20) days after this
Complaint and Notice are served by entering a written appearance personally or by
allorneyand filing in writing with the Court your defenses or objections to the claims set
forth against you. You are warned that if you fail to do so the case may proceed without
you and a judgment may be entered against you by the Court without further notice for any
money claimed in the Complaint or for any other claim or relief requested by the Plaintiff.
You may lose money or property or other rights important to you.
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO
NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE
OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP.
CUMBELAND COUNTY LAWYER REFERRAL SERVICE
Court Administrator
Cumberland County Courthouse
One Courthouse Square
Carlisle, Pennsylvania 17013
(717) 240.6200
',""'-"-~ ,,-;.,,,, '-;.-:-. ,.....".-....- eo, .
NOTlCIA
Le han demaandado a usled en la corte. SI usted quleie derenderse de estas
demandas expuestas en las paginas slguientes, usted tiene viente (20) dlas de plazo al
partir de la fecha de la demanda y la notificacion. Usted debe presentar una aparfencla
escrita 0 en persoa 0 por abogado y archlvar en la corte enforma escrita sus derensas 0 sus
objections alas demandas en contra de su persona. Sea avisado que sl usted no se
defiende, la corte tomara medidas y puede entrar una orden contra usted sin previa aviso 0
notificacfon y por cualquier queja 0 alivio que es pedido en la peticion de demanda,
Usted puede perder dfnero 0 sus propledades 0 otros derechos Importanted para usted.
LLEVE EST A DEMANDA A UN ABOGADO INMEDIA T AMENTE. SI NO TIENE
ABOGADO 0 SI NO TIENE EL DINERO SUFICIENTE DE PAGAR TAL SERVICIO, VAYA
EN PERSONA 0 LLAME POR TELEFONO A LA OFICINA CUYA DIRECCION SE
ENCUENTRA ESCRITA ABAjO PARA AVERIGUAR DONDE SE PUEDE CONSEGUIR
ASISTENCIA LEGAL.
CUMBELAND COUNTY LAWYER REFERRAL SERVICE
Court Administrator
Cumberland County Courthouse
One Courthouse Square
Carlisle, Pennsylvania 17013
(717) 240-6200
fl;Il}J~
David W. Knauer
Attorney for Plaintirr
Attorney 1.0. No. 21582
411-A East Main Street
Mechanicsburg, PA 17055
(717) 795.7790
Date:11~.;l./; 177 r-
- 2-
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
DANA K, POPE and
YElLIN R, POPE, his wife
Plaintiffs
CIVIL ACTION. LAW
v,
No,
RUTH W. NAILOR
JURY TRIAL DEMANDED
Defendant
COMPLAINT
1, The Plaintiff Dana K. Pope Is an adult Indlvlduill with an address of 1061
West Trlndle Road, Mechanlcsburg, Pennsylvania 17055,
2. The Plaintiff Yetlin R. POI>e Is an ,ulult IndlvlduI11 and sl>ouse of the Plaintiff
Dana K, Pope,
3. The Defendant Ruth W, Nailor Is an adult Individual with an address of 36
Cumberland Drive, Mechanlcsburg, Pennsylvania 17055.
4, At all times relevant herein, the Plaintiff Dana K. Pope was operating a
certain 1982 Honda B45 Magna motorcycle,
5, At all times relevant herein, the Defendant N,lllor was operating a 1992
Buick Century,
6, On October 27, 1994, at or about 12:24 1>.01., the Plaintiff was lawfully
proceeding south on Slate Route 0011 In the left lane.
~ '
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7. On the aforesaid date at the aforesaid time, the Defendant entered the left
lane of State Route 0011 North preparatory to make a left turn across State Route 0011.
a, On the aforesaid date at the aforesaid time, the Defendant crossed into the
lane of travel of the Plaintiff to make a left turn causing a sudden and violent collision with
the Plaintiff's aforesaid motorcycle.
9. The aforesaid collision was causing solely by the carelessness, recklessness,
and negligence of the Defendant Nailor In that she:
(a) failed to be observant of traffic proceeding lawfully in the opposite
direction on State Route 0011;
(b) failed to observe the Plaintiff who was then and there lawfully
proceeding In the opposite direction as aforesaid;
(c) commenced her turn across the lane of travel lawfully occupied by
the Plaintiff;
(d) failed to yield the right of way to the Plaintiff, who was proceeding in
the opposite direction; and
(e) struck the Plaintiff's aforesaid motorcycle.
10. As a result of the aforesaid collision, the Plaintiff has suffered severe and
sundry Injuries to his person.
-2-
COUNT t
Dana K. Pope v. Ruth W. Nailor
11, The Plalnllff Incorporates by reference thereto Paragraphs 1 through 10 of the
within Complaint,
12, As a result of the carelessness. recklessness, and negligence of the Defendant
Nailor, the Plalnllff has suffered severe and sundry Injuries to his person.
13. As a result of Ihe carelessness, recklessness, and negligence of the Defendant
Nailor, the Plalnllff has suffered p.lst pain illld suffering, past loss of wages, past emotional
distress, and past loss of enjoymenlof life and will in the (uture suffer pain and suffering,
IImltallons of economic horizons, lost w.lges, elllollonill distress, and loss of enjoyment of
life,
WHEREFORE, the Plalnllff Dana K, Pope demands judgment In his favor and against
the Defendant Nailor In an amount In excess o( the amount for mandatory referral to
arbitration.
COUNT II
Vellln R. Pope v, Ruth W. Nailor
14, The Plalnllff Incorporates by reference thereto Paragraphs 1 through 13 of the
within Complaint,
15, As a result of Ihe carelessness, recklessness, and negligence of the Defendant
Nailor, the Plalnllff Yetlln R. Pope has suffered the loss of consortium.
- 3-
WHEREFORE, the Plaintiff Yetlin R, Pope demands judgment in her favor and
against the Defendant Nailor in an amount In excess of the amount for mandatory referral
to arbitration.
Date: 7l~k- 07. f; 1'Jr;;;-
avid ,Kna r, Esquire
Attorney for Plaintiff
Attorney 1.0. No. 21582
411-A East Main Street
Mechanlcsburg, PA 17055
(717) 795-7790
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VERIFICATION
Subject to the penalties of 18 Pa,C.S.A. 4904 relating to unsworn falsification to
authorities, I hereby certify that the facts In the foregoing pleading are true and correct to
the best of my Information and belief.
Date:
/03/f'S'
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the
SHERIFF'S RETURN - REGULAR
CASE NO. 199~-0678~ P
COMMONWEALTH OF PENNSYLVANIA 1
COUNTY OF CUMBERLAND
POPE DANA K ET AL
VS.
NAILOR RUTH
KENNETH E, GOSSERT
CUMBERLAND County. Pennsylvania, who
to law. says, the within COMPLAINT
upon NAILOR RUTH W
defendant, at 905100 HOURS. on the ~ day of December
19~ at 36 CUM8ELRAND DRIVE
MECHANICSBURG. PA 17055
. Sheriff or Deputy Sheriff of
being duly sworn according
was served
. CUMBERLAND
County, Pennsylvenia, by handing
a true and attested copy of the
together with NOTICE
and at the seme time directing ~ attention
to RUTH NAILOR
COMPLAINT
to the contents thereof.
Sheriff's Costs.
Docketing
Service
Affidavit
Surcharge
18.00
3.92
.00
2.00
So Iin,!i)l7~ ~
r~-'-:'-r-'f("" ~
K. I homas IU1ne. l:iher1:f1
823.92 DAVID W. KNAUER
12/13/1995
by
Sworn and subscribed to before me
this ok ~ day of /..(b"...I....J
19 th' A. D.
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DANA K. POPE and
YETLIN R. POPE, his wife,
Plaintiffs
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
v.
RUTH NAILOR,
Defendant
NO. 95-6785
JURY TRIAL DEMANDED
NOTICE
TO: Dana K. Pope, Plaintiff
Yetlin R. Pope, Plaintiff
c/o David W. Knauer, Esquire
4ll-A East Main Street
Mechanicburg, PA 17055
YOU ARE HEREBY notified to plead to the enclosed New Matter
within twenty (20) days of service hereof or a default judgment may
be entered against you.
THOMAS, THOMAS & HAFER
c~~~e
305 North Front Street
P.O. Box 999
Harrisburg, PA 17108
(717) 255-7632
ATTORNEYS FOR DEFENDANT
DATED:
e/l31qb
DANA K. POPE and
YETLIN R. POPE, his wife,
Plaintiffs
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
v.
NO. 95-6785
RUTH NAILOR,
Defendant
JURY TRIAL DEMANDED
ANSWER AND NEW MATTER
1. Denied. After reasonable investigation, Defendant is
without information or knowledge sufficient to form a belief as to
the truth of the allegations,
2. Denied. After reasonable investigation, Defendant is
without information or knowledge sufficient to form a belief as to
the truth of the allegations.
3. Admitted.
4. Admitted.
5. Admitted.
6. Admitted.
7. Admitted.
8. Denied as stated.
It is admitted, however, that
Defendant turned left from center turning lane to cross over the
southbound lanes of SR11 intending to enter TR 572 (Silver Drive)
when Plaintiff struck the right rear bumper of Defendant's vehicle
with his motorcycle.
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9. Denied. The allegations of paragraph 9 and subparagraphs
9(a) through 9(e) of the Complaint are conclusions of law and/or
fact to which no answer is required. To the extent that an answer
may be required, the allegations are denied in accordance with
Pa.R.C.P. 1029(e).
10. Denied. After reasonable investigation, Defendant is
without information or knowledge sufficient to form a belief as to
the truth of the allegations,
COUNT I
11. The answers set forth above in paragraphs 1 through 10
are incorporated herein by reference.
12. Denied in accordance with Pa.R.C.P. 1029(e).
13. Denied in accordance with Pa.R.C.P. 1029(e).
WHEREFORE, Defendant demands judgment in her favor and against
Plaintiffs.
COUNT II
14. The answers set forth above in paragraphs 1 through 13
are incorporated herein by reference,
15. Denied in accordance with Pa.R.C.P, 1029(e).
WHEREFORE, Defendant demands judgment in her favor and against
Plaintiffs.
NEW MATTER
16 . Plaintiffs' claims may be barred or reduced by provisions
of the Motor Vehicle Financial Responsibility Act.
-2-
17. Plaintiffs' claims may be barred or limited by the
doctrine of comparative negligence.
18. Some or all of Plaintiffs' alleged injuries may be due to
pre-existing conditions.
19. Some or all of Plaintiffs' alleged injuries and damages
may not have been proximately caused by the accident.
20. Plaintiff Dana K. Pope may have failed to mitigate his
damages.
21, Some or all of the care and treatment obtained by
Plaintiff Dana K. Pope may not have been medically necessary.
WHEREFORE, Defendant demands judgment in his favor and against
Plaintiffs.
THOMAS, THOMAS & HAFER
c..~ <:~
c. Kent prlce, Esquire
305 North Front Street
P.O. Box 999
Harrisburg, PA 17108
(717) 255-7632
I.D. No. 06776
ATTORNEYS FOR DEFENDANT
-3-
.
R~~l~ ~~
VERIFICATION
I verify that the facts set forth in the foregoing Answer and
New Matter are true and correct to the best of my information,
knowledge and belief, although the language is that of counsel, and
to the extent that the content of the foregoing document is that of
counsel, I have relied upon him in making this verification. I
understand that any false statements contained herein are made
subject to the penalties of 18 Pa. C.B.A. 54904, relating to
unsworn falsification to authorities.
DATED: A",~v.s't- 8, ICJqi:.
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.
CERTIFICATE OF SERVICE
AND NOW, this 13th day of August, 1996, I, C. KENT PRICE,
ESQUIRE, for the firm of THOMAS, THOMAS & HAFER, attorneys for
Defendant, hereby certify that I have this day served the within
Answer and New Matter by depositing a copy of the same in the
United States Mail, postage prepaid, at Harrisburg, Pennsylvania,
addressed to:
David W. Knauer, Esquire
411-A East Main Street
Mechanicburg, PA 17055
THOMAS, THOMAS & HAFER
c~~~e
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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
DANA K. POPE and
YETlIN R, POPE, his wife
Plaintiffs
CIVIL ACTION - LAW
v,
No. 1995 Civil 6785
RUTH NAILOR
JURY TRIAL DEMANDED
Defendant
PLAINTIFF'S REPLY TO THE DEFENDANT'S NEW MA TIER
16-21. Denied as alleged, The Plaintiff avers to the contrary that Paragraphs 16-21
inclusive of the Defendant/s New Matter are conclusions of law to which no reply is
required pursuant to the Pennsylvania Rules of Civil Procedure and strict proof thereof is
demanded at time of trial.
WHEREFORE, the Plaintiff demands judgment in his favor and against the
Defendant on the Defendant's New Matter.
Respectfully submitted,
Date:a~/'" 1191.
DAVID W. KNAUER, P.C.
~~
Attorney for Plaintiff
Attorney 1.0. No. 21582
411.A East Main Street
Mechanicsburg, PA 17055
(717) 795-7790
~
CERTIFICATE OF SERVICE
I, David W. Knauer, hereby certify that I did this 14th day of August, 1996, serve a
true and correct copy of the within document on all counsel of record by United States
mall, first class, prepaid addressed as follows:
Co Kent Price, Esquire
Thomas, Thomas & Hafer
P. O. Box 999
Harrisburg, PA 17108
~~;a~
David W. Knauer
Attorney for Plaintiff
Attorney 1.0. No. 21582
411-A East Main Street
Mechanlcsburg, PA 17055
(717) 795-7790
.-
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v.
No, 1995 Civil 6785
,
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
DANA K, POPE and
YETLlN R. POPE, his wife
CIVIL ACTION. LAW
Plaintiffs
RUTH NAILOR
JURY TRIAL DEMANDED
Defendant
NOTICE OF DEPOSITION
Please be advised il)at on October 1, 1996, at 9:00 a.m., the Plaintiff will take the
deposition of Ruth Nailor at the office of David W, Knauer, P.C., 411.A East Main Street,
Mechanlcsburg, Pennsylvania, before a person authorized by law to administer oaths, The
oral examination will continue from day to day until completed.
You are requested to have your client present at the specified time and place. You
are invited to attend and participate in this examination.
U~J.~L
David W. Knauer '
Attorney for Plaintiff
Attorney I.D. No. 21582
411-A East Main Street
Mechanicsburg, PA 17055
(717) 795-7790
Date: September 16, 1996
.. , .,
. ,
CERTIFICATE OF SERVICE
I, David W. Knauer, hereby certify that I did this 16th day of September, 1996,
serve a true and correct copy of the within document on all counsel of record by United
States mail, first class, prepaid addressed as follows:
Co Kent Price, Esquire
Thomas, Thomas & Hafer
p, 0, Box 999
H.m,b.", PA 17108 L
lilt> J. L~~.
David W, Knauer, Esquire
Attorney for Plaintiff
Attorney I.D. No, 21582
411-A East Main Street
Mechanicsburg, PA 17055
(717) 795-7790
"
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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
DANA K. POPE and
YETLlN R, POPE, his wife
Plaintiffs
CIVIL ACTION. LAW
v,
No. 1995 Civil 6785
RUTH NAILOR
Defendant
JURY TRIAL DEMANDED
PLAINTIFF'S REPLY TO THE INTERROGATORIES
OF THE DEFENDANT RUTH NAILOR
1 laHc) , The Plaintiff has not lost income because he Is a salaried employee. However,
depending on his physical condition, his future economic horizons may be impaired. He
works with accident-related pain which, if unresolved, may limit his career with his current
employer as well as the types of work he may be able to do in the future.!
2(a)-(b). For past medical expenses, the Plaintiff will provide copies of bills upon receipt.
Future impairment of economic horizons has not yet been determined. The Plaintiff
reserves the right to supplement the answer to this Interrogatory.
3, The Plaintiff has no special losses except for property damage which has already
been resolved. In addition, see the Plaintiff's answer to Interrogatory No.1 above.
4, Bicycling, motorcycling, weight lifting, running, and hiking as well as normal
family activities.
5. Since the accident, the Plaintiff has not been able to bike, motorcycle, weight
lift, run or hike at the same level as before the accident or at all due to the pain caused by
the accident-related injuries. In addition, this pain has adversely impacted his normal
family activities.
6. Robert J. Beaudry, Jr., D.M.D.
Beaudry Oral Surgery
3600 Old Gettysburg Road
Camp Hill, PA 17011
Robert R. Kaneda, D.O.
East Shore Orthopedics
450 Powers Avenue
Harrisburg, PA 17109
'With regard to these Interrogatories, the Plaintiff incorporates by reference thereto
his responses the Defendant's counsel's questions in his deposition.
Brian Carver, D,C,
Herd Chiropractic Clinic, P.C.
2704 Market Street
Camp Hili, PA 17011
Magnetic Imaging Center
4665 Trlndle Road
Mechanlcsburg, PA 17055
7. The Plaintiff has not been admitted as an In-patient at any hospital.
8, The Plaintiff was transported by ambulance to Holy Spirit Hospital from the
accident scene. Since that time, the health care providers listed In response to
Interrogatory No.6 above have provided accident-related health care,
9. The Plaintiff suffers from temporomandibular joint dysfunction (TM)) as well as
soft tissue injuries. Diagnostic studies have not been completed. The Plaintiff has had a
continuing problem with muscle spasms and/or pain In his right arm, bolh legs, and his
hands,
10. Shortly after birth, the Plaintiff had a double hernia repair. In addition, when he
was three or four years old, he put his left fist through a glass door which required surgical
repair. When the Plaintiff was 17, he suffered a weight lifting injury while exercising his
legs that tore the skin down to the bone. The Plaintiff had a muscular sprain of the neck
which occurred and resolved in 1984. As to diseases, the Plaintiff has only suffered the
normal illnesses of life such as flues and colds.
11. None
12. Prior to the accident, the Plaintiff did not have a family physician.
13. See the Police Report.
14. As of the date of this answer, the Plaintiff has nol yet made a determination of
what exhibits he intends to use at time of trial. The Plaintiff reserves the right to
supplement the answer to this Interrogatory.
15. TMj is a permanent progressive, traumatic injury to the temporomandibular joint
system. As to other injuries, all diagnostic tests have not yet been completed, and the
Plaintiff has continuing pain.
16, Dr. Beaudry will be called as to the Plaintiff's TMj condition. As 10 the
chiropractic care, Dr. Carver will be called. The Plaintiff reserves the right to supplement
the answers to this Interrogatory.
- 2-
"
17. Expert reports will be provided upon receipt.
18. The Plaintiff will provide a copy of the curriculum vitae of each expert upon
receipt.
Respectfully submitted,
DAVID W. KNAUER, P.C.
10 . k,v!tV(-(l..
avid W. Knauer, Esquire
Attorney for the Plaintiff
Attorney I,D, No, 21582
411-A East Main Street
Mechanlcsburg, PA 17055
(717) 795-7790
Date: January 2, 1997
-3-
",e"
.;'"
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CERTIFICAH OF SERVICE
I, David W, Knauer, hereby certify that I did this 2nd day of January, 1997, serve a
true and correct copy of the within document on all counsel of record by United States
mail, first class, prepaid addressed as follows:
r
Co Kent Price, Esquire
Thomas, Thomas & Hafer
P. O. Box 999
Harrisburg, PA 17108
U"W. &N~4
David W. Knauer, Esquire
Attorney for Plaintiff
Attorney 1.0. No. 21582
411-A East Main Street
Mechanlcsburg, PA 17055
(717) 795-7790
. ,
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.A.. ..
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
DANA K, POPE and
YETLlN R. POPE, his wife
Plaintiffs
CIVIL ACTION - LAW
v,
No. 1995 Civil 6785
RUTH NAILOR
Defendant
JURY TRIAL DEMANDED
PLAINTIFF'S REPLY TO THE REQUEST FOR PRODUCTION
OF DOCUMENTS OF THE DEFENDANT RUTH NAILOR
1. See attached. Records from Magnetic Imaging Center will be provided upon
receipt.
Respectfully submitted,
DAVID W. KNAUER, P.C.
<;) "lJ. CrJfr'J"'- '"IJ
avid W. Knauer, Esquire
Attorney for the Plaintiff
Attorney I.D. No. 21582
411-A East Main Street
Mechanicsburg, PA 17055
(717) 795-7790
Date: January 2, 1997
.
~
.
~ '
CERTIFICATE OF SERVICE
I, David W, Knauer, hereby certify that 1 did this 2nd day of January, 1997, serve a
true and correct copy of the within document on all counsel of record by United States
mall, first class, prepaid addressed as follows:
C, Kent Price, Esquire
Thomas, Thomas & Hafer
p, O. Box 999
Harrisburg, PA 17108
( 1lvC~
vid W. Knauer, Esquire
Attorney for Plaintiff
Attorney 1.0. No. 21582
411-A East Main Street
Mechanlcsburg, PA 17055
(717) 795-7790
II.
8202-004881
AETNA LIFE IllS CO-AETtIA HEALTH PLANS
P.O. BOX 1738
READING, PA 19603
,
.
.
"'. '
"',
EXPLANATION OF PROVIDER PAYMENT
1..,111,,,111,,,,,,11.,,11,1,,1.1.1,,.11,,,,1111..,,1..1,,11,1
C HERD CLINIC
2704 MARKET ST
CAMP HILL PA 170],],-'1531
E-23-2110925
PAGE 1
02128/95
AETNA HAS IliPLEMEIlTED ADMIllISTRATIVE CHANGES WHEREBY All CHECKS AND DRAFTS ARE ISSUED IN
THE NAME OF THE PARTY WHOSE TAXPAYER IDENTIFICATION NUMBER (TIN) IS SUBMITTED AS PART OF
AN ASSIGIlED CLAIM, PAYMENTS ARE NOT MADE IN THE NAME OF THE INDIVIDUAL PRACTITIONER
WHO PERFORMED THE SERVICES IN QUESTION UNLESS SUCH PERSON'S TIN APPEARS ON THE SUBMITTED
CLAIM.
ADDITIOIlAllY, All PAYMEIlTS AIlD CLAIM EXPLAIlATIONS RELATING TO INDIVIDUAL PRACTITIOIlERS
SHARIIlG A CoMriol1 TIll AND BIllIllG ADDRESS ARE BULK MAILED TO SUCH ADDRESS,
A DRAFT WAS ISSUED TO C HERD CLINIC (8202-07460065) IN THE AMOUNT OF .119,00,
THE BENEFITS LISTED BELOW REFLECT YOUR PoRTIoll OF THIS PAYMEIlT, IF YOU HAVE AllY QUESTIoIIS
ABOUT THE INDIVIDUAL PAVMEIITS LISTED BELOW, PLEASE CONTACT THE APPROPRIATE ISSUING
SERVICE CEIITER,
NOTE. ALL IIlQUIRIES AIlD CLAIMS SHOULD REFEREIlCE THE INSURED ID NUMBER FOR PROMPT RESPollSE
SERVICE SERVICE SUBnITTED IIEDOTIATED COPAY PENOINO OR SEE DEDUCT PATIENT PAYABLE
DATES Pl CODE NO. EXPENSES ADJUSTHENT AHOUNT NOT PAYABLE RHKS IDLE COINSURANCE RESP AHO~~T
ISSUINO SERVICE CENTERP.D. BOX 25519 RICKnOND, VA 25260, - TEL. 11041 550-1540
PAYOR ID 60054 SUB-ID 051 ORP ND - 656047 ORP NAME - nECHANICSBURO
IIISURED. 0 POPE
PATIErlT,OANA
1~0994 OF 99213 1
120994 OF 97010 1
120994 OF 97014 1
1214-123094 OF 99213 4
1214-123094 OF 97010 4
1214-1230~4 OF .7014 4
CLAln TOTALS.
I1ISUREO
RELATION. SElF
30.00
20,00
20,00
120.00
10.00
80.00
ssa.OO
10.
375729656
PATIENT NOt 01-001530
30.00 Al
20.00 Al
20.00 AI
120.00 Al
10.00 Al
80.00 Al
350,00
64950~
0.00
0.00
0.00
0.00
0.00
0.00
0.00
NO PAY
OIAG. 7291 ORG. TCN.
30.00
20,00
20.00
120.00
10.00
80.00
350.00
ISSUED AIIDUNT
PAYOR ID 60054 SUB-ID 051
ORP NO - 656047 ORP NAME - OVERNITE TRANSPORTATIDN ConpANY
IIlSUREO. H FISHER
PIITIEIIT. HARRV
011&-013095 OF 9q213 2
CLAIn TDTALS.
IIlSUREO
RElATIOII. SelF
60.00
60.00
10.
190303062
PATIENT liD. 1001470
20.00 Al
20.00
OIAG. 7233 ORG. TCN. 64950.
20.00 40.00
20,00 40.00
ISSUED AMOUNT '40.00
ISSUING SERVICE CENTERP.D. BOX 5041 ROCXFORD. IL 61125, - TEL. 11151 229-2200
PAYOR ID 60054 SUI-ID 095 ORP ND - 657193 ORP NAHE - O. D, SEARLE I CD.
IIlSUREO. LK SANGER IIISUREO 10. 314803051
PATIENTtlISA RELATION, SELF PATIENT NOI 01022060
010495 OF 72050 1 90.00
DrAG! 7220 DRBI TeN. 60950:
90,00 90.00 0.00
I SEE RE\'ERSE SIDE FOR CHANGE IN ADDRESS OR BILLING INFORMATlONIPENDlNG OR NOT PAYABLE EXPLANATIONS I
PATIEIIT.
0104-010695
0104-010695
0104-010695
0111~S
SElF
NO. 01001530
60.00 Al
40,00 Al
40.00 Al
30.00 Al
170.00
DrAG! 8470 DRGt TeNt
60.00
40.00
40.00
30.00
170.00
ISSUED AItOUHT
IP-002603
II
AETNA LIFE IllS CO-AETNA HEALTH PLANS
P .0, BOX 17 38
RfADING, PA 19603
".
"', i
EXPLANATION OF PROVIDER PAYMENT
1"0111,0.111,010"11"0110110101110"1110,,1111,,"10.1,,11,1
BT CARVER
2704 MARKET STREET
CAMP HILL PA 170],],-4531
E-23-2110925
PAGE 1
DZl2B/95
AETNA HAS IMPLEMENTED ADMINISTRATIVE CHANGES WHEREBY ALL CHECKS AND DRAFTS ARE ISSUED IN
THE NAME OF THE PARTY WHOSE TAXPAYER IDENTIFICATION NUMBER (TIll> IS SUBMITTED AS PART OF
AN ASSIGNED CLAIM, PAYMENTS ARE NOT MADE III THE IIAME OF THE INDIVIDUAL PRACTITIOIIER
WHO PERFORMED THE SERVICES IN QUESTION UIILESS SUCH PERSON'S TIN APPEARS ON THE SUBMITTED
CLAIM.
ADDITIONALLY. ALL PAYMEIITS AND CLAIM EXPLANATIONS RELATING TO INDIVIDUAL PRACTITIONERS
SHARING A COMMON TIN AHD BILLING ADDRESS ARE BULK MAILED TO SUCH ADDRESS.
FOLLOWING IS AN EXPLANATION OF BENEFITS. IF YOU HAVE AllY QUESTIONS ABOUT THE INDIVIDUAL' 5
CLAIM LISTED BELOW, PLEASE CONTACT THE APPROPRIATE ISSUING SERVICE CENTER.
1I0TE. ALL INQUIRIES AND CLAIMS SHOULD REFERENCE THE INSURED ID NUMBER FOR PROMPT RESPONSE
SERVICE SERVIce SUBHITlED .IEGOTlATED COPAY PENDING DR SEE DEDUCT PATlENT PAYABLE
DATES Pl CODE NO. EXPENSES ADJUSTMENT 'HDUNT NOT PAVABlE RKK5 lalE COINSURANCE RES' AHDUNT
ISSUIND SERVICE CENTERP.D. BOX 25519 RICHHOHD, VA 23260, - TEL, 18041 550-8540
PAYOR ID 60054 SUB-ID 0058 DRP NO - 656047 DRP NAHE . HECHANICSBURD
INSURED.
PATIENT.
0104-010695
0104-010695
0104-010695
0111~S
D POPE INSURED ID.
DANA RELATIOIIo SElF
OF 99215 2 60.00
OF 97010 2 40,00
OF 97014 2 40,00
OF 99213 1 30.00
CLAIH TOTALS. 170.00
375729656
PATIENT 110. 01001530
60.00 C
40.00 C
40.00 C
3D.00 C
170.00
DrAG, 7291 DRGr
ISSUED AHOUHT
TeN. 64950'
0.00
0.00
0.00
O.ll...
0.00
NO PAY
DAliA RELATION.
OF 99215 2 60.00
OF 97010 2 40,00
OF 97014 2 40.00
OF ~9213 1 30.00
CLAIH TOTALS. 170.00
PATIEIIT
64950'
0.00
0,00
0.00
0.00
0.00
NO PAY
.. TDTAL .. eo.oo
SEE RE\'ERSE SIDE FOR CHANGE IN ADDRESS OR BILLING INFORMATlONIPENDING OR NOT PAYABLE EXPLANATIONS
II.
8202-009839
~.
..... '
EXPLANATIOIl OF PROVIDER PAVMEtlT
E-23-2110925
PAGE 1
01/27/95
C HERD CLIInc
2704 MARKET ST
CAMP HILL PA
170]']'-IlS31
AETNA HAS IMPLEt1ENTED ADMINISTRATIVE CHAIlGES WHEREBY ALL CHECKS AlID DRAFTS ARE ISSUED III
THE NAME OF THE PARTY WHOSE TAXPAYER IDENTIFICATIOtl IlUMBER (TIN) IS SUBMITTED AS PART OF
All ASSIGNED CLAIM. PAYI1EIlTS ARE NOT MADE III THE NAME OF THE INDIVIDUAL PRACTITIOIlER
WHO PERFORMED THE SERVICES IN QUESTIOIl UNLESS SUCH PERSON'S TIN APPEARS 011 THE SUBMITTED
CLAIM.
ADDITIOIlALLY, ALL PAYMENTS AIID CLAIM EXPLAIlATIOIIS RELATIIlG TO IIlDIVIDUAL PRACTITIONERS
SHARING A COMMON TIN AIlD BILLING ADDRESS ARE BULK MAILED TO SUCH ADDRESS.
A DRAFT WAS ISSUED TO C HERD CLIIlIC (8202-06958341) IN THE AMOUIlT OF $312.00.
THE BENEFITS LISTED BELOW REFLECT YOUR PORTIOIl OF THIS PAVMEtlT. IF YOU HAVE AllY QUESTIOIlS
ABOUT THE INDIVIDUAL PAYMEtlTS LISTED BELOW, PLEASE CONTACT THE APPROPRIATE ISSUIIlG
SERVICE CEIlTER,
tlOTE. ALL I1IQUIRIES AtlD CLAIMS SHOULD REFEREIlCE THE INSURED ID IlUMBER FOR PROMPT RESPOIISE.
SERVICE
DATES
SERVICE SUBnITTED NEGOTIATED CDPAY PEtlDIllG DR SEE DEDUCT
Pl COOl!' NO. E~PENSES ADJUSTHENT AHO'JNT IIOT PAYABLE RHKS tOLE cottlSURI.NCE
PATIENT PAYABLE
RESP AHOUNT
ISSUING SERVICE CENTERP.O. BOX 25519 RICHI1DND, VA 23:60, - TEL. 18041 330-8340
PAYOR 10 60054 SUB-ID 058 GRP NO - 656047 GRP NAnE - nECHANICSBURG
IIlSURED: D POPE
PATIENT.DANA
1:0994 OF 99213 1
1:0994 OF 97010 1
120994 OF 97014 1
1214-123094 OF 99213 4
1214-123094 OF 97010 4
1214-12!OQ4 OF 07014 4
CLAIn TOTALS.
IIlSURED
RELATIOI" SElF
50.00
20.00
20.00
120.00
80.00
80.00
350.00
10.
375729656
PATIENT NO. 0\-001530
30.00 C
20.00 C
20.00 C
120.00 C
80.00 C
80.00 C
350.00
DIAGt 7291 DRGt
ISSUED AnOUNT
TeN. 649501
0.00
0.00
0.00
0.00
0.00
0.00
0.00
NO PAY
--------------------------------------------------------------------------------.-.----.-.---.-------.-.-..------------.-.-
ISSUING SERVICE CENTERP.O. BOX 1058 KACDN, GA 31:02-105B, - TEL. 191:1 757-7400
PAYOR 10 60054 SUB-ID 125 GRP NO - 6978BO GRP NAnE - US SECURITY ASSOCIATES
IIlSURED. WR WHEELER
PATIEIIT,WAVllE
1212-121994 OF 99213 5
1212-121994 OF 97010 3
1212-121qQ4 OF Qr014 3
CLAIn TOTALS.
INSURED
RElATIOII. SElF
150.00
60.00
'0.00
270.00
ID.
165381606
PATIEIIT liD. 01-020550
1:0.00 E
40.00 E
40.00 E
200.00
DIAG,
7233 DRG1 TeNt
6.00 6.00
4.00 4.00
..00 4.110
14.00 14.00
ISSUED AnOUlIT
55950'
::4.00
16.00
H..OO
56.00
156.00
.. TOTAL U
.. TOTAL PAID ..
156.00
156.00
SEE REVERSE SIDE FOR CHANGE IN ADDRESS OR BILLING INFORMATIONIPENDING OR NOT PAYABLE EXPLANATIONS
\.... "'"
II
AETNA LIFE INS CO-AETNA HEALTH PLAIIS
P.O. BOX 1738
READIIIG, PA 19603
.
8202-009838
.
.
.
.
..... "
SUMMARY DF PROVIDER PAYMEIIT
ISSUED AMOUNT
DRAFT AMOUIIT
$312.00
$312.00
111,111,"111,"".11".11,1"1,1.1",11",,1111,,,,1,,1"11,1
C HERD CLINIC
2704 MARKET ST
CAMP HILL PA 170:Ll.-4S31
E-23-Z1109Z5
PAGE 1
01/27/95
AETNA HAS IMPLEl1EIITED ADMItIISTRATIVE CHANGES WHEREBY ALL CHECKS MID DRAFTS ARE ISSUED IN
THE NAME OF THE PARTY WHOSE TAXPAYER IDEllTIFICATIOII NUl1BER <TItIl IS SUBMITTED AS PART OF
AN ASSIGNED CLAIM, PAYMENTS ARE NOT MADE IN THE NAME OF THE INDIVIDUAL PRACTITIONER
WHO PERFORMED THE SERVICES III QUESTION UNLESS SUCH PERSOII'S TIN APPEARS ON THE SUBMITTED
CLAIM,
ADDITIONALLY. ALL PAYMENTS AIID CLAIM EXPLAIIATIOIIS RELATIIIG TO IllDIVIDUAL PRACTITIONERS
SHARING A COMMOrl TIll AIID BILLIllG ADDRESS ARE BULK MAILED TO SUCH ADDRESS.
ENCLOSED IS A DRAFT <8Z02-06958341) III THE AMOUIIT OF $31Z,00, THE FOLLOWING LIST
PROVIDES A BREAKDOWN OF EACH PROVIDER'S PORTION OF THIS DRAFT, PLEASE REFER TO THE
ATTACHED EXPLAIIATIOIIS OF DETAIL,
NOTE.
ALL INQUIRIES AND CLAIMS SHOULD REFERENCE THE IllSURED ID IIUMBER FOR PROMPT RESPOIISE,
PAYMEIITCS) ISSUED FOR.
TOTAL PAID.
C HERD CLINIC
GM DINCHER
00000
00001
$56.00
$256.00
I SEE REVERSE SIDE FOR CHANGE IN ADDRESS OR BILLING INFOR!IlATIONIPENDlNG OR NOT PAYABLE EXPLANATIONS I
, 0:::: (,J-N- ~D 110
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II- ~ .e... -
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R .a~ ~& ~~ 0 tl 0
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~ 15' 0 -4 -4 ii
s: - ii1. iiI . io
~ ~ j' 5' 11.. ll.g. !!L....
'28 ~ :fi 15' olI' 15' ....
::I.' ~il ~l is' mlii
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i5' ~ ~ "' !:
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UI
Chart your tractionlng on a daily basis
Weight used: Level 1 : Ibs. Level 2: Ibs.
Date Minutes Comments Date Minutes Comments
II ) II -:7 Ole.
Ii 111.1 ...1 1'1/<..
I
I
,
II
AETlIA LIFE IllS CO-AETlIA HEALTH PLAIIS
P,O. BOX 1758
REIIDING. PA 19603 ...
8202-00762B
.' .
EXPLANATION OF PROVI'DER PAYMENT
1,11111,11111..111111..,11.1.,1.1.1.,,11.11.111111..1.,1..11.1
BT CARVER
2704 MARKET STREET
CAMP HILL PA ], 70],],-453],
E-23-2110925-00002
PAGE 1
061Z8/95
AETNA HAS IMPLEMENTED ADMINISTRATIVE CHANGES WHEREBY ALL CHECKS AIID DRAFTS ARE ISSUED Itl
THE NAME OF THE PARTY WHOSE TAXPAVER IDEllTIFICATIOtl IIUMBER (TIll) IS SUBMITTED AS PART OF
All ASSIGIlED CLAIM. PAYMEIITS ARE 1I0T MADE III THE NAME OF THE IIIDIVIDUAL PRACTITIOIlER
WHO PERFORMED THE SERVICES IN QUESTION UIILESS SUCH PERSON'S TIN APPEARS ON THE SUBMITTED
CLAIM,
ADDITIONALLY, ALL PAYMENTS AIID CLAIM EXPLANATIONS RELATIIlG TO IIIDIVIDUAL PRACTITIOtlERS
SHARING A COMMOIl TIN AND BILLItlG ADDRESS ARE BULK MAILED TO SUCH ADDRESS.
A DRAFT WAS ISSUED TO HERD CLIllIC (B202-09656132) III THE AMOUNT OF $40.00,
THE BEIlEFITS LISTED BELOW REFLECT YOUR PORTION OF THIS PAYMENT. IF YOU HAVE ANY QUESTIOnS
ABOUT THE INDIVIDUAL PAYMENTS LISTED BELOW. PLEASE COtlTACT THE APPROPRIATE ISSUING
SERVICE CEIlTER.
NOTE. ALL INQUIRIES AND CLAIMS SHOULD REFERENCE THE INSURED 10 NUMBER FOR PROMPT RESPOIISE,
SERVICE SERVICE SUBMITTED NEGDTllTED CGPlY PENDING DR SEE DEDUCT PATIENT PAYABLE
DATES PL CODe NO. EXPENSES ADJUSTMENT AMOUNT NOT PI.Vl.tlLE RHJ(S IelE COINSURlNCE RESP AHOUt1T
ISSUING SERVICE CENTERP.O. BOX 25519 RICHMONO, VA 25260, - TEL. (8041 330-8340
PAYOR ID 60054 sua-ID 058 GRP NO . 656047 GRP NkME - OVERNITE TRANSPORTATION COMPANY
IlISURED. 0 POPE IIlSURED 10.
PATtErn ,DAliA HELATtDDrl. SELF
0!'8' 05~lt9S ..9,F 90213 2 ~_:oo
CLAIM TOTALS. 60.00
375729656
PATIEIIT 110. 01001530
20.00 Al
20.00
DIAG. 7291 DHG. TCN. 6'9517'
20.00 ':'0.00
20.00 40.00
ISSUED AMOUNT $40.00
.. TOTAL ...
.. DRAFT AMOUNT ..
040.00
$40.00
~
SEE REVERSE SIDE FOR CHANGE IN ADDRESS OR BILLING INFORMATlONIPENDING OR NOT PAYABLE EXPLANATIONS
. ..... '"y'',''' ,~.,
.. ""';..,",
II.
AETNA LIFE JIIS CO-AETllA HEALTH PlAIIS
P.O. BOX 1738
RIiADJ/lG. PA 19603
8202-007625
..,
SUMMARV OF PROVIDER PAVMENT
1",111",111""1,11,"11,1,,1,1,1,"1111I.1111,,"1,.1,,11,1
OM DINCHER
2704 MARKET STREET
CAMP HILL PA 170],],-4531
E-23-2110925
PAGE 1
06/28/95
AETNA HAS IMPLEMENTED ADMINISTRATIVE CHAIIGES WHEREBV ALL CHECKS AIID DRAFTS ARE ISSUED III
THE IlAME OF THE PARTV WHOSE TAXPAVER IDEIITIFICATION llUMBER (TIlll JS SUBMJTTEO AS PART OF
AN ASSJGIIED CLAIM, PAVMEllTS ARE NOT MADE JIl THE NAME OF THE JIIDIVJDUAL PRACTITIOllER
WHO PERFORMED THE SERVJCES IN QUESTJOII UllLESS SUCH PERSOll'S TIll APPEARS 011 THE SUBllITTED
CLAIM.
ADDITIONALLV. All PAVMEllTS AllD CLAIM EXPLAIIATIOIIS RELATIIIG TO IIIOJVIDUAL PRACTITIOllERS
SHARING A COMMON TIN AND BILLING ADDRESS ARE BULK MAILED TO SUCH ADDRESS.
EllCLOSED IS A DRAFT (8202-09656131) III THE AMOUNT OF $107,00, THE FOLLOWIIIG LJST
PROVIDES A BREAKDOWN OF EACH PROVIDER'S PORTION OF THIS DRAFT. PLEASE REFER TO THE
ATTACHED EXPLAIIATIONS OF DETAIL,
Il0TE,
All INQUIRIES AllD CLAIMS SHOULD REFEREllCE THE INSURED ID NUMBER FOR PROMPT RESPOllSE.
PAVMENT(S) ISSUED FOR,
TOTAL PAID,
BT CARVER
GM DIllCHER
00002
08157
$107.00
..00
ISSUED AMOUIIT
DRAFT AMOUllT
$107.00
$107,00
I SEE REVERSE SIDE FOR CHANGE IN ADDRESS OR BILLING INFORMATlONIPENDING OR NOT PAYABLE EXPLANATIONS I
II
2P-0001:
~.
~.
EXPLAIIATIOII OF PROVIDER PAYMENT
BT CARVER
2704 MARKET STREET
CAMP HILL PA
PAGE 1
06/13/95
E-23-2110925-00002
170],],-4531
AETllA HAS IMPLEMENTED ADMINISTRATIVE CHANGES WHEREBY ALL CHECKS AIID DRAFTS ARE ISSUED III
THE IIAME OF THE PARTY WHOSE TAXPAYER IDEIITIFICATIOII IIUMBER nUll IS SUBMITTED AS PART OF
All ASSIGllED CLAIM. PAYMENTS ARE 1l0T MADE III THE llAME OF THE UlDIVIDUAL PRACTITIOllER
WHO PERFORMED THE SERVICES IN QUESTION UIlLESS SUCH PERSOIl'S TIll APPEARS 011 THE SUBllITTED
CLAIM.
ADDITIONALLY. ALL PAYMENTS AIlD CLAIM EXPLANATIOllS RELATING TO UIDIVIDUAL PRACTITIONERS
SHARIUG A COMMOll TIll AIlD BILLWG ADDRESS ARE BULK MAILED TO SUCH ADDRESS.
FOLLOWUIG IS All EXPLAIlATION OF BEllEFITS. IF YOU HAVE AllY QUESTIONS ABOUT THE INDIVIDUAL'
CLAIM LISTED BELOW, PLEASE COllTACT THE APPROPRIATE ISSUUIG SERVICE CEIlTER.
1l0TE. ALL INQUIRIES AIlD CLAIMS SHOULD REFEREllCE THE IIlSURED ID NUMBER FOR PROMPT RESPOII:
SERVICE SERVICE SUBMITTED NEGOTIATED COPAY PENOI/ID OR SEE OEDUCT PATIENT PAYABLE
DiTES PL CODE ND. E)(P~NSES ADJUSTHENT AHOUNT NOT PAYABLE RI1t(S IDLE COINSUUNCE RES' AHOt:UT
ISSUINC SERVICE CENTERP.O, BOX 25519 RICHMOND, VA 23260, - TEL. 'ea~J 330-e3~0
PAYOR 10 600S~ SUB-ID Dose CRP NO - 656a~7 CRP NAME - OVERNITE TRANSPORTATION COMPANY
IIlSURED, D POPE IllSURED ID.
"',TIEIlT. DAllA REtATlO/1t SELF
~SOft-OS22QS OF .0213 2 60.00
CLAIM TOTALS. 60,00
375729656
PATIEllT 110. 01001530
60.00 A1
60,ao
DIAG. 7291 ORB. TCN. 649~:
60.00 O.C-
60.00 0.0:
ISSUED AMOUNT PEND ED
.. TOTAL .. co.o~
"b;!:l~ q.. IJ
f ~h_t~fJ vi'~"~
lJUN 1 ~ 1995 j
I SEE REVERSE SIDE FOR CHANGE IN ADDRESS OR BILLING INFORMATlONIPENDlNG OR NOT PAYABLE EXPLANATIONS I
ill.
8202-0:50240
.(
EXPLANATION OF PROVIDER PAYMENT
E-23-2110925
PAGE 1
04/28/95
HERD CLINIC
2704 MARKET ST
CAMP HILL PA
17011-4531
AETNA HAS IMPLEMENTED ADMINISTRATIVE CHAIlGES WHEREBY ALL CHECKS AIlO DRAFTS ARE ISSUED IN
THE NAME OF THE PARTY WHOSE TAXPAYER IDENTIFICATION NUMBER (TIN) IS SUBMITTED AS PART OF
AN ASSIGIlED CLAIM. PAY~IENTS ARE NOT MADE III THE NAME OF THE IIlDIVIDUAL PRACTITIONER
WHO PERFORMED THE SERVICES IN QUESTION UNLESS SUCH PERSON'S TIN APPEARS ON THE SUBMITTED
CLAIM,
ADDITIONALLY, ALL PAY~lEIlTS AND CLAIM EXPLANATIONS RELATING TO INDIVIDUAL PRACTITIONERS
SHARING A COMMON TIN AND BILLING ADDRESS ARE BULK MAILED TO SUCH ADDRESS,
A DRAFT WAS ISSUED TO HERD CLINIC (8202-08529155) IN THE AMOUIlT OF .730.00.
THE BEIlEFITS LISTED BELOW REFLECT YOUR PORTIOIl OF THIS PAYMENT. IF YOU HAVE AllY QUESTIONS
ABOUT THE I1UiIVIDUAL PAYMENTS LISTED BELOW, PLEASE CONTACT THE APPROPRIATE ISSUING
SERVICE CENTER,
NOTE, ALL IIIQUIRIES AND CLAIMS SHOULD REFEREIlCE THE INSURED ID NUMBER FOR PROMPT RESPONSE
SERVICE SERVICE SUBNITTED NEGOTIATED COPAY PENDING OR SEE DEDUCT PATIENT PAYABLE
DATES Pl CODE 'fO. EXPENSES ADJUSTHENT AHOUNT NOT PAYABLE RHKS tDlE COINSURANCE RESP AHDUNT
ISSUING SERVICE CENTERP.O. BOX 2551' RICHNOND, VA 23260, - TEL. 18041 330-8340
PAYOR 10 60054 SUB-ID 058 C~P NO - 656047 GRP NANE - NECHAHICSBURO
INSURED ID,
RElATlOI" SElF
50.00
20.00
20,00
120.00
BO.OO
80.00
550.00
375729656
PATIENT NO. 01-001530
DIAGt
INSURED, D POPE
PATIENT. DAllA
120"4 OF "213 1
120"4 OF '7010 1
1~0"4 OF '7014 1
1214-1230'4 OF "213 4
1214-1230'4 OF '7010 4
1~14-123094 OF 97014 4
CLAIN TOTALS'
7291 DRGI TeNt
6.00 6.00
4.00 4.00
4.00 4.00
24.00 24.00
16,00 16.00
16.00 16.00
70,00 70,00
ISSUED ANOUNT
64951(
2'1.0D
16.00
16.00
96.00
64.00
(,4.00
280.00
'280.00
1280.00
'280,00
.. TOTAL ..
.. TOTAL PAID ..
~~$~~"~
MAY 011995 '
I SEE REVERSE SIDE FOR CHANGE IN ADDRESS OR BILLING INFORMATlONIPENDING OR NOT PAYABLE EXPLANATIONS I
II
~
8202-050245
EXPLANATION OF PROVIDER PAYMENT
E-25-2110925-00002
PAGE 1
04/28/95
BT CARVER
2704 MARKET STREET
CAMP HILL PA
],7D]']'-4531
AETNA HAS IMPLEMENTED ADMltlISTRATlVE CHAIIGES WHEREBY ALL CHECKS AND DRAFTS ARE ISSUED IN
THE NAME OF THE PARTY WHOSE TAXPAYER IDEIITIFICATION NUMBER (TIN) IS SUBMITTED AS PART OF
AN ASSIGNED CLAIM. PAYMENTS ARE 1I0T HADE IN THE IIAME OF THE INDIVIDUAL PRACTITIOIlER
WHO PERFORMED THE SERVICES IN QUESTION UNLESS SUCH PERSON'S TIN APPEARS ON THE SUBMITTED
CLAIM.
ADDITIONALLY, ALL PAYMENTS AND CLAIM EXPLANATIONS RELATING TO IIlDIVIDUAL PRACTITIONERS
SHARING A COMMON TIN AND BILLING ADDRESS ARE BULK MAILED TO SUCH ADDRESS,
A DRAFT WAS ISSUED TO GM DINCHER (8202-08529156) III THE AMOUllT OF $401.60.
THE BEliEF ITS LISTED BELOW REFLECT YOUR PORTION OF THIS PAYMEIIT. IF YOU HAVE AllY QUESTIOIIS
ABOUT THE IIlDIVIDUAL PAYMENTS LISTED BELOW, PLEASE CONTACT THE APPROPRIATE ISSUING
SERVICE CENTER.
NOTE. ALL IIlQUIRIES AND CLAIMS SHOULD REFEREIICE THE INSURED ID NUMBER FOR PROMPT RESPONSE.
SERVICE
DAT~S
SERVICE SUBnITTED NEGOTIATED CDPAY PENDING DR SEE DEDUCT PATIENT PAYABLE
Pl COD~ NO. ~XPEHSES ADJUSTMENT AHOUNT NOT 'AVABL' RHKS YBl' COINSURANCE RES' AHOUNT
ISSUING SERVICE CENTERP.O. BOK 25519 RICHnOND, VA 23260, . TEL. 18041 550-8540
PAYOR 10 60054 SUB-ID 058 GRP NO - 656047 GRP NAnE - nECHANICSBURG
ID. 575729656
PATIENT liD. 01001530
INSURED
RELATIOtI1 SELF
65.00
40,00
210,00
140.00
140.00
o
655.00
IIISURED. D POPE
PATIENT. DANA
110294 OF 72070 1
110294 OF 99202 1
1104-112594 OF 99215 7
1104-112594 OF 97010 7
1104-112594 OF 97014 7
4 F .
CLAln TOTALS.
DIAG.
~5.00
40.00
48,00
TCIIt 649510'
65,00 0.00
40.00 0.00
80,40 129.60
28.00 112.00
28.00 112.00
7291 DRG.
32,40
28,00
2B.00
155.00
100.40 255.40
ISSUED AHOUNT
2~.OO C
25,00
11141J4 OF QQn70 1 25.00
CLAln TOTALS. 25.00
0104-010695 OF 99215 2 60.00
OlD4- 010695 OF 970lD 2 40,00
0104-0lD695 OF 97014 2 40.00
OlllQS OF I9q21! 1 30.00
CUln TOTALS. 170.00
ISSUED AHOUNT
60.00
40,00
40.00
30.00
170,00
ISSUED ,,"OUNT
60,00
40.00
40,00
30.00
170.00
l~
.. TOTAL ..
.. TOTAL PAID ..
401,60
U01.6D
0.00
0.00
NO ,,,y
0.00
0.00
0.00
0.00
0.00
HO PAY
9401.60
9401.60
SEE REVERSE SIDE FOR CHANGE IN ADDRESS OR BILLING INFORMATlONIPENDING OR NOT PAYABLE EXPLANATIONS
rm PICA ':_n. ;'1 jl::'.", .. ',C, m-
, ~o~"-'"' n::.....,. n~IALT".....ntUC.U.m,"'''' I'~ ::~~"'" ~ ,," ~ ""M"" , 11""&11III I}
:-J-,{ (~'J (~'.S$NJ (VA'-",,) (SlNOIIDJ ($5NJ.... lID) ...:..;,;, '7~'-':'t'~'~1
a. 'ATIINrl NAMa fLlII N.m.. 'If" H.m.. MIOGlf Irmllll ~. 'AllIHnl"UM DATI "r.lIlX.O .,...u..O'I....... ,.........., """......,__
MM,DD.VV
:IJ':'~ D,:,"A io-: '''l~ L'"4 .1 .;:': ~ ;:'I:;~'E ':'I'::,r.:"
I. 'ATIINT, ADD"III'No., SUitt) · ..{]IILAT~D,T:n".O .[l 1. mIURIO" ADOAIIIINo.. IItttl)
'. ~:, ~ 1.'l;"'3T "ir. ~. !.ltd_ ~ :'i.:-,.;;p .... "'..... .. Ot/l. :....,1..1 ,.IE-,T '\" ~l : >';:-.L :: .- C,: r
,
CITY ':~~T. .. '''TIlH1' STATUI CITY I.T~~~
...."0 MI"INQ 01....0 :
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ZUlli COOl I ~1U:'"ONllln;llla. Arll Coa.) ZI'C~I TIL.U"ONlllNCLUOI AAIA CODII
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t. OTHUlINIUAIO" NAMIIL.&aC Name, ,..... Name. MlCldlt /Mlall 10." '''TIlNrs CONDITION AILATlD TO: '1.INSURID', POuCY GROuP OR 'ICA NUMS,,, i
; :':-t-:'. '. - - : ~.,~
, .
.. OTHIR INSURID'S POLICY OR GROUP NUMSIR L Et.lPLOYUINnICUAAINT OA JIA!VIOuS) L INSuRED I CATI OfIIIRT" "n 'IX 'n "
Dyes QNO MM,D01VY
. " Ii', I';,..
..,
D, OTMI" INSURID'S DATI 0' IIRTH t.ln SEX D. AUTO ACCI::lENTl IUCI"""', D. EMpu)YER'S NAMI OR SCHCCt. HAWI
MM : DO : VY I M '0 Ovt. DNa . if}::':';I'1 -::" ':1:"1 ,,;: _, '... ,
! ~ ,
c. IMPLOYER'S NANE OR SCHOOL. NAI.lE C. OTHER "'QENT1 DNa c. INSURANCE PLAN tWol! OR PROGRAM fUoMl I
VES
,
d. INSURANce PLAN NAME OR PROQAAl,I "AME tOG, RESERVED FOA I.OCAL. USE a.IS n~ ANOn~EA1.TH BENEm p..Nf?
YES NO N.....'I1"'"'IO.."lClc:omDil1.4rtI.M
MAD BACK 0' 'ORM IUDAl COWLlnNQ & IIGMNQ THIS FOR"', " INSuREC'S OR AUTI10A:Z!C PERSON S SIONATUA! l'iIlnonz.
f2, PATllNrSCR AUTHORIzED PfRSON'S SIQNATUA! I M'lOnl. tnI,......ot.".. rtlICQ tlI Clt'* ifIIclrTNbon '*"1IFy ~ 01 mea.tM blntlrtllO N ioNln:;W ~"14* fer I
IOCWDCeII_c&IIm.llIIO""'~ClI~DII\IfIlI""'lOm""'Ol'IQf!'lf~wf'OKCftII......"....,. ~"GeI..'"hOIC ceo..
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i:'~T! !i1~7 ~ ~ C- :'.A ':' "_'. ;:: =:L.':: I~'" .: ~.I,' ,- ..
1",;1 , . ':"t," _ "r=. -' .... I
SIGNED O'TE S.'OfilED
14 DATI 0fI CuRRENT: ~ IU.NESSI"~ly'l'IGComIOA 115.11 PAnoo HAS HAD $AA,lE OR S;MlAR IWIESS l' DATES PATiENT UtWlLE TO WORK IN CO.IRR[NT OCC;';PAnCN
.... 0 DO , yy INJURY IAccoencl OR GIVE FIAST DATE MM. D::l . YV MM,DO.Y'f .......DD yY I
'.;.1 ~.... .... PAEDNANCY IUCP, FROM , , '0 , ,
.7, PilAAtE OF REFERRlNQ PHYSIC.....,., OR :r"EFi SOURCE /171. I D. NlNSfR OF REFERRINQ PI1,s.ciAAI 11. I1OSPITAUZATION DArES FlELATEQ TO CiJlVlENT SERviCES
VII 00 VV VII CO 'fY
'00lI , , TO , ,
'1 RESERVED FOR LOCAl. uSE 2~ D~LA8b, SC,"-'ADES
I ,
- ,.1- .. ....., - " , '.' .. ~ YES "" I ,
21. D:AG'IOSlS OR NATURE 01' IWiESS CFlINJURY. IRELATE ITEIotS 1.%.3 CR. TO ITEM 2'E BY I.INII ~ 22 MEOtCAIO RESuBMISSION
CODE I OR:GiNAL, AE'. NO. i
'L..::.:...S...;.. L.::..:...
3, .' -
23 PRIOR AUTHORIZATION NuIotBER ,
' '-'.'.", .' . I ,
,. . , . c C E , G " , , J I .
'of)' I ';8 I"':' '!:" e.\I~r:r"'~~~~Pil.:~:' Ol"&;b~SIS SCI1A."QU ~:D IJ;~ lEMa Ie:. .E~O'O" ,
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21 ~"'AfUlllE ()iJ PI1'f~N i:; lu~r 3Z ""IoI~"'~ ADDlIIns OF ,....CIUT'f V."llll SlRv.:U WElIIl J.:I .!1'fSCIA,H S 1UP~ElII S 8/UJ-.Q NAME. AD;)lIIlSl. ZJfJ COOl
I'" LUDIHCi DlO"lI C IDl'" lIIl'CI "t '"OlftIfllWlllOl"tlorOfhCtI ,",,-~f.. _~. " .
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'. ,_ -. ..' .... .. ---,
SIGHED ." ;'.!'. ~ 1011I..:. ,. , ,1.1i. :
0'" ..., '".
PLEASE
DO NOT
STAPLE
IN THIS
AREA
;','::
J
.
"."j, ?',):t. '~'!'l.."','~
r..l'":i':j"'ltl',
, :";'..,',,!
~ " ~. .-.... ~.
c
~ ,
.,'
'HEALTH INSURANCE CLAIM 'FORM
,
IA,PP"Cv!C 1'1' ........ C~CI'.. OH IoIEDC..... S["~.C[ ....1
PLEASE PRINT OR TYPE
APPROvt:l or.ta.o;164:lOI FOA~ ",,'..t500c.UO., FORl,I RA&-.500.
"""ROVED O~8"2~S-<105S FORM CWCP,,5OC. APPROVEO OMlk?no-ooo' ICM"l,lp...
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..
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C
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~
,
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Ih
II.
lP-003167
AETNA LIFE INS CO-AETNA HEALTH PLANS
P.O. BOX 1738
RE~DING, PA 19603 J
..
EXPLANATION OF PROVIDER PAYMENT
1...111.11111.1111.11...11.1111.1.1...11..111111.11I1111..11.1
BT CARVER
2704 MARKET STREET
CAMP HILL PA 170],],-4531
PAGE 1
03/16/95
E-23-21l0925
AETNA HAS IMPLEMENTED ADMINISTRATIVE CHAllGES WHEREBY ALL CHECKS AND DRAFTS ARE ISSUED IN
THE NAME OF THE PARTY WHOSE TAXPAYER IDENTIFICATION NUMBER (TIN) IS SUBMITTED AS PART OF
AN ASSIGNED CLAIM, PAYMENTS ARE NOT MADE IN THE NAME OF THE INDIVIDUAL PRACTITIONER
WHO PERFORtlED THE SERVICES IN QUESTION UNLESS SUCH PERSOll'S TIN APPEARS ON THE SUBMITTED
CLAIM,
ADDITIONALLY, ALL I'AYMEtlTS AND CLAIM EXPLANATIONS RELATlIlG TO I1lJjIVIDUAL PRACTITIONERS
SHARING A COMMOtl TIN AIID BILLING ADDRESS ARE BULK MAILED TO SUCH ADDRESS.
FOLLOWING IS AN EXPLANATION OF BENEFITS, IF YOU HAVE ANY QUESTIONS ABOUT THE INDIVIDUAL'S
CLAIM LISTED BELOW, PLEASE CONTACT THE APPROPRIATE ISSUING SERVICE CENTER,
NOTE. ALL INQUIRIES AND CLAIMS SHOULD REFERENCE THE INSURED ID NUMBER FOR PROMPT RESPOIlSE
SERVICE SERVICE SUBllInED NEGOTIATED COPAY PENDIIlG DR SEE DEDUCT
~ P X ~ ~H NA
PATIENT
. A
ISSUING SERVICE CEHTERP.O, BOX 2551' RICNHONO, VA 25260, - TEL. 180~1 550-85~0
PAYOR 10 6005~ SUB-IO 0058 GRP NO - 6560~7 GRP NAnE . HECNANICSBURG
375729656
AT tH N T 4 O'
OF 72070 1 65.GO A1 65.00 0.00
OF "202 1 40.00 A1 ~O,OO 0.00
OF "215 7 210.00 Al 21D,00 o .aD
OF '7010 7 140.00 Al 1~0.00 0.00
OF '7014 7 1~0.00 Al 1~0.00 0.00
o 0 A 6 0 o 0
CLAIH TOTALS. 655.00 655.00 0.00
ISSUED AHOUHT NO PAY
.. TOTAL .. SO.OO
SEE REVERSE SIDE fOR CHANGE IN ADDRESS OR BILLING INFORMA TIOSIPENDING OR NOT PAY ABLE EXPLANA TlONS
PLEASE
DO NOT
STAPLE
IN THIS
AREA
;:'c"j . 'H ;_! F~
1 :'.:.~U:;I:'i'j:';::
ca.
P. O. f\OX 85{'17<1
R I CHI'1CtJD
NFHEAIrrA 1~~Uf.1~'N~ CL~IMl=ORM
VA
. .
21.2a5--5.~'
rTTl .~A
I J.ltOIl;AH~ hlEUIl;AlU,........, l;nAM 'U~ ~ C..,.v,iPvA 1!lI~ UI"t" ". IN:JU"~u II 1.1.1. NUMBIR
h;~~,n;~'d 1(~<<w"SSNJ I j.VA',,'j n~~~H~n~~U~-p'~ I,/O} 375-72-q&5&
II'IC"~'
-
IHlTE'" 1/ :.
2 PA TlENT'& NAME. CUll Nam., '1'" Him.. t.lloaCI. 1Nl1&11
POPE DANA
6. PATIIN1". ADDRESS tNo., SUNIl
1121&1 WEST TRINDl..E ROAD
CLAIM REF
.)PATIENTSBIRTI1DATe .~ SEX..,......, "INSUREO'&NAMII~NaIN.'lfIt'Wnt,MloOlItrlll..,.
I~ ~ 0P,<' ~~v&l "IX I '1 I POPE DANA
S. PATI~ELATION~ TO ~ED ,......, 7. INSURfD I ACORUS lNo.. SetMU
S"'IX I_I 1'=""'1 101....1 I 10&1 WEST TRI~'Dl..E ROAD
. 'AnINT STATUS ClTY !"TATI
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21. CLAGt~OSIS OR NATURE OF ILWESS OR INJURy, IREl.ATE ITEMS 1oZ.. OR.. TO ITEM 241 BY CP.EI ~ :2.IIEOICAIO RE5U9\4IS$lON I
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I-fERIj CHIROPRACTIC CLINIC'
270. Morkel S"..I . Comp HIli, Pennsvlvonlo 17011 . (7\7) 737.1681
"
~ONTHLY PROGRESS REPORT
PATIENT: ~ p op..6--
Date of this report: DEC311994
T~e ove captioned patient:
{is under active care.
has been released from care.
has reached a state of maximum medical improvement for this condition
and has been released from active care. He/She has been advised to
return on an as needed basis for the control of pain and exacerbations.
This is ~ maintenance care.
His~ condition at this time:
~ is improving with the present course of treatment.
() remains static.
() is retrogressing.
Interim Aggravations or Accidents:
() extending standing, sitting or stooping.
() household duties.
( ) duties appurtenant to the patient's regular employment.
( ) Other (please specify)
Present subjective complaints:
.
,
Prognosis :
Treatment plan: This pati .t is t be seen time(s a week for the next
~ week(s), and will then be re-evaluated after ~t7 days for
his,.... existing health status.
The patient *IIis not disabled from work at this time because of this in~ury.
BRIAN T. CARVER, D.C.
SS' 255-78-3676
IRS'
23-2110925
HERB CHffiOPRACTIC CLINIC
270~ Marke' S.,ee. . Camp HIli, Pennsylvania 17011 . (717) 737.1681
MONTHLY PROGRESS REPORT
PATIENT: ~ ri,~e..-
Date of this report: JAN S 11995
The~ove captioned patient:
~~ !s under active care.
l has been released from care.
has reached a state of maximum medical improvement for this condition
and has been released from active care. He/She has been advised to
return on an as needed basis for the control of pain and exacerbations.
This is ~ maintenance care.
H~S condition at this time:
t ts improving with the present course of treatment.
( remains static.
() is retrogressing.
Interim Aggravations or Accidents:
( 1 extending standing, sitting or stooping.
( household duties.
( duties appurtenant to the patient's regular employment.
( Other (please specify)
Present subjective complaints: :[~ ~.
prOgnOsis:~~ 4-.
T.,,"'" ,1." Th" :::;"" " to b, ",. ~ 'i',(.) . ",. f" 'b, .",
~ week(s), and will then be re-evaluated after ~ days for
his;tIWexisting health status.
The patient~is not disabled from work at this time because of this injury.
BRIAN T. CARVER, D.C.
SS' 255-7B-3676
IRS'
23-2110925
..-
HERn CHIRo'PRActIC ClDNIC.
270-4 Market S"eel . Camp Hili" Pennsylvania 17011 . (717) 737.1681
"
MOHTHl T PROGRESS REPORT
PATIENT: ~ 'j)~pa..-
Date of ,this report: FEB 161995
me ove captioned patient:
is under active care.
has been released from care.
has reached a state of maximum medical improvement for this condition
and has been released from active care. He/She has been advised to (.
return on an as needed basis for the control of pain and exacerbations.
This is not maintenance care.
ms condition at this time:
is improving with the present course of treatment.
( remains static.
( is retrogressing.
Interim Aggravations or Accidents:
.
. I \ extending standing, sitting or stooping.
household duties.
duties appurtenant to the patient's regular employment.
Other (please specify)
Present suBjective complaint~: ~ utiL +- ~~:.....
Prognosis:
-
~t!lk(r&tz:f;
u.\.~
Treatment plan: This pat ent is to be seen time(s), a week for the next
week(s), and will then be re-evaluated after days for
his/her existing health status.
The patienttlVis not disabled from work at this time because of this injury.
.----.. . .---'"
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..... ...,_\R_.. ...... ~ .......It._. 1.._.
..,:
BRIAN T. CARVER. D.C.
55t 255-78-3676
IRS'
.
23-21l0925
ROErr.-Ge,:GLGGIC;'L REPORT
PATIENT:
A..
Cervic~1 Soine
( I tl.ld
(\)"';'<1i1d
I I Mild
Thoracic Saine
( I Mild
Lumbar Saine
C~TE OF X.RAY: J'- Ot .,,,,
( I Mederate
'( I :.Ioderate
I I :.Ioderate
ISe'/ere.
I Se'/ere
I Se'lere
Apexed It
~:e:(~ at
;'cex~ at
':'!:e:cec 3t
I I Negative for ~eo;ant frac~re or gross csteccat:oolcgy as '/isualized.
( I Lcss ef I I Se'/ereiy decreased () :,\i1c!y ceo;reasec lumbar loreetic e::r/e.
I I Apparent lumear m.(oscasm I I Mild I I Mocerate I 1 Sa'/ere.
I I Daxtro . scoiiescs. I I Miid I I Mocerate (1 Sa'/ere.
I I Le'/o _ scoliosis. I I Mild (I Moderate I I Se'/ere.
I I Narrew disc scaca between
I I Artic::lar facets aooear to be
I I Soendvlelir.:1eses. grade (II I 2 (I 3
( 1 Rig:ot ilium rotated
I I Left iiium retatec
( IOtMer
( I Negat!'/e for recent fracture or gross oSTeccy.fi'elog'( as '/isualized.
( I Loss of (I Se'lerely decreased M Miloly dec~eased cer/ic~llorcetic c::rve.
( I Negative fer discogenic lesien.
I I ~parent cer/ical myespasm,
I y(Cemo . scoliosis,
( I Le'/o, scoliosis.
I I Narrowed disc soaces between
( ) Encroachment ef the neuroforamina ber,',een
( 1.,Osteoarthritis of
1.10tMer
( I Negative fer reeent fracture or gross ostec;:a:J'1oiog'( as visualized.
I I K '(phetic curve acpesrs normal.
( I Apparent myos::asm.
( I Negative fer discogenic lesion.
I l~extl'o' scolicsis. ) I }..Mild
(v1' Le'/o . scoliesis, (.',..1' (/1 Mila
( ) Narrowed cis.:: ~ac!! be!'....een
I I Osteoart::ritis cf
( IOL'1er
E.~tremities
( I
( I
( I
Other
-
( I
I I
( I
OvervIew of X. Rav Finaings
I :.\cderate
) Se'/ere.
I Moderate
I.. '
...ccerate
I Se'/ere.
ISe'/ere.
;'ce.~ed at
Acexlr. at
-'
*,
i
i
\ \
.
HERD CHIROPRACTIC CLINIC
2704 Market Street . Camp HIli, Pennlylvanla 17011 . (717)737.1681
INITIAL REPORT
TO: Aetna Life Insurance Company
PATIENT: DANA POPE
DATE OF INJURY 10/27/94
EMPLOYER: Overnite Transportation
1. Incident of Injury "I was headinq west on Carlisle Pike, 84 yr. old female,
south in the turnin lane ulled in front of me..........instead of
completing her turn she came to a stop. t er rlg rear quar er pane . (over)
2. Patient's Complaints Constant dull neck pain, at times severe and throbbing,
dail frontal and temperal headaches, left & right hand pain, intermittent
sta ng ro lng ml - ac paln, occaSl na .
3. Objective Findings (Examination) Positive Foramina Compression, positive
Soto-Hall, positive right LaSeque's, positive Bilateral Ely's, positive
Kern's ain and restriction in cervical range of motion studies.
4. X-ray Analysis Summary Decrease in normal cervical lordosis, right cervical
spine deviation, left upper thoracic spine deviation.
5, Diagnosis 729.1 Cervical Myalgia, 729.2 Cervical Neuritis, 847.0 Cervical
Strain/Sprain, 724.1 Pain in the Thoracic Spine.
6. Alternate Summary (Comments) It is in my opinion, based upon the description
of the accident, the immediate onset of symptoms, my examination and xray
findin s, and m ex erience in similar cases, that this accident was the
cause of the n ury.
7. Disability Data Unknown at present time.
8, Examination Forms Attached? Yes
-
No
-
9. Additional Evaluations Attached?
Yes
-
No
-
10. Accident Report Attached?
Yes
-
No
-
Brian T. Carver, D.C., SS, 255-78-3676, IRS' 23-2110925
Doctor's Signature Date
11/21/94
Completed by
,.
.'
~I:r..
" ;r.
'., :
.
NOT'~ICAlION OF ACCIDENT INVESTIGATION
SILVER. ING\TOWNSHIP POLICE DEPARTMENT
6475.Carllsle PIke, Mechanlcsburg, PA 17055
Im,Il7.0101
Im)lll-OllI
(717) 231.11I1
"
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.:.
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REI'tlRlAILt:
.P
NON.REI'tlRTAlLE:
o
N'lle.I, h".,y gl,.n Ihlllh. ItC,o.nl ,"0,,,"0 '''ill' IS 'ling I"YOstlgJl'O by Silver Sp"ng Td"nSh'p Polle. OIpln.
m.nllnO lhallh. Common""'lh of Ptnnsyl,"n.. PoIIC' AeelCl,nl R,pon w~1 ,. su,m,n,o IS prmll'Id oy S'el"n
314&(e) ,llh' V.hlel. Cod.,
Thl'l' I NON.REI'tlRTAlLE leelOtnl1S pre,c"b.O 'y lh. V'h,el. Cocl., Th.lnlorlNlI,n subm'lled b."" i, Obll,n,O
by lh. Ollie" I,r your ..nyon/lntl In hIVIng Ih. p"pe, ,nlorlNllon lor your ,.,urane. company,
7HIS IS THE ONLY INFORMATION THE I'tlUCE WILL HAVE. NO REI'tlRI WILL IE MADE.
OWNlA
ODOAlSS
-
PO<a.IHCIOIHI N.OIIIII
M CARRIER &I CARAllA
ADDRESS ODORISS
69 On,STArE " ClTY,S"'l
& Z1P CODE , & lIPCODf.
70 USDOT. ce. NCI 70 USOO1. ce. NCI
~Vllt l3 ClAGO ,. QYWR ~'lH 7. GWWR
CONno, IOQYrYPE CCHnO,
75. NO OF ~tllZ.lAOOUS IS NO OF n RELtASE OF HAl YAT
AllES UATEAlALS nus yo HO lINKC
- Cllu.. - CllIlPAHY 1)11 S:~k
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.......
POLICE INFORMATION ACCIOENT LOCATION
IIUCIDEIH TA94-356 J :0, CO'i.'tlMaERlAND CODE 21
NUMBER
2. AGE'''CY SILVER SPRING '1WP. POLICE DEFT. 21. MU~I'i.~ SPRING '1WP. CODE 212
NAME
3. SrAnONt 212/21 · PAln0L6 PRINCIPAL ROADWA Y INFORMA TION
PnECINCT ZONE
l\ INVESTlli,'IO'mM COIDIAN BADGE 9 :2, nDU'E NO, on SROOll sarrn ( CARLISLE PIKE)
E.J. NUMBEn SlnEET NAME
· ArPnOVEDBV s;:e76-tLift;tv ~~~n;JI/O;J.. :3 SPEED ~~YPE ~:CCESS
L,MIT 45 HIGHWAV 0 CDNTnOL 1
7, ItlVESTlGATl01 18, A/lnlVAb26 INTERSECTING ROAD:
DATE 0-27-94 TIME hrs
ACCIDENT INFORMATION :8 nOUTE NO on T-572 (SILVER DR. EXTENDEDl
STnEET NAME
V. ACCIDENT 10-27-94 'OD<\fJ~y :7, SPEED NP f!9,TVPE 0 ~~CCESS 0
DATE LIMIT HIOHWAY CONTnOL
It T1MEOF 1224hrs 12. NUMBEA 2 IF NOT A T INTERSECTION:
DAV Ol' UNITS
t3 . H.I'tJFD 1'...'INiunED " PRrv. rnop. vO N~ 1n. CROSS srREET OR
ACCIDENT SEGMENT MARKER
"' 010 VEHICLE HAvE Ie' ':E l:lEMOvED 7. VEHIClE DAf.AACiE 31. DIReCTION N S E W 132. CISTA'4Ce
F'nOM THE SCEUE' O.IlDNE UNIT I [!] FnOM SITE FnOM SITE FT. MI
VUlT' :IUIT 2' '.L1GHT :13. DISTANCE WAS 0 0
Z . MOOF.nA TE QJ MEAsunED ESTIMATED
vO 1l1Kl vON0 3. SEVEnE UUIT 2' ~CO"STRUCTIO" 0 ~~nAFFIC PRI'~CIP"'L INTEnSECTlllG
ZOtlE CONTnOL QJ OJ
Ie IIAZAnOQUS vO Ill!] 'I. PENNDOT vO NI!] DEVICE
MATERIALS pnOPEnTV
UNIT '1 UNIT' 2
~ l.E'3ALl Y Y iJ 137 REG. 13.p~ATE 315 LEG^ll Y Y 'k137. REG 7LFCJr 3B, STATE
_ PARKED' 0 PLME W03728 PAnKED' 0 ex PLATE PA
~9 F^ TInE OR 45099800801 39 rA TITLE OA 34479705507
OUT.OF-STATE VIN OUT-oF.STATE VIN
10 O\'V'~E" to. OWllER
Rl1rH W. NAILCR DANA K. POPE
.11 QWIlER 'I'. OWNER
ADonESS 36 CUl)BEr,.lJ\ND DR. ADDRESS 1061 W. 'IRINDLE RD
'::i'2'CITY. SlATE 12. CITY, STAre CS~URr. I'll. 1 "In.;.;
& ZIPCOOE MOCHANICSBURG, PA. 17055 I ZIPCOoE
IJ VE^R ]:m!i& '3, VEA"", 14. MAKE
92
.11:; MODEL. (NOT "1"15 lN~ '5, MODEL 'I~~T Rd' l.e.l~s
BODY TYPE) CENlRURY V riD NO UtlKo BODV TVPE NO UIlKo
r.Il,IOOOY "8 lSPECIAL r~~EHICLE . ~BDoV ,n ~SPECIAL n ~~EHIClE .
.- TYPE 04 "" USAGE 0 OWNERSHIP TVPE USAGE OWt~ERSHIP
~o WMIALIMr"CT '.~.9~EHIClE 52)TnAVEL .,,' ~1"ITIAllMP^fT ~VEHIClE n ~~RAVEL dn
~!Nr 5_,_ ~~.!~!YLO - SPEEO POINT L- S7ATUS SPEED
....'I\Ir-.U1CLE ..,ll.1flIVF.R ~ r'- -1 5S.)ORIVER 53 )VEItIClE ~}DnIVEn ,I I !!5.\DRIVER
ORADIE'" 1 " pnESEIlCE 1 - CONDitiON 1 - G"AOIENT 1 PRESENCE 1 ".; CONDITlor., 1
~r. tllll'.Eft 02 555 062 1~1 'ip,>:E ~ll, CRIVER 23 509 061 rH. STAlE
IlUf.1BER '''UMBER PA
~. CnlVEn 58. DRIVER
IlAME Rl1rH W. NAILOR IlAME DANA K. POPE
~p onlliER 59. DRIVEA
ADDnESS 36 CUMBERIAND DR. ADDRESS 1061 W. 'IRINDLE RD.
;;n.CIfY, SfATE 17055 r.o. CITY, STATE
I ZlPCODE MOCHANICSBURG, PA. I ZIPCDoE MEX:Ill\NICSBURG. PA. 17055
~l ~E'I( F I ~, CAIE OF '96~~31i14 f11. SF.X --Ifl2. DATE OF 5.f' PHOt'E
BlnrH 02-26-10 M BlnTH 02-04-61 95-8676
fl.-1 COMM v~ 155. DRIVER 168 DRiveR &4. COMM VEH 165. CRlvEn lee. CRIVER
vO N CLASS C SSI vo Nib CLASS Q\ S S'
t>;' CAnRIER 67. CARRIER
-
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ADDRESS ADDnESS
'!~ CllY. STATE eg CITV. STATE ,~,~ ,....... II
. ZlrCOOE I ZlPCOOE
10 USDDT , -pee. puc. 70. USOOT , ICC' PUc, ...
7~lVEH l~CAROO U. OVWR ~VEH ~ ' CARGO 740VWA
'-, COIlF1Q. COY TYPE . CONFIO. 00'1' TYPE
75 NO OF Q.!J~AZAROOUS 77 RElfjSE 'OHAZ "'0 :5. liD OF ~, HAZAnDDUS 77. RE'OASE EJ HAZ MAT
AXLES MATERIALS v N UNK AXLES MATERIALS V N UtlKO
^^."5 fHc}21
1470850
PAGE,-1-
CENTEn FDn HIGHWAY SAFETY
-
~"';::".,
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~ I
COMMONWEAL TH.oF PENNSYL VANIA
POLICE ACCIDENT REPORT
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DIAGNOSIS SHEET
OATE
\'-'
PATIENT'S NM1E ,~)tM'..LG l-Y~
CERVICAL
1 723.2 Cervicocranial Syndrome
2 722.0 Displacement of Cervical Disc
3 ~3 Cervicobrachial Syndrome
A~ Cervical Myalgia
B 723.1 Cervicalgia
C 729.2 Cervical Neuralgia
o 723.4 Cervical Radiculitis
Ec..~ Cervical Neuritis
F 729.2 Radicular Neuralgia
G 729.2 Cranial Neuralgia
H 353.0 Cervical Plexus Compression
I 724.9 Compression of Spinal Nerve Root
K 346.9 Migraine Headaches
L 723.5 Cervical Torticollis
N 72B.B Cervical Myofascitis
o 73B.4 Cervical Spondylosis
P 336.9 Cervical Neurovascular Compression
Q 780.4 Vertigo (Neuropathic)
rr 847.~ Cervical Sprain/Strain
U 722.0 Cervical Disc Syndrome
V 729.2 Brachial Neuralgia
W 723.2 Cervical Nerve Root Compression
THORACIC
J-~
Y 723.4
Z 724.4
a 786.5
b 786.5
c 786.0
d 785.1
r 353.3
Displacement of Thoracic Int. Disc
Pain in the Thoracic Spine
Brachial Neuritis/Radiculitis
Thoracic Neuritis/Radiculitis
Chest pain, unspecified
Nerve root compression
Dyspnea
Heart Palpitations
Nerve root irritation/degeneration
LEG AND KlfEE
v 719.46 Pain in lower leg
t 844 Sprain/Strain of knee or leg
SHOULDER AND ELBOW
z 959.2 Injury to shoulder
> 996.3 Injury to elbow
OTHER
, 723.1
- 470
) 493.9
'\ 830.0
, 717.9
R 780.7
f 782.3
Spondylosis
Influenza
Asthma, Bronchial
TMJ Subluxation
Paravertebral Myofascitis
Fatigue
Edema
NOV \J 2 1994
LUKBAR, SACROILIAC, AND COCCYX
5 722.2
6 724.6
7 724.7
8 724.71
g 724.4
h 724.3
i 722.1
j 724.3
k 722.2
1 724.4
m 724.4
o 839.0
q 353.4
s 846.0
u 722.10
/ 724
729.5
Lumbar Int. Disc Syndrome
Disorders of the Lumbosacral or
Sacroiliac Joint
Unspecified Disorder/Coccyx
Hypermobility of Coccyx
Lumbago (low back back)
Sciatica
Disc Involvement
Sciatic neuritis
Intervertebral Disc Syndrome
Radicular Neuralgia
Neuritis (Lumbar/Lumbosacral)
Subluxation
Lumbar Plexus Disorder
Lumbar Sprain/Strain
Prolapse, protrusion, rupture or
herniation of disc
Other & Unspecified Disorders/Back
Inflammation of the Hip Joint
WRIST, HAND AND FINGERS
w 959.3 Injury to wrist
x 955.4 Injury to Hand
y 955.9 Injury to nerve in hand or wrist
S 357.2 Carpel Tunnel Syndrome
ANKLE, FOOT AND TOES
1 959.7 Injury to ankle or-foot
@ 845.0 Sprain/Strain of ankle
" 723.7 Calcaneal Spur
M 355.5 Tarsal Tunnel Syndrome
OTHER
~
7 729.82
\ 625.4
... 780.51
& 079.0
( 995.3
. 693.1
J 477 . 9
< 712.0
, 737
~. 956.1
j
[
] 551. 3
n 355.0
e 787.9
112.5
Bedwetting
Menstrual Pain/Cramps
PMS
Insomnia
Viral Infection, unspecified
Allergies, unspecified
Food Allergy
Respiratory Allergy
Arthritis
Curvature of spine
Spondylolosis
Degenerative Disc Disease
Degenerative Joint Disease
Hfatal Hernia
Sinus
GI Complaints
Candida
13. Do you. have any congenital (Irom birth) factors WhIC" ralate'to this problem?
describe:
( )Ves
po. If" yes. please
14. Do you have any previous Illnesses which relate to lhls case?
( )Ves
~o. " yes, please describe:
15. Have you ever been Involved!n an accident before?
1)71 Ves
) No, If yes, please describe, Including datels) and
type(s) of accidents, as well as InJury(les) received.
~, '&I
--&J,'""".6Nfi/15O t4~ /Sc'IIINflt:::A ..,S;I,..",u
,
.sw.&A.I..,~
Ffrj? u.',,fIEA ou~ 'iJ' €':5'~'<'~ j
16. Where were you taken after the accident? J/.( S{J,A,)1 '*...."'TA!
17. Have you ~een treated by another doctor since the accident? () Ves
and address:
What type of trealment did you receive? '~"'oH2I'T
21, Other penlnentlnformation:
WNO. "yes, please list doctor's name
18. Since this injury occurred. are your symptoms: () Improving (
19. Have you lost lime Irom work as a result 01 this accident? !):rVes
a. Last Day Worked: i.J. ,?':;. 'f'y/ -Jb 1(. I - 'itJ "w:>
) Gelling Worse ~same
( ) No. If yes. please complete this Question.
A,l*1T ~~I:tk"
b. Type of Employment: S~.o"'1Z '" t..~
. ~
c. Present Salary: i')!vA
d, Are you being compensated lor lime lost from wcrk? () Yes
y~U are receiving: J):--I A
( I No. If yes, ~Iease slale Iype of com~ensa:icn
20. Do you notice any activlly restrictions as a result ollhls Injury?
:z; eA7r/ T "Jt::'~ "A '-u"'-"',N'ito ~ UCoI CHI'S;!
. I --'
(A:l, Ves
, /./,,,,
( ,) No. If yes. please describe. In detail:
II-? '!t./
DATE
!) Q~ t:'&"O"TU'.
"
"
,.""
PER.,ONAL INJURY QUESTIONNAIRE
" 1-'7-
Name ~A. K, Yr~ OaleollnJury Ie e:-' W
Address I~bl "", ~IIVM I!.tJ Clly JI?~('IWI'L~.d~
Employer's Name () v5.t! ,v/Tt'. -rItAN'5" "J4:~"lIEmployer's Address ~61'
Vour Ins, CO. A6'77lI4l Policy'
Phone :7/;', ~of .fie; ~
SlateLL. Zip Iff> Sf""
CA(('.5/E //./tt: 71r~~C.Id..
Agent's Nam,i1N'A
Orlver/Olher Vehicle
Ins. Co,
~NO Name
) No Namels)
POlicy'
Have you relalned an allorney? I I Ves
Werelhere any wllnessell? l.eyes
NATURE OF ACCIOENT:
1. Oate ot Accident /0 -1..1 . oft! TIme ot Oay /1.!1S lTI~c,t:
2. Were you: Ii Orlver () Passenger () Front Seat ) 8ack Seat
3. Numberofpeoplelnyourvehlcle? I Olhervehicle? 2-
4, What direction were you headed? () North I) East
on (name olstr..t) elll CtlllLt.riE i'tf-E:
5. Whal direction was other vehicle headed? l){ North
on (nameofstreetl Srtt:E7' AD.rACEI\!'T' :r~ CA4L1<l.c
WWest
I South
( ) East
I I Soulh (I West
{J,lt" S.W.f,'l.$;/cf;.S Af(~:=::::lt,I .
.
6, Were you struck Irom: () Behind I I Front I
7, Were you knocked unconscious? ) Yes 1,,\,'1 No,
I I Right Side
DNA
) Left side
If yes. for hC'N long?
e, Were police notified? ~,k(Yes () No
9, Inyourownwords.pleasedescflbeaccidenl: -AT Arl1.c" '2.<<l-5 .,. '-"'S ~eA/)I"'" '.;::STd.""""" ...,,. c:,q,('a.<;
I'p<;.' ~~r ~r ..,: ~;: ..&:-1/-1 - B-:' 41'.11 LlU ~~h-' ~A~ .:SL."'~ ,.\1 -r;..E ~,~,'~.
J./J~n-' AJ,,&:A .v ,.:(.tt.;.vr c~ M'F .9tIAJ.I!,vA.. A ~,..-,- r.,A,t(,;V 7ZI 40iU N~.c.TJ.I 1t>~.,,,,,',,.s,J~'~,"'4!'1:
% MAA'A ~ A".:5~..c:..c.-7 C-l'1'2lII~1.I..,..,.M'.. 46,1( -r~ ~~ c..c...s.J 711 A c.c..r.,J.:n ..~ :z:. 11,.,- ~ ..(Ur~
J'.NlqU Afh<'G . ~NA\:': ~ .<.j.r,ICb.... ..:,y. oJ -.'" .,.".. - r ~ "Y' """""'... "~LJi "",,"-.-or = <'lit.,
10, Old you have any physical complaints BEFORE THE ACCIOENT? ( ) Ves ~Jj No, II yes. please describe In detaIl:
11. Please describe how you lell:
a, OURING the aCCIdent:
I/~~~ :;~
b, IMMEDIATELY AFT"R the aCCIdent:
"
I'ISJ'.::.tJ ,:),~,t:' <:f oP.../(7"
,.
c, LATER THAT OAY:
d. THE NEXT OAY:
/0
u
12. What are your PRESENT complaonts and symptoms?
Nt":J: L"'~:~ t..'t,.YA~.E' ~''':'' .~~I". ~'-;",~,
, ,
<~~'h.t-.nl'if.~t -:.1eI..,J ('c:.JJ
BP \0<i.t (,,~ RI or LI H.nd.d Rhumbl'r9 ~\
'~<;k" BIUP' '+'
Pulit' TrtCrp' I' I
Lung, I o.g ~ .,.,
HI'.rt 1...\ I).a.;. P., -\'\ 1 I.
Achlne, HI
Kl'mp,
I 011 Sm 10 Voc Sw.1 &hl",'" -
2 Oce . &. Lgl II, Shrug
J 4.6EyoM 12 Tng Mov, H.Ad rd.
S SIn. II Tal" 0'0 Sc, F \ Shld H"lh L.-
7 Smile Op.h, Sc F, II..H'gh
B. AcOUlhCl N...I E~"m ~. ft'" H.Ad Ru.
9 Oog T 1110 PInWM.
Thigh MUI FlotOn
CAll Mu. EJ.lrnllOn
Btcrpl L. ROlihon
Forrarm R ROlAhOn
Heighl lo' Weighl \ <6D \ .~~ ~Q.,-;-" ~ t:: ~~: ~
~mp~i:"~~. ' -~ Id[~1l~~ r~OCAUZA~O
-:(s & --L Ne~' ~ . c.. &krS~~t1. ~t~ ' --'.-- -:-
r: +~~~., . @fmtS~.. I ~t
~~. :.r", ... Dc<
~j).. .,(i)f..L-'~' W\:\~:-~~) JJ~~' .~: ~ ~
*i@9~ . J;: ~~~l~~~( ~,~~I~ Uf~~A.~ ,
- j\t.{" \r.,..---...c::: 11 J ' ) . S,Sp".m -lh' .', -
d~ ll..~ -(It.IIl~\~UJ~.J ~~ ~~~~.l~~'
f.}l> I ~\o =- F C l!- - 1 ~w<;f'. S dl (/5/;':
-J.' \ Rr. or LI Hand,d Rhombfrg or amp _ _ Cervica~lIon.u I. t_
Oynamonwlrr BlClP' 4-\ La"eque', N Exam Pain I
L I (R) Tricrp...l:l. Broggord - =. Flu,on 60
S~ ,,5[ Eltl, 0'9 ~ Fabere - ElltenllOn
Pal. .;':)...,.,.. L~ln -..- L ROlallon
Aeh,lI.. .f~ ..do SOTO HALL R ROII,,,,n
_ _ ~. L l..11.Flu
KempI PSOAS - ':" _ 6- R La. Flu
Babln,kl EL V'S --......
H.Ad Tdl - Lg, Length" SIZe Dorio-Lumbar Molion Sludiu
Shld, H"lh \.4~"'I' Ll. R. N 1m E.am Pain
II~ High Thigh Mus FluK)n
Hnd ROI...... Call Mus E_lfnSK)n
SteIp, L. Rolallon
Forearm R ROlolllOn
L La, Flu
R La, Fie'
BP
Pul,.
lung'
Hlarl
I. Oll,Sm,
2, Oce,." Lgl.
J 4, 6 Eye M,
5 ~n. & Tasle
7. Smile
8. ACOUStlC1
9. Gag Tasle
Heighl \0
Present Complaints:
./ - '':Ii' VI" . "'" .,
fur C""'I'..l' ."\- ." . ..I C.r,:ic.1 MOliva Sludi~1
c;: ,_ J,.. ~\'"
1.1..I'Qlll'" . Norm EliI.am Pain
UI"'J,p,1l ~\-,l'1~llICln \
F.lht'II' ~. E.lrn'lOn ,~
Ll'WIIl ~- L Rolahon MO
SOTO HALL ~ R RntO'Km
~-L Lat Flu 40 '
PSOAS'- R La. Flu 10
ELV'S
Lg L.ngth & 5... DorIO-Lumbar Molion Scud;"1
LI RI No Exam Pain
I
-
C
<:
t:.
<;
l::
~,
I'
..
..
"
10, Voc, Swot
II Shrug
12, Tng, Mov,
010 Sc, F,
Op.h, Sc, F,
Nasal Exam
PinwMel
Weight I CD
...I - ~~'ttt.w~:!6 ,
{-~'ve.cll:'~ ~0\\Ab\.~l ,I}-b-L~+
..Y ~ If"'-' l.,.,.. C ::'I~.
~~ f')p.-Q.-~'
- [!}ii:ffJ ~~j bNl-rhes ~
-.1' r~ L_ .,~1.. ....-1.1....._
r2: l5~~~U;f""'~I\l~'
3 ~ khlLIMl-' ~ ~' !rlr'Ult L{.
LOCA ATlON
PPain
T.Tender
N,Numb
H,HypoeSlhes..
S,Spa.m
,.
'..14&:.
;:"'1
," "(..
. ,."gO'U.""'....CN#>oU..... 11""'1.)'''1
fJIIf.1t /530
Name1b?e :DANA
J
Phone: Home '19.!:J--.r/{' 76 Work 1.'9'!:J.5/],x I
,Nt. . ~01i'
OX-ROY. ,'-'-9'f
[ )
,P.r I
I
-I'~Li-.A-
I
B 10 - 2 x per day
BR - bed rllt
,CC - chief complaint
.CONS - conwltition
cp - cervical pain
OFW - disqualified from work
ox - diagnosis
EA - electric accupuncture
EMS - electromuscle stimulation
E)UU: - exacerbation
FP - finger pain
FUR EX REV - further exam reveals
ce - qUlrded condition
HA - headache
HP - head pain
tIP - hot: pack
I - infedor
IKE - isokinetic exercise
IHE - independent medical examination
IMT - increased muscle tone
INS - instructions (home)
KA - kinetic activities
Kn P - Knee pain
tAT - lateral
tP.P - leg pain
LP - lumbar pain
LS - 1l21'bar spine
11 - medial
HOC - maximum cervical compression
tt1I - maximum medical improvement
Me - moderate
MS - muscle spasm
N - normal
NW - no work
08LIQ - oblique
ORT SUP - orthopedic support
PA - pares~iesias
POST - postedor
P. REV. - palpation reveals
PTM - physical therapy modal.
R - right
RES - response
ReT - refer to
F&l - return to work
S - severe
SOM - sternocleidomastoid muscle
SH - shoulder
SP - spinalator
SPC - supportive care
STL - straight leg raise
BIL - bilateral
~~ - back to work
CN - cranial nerves
. COV - chiropractic office visit
cs- cervical spine
DI - diathermy
E - excellent
EL - elbow
EX REV - exam reveals
FP - foot pain
FSLV - findings same as last visit
G - qood
GT - George's Test
HoTRAC - home traction
HP - hip pain
HVG - high voltage galvanism
IE - isotonic exercise
lHE EX - isometric exercise
IMP'I - improvement
'IPVMT - increased paravertebral muscle tone
IS - increased symptoms
KN - knee
L - left
LD - light duty
tMi - light manual manipulation
LRCH - limited range of motion
LV - low volt
MAS - massage
tt1 - mild to moderate
MN - morning and night
MRI - magnetic resonance imaging
MVA - motor vehicle accident
NC - no complaint
o - occipital
CCC - occasional
P - pain
PG - prognosis
PR - poor
PS - paresis,
pv - paravertebral
RNO - radiculitis
RESCHED - rescheduled
ROM - range of motion
S - superior
S - soreness
SE - shoulder exercise
SH - shoulder pain
SP - sprain
ST .. strain
STM - soft tissue manipulation
~
&It.. OIlhOPtdlc~ I!C.
. Robtn R, KIntda. 0,0. .
ICIIh L le'..... D 0
450 /Iowi;'Avi .
.'-'..11 17108(717)111"
TAX 10 II
DANA POPE .," 01Bal3
1861 W TRIOO AD
!'Eo.1NICSBURG PA 17~
OESCRIPTI!Jl
DR PLACE
DllTE PROC
01-17-96 m0~ LEVEL IV NEll PATIENT ~ 3
01-17-96 72850 XR CERVI~ SPIrt: ~ 3
01-17-96 7JIIHrS XR WRIST flI( 3
01-31-96 99212 LEVEL 2 ESTABLISHED ~ 3
01-31-96 L3See-se COCKUP SPLINT ~ 3
TOiAL C;oj,jRG;;
TOTAL DRLUl:E DJ::
D:A6~JS:;1
7<3,1 c;Rvl~GIA
719,.3 P~IN IN J~I~1 JN~Q.~INS FOREARK
.
0,-:5-,i
CHAAOES
ue.ee
I~,OO
168.00
JS,ee
5e.ee
46.,00
.65,~4
DMjA K. }'OPE
1/17/96
Dana Popa, a 34-year701d supervisor for Overnite Transportation, was seen in the
office today for complaints referable to a motorcycle accident in October 1994.
He Wil riding s motorcycle. struck s car and turned over, He is right hand
dominant. He is complaining of pain in his neck and both wrists, with pain
sometimes radiating up his forearm, Hs also has pain in his left jsw area at
times .
, FILii NOTES
He was seen at Holy Spirit Hoapital whers x-raya were done and he was placed on
ASA. He was then seen at the Herd Clinic. initially being seen three times a
week. then weekly for four to five months,
In the mechanism of his injury, he struck the car. went over the car. and landed
on his handa and his jaw.
His past medical history is positive for pneumonis as a child. He has no known
medicinal sllergies. He is on no medications at this time,
On examination his cervicsl range of motion is intact. with normal
flexion/extension. lateral bending and rotation. He has no motor deficits of
either upper extremity, He has intact biceps. triceps, and brschioradialis
reflexea. and no evidence of sensory impairment,
His range of motion of both
exhibits good grip strength.
or hands.
wrists is normsl and comparable side to side. He
No evidence of synovitis is noted in the wrists
X-rays of the cervical spine and wrists ...ere obtained, ...ithout evidence of sny
abnormalities.
It appears that he had a soft tissue injury affecting his neck and wrists. I
have recommended that he undergo a Functionsl Capacity Evaluation to address what
deficits he has. then direct a specific therapy and rehab program regarding those
deficits. He ...ill be rechecked following thst.
RRK/jep
1/31/96
Dsna wss rechecked today. We reviewed his FCE with him. He is in a very heavy
category, which is good. We have gone over some things he can do on a day-to-
day basis to control his pain--ibuprofen. ice, heat when things start to subside.
He will do this snd be rechecked on a prn basis.
RRK/jep
\
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d\8..'V\~-7~'---.-r;/ '?~::'~ ':.~~:':j'~'~:?!5.~~,~~ ~!~
"'..",'~
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,--MNRlW
_... --~-_..- ....--...- --.- ...--.--.
---_.__._-_._....-"._-_._~..._..... .--.....-.--..---.-... .. ...
----.-.--- --.-..-'.-'.--'-'--.-'."
._.._...~ ..--... - ._.~--- _.._....._-~- -. -_. -.....-.
--.---..----......-.. ----...---.-... -..-.-"-.-'."-.-'-
- .-.---.--.---. -...-.-.-...-----.....-...-.- _. .---. ...~-- ~ -.-- .-. . ..... -
-----..-..------..-- ....---...-. -~,- ._.~._-_.._-._~
---------~---_.- -- .-----...- ..- -...-
EAST SHORE ORTHOPEDIC ASSOCIATES, P.C.
PATIEN:r HISTORY
DATE /- /$-?p PATI~NTN~E &ti..,'J;Lt<...j{,~-( AGE 3~
NAME OF NURSE TAKINO HISTORY '{.I.:(/!Jp...j ~ 11 ' _
QUffCOMPLAINT: - t?tU~.,4Jl ~"Ct' OI-y ~--tl ,d-<Ju.~b - ~4j '~"''k..t~n:...W
~~a.~ ~,rl.; ~1.I:.a<.,"X--- .6n?l.&~4~ r1~ 4-;' L rr~
~~ OFiN~~R~: - f,' . "Jcn _ 'J.' I .
. ~ ............ 7~,( I O/~..-(,.4] "Y/l~ CLj c4
.a ~ ~ckuf - ~~:/c..., M 4~t./i a.. (: tvv --I- 1. ~ J _ 4 /
-1& ........,.t<..." Q1,~
II
i
,
I
TREATMENT RECEIVE~: (X, RAY, MRI, P.T.. MEDICATIONS) ~ lie -<.tNl., .c!W1A. c.u4 ~ 5;f!t.,U,f-
'x. -,d M-J. -- A 54. - /u.. r-t,Uf" tit., .-a..e.;.:........@ /Ook;!",,/ d1~ ./.J-.rd' (,M"-t~J
....a..u..... tI "', .3Xw{c A7&t1 u!..:.?;./.:.e;./,k ~-~- /?'Jt4r;), -
PAST MEDICAL & SURGICAL HISTORY: ":' ,/J.:~.te',;,.1t.()4. ~ Pt.-oct..ll ,
ALLERGIES: - }1../(;}(t!-. -
PRESENT MEDICATIONS: J1..1l'-<-
cp,.,:.: 9~
"",,_.~~,-'.:.-_.
SYSTEMS REVIEW
CARDIOVASCULAR:
~rr,
( ) STROKE
( ) HEART ArrACK
( ) ANOINA
(
( ) CIRCULATION PROBLEMS
( ) HIGH BLOOD PRESSURE
( ) CONTROLLED
) CHEST PAIN
RESPIRATORY:
( ) DIFFICULTI BREATHING
( ) ASTHMA
(
(
) MORNINO COUOH
) ALLERGIES
HOW LONe?
( ) POSITIVE TB
~ SINUS PROBLEMS
( ) NOSE BLEEDS
OASTRO.INTESTINAL: /t~~
( ) STOM~ ULCERS
( ) NERVOUS STOMACH
( ) RECENT CHANOE IN BOWEL HABITS
( ) CONSTIPATION
( ) ACTIVE ( ) HEALED
( ) USE OF ANTACIDS OR LAXATIVES
) DIARRHEA
BLEEDINO PROFILE: /u. /
( ) FAMIL~ORY OF BLEEDING
( ) FREQUENT NOSE BLEEDS
( ) EASY BRUISING
( ) ANEMIA
( ) LIVER DISEASE
GENITO.URINARY: It.~'
( ) DIFFICULTI VOIDINO
( ) BLOOD IN URINE
( ) INCONTINENCE
PAINFUL URINATION
) FREQUENCY
NEURO,f-'USCULAR:
( X FREQUENT HEADACHES
( ) SEIZURE DISORDER
tXJOINT PAIN
( ) BEING TREATED FOR ARTHRITIS
SYSTEMS REVIEW CONTINUED
ENDOCRINE:
~A.J/
(-1-OIAEiETES
) DIET
) INSULIN
) ORAL MEDICATIONS
(-!THYROID PROBLEMS
( '/tOST OR OAINED MORE THAN 10 POUNDS IN LAST THREE MONTHS
ENT:
EYES
C--) OLAUCOMA
U LOSS OF VISION
EARS
(} DEAFNESS
( -tRINOINO IN EARS
MOUTH
(_) DENTURES
~(v:V'-4
REPRODU
. WOMEN)
( ) FD
( ) /I OFPREONANCI~~
( ) POSSIBILITY OF PREONANC
( ) AOE AT MENOPAUSE
CANCER:
'/vv
( ) CHEMO
BLOOD TRANSFUSIONS: 7" J
WHEN
OTHER INFORMATION:
OCCUPATION f!,'../I~~/.(.A'"
I' /
) RADIATION
/~ j1{gt;./- r~~TUS
v
w~
DATE LAST WORKED
~'
~~
FATHER:
.
LlVINO L--.
-
DECEASED
-
-
HEALTH STATUS _ ~~,.....
CAUse OF DEATH _
MOTHER:
LlVINO _
DeCEASED _ '-
-
HEALTH STATUS
CAuseOFDEAiH -_(i'd...tJ r~;
!
SIBLlNOS:
-
.....,
HABITS:
PACKS OF C/OAREirEs/DA Y
C/OARS/DA Y
PIPEFUlS/DA Y
CUPS OF COFFEEtDA Y
CUPS OF TEA/DAY
B07'iLEs OF BEeR/DA Y
SHOTS OF LIQUOR/DA Y
ReCREATIONAL DRUQS
- -
-- -
A...J'I ~q # '_
- ~-
-
-- ~
d-(] c? C{...
-- -
_4:: L....r;t? _
-
- -
TREATMENT:
C. '':;<:H' r'I~
- I . .
c.. Ada:- w ~t-( 1\0 C\c)
- U"-NL. ~ h-_ -<c don""",,
~ (1--..0 "~)
rev (J ~'Il\ 1C.E.
CT
WORk StATUS
QATg / I 17/*
WORKING
MODIFliED =______==:::_
PARi'ilMa
--..-.... "- ... ..~--~-
Nor \.voo;::.. :I:!".
'.:-t... '_
. -.. ..~.. ". .......-...-
C'H~f\!'"';.'" .
~"'~"~.;.:::::1:~..:.'.
. .. .... -
M::;T!~I
--.....-....
'.. ..... ----.;.,'
ft10fji::::: .~
.... ....
'. . '. ..... . ...........-"""""""'--
PAAr. 'f/Me:
-. "'-. -.--..- -------
l~,.'..:.~.v
...... '. .--.h.... ........._.......
........--
.....-..-
. .HEALTHOOJJ)}iJi}{J
SpotIs MediCIne & RehaOilnatlOll Centfll
CUENT:
EMPLOYER:
DATE OF INJURY:
DATE OF EVALUATION:
DATE OF REPORT:
SS:
HEALTHSOUTH 1.0. NO.:
REFERRED BY:
PHYSICIAN:
INSURANCE CARRIER:
INSURANCE 1.0. NO.:
Dana K. Pope
Overnight Transportation
October, 1994
January 29, 1996
January 30, 1996
375.72.9656
599930
Dr. R. Kaneda
Dr. R. Kaneda
Aetna
375729656
WORK CAPACITIES ASSESSMENT SUMMARY REPORT
PURPOSE OF ASSESSMENT
Mr. Dana K. Pope was referred to HEALTHSOUTH Sports Medicine and Rehabilitation
Center for assessment of his current physical/functional capabilities with regard to returning
to his usual and customary job as a dock supervisor, and for determination of his potential to
safely return to that job situation.
SUMMARY OF RRC;ULTS
Mr. Pope is a 34 year old male with the current diagnosis of persistent cervical and ....'list
pain. He reported that the injury took place in October, 1994 when he was involved in a
motor cycle accident, in which a person had pulled out in front of him. His aerobic capacity
assessment was found to be Good for his age. Deficits found in the musculoskeletal
evaluation included: slight forward head and rounded shoulders and some complaints of
isolated pain over both wrists.
Functional testing revealed that Mr. Pope is presently lifting in the Very Hea"y category of
work as demonstrated by his occasional floor to knuckle lift of 135 pounds, waist to shou~der
lift of 135 pounds, shoulder to overhead lift of 135 pounds, and carry of 135 pounds 100 feet
with pivot. During positional tolerance testing, the client demonstrated tolerance of
450 Powers Avenue. Harrisburg, PA 17109 . 717558.8511 . Fax 717558.9317
. .
. .
Work Capacities Assessment
Re: Dana K. Pope
radial/ulnar deviation, supination, pronation, fine motor work, stacking, repetitive reaching,
typing, push/pull, forward reaching, static squatting, repetitive bending, kneeling, crawling,
overhead reaching, static bending, staircllmblng, walking, standing and silting on a constant
basis.
2
Maximal voluntary effort testing was completed using the JAMAR Hand Dynamometer, the
Grip Dynamometer and the Lido Static. The results were valid and consistent. There were
no signs of symptom magnlncatlon behavior.
The results of his evaluation indicate that his performance is adequate for him to return to
full time/full duty as described by the client.
RECOMMENDATIONS
We would recommend the following:
1. It is felt that Mr. Pope would be capable of returning to work on a full time/full duly
basis.
SUBJECTIVE HISTORY
Mr. Pope is a 34 year old male with the diagnosis of persistent cervical and wrist pain. He
was Injured in October, 1994 when he was involved in a motor cycle accident.
Previous treatment for his injury includes: seeing 3 doctors as well as receiving chiropractic
care from Dr. Carver for 8 months 2-3x1week.
Mr. Pope reported a pain intensity level of 5 (0 = no pain; 10 = severe pain). He/She
reported that his pain ranges from a 0 at best to 7-8 at its worst. He stated that lifting heavy
objects aggravates his symptoms the most, and that not using wrists provides the most relief.
JOB DESCRIPTION
A formal job analysis was not provided prior to evaluation, therefore, a job description was
obtained from the client, the employer, and the Dictionary of Occupational Titles.
Mr. Pope reported that, at the time of his injury, he was employed by Overnight
Transportation Co. as a dock supervisor. He described ,"ork in his job as requiring:
maximal weight lifted of 250 pounds, frequent weight lifted of 75 pounds, a maximum
push/pull weight of 1.000+ pounds and a maximum carry of 250 pounds. Positional
Work Capacities Assessment
Re: Dana K. Pope
tolerances required for his job as described by the patient include: slning, stalrcllmbing,
sustained bending, crawling, kneeling, typing, repetitive reaching and filing on an occasional
basis, radial/ulnar deviation, supination/pronation, fine motor work, stacking, sorting,
writing, repetitive reaching, push/pull, forward reaching, pivot twisting, crouching, stooping,
squaning, overhead reaching, walking and standing on a constant basis.
3
By his description, his work falls into the Very Hea\'Y work classification category.
The Dictionary of Occupational Titles lists the work of a dock supervisor (D.O.T.# 922.137-
018) in the Medium work classification category, and the work of a dock worker (D.O.T.#
922.687-062) in the Heavy category.
CARDIOVASCULAR ASSESSMENT
The American Heart Association "cardiovascular profile" ranked Mr. Pope in the I\mDIUI\f
RISK category for the development of cardiovascular disease. His resting blood pressure
was 136/84, and his resting heart rate was 64 beats per minute.
An aerobic capacity assessment revealed an estimated maximum V02 of 44.99 milliliters per
kilogram per minute and an estimated maximum MET level of 5.14 METS. He is classified
as having an Good aerobic capacity for his age and sex (American Heart Association).
MUSCULOSKELETAL SCREEN
POSTURE: Slight forward head, rounded shoulders.
RANGE OF MOTION: Cervical within normal limits, upper extremities within normal
limits.
STRENGTH: 5/5 upper extremities, grip dynamometer test valid Bell.shaped curve.
NEUROLOGICAL: Sensation within normal limits.
FLEXIBIUTY: Within normal limits.
SOFT TISSUE ASSESSMENT: N/A to cervical area and complaints of isolated pain over
bilateral wrists.
"
Work Capacities Assessment
Re: Dana K. Pope
FUNCTIONAL CAPACITIES ASSESSMENTIWORK TOLERANCE SCREEN
4
A thorough "functional" evaluation was completed. The safe maximum limits for material
handling activities and the functional limits for non.material handling activities are
summarized in the tables below.
Frequent material handling and non.material handling (positional) tolerances were assessed in
a continuous activity circuit of job simulated tasks consisting of sitting, standing, walking,
stairclimblng, static bending, overhead reaching, crawling, kneeling, repetitive bending,
static squatting, forward reaching, push/pull, typing, repetitive reaching, stacking, fme motor
work, supination/pronation and radiallilnar deviation. The interval of activity lasted 60
minutes minutes of a scheduled sixty minutes.
Conslstencv of Effort TestiDl!:
Mr. Pope underwent a formal screening procedure of 5 different isometric strength tests
designed to identify those individuals who put forth less than maximum effort on the
evaluation tasks. Each task was repeated 3-4 times to test for consistency of response. A
coefficient of variance statistic was calculated for each task.
Static StreDluh
JAMAR Dvnamometer GriD Strenl!th
Position (L) Peak Force ~ (R) Peak Force Q..Y..
Position #1 45, 36, 40, 46 9% 59,42, 43, 45 9%
Ibs. lbs.
Position #2 114, 114, 114, 0% 121, 106, 135, 10%
113 Ibs. 133 Ibs.
Position #3 132, 121, 116, 6% 131, 110, 116, 7%
114 Ibs. 114 Ibs.
Position #4 104, 100. 95, 4% 83, 96, 87, 89 6%
103 Ibs. Ibs.
Position #5 89. 85, 84, 94 5% 84, 90, 80, 80 5%
Ibs. Ibs.
_., ~r..._ ~".._.
. .
Work Capacities Assessment
Re: Dana K. Pope
LIDO STATIC LIFT TEST
.
5
~ Lift CQnacitv ~ Oct. Work Demand Level
Leg Lift 147, 140, 139 2% Very Heavy
Ibs.
Arm Lift 354, 332, 351 2% Very Heavy
Ibs.
. .
. .
Work Capacities Assessment
Re: Dana K. Pope
FUNCTIONAL CAPACITIES EVALUATION WORK TOLERANCE SCREEN
ISOMETRIC CONSISTENCY TESTS:
TEST TRIALS(LBS OF AVERAGE S.D./C.V.
FORCE)
Strain Gauge Squat Lift 442.8,404.6, 357.8, 409.0 37.6
430.8 9%
Isometric Push 32.8, 33.6, 29.4, 33 32.2 2
6%
Isometric Pull 39.6, 33.6, 35.6, 33.6 35.6 2.8
7%
0%-15% considered consistent in effort
S.D. = Standard Deviation C. V. = Coefficient of Variation
Comments: Patient complains of pain in right wrist at 6/10 on the pain scale.
c
6
. .
Work Capacities Assessment 7
Re: Dana K. Pope
MATERIAL HANDLING (LIFI'ING):
UFT DEMONSTRATED Adequate for job
Occasional Constant Yes/No
Floor to Knuckle 135 Ibs. 851bs. Yes
Knuckle to Shoulder 135 Ibs. 851bs. Yes
Shoulder to 135 Ibs. 851bs. Yes
Overhead
Push/Pull 86/87 Ibs. 86/87 Ibs. Yes
100 ft. Carry 135 Ibs. 851bs. Yes
NON-MATERIAL HANDLING:
ACTIVITY
DEMONSTRATED
Sitting
(60 MinlEpisode)
Standing
(30 MinlEpisode)
Walking
(1/2 Mile/Episode)
Climbing (stairs)
(4 Flights/Episode)
Trunk Bending
(I MinlEpisode X6/Hr)
Overhead Reach
(1 MinlEpisode X6/Hr)
Crawling
(I0'/Episode X6/Hr)
60 minutes - constant
60 minutes - constant
15 minutes - constant
4 flights per 6 episodes - constant
60 minute circuit - constant
60 minute circuit - constant
. · 10 feet" 6 episodes - constant
'-
Comments: · Denotes patient did have some trouble performing exercises secondary to
increased pain.
Thank you for referring Mr. Dana K. Pope to HEALTHSOUTH Sports Medicine and
Rehabilitation Center. If you have any further questions regarding his evaluation or the
recommendations made, please do not hesitate to contact us.
Work Capacities Assessment
. Re: Dana K. Pope
. .
ACTIVITY
DEMONSTRATED
60 minute circuit - constant
Static Squatting
(5x/Episode X6/Hr)
Kneeling
(1 Min/Episode X6/Hr)
Stooping (repetitive
bending)
(5X/Episode X6/Hr)
Push/pull
Typing
Supination/Pronation
Sustained Forward Reaching
(1 MinlEpisode X6)
Radial/Ulnar Deviation
60 minute circuit - constant
60 minute circuit - constant
5 times. frequent
60 minute circuit - constant
· 60 minute circuit - constant
60 minute circuit - constant
60 minute circuit - constant
Forward Reaching
(5X1Episode X6)
60 minute circuit - constant
Sincerely,
~ l L~
Shawn Lesh
Work Start Coordinator
tl'l'JJ- ~. n. c].l T
Michelle Wieger. P.T.. C.H.T.
SL:bu
8
'. 'h""'!"'tJ':-t:''1~~:4:~!ill.,',,*''__4'''''''~_
EAST SHORE ORTHOPEDIC ASSOCIATES, LTD,
X.RAY. REPORT
Dana Popa
96-116
NUMBER
34
AGE
NAME
1/17/96
DATE
Cervical Spine; Bilateral Wrists
STUDY
X-ray of the cervical spine does not show any evidence of recent fracture or
dislocation. There is normal cervicsl lordosis. No avidence of significant
osteophyte formation is noted. The intervertebral disc heights are well
preserved.
CP"'27-2:'tS
X-rays of both wrists do not show any evidence of recent fracture, dislocation,
or other osseous abnormalitiee.
Robert R. Keneda, D.O.
RRK/jep
'.V':~ ~~: ": ' . .~ ;\.,.",;li.!~;t':!i"',''''~'''~._''~ . '..~r;'~..!..~.~"'~: "'~I::' .~'I ~~.(, ~.. ~:'~ .~~~.~!}J~
.r.~4....,..... i~ r't;..." ....,... I......... .111
'HI"'~ .W.1.,,:r-... .;,....,'..(,i...:.~' '., " '. :." I '1'." ......;;0,
, ., ". .'.-I\.I.....J:: ,- .f ... r . "".,.' '.,
:Zi~i.:,.. .i:',:'::\':"~.?.i:":'. .:. . HOLY SP;RlT.HOSPIT~;':" "', '"
;' : ." : . I :. ,:'. ". . lBPAl\~IlBHT 01' RADIOLOGY AHO DIAGNOSUe I"AGING
. , . ~ :'. '.' . CAHP HILL', PBHHSVI.VAHIA 170 II
. .' " t1l71 763-2&00
PATIIDlTI POPS, DAN'"
.,. .::" IlRI '254387 .
:....: BOC ssei .315-12-'.1'"
;.,:, . . ,'ORO'DR": IillLUCA, RICHARD
.j' ... ,." "PT 'n' ps" S)I .~ 0'
r .1..: . . . ~:..~ .f ': . , .. . ,: : " . .....
t/':f::'::::;~'.IlA:m ~ 01271~9940' I 43PI1
..'::,:" :;..LOCATXOH'!B!=U . '.'
':;'.'~r~j.r.;.~.":' .~:....,J;"P~. ' :
'. II. :.:.....:. "." ".-'.' "-'..' :!
t. .... .1., ".. ,,: ,'. .
;':' '.
"
DICTATION DATSI 10/27/94 3132P"
TRAHSCRIPnOM OATS 10/271199. O:l130P" ,
, ....".
. . ~ ...... II::
AARIV~ DATSI
IIOSP &BRUCh
. .' ..'
, ,
:
.'
BCU
,
'.
.'.;
'.' BlCAIlIIlATIOKI' ClJIlVXCAL sPt\ola LIHITElJ C I V I
. '.
. COKKENTS':A slngl. ~o,.-i.bl. lat.ral view of the cervicaL sptn. r.v.al.
.'no a&1d1Ilnunt,. fracture 'Or other abnorullty.
'.
'.
"~
. '.
.'
'.
J
'.
.'
..;..
'.
"
'.
'.
.
t
~I)J.
f P[)
DICTATED BY, R. P. Shll,,;,t
. .. _ .... . _ a . I
IO'd 6~C'ON PO:61 9S'll U~(
I1.D./IWI
~S6~-~~l-ll~.~N -31
. .
, .
al:lll,l.I:<f-:~ . H':;' h
"
'.
DICTATION D~TBI tO/21194 3132PK
TRANSCRIPTION DATS 10/211199. 05132PK
PATIlIII11 POPS, DAII~
/tR,. 2'4381
SOC:8BC1 37S-1~~9'S'
ORa DR, I' DKLUCA,' RICHARD
PT TYP8,'8.. :" . . .
lDl DATS 10/27/19'. oli43PH
LOCAtIOM' : B~.~" '
. . .. :-.' .
,
"
. AWVA!.',MTBI"':
HOsP SrlRVICBI'
leu
. '.' ','"
....... ....M.'...
, .
BlAKINATIONf'LllI'T WRIST I BY I
. '.'
'.
COHI18HTBI Thl!. ,~one and Joint structuru Ipp..r norAII. I cannot exclude
.o....~ft. tl..u~ ,vIlltng Involving the proxl..l hAnd.
"
CONCLUSION, No frlDture Dr dllloc.tlon II prl.lnt.
.
.'
,,'J,'
I"
'/ .
I;
(;o)'d
/Jjl(
DICTATED BY' R. P. Stl~art.
nlTl: n. I\X~lh 10/2711994
E,W'tJt~ rO:61 9:.'~1 U~.:
I'l.D./SlIV
:.t~lf,~-~9l-~ 1.:.' (JU 131
Bij'/Aij~-X 'H'S'H
.. t'; "t....;:..'.,.~~."....::,.... "', .f~,.),\",,"tJ"I"i" .'. .-'.' '.' '~f .,..:,..!....,..:L~~f.ft.il".',... " . ~.flr.:";t1",""P~,'1
;j, , .. . ..., ,....,. . .", ...., "1'""'''''' .,1'.. dr.ll .....r .'...J'..~.~. .
" ...1~-..'..... .'.. '. f.:...:...~l~"~,.l":"., ,.-.....;...p:..t~.
; .. ""'>. .;'. . . '. .:'... ..... : :.II"";'!.',,'!'\~. ''':';:'.~''':'':~!'
~ ", . , . '
...' '. , ,:,., . HOLY ~1RIT_ .HOSPITM. . ;.'''' ...,..... . .. '.
. '; tllll'ARTKBllT ClIP RADIO~OIlV AND DIAGNOSTIC I",o.II1NO . I' , .
. CMP HILL, PSllllS'tLYAHIA. 110 It
I 7171 763-2600
,
I
~'"
J -
"
.-
PATlBII1l POPB,' DW.
lIRi 254387
BOQ SIC. 375-721,656
ORD DR," DlLUCA; RICIIMO
PT TYPal B .' .
ADIl DATI 10/zi;t1994 01143Pll
LOCA'rION ICU
DICTATION DATIl to/27/9' 3,32P"
TRANSCRIPTION DATB 10/27/1994 05.33P"
.'
'.
, ,
. .
. " I'
ARRIVAL' DATI.
HOSl' SSRVICBI BeU
;'.
~... I..
'"
. BlCAIIJNATIONI CBRYICAL SPINS ceMPLETS IBV)
..
'.
CO"~NTSI Align.ent I. normal.' wIth pr..or,ed disc .p,c,., No rracture.
.In ...n. Th.' exit. rcrasln. appll8l' narall'. Th. atlarito axld
r.latlon.hlp.'ar. narm.l. The odont.old I. Int.ct.
CONCLUSION, Hogatl'. st.udV'
.
.
0;-4...,.,
.. :.-~~.
.' ~~t: :.;
. ..
DICTATS:! BY:
EO'd &~O'~~ ~Q:&l
IJft'
Ro P. Sttll6rt,
~.;.'." )1" "u"'l:; ~
... ~ ..
81:11J,~I:I;:j-X . H" S' H
.1.,,"
':'..:\..
.; :~. ..'. .
. ....
II.Do/gav
"
~~6~-~9l-l1~'O~ 131
'.".:
~.~"t'~"'.J&:"t;:.~.;t"t'~. :.~'l' ,.. ", ".. . ," ' . ., .i.'~: 'I:" . ...:\.M'(:"f..'l'ti~\:~.,(O ''''.''f..~:'
(.1 p,..,.).. .......,. .......1" .' .. . ....: .'I-I~ ,..,P!.,ltl;.f..l.l......~.
, "'. .. .'. .......,.:.........
',' ..,...., . "HOL'y.:MRItHOSpml. .',.- .' .'. . :,,<...::':
DiPARTHINT O~ RADIOLOGY AND DIAGNOSTIC IMAGING
, ...' ClIKP HIL\., PBlINSYl.YAHIA 110n -
17171 7r.3-2600
PATIENT. POPS,' OAH1I
lIRa 2:14387 "
. SOC sse, 37:1-72!9f>S6'
.
. ORn DR.. D8t.UC1l'i RICHARD
PT.TYPSI'S . , .
AIllt 011'1810/2711'" 01.43P"
LOCA'I'IOH ECU
,
DICTATION OATS. 10/27/94 3.32PI1
TRANSCRIPTION D1ITH to/27/1,9. .O:l135PH
,....
AIlIIIYAL OATH.
HOSP SBHYICS. lCU
.'
SlCAHINATION I LEPT HAHD 13Y I
COI1IlIlHTS, T"~ bon~ and Joint struaturu appear norall. . No frlctur. Is
,leR.
CONCl.USIOlI1 lI.g.tln 5t~dV' 'e'e cannot udud. 5011' sv.1Llng.
,.
,
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DICTATION DATSI 10/27/94 3132PH
TRANSCRIPTION DATH 10/27/1994 05135PH
"
PATISHTI POPS, DANA
. /lRi. 2S4387 ,
. saC SSCI'375-n":"Sr.
ORD DR. I DtlLUCA; RICHARD
PT TYPSI' B '
AUK ~fB'IQ/27/1994 QI143PH
LOCATlON BCU
"
......
.'
AllRIYAL DA TB I
HOSP SBRVICS.
llCU
BXMINATIOlh RIGHT HMlo 13Vl
"
COI1I1ENTS.
:...
Examination of thl right ~and 1'111.1, no Ivldlnce of fractura or
dlllocatlon. . No bone or 50ft tlssu. Ibnorlllllty Is tdlntlflad.
CONCLUSION.
Norall axamlnatlon ot\thl right hind.
c
11 !;yo..
p1U
OICT;'TED B'(, R, P. S~~"lrt, H.o./gov
SO'd E,W'['ll ~O:E,I ~11,;'Ii'lj[:.:
~Y&~-~9l-ll,'ON 131
B~l/A~~-X 'H'S'H
I'ATIaNTI POPS, DANll
IIllI 154381
sOC SICI 375-72-965&
ORC OR" DllLUCA, RICIlllRD
PT TYPlh 'I "
llDft DATI loiZ7/1994 01143PH
LOCATION leu
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DBPllRTMSNY O~ RADIOLOGY AND DIAGNOSTIC I"AGIN~
. CAHP HII.I., PBNNSYI.YANIA 110tl
11111 763-2&00
DICTATION DllTBI 10/27/'4 3.32P"
TRAHSCRIPTIOM DA71 10/21/1'94 OS.37PH
MRIYIII. DATIl
HDSP SllRYICSI acu
BXAllIHllTION. LEFT KIln I !IV I
COHHElITS I
Exa~lnatlon of the left kn~9 r.~..l. no 'Yldence of fracture or
dlalocatlon. No b~ne or 5Df~ t1S~9 abnor.allty I. 1~lntltled,
CONCI.USION.
-
Ilorul UI.tnati.", of th.. left knee.
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....
DR. ROBERT J. BEAUDRY, Jr.
TMJ HISTORY
Name: _"'i).wA ~l'Q~
Today's Dale: t. /., I 'It"
PLEASE TELL US ABOUT YOUR CONDITION AND CIRCLE ANY NUMBERS WHICH YOU
WOULD LIKE TO ELABORATE ON DURING YOUR CONSULTATION WITH DR. BEAUDRY.
1. What problem brought you Into the office today?
--r'R r INt.- ""0 b(OC<-l"-'F '"T#A.."r Nt."rJl IAIG. IS WA....... wrT H
""",.::7"'CL- .)
,
2. Do you have Jaw Joint pain? .,.(,l~ () No Yes () Right (o-eft
3. Do you have ear pain? o(V".. ( ) No f9. Yes ( ) Right (d)Left
4. Are you aware o!llour Jew making noises such as clicking, popping or thumping?
(pJNo () During chewing ( ) Right ( ) Left
( ) During extreme opening ( ) Right ( ) Left
( ) During speech ( ) Right ( ) Left
5. Do you have any problems In your other Joints? ( ) No ( ) Yes
If yes. whal jolnls 1fA.N.!.$ V- e "&oLd:' of- ~C(<' , 5"0'" eT.....u 1JAc1c_
Whallrealmenls have you had? C.I,lIIt. A\A<:,. "'"
flpJo () Yes
( ) Right
() Left
6. Do you have pain when you chew?
Where?
7. Do you have pain when you open wide or take a big bite?
~No () Yes ( ) Right
B. Do you have pain when you speak? ~No () Yes ( ) Righi
9. Does the pain or discomfort Interfere wllh your work or other acUvllles?
'j<bNo () Yes ( ) Occasionally
( ) Left
() Left
How does It Inlerfere?
10. Are cerlaln foods difficult to chew? 0 ( ) Yes
( ) Hard. tough ( ) Lettuce ( ) Thlc sandwiches () Gum ( ) Ice cubes
11. Do you prefer to chew on one side? U'No () Yes. ( ) Right ( ) Left
Is this because of pain? ( ) No () Yes
12. How long has this problem bothered you? M,rl I fFAL
13. Must you lake medlcaUon for the pain or discomfort? (Please Iisl medlcallons al#31)
. 1[1 No () Yes () Occasionally
'.
-
14. Have you ever been In an accident or received a blow to the fece that may hay~
been the cause of your current head and neck symptoms? ( ) No ~Yes
Please describe your Injury: ·
15, Have you ever reported symptoms of fr"quent headaches, TMJ pain, or jaw pain to
any dentist, physician or other health care pr~lder prior to your accident?
jJQ No () Yes
Name: ,. .
16. Have you ever been treated for headaches or Jaw misalignment? PrNo () Yes
17. Has any health care provider ever Informed you that you required any ~y.~ of
treatment for TMJ, headaches, or Jaw misalignment? "fIVo () Yes
;
18, Have you ever had your teeth ground on to make them fit together beller?
() No () Yes .1/
19. Are you aware of clenching or grinding your teeth? ~NO ~ Yes
Does it seem excessive to you? . _ / No () Yes
20. Has your jaw ever locked or hesitated to move? 7lf..No ( ) Open Closed
21. Have you had surgery requiring general anesl!JaSla?) () No t!JtYes
Please specify ~47' CAN.d,-(,..l.:- 606'_-
22. Do you have any of the following habits?
( ) Gum or ice chewer ( ) Fingernail biler ( ) Pipe starn biter
( ) Pencil biter ( ) Cheak biler ( ) Hand/Jaw position
( ) Play musical Instrument/Sing ( ) Wide open moulh pfPcadure
( ) Telephone/shoulder positioning () Other OC&1'!fI5!a.JA./'y ctf(;"J 708Ac.:.-,
23. Do you have headaches? ( ) No !W Yes
~ .#Frontal'. ~[g~t (J!;rBft
PrOccaslonat ( ) Temporal ( ) Right ( ) Left
( LReguler ( ) Eye ( ) Right ( ) Left
oN Moderate (.>('Jaw ( ) Right ( ) Left
( ) Severe ( ) Back of head ( ) Right ( ) Left
( ) Mlgralna N'Neck ( ) Right ( ) Left
24. On a scale of 0.5, where 0 represents no pain and 5 represents extreme pain,
Indlcnte your pain level when you called for the appointment J Today ~
25. Have you had any denle:l~rk recently (extractions, orthodontics, fillings, crowns,
cleaning?) Pf No_ () Yes W~ your problem aggravated? ( ) No (J Yes
Who are your Dentists ~ MV'ce LGK?' .
26. Do you fe~lj)llrvous? Are you under emotional tension?
M No ( ) Questionable. ( ) Probable ( ) Definite
Please explain '
27. Does the problem you came In for bother you more...?
( ) In the morning ( ) Evening
( ) Mld-aftamoon /;1 INhlle ~g 10 sleep
What makes it better? Nfl'"",v
What makes it worse?
PrfJo specific time
( ) All of the time
. '
.-
28~0 you snore or wake up for no apparent reason?
29. Does this problem alter your lifestyle?
How?
M No () Yes
;(tNO () Yes
30. Does your TMJ problem create additional stress because of pain, problems at work
or family lifestyle? Please explain /tP
31. Please list all medications you have been taking. ~€ItP
32. Please list any other medical problems requiring treatment.
33. Does anyone else In your family have Jaw pain? i:l No () Yes
34. Please list any evaluations and treatments you have had for this problem.
Doctor Specialty Treatment Effectiveness Dale
1.
2.
3,
4.
5.
6,
35. Other pertinent history which you feel Is relevant to your problem.
s'j) q~/! /?"
?~ ftt::
Date
PLEASE COMPLETE AND RETURN THIS FORM TO THE RECEPTIONIST OR MAIL IT TO:
"
Dr. Robert J. Beaudry Jr.
3600 Old Gettysburg Road
Camp Hili, PA, 17011
717.783.7830 phone
. 717.763.1088 fax
"-
June 14, 1996
d'''
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RE: POPE, Dana K,
1061 W. Trind1e Road
Mechanicsburq. PA 17055
AGE: 35
sS/: 375-72-9656
STUDY: MaI ot the temporomandibular joints,
RObert,Beaudry, DHD
RUle out maniscal tear.
Cheek and jaw pain extendinq into neck and
both arms with a remote history ot trauma,
1, 1,5 Tes1a; TMJ coil
2, Oblique coronal T1
3. Oblique saqittal T1 with CINE
COMMENTS: The position ot the posterior bands is at
12:00 o,'c10ck bilaterally on closed views.
open mouth views show tull anterior translation ot both condyles
and the menisci maintain a normal position over the heads ot the
condyles.
REFERRING PHYSICIAN:
CLINICAL DIAGNOSIS:
CLINICAL HISTORY:
MaI PULSE SEQUENCES:
MaI examination ot the 'I'M joints
includinq kinematic series is normal.
Thank you for reterrinq this patient to us,
CONCLUSION:
Sincerely,
"
GSD/mjd
.
t.
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PROGRESS NOTES
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DANA K. POPE and
YElLIN R. POPE, his wife
Assumpsit
fRAfCIPE FOR L1STI~G CASE FOR nUAL
(Must be typewrlllen and submilled in duplicate)
TO THE PROTHONOTARY OF CUMBERLAND COUNTY
Please list the following case:
ICheck one) ( X ) for JURY trial at the next term of civil court.
( ) for trial without Jury.
CAPTION OF CASE
(entire caption must be stated in full)
(check one)
Trespass
(Plaintirr)
vs.
( X ) Trespass (Motor Vehicle)
RUTH NAILOR
IDefendant)
(other)
vs.
The trial list will be called on
February. 18. 1997
Trials commence on March 17. 1997
Pretrials will be held on February 26. 1997,
(Briefs are due 5 days before pretrials.)
Signed:
(The party listing this case for trial shall
provide forthwith a copy of the praecipe to
all counsel, pursuant to local Rule 214-1.)
No. 6785 Civil 19 95
Indicate the allorney who will try case for the party who riles this praecipe: David W. Knauer.
Esquire. 411.A East Main Street. Mechanicsbure. PA 17055
Indicate trial counsel for other parties if known: C. Kent Price. Thomas. Thomas & Hafer.
This case is ready for trial.
Print Name:
Date: lanuary 27. 1997
Allorney (or: Plaintiffs
....,.,.,.,"~,.J<,..'W.,-;''''N_..,.;..
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25.
DANA K. POPE AND YETLIN R.
POPE, HIS WIFE
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
V
NO. 95.6785 CIVIL TERM
RUTH NAILOR
ORDER OF COURT
AND NOW, February 19, 1997, by agreement of counsel, the above.
captioned matter Is hereby continued from the March 1997 Trial Term. Counsel Is
directed to rellst the case when ready.
By the Court,
David W. Knauer, Esq.
For the Plaintiff
.~?
GO{'
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C. Kent Price, Esq.
For the Defendant
Court Administrator
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RLED-OFRCE
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fRAEClPE FQR LISTING CAS~ FOR TRI~L
(Must be typewrlllen and submilled In duplicate)
TO THE PROTHONOTARY OF CUMBERLAND COUNTY
Please list the (ollowlng case:
(Check one) ( X ) (or JURY trial at the next term o( civil court.
( ) (or trial without Jury.
C.i c') (1
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CAPTION OF CASE
(entire caption must be stated In (ull)
(check one)
DANA K. POPE and
YETLlN R. POPE, his wife
( ) Assumpsit
Trespass
IPlalnti(f)
vs.
( X ) Trespass (Motor Vehicle)
RUTH NAILOR
)
(De(endant)
(other)
vs.
The trial list will be called on April 21.
1997
Trials commence on May 19. 1997
Pretrials will be held on April 30. 1997
(Brie(s are due 5 days before pretrials.)
(The party listing this case (or trial shall
provide (orthwlth a copy o( the praecipe to
all counsel, pursuant to local Rule 214-1.)
No. 6785 Civil 19 95
Indicate the attorney who will try case (or the party who files this praecipe: David W. Knauer.
Esquire. 411.A East Main Street. Mechanicsburl:' PA 17055
Indicate trial counsel (or other parties i( known: C. Kent Price. Thomas. Thomas & Ha(er.
.
This case is ready (or trial.
Signed:
Print Name: David W. Knauer
Date: March 20. 1997
Attorney (or: Plainti(fs
20.
DANA K. POPE AND YETLIN R.
POPE, HIS WIFE
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
V
RUTH NAILOR
.
.
: NO. 95-6785 CIVIL TERM
ORDER OF COURT
AND NOW, April 21, 1997. counsel having failed to call the above case for
trial, the case is stricken from the May 19,1997 trial lis!. Counsel may rellst the case for
trial when ready.
By the Court,
David W. Knauer, Esq.
For the Plaintiff
C. Kent Price, Esq.
For the Defendant
mO.....\t~ ~\e!.>
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.
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
DANA K. POPE and
YElLIN R. POPE, his wife
Plaintiffs
CIVIL ACTION - LAW
v.
No. 1995 Civil 6785
RUTH NAILOR
Defendant
JURY TRIAL DEMANDED
NOTICE OF DEPOSITION
Please be advised that on May 13, 1996, at 4:00 p.m., the Plaintiff will take the
deposition of Brian Carver, D.C., at the office of Herd Chiropractic Clinic, P.C., 2704
Market Street, Camp Hili, Pennsylvania, before a person authorized by law to administer
oaths. The oral examination will continue from day to day until completed.
You are requested to have your client present at the specified time and place.
You are Invited to attend and participate in this examination.
Respectfully submitted,
Date: April 28, 1997
av d W. Knauer, Ire
Attomey for the Plaintiff
Attomey 1.0. No. 21582
411-A East Main Street
Mechanicsburg, PA 17055
(717) 795-7790
-
~
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
DANA K. POPE and
YETLIN R. POPE, his wife
Plaintiffs
CIVIL ACTION - LAW
v.
No. 1995 Civil 6785
RUTH NAILOR
Defendant
JURY TRIAL DEMANDED
CERTIFICATE OF SERVICE
I, David W. Knauer, hereby certify that I did this 28th day of April, 1997, serve a
true and correct copy of the within document on all counsel of record by United States
mail, first class, prepaid addressed as follows:
C. Kent Price, Esquire
Thomas, Thomas & Hafer
P. O. Box 999
Harrisburg, PA 17108
avid W. Knauer,
Attomey for Plaintiff
Attomey I.D. No. 21582
411-A East Main Street
Mechanlcsburg, PA 17055
(717) 795-7790
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(Must be typewritten and submitted In duplicate)
TO THE PROTHONOTARY OF CUMBERLAND COUNTY
Please list the following case:
(Check one) ( X ) for JURY trial at the next term of civil court.
( ) for trial without Jury.
CAPTION OF CASE
(entire caption must be stated In fUll)
(check one)
( ) Assumpsit
( ) Trespass
( X ) Trespass (Motor Vehicle)
DANA K. POPE and
YETLIN R. POPE, his wife
(Plaintiff)
vs.
RUTH NAILOR
( )
(Defendant)
(other)
vs.
The trial list will be called on June 10.
1997
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it: ...: 11.1
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15 ,... a
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Trials commence on Julv 7.1997
Pretrials will be held on June 18. 1997
(Briefs are due 5 days before pretrials.)
(The party listing this case for trial shall
provide forthwith a copy of the praecipe to
all counsel, ursuant to local Rule 214-1.
No. 6785 Civil 19 95
Indicate the attomey who will try case for the party who files this praecipe: David W.
Knauer. EsquIre. 411.A East MaIn Street. Mechanlcsburq. PA 17055
Indicate trial counsel for other parties If known:
P. O. Box 999. Harrlsbul'9. PA 17108
C. Kent Price. Thomas. Thomas & Hafer.
(' r'
Signed: . .~h) ,h
I
Print Name: David W. Knaupr
This case Is ready for trial.
Date: May 2.1997
Attorney for: Plaintiffs
, ~ ,
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.;,
~.
,:'
(Must be typewritten and submitted in duplicate)
TO THE PROTHONOTARY OF CUMBERLAND COUNTY
Please list the following case:
(Check one) ( X ) for JURY trial at the next term of civil court.
( ) for trial without Jury.
(I '3 Q,
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CAPTION OF CASE
(entire caption must be stated In full)
(check one)
( ) Assumpsit
( ) Trespass
( X ) Trespass (Motor Vehicle)
DANA K. POPE and
YETLlN R. POPE, his wife
(Plaintiff)
vs.
RUTH NAILOR
( )
(Defendant)
(other)
vs.
The trial list will be called on AU(Just 12.
1997
Trials commence on September 15.1997.
Pretrials will be held on August 27.1997.
(Briefs are due 5 days before pretrials.)
(The party listing this case for trial shall
provide forthwith a copy of the praecipe to
all counsel. ursuant to local Rule 214-1.)
No. 6785 Civil 19 95
Indicate the attorney who will try case for the party who files this praecipe: David W.
Knauer. Esquire. 411-A East Main Street. Mechanlcsburlj/. PA 17055
Indicate trial counsel for other parties if known:
P. O. Box 999. Harrlsburq. PA 17108
C. Kent Price. Thomas. Thomas & Hafer.
This case Is ready for trial.
Signed: ~~ 51 lJJ, kN /)r()~ I w-..
Print Name: David W. Knauer
Date: July 9. 1997
Attorney for: Plaintiffs
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19.
DANA K. POPE AND YElliN R.
POPE, HIS WIFE
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
V
RUTH NAILOR
.
.
: NO. 95-6785 CIVIL TERM
ORDER OF COURT
AND NOW, August 13,1997, by agreement of counsel, the above-
captioned matter Is hereby continued from the September 15, 1997 trial term. Counsel
is directed to rellst the case when ready.
By the Court,
David W. Knauer, Esq.
For the Plaintiff
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C. Kent Price, Esq.
For the Defendant
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Court Adminlstretor
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TO THE PROTHONOTARY OF CUMBERLAND COUNTY
Please list the fOllowing case:
(Check one) ( X ) for JURY trial at the next term of civil court.
( ) for trial without jury.
CAPTION OF CASE
(entire caption must be stated in full)
DANA K. POPE and
YETLlN R. POPE, his wife
(Plaintiff)
vs.
RUTH NAILOR
vs.
(Defendant)
(check one)
( ) Assumpsit
( ) Trespass
( X ) Trespass (Motor Vehicle)
( )
(other)
The trial fist will be called on October 14.
1997
Trials commence on November 10.1997.
Pretrials will be held on October 22.1997.
(Briefs are due 5 days before pretrials.)
(The party listing this case for trial shall
provide forthwith a copy of the praecipe to
all counsel, ursuant to local Rule 214-1.
No. 6785 Civil 19 95
Indicate the attomey who will try case for the party who files this praecipe: David W.
Knauer. Esquire. 411.A East Main Street. Mechanlcsburq. PA 17055
Indicate trial counsel for other parties If known: C. Kent Price. Thomas. Thomas & Hafer.
This case Is ready for trial.
Date: SeDtember 18.1997
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Signed:
Print Name: David W. Knauer
Attorney for: Plaintiffs
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DANA K. POPE AND YETLlN
R. POPE, HIS WIFE
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
V
RUTH NAILOR
.
.
: NO, 95-6785 CIVIL TERM
ORDER OF COURT
AND NOW, October 18, 1997, counsel having failed to call the above
case for trial, the case Is stricken from the November 10, 1997 trial list. Counsel may
rellst the case for trial when ready.
By the Court,
David W. Knauer, Esq.
For the Plaintiff
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C. Kent Price, Esq.
For the Defendant
Court AdmInistrator
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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
DANA K. POPE and
YETLlN R. POPE, his wife
Plaintiffs
CIVIL ACTION - LAW
v.
No. 1995 Civil 6785
RUTH NAILOR
Defendant
JURY TRIAL DEMANDED
NOTICE OF DEPOSITION
Please be advised that on January 21.1998, at 7:30 a.m, the Plalntlfwlll take the
deposition of Steven B. Wolf, M,D., at the offices of Orthopedic Institute of Pennsylvania,
875 Poplar Church Road, Camp Hill, Pennsylvania, before a person authorized by law to
administer oaths. The oral examination will continue from day to day until completed.
You are requested to have your client present at the specified time and place.
You are invited to attend and participate In this examination,
Respectfully submitted,
p """-
avid W, Knauer, Esquire
Attorney for the Plaintiff
Attorney 1.0, No. 21582
411-A East Main Street
Mechanlcsburg. PA 17055
(717) 795-7790
Date: October 24, 1997
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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
DANA K. POPE and
YETLIN R. POPE, his wife
Plaintiffs
v.
RUTH NAILOR
Defendant
CIVIL ACTION - LAW
No. 1995 Civil 6785
JURY TRIAL DEMANDED
CERTIFICATE OF SERVICE
I, David W. Knauer, hereby certify that I did this 24th day of October, 1997, serve
a true and correct copy of the within document on all counsel of record by United States
mall, first class, prepaid addressed as follows:
C. Kent Price, Esquire
Thomas, Thomas & Hafer
P. O. Box 999
Harrisburg, PA 17108
U'D~-hL
David W. Knauer, Esquire
Attomey for Plaintiff
Attorney I,D. No. 21582
411-A East Main Street
Mechanicsburg. PA 17055
(717) 795-7790
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(Must be typewritten and submitted In duplicato)
TO THE PROTHONOTARY OF CUMBERLAND COUNTY
Please list the folloWing case:
(Check one) ( X ) for JURY trial at the next term of civil court.
( ) for trial without Jury.
CAPTION OF CASE
(entire caption must be stated In full)
(check one)
( ) Assumpsit
( ) Trespass
( X ) Trespass (Motor Vehicle)
DANA K. POPE and
YETLIN R. POPE, his wife
(Plaintiff)
vs.
RUTH NAILOR
( )
(Defendant)
(other)
vs.
The trial list will be called on December 30.
1998
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Trials commence on Februrarv 2. 1998
Pretrials will be held on Januarv 7.1998
(Briefs are due 5 days before pretrials,)
(The party listing this case for trial shall provide
forthwith a copy of the praecipe to all counsel,
pursuant to local Rule 214-1.)
No. 6785 Civil 19 95
Indicate the attorney who will try case for the party who files this praecipe: David W.
Knauer. Esoulre. 411-A East Main Street. Mechanlcsburq. PA 17055
Indicate trial counsel for other parties if known: C. Kent Price. Esquire. Thomas. Thomas
This case Is ready for trial.
Signed:
Print Name: David W. Knauer
Date: October 24.1997
Attorney for: Plaintiffs
DANA K. POPE and
YETLIN R. POPE, his wife,
Plaintiffs
v.
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
NO. 95-6785
JURY TRIAL DEMANDED
RUTH NAILOR,
Defendant
PRAECIPE
TO THE PROTHONOTARY:
please mark the docket in the above-captioned matter as
settled and discontinued with prejudice.
0ti./J f!.~.
411-A East Main Street
Mechanicburg, PA 17055
, ~A ATTORNEYS FOR PLAINTIFFS
DATED(JV"urJ Z, t7'J(f
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